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FORM N-4, ITEM 24(b)(4)(4.17)
GUARANTEED BENEFIT EMPLOYER SPONSORED TDA AND QUALIFIED PLAN
CONTRACT NO. GB10.OM-K
OMNI AULONE CONTRACT
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CONTRACT NUMBER: [GA XX,XXX]
CONTRACTHOLDER: [ABC COMPANY]
DATE OF ISSUE: [JANUARY 2, 2002]
CONTRACT DATE: [JANUARY 1, 2002]
FIRST CONTRACT ANNIVERSARY: [JANUARY 1, 2003]
American United Life Insurance Company (AUL) issues this contract in
consideration of the Contractholder's application and its payment of
Contributions to AUL. When used in this contract, "we," "us," or "our" refer to
AUL and "you" or "your" refer to the Contractholder.
All provisions and conditions stated on this and subsequent pages are part of
this contract.
This contract is signed for us at our Home Office in Indianapolis, Indiana. Our
mailing address is ▇.▇. ▇▇▇ ▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇. Our street
address is ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇.
NOTICE OF [TEN] DAY RIGHT TO EXAMINE CONTRACT
Please read this contract carefully. You may return the contract for any reason
within [ten] days after receiving it. If returned, the contract is void from the
beginning and any Contributions will be refunded.
AMERICAN UNITED LIFE INSURANCE COMPANY
By /s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇
Chairman of the Board,
President, & Chief Executive Officer
Attest
Secretary
AUL American Series
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)]
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THIS CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THIS CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
TABLE OF CONTENTS
SECTION 1 DEFINITIONS [3]
SECTION 2 ADMINISTRATION OF PARTICIPANT ACCOUNTS [7]
2.1---- How Contributions Are Handled
2.2---- Transfers from Other Retirement Programs
2.3---- Reallocation of Participant Accounts
2.4---- Excess Contributions
2.5---- Transfers from Other Contracts
SECTION 3 - OPERATION OF FIXED INTEREST ACCOUNT [9]
3.1---- Allocations to Participant Accounts
3.2---- Provision of Guaranteed Rates for Interest Pockets
3.3---- Renewal of Guaranteed Rates
3.4---- Minimum Rate Guarantee
3.5---- Allocation of Withdrawals
3.6---- Limitation on Contributions and Transfers to FIA
SECTION 4 VALUATION OF INVESTMENT ACCOUNTS [10]
4.1---- Operation of Investment Accounts
4.2---- Valuation of Mutual Funds and Other Entities
4.3---- Accumulation Units
4.4---- Value of Accumulation Units
4.5---- Valuing Participant Accounts
SECTION 5 BENEFIT PAYMENTS AND TRANSFERS [11]
5.1---- General Withdrawal Provisions
5.2---- Plan Benefit Payments
5.3---- Transfers Between Investment Options
5.4---- Transfers to and from the FIA
SECTION 6 - ANNUITIES [16]
6.1---- Annuity Purchases
6.2---- Annuity Options
6.3---- Determining Annuity Amount
6.4---- Proof of Age and Survival; Minimum Payments
6.5---- Annuity Certificates
SECTION 7 OTHER CONTRACT CHARGES [17]
7.1---- Investment Option Charge (IOC)
7.2---- Taxes
7.3---- Reduction or Waiver of Charges
GB10.OM-K [(SBR)] 1
7.4---- Other Charges
7.5----- Variable Investment Plus (VIP) Credit Factor
SECTION 8 CONTRACT MODIFICATIONS [19]
8.1---- Contract Amendment
8.2---- Rates and Section 7 Charges
8.3---- Conformance with Law
8.4---- Addition, Deletion, or Substitution of Investments
8.5---- Our Right to Initiate Changes
8.6---- Prohibited Amendments
SECTION 9 TERMINATION OF CONTRACT [21]
9.1---- Termination by You
9.2---- Payment Upon Termination by You
9.3---- Termination by Us
9.4---- Payment Upon Termination by Us
9.5---- Indemnification Required
9.6---- Effect on Contract Obligations
SECTION 10 GENERAL PROVISIONS [23]
10.1---- Ownership
10.2---- Entire Contract
10.3---- Benefit Determinations
10.4---- Recordkeeping Services
10.5---- Representations and Warranties
10.6---- Contractholder Representative; Misstatement of Data
10.7---- Assignment by Contractholder
10.8---- Form of Request, Notice, Instruction, or Direction
10.9---- Effect of Disqualification
10.10--- [Quarterly] Statement of Account Value
10.11--- Conformity with Law
10.12--- Gender and Number
10.13--- Facility of Payment
10.14--- Voting
10.15--- Acceptance of New Participants or Contributions
10.16--- Our Annual Statement
10.17--- Nonforfeitability and Nontransferability
10.18--- Notice of Annual Meeting of Members
[TABLE OF CONTRACT CHARGES] [26]
[TABLE OF GUARANTEED IMMEDIATE ANNUITIES] [27]
[TABLE OF INVESTMENT ACCOUNTS] [28]
GB10.OM-K [(SBR)] 2
SECTION 1 DEFINITIONS
1.1 "Account Value" for a Participant Account as of a date is:
(a) that account's balance of Code Sections 401(a) and 403(b) funds in the
Fixed Interest Account (FIA), if any, on that date; plus
(b) the value of that account's Accumulation Units attributable to Code
Sections 401(a) and 403(b) funds in each Investment Account on that
date.
1.2 "Accumulation Unit" is a valuation device used to measure increases in and
decreases to the value of any Investment Account.
1.3 "Annuity Commencement Date" is the first day of the month an annuity begins
under this contract. This date may not be later than the date a
Participant's periodic benefits are required to commence under the Code.
1.4 "Business Day" is any day both the New York Stock Exchange and our Home
Office are open for the general conduct of business.
1.5 "Code" means the Internal Revenue Code of 1986, as amended, and any
applicable regulations or rulings thereunder.
1.6 The "First Contract Anniversary" is listed on the contract face page.
Subsequent "Contract Anniversaries" are on the same day of each subsequent
year.
1.7 "Contract Quarter" is each of the four successive threemonth periods in a
Contract Year.
1.8 The first "Contract Year" starts on the Contract Date and ends on the day
before the First Contract Anniversary. Each subsequent Contract Year starts
on a Contract Anniversary and ends on the day before the next Contract
Anniversary.
1.9 "Contributions" are funds which can be allocated to Participant Accounts
according to your instructions and which have been paid to us pursuant to
the Plan or transferred from a prior AUL group annuity contract or a prior
funding medium. Such transferred funds may be listed under categories other
than "Contributions" on annual and quarterly reporting.
1.10 A "Contribution-Source" means each type of Contribution allowed under the
Plan, including the following types of Code Section 403(b) Contributions:
(a) "Elective Deferrals," which means, with respect to any taxable year,
any Contribution made under a salary reduction agreement. A
Contribution made under a salary reduction agreement is not treated as
an Elective Deferral if, under the salary reduction agreement, such
Contribution is made pursuant to a one-time irrevocable election made
by the Participant at the time of initial eligibility to participate
in the agreement, or is made pursuant to a similar arrangement
involving a one-time irrevocable election specified in Regulations
issued under the Code.
(b) "Employee Mandatory Contributions," which means Contributions made
under a salary reduction agreement pursuant to a one-time irrevocable
election made by the Participant at the time of initial eligibility to
participate in the agreement, or made pursuant to a similar
arrangement involving a one-time irrevocable election specified in
Regulations
GB10.OM-K [(SBR)] 3
issued under the Code.
(c) "Employer Contributions," which means Contributions made by the
Participant's employer that are not made pursuant to (a) or (b) above.
1.11 "Excess Contributions" are Contributions in excess of the applicable Code
limits.
1.12 "Fixed Interest Account" or "FIA" is an Investment Option described in
Section 3 to which Contributions may be allocated for accumulation at the
Guaranteed Rates. The FIA funds constitute a portion of our general asset
account.
1.13 "Guaranteed Rates" are the guaranteed annual effective rates of interest we
credit to each Interest Pocket. We credit interest daily to each Interest
Pocket. A Guaranteed Rate may be modified only as described in Section 3.3.
1.14 "Home Office" is our principal office in Indianapolis, Indiana. For
anything to be "received by AUL," it must be received at our Home Office.
1.15 "Interest Pocket" means a tracking method which associates funds allocated
to the FIA over a specific time period with a specific Guaranteed Rate, as
described in Section 3. After the guaranteed period provided in Section 3.3
has elapsed, we may consolidate two or more Interest Pockets in conjunction
with the announcement of new Guaranteed Rates.
1.16 "Investment Account" means each distinct portfolio established within our
[Variable Account] and identified in the Table of Investment Accounts in
this contract. Amounts allocated to any Investment Account are invested in
the shares of the corresponding Mutual Fund, Portfolio, or other entity
identified in the Table of Investment Accounts. Our "[Variable Account]" is
a separate account we maintain under Indiana law which is called the AUL
American Unit Trust and which is registered under the Investment Company
Act of 1940 as a unit investment trust. "Competing Investment Accounts" are
those Investment Accounts listed in the Table of Investment Accounts which
are marked with an asterisk (*).
1.17 "Investment Option" is the FIA or any Investment Account.
1.18 The "Market Value Adjustment" or "MVA" is determined, as of the calculation
date, by multiplying a percentage times the Withdrawal Value of Code
Section 401(a) funds being paid from the FIA under [Sections 5.2, 5.4, or
9.2].
[If i is greater than j, the percentage equals 5 times (i-j) and the amount
of the Adjustment is deducted from the Withdrawal Value. (This is called a
negative MVA.) If j is greater than i, the percentage equals 4 times (j-i)
and the amount of the Adjustment is added to the Withdrawal Value. (This is
called a positive MVA.) For purposes of this Section:
i= the Guaranteed Rate we credit to new Contributions, and
j= the dollarweighted average rate of interest we credit to amounts
withdrawn from the FIA under Sections 5.2, 5.4, or 9.2.]
Our determination of the Market Value Adjustment is conclusive.
1.19 "Mutual Fund" means any diversified, openend, management company made
available by us and listed in the Table of Investment Accounts.
GB10.OM-K [(SBR)] 4
1.20 "Participant" is any person participating in a Plan that has a Participant
Account.
1.21 "Participant Account" is an account under this contract for each
Participant. Each Contribution-Source is tracked separately within the
Participant Account. We credit Contributions to Participant Accounts and
Contribution-Sources as you direct.
1.22 "Plan" means a plan of the Plan Sponsor that is qualified under Code
Section 401(a) or Code Section 403(b) and that invests in this contract.
1.23 "Plan Sponsor" is [ABC Company].
1.24 "Portfolio" is a portfolio established within a particular Mutual Fund, as
described in the Mutual Fund's current prospectus.
1.25 "Valuation Periods" start at the close of each Business Day and end at the
close of the next Business Day.
[(Contract Year)]
1.26 The "Withdrawal Charge" is [a percentage of the Account Value withdrawn
under this contract.] The Withdrawal Charge will not apply to Account
Values withdrawn to provide certain benefit payments or an annuity as
described in [Sections 5.2 and 6.1, respectively. The percentage varies by
the Contract Year in which a withdrawal is made.] The Withdrawal Charge
percentage is as follows:
[During Contract Years Percentage
1 5
2 4
3 3
4 2
5 1
Thereafter 0]
In no event will the cumulative total of all Withdrawal Charges, including
those previously assessed against any amount withdrawn from a Participant
Account, exceed [8.5%] of total Contributions allocated to that Participant
Account.
[(Participant Account Year)]
1.26 The "Withdrawal Charge" is [a percentage of the Account Value withdrawn
under this contract.] The Withdrawal Charge will not apply to Account
Values withdrawn to provide certain benefit payments or an annuity as
described in [Sections 5.2 and 6.1, respectively. The percentage varies by
the Participant Account Year in which the withdrawal is made. The first
Participant Account Year begins on the date we establish the Participant
Account and credit the first Contribution to it, and ends on the day before
the next anniversary of that date. Each Participant Account Year thereafter
begins on such an anniversary date and ends on the day before the next
anniversary date.] The Withdrawal Charge percentage is as follows:
[During
Participant Account Years Percentage
1 5
2 4
3 3
4 2
5 1
Thereafter 0]
In no event will the cumulative total of all Withdrawal Charges, including
those previously assessed against any amount withdrawn from a Participant
Account, exceed [8.5%] of total Contributions allocated to that Participant
Account.
1.27 "Withdrawal Value" is a Participant's Account Value, less any Withdrawal
Charge.
GB10.OM-K [(SBR)] 6
SECTION 2 ADMINISTRATION OF PARTICIPANT ACCOUNTS
2.1 How Contributions Are Handled: Contributions are credited to the
appropriate Contribution-Sources within each Participant Account as you
direct in your allocation instructions. Code Section 403(b) Contributions
must be identified as Elective Deferrals, Employee Mandatory Contributions,
or Employer Contributions. A Participant's initial Contribution is
allocated to the Participant Account [by the second Business Day after] we
(1) receive the initial Contribution or, if later, (2) receive all data
necessary to complete the allocation (including data required to establish
the Participant Account, the amount of the Participant's Contribution, and
Investment Option elections). Subsequent Contributions are allocated to the
Participant Account [on the Business Day] we (1) receive that Contribution
or, if later, (2) receive all data necessary to complete the allocation.
If we receive funds which cannot be allocated to a Participant's Account,
those funds will be returned to you in their entirety or, at our option,
only the unallocable portion will be returned to you, [within 5 Business
Days.
Notwithstanding the previous paragraph, Code Section 401(a) funds received
from a prior Plan provider which we cannot allocate to Participant Accounts
will not be returned to you or to such provider, but instead will be
allocated to a Contractholder-level account and invested in those
Investment Options approved by you. When we receive the allocation data
from the prior Plan provider, such funds (plus gains/minus losses) will be
transferred from the Contractholder-level account to the appropriate
Participant Account(s).
If we can allocate a Contribution to a Participant's Account, but we have
not received Investment Option elections for that Participant, the
Contribution will be credited to the AUL Money Market Investment Account.
However, such a Contribution will be credited to the FIA (not the AUL Money
Market Investment Account) if the FIA is an available Investment Option and
if you elect the 90-day transfer option outlined in Section 5.4(a)(1).
Subsequently received Investment Option elections for that Participant will
be used to allocate future Contributions only. We will transfer amounts
previously allocated for that Participant to the AUL Money Market
Investment Account (or the FIA), plus gains or minus losses thereon, only
if we are directed to make a transfer. This transfer request must be
submitted in a format specifically authorized by us.]
Participant Account funds may be allocated to Investment Options in any
increments acceptable to us. Investment Option elections remain in effect
until changed by you or your designee. A change in Investment Option
elections is made by giving us new Investment Option elections.
2.2 Transfers from Other Retirement Programs: [If permitted by the Plan and by
applicable state and federal law, we may accept, or may initiate the
transfer of, amounts transferred from other retirement programs. Such
transferred amounts, as identified by you, are credited as a rollover
Contribution under the appropriate Participant Account and are tracked
within this contract as required by applicable state and federal law.]
2.3 Reallocation of Participant Accounts: You may direct us to reallocate all
or a portion of the Account Value of any Participant Account among other
Participant Accounts. You must certify that such reallocation is in
accordance with the Plan.
GB10.OM-K [(SBR)] 7
2.4 Excess Contributions: Contributions may vary in amount and frequency, as
determined by your Plan.
On receipt of instructions from you, we will withdraw Excess Contributions,
plus gains and minus losses, from a Participant Account and return them to
the Participant, or as you direct. Such instructions must state the amount
to be returned and certify that such Contributions are Excess Contributions
and that such return is permitted by the Plan and the Code. A return of
Excess Contributions is treated like a Plan benefit payment, under Section
5.2(a).
No Participant is permitted to have elective deferral contributions (within
the meaning of Code Section 402(g)(3)) made during a calendar year under
this contract, or under any other plans, contracts, or arrangements
maintained by his employer, in excess of the dollar limitation in effect
under Code Section 402(g)(1) and any Regulations issued thereunder for
taxable years beginning in such calendar year.
2.5 Transfers from Other Contracts: We may require amounts transferred to a
Participant Account from other AUL group annuity contracts to be credited
to [the FIA]. We will advise you if this limitation applies before
accepting such a transfer.
GB10.OM-K [(SBR)] 8
SECTION 3 -- OPERATION OF FIXED INTEREST ACCOUNT
3.1 Allocations to Participant Accounts: We credit each Participant's
Contributions to the FIA based on the information you provide. We credit
interest daily from the date of the Contribution or transfer to the FIA to
the date of withdrawal or transfer from the FIA to an Investment Account.
3.2 Provision of Guaranteed Rates for Interest Pockets: At least [10 days] in
advance of each [calendar] [quarter], we will declare a Guaranteed Rate for
the Interest Pocket for that [quarter]. All Contributions or transfers
hereunder which are allocated to the FIA during that [quarter] will earn
interest at that Guaranteed Rate until that [quarterly] pocket matures on
[the second January 1] following the [quarter] in which that pocket was
established.
3.3 Renewal of Guaranteed Rates: Those [quarterly] Interest Pockets which
mature at the same time will be combined into [an annual renewal Interest
Pocket]. Funds associated with that [annual renewal Interest Pocket] will
earn interest for [a full year] at the Guaranteed Rate declared for that
pocket. A new Guaranteed Rate for each [annual renewal Interest Pocket]
will be declared [at least 30 days prior to every January 1 for the 5 years
following the establishment of that pocket]. An [annual renewal Interest
Pocket] will mature on [January 1 of the sixth year following its
establishment], when it will be combined into [one annual portfolio
Interest Pocket]. Funds associated with that [annual portfolio Interest
Pocket] will earn interest for [a full year] at the Guaranteed Rate for
that pocket, which will be declared [at least 30 days prior to every
January 1].
3.4 Minimum Rate Guarantee: No Guaranteed Rate may be less than an annual
effective interest rate of [3.00%].
3.5 Allocation of Withdrawals: Withdrawals or transfers from the FIA are on a
first-in/first-out (FIFO) basis. All amounts paid during an installment
payout period are paid from all Investment Options on a pro-rata basis.
3.6 Limitation on Contributions and Transfers to FIA: Except for annuity
purchases as described in Section 6.1, we reserve the right to limit or
disallow allocation of new Contributions and transfers to the FIA upon [30
days] notice to you.
GB10.OM-K [(SBR)] 9
SECTION 4 VALUATION OF INVESTMENT ACCOUNTS
4.1 Operation of Investment Accounts: All income, gains, or losses, realized or
unrealized, from assets held in any Investment Account are credited to or
charged against the applicable Investment Account without regard to our
other income, gains, or losses. Investment Account assets are not
chargeable with liabilities arising out of any other business we may
conduct.
4.2 Valuation of Mutual Funds and Other Entities: The current report or
prospectus for each Mutual Fund or other entity listed in the second column
of the Table of Investment Accounts describes how that Mutual Fund's or
other entity's assets are valued.
4.3 Accumulation Units: We credit amounts allocated to an Investment Account in
Accumulation Units. The Accumulation Unit value used is the one for the
Valuation Period when we allocate the amount to the Investment Account.
4.4 Value of Accumulation Units: We establish the initial Accumulation Unit
value for a new Investment Account on the inception date of that Investment
Account. The value of an Accumulation Unit for any later Valuation Period
reflects [the Section 4.1 income, gains, and losses and the Section 7.1
Investment Option Charge (IOC)]. We determine the Accumulation Unit value
before giving effect to any additions, withdrawals, or transfers in the
current Valuation Period.
4.5 Valuing Participant Accounts: We determine the Account Value in an
Investment Account by multiplying the Accumulation Units in a Participant
Account by the Accumulation Unit value. The Accumulation Unit value of an
Investment Account changes only on a Business Day.
GB10.OM-K [(SBR)] 10
SECTION 5 BENEFIT PAYMENTS AND TRANSFERS
5.1 General Withdrawal Provisions: Subject to the following provisions of this
Section, and prior to notification of contract termination (but not
thereafter), you may direct us to withdraw all or a portion of a
Participant's Account Value pursuant to Section 5.2 to provide a single-sum
payment to you to pay Plan benefits.
(a) Amounts attributable to amounts held as of December 31, 1988 under
another Code Section 403(b) annuity contract may be withdrawn to
provide such benefits.
(b) Amounts attributable to Code Section 403(b) Contributions made other
than pursuant to a salary reduction agreement (within the meaning of
Code Section 402(g)(3)(C)) may be withdrawn to provide such benefits.
(c) Amounts attributable to Code Section 403(b) Contributions made
pursuant to a salary reduction agreement (within the meaning of Code
Section 402(g)(3)(C)) may be withdrawn to provide such benefits,
provided that the withdrawal is made to provide a loan or that any
distribution of such amount shall not occur until the Participant has
either attained age 59 1/2, separated from service, died, become
totally disabled (as defined by the Plan), or experienced a hardship
(as defined by the Plan). However, in the case of a hardship
withdrawal, any gain credited to such Contributions may not be
withdrawn.
(d) Withdrawal of any amount from this contract which is transferred
directly by us pursuant to your or Participant instructions to another
Code Section 403(b) tax-deferred annuity funding vehicle under
applicable IRS rules and regulations is not the provision of a Plan
benefit for purposes of Section 5.2, but instead is a Contract
termination as to that amount for that Participant; and any such
withdrawal shall be subject to application of the Withdrawal Charge
pursuant to Section 5.2(a)(3). You hereby grant to a Participant the
right to direct the withdrawal and direct transfer of his voluntary
Elective Deferrals (as determined by you) to another Code Section
403(b) tax-deferred annuity funding vehicle.
(e) If, as provided in Internal Revenue Code Regulation Section
1.403(b)-2T Q&A-2, the distributee of any eligible rollover
distribution elects to have the distribution paid directly to an
eligible retirement plan (as defined in Q&A-1 of that Section) and
specifies the eligible retirement plan to which the distribution is to
be paid, then the distribution shall be paid to that eligible
retirement plan in a direct rollover.
(f) We are not responsible for determining a Participant's compliance with
the requirements above. Any withdrawal request submitted by you must
include certification as to the purpose of the withdrawal. You assume
full responsibility for determining whether any withdrawal is
permitted under applicable law and under the terms of a particular
Plan. We may rely solely upon your representations made in the
withdrawal request.
(g) [Withdrawals from a Participant Account's FIA share may not be made in
an amount less than the smaller of $500 or the Participant Account's
entire FIA share. If a withdrawal reduces the Participant Account's
FIA share to less than $500, such remaining share shall also be
withdrawn.]
(h) A withdrawal request is effective, and the Account Value to be applied
pursuant to Section 5.2 is determined, on the Business Day that we
receive a proper withdrawal request (or due
GB10.OM-K [(SBR)] 11
proof of death, if received later).
(i) We will pay any cash lump-sum to you or your designee within [7 days]
from the appropriate Business Day as determined in Subsection (h)
above, except as we may be permitted to defer such payment of amounts
withdrawn from the Variable Account in accordance with appropriate
provisions of the federal securities laws. We reserve the right to
defer the payment of amounts withdrawn from the FIA for a period of up
to [6 months] after we receive the withdrawal request.
5.2 Plan Benefit Payments: You will advise us of any person for whom a payment
is due under the Plan, including the nature and amount of such payment,
before the date such payment is due or as soon thereafter as is
practicable.
(a) Subject to the limitations provided in Section 5.1 and Subsection (b)
below, prior to notification of contract termination (but not
thereafter), you may direct us to withdraw all or a portion of a
Participant Account to provide a single-sum payment to you to pay:
[(1) Plan benefits for retirement, death, disability, hardships,
loans, required minimum distribution benefits pursuant to Code
Section 401(a)(9), or, for Code Section 403(b) plans or
profitsharing plans, benefits after age 59 1/2 or as otherwise
allowed by the Code (provided that such benefits after age 59 1/2
or as otherwise allowed by the Code are paid in a taxable
distribution to the Participant). Such a withdrawal is not
subject to a Withdrawal Charge or Market Value Adjustment.
(2) Plan benefits for termination of employment. Such a withdrawal is
not subject to a Withdrawal Charge or Market Value Adjustment,
with the following exceptions:
(A) Any such payment requested for a Participant who terminates
employment on or after the date your Plan is terminated is
subject to a Withdrawal Charge and Market Value Adjustment.
(B) Any such payment requested for a Participant whose
termination of employment is part of a partial Plan
termination under IRS guidelines is subject to a Withdrawal
Charge and Market Value Adjustment.
(C) Even if there is no full or partial Plan termination under
paragraphs (1) and (2) above, any such termination of
employment payments during the Contract Year (or, at our
option, during the 365-day period preceding our receipt of a
termination of employment benefit payment request) which
exceed 20% of the aggregate Account Value of all Participant
Accounts determined as of the first day of the Contract Year
(or the first day of the 365-day period) are subject to a
Withdrawal Charge and Market Value Adjustment.
(D) Any such payment requested for a Participant who terminates
employment on or after the date the Plan Sponsor files for
protection under federal bankruptcy law, is deemed
insolvent, dissolves, closes,
GB10.OM-K [(SBR)] 12
or shuts down its business, or ceases operations is subject
to a Withdrawal Charge and Market Value Adjustment.
(3) Plan benefits not otherwise listed in paragraphs (1) and (2)
above. Such a withdrawal is subject to a Withdrawal Charge and
Market Value Adjustment.]
(b) Regarding death benefits specifically, notwithstanding the provisions
of Section 9, upon receipt from you of instructions and of due proof
of the Participant's (and, if applicable, the beneficiary's) death
prior to the date the Participant Account is closed, we will apply the
Account Value of the Participant Account, minus any charges described
in Section 7 that are not included in the Accumulation Unit value, for
the purpose of providing a death benefit under the Plan. The death
benefit will be paid to the Participant's beneficiary according to the
method of payment elected by the beneficiary (unless such method of
payment was previously elected by the Participant). The Participant's
beneficiary may also designate a beneficiary.
The Code Section 403(b) death benefit will be payable:
(1) in a single sum or other method not provided in (2) below;
provided, however, that the entire Account Value, minus any
charges described in Section 7 that are not included in the
Accumulation Unit value, must be paid to the beneficiary on or
before December 31 of the calendar year which contains the fifth
anniversary of the Participant's death, or
(2) as an annuity in accordance with the Annuity Options shown in
Section 6.2 over a period not to exceed the life or life
expectancy of the beneficiary. If the beneficiary is not the
Participant's surviving spouse, the annuity must begin on or
before December 31 of the calendar year immediately following the
calendar year in which the Participant died. If the beneficiary
is the Participant's surviving spouse, the annuity need not begin
before December 31 of the calendar year in which the Participant
would have attained age 70 1/2.
If a Participant dies on or after his Annuity Commencement Date, any
interest remaining under the Annuity Option selected will be paid at
least as rapidly as prior to the Participant's death.
(c) Under Subsection (a)(2) (A), (B), (C), and (D) and under (a)(3) above,
if the entire Account Value is withdrawn, the amount paid equals the
Withdrawal Value minus any charges described in Section 7 which are
not included in the Accumulation Unit value, subject to the Market
Value Adjustment. If a portion of the Account Value is withdrawn, the
Account Value is reduced by an amount sufficient to make the payment
requested and to cover the Withdrawal Charge and any charges described
in Section 7 which are not included in the Accumulation Unit value,
subject to the Market Value Adjustment applied to all FIA amounts
withdrawn from the Participant Account.
(d) Notwithstanding the previous provisions of this Section, in the first
Contract Year in which a Participant Account is established, you may
withdraw from that Participant Account up to [10%] of the sum of the
Account Value of that Participant Account (determined as of the later
of the Contract Date or the Contract Anniversary immediately
GB10.OM-K [(SBR)] 13
preceding the withdrawal request) plus Contributions made for that
Participant during that Contract Year, without application of the
Withdrawal Charge or Market Value Adjustment. You may do the same in
the next succeeding Contract Year. In any subsequent Contract Year,
you may withdraw from that Participant Account up to [10%] of the
Account Value of that Participant Account (determined as of the
Contract Anniversary immediately preceding the withdrawal request)
without application of the Withdrawal Charge or Market Value
Adjustment.
5.3 Transfers between Investment Options: You may direct us to transfer amounts
between Investment Options, or to initiate Participant-directed transfers
between Investment Options. A transfer is deemed "Participant-directed"
only if it reflects the Participant's investment choice, free of any
suggestion or influence by you, the Plan Sponsor, or any fiduciary or other
party to the administration or management of the Plan [(with the exception
of any investment advice rendered by a third-party provider for whom an
Investment Advice Provider Fee is earned under the Table of Contract
Charges)]. A transfer that is not "Participant-directed" is
Contractholder-directed and is subject to a Market Value Adjustment under
Section 5.4(b). Transfers are effective on [the Business Day we receive the
transfer direction]. Transfer directions for a Participant Account may be
made [daily on any Business Day]. We will make the transfer as requested
within [7 days] from the date we receive the request, except as we may be
permitted to defer the transfer of amounts withdrawn from the Variable
Account in accordance with appropriate provisions of the federal securities
laws. We reserve the right to defer a transfer of amounts from the FIA for
a period of up to [6 months] after we receive the transfer request. 5.4
Transfers to and from the FIA:
[(a) Participant-directed Transfers (as defined in Section 5.3):
(1)1 If you do not make available to Participants any of the Competing
Investment Accounts identified in the Table of Investment
Accounts, once a Participant transfers funds from the FIA to an
Investment Account, he may transfer funds to the FIA only after
90 days have elapsed since the date of his last transfer from the
FIA.
(1)2 If you make available to Participants any of the Competing
Investment Accounts identified in the Table of Investment
Accounts, the 90-day transfer restriction discussed in Paragraph
(1) above does not apply. Instead:
(A) if a Participant's FIA Account Value is less than $2,500 as
of the first day of the Contract Year in which we receive
the transfer request, the Participant may transfer any
amount from the FIA.
(B) if a Participant's FIA Account Value is $2,500 or more as of
the first day of the Contract Year in which we receive the
transfer request, no more than 20% of the Participant's FIA
Account Value as of the first day of that Contract Year less
amounts previously transferred by him during that Contract
Year may be transferred by him from the FIA as of the date
we receive the transfer request.
(b) Contractholder-directed Transfers:
GB10.OM-K [(SBR)] 14
(2)1 Contractholder-directed transfers from the FIA to an Investment
Account are subject to a Market Value Adjustment.
(2) Contractholder-directed transfers to the FIA from an
Investment Account are subject to our approval.
(3) We may cease to permit Contractholder-directed transfers
upon 30 days notice to you.]
GB10.OM-K [(SBR)] 15
SECTION 6 - ANNUITIES
6.1 Annuity Purchases: Prior to notification of contract termination (but not
thereafter), you may withdraw all or a portion of a Participant's Account
Value to provide an annuity reflecting Plan benefits. Such a withdrawal is
not subject to a Withdrawal Charge or Market Value Adjustment. [On the date
we receive an annuity purchase request, we transfer the entire Participant
Account to the FIA if it is an available Investment Option, otherwise to
the AUL Money Market Investment Account. Such amounts remain in the FIA or
the AUL Money Market Investment Account until the full Account Value
(reflecting gains and losses) is applied to purchase the annuity on the
last day of the month preceding the Annuity Commencement Date. As of that
annuity purchase date, such Participant Account funds are no longer
maintained in this contract.]
Your annuity purchase request must specify the purpose for the annuity, the
election of an annuity option, Annuity Commencement Date, any contingent
annuitant or beneficiary, and any additional information we require. If the
Participant or any contingent annuitant dies before the Annuity
Commencement Date, the annuity election is cancelled.
The minimum amount which you may apply to purchase an annuity is [$10,000].
6.2 Annuity Options: You may elect any optional form of annuity we offer at the
time of purchase. Available annuity options always include:
(a) Life Annuity. A monthly annuity is payable as long as the annuitant
lives.
(b) Survivorship Annuity. A monthly annuity is payable as long as the
annuitant lives. After the annuitant's death, all or a portion of the
monthly annuity is paid to the contingent annuitant as long as the
contingent annuitant lives.
If a certain period annuity is available, the certain period may not extend
beyond the life expectancy of a Participant or the joint life expectancy of
a Participant and any contingent annuitant, as determined on the Annuity
Commencement Date.
6.3 Determining Annuity Amount: We compute the annuity amount using the factors
reflected in the Table of Guaranteed Immediate Annuities attached to this
contract. However, if our current single premium, nonparticipating,
immediate annuity rates for this class of group annuity contracts produce a
higher monthly annuity than the Table of Guaranteed Immediate Annuities,
then that more favorable annuity rate is applied.
6.4 Proof of Age and Survival; Minimum Payments: We may require proof of any
annuitant's or contingent annuitant's date of birth before commencing
payments under any annuity. We may also require proof that an annuitant or
contingent annuitant is living before making any annuity payment. If a
monthly annuity is less than our current established minimum payment, we
may make payments on a less-frequent basis.
6.5 Annuity Certificates: We issue to each person for whom an annuity is
purchased a certificate setting forth the annuity's amount and terms.
GB10.OM-K [(SBR)] 16
SECTION 7 OTHER CONTRACT CHARGES
7.1 [Investment Option Charge (IOC): Under Section 4.4, the Accumulation Unit
values of all Investment Accounts reflect the daily equivalent of an IOC
expressed as an annual percentage.
The IOC for an Investment Account is applied directly against the
Investment Account and is equal to the sum of "x" + "y" where:
"x" = a current charge for the investment advisory fees and for the
operational, organizational, and other expenses of the corresponding
Mutual Fund, Portfolio, or other entity in which the Investment
Account invests. Periodically, for a given Investment Account, "x"
will change to reflect changes in the related expenses and other
factors. Any change in "x" for an Investment Account will be effective
without prior written notice. Copies of the prospectuses or reports of
the Mutual Fund, Portfolio, or other entity are available for review.
"y" = a current combined mortality risk charge and expense risk charge of
1.25%.
7.2 Taxes: We may deduct charges equal to any premium tax we incur from the
balance applied to purchase an annuity or at such other time as premium
taxes are incurred by AUL. We may also deduct from Investment Accounts
reasonable charges for federal, state, or local income taxes we incur that
are attributable to such Investment Accounts.
7.3 Reduction or Waiver of Charges: We may reduce or waive the Withdrawal
Charge or the charges discussed above if the appropriate expenses
associated with the sale or administration of any contract are reduced or
if a contract is sold covering our employees or directors, those of the AUL
American Series Fund, Inc., or to either's affiliates.
7.4 Other Charges:
[(a) We apply those charges listed in the Table of Contract Charges.
(b) Charges due AUL for which the Plan is responsible, and which the Plan
Sponsor and Contractholder have otherwise agreed to in writing, which
are unpaid 60 days after the payment due date, will be deducted from
Participant Accounts on a pro-rata basis. These charges may include,
but are not limited to, participant statement mailing fees, Form 5500
fees, administrative fees, data reconciliation and reconstruction
fees, commissions, and contract application/installation fees for a
takeover Plan. Charges for which the Plan Sponsor (not the Plan) is
responsible, and which the Plan Sponsor has otherwise agreed to in
writing, must be paid by the Plan Sponsor. These charges include
contract application/installation fees for a new Plan.]
[7.5 Variable Investment Plus (VIP) Credit Factor: We determine a VIP credit
factor each month by multiplying the portions of the aggregate monthend
Account Value in all Investment Accounts by the monthly equivalent of the
corresponding annual VIP credit factors in the table below. The sum of
these products is divided by the aggregate monthend Account Value in all
Investment Accounts. We multiply the resulting percentage by each
Participant's monthend Account Value in each Investment Account, and add
the resulting
GB10.OM-K [(SBR)] 17
amount to the Participant's Account Value for that Investment Account.
Aggregate MonthEnd Account Value
allocated to Investment Accounts Annual VIP Credit Factors
First $ 750,000 0.10%
Next $ 750,000 0.30%
Next $ 1,000,000 0.45%
Next $ 2,500,000 0.75%
Next $ 5,000,000 0.85%
Over $10,000,000 0.95%
The VIP Credit Factor may be reduced by an annual charge percentage equal
to the current fixed dollar charge for expenses you have selected and
agreed to in your AUL administrative services agreement divided by the
aggregate period-end Account Value in all Investment Accounts. Period-end
will be month-end. Alternatively, at our option and upon 30 days notice to
you prior to the beginning of the next calendar quarter, we may use the
aggregate calendar quarter-end Account Value in all Investment Accounts to
calculate this charge. We also reserve the right to revert to a month-end
calculation upon 30 days notice to you prior to the beginning of the month
in which the change is to be effective. Such charge percentage may not
reduce the VIP Credit Factor below 0%.]
GB10.OM-K [(SBR)] 18
SECTION 8 CONTRACT MODIFICATIONS
8.1 Contract Amendment: You and we may agree to any change or amendment to this
Contract without the consent of any other person or entity. This contract
cannot be modified or amended, nor can any provision or condition be
waived, except by written authorization of a corporate officer of AUL.
8.2 Rates and Section 7 Charges: We may announce new Guaranteed Rates, as
described in Sections 3.2 and 3.3 (including the consolidation of existing
Interest Pockets). However, as provided in Sections 3.2 and 3.3, we may not
change the declared Guaranteed Rate applicable to an established Interest
Pocket during the guaranteed period. We may also modify the charge levels
in Section 7 (but may not exceed the maximum charge levels listed in the
Table of Contract Charges) using the procedures of Section 8.5.
8.3 Conformance with Law: We may amend this contract at any time, without your
consent, or that of any other person or entity, if the amendment is
reasonably needed to comply with, or give you or Participants the benefit
of, any provisions of federal or state laws. Any such amendment will be
delivered to you prior to its effective date.
8.4 Addition, Deletion, or Substitution of Investments:
(a) We reserve the right, subject to compliance with applicable law, to
make additions to, deletions from, substitution for, or combinations
of, the securities that are held by any Investment Account or that any
Investment Account may purchase. We reserve the right to eliminate the
shares of any of the eligible Mutual Funds, Portfolios, or other
entities and to substitute shares of, or interests in, another Mutual
Fund, Portfolio, or another investment vehicle, for shares already
purchased or to be purchased in the future under the contract, if the
shares of any or all eligible Mutual Funds, Portfolios, or other
entities are no longer available for investment or if further
investment in any or all eligible Mutual Funds, Portfolios, or other
entities becomes inappropriate in view of the purposes of the
contract. Where required under applicable law, we will not substitute
any shares attributable to your interest in any Investment Account
without notice, your approval or Participant approval, or prior
approval of the Securities and Exchange Commission or a state
insurance commissioner, and without following the filing or other
procedures established by applicable state insurance regulators.
Nothing contained herein will prevent the Variable Account from
purchasing other securities for other series or classes of contracts,
or from effecting a conversion between series or classes of contracts
on the basis of requests made by a majority of other contractholders
or as permitted by federal law.
(b) We reserve the right to establish additional Investment Accounts, each
of which would invest in the corresponding Mutual Fund, Portfolio, or
other entity, or in other securities or investment vehicles. We
reserve the right to eliminate or combine existing Investment Accounts
if marketing, tax, or investment conditions warrant. We reserve the
right to provide other Investment Options under this contract at any
time. Subject to any required regulatory approvals, we reserve the
right to transfer assets from any Investment Account to another
separate account of AUL or Investment Account.
(c) In the event of any such substitution or change, we may, by
appropriate amendment, make such changes in this contract as may be
necessary or appropriate to reflect such
GB10.OM-K [(SBR)] 19
substitution or change. Any transfer request or Investment Option
election received on or after the effective date of such substitution
or change which reflects the previous Investment Option which has been
substituted or changed will be transacted using the new substituted or
changed Investment Option. If deemed by us to be in the best interests
of persons or entities having voting rights under this contract, the
Variable Account may be operated as a management investment company
under the Investment Company Act of 1940 or any other form permitted
by law, it may be deregistered in the event such registration is no
longer required under the Investment Company Act of 1940, or it may be
combined with other separate accounts of AUL or an affiliate thereof.
We may take such action as is necessary to comply with, or to obtain,
exemptions from the Securities and Exchange Commission with regard to
the Variable Account. Subject to compliance with applicable law, we
also may combine one or more Investment Accounts and may establish a
committee, board, or other group to manage one or more aspects of the
Investment Accounts. 8.5 Our Right to Initiate Changes: In addition to
those amendments permitted by Sections 8.2, 8.3, and 8.4, we may
initiate an additional provision or modification of any other
provision of this contract (except for those prohibited amendments
listed in Section 8.6) by giving you [60 days] notice of such
modification. Any such modification is effective without your
affirmative assent.
8.6 Prohibited Amendments:
(a) Notwithstanding our right to initiate changes under Section 8.5, we
may not initiate changes to the minimum Guaranteed Rate specified in
Section 3.4, our obligation to set Guaranteed Rates for the period of
time specified in Sections 3.2 and 3.3, the payment provisions upon
contract termination specified in Section 9.2, the maximum charge
levels listed in the Table of Contract Charges, or the Table of
Guaranteed Immediate Annuities.
(b) No modification to this contract may change the terms of a previously
purchased annuity or reduce any interest guarantee applicable to
Participant Account balances held in the FIA on the modification's
effective date.
GB10.OM-K [(SBR)] 20
SECTION 9 TERMINATION OF CONTRACT
9.1 Termination by You: You may terminate this contract by giving us notice and
electing a form of payment described in Section 9.2. Such termination is
effective on [the Business Day that we receive your notice.]
9.2 Payment Upon Termination by You: If you terminate the contract, you may
elect the following options:
(a) Lump-Sum: We pay you [the aggregate Withdrawal Value of all
Participant Accounts attributable to Code Section 401(a) funds, plus
or minus any FIA MVA]. Such Withdrawal Value and MVA will be
determined on the termination effective date and paid within [7 days]
from the termination effective date, except as we may be permitted to
defer payment in accordance with appropriate provisions of the federal
securities laws.
(b) Payment of Investment Accounts in Lump-Sum and FIA in Installments:
For Code Section 401(a) funds or Code Section 403(b) funds, you may
have the aggregate Investment Account Withdrawal Value of all
Participant Accounts paid to you in a lump-sum, with the aggregate FIA
Withdrawal Value of all Participant Accounts paid in [6] equal annual
installments. The aggregate Investment Account Withdrawal Value will
be determined on the termination effective date and paid within [7
days] from the termination effective date, except as we may be
permitted to defer payment in accordance with appropriate provisions
of the federal securities laws. The initial FIA installment is
calculated on the termination effective date and paid within [7 days]
from the termination effective date. Subsequent installments are paid
on the anniversary of the termination effective date. During the
installment payment period, interest is credited to amounts in the FIA
at a rate equal to the current average Guaranteed Rate (as determined
on the first installment payment date) of all your Interest Pockets,
less [1%]. The minimum rate guarantee provided in Section 3.4 applies
to the interest credited under this Section. Interest is paid with
each installment.
(c) Transfer to Another Contract: [You may transfer the aggregate Account
Value of all Participant Accounts, or you may permit a Participant to
transfer his Account Value, to any group annuity contract which has a
withdrawal charge which we may make available. You may transfer the
aggregate Withdrawal Value of all Participant Accounts, or you may
permit a Participant to transfer his Withdrawal Value, to any group
annuity contract which does not have a withdrawal charge which we may
make available. Any such amounts are transferred on the termination
effective date.]
9.3 Termination by Us: We have the right, subject to applicable state law, to
terminate any Participant Account established under this contract at any
time during the Contract Year if the Account Value of the Participant
Account is less than [$200] for the first Contract Year in which a
Contribution is made for the Participant, and [$400] for any subsequent
Contract Year, and at least [6 months] have elapsed since the last previous
Contribution to the contract. If we elect to terminate a Participant
Account, the termination will be effective on the date [6 months] following
the date we give notice to you and the Participant that the Participant
Account is to be terminated, provided that any Contributions made during
the [6-month period] are insufficient to raise the Account Value up to the
minimum level.
GB10.OM-K [(SBR)] 21
9.4 Payment Upon Termination by Us: As of the effective date of termination of
a Participant Account by us, we may elect to have a single sum equal to the
Account Value of the Participant Account on the effective date of
termination paid to you within [7 days] from that date. Any such payment is
in full settlement of the Participant Account under this contract and in
lieu of any other payment under its terms.
9.5 Indemnification Required: Payments or transfers under Section 9.2 are in
full settlement of our obligations under this contract. Prior to making
such payments or transfers under Section 9.2, we may require you and the
Plan Sponsor to indemnify and hold us harmless from any and all losses,
claims, or demands that may later be asserted against us in connection with
the making of such payment or transfer.
9.6 Effect on Contract Obligations: Any annuities purchased prior to
notification of contract termination are unaffected by a termination. We
may refuse further Contributions at any time after a termination notice has
been given. If we have been providing recordkeeping services, such services
stop on [the termination effective date. If we cease to provide Plan
recordkeeping for any reason, any administrative services agreement between
you and us regarding your Plan and/or this contract is thereby terminated.]
This contract terminates automatically if no amounts remain in either the
FIA or any Investment Account.
GB10.OM-K [(SBR)] 22
SECTION 10 GENERAL PROVISIONS
10.1 Ownership: You own this contract. No other person or entity has any right,
title, or interest in this contract or to amounts received or credited
under it until such amounts are made available to them by you. All amounts
received or credited under this contract become our property. We are
obligated to make only the payments or distributions specified in this
contract.
10.2 Entire Contract: This contract and your application constitute the entire
agreement between you and us. We are not a party to, nor bound by, a Plan,
trust, custodial agreement, or other agreement, or any amendment or
modification to any of the same. We are not a fiduciary under this contract
or under any such Plan, trust, custodial agreement, or other agreement.
10.3 Benefit Determinations: You will furnish to us whatever information is
necessary to establish the eligibility for and amount of annuity or other
benefit due. We rely solely on your instructions and certifications with
respect to Participant benefits. You are fully responsible for determining:
(a) whether benefit payments are permitted under applicable law and the
Plan and
(b) the existence or amount of Excess Contributions (plus gains or minus
losses thereon), or that returns of Excess Contributions are permitted
by the Plan and the Code.
We may rely on your or your designee's statements or representations in
honoring any benefit payment request.
[We require that a Participant execute and submit to us an affidavit which
we prepare in order that we may process that Participant's benefit payable
under this contract if you, the Plan Sponsor, the Plan Trustee, and the
Plan Administrator are no longer in existence at the time we receive that
Participant's benefit payment request.]
10.4 Recordkeeping Services: [We generally provide Plan recordkeeping services
when all of a Plan's funds are held under this contract. We decline to
provide Plan recordkeeping services if you elect to allocate Plan funds to
investments other than this contract, or if your Plan's recordkeeping
practices, in our judgment, impose an administrative or financial burden on
us. If we cease to provide Plan recordkeeping for any reason, any
administrative services agreement between you and us regarding your Plan
and/or this contract is thereby terminated.]
10.5 Representations and Warranties: You and we mutually represent and warrant,
each to the other, that each is fully authorized to enter into this
contract and that this contract is a valid and binding obligation and that
the execution of this contract does not violate any law, regulation,
judgment, or order by which the representing party is bound. In addition,
you represent and warrant to us that:
(a) the Code Section 401(a) Plan and the Code Section 403(b) Plan meet the
requirements of Code Section 401(a) and Code Section 403(b),
respectively;
(b) the execution of this contract has been authorized by the Plan
fiduciary responsible for Plan investment decisions; and
GB10.OM-K [(SBR)] 23
(c) the execution or performance of this contract does not violate any
Plan provision or any law, regulation, judgment, or order by which the
Plan is bound.
We do not make any representation or warranty regarding the federal,
state, or local tax status of this contract, any Participant Account,
or any transaction involving this contract.
10.6 Contractholder Representative; Misstatement of Data: You may designate a
representative to act on your behalf under Sections 2 or 3 or to receive
any payment under Sections 5 or 9. We may rely on any information you, your
designee, or a Participant furnish. We need not inquire as to the accuracy
or completeness of such information. If any essential data pertaining to
any person has been omitted or misstated, including, but not limited to, a
misstatement of an annuitant's or contingent annuitant's age, we will make
an equitable adjustment to provide the annuity or other benefit determined
using correct data.
10.7 Assignment by Contractholder: You may assign your interest in Code Section
401(a) funds held in this contract by filing the original or a duplicate of
the assignment with us. We are not responsible for the validity of an
assignment.
10.8 Form of Request, Notice, Instruction, or Direction: When reference is made
to you, your designee, or a Participant making a request or giving notice,
instruction, or direction, such request, notice, instruction, or direction
must be in writing, or in a form otherwise acceptable to us, and is
effective when we receive it.
10.9 Effect of Disqualification: You will promptly notify us if you determine
that there is a reasonable basis for believing the Code Section 401(a)Plan
is no longer qualified under Code Section 401(a). In such event, each
Participant Account's share of each Investment Account is withdrawn and
transferred to [Liquid Interest Fund II (LIF II) within our general asset
account, where such funds earn a fixed annual effective interest rate of
3.00% from the date of allocation to LIF II until the earlier of the date
those funds are withdrawn from the contract or the date the Code Section
401(a) Plan is again qualified and such funds are transferred to the
appropriate Investment Options pursuant to applicable Investment Option
elections]. No amounts attributable to this contract can be placed in any
Investment Account until the Code Section 401(a) Plan is again qualified.
10.10 [Quarterly] Statement of Account Value: Reasonably promptly after the end
of each [Contract Quarter], we will prepare a statement of the Account
Value of each Participant Account that is maintained under this contract.
10.11 Conformity with Law: Any benefit payable under this contract shall not be
less than the minimum benefit required by the insurance laws of the state
in which the contract is delivered. Language in this contract referring to
state or federal tax, securities, or other statutes or rules do not
incorporate within this contract any such statutes or rules.
10.12 Gender and Number: Whenever the context so requires, the plural includes
the singular, the singular the plural, and the masculine the feminine.
10.13 Facility of Payment: If any Participant, contingent annuitant, or
beneficiary is legally incapable of giving a valid receipt for any payment,
if no guardian has been appointed, and if we receive a valid power of
attorney for such Participant, contingent annuitant, or beneficiary, we may
pay
GB10.OM-K [(SBR)] 24
the person or persons named in such power of attorney. We may also pay you
directly or as you otherwise instruct. Any such payment fully discharges us
to the extent of such payment.
10.14 Voting: We own all shares of a Mutual Fund, Portfolio, or other entity
held in an Investment Account. We exercise the voting rights of such shares
at all shareholder meetings on all matters requiring shareholder voting
under the Investment Company Act of 1940 or other applicable laws. Our vote
reflects instructions received from persons having the voting interest in
the shares, as follows: (a) You have the voting interest under this
contract. Unless otherwise required by applicable law, the number of shares
of a Mutual Fund, Portfolio, or other entity for which you may give voting
instructions is determined by dividing the aggregate Account Values in the
affected Investment Account by the net asset value of the shares of the
Mutual Fund, Portfolio, or other entity. Fractional votes are counted. Our
determination is made as of the date used by the Mutual Fund, Portfolio, or
other entity to determine shareholders eligible to vote.
(b) We vote shares proportionally, to reflect the voting instructions we
receive in a timely manner from you and from all other
contractholders. If no timely voting instructions are received from
you, we vote shares proportionally, to reflect the voting instructions
we received in a timely manner for all other contracts.
To the extent permitted by applicable law, we may vote shares in our own
right or may modify the above procedures to reflect changes in the law or
its interpretation.
We will provide prospectuses and other reports as required by applicable
federal law.
10.15 Acceptance of New Participants or Contributions: We may refuse to accept
new Participants or new Contributions at any time.
10.16 Our Annual Statement: No provision of this contract controls, determines,
or modifies any annual statement made by us to any insurance department,
contractholder, regulatory body, or other person. Nor does anything in such
annual statement control, determine, or modify the provisions of this
contract.
10.17 Nonforfeitability and Nontransferability: The entire Withdrawal Value of
the vested portion (as determined pursuant to the Code Section 403(b) Plan)
of Code Section 403(b) funds of a Participant Account under this contract
is nonforfeitable at all times. No sum payable under this contract which is
attributable to Code Section 403(b) funds with respect to a Participant may
be sold, assigned, discounted, or pledged as collateral for a loan or as
security for the performance of an obligation or for any other purpose to
any person or entity other than us. In addition, to the extent permitted by
law, no such sum shall in any way be subject to legal process requiring the
payment of any claim against the payee.
10.18 Notice of Annual Meeting of Members: By-law, Art II, Sec. 2: the regular
annual meeting of the members of American United Mutual Insurance Holding
Company shall be held at its principal place of business on [the third
Thursday in February each year at ten o'clock A.M.] local time or at such
other location, place, or time as may be designated by the Board of
Directors. The election of directors shall be held at the annual meeting.
GB10.OM-K [(SBR)] 25
[TABLE OF CONTRACT CHARGES
(1) Participant Account Charge: We deduct a Participant Account Charge of up to
$10 per Contract Quarter on the last day of each Contract Quarter from each
Participant Account in existence on such day for as long as the Participant
Account is in effect. Alternatively, we may ▇▇▇▇ this charge to you. If the
entire balance of a Participant Account is applied or withdrawn before the
last day of the Contract Quarter pursuant to the contract, the Participant
Account Charge attributable to the period of time which has elapsed since
the first day of the Contract Quarter in which such application or
withdrawal of funds is made will not be deducted from the amount applied or
withdrawn and will not be billed to you.
(2) Loan Initiation Fee: We assess a Loan Initiation Fee of up to $100 against
the Account of any Participant for whom a Plan loan withdrawal is requested
under this contract.
(3) Charge for Non-Electronic Transfers: We charge a service fee of up to $5
for non-electronic transfers between Investment Options, which will either
be billed to you or deducted from the applicable Participant Account.
(4) Distribution Fee: We ▇▇▇▇ you for a Distribution Fee of up to $40 for each
Participant for whom a withdrawal is made under this contract in which the
entire Participant Account is distributed in a lump-sum. Alternatively, we
may assess this Distribution Fee against the affected Participant Account
if permitted under applicable law, regulations, and rulings.
(5) Investment Advice Provider Fee: We ▇▇▇▇ you for an Investment Advice
Provider Fee in an amount separately agreed upon by you and the third-party
investment advice provider. Alternatively, we may assess this Investment
Advice Provider Fee against the Account of each Participant who utilizes
the investment advice provider's services if permitted under applicable
law, regulations, and rulings. The entire fee collected by us will be
forwarded to the investment advice provider. No portion of this fee will be
retained by us.
(6) Contract Termination Individual Participant Check Fee: We ▇▇▇▇ you for a
fee of up to $100 for each Participant for whom an individual check is
prepared upon contract termination. (This charge does not apply to a
lump-sum payment to you upon contract termination.) Alternatively, we may
assess this fee against the affected Participant Account if permitted under
applicable law, regulations, and rulings.]
GB10.OM-K [(SBR)] 26
[TABLE OF GUARANTEED IMMEDIATE ANNUITIES
MONTHLY INCOME PER $1,000 OF ACCOUNT VALUE
10 YEAR CERTAIN
ADJUSTED AGE LIFE ANNUITY AND LIFE ANNUITY
45 2.9690 2.9632
46 3.0190 3.0124
47 3.0715 3.0641
48 3.1269 3.1185
49 3.1852 3.1756
50 3.2466 3.2357
51 3.3115 3.2988
52 3.3800 3.3653
53 3.4525 3.4352
54 3.5291 3.5088
55 3.6104 3.5863
56 3.6966 3.6678
57 3.7881 3.7536
58 3.8850 3.8437
59 3.9877 3.9382
60 4.0964 4.0374
61 4.2115 4.1414
62 4.3334 4.2505
63 4.4626 4.3650
64 4.5994 4.4850
65 4.7442 4.6108
66 4.8977 4.7425
67 5.0608 4.8804
68 5.2347 5.0250
69 5.4213 5.1766
70 5.6229 5.3356
71 5.8412 5.5020
72 6.0778 5.6755
73 6.3336 5.8552
74 6.6097 6.0404
75 6.9084 6.2302
Adjusted Age = Actual Age at Settlement (in years and completed months) less the
following number of months: [.6 times (Birth Year 1915)] rounded to the nearest
integer.
Guaranteed purchase rates are 96% of the net single premium for the benefit
provided based on the unprojected 1994 Group Annuity Reserving Table for females
with interest at 2%.]
GB10.OM-K [(SBR)] 27
TABLE OF INVESTMENT ACCOUNTS
The following Investment Accounts are made available to you under this contract.
By completing a form we require, you may restrict the Investment Accounts you
make available to your Participants. Amounts allocated to any Investment Account
identified below are invested in the shares of the corresponding Mutual Fund,
Portfolio, or other entity listed below. [The Competing Investment Accounts
marked with an asterisk (*) are not available if your Plan uses the FIA and if
you do not want the FIA 20% annual transfer restriction applicable to
Participant-directed transfers provided in Section 5.4(a)(2) to apply.
Investment Account Mutual Fund, Portfolio, or Other Entity
------------------ ---------------------------------------
AUL American Aggressive Investor Portfolio AUL American Aggressive Investor Portfolio
AUL American Bond AUL American Bond
AUL American Conservative Investor Portfolio AUL American Conservative Investor Portfolio
AUL American Equity AUL American Equity
AUL American Managed AUL American Managed
AUL American Moderate Investor Portfolio AUL American Moderate Investor Portfolio
AUL American Money Market * AUL American Money Market
AUL American Tactical Asset Allocation Portfolio AUL American Tactical Asset Allocation Portfolio
▇▇▇▇▇ American Growth ▇▇▇▇▇ American Growth
▇▇▇▇▇ American Balanced ▇▇▇▇▇ American Balanced
▇▇▇▇▇ American Leveraged All Cap ▇▇▇▇▇ American Leveraged All Cap
American Century Equity Income American Century Equity Income
American Century Income and Growth American Century Income and Growth
American Century International Growth American Century International Growth
American Century Select American Century Select
American Century Small Cap Value American Century Small Cap Value
American Century Ultra American Century Ultra
American Century VP Capital Appreciation American Century VP Capital Appreciation
▇▇▇▇▇▇▇ Social MidCap Growth ▇▇▇▇▇▇▇ Social MidCap Growth
Fidelity VIP EquityIncome Fidelity VIP EquityIncome
Fidelity VIP Growth Fidelity VIP Growth
Fidelity VIP High Income Fidelity VIP High Income
Fidelity VIP Overseas Fidelity VIP Overseas
Fidelity VIP II Asset Manager Fidelity VIP II Asset Manager
Fidelity VIP II Contrafund Fidelity VIP II Contrafund
INVESCO Dynamics INVESCO Dynamics
INVESCO Energy INVESCO Energy
INVESCO Financial Services INVESCO Financial Services
INVESCO Health Sciences INVESCO Health Sciences
INVESCO Technology INVESCO Technology
INVESCO Telecommunications INVESCO Telecommunications
Janus Aspen Series Flexible Income Portfolio Janus Aspen Series Flexible Income Portfolio
Janus Aspen Series Worldwide Growth Portfolio Janus Aspen Series Worldwide Growth Portfolio
PBHG Emerging Growth Fund PBHG Emerging Growth Fund
PBHG Growth II PBHG Growth II
PBHG Ins. Technology and Communication PBHG Ins. Technology and Communication
PBHG Large Cap Value Fund PBHG Large Cap Value Fund
SAFECO Resources Series Trust Equity Portfolio SAFECO Resources Series Trust Equity Portfolio
SAFECO Resources Series Trust Growth Portfolio SAFECO Resources Series Trust Growth Portfolio
State Street Equity 500 Index Fund State Street Equity 500 Index Fund
▇. ▇▇▇▇ Price Equity Income Portfolio ▇. ▇▇▇▇ Price Equity Income Portfolio
▇. ▇▇▇▇ Price European Stock ▇. ▇▇▇▇ Price European Stock
Vanguard Explorer Vanguard Explorer
Vanguard ShortTerm Federal * Vanguard ShortTerm Federal]
GB10.OM-K
THE FOLLOWING PAGES ARE SPECIAL STATES PAGES THAT WERE
FILED FOR FORM GB10.OM-K. (EACH PAGE REFLECTS THE
APPROPRIATE STATE.)
GB10.OM-K
American United Life Insurance Company (R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER: [GA XX,XXX]
CONTRACTHOLDER: [ABC COMPANY]
DATE OF ISSUE: [JANUARY 2, 2002]
CONTRACT DATE: [JANUARY 1, 2002]
FIRST CONTRACT ANNIVERSARY: [JANUARY 1, 2003]
American United Life Insurance Company (AUL) issues this contract in
consideration of the Contractholder's application and its payment of
Contributions to AUL. When used in this contract, "we," "us," or "our" refer to
AUL and "you" or "your" refer to the Contractholder.
All provisions and conditions stated on this and subsequent pages are part of
this contract.
This contract is signed for us at our Home Office in Indianapolis, Indiana. Our
mailing address is ▇.▇. ▇▇▇ ▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇. Our street
address is ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇.
NOTICE OF [TEN] DAY RIGHT TO EXAMINE CONTRACT
Please read this contract carefully. You may return the contract for any reason
within [ten] days after receiving it. If returned, the contract is void from the
beginning and any Contributions will be refunded.
AMERICAN UNITED LIFE INSURANCE COMPANY
By /s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇
Chairman of the Board,
President, & Chief Executive Officer
Attest
Secretary
AUL American Series
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)]
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THIS CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THIS CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
Amounts withdrawn from the Fixed Interest Account may be subject to a Market
Value Adjustment.
Use of adjusted age method will reduce the guaranteed annuity benefit.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
GB10.OM-K (CT) [(SBR)]
SECTION 6 - ANNUITIES
6.1 Annuity Purchases: Prior to notification of contract termination (but not
thereafter), you may withdraw all or a portion of a Participant's Account
Value to provide an annuity reflecting Plan benefits. Such a withdrawal is
not subject to a Withdrawal Charge or Market Value Adjustment. [On the date
we receive an annuity purchase request, we transfer the entire Participant
Account to the FIA if it is an available Investment Option, otherwise to
the AUL Money Market Investment Account. Such amounts remain in the FIA or
the AUL Money Market Investment Account until the full Account Value
(reflecting gains and losses) is applied to purchase the annuity on the
last day of the month preceding the Annuity Commencement Date. As of that
annuity purchase date, such Participant Account funds are no longer
maintained in this contract.]
Your annuity purchase request must specify the purpose for the annuity, the
election of an annuity option, Annuity Commencement Date, any contingent
annuitant or beneficiary, and any additional information we require. If the
Participant or any contingent annuitant dies before the Annuity
Commencement Date, the annuity election is cancelled.
The minimum amount which you may apply to purchase an annuity is [$10,000].
6.2 Annuity Options: You may elect any optional form of annuity we offer at the
time of purchase. Available annuity options always include:
(a) Life Annuity. A monthly annuity is payable as long as the annuitant
lives.
(b) Survivorship Annuity. A monthly annuity is payable as long as the
annuitant lives. After the annuitant's death, all or a portion of the
monthly annuity is paid to the contingent annuitant as long as the
contingent annuitant lives.
If a certain period annuity is available, the certain period may not extend
beyond the life expectancy of a Participant or the joint life expectancy of
a Participant and any contingent annuitant, as determined on the Annuity
Commencement Date.
6.3 Determining Annuity Amount: We compute the annuity amount using the
annuitant's adjusted age on the Annuity Commencement Date and the factors
shown in the Table of Guaranteed Immediate Annuities attached to this
contract. Use of the adjusted age method results in a lower guaranteed
annuity benefit than would be payable if the actual age method was used.
However, if our current single premium nonparticipating immediate annuity
rates for this class of group annuity contracts using the actual age method
produces a higher monthly annuity than the Table of Guaranteed Immediate
Annuities using the adjusted age method, then that more favorable rate will
be applied.
6.4 Proof of Age and Survival; Minimum Payments: We may require proof of any
annuitant's or contingent annuitant's date of birth before commencing
payments under any annuity. We may also require proof that an annuitant or
contingent annuitant is living before making any annuity payment. If a
monthly annuity is less than our current established minimum payment, we
may make payments on a less-frequent basis.
6.5 Annuity Certificates: We issue to each person for whom an annuity is
purchased a certificate setting forth the annuity's amount and terms.
GB10.OM-K (CT) [(SBR)] 16
[TABLE OF CONTRACT CHARGES
(1) Participant Account Charge: We deduct a Participant Account Charge of up to
$10 per Contract Quarter on the last day of each Contract Quarter from each
Participant Account in existence on such day for as long as the Participant
Account is in effect. Alternatively, we may ▇▇▇▇ this charge to you. If the
entire balance of a Participant Account is applied or withdrawn before the
last day of the Contract Quarter pursuant to the contract, the Participant
Account Charge attributable to the period of time which has elapsed since
the first day of the Contract Quarter in which such application or
withdrawal of funds is made will not be deducted from the amount applied or
withdrawn and will not be billed to you.
(2) Charge for Non-Electronic Transfers: We charge a service fee of up to $5
for non-electronic transfers between Investment Options, which will either
be billed to you or deducted from the applicable Participant Account.
(3) Distribution Fee: We ▇▇▇▇ you for a Distribution Fee of up to $40 for each
Participant for whom a withdrawal is made under this contract in which the
entire Participant Account is distributed in a lump-sum. Alternatively, we
may assess this Distribution Fee against the affected Participant Account
if permitted under applicable law, regulations, and rulings.
(4) Investment Advice Provider Fee: We ▇▇▇▇ you for an Investment Advice
Provider Fee in an amount separately agreed upon by you and the third-party
investment advice provider. Alternatively, we may assess this Investment
Advice Provider Fee against the Account of each Participant who utilizes
the investment advice provider's services if permitted under applicable
law, regulations, and rulings. The entire fee collected by us will be
forwarded to the investment advice provider. No portion of this fee will be
retained by us.
(5) Contract Termination Individual Participant Check Fee: We ▇▇▇▇ you for a
fee of up to $100 for each Participant for whom an individual check is
prepared upon contract termination. (This charge does not apply to a
lump-sum payment to you upon contract termination.) Alternatively, we may
assess this fee against the affected Participant Account if permitted under
applicable law, regulations, and rulings.]
GB10.OM-K (CT) [(SBR)] 26
7.5---- Variable Investment Plus (VIP) Credit Factor
SECTION 8 CONTRACT MODIFICATIONS [19]
8.1---- Contract Amendment
8.2---- Rates and Section 7 Charges
8.3---- Conformance with Law
8.4---- Addition, Deletion, or Substitution of Investments
8.5---- Our Right to Initiate Changes
8.6---- Prohibited Amendments
SECTION 9 TERMINATION OF CONTRACT [21]
9.1---- Termination by You
9.2---- Payment Upon Termination by You
9.3---- Termination by Us
9.4---- Payment Upon Termination by Us
9.5---- Indemnification Required
9.6---- Effect on Contract Obligations
SECTION 10 GENERAL PROVISIONS [23]
10.1---- Ownership
10.2---- Entire Contract
10.3---- Benefit Determinations
10.4---- Recordkeeping Services
10.5---- Representations
10.6---- Contractholder Representative; Misstatement of Data
10.7---- Assignment by Contractholder
10.8---- Form of Request, Notice, Instruction, or Direction
10.9---- Effect of Disqualification
10.10--- [Quarterly] Statement of Account Value
10.11--- Conformity with Law
10.12--- Gender and Number
10.13--- Facility of Payment
10.14--- Voting
10.15--- Acceptance of New Participants or Contributions
10.16--- Our Annual Statement
10.17--- Nonforfeitability and Nontransferability
10.18--- Notice of Annual Meeting of Members
[TABLE OF CONTRACT CHARGES] [26]
[TABLE OF GUARANTEED IMMEDIATE ANNUITIES] [27]
[TABLE OF INVESTMENT ACCOUNTS] [28]
GB10.OM-K (KY) [(SBR)] 2
SECTION 10 GENERAL PROVISIONS
10.1 Ownership: You own this contract. No other person or entity has any right,
title, or interest in this contract or to amounts received or credited
under it until such amounts are made available to them by you. All amounts
received or credited under this contract become our property. We are
obligated to make only the payments or distributions specified in this
contract.
10.2 Entire Contract: This contract and your application constitute the entire
agreement between you and us. We are not a party to, nor bound by, a Plan,
trust, custodial agreement, or other agreement, or any amendment or
modification to any of the same. We are not a fiduciary under this contract
or under any such Plan, trust, custodial agreement, or other agreement.
10.3 Benefit Determinations: You will furnish to us whatever information is
necessary to establish the eligibility for and amount of annuity or other
benefit due. We rely solely on your instructions and certifications with
respect to Participant benefits. You are fully responsible for determining:
(a) whether benefit payments are permitted under applicable law and the
Plan and
(b) the existence or amount of Excess Contributions (plus gains or minus
losses thereon), or that returns of Excess Contributions are permitted
by the Plan and the Code.
We may rely on your or your designee's statements or representations in
honoring any benefit payment request.
[We require that a Participant execute and submit to us an affidavit which
we prepare in order that we may process that Participant's benefit payable
under this contract if you, the Plan Sponsor, the Plan Trustee, and the
Plan Administrator are no longer in existence at the time we receive that
Participant's benefit payment request.]
9.5 Recordkeeping Services: [We generally provide Plan recordkeeping services
when all of a Plan's funds are held under this contract. We decline to
provide Plan recordkeeping services if you elect to allocate Plan funds to
investments other than this contract, or if your Plan's recordkeeping
practices, in our judgment, impose an administrative or financial burden on
us. If we cease to provide Plan recordkeeping for any reason, any
administrative services agreement between you and us regarding your Plan
and/or this contract is thereby terminated.]
10.5 Representations: You and we mutually represent, each to the other, that
each is fully authorized to enter into this contract and that this contract
is a valid and binding obligation and that the execution of this contract
does not violate any law, regulation, judgment, or order by which the
representing party is bound. In addition, you represent to us that:
(a) the Code Section 401(a) Plan and the Code Section 403(b) Plan meet the
requirements of Code Section 401(a) and Code Section 403(b),
respectively;
(b) the execution of this contract has been authorized by the Plan
fiduciary responsible for Plan investment decisions; and
(c) the execution or performance of this contract does not violate any
Plan provision or any law, regulation, judgment, or order by which the
Plan is bound.
GB10.OM-K (KY) [(SBR)] 23
We do not make any representation regarding the federal, state, or local
tax status of this contract, any Participant Account, or any transaction
involving this contract.
10.6 Contractholder Representative; Misstatement of Data: You may designate a
representative to act on your behalf under Sections 2 or 3 or to receive
any payment under Sections 5 or 9. We may rely on any information you, your
designee, or a Participant furnish. We need not inquire as to the accuracy
or completeness of such information. If any essential data pertaining to
any person has been omitted or misstated, including, but not limited to, a
misstatement of an annuitant's or contingent annuitant's age, we will make
an equitable adjustment to provide the annuity or other benefit determined
using correct data.
10.7 Assignment by Contractholder: You may assign your interest in Code Section
401(a) funds held in this contract by filing the original or a duplicate of
the assignment with us. We are not responsible for the validity of an
assignment.
10.8 Form of Request, Notice, Instruction, or Direction: When reference is made
to you, your designee, or a Participant making a request or giving notice,
instruction, or direction, such request, notice, instruction, or direction
must be in writing, or in a form otherwise acceptable to us, and is
effective when we receive it.
10.9 Effect of Disqualification: You will promptly notify us if you determine
that there is a reasonable basis for believing the Code Section 401(a)Plan
is no longer qualified under Code Section 401(a). In such event, each
Participant Account's share of each Investment Account is withdrawn and
transferred to [Liquid Interest Fund II (LIF II) within our general asset
account, where such funds earn a fixed annual effective interest rate of
3.00% from the date of allocation to LIF II until the earlier of the date
those funds are withdrawn from the contract or the date the Code Section
401(a) Plan is again qualified and such funds are transferred to the
appropriate Investment Options pursuant to applicable Investment Option
elections]. No amounts attributable to this contract can be placed in any
Investment Account until the Code Section 401(a) Plan is again qualified.
10.10 [Quarterly] Statement of Account Value: Reasonably promptly after the end
of each [Contract Quarter], we will prepare a statement of the Account
Value of each Participant Account that is maintained under this contract.
10.11 Conformity with Law: Any benefit payable under this contract shall not be
less than the minimum benefit required by the insurance laws of the state
in which the contract is delivered. Language in this contract referring to
state or federal tax, securities, or other statutes or rules do not
incorporate within this contract any such statutes or rules.
10.12 Gender and Number: Whenever the context so requires, the plural includes
the singular, the singular the plural, and the masculine the feminine.
10.13 Facility of Payment: If any Participant, contingent annuitant, or
beneficiary is legally incapable of giving a valid receipt for any payment,
if no guardian has been appointed, and if we receive a valid power of
attorney for such Participant, contingent annuitant, or beneficiary, we may
pay the person or persons named in such power of attorney. We may also pay
you directly or as you otherwise instruct. Any such payment fully
discharges us to the extent of such payment.
GB10.OM-K (KY) [(SBR)] 24
10.14 Voting: We own all shares of a Mutual Fund, Portfolio, or other entity
held in an Investment Account. We exercise the voting rights of such shares
at all shareholder meetings on all matters requiring
GB10.OM-K (KY) [(SBR)] 24
American United Life Insurance Company (R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER: [GA XX,XXX]
CONTRACTHOLDER: [ABC COMPANY]
DATE OF ISSUE: [JANUARY 2, 2002]
CONTRACT DATE: [JANUARY 1, 2002]
FIRST CONTRACT ANNIVERSARY: [JANUARY 1, 2003]
American United Life Insurance Company (AUL) issues this contract in
consideration of the Contractholder's application and its payment of
Contributions to AUL. When used in this contract, "we," "us," or "our" refer to
AUL and "you" or "your" refer to the Contractholder.
All provisions and conditions stated on this and subsequent pages are part of
this contract.
This contract is signed for us at our Home Office in Indianapolis, Indiana. Our
mailing address is ▇.▇. ▇▇▇ ▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇. Our street
address is ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇.
NOTICE OF TEN DAY RIGHT TO EXAMINE CONTRACT
Please read this contract carefully. You may return the contract for any reason
within ten days after receiving it. If returned, the contract is void from the
beginning and any Contributions will be refunded.
AMERICAN UNITED LIFE INSURANCE COMPANY
By /s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇
Chairman of the Board,
President, & Chief Executive Officer
Attest
Secretary
AUL American Series
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)]
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THIS CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THIS CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
GB10.OM-K A Stock Company [(SBR]
(NE)
American United Life Insurance Company (R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER: [GA XX,XXX]
CONTRACTHOLDER: [ABC COMPANY]
DATE OF ISSUE: [JANUARY 2, 2002]
CONTRACT DATE: [JANUARY 1, 2002]
FIRST CONTRACT ANNIVERSARY: [JANUARY 1, 2003]
American United Life Insurance Company (AUL) issues this contract in
consideration of the Contractholder's application and its payment of
Contributions to AUL. When used in this contract, "we," "us," or "our" refer to
AUL and "you" or "your" refer to the Contractholder.
All provisions and conditions stated on this and subsequent pages are part of
this contract.
This contract is signed for us at our Home Office in Indianapolis, Indiana. Our
mailing address is ▇.▇. ▇▇▇ ▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇. Our street
address is ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇.
NOTICE OF TWENTY DAY RIGHT TO EXAMINE CONTRACT
Please read this contract carefully. You may return the contract for any reason
within twenty days after receiving it. If returned, the contract is void from
the beginning and any Contributions will be refunded.
AMERICAN UNITED LIFE INSURANCE COMPANY
By /s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇
Chairman of the Board,
President, & Chief Executive Officer
Attest
Secretary
AUL American Series
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)]
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THIS CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THIS CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
GB10.OM-K (ND) [(SBR]
SECTION 7 OTHER CONTRACT CHARGES
7.1 [Investment Option Charge (IOC): Under Section 4.4, the Accumulation Unit
values of all Investment Accounts reflect the daily equivalent of an IOC
expressed as an annual percentage.
The IOC for an Investment Account is applied directly against the
Investment Account and is equal to the sum of "x" + "y" where:
"x" = a current charge for the investment advisory fees and for the
operational, organizational, and other expenses of the corresponding
Mutual Fund, Portfolio, or other entity in which the Investment
Account invests. Periodically, for a given Investment Account, "x"
will change to reflect changes in the related expenses and other
factors. Any change in "x" for an Investment Account will be effective
without prior written notice. Copies of the prospectuses or reports of
the Mutual Fund, Portfolio, or other entity are available for review.
"y" = a current combined mortality risk charge and expense risk charge of
1.25%.]
7.2 Taxes: We may deduct from Investment Accounts reasonable charges for
federal, state, or local income taxes we incur that are attributable to
such Investment Accounts.
7.3 Reduction or Waiver of Charges: We may reduce or waive the Withdrawal
Charge or the charges discussed above if the appropriate expenses
associated with the sale or administration of any contract are reduced or
if a contract is sold covering our employees or directors, those of the AUL
American Series Fund, Inc., or to either's affiliates.
7.4 Other Charges:
[(a) We apply those charges listed in the Table of Contract Charges.
(g) Charges due AUL for which the Plan is responsible, and which the Plan
Sponsor and Contractholder have otherwise agreed to in writing, which
are unpaid 60 days after the payment due date, will be deducted from
Participant Accounts on a pro-rata basis. These charges may include,
but are not limited to, participant statement mailing fees, Form 5500
fees, administrative fees, data reconciliation and reconstruction
fees, commissions, and contract application/installation fees for a
takeover Plan. Charges for which the Plan Sponsor (not the Plan) is
responsible, and which the Plan Sponsor has otherwise agreed to in
writing, must be paid by the Plan Sponsor. These charges include
contract application/installation fees for a new Plan.]
[7.5 Variable Investment Plus (VIP) Credit Factor: We determine a VIP credit
factor each month by multiplying the portions of the aggregate monthend
Account Value in all Investment Accounts by the monthly equivalent of the
corresponding annual VIP credit factors in the table below. The sum of
these products is divided by the aggregate monthend Account Value in all
Investment Accounts. We multiply the resulting percentage by each
Participant's monthend Account Value in each Investment Account, and add
the resulting amount to the Participant's Account Value for that Investment
Account.
GB10.OM-K (NM) [(SBR)] 17
American United Life Insurance Company (R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER: [GA XX,XXX]
CONTRACTHOLDER: [ABC COMPANY]
DATE OF ISSUE: [JANUARY 2, 2002]
CONTRACT DATE: [JANUARY 1, 2002]
FIRST CONTRACT ANNIVERSARY: [JANUARY 1, 2003]
American United Life Insurance Company (AUL) issues this contract in
consideration of the Contractholder's application and its payment of
Contributions to AUL. When used in this contract, "we," "us," or "our" refer to
AUL and "you" or "your" refer to the Contractholder.
All provisions and conditions stated on this and subsequent pages are part of
this contract.
This contract is signed for us at our Home Office in Indianapolis, Indiana. Our
mailing address is ▇.▇. ▇▇▇ ▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇. Our street
address is ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇.
NOTICE OF TEN DAY RIGHT TO EXAMINE CONTRACT
Please read this contract carefully. You may return the contract for any reason
within ten days after receiving it. If returned, the contract is void from the
beginning and any Contributions will be refunded.
AMERICAN UNITED LIFE INSURANCE COMPANY
By /s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇
Chairman of the Board,
President, & Chief Executive Officer
Attest
Secretary
AUL American Series
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)]
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THIS CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THIS CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
WARNING: Any person who knowingly, and with intent to injure, defraud or deceive
any insurer, makes any claim for the proceeds of an insurance policy containing
any false, incomplete or misleading information is guilty of a felony.
GB10.OM-K (Oklahoma) [(SBR)]
ECTION 10 GENERAL PROVISIONS
10.1 Ownership: You own this contract. No other person or entity has any right,
title, or interest in this contract or to amounts received or credited
under it until such amounts are made available to them by you. All amounts
received or credited under this contract become our property. We are
obligated to make only the payments or distributions specified in this
contract.
10.2 Entire Contract: This contract, your application, and any amendments,
riders, or endorsements to the contract constitute the entire agreement
between you and us. We are not a party to, nor bound by, a Plan, trust,
custodial agreement, or other agreement, or any amendment or modification
to any of the same. We are not a fiduciary under this contract or under any
such Plan, trust, custodial agreement, or other agreement.
10.3 Benefit Determinations: You will furnish to us whatever information is
necessary to establish the eligibility for and amount of annuity or other
benefit due. We rely solely on your instructions and certifications with
respect to Participant benefits. You are fully responsible for determining:
(a) whether benefit payments are permitted under applicable law and the
Plan and
(b) the existence or amount of Excess Contributions (plus gains or minus
losses thereon), or that returns of Excess Contributions are permitted
by the Plan and the Code.
We may rely on your or your designee's statements or representations in
honoring any benefit payment request.
[We require that a Participant execute and submit to us an affidavit which
we prepare in order that we may process that Participant's benefit payable
under this contract if you, the Plan Sponsor, the Plan Trustee, and the
Plan Administrator are no longer in existence at the time we receive that
Participant's benefit payment request.]
10.4 Recordkeeping Services: [We generally provide Plan recordkeeping services
when all of a Plan's funds are held under this contract. We decline to
provide Plan recordkeeping services if you elect to allocate Plan funds to
investments other than this contract, or if your Plan's recordkeeping
practices, in our judgment, impose an administrative or financial burden on
us. If we cease to provide Plan recordkeeping for any reason, any
administrative services agreement between you and us regarding your Plan
and/or this contract is thereby terminated.]
10.5 Representations and Warranties: You and we mutually represent and warrant,
each to the other, that each is fully authorized to enter into this
contract and that this contract is a valid and binding obligation and that
the execution of this contract does not violate any law, regulation,
judgment, or order by which the representing party is bound. In addition,
you represent and warrant to us that:
(a) the Code Section 401(a) Plan and the Code Section 403(b) Plan meet the
requirements of Code Section 401(a) and Code Section 403(b),
respectively;
(b) the execution of this contract has been authorized by the Plan
fiduciary responsible for Plan investment decisions; and
(c) the execution or performance of this contract does not violate any
Plan provision or any law, regulation, judgment, or order by which the
Plan is bound.
GB10.OM-K (OK) [(SBR)] 23
American United Life Insurance Company (R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER: [GA XX,XXX]
CONTRACTHOLDER: [ABC COMPANY]
DATE OF ISSUE: [JANUARY 2, 2002]
CONTRACT DATE: [JANUARY 1, 2002]
FIRST CONTRACT ANNIVERSARY: [JANUARY 1, 2003]
American United Life Insurance Company (AUL) issues this contract in
consideration of the Contractholder's application and its payment of
Contributions to AUL. When used in this contract, "we," "us," or "our" refer to
AUL and "you" or "your" refer to the Contractholder.
All provisions and conditions stated on this and subsequent pages are part of
this contract.
This contract is signed for us at our Home Office in Indianapolis, Indiana. Our
mailing address is ▇.▇. ▇▇▇ ▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇. Our street
address is ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇.
NOTICE OF TEN DAY RIGHT TO EXAMINE CONTRACT
Please read this contract carefully. You may return the contract for any reason
within ten days after receiving it. If returned, the contract is void from the
beginning and any Contributions will be refunded.
AMERICAN UNITED LIFE INSURANCE COMPANY
By /s/ ▇▇▇▇▇ ▇. ▇▇▇▇▇▇
Chairman of the Board,
President, & Chief Executive Officer
Attest
Secretary
AUL American Series
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)]
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THIS CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THIS CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
THE AMOUNT OF BENEFITS UNDER THE FIXED INTEREST ACCOUNT MAY INCREASE OR DECREASE
DUE TO THE APPLICATION OF A MARKET VALUE ADJUSTMENT.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
GB10.OM-K (VT) [(SBR)]
SECTION 8 CONTRACT MODIFICATIONS
8.1 Contract Amendment: You and we may agree to any change or amendment to this
Contract without the consent of any other person or entity. This contract
cannot be modified or amended, nor can any provision or condition be
waived, except by written authorization of a corporate officer of AUL.
8.2 Rates and Section 7 Charges: We may announce new Guaranteed Rates, as
described in Sections 3.2 and 3.3 (including the consolidation of existing
Interest Pockets). However, as provided in Sections 3.2 and 3.3, we may not
change the declared Guaranteed Rate applicable to an established Interest
Pocket during the guaranteed period. We may also modify the charge levels
in Section 7 (but may not exceed the maximum charge levels listed in the
Table of Contract Charges) using the procedures of Section 8.5.
8.3 Conformance with Law: We may amend this contract at any time, without your
consent, or that of any other person or entity, if the amendment is
reasonably needed to comply with, or give you or Participants the benefit
of, any provisions of federal or state laws. Any such amendment must be
approved by the state of Vermont and delivered to you prior to its
effective date.
8.4 Addition, Deletion, or Substitution of Investments:
(a) We reserve the right, subject to compliance with applicable law, to
make additions to, deletions from, substitution for, or combinations
of, the securities that are held by any Investment Account or that any
Investment Account may purchase. We reserve the right to eliminate the
shares of any of the eligible Mutual Funds, Portfolios, or other
entities and to substitute shares of, or interests in, another Mutual
Fund, Portfolio, or another investment vehicle, for shares already
purchased or to be purchased in the future under the contract, if the
shares of any or all eligible Mutual Funds, Portfolios, or other
entities are no longer available for investment or if further
investment in any or all eligible Mutual Funds, Portfolios, or other
entities becomes inappropriate in view of the purposes of the
contract. Where required under applicable law, we will not substitute
any shares attributable to your interest in any Investment Account
without notice, your approval or Participant approval, or prior
approval of the Securities and Exchange Commission or a state
insurance commissioner, and without following the filing or other
procedures established by applicable state insurance regulators.
Nothing contained herein will prevent the Variable Account from
purchasing other securities for other series or classes of contracts,
or from effecting a conversion between series or classes of contracts
on the basis of requests made by a majority of other contractholders
or as permitted by federal law.
(b) We reserve the right to establish additional Investment Accounts, each
of which would invest in the corresponding Mutual Fund, Portfolio, or
other entity, or in other securities or investment vehicles. We
reserve the right to eliminate or combine existing Investment Accounts
if marketing, tax, or investment conditions warrant. We reserve the
right to provide other Investment Options under this contract at any
time. Subject to any required regulatory approvals, we reserve the
right to transfer assets from any Investment Account to another
separate account of AUL or Investment Account.
(c) In the event of any such substitution or change, we may, by
appropriate amendment, make such changes in this contract as may be
necessary or appropriate to reflect such substitution or change. Any
transfer request or Investment Option election received on or after
the effective date of such substitution or change which reflects the
previous Investment Option which has
GB10.OM-K (VT) [(SBR)] 19
been substituted or changed will be transacted using the new
substituted or changed Investment Option. If deemed by us to be in the
best interests of persons or entities having voting rights under this
contract, the Variable Account may be operated as a management
investment company under the Investment Company Act of 1940 or any
other form permitted by law, it may be deregistered in the event such
registration is no longer required under the Investment Company Act of
1940, or it may be combined with other separate accounts of AUL or an
affiliate thereof. We may take such action as is necessary to comply
with, or to obtain, exemptions from the Securities and Exchange
Commission with regard to the Variable Account. Subject to compliance
with applicable law, we also may combine one or more Investment
Accounts and may establish a committee, board, or other group to
manage one or more aspects of the Investment Accounts.
8.5 Our Right to Initiate Changes: In addition to those amendments permitted by
Sections 8.2, 8.3, and 8.4, we may initiate an additional provision or
modification of any other provision of this contract (except for those
prohibited amendments listed in Section 8.6) by giving you [60 days] notice
prior to the contract anniversary of such modification. Any such
modification is effective without your affirmative assent.
8.6 Prohibited Amendments:
(a) Notwithstanding our right to initiate changes under Section 8.5, we
may not initiate changes to the minimum Guaranteed Rate specified in
Section 3.4, our obligation to set Guaranteed Rates for the period of
time specified in Sections 3.2 and 3.3, the payment provisions upon
contract termination specified in Section 9.2, the maximum charge
levels listed in the Table of Contract Charges, or the Table of
Guaranteed Immediate Annuities.
(b) No modification to this contract may change the terms of a previously
purchased annuity or reduce any interest guarantee applicable to
Participant Account balances held in the FIA on the modification's
effective date.
GB10.OM-K (VT) [(SBR)] 20
--------------------------------------------------------------------------------
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity Certificate
Certificate No. GB10.OM-C
OMNI AULONE Certificate
--------------------------------------------------------------------------------
American United Life Insurance Company(R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER [GAXXXXX]
CONTRACTHOLDER [ABC SCHOOL]
PARTICIPANT'S NAME [▇▇▇▇ ▇▇▇]
SOCIAL SECURITY NUMBER [▇▇▇▇▇▇▇▇▇]
American United Life Insurance Company hereby certifies that the Contractholder
and AUL have entered into a MultipleFund Group Variable Annuity Contract (the
Contract) in connection with the Contractholder's qualified Internal Revenue
Code Section 401(a) Plan and/or Code Section 403(b) taxdeferred annuity Plan,
and that AUL has created an account in your name to receive Contributions from
the Contractholder for your benefit pursuant to the Contract. When used in this
certificate, 'we," "us," or "our" refer to AUL.
The only parties to the Contract are the Contractholder and AUL. All rights and
benefits are determined in accordance with the provisions of the Contract.
Benefits under the Contract will be paid at the Contractholder's direction.
Any amendments to, or changes in, the Contract will be binding and conclusive on
you and your beneficiary.
This certificate is not itself the Contract, but is a certificate of
participation in the Contract.
AMERICAN UNITED LIFE INSURANCE COMPANY
Secretary
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)] Certificate
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THE CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THE CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
GB10.OM-C [(SBR)]
TABLE OF CONTENTS
SECTION 1 DEFINITIONS [3]
SECTION 2 ADMINISTRATION OF YOUR PARTICIPANT ACCOUNT [7]
2.1---- How Contributions Are Handled
2.2---- Transfers from Other Retirement Programs
2.3---- Reallocation of Participant Accounts
2.4---- Excess Contributions
2.5---- Transfers from Other Contracts
SECTION 3 - OPERATION OF FIXED INTEREST ACCOUNT [9]
3.1---- Allocations to Your Participant Account
3.2---- Provision of Guaranteed Rates for Interest Pockets
3.3---- Renewal of Guaranteed Rates
3.4---- Minimum Rate Guarantee
3.5---- Allocation of Withdrawals
3.6---- Limitation on Contributions and Transfers to FIA
SECTION 4 VALUATION OF INVESTMENT ACCOUNTS [10]
4.1---- Operation of Investment Accounts
4.2---- Valuation of Mutual Funds and Other Entities
4.3---- Accumulation Units
4.4---- Value of Accumulation Units
4.5---- Valuing Your Participant Account
SECTION 5 BENEFIT PAYMENTS AND TRANSFERS [11]
5.1---- General Withdrawal Provisions
5.2---- Plan Benefit Payments
5.3---- Transfers Between Investment Options
5.4---- Transfers to and from the FIA
SECTION 6 - ANNUITIES [16]
6.1---- Annuity Purchases
6.2---- Annuity Options
6.3---- Determining Annuity Amount
6.4---- Proof of Age and Survival; Minimum Payments
6.5---- Annuity Certificates
SECTION 7 OTHER CONTRACT CHARGES [17]
7.1---- Investment Option Charge (IOC)
GB10.OM-C [(SBR)]
1
7.2---- Taxes
7.3---- Reduction or Waiver of Charges
7.4---- Other Charges
7.5---- Variable Investment Plus (VIP) Credit Factor
SECTION 8 CONTRACT MODIFICATIONS [19]
8.1---- Contract Amendment
8.2---- Rates and Section 7 Charges
8.3---- Conformance with Law
8.4---- Addition, Deletion, or Substitution of Investments
8.5---- Our Right to Initiate Changes
8.6---- Prohibited Amendments
SECTION 9 TERMINATION OF CONTRACT [21]
9.1---- Termination by the Contractholder
9.2---- Payment Upon Termination by the Contractholder
9.3---- Termination by Us
9.4---- Payment Upon Termination by Us
9.5---- Indemnification Required
9.6---- Effect on Contract Obligations
SECTION 10 GENERAL PROVISIONS [23]
10.1---- Ownership
10.2---- Entire Contract
10.3---- Benefit Determinations
10.4---- Recordkeeping Services
10.5---- Representations and Warranties
10.6---- Contractholder Representative; Misstatement of Data
10.7---- Assignment by Contractholder
10.8---- Form of Request, Notice, Instruction, or Direction
10.9---- Effect of Disqualification
10.10--- [Quarterly] Statement of Account Value
10.11--- Conformity with Law
10.12--- Gender and Number
10.13--- Facility of Payment
10.14--- Voting
10.15--- Acceptance of New Participants or Contributions
10.16--- Our Annual Statement
10.17--- Nonforfeitability and Nontransferability
10.18--- Notice of Annual Meeting of Members
[TABLE OF CONTRACT CHARGES] [26]
[TABLE OF GUARANTEED IMMEDIATE ANNUITIES] [27]
GB10.OM-C [(SBR)]
2
[TABLE OF INVESTMENT ACCOUNTS] [28]
GB10.OM-C [(SBR)]
3
SECTION 1 DEFINITIONS
1.1 "Account Value" for your Participant Account as of a date is:
(a) your account's balance of Code Sections 401(a) and 403(b) funds in the
Fixed Interest Account (FIA), if any, on that date; plus
(b) the value of your account's Accumulation Units attributable to Code
Sections 401(a) and 403(b) funds in each Investment Account on that
date.
1.2 "Accumulation Unit" is a valuation device used to measure increases in and
decreases to the value of any Investment Account.
1.3 "Annuity Commencement Date" is the first day of the month an annuity begins
under the contract. This date may not be later than the date your periodic
benefits are required to commence under the Code.
1.4 "Business Day" is any day both the New York Stock Exchange and our Home
Office are open for the general conduct of business.
1.5 "Code" means the Internal Revenue Code of 1986, as amended, and any
applicable regulations or rulings thereunder.
1.6 The "First Contract Anniversary" is listed on the contract face page.
Subsequent "Contract Anniversaries" are on the same day of each subsequent
year.
1.7 "Contract Quarter" is each of the four successive threemonth periods in a
Contract Year.
1.8 The first "Contract Year" starts on the Contract Date and ends on the day
before the First Contract Anniversary. Each subsequent Contract Year starts
on a Contract Anniversary and ends on the day before the next Contract
Anniversary.
1.9 "Contributions" are funds which can be allocated to Participant Accounts,
including yours, according to the Contractholder's instructions and which
have been paid to us pursuant to the Plan or transferred from a prior AUL
group annuity contract or a prior funding medium. Such transferred funds
may be listed under categories other than "Contributions" on annual and
quarterly reporting.
1.10 A "Contribution-Source" means each type of Contribution allowed under the
Plan, including the following types of Code Section 403(b) Contributions:
(a) "Elective Deferrals," which means, with respect to any taxable year,
any Contribution made under a salary reduction agreement. A
Contribution made under a salary reduction agreement is not treated as
an Elective Deferral if, under the salary reduction agreement, such
Contribution is made pursuant to a one-time irrevocable election made
by you at the time of your initial eligibility to participate in the
agreement, or is made pursuant to a similar arrangement involving a
one-time irrevocable election specified in Regulations issued under
the Code.
GB10.OM-C [(SBR)]
4
(b) "Employee Mandatory Contributions," which means Contributions made
under a salary reduction agreement pursuant to a one-time irrevocable
election made by you at the time of your initial eligibility to
participate in the agreement, or made pursuant to a similar
arrangement involving a one-time irrevocable election specified in
Regulations issued under the Code.
(c) "Employer Contributions," which means Contributions made by your
employer that are not made pursuant to (a) or (b) above.
1.11 "Excess Contributions" are Contributions in excess of the applicable Code
limits.
1.12 "Fixed Interest Account" or "FIA" is an Investment Option described in
Section 3 to which Contributions may be allocated for accumulation at the
Guaranteed Rates. The FIA funds constitute a portion of our general asset
account.
1.13 "Guaranteed Rates" are the guaranteed annual effective rates of interest we
credit to each Interest Pocket. We credit interest daily to each Interest
Pocket. A Guaranteed Rate may be modified only as described in Section 3.3.
1.14 "Home Office" is our principal office in Indianapolis, Indiana. For
anything to be "received by AUL," it must be received at our Home Office.
1.15 "Interest Pocket" means a tracking method which associates funds allocated
to the FIA over a specific time period with a specific Guaranteed Rate, as
described in Section 3. After the guaranteed period provided in Section
Section 3.3 has elapsed, we may consolidate two or more Interest Pockets in
conjunction with the announcement of new Guaranteed Rates.
1.16 "Investment Account" means each distinct portfolio established within our
[Variable Account] and identified in the Table of Investment Accounts in
the contract. Amounts allocated to any Investment Account are invested in
the shares of the corresponding Mutual Fund, Portfolio, or other entity
identified in the Table of Investment Accounts. Our "[Variable Account]" is
a separate account we maintain under Indiana law which is called the AUL
American Unit Trust and which is registered under the Investment Company
Act of 1940 as a unit investment trust. "Competing Investment Accounts" are
those Investment Accounts listed in the Table of Investment Accounts which
are marked with an asterisk (*).
1.17 "Investment Option" is the FIA or any Investment Account.
1.18 The "Market Value Adjustment" or "MVA" is determined, as of the calculation
date, by multiplying a percentage times the Withdrawal Value of Code
Section 401(a) funds being paid from the FIA under [Sections 5.2, 5.4, or
9.2].
[If i is greater than j, the percentage equals 5 times (i-j) and the amount
of the Adjustment is deducted from the Withdrawal Value. (This is called a
negative MVA.) If j is greater than i, the percentage equals 4 times (j-i)
and the amount of the Adjustment is added to the Withdrawal Value. (This is
called a positive MVA.) For purposes of this Section:
i= the Guaranteed Rate we credit to new Contributions, and
j= the dollarweighted average rate of interest we credit to amounts
withdrawn from the FIA under Sections 5.2, 5.4, or 9.2.]
GB10.OM-C [(SBR)]
5
Our determination of the Market Value Adjustment is conclusive.
1.19 "Mutual Fund" means any diversified, openend, management company made
available by us and listed in the Table of Investment Accounts.
1.20 "Participant" is any person participating in a Plan that has a Participant
Account.
1.21 Your "Participant Account" is an account under the contract for you. Each
Contribution-Source is tracked separately within your Participant Account.
We credit Contributions to your Participant Account and
Contribution-Sources as the Contractholder directs.
1.22 "Plan" means a plan of the Plan Sponsor that is qualified under Code
Section 401(a) or Code Section 403(b) and that invests in the contract.
1.23 "Plan Sponsor" is [ABC Company].
1.24 "Portfolio" is a portfolio established within a particular Mutual Fund, as
described in the Mutual Fund's current prospectus.
1.25 "Valuation Periods" start at the close of each Business Day and end at the
close of the next Business Day.
[(Contract Year)]
1.26 The "Withdrawal Charge" is [a percentage of the Account Value withdrawn
under the contract.] The Withdrawal Charge will not apply to Account Values
withdrawn to provide certain benefit payments or an annuity as described in
[Sections 5.2 and 6.1, respectively. The percentage varies by the Contract
Year in which a withdrawal is made.] The Withdrawal Charge percentage is as
follows:
[During Contract Years Percentage
1 7
2 6
3 5
4 4
5 3
6 2
7 1
Thereafter 0]
In no event will the cumulative total of all Withdrawal Charges, including
those previously assessed against any amount withdrawn from your
Participant Account, exceed [8.5%] of total Contributions allocated to your
Participant Account.
[(Participant Account Year)]
1.26 The "Withdrawal Charge" is [a percentage of the Account Value withdrawn
under the contract.] The Withdrawal Charge will not apply to Account Values
withdrawn to provide certain benefit payments or an annuity as described in
[Sections 5.2 and 6.1, respectively. The percentage varies by the
Participant Account Year in which the withdrawal is made. The first
Participant Account Year begins on the date we establish your Participant
Account and credit the first Contribution to it, and ends on the day before
the next anniversary of
GB10.OM-C [(SBR)]
6
that date. Each Participant Account Year thereafter begins on such an
anniversary date and ends on the day before the next anniversary date.] The
Withdrawal Charge percentage is as follows:
[During
Participant Account Years Percentage
1 7
2 6
3 5
4 4
5 3
6 2
7 1
Thereafter 0]
In no event will the cumulative total of all Withdrawal Charges, including
those previously assessed against any amount withdrawn from your
Participant Account, exceed [8.5%] of total Contributions allocated to your
Participant Account.
1.27 "Withdrawal Value" is your Account Value, less any Withdrawal Charge.
GB10.OM-C [(SBR)]
7
SECTION 2 ADMINISTRATION OF YOUR PARTICIPANT ACCOUNT
2.1 How Contributions Are Handled: Contributions are credited to the
appropriate Contribution-Sources within your Participant Account as the
Contractholder directs in its allocation instructions. Code Section 403(b)
Contributions must be identified as Elective Deferrals, Employee Mandatory
Contributions, or Employer Contributions. Your initial Contribution is
allocated to your Participant Account [by the second Business Day after] we
(1) receive the initial Contribution or, if later, (2) receive all data
necessary to complete the allocation (including data required to establish
your Participant Account, the amount of your Contribution, and Investment
Option elections). Subsequent Contributions are allocated to your
Participant Account [on the Business Day] we (1) receive that Contribution
or, if later, (2) receive all data necessary to complete the allocation.
If we receive funds which cannot be allocated to your Participant Account,
those funds will be returned to the Contractholder in their entirety or, at
our option, only the unallocable portion will be returned to the
Contractholder, [within 5 Business Days.
Notwithstanding the previous paragraph, Code Section 401(a) funds received
from a prior Plan provider which we cannot allocate your Participant
Account will not be returned to the Contractholder or to such provider, but
instead will be allocated to a Contractholder-level account and invested in
those Investment Options approved by the Contractholder. When we receive
the allocation data from the prior Plan provider, such funds (plus
gains/minus losses) will be transferred from the Contractholder-level
account to your Participant Account.
If we can allocate a Contribution to your Participant Account, but we have
not received your Investment Option elections, the Contribution will be
credited to the AUL Money Market Investment Account. However, such a
Contribution will be credited to the FIA (not the AUL Money Market
Investment Account) if the FIA is an available Investment Option and if the
Contractholder elects the 90-day transfer option outlined in Section
5.4(a)(1). Subsequently received Investment Option elections for you will
be used to allocate future Contributions only. We will transfer amounts
previously allocated for you to the AUL Money Market Investment Account (or
the FIA), plus gains or minus losses thereon, only if we are directed to
make a transfer. This transfer request must be submitted in a format
specifically authorized by us.]
Your Participant Account funds may be allocated to Investment Options in
any increments acceptable to us. Your Investment Option elections remain in
effect until changed by the Contractholder or its designee. A change in
Investment Option elections is made by giving us new Investment Option
elections.
2.2 Transfers from Other Retirement Programs: [If permitted by the Plan and by
applicable state and federal law, we may accept, or may initiate the
transfer of, amounts transferred from other retirement programs. Such
transferred amounts, as identified by the Contractholder, are credited as a
rollover Contribution under the appropriate Participant Account and are
tracked within the contract as required by applicable state and federal
law.]
GB10.OM-C [(SBR)]
8
2.3 Reallocation of Your Participant Account: The Contractholder may direct us
to reallocate all or a portion of the Account Value of a Participant
Account among other Participant Accounts. The Contractholder must certify
that such reallocation is in accordance with the Plan.
2.4 Excess Contributions: Contributions may vary in amount and frequency, as
determined by the Plan.
On receipt of instructions from the Contractholder, we will withdraw Excess
Contributions, plus gains and minus losses, from your Participant Account
and return them to you, or as the Contractholder directs. Such instructions
must state the amount to be returned and certify that such Contributions
are Excess Contributions and that such return is permitted by the Plan and
the Code. A return of Excess Contributions is treated like a Plan benefit
payment, under Section 5.2(a).
You are not permitted to have elective deferral contributions (within the
meaning of Code Section 402(g)(3)) made during a calendar year under the
contract, or under any other plans, contracts, or arrangements maintained
by your employer, in excess of the dollar limitation in effect under Code
Section 402(g)(1) and any Regulations issued thereunder for taxable years
beginning in such calendar year.
2.5 Transfers from Other Contracts: We may require amounts transferred to your
Participant Account from other AUL group annuity contracts to be credited
to [the FIA]. We will advise the Contractholder if this limitation applies
before accepting such a transfer.
GB10.OM-C [(SBR)]
9
SECTION 3 -- OPERATION OF FIXED INTEREST ACCOUNT
3.1 Allocations to Your Participant Account: We credit Contributions for you to
the FIA based on the information the Contractholder provides. We credit
interest daily from the date of the Contribution or transfer to the FIA to
the date of withdrawal or transfer from the FIA to an Investment Account.
3.2 Provision of Guaranteed Rates for Interest Pockets: At least [10 days] in
advance of each [calendar] [quarter], we will declare a Guaranteed Rate for
the Interest Pocket for that [quarter]. All Contributions or transfers
hereunder which are allocated to the FIA during that [quarter] will earn
interest at that Guaranteed Rate until that [quarterly] pocket matures on
[the second January 1] following the [quarter] in which that pocket was
established.
3.3 Renewal of Guaranteed Rates: Those [quarterly] Interest Pockets that mature
at the same time will be combined into [an annual renewal Interest Pocket].
Funds associated with that [annual renewal Interest Pocket] will earn
interest for [a full year] at the Guaranteed Rate declared for that pocket.
A new Guaranteed Rate for each [annual renewal Interest Pocket] will be
declared [at least 30 days prior to every January 1 for the 5 years
following the establishment of that pocket]. An [annual renewal Interest
Pocket] will mature on [January 1 of the sixth year following its
establishment], when it will be combined into [one annual portfolio
Interest Pocket]. Funds associated with that [annual portfolio Interest
Pocket] will earn interest for [a full year] at the Guaranteed Rate for
that pocket, which will be declared [at least 30 days prior to every
January 1].
3.4 Minimum Rate Guarantee: No Guaranteed Rate may be less than an annual
effective interest rate of [3.00%].
3.5 Allocation of Withdrawals: Withdrawals or transfers from the FIA are on a
first-in/first-out (FIFO) basis. All amounts paid during an installment
payout period are paid from all Investment Options on a pro-rata basis.
3.6 Limitation on Contributions and Transfers to FIA: Except for annuity
purchases as described in Section 6.1, we reserve the right to limit or
disallow allocation of new Contributions and transfers to the FIA upon [30
days] notice to the Contractholder.
GB10.OM-C [(SBR)]
10
SECTION 4 VALUATION OF INVESTMENT ACCOUNTS
4.1 Operation of Investment Accounts: All income, gains, or losses, realized or
unrealized, from assets held in any Investment Account are credited to or
charged against the applicable Investment Account without regard to our
other income, gains, or losses. Investment Account assets are not
chargeable with liabilities arising out of any other business we may
conduct.
4.2 Valuation of Mutual Funds and Other Entities: The current report or
prospectus for each Mutual Fund or other entity listed in the second column
of the Table of Investment Accounts describes how that Mutual Fund's or
other entity's assets are valued.
4.3 Accumulation Units: We credit amounts allocated to an Investment Account in
Accumulation Units. The Accumulation Unit value used is the one for the
Valuation Period when we allocate the amount to the Investment Account.
4.4 Value of Accumulation Units: We establish the initial Accumulation Unit
value for a new Investment Account on the inception date of that Investment
Account. The value of an Accumulation Unit for any later Valuation Period
reflects [the Section 4.1 income, gains, and losses and the Section 7.1
Investment Option Charge (IOC)]. We determine the Accumulation Unit value
before giving effect to any additions, withdrawals, or transfers in the
current Valuation Period.
4.5 Valuing Your Participant Account: We determine the Account Value in an
Investment Account by multiplying the Accumulation Units in your
Participant Account by the Accumulation Unit value. The Accumulation Unit
value of an Investment Account changes only on a Business Day.
GB10.OM-C [(SBR)]
11
SECTION 5 BENEFIT PAYMENTS AND TRANSFERS
5.1 General Withdrawal Provisions: Subject to the following provisions of this
Section, and prior to notification of contract termination (but not
thereafter), the Contractholder may direct us to withdraw all or a portion
of your Account Value pursuant to Section 5.2 to provide a single-sum
payment to the Contractholder to pay Plan benefits.
(a) Amounts attributable to amounts held as of December 31, 1988 under
another Code Section 403(b) annuity contract may be withdrawn to
provide such benefits.
(b) Amounts attributable to Code Section 403(b) Contributions made other
than pursuant to a salary reduction agreement (within the meaning of
Code Section 402(g)(3)(C)) may be withdrawn to provide such benefits.
(c) Amounts attributable to Code Section 403(b) Contributions made
pursuant to a salary reduction agreement (within the meaning of Code
Section 402(g)(3)(C)) may be withdrawn to provide such benefits,
provided that the withdrawal is made to provide a loan or that any
distribution of such amount shall not occur until you have either
attained age 59 1/2, separated from service, died, become totally
disabled (as defined by the Plan), or experienced a hardship (as
defined by the Plan). However, in the case of a hardship withdrawal,
any gain credited to such Contributions may not be withdrawn.
(d) Withdrawal of any amount from the contract which is transferred
directly by us pursuant to the Contractholder's or your instructions
to another Code Section 403(b) tax-deferred annuity funding vehicle
under applicable IRS rules and regulations is not the provision of a
Plan benefit for purposes of Section 5.2, but instead is a Contract
termination as to that amount for you; and any such withdrawal is
subject to application of the Withdrawal Charge pursuant to Section
5.2(a)(3). The Contractholder grants to you the right to direct the
withdrawal and direct transfer of your voluntary Elective Deferrals
(as determined by the Contractholder) to another Code Section 403(b)
tax-deferred annuity funding vehicle.
(e) If, as provided in Internal Revenue Code Regulation Section
1.403(b)-2T Q&A-2, the distributee of any eligible rollover
distribution elects to have the distribution paid directly to an
eligible retirement plan (as defined in Q&A-1 of that Section) and
specifies the eligible retirement plan to which the distribution is to
be paid, then the distribution shall be paid to that eligible
retirement plan in a direct rollover.
(f) We are not responsible for determining your compliance with the
requirements above. Any withdrawal request submitted by the
Contractholder must include certification as to the purpose of the
withdrawal. The Contractholder assumes full responsibility for
determining whether any withdrawal is permitted under applicable law
and under the terms of a particular Plan. We may rely solely upon the
Contractholder's representations made in the withdrawal request.
(g) [Withdrawals from your Participant Account FIA share may not be made
in an amount less than the smaller of $500 or your Participant Account
entire FIA share. If a withdrawal reduces your Participant Account FIA
share to less than $500, such remaining share shall also be
withdrawn.]
GB10.OM-C [(SBR)]
12
(h) A withdrawal request is effective, and the Account Value to be applied
pursuant to Section 5.2 is determined, on the Business Day that we
receive a proper withdrawal request (or due proof of death, if
received later).
(i) We will pay any cash lump-sum to the Contractholder or its designee
within [7 days] from the appropriate Business Day as determined in
Subsection (h) above, except as we may be permitted to defer such
payment of amounts withdrawn from the Variable Account in accordance
with appropriate provisions of the federal securities laws. We reserve
the right to defer the payment of amounts withdrawn from the FIA for a
period of up to [6 months] after we receive the withdrawal request.
5.2 Plan Benefit Payments: The Contractholder will advise us of any person for
whom a payment is due under the Plan, including the nature and amount of
such payment, before the date such payment is due or as soon thereafter as
is practicable.
(a) Subject to the limitations provided in Section 5.1 and Subsection (b)
below, prior to notification of contract termination (but not
thereafter), the Contractholder may direct us to withdraw all or a
portion of your Participant Account to provide a single-sum payment to
the Contractholder to pay:
[(1) Plan benefits for retirement, death, disability, hardships,
loans, required minimum distribution benefits pursuant to Code
Section 401(a)(9), or, for Code Section 403(b) plans or
profitsharing plans, benefits after age 59 1/2 or as otherwise
allowed by the Code (provided that such benefits after age 59 1/2
or as otherwise allowed by the Code are paid in a taxable
distribution to you). Such a withdrawal is not subject to a
Withdrawal Charge or Market Value Adjustment.
(2) Plan benefits for termination of employment. Such a withdrawal is
not subject to a Withdrawal Charge or Market Value Adjustment,
with the following exceptions:
(A) Any such payment requested for a Participant who terminates
employment on or after the date your Plan is terminated is
subject to a Withdrawal Charge and Market Value Adjustment.
(B) Any such payment requested for a Participant whose
termination of employment is part of a partial Plan
termination under IRS guidelines is subject to a Withdrawal
Charge and Market Value Adjustment.
(C) Even if there is no full or partial Plan termination under
paragraphs (1) and (2) above, any such termination of
employment payments during the Contract Year (or, at our
option, during the 365-day period preceding our receipt of a
termination of employment benefit payment request) which
exceed 20% of the aggregate Account Value of all Participant
Accounts determined as of the first day of the
GB10.OM-C [(SBR)]
13
Contract Year (or the first day of the 365-day period) are
subject to a Withdrawal Charge and Market Value Adjustment.
(D) Any such payment requested for a Participant who terminates
employment on or after the date the Plan Sponsor files for
protection under federal bankruptcy law, is deemed
insolvent, dissolves, closes, or shuts down its business, or
ceases operations is subject to a Withdrawal Charge and
Market Value Adjustment.
(3) Plan benefits not otherwise listed in paragraphs (1) and (2)
above. Such a withdrawal is subject to a Withdrawal Charge and
Market Value Adjustment.]
(b) Regarding death benefits specifically, notwithstanding the provisions
of Section 9, upon receipt from the Contractholder of instructions and
of due proof of your (and, if applicable, your beneficiary's) death
prior to the date your Participant Account is closed, we will apply
your Account Value, minus any charges described in Section 7 that are
not included in the Accumulation Unit value, for the purpose of
providing a death benefit under the Plan. The death benefit will be
paid to your beneficiary according to the method of payment elected by
the beneficiary (unless such method of payment was previously elected
by you). Your beneficiary may also designate a beneficiary.
The Code Section 403(b) death benefit will be payable:
(1) in a single sum or other method not provided in (2) below;
provided, however, that the entire Account Value, minus any
charges described in Section 7 that are not included in the
Accumulation Unit value, must be paid to the beneficiary on or
before December 31 of the calendar year which contains the fifth
anniversary of your death, or
(2) as an annuity in accordance with the Annuity Options shown in
Section 6.2 over a period not to exceed the life or life
expectancy of your beneficiary. If your beneficiary is not your
surviving spouse, the annuity must begin on or before December 31
of the calendar year immediately following the calendar year in
which you die. If your beneficiary is your surviving spouse, the
annuity need not begin before December 31 of the calendar year in
which you would have attained age 70 1/2.
If you die on or after his Annuity Commencement Date, any interest
remaining under the Annuity Option selected will be paid at least as
rapidly as prior to your death.
(c) Under Subsection (a)(2) (A), (B), (C), and (D) and under (a)(3)
above, if your entire Account Value is withdrawn, the amount paid
equals your Withdrawal Value minus any charges described in
Section 7 which are not included in the Accumulation Unit value,
subject to the Market Value Adjustment. If a portion of your
Account Value is withdrawn, your Account Value is reduced by an
amount sufficient to make the payment requested and to cover the
Withdrawal Charge and any charges described in Section 7 which
are not included in
GB10.OM-C [(SBR)]
14
the Accumulation Unit value, subject to the Market Value
Adjustment applied to all FIA amounts withdrawn from your
Participant Account.
(d) Notwithstanding the previous provisions of this Section, in the
Contract Year in which your Participant Account is established,
the Contractholder may withdraw from your Participant Account up
to [10%] of the sum of your Account Value (determined as of the
later of the Contract Date or the Contract Anniversary
immediately preceding the withdrawal request) plus Contributions
made for you during that Contract Year, without application of
the Withdrawal Charge or Market Value Adjustment. The
Contractholder may do the same in the next succeeding Contract
Year. In any subsequent Contract Year, the Contractholder may
withdraw from your Participant Account up to [10%] of your
Account Value (determined as of the Contract Anniversary
immediately preceding the withdrawal request) without application
of the Withdrawal Charge or Market Value Adjustment.
5.3 Transfers between Investment Options: The Contractholder may direct us to
transfer amounts between Investment Options, or to initiate a
Participant-directed transfer between Investment Options. A transfer is
deemed "Participant-directed" only if it reflects your investment choice,
free of any suggestion or influence by the Contractholder, the Plan
Sponsor, or any fiduciary or other party to the administration or
management of the Plan [(with the exception of any investment advice
rendered by a third-party provider for whom an Investment Advice Provider
Fee is earned under the Table of Contract Charges)]. A transfer that is not
"Participant-directed" is Contractholder-directed and is subject to a
Market Value Adjustment under Section 5.4(b). Transfers are effective on
[the Business Day we receive the transfer direction]. Transfer directions
for your Participant Account may be made [daily on any Business Day]. We
will make the transfer as requested within [7 days] from the date we
receive the request, except as we may be permitted to defer the transfer of
amounts withdrawn from the Variable Account in accordance with appropriate
provisions of the federal securities laws. We reserve the right to defer a
transfer of amounts from the FIA for a period of up to [6 months] after we
receive the transfer request. 5.4 Transfers to and from the FIA:
[(a) Participant-directed Transfers (as defined in Section 5.3):
(1)1 If the Contractholder does not make available to you any of the
Competing Investment Accounts identified in the Table of
Investment Accounts, once you transfer funds from the FIA to an
Investment Account, you may transfer funds to the FIA only after
90 days have elapsed since the date of your last transfer from
the FIA.
(1)2 If the Contractholder makes available to you any of the Competing
Investment Accounts identified in the Table of Investment
Accounts, the 90-day transfer restriction discussed in Paragraph
(1) above does not apply. Instead:
GB10.OM-C [(SBR)]
15
(A) if your FIA Account Value is less than $2,500 as of the
first day of the Contract Year in which we receive the
transfer request, you may transfer any amount from the FIA.
(B) if your FIA Account Value is $2,500 or more as of the first
day of the Contract Year in which we receive the transfer
request, no more than 20% of your FIA Account Value as of
the first day of that Contract Year less amounts previously
transferred by you during that Contract Year may be
transferred by you from the FIA as of the date we receive
the transfer request.
(b) Contractholder-directed Transfers:
(2)1 Contractholder-directed transfers from the FIA to an Investment
Account are subject to a Market Value Adjustment.
(2) Contractholder-directed transfers to the FIA from an Investment
Account are subject to our approval.
(3) We may cease to permit Contractholder-directed transfers upon 30
days notice to the Contractholder.]
GB10.OM-C [(SBR)]
16
SECTION 6 - ANNUITIES
6.1 Annuity Purchases: Prior to notification of contract termination (but not
thereafter), the Contractholder may withdraw all or a portion of a your
Account Value to provide an annuity reflecting Plan benefits. Such a
withdrawal is not subject to a Withdrawal Charge or Market Value
Adjustment. [On the date we receive an annuity purchase request, we
transfer your entire Participant Account to the FIA if it is an available
Investment Option, otherwise to the AUL Money Market Investment Account.
Such amounts remain in the FIA or the AUL Money Market Investment Account
until the full Account Value (reflecting gains and losses) is applied to
purchase the annuity on the last day of the month preceding the Annuity
Commencement Date. As of that annuity purchase date, your Participant
Account funds are no longer maintained in the contract.]
The Contractholder's annuity purchase request must specify the purpose for
the annuity, the election of an annuity option, Annuity Commencement Date,
any contingent annuitant or beneficiary, and any additional information we
require. If you or any contingent annuitant dies before the Annuity
Commencement Date, the annuity election is cancelled.
The minimum amount that the Contractholder may apply to purchase an annuity
is [$10,000].
6.2 Annuity Options: The Contractholder may elect any optional form of annuity
we offer at the time of purchase. Available annuity options always include:
(a) Life Annuity. A monthly annuity is payable as long as the annuitant
lives.
(b) Survivorship Annuity. A monthly annuity is payable as long as the
annuitant lives. After the annuitant's death, all or a portion of the
monthly annuity is paid to the contingent annuitant as long as the
contingent annuitant lives.
If a certain period annuity is available, the certain period may not extend
beyond your life expectancy or the joint life expectancy of you and any
contingent annuitant, as determined on the Annuity Commencement Date.
6.3 Determining Annuity Amount: We compute the annuity amount using the factors
reflected in the Table of Guaranteed Immediate Annuities attached to the
contract. However, if our current single premium, nonparticipating,
immediate annuity rates for this class of group annuity contracts produce a
higher monthly annuity than the Table of Guaranteed Immediate Annuities,
then that more favorable annuity rate is applied.
6.4 Proof of Age and Survival; Minimum Payments: We may require proof of any
annuitant's or contingent annuitant's date of birth before commencing
payments under any annuity. We may also require proof that an annuitant or
contingent annuitant is living before making any annuity payment. If a
monthly annuity is less than our current established minimum payment, we
may make payments on a less-frequent basis.
6.5 Annuity Certificates: We issue to each person for whom an annuity is
purchased a certificate setting forth the annuity's amount and terms.
GB10.OM-C [(SBR)]
17
SECTION 7 OTHER CONTRACT CHARGES
7.1 [Investment Option Charge (IOC): Under Section 4.4, the Accumulation Unit
values of all Investment Accounts reflect the daily equivalent of an IOC
expressed as an annual percentage.
The IOC for an Investment Account is applied directly against the
Investment Account and is equal to the sum of "x" + "y" where:
"x" = a current charge for the investment advisory fees and for the
operational, organizational, and other expenses of the corresponding
Mutual Fund, Portfolio, or other entity in which the Investment
Account invests. Periodically, for a given Investment Account, "x"
will change to reflect changes in the related expenses and other
factors. Any change in "x" for an Investment Account will be effective
without prior written notice. Copies of the prospectuses or reports of
the Mutual Fund, Portfolio, or other entity are available for review.
"y" = a current combined mortality risk charge and expense risk charge of
1.25%.
7.2 Taxes: We may deduct charges equal to any premium tax we incur from the
balance applied to purchase an annuity or at such other time as premium
taxes are incurred by AUL. We may also deduct from Investment Accounts
reasonable charges for federal, state, or local income taxes we incur that
are attributable to such Investment Accounts.
7.3 Reduction or Waiver of Charges: We may reduce or waive the Withdrawal
Charge or the charges discussed above if the appropriate expenses
associated with the sale or administration of any contract are reduced or
if a contract is sold covering our employees or directors, those of the AUL
American Series Fund, Inc., or to either's affiliates.
7.4 Other Charges:
[(a) We apply those charges listed in the Table of Contract Charges.
(b) Charges due AUL for which the Plan is responsible, and which the Plan
Sponsor and Contractholder have otherwise agreed to in writing, which
are unpaid 60 days after the payment due date, will be deducted from
Participant Accounts on a pro-rata basis. These charges may include,
but are not limited to, participant statement mailing fees, Form 5500
fees, administrative fees, data reconciliation and reconstruction
fees, commissions, and contract application/installation fees for a
takeover Plan. Charges for which the Plan Sponsor (not the Plan) is
responsible, and which the Plan Sponsor has otherwise agreed to in
writing, must be paid by the Plan Sponsor. These charges include
contract application/installation fees for a new Plan.]
[7.5 Variable Investment Plus (VIP) Credit Factor: We determine a VIP credit
factor each month by multiplying the portions of the aggregate monthend
Account Value in all Investment Accounts by the monthly equivalent of the
corresponding annual VIP credit
GB10.OM-C [(SBR)]
18
factors in the table below. The sum of these products is divided by the
aggregate monthend Account Value in all Investment Accounts. We multiply
the resulting percentage by your monthend Account Value in each Investment
Account, and add the resulting amount to your Account Value for that
Investment Account.
Aggregate MonthEnd Account Value
allocated to Investment Accounts Annual VIP Credit Factors
First $ 750,000 0.10%
Next $ 750,000 0.30%
Next $ 1,000,000 0.45%
Next $ 2,500,000 0.75%
Next $ 5,000,000 0.85%
Over $10,000,000 0.95%
The VIP Credit Factor may be reduced by an annual charge percentage equal
to the current fixed dollar charge for expenses the Contractholder has
selected and agreed to in its AUL administrative services agreement divided
by the aggregate period-end Account Value in all Investment Accounts.
Period-end will be month-end. Alternatively, at our option and upon 30 days
notice to the Contractholder prior to the beginning of the next calendar
quarter, we may use the aggregate calendar quarter-end Account Value in all
Investment Accounts to calculate this charge. We also reserve the right to
revert to a month-end calculation upon 30 days notice to the Contractholder
prior to the beginning of the month in which the change is to be effective.
Such charge percentage may not reduce the VIP Credit Factor below 0%.]
GB10.OM-C [(SBR)]
19
SECTION 8 CONTRACT MODIFICATIONS
8.1 Contract Amendment: The Contractholder and we may agree to any change or
amendment to the Contract without the consent of any other person or
entity. The contract cannot be modified or amended, nor can any provision
or condition be waived, except by written authorization of a corporate
officer of AUL.
8.2 Rates and Section 7 Charges: We may announce new Guaranteed Rates, as
described in Sections 3.2 and 3.3 (including the consolidation of existing
Interest Pockets). However, as provided in Sections 3.2 and 3.3, we may not
change the declared Guaranteed Rate applicable to an established Interest
Pocket during the guaranteed period. We may also modify the charge levels
in Section 7 (but may not exceed the maximum charge levels listed in the
Table of Contract Charges) using the procedures of Section 8.5.
8.3 Conformance with Law: We may amend the contract at any time, without the
Contractholder's consent, or that of any other person or entity, if the
amendment is reasonably needed to comply with, or give you or the
Contractholder the benefit of, any provisions of federal or state laws. Any
such amendment will be delivered to the Contractholder prior to its
effective date.
8.4 Addition, Deletion, or Substitution of Investments:
(a) We reserve the right, subject to compliance with applicable law, to
make additions to, deletions from, substitution for, or combinations
of, the securities that are held by any Investment Account or that any
Investment Account may purchase. We reserve the right to eliminate the
shares of any of the eligible Mutual Funds, Portfolios, or other
entities and to substitute shares of, or interests in, another Mutual
Fund, Portfolio, or another investment vehicle, for shares already
purchased or to be purchased in the future under the contract, if the
shares of any or all eligible Mutual Funds, Portfolios, or other
entities are no longer available for investment or if further
investment in any or all eligible Mutual Funds, Portfolios, or other
entities becomes inappropriate in view of the purposes of the
contract. Where required under applicable law, we will not substitute
any shares attributable to the Contractholder's interest in any
Investment Account without notice, your approval or the
Contractholder's approval, or prior approval of the Securities and
Exchange Commission or a state insurance commissioner, and without
following the filing or other procedures established by applicable
state insurance regulators.
Nothing contained herein will prevent the Variable Account from
purchasing other securities for other series or classes of contracts,
or from effecting a conversion between series or classes of contracts
on the basis of requests made by a majority of other contractholders
or as permitted by federal law.
(b) We reserve the right to establish additional Investment Accounts, each
of which would invest in the corresponding Mutual Fund, Portfolio, or
other entity, or in other securities or investment vehicles. We
reserve the right to eliminate or combine existing Investment Accounts
if marketing, tax, or investment conditions warrant. We reserve the
right to provide other Investment Options under the contract at any
time. Subject to any required
GB10.OM-C [(SBR)]
20
regulatory approvals, we reserve the right to transfer assets from any
Investment Account to another separate account of AUL or Investment
Account.
(c) In the event of any such substitution or change, we may, by
appropriate amendment, make such changes in the contract as may be
necessary or appropriate to reflect such substitution or change. Any
transfer request or Investment Option election received on or after
the effective date of such substitution or change which reflects the
previous Investment Option which has been substituted or changed will
be transacted using the new substituted or changed Investment Option.
If deemed by us to be in the best interests of persons or entities
having voting rights under the contract, the Variable Account may be
operated as a management investment company under the Investment
Company Act of 1940 or any other form permitted by law, it may be
deregistered in the event such registration is no longer required
under the Investment Company Act of 1940, or it may be combined with
other separate accounts of AUL or an affiliate thereof. We may take
such action as is necessary to comply with, or to obtain, exemptions
from the Securities and Exchange Commission with regard to the
Variable Account. Subject to compliance with applicable law, we also
may combine one or more Investment Accounts and may establish a
committee, board, or other group to manage one or more aspects of the
Investment Accounts. 8.5 Our Right to Initiate Changes: In addition to
those amendments permitted by Sections 8.2, 8.3, and 8.4, we may
initiate an additional provision or modification of any other
provision of the contract (except for those prohibited amendments
listed in Section 8.6) by giving the Contractholder [60 days] notice
of such modification. Any such modification is effective without the
Contractholder's affirmative assent.
8.6 Prohibited Amendments:
(a) Notwithstanding our right to initiate changes under Section 8.5, we
may not initiate changes to the minimum Guaranteed Rate specified in
Section 3.4, our obligation to set Guaranteed Rates for the period of
time specified in Sections 3.2 and 3.3, the payment provisions upon
contract termination specified in Section 9.2, the maximum charge
levels listed in the Table of Contract Charges, or the Table of
Guaranteed Immediate Annuities.
(b) No modification to the contract may change the terms of a previously
purchased annuity or reduce any interest guarantee applicable to your
FIA balance on the modification's effective date.
GB10.OM-C [(SBR)]
21
SECTION 9 TERMINATION OF CONTRACT
9.1 Termination by the Contractholder: The Contractholder may terminate the
contract by giving us notice and electing a form of payment described in
Section 9.2. Such termination is effective on [the Business Day that we
receive the Contractholder's notice.]
9.2 Payment Upon Termination by the Contractholder: If the Contractholder
terminates the contract, the Contractholder may elect the following
options:
(a) Lump-Sum: We pay the Contractholder [the aggregate Withdrawal Value of
all Participant Accounts attributable to Code Section 401(a) funds,
plus or minus any FIA MVA]. Such Withdrawal Value and MVA will be
determined on the termination effective date and paid within [7 days]
from the termination effective date, except as we may be permitted to
defer payment in accordance with appropriate provisions of the federal
securities laws.
(b) Payment of Investment Accounts in Lump-Sum and FIA in Installments:
For Code Section 401(a) funds or Code Section 403(b) funds, the
Contractholder may have the aggregate Investment Account Withdrawal
Value of all Participant Accounts paid to the Contractholder in a
lump-sum, with the aggregate FIA Withdrawal Value of all Participant
Accounts paid in [6] equal annual installments. The aggregate
Investment Account Withdrawal Value will be determined on the
termination effective date and paid within [7 days] from the
termination effective date, except as we may be permitted to defer
payment in accordance with appropriate provisions of the federal
securities laws. The initial FIA installment is calculated on the
termination effective date and paid within [7 days] from the
termination effective date. Subsequent installments are paid on the
anniversary of the termination effective date. During the installment
payment period, interest is credited to amounts in the FIA at a rate
equal to the current average Guaranteed Rate (as determined on the
first installment payment date) of all Interest Pockets, less [1%].
The minimum rate guarantee provided in Section 3.4 applies to the
interest credited under this Section. Interest is paid with each
installment.
(c) Transfer to Another Contract: [The Contractholder may transfer the
aggregate Account Value of all Participant Accounts, or it may permit
you to transfer your Account Value, to any group annuity contract
which has a withdrawal charge which we may make available. The
Contractholder may transfer the aggregate Withdrawal Value of all
Participant Accounts, or it may permit you to transfer your Withdrawal
Value, to any group annuity contract that does not have a withdrawal
charge which we may make available. Any such amounts are transferred
on the termination effective date.]
9.3 Termination by Us: We have the right, subject to applicable state law, to
terminate your Participant Account established under the contract at any
time during the Contract Year if your Account Value is less than [$200] for
the first Contract Year in which a Contribution is made for you, and [$400]
for any subsequent Contract Year, and at least [6 months] have elapsed
since the last previous Contribution for you to the contract. If we elect
to terminate your Participant Account, the termination will be effective on
the date [6 months] following the date we give
GB10.OM-C [(SBR)]
22
notice to the Contractholder and you that your Participant Account is to be
terminated, provided that any Contributions made for you during the
[6-month period] are insufficient to raise your Account Value up to the
minimum level.
9.4 Payment Upon Termination by Us: As of the effective date of termination of
your Participant Account by us, we may elect to have a single sum equal to
your Account Value on the effective date of termination paid to the
Contractholder within [7 days] from that date. Any such payment is in full
settlement of your Participant Account under the contract and in lieu of
any other payment under its terms.
9.5 Indemnification Required: Payments or transfers under Section 9.2 are in
full settlement of our obligations under the contract. Prior to making such
payments or transfers under Section 9.2, we may require the Contractholder
and the Plan Sponsor to indemnify and hold us harmless from any and all
losses, claims, or demands that may later be asserted against us in
connection with the making of such payment or transfer.
9.6 Effect on Contract Obligations: Any annuities purchased prior to
notification of contract termination are unaffected by a termination. We
may refuse further Contributions at any time after a termination notice has
been given. If we have been providing recordkeeping services, such services
stop on [the termination effective date. If we cease to provide Plan
recordkeeping for any reason, any administrative services agreement between
the Contractholder and us regarding the Plan and/or the contract is thereby
terminated.] The contract terminates automatically if no amounts remain in
either the FIA or any Investment Account.
GB10.OM-C [(SBR)]
23
SECTION 10 GENERAL PROVISIONS
10.1 Ownership: The Contractholder owns the contract. No other person or entity
has any right, title, or interest in the contract or to amounts received or
credited under it until such amounts are made available to them by the
Contractholder. All amounts received or credited under the contract become
our property. We are obligated to make only the payments or distributions
specified in the contract.
10.2 Entire Contract: The contract and the Contractholder's application
constitute the entire agreement between the Contractholder and us. We are
not a party to, nor bound by, a Plan, trust, custodial agreement, or other
agreement, or any amendment or modification to any of the same. We are not
a fiduciary under the contract or under any such Plan, trust, custodial
agreement, or other agreement.
10.3 Benefit Determinations: The Contractholder will furnish to us whatever
information is necessary to establish the eligibility for and amount of
annuity or other benefit due. We rely solely on the Contractholder's
instructions and certifications with respect to your benefits. The
Contractholder is fully responsible for determining:
(a) whether benefit payments are permitted under applicable law and the
Plan and
(b) the existence or amount of Excess Contributions (plus gains or minus
losses thereon), or that returns of Excess Contributions are permitted
by the Plan and the Code.
We may rely on the Contractholder's or its designee's statements or
representations in honoring any benefit payment request.
[We require that you execute and submit to us an affidavit which we prepare
in order that we may process your benefit payable under the contract if the
Contractholder, the Plan Sponsor, the Plan Trustee, and the Plan
Administrator are no longer in existence at the time we receive your
benefit payment request.]
10.4 Recordkeeping Services: [We generally provide Plan recordkeeping services
when all of a Plan's funds are held under the contract. We decline to
provide Plan recordkeeping services if the Contractholder elects to
allocate Plan funds to investments other than the contract, or if the
Plan's recordkeeping practices, in our judgment, impose an administrative
or financial burden on us. If we cease to provide Plan recordkeeping for
any reason, any administrative services agreement between the
Contractholder and us regarding the Plan and/or the contract is thereby
terminated.]
10.5 Representations and Warranties: The Contractholder and we mutually
represent and warrant, each to the other, that each is fully authorized to
enter into the contract and that the contract is a valid and binding
obligation and that the execution of the contract does not violate any law,
regulation, judgment, or order by which the representing party is bound. In
addition, the Contractholder represents and warrants to us that:
GB10.OM-C [(SBR)]
24
(a) the Code Section 401(a) Plan and the Code Section 403(b) Plan meet the
requirements of Code Section 401(a) and Code Section 403(b),
respectively;
(b) the execution of the contract has been authorized by the Plan
fiduciary responsible for Plan investment decisions; and
(c) the execution or performance of the contract does not violate any Plan
provision or any law, regulation, judgment, or order by which the Plan
is bound.
We do not make any representation or warranty regarding the federal, state,
or local tax status of the contract, your Participant Account, or any
transaction involving the contract.
10.6 Contractholder Representative; Misstatement of Data: The Contractholder may
designate a representative to act on its behalf under Sections 2 or 3 or to
receive any payment under Sections 5 or 9. We may rely on any information
the Contractholder, its designee, or you furnish. We need not inquire as to
the accuracy or completeness of such information. If any essential data
pertaining to any person has been omitted or misstated, including, but not
limited to, a misstatement of an annuitant's or contingent annuitant's age,
we will make an equitable adjustment to provide the annuity or other
benefit determined using correct data.
10.7 Assignment by Contractholder: The Contractholder may assign its interest in
Code Section 401(a) funds held in the contract by filing the original or a
duplicate of the assignment with us. We are not responsible for the
validity of an assignment.
10.8 Form of Request, Notice, Instruction, or Direction: When reference is made
to the Contractholder, its designee, or you making a request or giving
notice, instruction, or direction, such request, notice, instruction, or
direction must be in writing, or in a form otherwise acceptable to us, and
is effective when we receive it.
10.9 Effect of Disqualification: The Contractholder will promptly notify us if
it determines that there is a reasonable basis for believing the Code
Section 401(a)Plan is no longer qualified under Code Section 401(a). In
such event, your Participant Account share of each Investment Account is
withdrawn and transferred to [Liquid Interest Fund II (LIF II) within our
general asset account, where such funds earn a fixed annual effective
interest rate of 3.00% from the date of allocation to LIF II until the
earlier of the date those funds are withdrawn from the contract or the date
the Code Section 401(a) Plan is again qualified and such funds are
transferred to the appropriate Investment Options pursuant to applicable
Investment Option elections]. No amounts attributable to the contract can
be placed in any Investment Account until the Code Section 401(a) Plan is
again qualified.
10.10 [Quarterly] Statement of Account Value: Reasonably promptly after the end
of each [Contract Quarter], we will prepare a statement of the Account
Value of each Participant Account that is maintained under the contract.
10.11 Conformity with Law: Any benefit payable under the contract shall not be
less than the minimum benefit required by the insurance laws of the state
in which the contract is delivered. Language in the contract referring to
state or federal tax, securities, or other statutes or rules do not
incorporate within the contract any such statutes or rules.
GB10.OM-C [(SBR)]
25
10.12 Gender and Number: Whenever the context so requires, the plural includes
the singular, the singular the plural, and the masculine the feminine.
10.13 Facility of Payment: If you, your contingent annuitant, or your
beneficiary is legally incapable of giving a valid receipt for any payment,
if no guardian has been appointed, and if we receive a valid power of
attorney for you, your contingent annuitant, or your beneficiary, we may
pay the person or persons named in such power of attorney. We may also pay
the Contractholder directly or as it otherwise instructs. Any such payment
fully discharges us to the extent of such payment.
10.14 Voting: We own all shares of a Mutual Fund, Portfolio, or other entity
held in an Investment Account. We exercise the voting rights of such shares
at all shareholder meetings on all matters requiring shareholder voting
under the Investment Company Act of 1940 or other applicable laws. Our vote
reflects instructions received from persons having the voting interest in
the shares, as follows:
(a) The Contractholder has the voting interest under the contract. Unless
otherwise required by applicable law, the number of shares of a Mutual
Fund, Portfolio, or other entity for which the Contractholder may give
voting instructions is determined by dividing the aggregate Account
Values in the affected Investment Account by the net asset value of
the shares of the Mutual Fund, Portfolio, or other entity. Fractional
votes are counted. Our determination is made as of the date used by
the Mutual Fund, Portfolio, or other entity to determine shareholders
eligible to vote.
(b) We vote shares proportionally, to reflect the voting instructions we
receive in a timely manner from the Contractholder and from all other
contractholders. If no timely voting instructions are received from
the Contractholder, we vote shares proportionally, to reflect the
voting instructions we received in a timely manner for all other
contracts.
To the extent permitted by applicable law, we may vote shares in our own
right or may modify the above procedures to reflect changes in the law or
its interpretation.
We will provide prospectuses and other reports as required by applicable
federal law.
10.15 Acceptance of New Participants or Contributions: We may refuse to accept
new Participants or new Contributions at any time.
10.16 Our Annual Statement: No provision of the contract controls, determines,
or modifies any annual statement made by us to any insurance department,
contractholder, regulatory body, or other person. Nor does anything in such
annual statement control, determine, or modify the provisions of the
contract.
10.17 Nonforfeitability and Nontransferability: The entire Withdrawal Value of
the vested portion (as determined pursuant to the Code Section 403(b) Plan)
of Code Section 403(b) funds of your Participant Account under the contract
is nonforfeitable at all times. No sum payable under the contract which is
attributable to your Code Section 403(b) funds may be sold, assigned,
discounted, or pledged as collateral for a loan or as security for the
performance of an obligation or for any other purpose to any person or
entity other than us. In addition, to the extent permitted by law, no such
sum shall in any way be subject to legal process requiring the payment of
any claim against the payee.
10.18 Notice of Annual Meeting of Members: By-law, Art II, Sec. 2: the regular
annual meeting of the members of American United Mutual Insurance Holding
Company shall be held at its principal
GB10.OM-C [(SBR)]
26
place of business on [the third Thursday in February each year at ten
o'clock A.M.] local time or at such other location, place, or time as may
be designated by the Board of Directors. The election of directors shall be
held at the annual meeting.
GB10.OM-C [(SBR)]
27
[TABLE OF CONTRACT CHARGES
(1) Participant Account Charge: We deduct a Participant Account Charge of up to
$10 per Contract Quarter on the last day of each Contract Quarter from each
Participant Account in existence on such day for as long as the Participant
Account is in effect. Alternatively, we may ▇▇▇▇ this charge to the
Contractholder. If the entire balance of a Participant Account is applied
or withdrawn before the last day of the Contract Quarter pursuant to the
contract, the Participant Account Charge attributable to the period of time
which has elapsed since the first day of the Contract Quarter in which such
application or withdrawal of funds is made will not be deducted from the
amount applied or withdrawn and will not be billed to the Contractholder.
(2) Loan Initiation Fee: We assess a Loan Initiation Fee of up to $100 against
the Account of any Participant for whom a Plan loan withdrawal is requested
under the contract.
(3) Charge for Non-Electronic Transfers: We charge a service fee of up to $5
for non-electronic transfers between Investment Options, which will either
be billed to the Contractholder or deducted from the applicable Participant
Account.
(4) Distribution Fee: We ▇▇▇▇ the Contractholder for a Distribution Fee of up
to $40 for each Participant for whom a withdrawal is made under the
contract in which the entire Participant Account is distributed in a
lump-sum. Alternatively, we may assess this Distribution Fee against the
affected Participant Account if permitted under applicable law,
regulations, and rulings.
(5) Investment Advice Provider Fee: We ▇▇▇▇ the Contractholder for an
Investment Advice Provider Fee in an amount separately agreed upon by the
Contractholder and the third-party investment advice provider.
Alternatively, we may assess this Investment Advice Provider Fee against
the Account of each Participant who utilizes the investment advice
provider's services if permitted under applicable law, regulations, and
rulings. The entire fee collected by us will be forwarded to the investment
advice provider. No portion of this fee will be retained by us.
(6) Contract Termination Individual Participant Check Fee: We ▇▇▇▇ the
Contractholder for a fee of up to $100 for each Participant for whom an
individual check is prepared upon contract termination. (This charge does
not apply to a lump-sum payment to the Contractholder upon contract
termination.) Alternatively, we may assess this fee against the affected
Participant Account if permitted under applicable law, regulations, and
rulings.]
GB10.OM-C [(SBR)]
28
[TABLE OF GUARANTEED IMMEDIATE ANNUITIES
MONTHLY INCOME PER $1,000 OF ACCOUNT VALUE
10 YEAR CERTAIN
ADJUSTED AGE LIFE ANNUITY AND LIFE ANNUITY
45 2.9690 2.9632
46 3.0190 3.0124
47 3.0715 3.0641
48 3.1269 3.1185
49 3.1852 3.1756
50 3.2466 3.2357
51 3.3115 3.2988
52 3.3800 3.3653
53 3.4525 3.4352
54 3.5291 3.5088
55 3.6104 3.5863
56 3.6966 3.6678
57 3.7881 3.7536
58 3.8850 3.8437
59 3.9877 3.9382
60 4.0964 4.0374
61 4.2115 4.1414
62 4.3334 4.2505
63 4.4626 4.3650
64 4.5994 4.4850
65 4.7442 4.6108
66 4.8977 4.7425
67 5.0608 4.8804
68 5.2347 5.0250
69 5.4213 5.1766
70 5.6229 5.3356
71 5.8412 5.5020
72 6.0778 5.6755
73 6.3336 5.8552
74 6.6097 6.0404
75 6.9084 6.2302
Adjusted Age = Actual Age at Settlement (in years and completed months) less the
following number of months: [.6 times (Birth Year 1915)] rounded to the nearest
integer.
Guaranteed purchase rates are 96% of the net single premium for the benefit
provided based on the unprojected 1994 Group Annuity Reserving Table for females
with interest at 2%.]
GB10.OM-C [(SBR)]
29
TABLE OF INVESTMENT ACCOUNTS
The following Investment Accounts are made available to the Contractholder under
the contract. By completing a form we require, the Contractholder may restrict
the Investment Accounts it makes available to you. Amounts allocated to any
Investment Account identified below are invested in the shares of the
corresponding Mutual Fund, Portfolio, or other entity listed below. [The
Competing Investment Accounts marked with an asterisk (*) are not available if
the Plan uses the FIA and if the Contractholder does not want the FIA 20% annual
transfer restriction applicable to Participant-directed transfers provided in
Section 5.4(a)(2) to apply.
Investment Account Mutual Fund, Portfolio, or Other Entity
------------------ ---------------------------------------
AUL American Aggressive Investor Portfolio AUL American Aggressive Investor Portfolio
AUL American Bond AUL American Bond
AUL American Conservative Investor Portfolio AUL American Conservative Investor Portfolio
AUL American Equity AUL American Equity
AUL American Managed AUL American Managed
AUL American Moderate Investor Portfolio AUL American Moderate Investor Portfolio
AUL American Money Market * AUL American Money Market
AUL American Tactical Asset Allocation Portfolio AUL American Tactical Asset Allocation Portfolio
▇▇▇▇▇ American Growth ▇▇▇▇▇ American Growth
▇▇▇▇▇ American Balanced ▇▇▇▇▇ American Balanced
▇▇▇▇▇ American Leveraged All Cap ▇▇▇▇▇ American Leveraged All Cap
American Century Equity Income American Century Equity Income
American Century Income and Growth American Century Income and Growth
American Century International Growth American Century International Growth
American Century Select American Century Select
American Century Small Cap Value American Century Small Cap Value
American Century Ultra American Century Ultra
American Century VP Capital Appreciation American Century VP Capital Appreciation
▇▇▇▇▇▇▇ Social MidCap Growth ▇▇▇▇▇▇▇ Social MidCap Growth
Fidelity VIP EquityIncome Fidelity VIP EquityIncome
Fidelity VIP Growth Fidelity VIP Growth
Fidelity VIP High Income Fidelity VIP High Income
Fidelity VIP Overseas Fidelity VIP Overseas
Fidelity VIP II Asset Manager Fidelity VIP II Asset Manager
Fidelity VIP II Contrafund Fidelity VIP II Contrafund
INVESCO Dynamics INVESCO Dynamics
INVESCO Energy INVESCO Energy
INVESCO Financial Services INVESCO Financial Services
INVESCO Health Sciences INVESCO Health Sciences
INVESCO Technology INVESCO Technology
INVESCO Telecommunications INVESCO Telecommunications
Janus Aspen Series Flexible Income Portfolio Janus Aspen Series Flexible Income Portfolio
Janus Aspen Series Worldwide Growth Portfolio Janus Aspen Series Worldwide Growth Portfolio
PBHG Emerging Growth Fund PBHG Emerging Growth Fund
PBHG Growth II PBHG Growth II
PBHG Ins. Technology and Communication PBHG Ins. Technology and Communication
PBHG Large Cap Value Fund PBHG Large Cap Value Fund
SAFECO Resources Series Trust Equity Portfolio SAFECO Resources Series Trust Equity Portfolio
SAFECO Resources Series Trust Growth Portfolio SAFECO Resources Series Trust Growth Portfolio
State Street Equity 500 Index Fund State Street Equity 500 Index Fund
▇. ▇▇▇▇ Price Equity Income Portfolio ▇. ▇▇▇▇ Price Equity Income Portfolio
▇. ▇▇▇▇ Price European Stock ▇. ▇▇▇▇ Price European Stock
Vanguard Explorer Vanguard Explorer
Vanguard ShortTerm Federal * Vanguard ShortTerm Federal]
GB10.OM-C [(SBR)]
30
THE FOLLOWING PAGES ARE SPECIAL STATES PAGES THAT WERE
FILED FOR FORM GB10.OM-C. (EACH PAGE REFLECTS THE
APPROPRIATE STATE.)
GB10.OM-C [(SBR)]
American United Life Insurance Company(R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER [GAXXXXX]
CONTRACTHOLDER [ABC SCHOOL]
PARTICIPANT'S NAME [▇▇▇▇ ▇▇▇]
SOCIAL SECURITY NUMBER [▇▇▇▇▇▇▇▇▇]
American United Life Insurance Company hereby certifies that the Contractholder
and AUL have entered into a MultipleFund Group Variable Annuity Contract (the
Contract) in connection with the Contractholder's qualified Internal Revenue
Code Section 401(a) Plan and/or Code Section 403(b) taxdeferred annuity Plan,
and that AUL has created an account in your name to receive Contributions from
the Contractholder for your benefit pursuant to the Contract. When used in this
certificate, "we," "us," or "our" refer to AUL.
The only parties to the Contract are the Contractholder and AUL. All rights and
benefits are determined in accordance with the provisions of the Contract.
Benefits under the Contract will be paid at the Contractholder's direction.
Any amendments to, or changes in, the Contract will be binding and conclusive on
you and your beneficiary.
This certificate is not itself the Contract, but is a certificate of
participation in the Contract.
AMERICAN UNITED LIFE INSURANCE COMPANY
Secretary
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)] Certificate
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THE CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THE CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
Amounts withdrawn from the Fixed Interest Account may be subject to a Market
Value Adjustment.
Use of adjusted age method will reduce the guaranteed annuity benefit.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
GB10.OM-C (CT)
[(SBR)]
SECTION 6 - ANNUITIES
6.1 Annuity Purchases: Prior to notification of contract termination (but not
thereafter), the Contractholder may withdraw all or a portion of a your
Account Value to provide an annuity reflecting Plan benefits. Such a
withdrawal is not subject to a Withdrawal Charge or Market Value
Adjustment. [On the date we receive an annuity purchase request, we
transfer your entire Participant Account to the FIA if it is an available
Investment Option, otherwise to the AUL Money Market Investment Account.
Such amounts remain in the FIA or the AUL Money Market Investment Account
until the full Account Value (reflecting gains and losses) is applied to
purchase the annuity on the last day of the month preceding the Annuity
Commencement Date. As of that annuity purchase date, your Participant
Account funds are no longer maintained in the contract.]
The Contractholder's annuity purchase request must specify the purpose for
the annuity, the election of an annuity option, Annuity Commencement Date,
any contingent annuitant or beneficiary, and any additional information we
require. If you or any contingent annuitant dies before the Annuity
Commencement Date, the annuity election is cancelled.
The minimum amount that the Contractholder may apply to purchase an annuity
is [$10,000].
6.2 Annuity Options: The Contractholder may elect any optional form of annuity
we offer at the time of purchase. Available annuity options always include:
(a) Life Annuity. A monthly annuity is payable as long as the annuitant
lives.
(b) Survivorship Annuity. A monthly annuity is payable as long as the
annuitant lives. After the annuitant's death, all or a portion of the
monthly annuity is paid to the contingent annuitant as long as the
contingent annuitant lives.
If a certain period annuity is available, the certain period may not extend
beyond your life expectancy or the joint life expectancy of you and any
contingent annuitant, as determined on the Annuity Commencement Date.
6.3 Determining Annuity Amount: We compute the annuity amount using the
annuitant's adjusted age on the Annuity Commencement Date and the factors
shown in the Table of Guaranteed Immediate Annuities attached to this
contract. Use of the adjusted age method results in a lower guaranteed
annuity benefit than would be payable if the actual age method was used.
However, if our current single premium nonparticipating immediate annuity
rates for this class of group annuity contracts using the actual age method
produces a higher monthly annuity than the Table of Guaranteed Immediate
Annuities using the adjusted age method, then that more favorable rate will
be applied.
6.4 Proof of Age and Survival; Minimum Payments: We may require proof of any
annuitant's or contingent annuitant's date of birth before commencing
payments under any annuity. We may also require proof that an annuitant or
contingent annuitant is living before making any annuity payment. If a
monthly annuity is less than our current established minimum payment, we
may make payments on a less-frequent basis.
6.5 Annuity Certificates: We issue to each person for whom an annuity is
purchased a certificate setting forth the annuity's amount and terms.
GB10.OM-C (CT)
[(SBR)] 16
[TABLE OF CONTRACT CHARGES
(1) Participant Account Charge: We deduct a Participant Account Charge of up to
$10 per Contract Quarter on the last day of each Contract Quarter from each
Participant Account in existence on such day for as long as the Participant
Account is in effect. Alternatively, we may ▇▇▇▇ this charge to the
Contractholder. If the entire balance of a Participant Account is applied
or withdrawn before the last day of the Contract Quarter pursuant to the
contract, the Participant Account Charge attributable to the period of time
which has elapsed since the first day of the Contract Quarter in which such
application or withdrawal of funds is made will not be deducted from the
amount applied or withdrawn and will not be billed to the Contractholder.
(2) Charge for Non-Electronic Transfers: We charge a service fee of up to $5
for non-electronic transfers between Investment Options, which will either
be billed to the Contractholder or deducted from the applicable Participant
Account.
(3) Distribution Fee: We ▇▇▇▇ the Contractholder for a Distribution Fee of up
to $40 for each Participant for whom a withdrawal is made under the
contract in which the entire Participant Account is distributed in a
lump-sum. Alternatively, we may assess this Distribution Fee against the
affected Participant Account if permitted under applicable law,
regulations, and rulings.
(4) Investment Advice Provider Fee: We ▇▇▇▇ the Contractholder for an
Investment Advice Provider Fee in an amount separately agreed upon by the
Contractholder and the third-party investment advice provider.
Alternatively, we may assess this Investment Advice Provider Fee against
the Account of each Participant who utilizes the investment advice
provider's services if permitted under applicable law, regulations, and
rulings. The entire fee collected by us will be forwarded to the investment
advice provider. No portion of this fee will be retained by us.
(5) Contract Termination Individual Participant Check Fee: We ▇▇▇▇ the
Contractholder for a fee of up to $100 for each Participant for whom an
individual check is prepared upon contract termination. (This charge does
not apply to a lump-sum payment to the Contractholder upon contract
termination.) Alternatively, we may assess this fee against the affected
Participant Account if permitted under applicable law, regulations, and
rulings.]
GB10.OM-C (CT)
[(SBR)] 26
7.3---- Reduction or Waiver of Charges
7.4---- Other Charges
7.5---- Variable Investment Plus (VIP) Credit Factor
SECTION 8 CONTRACT MODIFICATIONS [19]
8.1---- Contract Amendment
8.2---- Rates and Section 7 Charges
8.3---- Conformance with Law
8.4---- Addition, Deletion, or Substitution of Investments
8.5---- Our Right to Initiate Changes
8.6---- Prohibited Amendments
SECTION 9 TERMINATION OF CONTRACT [21]
9.1---- Termination by the Contractholder
9.2---- Payment Upon Termination by the Contractholder
9.3---- Termination by Us
9.4---- Payment Upon Termination by Us
9.5---- Indemnification Required
9.6---- Effect on Contract Obligations
SECTION 10 GENERAL PROVISIONS [23]
10.1--- Ownership
10.2--- Entire Contract
10.3--- Benefit Determinations
10.4--- Recordkeeping Services
10.5--- Representations
10.6--- Contractholder Representative; Misstatement of Data
10.7--- Assignment by Contractholder
10.8--- Form of Request, Notice, Instruction, or Direction
10.9--- Effect of Disqualification
10.10-- [Quarterly] Statement of Account Value
10.11-- Conformity with Law
10.12-- Gender and Number
10.13-- Facility of Payment
10.14-- Voting
10.15-- Acceptance of New Participants or Contributions
10.16-- Our Annual Statement
10.17-- Nonforfeitability and Nontransferability
10.18-- Notice of Annual Meeting of Members
[TABLE OF CONTRACT CHARGES] [26]
[TABLE OF GUARANTEED IMMEDIATE ANNUITIES] [27]
[TABLE OF INVESTMENT ACCOUNTS] [28]
GB10.OM-C (KY)
[(SBR)] 2
SECTION 10 GENERAL PROVISIONS
10.1 Ownership: The Contractholder owns the contract. No other person or entity
has any right, title, or interest in the contract or to amounts received or
credited under it until such amounts are made available to them by the
Contractholder. All amounts received or credited under the contract become
our property. We are obligated to make only the payments or distributions
specified in the contract.
10.2 Entire Contract: The contract and the Contractholder's application
constitute the entire agreement between the Contractholder and us. We are
not a party to, nor bound by, a Plan, trust, custodial agreement, or other
agreement, or any amendment or modification to any of the same. We are not
a fiduciary under the contract or under any such Plan, trust, custodial
agreement, or other agreement.
10.3 Benefit Determinations: The Contractholder will furnish to us whatever
information is necessary to establish the eligibility for and amount of
annuity or other benefit due. We rely solely on the Contractholder's
instructions and certifications with respect to your benefits. The
Contractholder is fully responsible for determining:
(a) whether benefit payments are permitted under applicable law and the
Plan and
(b) the existence or amount of Excess Contributions (plus gains or minus
losses thereon), or that returns of Excess Contributions are permitted
by the Plan and the Code.
We may rely on the Contractholder's or its designee's statements or
representations in honoring any benefit payment request.
[We require that you execute and submit to us an affidavit which we prepare
in order that we may process your benefit payable under the contract if the
Contractholder, the Plan Sponsor, the Plan Trustee, and the Plan
Administrator are no longer in existence at the time we receive your
benefit payment request.]
10.4 Recordkeeping Services: [We generally provide Plan recordkeeping services
when all of a Plan's funds are held under the contract. We decline to
provide Plan recordkeeping services if the Contractholder elects to
allocate Plan funds to investments other than the contract, or if the
Plan's recordkeeping practices, in our judgment, impose an administrative
or financial burden on us. If we cease to provide Plan recordkeeping for
any reason, any administrative services agreement between the
Contractholder and us regarding the Plan and/or the contract is thereby
terminated.]
10.5 Representations: The Contractholder and we mutually represent, each to the
other, that each is fully authorized to enter into the contract and that
the contract is a valid and binding obligation and that the execution of
the contract does not violate any law, regulation, judgment, or order by
which the representing party is bound. In addition, the Contractholder
represents to us that:
(a) the Code Section 401(a) Plan and the Code Section 403(b) Plan meet the
requirements of Code Section 401(a) and Code Section 403(b),
respectively;
GB10.OM-C (KY)
[(SBR)] 23
(b) the execution of the contract has been authorized by the Plan
fiduciary responsible for Plan investment decisions; and
(c) the execution or performance of the contract does not violate any Plan
provision or any law, regulation, judgment, or order by which the Plan
is bound.
We do not make any representation regarding the federal, state, or local
tax status of the contract, your Participant Account, or any transaction
involving the contract.
10.6 Contractholder Representative; Misstatement of Data: The Contractholder may
designate a representative to act on its behalf under Sections 2 or 3 or to
receive any payment under Sections 5 or 9. We may rely on any information
the Contractholder, its designee, or you furnish. We need not inquire as to
the accuracy or completeness of such information. If any essential data
pertaining to any person has been omitted or misstated, including, but not
limited to, a misstatement of an annuitant's or contingent annuitant's age,
we will make an equitable adjustment to provide the annuity or other
benefit determined using correct data.
10.7 Assignment by Contractholder: The Contractholder may assign its interest in
Code Section 401(a) funds held in the contract by filing the original or a
duplicate of the assignment with us. We are not responsible for the
validity of an assignment.
10.8 Form of Request, Notice, Instruction, or Direction: When reference is made
to the Contractholder, its designee, or you making a request or giving
notice, instruction, or direction, such request, notice, instruction, or
direction must be in writing, or in a form otherwise acceptable to us, and
is effective when we receive it.
10.9 Effect of Disqualification: The Contractholder will promptly notify us if
it determines that there is a reasonable basis for believing the Code
Section 01(a)Plan is no longer qualified under Code Section 401(a). In such
event, your Participant Account share of each Investment Account is
withdrawn and transferred to [Liquid Interest Fund II (LIF II) within our
general asset account, where such funds earn a fixed annual effective
interest rate of 3.00% from the date of allocation to LIF II until the
earlier of the date those funds are withdrawn from the contract or the date
the Code Section 401(a) Plan is again qualified and such funds are
transferred to the appropriate Investment Options pursuant to applicable
Investment Option elections]. No amounts attributable to the contract can
be placed in any Investment Account until the Code Section 401(a) Plan is
again qualified.
10.10 [Quarterly] Statement of Account Value: Reasonably promptly after the end
of each [Contract Quarter], we will prepare a statement of the Account
Value of each Participant Account that is maintained under the contract.
10.11 Conformity with Law: Any benefit payable under the contract shall not be
less than the minimum benefit required by the insurance laws of the state
in which the contract is delivered. Language in the contract referring to
state or federal tax, securities, or other statutes or rules do not
incorporate within the contract any such statutes or rules.
10.12 Gender and Number: Whenever the context so requires, the plural includes
the singular, the singular the plural, and the masculine the feminine.
GB10.OM-C (KY)
[(SBR)] 24
(D) Any such payment requested for a Participant who terminates
employment on or after the date the Plan Sponsor files for
protection under federal bankruptcy law, is deemed
insolvent, dissolves, closes, or shuts down its business, or
ceases operations is subject to a Withdrawal Charge and
Market Value Adjustment.
(3) Plan benefits not otherwise listed in paragraphs (1) and (2)
above. Such a withdrawal is subject to a Withdrawal Charge and
Market Value Adjustment.]
(b) Regarding death benefits specifically, notwithstanding the provisions
of Section 9, upon receipt from the Contractholder of instructions and
of due proof of your (and, if applicable, your beneficiary's) death
prior to the date your Participant Account is closed, we will apply
your Account Value, minus any charges described in Section 7 that are
not included in the Accumulation Unit value, for the purpose of
providing a death benefit under the Plan. The death benefit will be
paid to your beneficiary according to the method of payment elected by
the beneficiary (unless such method of payment was previously elected
by you). Your beneficiary may also designate a beneficiary.
The Code Section 403(b) death benefit will be payable:
(1) in a single sum or other method not provided in (2) below;
provided, however, that the entire Account Value, minus any
charges described in Section 7 that are not included in the
Accumulation Unit value, must be paid to the beneficiary on or
before December 31 of the calendar year which contains the fifth
anniversary of your death, or
(2) as an annuity in accordance with the Annuity Options shown in
Section 6.2 over a period not to exceed the life or life
expectancy of your beneficiary. If your beneficiary is not your
surviving spouse, the annuity must begin on or before December 31
of the calendar year immediately following the calendar year in
which you die. If your beneficiary is your surviving spouse, the
annuity need not begin before December 31 of the calendar year in
which you would have attained age 70 1/2.
If you die on or after his Annuity Commencement Date, any interest
remaining under the Annuity Option selected will be paid at least as
rapidly as prior to your death.
Settlement of a death benefit must be made within 30 days of receipt
of proof of death by AUL. The beneficiary, within 30 days of receipt
of proof of death by AUL, may elect the settlement option to leave the
death benefit on deposit in the contract pursuant to the provisions of
the contract.
However, if settlement is not made within 30 days of receipt of death
by AUL, the death benefit shall be transferred to [the Fixed Interest
Account] on the 30th day (or on the preceding Business Day, if the
30th day is not a Business Day) and held in [the Fixed Interest
Account] until paid. Upon transfer to [the Fixed Interest Account],
the death benefit will earn interest at the discount rate on 90-day
commercial paper in effect at the Federal Reserve Bank in the ninth
Federal Reserve district at the time of proof of death, until paid.
(c) Under Subsection (a)(2) (A), (B), (C), and (D) and under (a)(3) above,
if your entire Account Value is withdrawn, the amount paid equals your
Withdrawal Value minus any charges described in Section 7 which are
not included in the Accumulation Unit value, subject to the Market
Value Adjustment. If a portion of your Account Value is withdrawn,
your Account Value is reduced by an amount sufficient to make the
payment requested and to cover the Withdrawal Charge and any charges
described in Section 7 which are not included in the Accumulation Unit
value, subject to the Market Value Adjustment applied to all FIA
amounts withdrawn from your Participant Account.
GB10.OM-C (MT)
[(SBR)] 13
(d) Notwithstanding the previous provisions of this Section, in the
Contract Year in which your Participant Account is established, the
Contractholder may withdraw from your Participant Account up to [10%]
of the sum of your Account Value (determined as of the later of the
GB10.OM-C (MT)
[(SBR)] 13
American United Life Insurance Company(R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER [GAXXXXX]
CONTRACTHOLDER [ABC SCHOOL]
PARTICIPANT'S NAME [▇▇▇▇ ▇▇▇]
SOCIAL SECURITY NUMBER [▇▇▇▇▇▇▇▇▇]
American United Life Insurance Company hereby certifies that the Contractholder
and AUL have entered into a MultipleFund Group Variable Annuity Contract (the
Contract) in connection with the Contractholder's qualified Internal Revenue
Code Section 401(a) Plan and/or Code Section 403(b) taxdeferred annuity Plan,
and that AUL has created an account in your name to receive Contributions from
the Contractholder for your benefit pursuant to the Contract. When used in this
certificate, "we," "us," or "our" refer to AUL.
The only parties to the Contract are the Contractholder and AUL. All rights and
benefits are determined in accordance with the provisions of the Contract.
Benefits under the Contract will be paid at the Contractholder's direction.
Any amendments to, or changes in, the Contract will be binding and conclusive on
you and your beneficiary.
This certificate is not itself the Contract, but is a certificate of
participation in the Contract.
AMERICAN UNITED LIFE INSURANCE COMPANY
Secretary
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)] Certificate
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THE CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THE CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
GB10.OM-C A Stock Company [(SBR)]
(Nebraska)
SECTION 7 OTHER CONTRACT CHARGES
7.1 [Investment Option Charge (IOC): Under Section 4.4, the Accumulation Unit
values of all Investment Accounts reflect the daily equivalent of an IOC
expressed as an annual percentage.
The IOC for an Investment Account is applied directly against the
Investment Account and is equal to the sum of "x" + "y" where:
"x" = a current charge for the investment advisory fees and for the
operational, organizational, and other expenses of the corresponding
Mutual Fund, Portfolio, or other entity in which the Investment
Account invests. Periodically, for a given Investment Account, "x"
will change to reflect changes in the related expenses and other
factors. Any change in "x" for an Investment Account will be effective
without prior written notice. Copies of the prospectuses or reports of
the Mutual Fund, Portfolio, or other entity are available for review.
"y" = a current combined mortality risk charge and expense risk charge of
1.25%.
7.2 Taxes: We may deduct from Investment Accounts reasonable charges for
federal, state, or local income taxes we incur that are attributable to
such Investment Accounts.
7.3 Reduction or Waiver of Charges: We may reduce or waive the Withdrawal
Charge or the charges discussed above if the appropriate expenses
associated with the sale or administration of any contract are reduced or
if a contract is sold covering our employees or directors, those of the AUL
American Series Fund, Inc., or to either's affiliates.
7.4 Other Charges:
[(a) We apply those charges listed in the Table of Contract Charges.
(g) Charges due AUL for which the Plan is responsible, and which the Plan
Sponsor and Contractholder have otherwise agreed to in writing, which
are unpaid 60 days after the payment due date, will be deducted from
Participant Accounts on a pro-rata basis. These charges may include,
but are not limited to, participant statement mailing fees, Form 5500
fees, administrative fees, data reconciliation and reconstruction
fees, commissions, and contract application/installation fees for a
takeover Plan. Charges for which the Plan Sponsor (not the Plan) is
responsible, and which the Plan Sponsor has otherwise agreed to in
writing, must be paid by the Plan Sponsor. These charges include
contract application/installation fees for a new Plan.]
[7.5 Variable Investment Plus (VIP) Credit Factor: We determine a VIP credit
factor each month by multiplying the portions of the aggregate monthend
Account Value in all Investment Accounts by the monthly equivalent of the
corresponding annual VIP credit factors in the table below. The sum of
these products is divided by the aggregate monthend Account Value in all
Investment Accounts. We multiply the resulting percentage by your monthend
Account Value in each Investment Account, and add the resulting amount to
your Account Value for that Investment Account.
GB10.OM-C (NM)
[(SBR)] 17
American United Life Insurance Company (R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER [GAXXXXX]
CONTRACTHOLDER [ABC SCHOOL]
PARTICIPANT'S NAME [▇▇▇▇ ▇▇▇]
SOCIAL SECURITY NUMBER [▇▇▇▇▇▇▇▇▇]
American United Life Insurance Company hereby certifies that the Contractholder
and AUL have entered into a MultipleFund Group Variable Annuity Contract (the
Contract) in connection with the Contractholder's qualified Internal Revenue
Code Section 401(a) Plan and/or Code Section 403(b) taxdeferred annuity Plan,
and that AUL has created an account in your name to receive Contributions from
the Contractholder for your benefit pursuant to the Contract. When used in this
certificate, "we," "us," or "our" refer to AUL.
The only parties to the Contract are the Contractholder and AUL. All rights and
benefits are determined in accordance with the provisions of the Contract.
Benefits under the Contract will be paid at the Contractholder's direction.
Any amendments to, or changes in, the Contract will be binding and conclusive on
you and your beneficiary.
This certificate is not itself the Contract, but is a certificate of
participation in the Contract.
AMERICAN UNITED LIFE INSURANCE COMPANY
Secretary
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)] Certificate
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THE CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THE CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
WARNING: Any person who knowingly, and with intent to injure, defraud or deceive
any insurer, makes any claim for the proceeds of an insurance policy containing
any false, incomplete or misleading information is guilty of a felony.
GB10.OM-C (Oklahoma)
[(SBR)]
SECTION 10 GENERAL PROVISIONS
10.1 Ownership: The Contractholder owns the contract. No other person or entity
has any right, title, or interest in the contract or to amounts received or
credited under it until such amounts are made available to them by the
Contractholder. All amounts received or credited under the contract become
our property. We are obligated to make only the payments or distributions
specified in the contract.
10.2 Entire Contract: The contract and the Contractholder's application, and any
amendments, riders, or endorsements to the contract constitute the entire
agreement between the Contractholder and us. We are not a party to, nor
bound by, a Plan, trust, custodial agreement, or other agreement, or any
amendment or modification to any of the same. We are not a fiduciary under
the contract or under any such Plan, trust, custodial agreement, or other
agreement.
10.3 Benefit Determinations: The Contractholder will furnish to us whatever
information is necessary to establish the eligibility for and amount of
annuity or other benefit due. We rely solely on the Contractholder's
instructions and certifications with respect to your benefits. The
Contractholder is fully responsible for determining:
(a) whether benefit payments are permitted under applicable law and the
Plan and
(b) the existence or amount of Excess Contributions (plus gains or minus
losses thereon), or that returns of Excess Contributions are permitted
by the Plan and the Code.
We may rely on the Contractholder's or its designee's statements or
representations in honoring any benefit payment request.
[We require that you execute and submit to us an affidavit which we prepare
in order that we may process your benefit payable under the contract if the
Contractholder, the Plan Sponsor, the Plan Trustee, and the Plan
Administrator are no longer in existence at the time we receive your
benefit payment request.]
10.4 Recordkeeping Services: [We generally provide Plan recordkeeping services
when all of a Plan's funds are held under the contract. We decline to
provide Plan recordkeeping services if the Contractholder elects to
allocate Plan funds to investments other than the contract, or if the
Plan's recordkeeping practices, in our judgment, impose an administrative
or financial burden on us. If we cease to provide Plan recordkeeping for
any reason, any administrative services agreement between the
Contractholder and us regarding the Plan and/or the contract is thereby
terminated.]
10.5 Representations and Warranties: The Contractholder and we mutually
represent and warrant, each to the other, that each is fully authorized to
enter into the contract and that the contract is a valid and binding
obligation and that the execution of the contract does not violate any law,
regulation, judgment, or order by which the representing party is bound. In
addition, the Contractholder represents and warrants to us that:
(a) the Code Section 401(a) Plan and the Code Section 403(b) Plan meet the
requirements of Code Section 401(a) and Code Section 403(b),
respectively;
GB10.OM-C (Oklahoma)
[(SBR)] 23
American United Life Insurance Company (R)
▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
CONTRACT NUMBER [GAXXXXX]
CONTRACTHOLDER ABC SCHOOL]
PARTICIPANT'S NAME [▇▇▇▇ ▇▇▇]
SOCIAL SECURITY NUMBER [▇▇▇▇▇▇▇▇▇]
American United Life Insurance Company hereby certifies that the Contractholder
and AUL have entered into a MultipleFund Group Variable Annuity Contract (the
Contract) in connection with the Contractholder's qualified Internal Revenue
Code Section 401(a) Plan and/or Code Section 403(b) taxdeferred annuity Plan,
and that AUL has created an account in your name to receive Contributions from
the Contractholder for your benefit pursuant to the Contract. When used in this
certificate, "we," "us," or "our" refer to AUL.
The only parties to the Contract are the Contractholder and AUL. All rights and
benefits are determined in accordance with the provisions of the Contract.
Benefits under the Contract will be paid at the Contractholder's direction.
Any amendments to, or changes in, the Contract will be binding and conclusive on
you and your beneficiary.
This certificate is not itself the Contract, but is a certificate of
participation in the Contract.
AMERICAN UNITED LIFE INSURANCE COMPANY
Secretary
Guaranteed Benefit Employer-Sponsored TDA and Qualified Plan
Multiple-Fund Group Variable Annuity [(X)(SBR)] Certificate
Current Interest Credited
Nonparticipating
ACCUMULATION UNITS IN AN INVESTMENT ACCOUNT UNDER THE CONTRACT MAY INCREASE OR
DECREASE IN VALUE ACCORDING TO THE INVESTMENT PERFORMANCE OF THE UNDERLYING
INVESTMENTS HELD BY THE INVESTMENT ACCOUNT. THE VALUE OF SUCH ASSETS AND
ACCUMULATION UNITS IS NOT GUARANTEED. SECTION [4] OF THE CONTRACT EXPLAINS THE
VALUATION OF SUCH ASSETS AND ACCUMULATION UNITS.
THE AMOUNT OF BENEFITS UNDER THE FIXED INTEREST ACCOUNT MAY INCREASE OR DECREASE
DUE TO THE APPLICATION OF A MARKET VALUE ADJUSTMENT.
If you have questions concerning your contract, or wish to register a complaint,
you may reach us by calling [▇-▇▇▇-▇▇▇-▇▇▇▇].
GB10.OM-C (VT)
[(SBR)]
SECTION 8 CONTRACT MODIFICATIONS
8.1 Contract Amendment: The Contractholder and we may agree to any change or
amendment to the Contract without the consent of any other person or
entity. The contract cannot be modified or amended, nor can any provision
or condition be waived, except by written authorization of a corporate
officer of AUL.
8.2 Rates and Section 7 Charges: We may announce new Guaranteed Rates, as
described in Sections 3.2 and 3.3 (including the consolidation of existing
Interest Pockets). However, as provided in Sections 3.2 and 3.3, we may not
change the declared Guaranteed Rate applicable to an established Interest
Pocket during the guaranteed period. We may also modify the charge levels
in Section 7 (but may not exceed the maximum charge levels listed in the
Table of Contract Charges) using the procedures of Section 8.5.
8.3 Conformance with Law: We may amend the contract at any time, without the
Contractholder's consent, or that of any other person or entity, if the
amendment is reasonably needed to comply with, or give you or the
Contractholder the benefit of, any provisions of federal or state laws. Any
such amendment must be approved by the state of Vermont and delivered to
the Contractholder prior to its effective date.
8.4 Addition, Deletion, or Substitution of Investments:
(a) We reserve the right, subject to compliance with applicable law, to
make additions to, deletions from, substitution for, or combinations
of, the securities that are held by any Investment Account or that any
Investment Account may purchase. We reserve the right to eliminate the
shares of any of the eligible Mutual Funds, Portfolios, or other
entities and to substitute shares of, or interests in, another Mutual
Fund, Portfolio, or another investment vehicle, for shares already
purchased or to be purchased in the future under the contract, if the
shares of any or all eligible Mutual Funds, Portfolios, or other
entities are no longer available for investment or if further
investment in any or all eligible Mutual Funds, Portfolios, or other
entities becomes inappropriate in view of the purposes of the
contract. Where required under applicable law, we will not substitute
any shares attributable to the Contractholder's interest in any
Investment Account without notice, your approval or the
Contractholder's approval, or prior approval of the Securities and
Exchange Commission or a state insurance commissioner, and without
following the filing or other procedures established by applicable
state insurance regulators.
Nothing contained herein will prevent the Variable Account from
purchasing other securities for other series or classes of contracts,
or from effecting a conversion between series or classes of contracts
on the basis of requests made by a majority of other contractholders
or as permitted by federal law.
(b) We reserve the right to establish additional Investment Accounts, each
of which would invest in the corresponding Mutual Fund, Portfolio, or
other entity, or in other securities or investment vehicles. We
reserve the right to eliminate or combine existing Investment Accounts
if marketing, tax, or investment conditions warrant. We reserve the
right to provide other Investment Options under the contract at any
time. Subject to any required regulatory approvals, we reserve the
right to transfer assets from any Investment Account to another
separate account of AUL or Investment Account.
GB10.OM-C (VT)
[(SBR)] 19
(c) In the event of any such substitution or change, we may, by
appropriate amendment, make such changes in the contract as may be
necessary or appropriate to reflect such substitution or change. Any
transfer request or Investment Option election received on or after
the effective date of such substitution or change which reflects the
previous Investment Option which has been substituted or changed will
be transacted using the new substituted or changed Investment Option.
If deemed by us to be in the best interests of persons or entities
having voting rights under the contract, the Variable Account may be
operated as a management investment company under the Investment
Company Act of 1940 or any other form permitted by law, it may be
deregistered in the event such registration is no longer required
under the Investment Company Act of 1940, or it may be combined with
other separate accounts of AUL or an affiliate thereof. We may take
such action as is necessary to comply with, or to obtain, exemptions
from the Securities and Exchange Commission with regard to the
Variable Account. Subject to compliance with applicable law, we also
may combine one or more Investment Accounts and may establish a
committee, board, or other group to manage one or more aspects of the
Investment Accounts.
8.5 Our Right to Initiate Changes: In addition to those amendments permitted by
Sections 8.2, 8.3, and 8.4, we may initiate an additional provision or
modification of any other provision of the contract (except for those
prohibited amendments listed in Section 8.6) by giving the Contractholder
[60 days] notice prior to the contract anniversary of such modification.
Any such modification is effective without the Contractholder's affirmative
assent.
8.6 Prohibited Amendments:
(a) Notwithstanding our right to initiate changes under Section 8.5, we
may not initiate changes to the minimum Guaranteed Rate specified in
Section 3.4, our obligation to set Guaranteed Rates for the period of
time specified in Sections 3.2 and 3.3, the payment provisions upon
contract termination specified in Section 9.2, the maximum charge
levels listed in the Table of Contract Charges, or the Table of
Guaranteed Immediate Annuities.
(b) No modification to the contract may change the terms of a previously
purchased annuity or reduce any interest guarantee applicable to your
FIA balance on the modification's effective date.
GB10.OM-C (VT)
[(SBR)] 20
