THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇
organized in 1880
▇▇▇▇▇▇ AGREES TO THE TERMS AND PROVISIONS CONTAINED IN THIS POLICY
The Minnesota Mutual Life Insurance Company (herein called Minnesota Mutual)
agrees to pay at its Home Office in St. ▇▇▇▇, Minnesota, the benefits provided
by this contract.
This contract is issued in consideration of the application therefor and the
payment by the Contract Owner of purchase payments as hereinafter provided.
This contract is executed by Minnesota Mutual at its Home Office in St. ▇▇▇▇,
Minnesota, to take effect as of the Effective Date.
/s/ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ /s/ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇
Secretary Registrar President
GROUP DEPOSIT ADMINISTRATION CONTRACT
VARIABLE ANNUITY BENEFITS--
FIXED DOLLAR ANNUITY BENEFITS--PARTICIPATING
NO INDIVIDUAL ALLOCATION--NON-CONTRIBUTORY
ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON
INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE
NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT
F.1607 Rev. 3-70 Page 1
TABLE OF CONTENTS
SECTION DESCRIPTION PAGE
------- ----------- ----
1. . . . . . . . DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . 3
2. . . . . . . . BENEFIT PROVISIONS. . . . . . . . . . . . . . . . . . 3-4
2.01. . . . . . . .Notice of Benefits . . . . . . . . . . . . . . . . 3
2.02. . . . . . . .Amount of Annuity Payments Under an
Optional Annuity Form . . . . . . . . . . . . . 3
2.03. . . . . . . .Variable and Fixed Dollar Annuities. . . . . . . . 4
2.04. . . . . . . .Withdrawals from Active Life Fund. . . . . . . . . 4
3 . . . . . . . PURCHASE PAYMENTS . . . . . . . . . . . . . . . . . . 4-5
3.01. . . . . . . .Amount of Purchase Payments. . . . . . . . . . . . 4
3.02. . . . . . . .Application of Purchase Payments . . . . . . . . . 4
3.03. . . . . . . .Actuarial Assistance by Minnesota
Mutual. . . . . . . . . . . . . . . . . . . . . 5
3.04. . . . . . . .Limitations on Purchase Payments . . . . . . . . . 5
4 . . . . . . . VALUATION . . . . . . . . . . . . . . . . . . . . . . . 5
4.01. . . . . . . .Net Investment Rate and Net
Investment Factor . . . . . . . . . . . . . . . 5
4.02. . . . . . . .Accumulation Unit Value. . . . . . . . . . . . . . 5
4.03. . . . . . . .Annuity Unit Value . . . . . . . . . . . . . . . . 5
4.04. . . . . . . .Accumulation Value . . . . . . . . . . . . . . . . 5
4.05. . . . . . . .Valuation of Separate Account Assets . . . . . . . 5
5 . . . . . . . DISCONTINUANCE OF PURCHASE PAYMENTS . . . . . . . . . . 6
5.01. . . . . . . .Effective Date . . . . . . . . . . . . . . . . . . 6
5.02. . . . . . . .Effect of Discontinuance of
Purchase Payments . . . . . . . . . . . . . . . 6
6 . . . . . . . GENERAL PROVISIONS. . . . . . . . . . . . . . . . . . 6-7
6.01. . . . . . . .Contract . . . . . . . . . . . . . . . . . . . . . 6
6.02. . . . . . . .Modification of Contract . . . . . . . . . . . . . 6
6.03. . . . . . . .Beneficiary. . . . . . . . . . . . . . . . . . . . 6
6.04. . . . . . . .Participation in Divisible Surplus . . . . . . . . 7
6.05. . . . . . . .Certificates and Statements. . . . . . . . . . . . 7
6.06. . . . . . . .Information To Be Furnished. . . . . . . . . . . . 7
6.07. . . . . . . .Adjustments on Account of
Misstatements . . . . . . . . . . . . . . . . . 7
6.08. . . . . . . .Facility of Payment. . . . . . . . . . . . . . . . 7
6.09. . . . . . . .Evidence of Survival . . . . . . . . . . . . . . . 7
6.10. . . . . . . .Assignment . . . . . . . . . . . . . . . . . . . . 7
6.11. . . . . . . .Reserves . . . . . . . . . . . . . . . . . . . . . 7
6.12. . . . . . . .Voting Rights. . . . . . . . . . . . . . . . . . . 7
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6.13. . . . . . . .Relation of This Contract to
Separate Account. . . . . . . . . . . . . . . . 7
6.14. . . . . . . .Deferment of Payments. . . . . . . . . . . . . . . 7
6.15. . . . . . . .Termination of Contract. . . . . . . . . . . . . . 7
7 . . . . . . . ANNUITY FORMS AND TABLES. . . . . . . . . . . . . . . 8-9
7.01. . . . . . . .General. . . . . . . . . . . . . . . . . . . . . . 8
7.02. . . . . . . .Annuity Forms. . . . . . . . . . . . . . . . . . . 8
7.03. . . . . . . .Amount of Consideration Required to
Purchase First Monthly Annuity
Payment of $1.00. . . . . . . . . . . . . . . . 9
CONTRACT OWNER:
EFFECTIVE DATE:
CONTRACT NUMBER:
JURISDICTION:
PLAN:
SECTION 1. DEFINITIONS
1.01 PLAN
"Plan" means the Plan specified on Page 2 hereof. The Contract Owner will
furnish Minnesota Mutual with a copy of the Plan and with a copy of any
subsequent amendment or modification thereof. The terms of this contract will
apply to the Plan as constituted on the Effective Date of this contract and, if
Minnesota Mutual consents, to each amendment or modification of the Plan which
is placed on file with Minnesota Mutual.
1.02 PARTICIPANT
A person eligible to participant under the Plan, and on whose behalf purchase
payments have been or are being made under this contract.
1.03 CONTRACT ANNIVERSARY
An anniversary of the Effective Date of this contract.
1.04 CONTRACT YEAR
A period of one year commencing with the Effective Date or with any Contract
Anniversary.
1.05 ANNUITY PAYMENTS
A series of payments purchased under this contract for a Participant.
1.06 ANNUITY COMMENCEMENT DATE
The date upon which Annuity Payments begin, as determined in accordance with the
Plan. Such date may be the first day of any calendar month following the
Participant's 50th birthday, provided that it may not be later than the
Participant's 75th birthday.
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1.07 NORMAL ANNUITY FORM
The form of Annuity Payments so designated in the Plan.
1.08 OPTIONAL ANNUITY FORM
A form of Annuity Payments (other than the Normal Annuity form) specified in
Section 7.
1.09 SEPARATE ACCOUNT
Those assets of Minnesota Mutual in a separate investment account entitled
"Minnesota Mutual Variable Fund D", established by Minnesota Mutual for this
class of contracts in accordance with the laws of Minnesota.
1.10 GENERAL ACCOUNT
All assets of Minnesota Mutual other than those in Variable Fund D or in other
separate accounts established by Minnesota Mutual.
1.11 VALUATION DATE
Each date on which the New York Stock Exchange is open for trading, with the
valuation occurring as of the close of business of the Exchange on such date. A
valuation period is the period between successive Valuation Dates.
1.12 ACTIVE LIFE FUND
The sum of all General Account and Separate Account Accumulation Units under the
contract
1.13 ACCUMULATION VALUE
The dollar value of the Active Life Fund, as determined in accordance with
Section 4.04.
SECTION 2. BENEFIT PROVISIONS
2.01 NOTICE OF BENEFITS
Written notice shall be given Minnesota Mutual by the Contract Owner whenever
any portion of the Active Life Fund is to be applied to provide benefits to a
Participant or other person in accordance with the Plan. If such notice is with
respect to Annuity Payments, it must be given at least 30 days prior to the
Annuity Commencement Date, and it must specify (1) the amount of the first
monthly Annuity Payment under the Normal Annuity Form, (2) whether Annuity
Payments shall be made under the Normal Annuity Form or under an Optional
Annuity Form, (3) the Annuity Commencement Date, (4) the type of annuity
desired, i.e., Variable annuity, Fixed Dollar Annuity, of a combination thereof,
and (5) such other information about the Participant as Minnesota Mutual may
require. if such notice is with respect to other benefits which may be called
for by the Plan, it must specify (1) the nature and amount of such benefits, (2)
the person to whom such benefits are to be paid, and (3) the date on which
payment is to be made. If the first monthly Annuity Payment on either Fixed
Dollar or Variable Annuity would be less than $20, Minnesota Mutual shall make a
single sum payment to the Participant, as of his Annuity
Page 4
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Commencement Date, of the consideration which would otherwise have been required
to purchase such Annuity Payments, and the Participant shall thereafter have no
further rights under the contract.
2.02 AMOUNT OF ANNUITY PAYMENTS UNDER AN OPTIONAL ANNUITY FORM
Unless otherwise provided in the Plan, the amount of the first monthly Annuity
Payment under an Optional Annuity Form shall be determined as the quotient of
(1) divided by (2) below:
(1) The total consideration which would be required on behalf of the
Participant at his Annuity Commencement Date to purchase his monthly Annuity
Payments on the Normal Annuity Form with the first such monthly Annuity
Payment being in the amount determined by the Plan.
(2)The consideration required on behalf of the Participant at his Annuity
Commencement Date to purchase a first monthly Annuity Payment of $1.00 under
the Optional Annuity Form elected.
2.03 VARIABLE AND FIXED DOLLAR ANNUITIES
(a) Variable Annuity--A variable annuity is an annuity with payments varying
in amount in accordance with the net investment result of the Separate
Account. A number of Separate Account annuity units is determined by
dividing the first monthly Annuity Payment by the Separate Account annuity
unit value at the Annuity Commencement Date. The number of such annuity
units remains unchanged during the period of Annuity Payments.
The dollar amount of the second and subsequent payments is not guaranteed,
and may change from month to month. The dollar amount of each such payment
is determined by multiplying the number of Separate Account annuity units by
the Separate Account annuity unit value at the due date of such payment.
Minnesota Mutual guarantees that the dollar amount of each payment after the
first will not be affected by adverse mortality experience or by an increase
in Minnesota Mutual's expenses in excess of the expense deductions provided
for in the contract.
(b) Fixed Dollar Annuity--A fixed dollar annuity is an annuity payable from
the General Account, with payments which remain fixed as to dollar amount
throughout the period of Annuity Payments. A number of General Account
annuity units is determined when payments commence, but the General Account
annuity unit value is always $1.00. The number of such annuity units remains
unchanged during the period of Annuity Payments.
2.04 WITHDRAWALS FROM ACTIVE LIFE FUND
As of a Participant's Annuity Commencement Date, a number of accumulation units
shall be cancelled, such that the dollar value thereof is equal to the
consideration required to purchase Annuity Payments for the Participant. Unless
Minnesota Mutual shall be notified in writing to the contrary by the Contract
Owner at least 30 days prior to the Participant's Annuity
Page 5
(16107 Rev. 3-70)
Commencement Date, General Account accumulation units will be cancelled to
purchase a fixed dollar annuity and Separate Account accumulation units will be
cancelled to purchase a variable annuity. The number of accumulation units so
cancelled shall be withdrawn from the Active Life Fund.
As of the date any other benefit payment is due a Participant or a beneficiary
in accordance with the Plan, a number of accumulation units shall be cancelled,
such that the dollar value thereof is equal to the amount of the benefit payment
made. Such payment shall be effected by the cancellation of General account
accumulation units; provided, however, that if the number of General Account
accumulation units is insufficient, or if the Contract Owner shall so request in
writing to Minnesota Mutual, Separate Account accumulation units shall be
cancelled to effect such payment. The number of accumulation units so canceled
shall be withdrawn from the Active Life Fund.
If the Active Life fund is insufficient to make a withdrawal therefrom in
accordance with this Section, an additional purchase payment shall be required
of the Contract Owner in an amount sufficient to permit such withdrawal.
SECTION 3. PURCHASE PAYMENTS
3.01 AMOUNT OF PURCHASE PAYMENTS
The aggregate amount of purchase payments to be paid by the Contract Owner in
each Contract Year, and the portion of such purchase payments to be allocated to
the Separate Account and the General Account, shall be as determined by the
Contract Owner. All purchase payments are payable at the Home Office of
Minnesota Mutual.
3.02 APPLICATION OF PURCHASE PAYMENTS
Deductions totaling 7%, plus any applicable premium taxes on the purchase
payments shall be made by Minnesota Mutual from each purchase payment received.
The balance of each purchase payment remaining after these deductions is
hereinafter called the net purchase payment. Minnesota Mutual shall determine
the number of accumulation units provided by the net purchase payment by
dividing the net purchase payment by the then current accumulation unit value.
Such determination shall be made as of the Valuation Date coincident with or
next following the date on which such purchase payment is received by Minnesota
Mutual at its Home Office, and shall be made separately for net purchase
payments allocated to the General Account and the Separate Account. The number
of accumulation units so determined shall not be affected by any subsequent
change in the accumulation unit value. The General Account accumulation unit
value will increase at the net investment rate specified in Section 4.01(a), but
the Separate Account accumulation unit value may vary from period to period.
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3.03 ACTUARIAL ASSISTANCE BY MINNESOTA MUTUAL
Upon request by the Contract Owner, Minnesota Mutual shall furnish actuarial
assistance in estimating the amount of purchase payments appropriate to fund the
Plan. However, Minnesota Mutual shall not thereby assume any responsibility as
to the sufficiency of the contributions.
3.04 LIMITATIONS ON PURCHASE PAYMENTS
Minnesota Mutual may limit the maximum purchase payments which will be accepted
under the contract for any Contract Year to the greater of (a) the purchase
payments made under the contract for the immediately preceding Contract Year, or
(b) the average purchase payments made under the contract for all prior Contract
Years.
SECTION 4. VALUATION
4.01 NET INVESTMENT RATE AND NET INVESTMENT FACTOR
(a) The General Account net investment rate for each valuation period shall
not be less than the equivalent of an investment rate of 4 1/2% compounded
annually during the first 5 Contract Years, 4% compounded annually during the
6th through 10th Contract Years, and 3 1/2% compounded annually thereafter.
(b) The Separate Account net investment rate for any valuation period is
equal to the gross investment rate expressed in decimal form to six places,
less a deduction of not more than .0106 per annum. The amount of the
deduction may be changed from time to time by Minnesota Mutual, but not more
often than annually, and in no event will the deduction exceed .0106 per
annum. Such gross investment rate is equal to (1) the investment income and
capital gains and losses, whether realized or unrealized, on the assets of
the Separate Account during such valuation period, less a deduction for any
applicable income taxes arising from such income and realized and unrealized
capital gains, divided by (2) the value of such assets at the beginning of
the valuation period. Such gross investment rate may be either positive or
negative.
(c) The net investment factor for each Account is the sum of 1.000000 plus
the net investment rate for the Account.
4.02 ACCUMULATION UNIT VALUE
The General Account and Separate Account accumulation unit values were set at
$1.000000 on the first Valuation Date of the Separate Account. The respective
accumulation unit values in each Account on any subsequent Valuation Date are
determined by multiplying the accumulation unit value on the immediately
preceding Valuation Date by the net investment factor for that Account for the
valuation period just ended. The accumulation unit value as of any date other
than a Valuation Date is equal to its value on the next succeeding Valuation
Date.
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4.03 ANNUITY UNIT VALUE
The value of a General Account annuity unit will always be $1.00. The value of
a Separate Account annuity unit is determined monthly as of the first day of
each month. The value of a Separate Account annuity unit on the first day of
each month is equal to its value on the first day of the preceding month
multiplied by the product of (a) .997137, and (b) the ratio of the Separate
Account accumulation unit value for the valuation Date next following the
fourteenth day of the preceding month to the corresponding accumulation unit
value for the Valuation Date next following the fourteenth day of the second
preceding month. The value of an annuity unit on any date other than the first
day of a month is equal to its value on the first day of the next succeeding
month.
4.04 ACCUMULATION VALUE
The Accumulation Value as of any date is equal to the product of (a) the Active
Life Fund, and (b) the accumulation unit value. Such calculation shall be made
separately for the portions of the Active Life Fund made up of General Account
and Separate Account accumulation units. The applicable General Account or
Separate Account accumulation unit value is the accumulation unit value
coincident with or next following the date on which the Accumulation Value is
being determined; provided, however that for purposes of determining the
withdrawal from the Active Life Fund required to effect Annuity Payments, the
applicable accumulation unit value is the value on the Valuation Date next
following the fourteenth day of the month preceding the Annuity Commencement
Date.
4.05 VALUATION OF SEPARATE ACCOUNT ASSETS
The valuation of all assets in the Separate Account shall be determined in
accordance with the provisions of the rules and regulations of the Separate
Account.
SECTION 5.
DISCONTINUANCE OF PURCHASE PAYMENTS
5.01 EFFECTIVE DATE
Purchase payments may be discontinued under either of the following
circumstances:
(a) The Contract Owner may discontinue purchase payments as of a date
specified in a written notice to Minnesota Mutual at its Home Office,
provided that such date may not be earlier than the date of receipt of such
notice by Minnesota Mutual.
(b) Minnesota Mutual may discontinue acceptance of purchase payments as of a
date specified in a written notice to the Contract Owner if the contract is
no longer part of a plan qualified under Section 401 (a), 403(a), or other
provision of the Internal Revenue Code allowing similar tax treatment.
Page 8
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5.02 EFFECT OF DISCONTINUANCE OF PURCHASE PAYMENTS
Discontinuance of purchase payments will have no effect on Participants as to
whom Annuity Payments have commenced.
If discontinuance of purchase payments is by reason of the provisions of Section
5.01(a) above, and the Contract Owner prior to the effective date of such
discontinuance certifies in writing to Minnesota Mutual that the Plan is to be
continued as a Plan meeting the requirements of Section 401 (a) or 403(a) of the
Internal Revenue Code (a "qualified Plan"), the Active Life Fund may be
cancelled at the request of the Contract Owner and the Accumulation Value
transferred by Minnesota Mutual to an insurance company or trustee designated by
the Contract Owner. The transfer date shall be the first Valuation Date to
occur following the effective date of discontinuance of purchase payments.
Payment of the Accumulation Value shall be made in a single sum as of the
transfer date, except that Minnesota Mutual may elect to pay in monthly
installments of not more than $10,000 each, such portion of the Accumulation
Value which is part of the General Account.
If discontinuance of purchase payments occurs, and the Accumulation Value is not
transferred in accordance with the provisions of the preceding paragraph, the
Participants in the Plan will receive a 100% vested interest in all benefits
accrued under the terms of the Plan to the extent provided by the Accumulation
Value hereunder as of the effective date of discontinuance.
After discontinuance of purchase payments, purchase payments may subsequently be
resumed only with the written consent of Minnesota Mutual.
SECTION 6. GENERAL PROVISIONS
6.01 CONTRACT
This contract and the application therefor, which is attached hereto, constitute
the entire contract between the parties. This contract is delivered in, and
shall be construed according to the laws of the jurisdiction specified on Page 2
hereof. With respect to all transactions regarding this contract, except as may
be otherwise specifically provided, Minnesota Mutual may deal with the Contract
Owner on the basis that the Contract Owner has full ownership and control of the
contract.
6.02 MODIFICATION OF CONTRACT
This contract may be modified at any time by written agreement between Minnesota
Mutual and the Contract Owner. However, no such modification will adversely
affect the rights of any Participant unless the modification is made to comply
with a law or government regulation.
No person except the President, a Vice President, the Secretary, or an Assistant
Secretary of Minnesota Mutual has authority on behalf of Minnesota Mutual to
modify the contract or to waive any requirement of the contract. Minnesota
Mutual shall not be bound by any promise or representation made by or to any
agent or person other than as above.
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6.03 BENEFICIARY
A Participant may designate a beneficiary to receive any amount which may become
payable to such beneficiary under the terms of the Plan. The designation may be
made or changed by the Participant at any time during his lifetime by filing
satisfactory written notice with Minnesota Mutual at its Home Office. The new
designation shall take effect only upon being recorded by Minnesota Mutual at
its Home Office. When so recorded, even in the Participant is not then living,
it shall take effect as of the date the notice was signed, subject to any
payment made by Minnesota Mutual before recording the change.
The interest of any beneficiary who dies before the Participant shall terminate
at the death of that beneficiary. If the interest of all designated
beneficiaries has terminated, any proceeds payable at the Participant's death
shall be paid to the persons who, by evidence satisfactory to Minnesota Mutual,
appear to be the lawful children of the Participant. The proceeds shall be
divided equally among those children. If no child is living, the proceeds shall
be payable to the Participant's estate. "Child" and "children" refer only to
the first generation.
6.04 PARTICIPATION IN DIVISIBLE SURPLUS
This is a participating contract. The portion, if any, of the divisible surplus
of Minnesota Mutual accruing upon this contract shall be determined annually by
Minnesota Mutual and shall be credited to the contract on such basis as is
determined by Minnesota Mutual.
6.05 CERTIFICATES AND STATEMENTS
Minnesota Mutual shall issue to each Participant as to whom Annuity Payments are
provided hereunder an individual certificate setting forth the amount and terms
of such Annuity Payments. At least once in each Contract Year, Minnesota Mutual
will furnish the Contract-holder a statement of the Active Life Fund, the
current accumulation unit value, and the Accumulation Value. Such statement
shall be as of a date within four months of the mailing of the statement.
6.06 INFORMATION TO BE FURNISHED
The Contract Owner shall furnish any information or evidence which Minnesota
Mutual may reasonably require in order to administer this contract. If the
Contract Owner cannot furnish any required item of information, Minnesota Mutual
may request the person concerned to furnish such information. Minnesota Mutual
shall not be liable for the fulfillment of any obligation in any way dependent
on such information until it receives such information in a form satisfactory to
it.
Information furnished to Minnesota Mutual may be corrected for demonstrated
errors therein except that such correction will be at the option of Minnesota
Mutual when it has already acted to its prejudice by relying on such
information.
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6.07 ADJUSTMENTS ON ACCOUNT OF MISSTATEMENTS
If it shall be found that the age or sex of any person with respect to whom an
annuity shall have been purchased hereunder shall have been misstated, the
amount of the annuity payable by Minnesota Mutual shall be that provided by the
number of accumulation units allocated to effect such annuity on the basis of
the corrected information without changing the date of the first payment of the
annuity. The dollar amount of any underpayment made by Minnesota Mutual shall
be paid in full with the next payment due such person or his beneficiary. The
dollar amount of any overpayment made by Minnesota Mutual shall be deducted from
payments subsequently accruing to such person or his beneficiary under this
contract.
6.08 FACILITY OF PAYMENT
If Minnesota Mutual receives evidence satisfactory to it that any person is
legally, physically or mentally incapable of giving a valid release for any
payment due such person under this contract, Minnesota Mutual may make payment
thereof to such other person, persons, or institution who appear to Minnesota
Mutual as having assumed the custody and principal support of the person to whom
such payment is due. Minnesota Mutual shall be released from liability to the
extent of such payment.
6.09 EVIDENCE OF SURVIVAL
When any payment under this contract is contingent upon the survival of any
person, evidence of such person's survival must be furnished to Minnesota Mutual
either by personal endorsement of the check drawn for said payment or by other
means satisfactory to Minnesota Mutual.
6.10 ASSIGNMENT
This contract may not be assigned, sold, transferred, discounted, or pledged as
collateral for a loan or as security for the performance of an obligation or for
any other purpose, and, to the maximum extent permitted by law, benefits payable
under this contract shall be exempt from the claims of creditors.
6.11 RESERVES
The reserve held by Minnesota Mutual for any Annuity Payments hereunder shall be
not less than the reserve liability determined by Minnesota Mutual in accordance
with the mortality table and interest rate used to establish the amount of the
first such Annuity Payment.
6.12 VOTING RIGHTS
The Contract Owner and each Participant as to whom Annuity Payments have
commenced shall have the right to vote at the meetings of owners of contracts
for which reserves are maintained in the Separate Account, and shall cast the
votes attributable to this contract in conformity with the provisions of the
rules and regulations of the Separate Account.
6.13 RELATION OF THIS CONTRACT TO SEPARATE ACCOUNT
Minnesota Mutual shall have exclusive and absolute ownership and control of the
assets of both its General Account and its Separate Account.
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6.14 DEFERMENT OF PAYMENTS
Whenever any payment under this contract is to be made in a single sum, payment
will be made within 7 days after the date written request for such payment is
received by Minnesota Mutual at its Home Office, except that payment in a single
sum of any death benefit payable to a beneficiary will be made within 7 days
after the date due proof of death is received by Minnesota Mutual at its Home
Office and except as Minnesota Mutual may be permitted to defer any payment
under the Investment Company Act of 1940.
6.15 TERMINATION OF CONTRACT
This contract shall finally terminate and cease to be in effect when Minnesota
Mutual shall have completed all payments due hereunder.
7.01 GENERAL
The consideration required at a Participant's Annuity Commencement Date to
purchase a first monthly Annuity Payment of $1.00 under the Normal Annuity Form
of an Optional Annuity Form is obtained from the appropriate table in this
Section 7. The amount of the consideration depends upon the sex and adjusted
age of the Participant and any joint annuitant. The adjusted age is determined
from the actual age nearest birthday at the time the first Annuity Payment is
due in the following manner:
CALENDAR YEAR ADJUSTED AGE IS
OF BIRTH EQUAL TO----
--------------- ------------
Prior to 1900 Actual Age Plus 1
1900-1919 Actual Age
1920-1939 Actual Age Minus 1
1940-1959 Actual Age Minus 2
1960 and Later Actual Age Minus 3
The amounts of consideration shown in the tables are based on the Progressive
Annuity Table with interest at the rate of 3.5% per annum and assume births in
the year 1900. In the event the purchase of Annuity Payments becomes subject to
any applicable premium taxes which were not previously deducted under the
provisions of Section 3.02, the amounts shown in the tables shall be
appropriately adjusted. Minnesota Mutual reserves the right to require proof
satisfactory to it of the age of the Participant and any joint annuitant prior
to the purchase of Annuity Payments.
Considerations required for ages not shown in the tables, for deferred Annuity
Payments, and for additional forms of Annuity Payments which may be mutually
agreed upon by Minnesota Mutual and the Contract Owner shall be calculated by
Minnesota Mutual on the same actuarial basis.
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7.02 ANNUITY FORMS
Option 1--Life Annuity--An annuity payable monthly during the lifetime of the
Participant and terminating with the last monthly payment preceding the death of
the Participant.
Option 2--Life annuity with a Period Certain of 120 months (Option 2A), 180
months (Option 2B), or 240 months Option 2C)--An annuity payable monthly during
the lifetime of the Participant, with the guarantee that if the Participant dies
before payments have been made for the Period Certain elected, payments will
continue to the beneficiary during the remainder of such Period Certain; or, if
the beneficiary so elects, the present value of the remaining guaranteed number
of payments, based on the then current dollar amount of one such payment and
commuted on the basis of 3.5% interest compounded annually, shall be paid in a
single sum to the beneficiary.
Option 3--Joint and Last Survivor Annuity--An annuity payable monthly during the
joint lifetime of the Participant and a designated joint annuitant and
continuing thereafter during the remaining lifetime of the survivor.
Option 4--Period Certain Annuity--An annuity payable monthly for a Period
Certain of from 1 to 15 years, as elected. If the Participant dies before
payments have been made for the Period Certain elected, payments will continue
to the beneficiary during the remainder of such Period Certain. At any time
during the payment period, the payee may elect that (1) the present value of the
remaining guaranteed number of payments, based on the then current dollar amount
of such payment and commuted on the basis of 3.5% interest compounded annually,
shall be paid in a single sum, or (2) such commuted amount shall be applied to
effect a life annuity under Option 1 or Option 2.
The first payment under any of these Annuity Forms will be determined in
accordance with Section 2.01 and 2.02. The second and subsequent payments will
be determined in accordance with Section 2.03. Minnesota Mutual reserves the
right to require proof satisfactory to it of the age of the Participant and any
Joint Annuitant prior to making the first payment under any Annuity Form.
7.03 AMOUNT OF CONSIDERATION REQUIRED TO PURCHASE FIRST MONTHLY ANNUITY
PAYMENT OF $1.00
ADJUSTED AGE
OF ANNUITANT SINGLE LIFE ANNUITIES
------------- ------------------------------------------------------
MALE FEMALE OPTION 1 OPTION 2A OPTION 2B OPTION 2C
------ ------ -------- --------- -------- ---------
50 54 $210.85 $213.06 $216.23 $221.20
51 55 206.73 209.18 212.68 218.16
52 56 202.54 205.26 209.12 215.14
53 57 198.27 201.28 205.55 212.15
54 58 193.93 197.26 201.96 209.21
Page 13
(16107 Rev. 3-70)
55 59 189.51 193.20 198.39 206.32
56 60 185.03 189.11 194.82 203.50
57 61 180.45 185.00 191.28 200.75
58 62 175.87 180.87 187.77 198.10
59 63 171.21 176.73 184.31 195.55
60 64 166.49 172.59 180.91 193.11
61 65 161.73 168.47 177.58 190.81
62 66 156.93 164.37 174.34 188.63
63 67 152.09 160.30 171.19 186.61
64 68 147.23 156.28 168.16 184.74
65 69 142.35 152.31 165.25 183.02
66 70 137.46 148.42 162.48 181.48
67 71 132.56 144.62 159.86 180.10
68 72 127.67 140.92 157.40 178.88
69 73 122.79 137.32 155.12 177.83
70 74 117.93 133.86 153.01 176.93
OPTION 3-JOINT AND LAST SURVIVOR ANNUITY
ADJUSTED AGE OF
JOINT ANNUITANT* ADJUSTED AGE OF PARTICIPANT*
---------------- ------------------------------------------------------------------
M-51 M-56 M-58 M-61 M-63 M-66 M-71
MALE FEMALE F-55 F-60 F-62 F-65 F-67 F-70 F-75
------------------- ----- ----- ----- ----- ----- ----- ------
50 54 $237.79 $229.86 $227.15 $223.59 $221.57 $218.93 $215.74
55 59 229.05 218.34 214.55 209.38 206.35 202.42 197.39
57 61 225.97 214.14 209.85 204.01 200.50 195.92 190.01
60 64 221.91 208.43 203.38 196.39 192.18 186.50 179.02
62 66 219.55 204.98 199.50 191.71 186.96 180.56 171.88
65 69 216.52 200.49 194.31 185.42 179.84 172.21 161.64
70 74 212.70 194.65 187.43 176.84 170.06 160.43 146.43
* The amount of consideration required for ages not shown in this table
will be calculated on the same basis as those shown and may be obtained from
Minnesota Mutual.
OPTION 4-- PERIOD CERTAIN ANNUITY
PERIOD CERTAIN AMOUNT OF PERIOD CERTAIN AMOUNT OF
(YEARS) CONSIDERATION (YEARS) CONSIDERATION
------- ------------- -------- -------------
1 $11.81 9 93.02
2 23.22 10 101.73
3 34.26 11 110.01
4 44.90 12 118.20
Page 14
(16107 Rev. 3-70)
5 55.19 13 125.94
6 65.15 14 133.51
7 74.74 15 140.85
8 84.03 15 140.85
APPLICATION IS HEREBY MADE TO
THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
SAINT ▇▇▇▇, MINNESOTA 55101
for a Group contract providing Variable and/or Fixed Dollar annuity benefits.
1. The contract shall cover employees of:
----------------------------------------------------------------------
(Employer name as appears above will be used in legal documents-BE
ACCURATE)
Address
-------------------------------------------------------------------
--------------------------------------------------------------------------
2. If Contract Owner will be a Trust give EXACT name of Trust
------------
3. Type of contract applied for:
/ / Group Accumulation Annuity
/ / Group Deposit Administration
4. Until further notice, the allocation of contributions to the Separate
Account and the General Account shall be:
To Separate Account____________%
To General Account ____________%
/ / Optional (for Group Accumulation Annuity Contract only)
Each participant may elect the % allocation.
5. Effective Date requested
-------------------------------------------------
Page 15
(16107 Rev. 3-70)
6. SPECIFICATIONS OF THE PLAN: If Contract Owner is Employer, complete all
items on Plan Specification Form 17171 and submit with this application.
If Contract Owner is a Trust, submit executed copy of Trust Agreement.
This application will be superseded by a final application to be made by
the Contract Owner when the contract is delivered and its terms accepted.
IT IS UNDERSTOOD THAT ALL PAYMENTS AND VALUES OF ANY CONTRACT ISSUED, WHEN BASED
ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT
GUARANTEED AS TO FIXED DOLLAR AMOUNT. RECEIPT OF A CURRENT VARIABLE ANNUITY
PROSPECTUS FOR MINNESOTA MUTUAL VARIABLE FUND D IS HEREBY ACKNOWLEDGED.
Signed at______________________________this date_____________________________
I certify that a current prospectus was delivered, ___________________________
and that no written sales materials other than (Contract Owner)
those furnished by the Home Office were used.
By
------------------------
Title
-----------------------
------------------------------ ------------
Registered Representative Code
--------------------------------------------------------------------------------
-------------------------------------------------------------------------------
FOR HOME OFFICE USE ONLY
Accepted by_______________________ Date_____________________Contract No._______
F. 17170 5-70
Page 16
(16107 Rev. 3-70)
APPLICATION
IS ▇▇▇▇▇▇ MADE TO
THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
VICTORY SQUARE, SAINT ▇▇▇▇, MINNESOTA
for Contract Number____________________. Said contract is hereby approved and
the terms thereof are hereby accepted.
This application is executed in duplicate, one copy being attached to said
contract and the other being returned to The Minnesota Mutual Life Insurance
Company.
It is agreed that this application supersedes any previous application for the
said contract.
Executed at_______________________________________Date_________________________
For___________________________________________________________the Contract Owner
By____________________________Title___________________________________________
_____________________________________ _______ _____________________________
Signature of Registered Representative Code Broker-Dealer
F. 16847 Rev. 3-70
GROUP DEPOSIT ADMINISTRATION CONTRACT
VARIABLE ANNUITY BENEFITS--FIXED DOLLAR
ANNUITY BENEFITS--PARTICIPATING
NO INDIVIDUAL ALLOCATION--NON-CONTRIBUTORY
The owner is hereby notified that by virtue of his Policy he is a member of The
Minnesota Mutual Life Insurance Company, and that the annual Meetings of said
Company are held at its Home Office on the first Tuesday in March of each year
at three o'clock in the afternoon.
THE MINNESOTA MUTUAL LIFE INSURANCE COMPANY
▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇
▇▇▇▇▇▇▇▇▇ IN 1880
F. 16107 Rev. 3-70
Page 17
(16107 Rev. 3-70)
Page 18
(16107 Rev 3-70)
