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SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM N-8B-2
REGISTRATION STATEMENT OF UNIT INVESTMENT
TRUSTS WHICH ARE CURRENTLY
ISSUING SECURITIES
PURSUANT TO SECTION 8(B) OF THE
INVESTMENT COMPANY ACT OF 1940
CG CORPORATE INSURANCE VARIABLE LIFE SEPARATE ACCOUNT 02
OF
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
ISSUER OF PERIODIC PAYMENT PLAN CERTIFICATES
ONLY FOR PURPOSES OF INFORMATION PROVIDED HEREIN
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ORGANIZATION AND GENERAL INFORMATION
1. (a)Furnish name of the trust and the Internal Revenue Service Employer
Identification Number.
CG Corporate Insurance Variable Life Separate Account 02 of Connecticut
General Life Insurance Company ("Account"). The Account has no Internal
Revenue Service Employer Identification number.
(b)Furnish title of each class or series of securities issued by the trust.
Flexible Premium Variable Life Insurance Policies ("Policies"). Policy
provisions may vary in some states to comply with applicable law.
2. Furnish name and principal business address and ZIP Code and the Internal
Revenue Service Employer Identification Number of each depositor of the
trust.
Connecticut General Life Insurance Company ("Company")
900 Cottage Grove Road
Bloomfield, CT 06002
Internal Revenue Service Employer
Identification Number: 06-0303370
3. Furnish name and principal business address and ZIP Code and the Internal
Revenue Service Employer Identification Number of each custodian or trustee
of the trust indicating for which class or series of securities each
custodian or trustee is acting.
Not applicable.
4. Furnish name and principal business address and ZIP Code and the Internal
Revenue Service Employer Identification Number of each principal underwriter
currently distributing securities of the trust.
CIGNA Financial Advisors, Inc. ("CFA")
900 Cottage Grove Road
Bloomfield, CT 06002
Internal Revenue Service Employer
Identification Number: 06-0841987
5. Furnish name of state or other sovereign power, the laws which govern with
respect to the organization of the trust.
Connecticut.
6. (a)Furnish the dates of execution and termination of any indenture or
agreement currently in effect under the terms of which the trust was
organized and issued or proposes to issue securities.
The Account was established under Connecticut law pursuant to a
resolution of the Board of Directors of the Company dated February 23,
1996. The Account will continue in existence until the Company's Board of
Directors directs that it be terminated.
(b)Furnish the dates of execution and termination of any indenture or
agreement currently in effect pursuant to which the proceeds of payments
on securities issued or to be issued by the trust are held by the
custodian or trustee.
Not applicable.
7. Furnish in chronological order the following information with respect to
each change of name of the trust since January 1, 1930.
Not applicable.
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8. State the date on which the fiscal year of the trust ends.
December 31.
MATERIAL LITIGATION
9. Furnish a description of any pending legal proceedings, material with
respect to the security holders of the trust by reason of the nature of the
claim or the amount thereof, to which the trust, the depositor, or the
principal underwriter is a party or of which the assets of the trust are the
subject, including the substance of the claims involved in such proceeding
and the title of the proceeding. Furnish a similar statement with respect to
any pending administrative proceeding commenced by a governmental authority
or any such proceeding or legal proceeding known to be contemplated by a
governmental authority. Include any proceeding which, although immaterial
itself, is representative of, or one of, a group which in the aggregate is
material.
No such legal or administrative proceedings are pending. No legal or
administrative proceedings are known to be contemplated by a governmental
authority.
II.
GENERAL DESCRIPTION OF THE TRUST
AND SECURITIES OF THE TRUST
GENERAL INFORMATION CONCERNING THE SECURITIES
OF THE TRUST AND THE RIGHTS OF HOLDERS
10. Furnish a brief statement with respect to the following matters for each
class or series of securities issued by the trust:
(a)Whether the securities are of the registered or bearer type.
The Policies which are to be issued are of the registered type, insofar
as the Policies are personal to the owners of the Policies
("policyowners"), and the records concerning the policyowners are
maintained by or on behalf of the Company.
(b)Whether the securities are of the cumulative or distributive type.
The Policies are of the cumulative type, providing for no distribution of
income, dividends, or capital gains. Such amounts are not separately
identifiable but are reflected in the accumulation value and may be
reflected in the death benefit under a Policy at any time.
(c)The rights of security holders with respect to withdrawal or redemption.
A Policy may be cancelled within the right-to-examine period in
accordance with applicable state law. In most states, the Policy must be
returned within the later of (i) 10 days after receipt by a policyowner
of it and the Company's notice to the policyowner of this right or (ii)
45 days after the application for insurance is signed by the applicant
and mailed or delivered to the Company or its representative. If the
Policy is cancelled in a timely fashion, the Company will refund the
premiums paid, without interest, unless state law requires otherwise. The
initial premium is held in the Money Market Fund of the Account and not
allocated to the other Funds of the Account even if the policyowner so
directed until three days following expiration of the right-to-examine
period. Refunds will usually occur within seven days of notice of
cancellation although a refund of premiums paid by check may be delayed
until the check clears a policyowner's bank.
At any time before the death of the insured, a policyowner may totally or
partially surrender a Policy by sending a written request to the Company
at its Corporate
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Variable Products Service Center (the "Center"). The amount of a partial
surrender may be no less than the minimum amount set forth in the Policy,
currently $500, and not more than 90% of the Accumulation value, less any
outstanding loan balance, at the end of the valuation period in which the
election becomes or would become effective. The amount available for
surrender is the Accumulation Value, less any outstanding loan balance,
plus any premium loan credits, at the end of the valuation period during
which the surrender or request is received at the Center. Accumulation
Value in the Account available for surrender on any given valuation day
reflects total net premiums (premiums paid less a premium load of 3.5% to
cover applicable state and federal taxes, and 3.0%, plus 40% of the first
year premium up to the SEC Guideline Premium Amount, to cover sales load.
In addition, a premium load equal to 25% of the increase in Specified
Amount will be deducted from premiums received during the 12 months
following the increase) allocated to the Account, investment performance
through the date of the request, other charges incurred in connection
with a Policy, and any partial surrenders. If the Policy is totally
surrendered during the first 12 months after issue a credit will be paid
equal to 60% of all premium loads previously deducted. If the Policy is
totally surrendered during the months 13 through 24, the credit will
equal 30% of all premium loads previously deducted. No partial surrender
will be permitted which would result in a specified amount lower than the
then current minimum for which a Policy would be issued. The Accumulation
Value will vary daily. The method for calculating Accumulation Value is
described in Item 10(i)(3).
If a Policy is being totally surrendered, it must be returned to the
Company along with the request. Any unpaid charges and indebtedness,
together with applicable surrender credits, will be deducted from or
added to the Accumulation Value.
Payment of a Policy's Accumulation Value, plus applicable surrender
credits and transaction charges, in connection with a partial or full
surrender, respectively, will normally occur within seven (7) days after
receipt of a written request. Payment may be postponed whenever: (i) the
New York Stock Exchange is closed, other than customary week-end and
holiday closings, or trading on the New York Stock Exchange is restricted
as determined by the Securities and Exchange Commission ("Commission");
(ii) the Commission by order permits postponement for the protection of
policyowners; (iii) an emergency exists, as determined by the Commission,
as a result of which disposal of securities is not reasonably practicable
or it is not reasonable practicable to determine the value of the
Account's assets.
A policyowner may elect to have the surrender amount paid in a lump sum
or under one of the settlement options referred to in Item 10(i)(7). Upon
the death of the insured, the designated beneficiary is entitled to
receive the death benefit under a Policy. The death benefit is described
in Item 10(i)(2).
See Item 13 for a discussion of applicable surrender charges.
(d)The rights of security holders with respect to conversion, transfer,
partial redemption, and similar matters.
At any time within 24 months of the issuance of a Policy, the policyowner
may convert a Policy to a flexible premium adjustable life insurance
policy then being offered by the Company's Corporate Insurance
Department, providing benefits which do not depend on the investment
experience of a separate account. The new policy will have, at the
policyowner's election, the same specified amount or the same net amount
at risk (death benefit less Accumulation Value) as the Policy as well as
the same issue age, policy date and rate class as the Policy. No evidence
of insurability is required for such an exchange unless the election of
the policyowner results in an increase in the net amount at risk.
A policyowner may obtain policy loans, as described in Item 21.
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A policyowner may make surrenders, as described in Item 10(c), subject to
a $25 transaction charge on a partial surrender or applicable surrender
credits on a total surrender, as described in Item 13.
A policyowner may allocate net premiums (premiums paid less the premium
load described above) among (a) the sub-accounts of the Account (the
"Sub-Accounts") and (b) the Fixed Account, as described in Item 15.
Transfers among the Sub-Accounts are permitted subject to certain
conditions. Up to 20% of Policy values in the Fixed Account may be
transferred in a policy year to one or more of the Sub-Accounts. If the
total amount held in the Fixed Account is less than $5,000, the total
balance may be transferred to one or more of the Sub-Accounts. However,
such transfers from the Fixed Account are only allowed within the 30-day
period following a policy anniversary. Transfers to the Fixed Account
from one or more of the Sub-Accounts may be made within the 30 days prior
to each policy anniversary. The first 4 transfers in a policy year are
free of any transfer charge. A $25 transfer charge will be imposed for
the fifth and each subsequent transfer in a policy year. Transfers
resulting from policy loans and the exercise of conversion rights will
not be subject to any charge and will not count against the number of
free transfers. The Company will implement all transfers and determine
all values at the end of the valuation period during which the transfer
request is received and recorded. The Company may, at any time, revoke or
modify the transfer privilege.
(e)If the trust is the issuer of periodic plan certificates, the substance
of the provisions of any indenture or agreement with respect to lapses or
defaults by security holders in making principal payments, and with
respect to reinstatement.
The duration of a Policy depends upon the surrender value. Except as
noted below, a Policy will lapse only when the surrender value is
insufficient to cover the monthly deduction on the monthly anniversary
day.
If the surrender value is insufficient to cover the monthly deduction,
the Company will notify a policyowner of the minimum payment needed to
keep the Policy in force. A policyowner will have a grace period of 61
days for the Company to receive sufficient payments. The notice will be
sent at least 31 days before the end of the grace period. If the Company
does not receive a sufficient payment within the grace period, lapse of
the Policy will result. If a sufficient payment is received during the
grace period, any resulting net premium will be allocated among the
Sub-Accounts and the Fixed Account based on the most recent previous
premium payment, unless the Company is instructed otherwise, and any
monthly deductions due will be charged to the Sub-Accounts and the Fixed
Account.
The Company will allow reinstatement at any time within the Insured's
lifetime; reinstatement will require evidence of insurability, and the
payment of an amount which will keep the Policy in force for at least two
months.
(f)The substance of the provisions of any indenture or agreement with
respect to voting rights, together with the names of any persons other
than security holders given the right to exercise voting rights
pertaining to the trust's securities or the underlying securities and the
relationship of such persons to the trust.
To the extent required by law, the Company will vote the shares of the
various mutual funds held in the Account (the "Funds") at regular and
special shareholder meetings of the Funds in accordance with instructions
received from persons having voting interest in the corresponding
Sub-Accounts. If, however, the Investment Company Act of 1940
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("1940 Act") or any regulation thereunder would be amended or if the
present interpretation thereof should change, and as a result the Company
determines that it is permitted to vote the Fund(s) shares in its own
right, it may elect to do so.
The number of votes which a policyowner has the right to instruct will be
calculated separately for each Sub-Account. This number will be
determined by dividing the Policy's Accumulation Value in a Sub-Account
by the net asset value per share of the corresponding Fund. In
determining the number of votes, fractional shares will be recognized.
The number of votes that a policyowner has the right to instruct will be
determined as of the date coincident with the date established by the
Appropriate Trust for determining shareholders eligible to vote at the
meeting of the Fund, but not more than 60 days before the meeting of the
Fund. Voting instructions will be solicited by written communication at
least 14 days prior to such meeting in accordance with procedures
established by the Fund. Each person having a voting interest in the Fund
will receive appropriate proxy materials and reports.
The Company will vote the Fund shares as to which no timely instructions
are received in proportion to the voting instructions from others with an
interest in the particular Sub-Account. Voting instructions to abstain on
any item to be voted upon will be applied to reduce the votes eligible to
be cast by the Company.
The Company may, if required by State insurance regulatory authorities,
disregard voting instructions if the instructions require that the shares
be voted so as to cause a change in the sub-classification or investment
objectives of the Fund or to approve or disapprove an investment advisory
contract for a Fund. A change would be disapproved only if the proposed
change is contrary to state law or prohibited by state regulatory
authorities or we determine that the change would have an adverse effect
on the Sub-Account in that the proposed investment policy for a Fund may
result in overly speculative or unsound investments. In the event the
Company disregards voting instructions, a summary of that action and the
reasons for such action will be included in the next annual report to
policyowners.
(g)Whether security holders must be given notice of any change in:
(1) the composition of the assets of the trust.
The Company reserves the right, subject to compliance with
applicable law:
(i) to make additions to, deletions from, or substitutions for the
Fund shares that are held or purchased by the Account;
(ii) to eliminate the shares of any Fund and to substitute shares of
another open-end, registered investment company, if the shares
of that Fund are no longer available for investment, or if in
its judgment further investment in that Fund should become
inappropriate in view of the investment objectives of the
Account;
(iii) to eliminate one or more Sub-Accounts, if, in its sole
discretion, marketing, tax or investment conditions warrant;
(iv) to operate the Account as a management company under the 1940
Act;
(v) to deregister the Account under the 1940 Act in the event such
registration is no longer required; and
(vi) to combine the Account with one or more of the Company's other
separate accounts as may be established.
In no event will any of the changes described above be made without
notice to policyowners in accordance with the 1940 Act and without
obtaining, as necessary, prior approval of the Commission.
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(2) the terms and conditions of the securities issued by the trust.
No changes in the terms and conditions of a Policy that affect a
policyowner's rights will be made without notice to the policyowner.
(3) the provisions of any indenture or agreement of the trust.
Not applicable.
(4) the identity of the depositor, trustee or custodian.
The Account has no trustee or custodian. There is no provision
requiring notice to, or consent of, security holders, with respect
to a change in the identity of the depositor.
(h)Whether the consent of security holders is required in order for action
to be taken concerning any change in:
(1) the composition of the assets of the trust.
Consent of policyowners is not required when changing the underlying
securities of the Account. However, to change such securities,
approval of the Commission is required by Section 26(b) of the 1940
Act. Except as required by Federal or State law or regulation, no
action will be taken by the Company which will adversely affect the
rights of policyowners without their consent.
(2) the terms and conditions of the securities issued by the trust.
No changes in the terms and conditions of a Policy that affect a
policyowner's rights will be made without notice to the policyowner.
The Company reserves the right to amend the Policy without
policyowner consent as may be necessary to comply with applicable
law.
(3) the provisions of any indenture or agreement of the trust.
Not applicable.
(4) the identity of the depositor, trustee or custodian.
See Item 10(g)(4).
(i)Any other principal feature of the securities issued by the trust or any
other principal right, privilege or obligation not covered by
subdivisions (a) to (g) or by any other item in this form.
(1) PREMIUM PAYMENTS. The policyowner may make premium payments in any
amount and at any frequency, subject to the basic premium
requirements and certain restrictions stated in the Policy.
A policyowner may also determine a planned periodic premium payment
schedule that provides for the payment of a level premium at a fixed
interval for a specified period of time. A policyowner need not make
premium payments in accordance with such planned periodic premium
schedule and the failure to make a planned payment will not itself
cause a Policy to lapse. A policyowner may make unscheduled premium
payments subject to restrictions listed in the Policy.
A load of 3.5% for state and federal taxes and 3.0% for sales
charges will be deducted from each premium payment. In addition,
40.0% of the first year premium up to one SEC Guideline Premium
Amount will be deducted for sales load. In the event that the
Specified Amount under the Policy is increased, a premium load of
25% of the increase in the SEC Guideline Premium Amount will be
applied to
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premiums received during the 12 months following the increase. See
Item 13. Additional net premium payments (premium payments net of
that load) made by a policyowner while there is indebtedness will be
treated first as loan repayments.
In the application for a Policy, a policyowner can allocate net
premiums (total premium less premium load) among the Sub-Accounts
and the Fixed Account. The net premium will be allocated on the
first valuation day following the expiration of the right-to-examine
period (see Item 10(c)) in accordance with the directions in the
application. Net premiums paid after the issue date will be
allocated in accordance with the policyowner's instructions in the
application. Percentages must be in whole numbers, with at least 10%
allocated to a particular Sub-Account or the Fixed Account. The
allocation for future net premiums may be changed at any time once
the Company receives written notification from the policyowner at
the Center.
(2) GENERAL DESCRIPTION OF BASIC POLICY BENEFITS. (A) DEATH
BENEFIT. As long as the Policy remains in force, the Company will,
upon receipt of proof of the insured's death, pay the death benefit
proceeds of the Policy, reduced by any outstanding indebtedness and
due and unpaid charges, to the named beneficiary in accordance with
the designated death benefit option. Death benefits will be
determined at the end of the valuation period during which the
insured dies. The proceeds may be paid in a lump sum or under one or
more of the settlement options which may be added by rider.
The Policies provide three death benefit options: Death Benefit
Option A ("Option A"), Death Benefit Option B ("Option B") and Death
Benefit Option C ("Option C"). Generally, a policyowner designates
the death benefit option in the application. Absent such a
designation, Option B is in effect. The death benefit under Option B
is the greater of the specified amount of the Policy or a specified
percentage (the "corridor percentage") times the Accumulation Value
(in the latter case, the Policy would be "in the Corridor"). The
death benefit under Option A is equal to the greater of the
specified amount plus the Accumulation Value of the Policy or the
corridor percentage times the Accumulation Value. The death benefit
under Option C is equal to the greater of the specified amount plus
the sum of premiums paid or the corridor percentage times the
Accumulation Value.
(b) SPECIFIED AMOUNT. A policyowner may increase or decrease the
specified amount. For any increase, we will require satisfactory
evidence of insurability. The effective date of the increase will be
the monthly anniversary day on or following approval of the increase
by the Company. No decrease may reduce the specified amount to less
than the then current minimum for this type of Policy. Any decrease
will be applied first to the most recent coverage under the Policy,
then to the next most recent, and so forth.
Generally, the death benefit option in effect may be changed by
sending a written request for change to the Center. The death
benefit may not be changed if it would result in a specified amount
less than the minimum specified amount then allowed by the Company
(currently $50,000). The effective date of any change will be the
monthly anniversary day on or following receipt of the request.
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The specified amount will be changed when a change in death benefit
option is made. If the change is from Option B to Option A, the new
specified amount will equal the Death Benefit, less the Accumulation
Value. If the change is from Option B to Option C, the new specified
amount will equal the death benefit less premiums paid as of the
effective date of the change. If the change is from Option A to
Option B, the new specified amount will equal the death benefit as
of the date of the change. If the change is from Option A to Option
C, the new specified amount will equal the death benefit less
premiums paid as of the effective date of the change. If the change
is from Option C to Option B, the new specified amount will equal
the death benefit as of the effective date of the change. If the
change is from Option C to Option A, the new specified amount will
equal the Death Benefit less the Accumulation Value.
(3) CALCULATION OF EACH SUB-ACCOUNT'S VALUE. When the initial premium
has been paid, the Policy's value in a Sub-Account will equal the
portion of the net premium allocated to the Sub-Account reduced by
the portion of the first monthly deduction allocated to that
Sub-Account.
Thereafter, on each valuation day, the Policy's account value in
each Sub-Account will equal:
(a) The Policy's Accumulation Value in the Sub-Account on the
preceding valuation day, multiplied by the net investment factor
for the current valuation period; plus
(b) Any net premium payments received during the current valuation
period which are allocated to the Sub-Account; plus
(c) All account values transferred to the Sub-Account from the Fixed
Account or Loan Account or from another Sub-Account during the
current valuation period; minus
(d) All account values transferred from the Sub-Account to the Fixed
Account or Loan Account or to another Sub-Account during the
current valuation period; minus
(e) All partial surrenders from the Sub-Account during the current
valuation period; minus
(f) The portion of the monthly deduction allocated to the
Sub-Account during the current valuation period.
A Policy's Accumulation Value equals the sum of a Policy's value in
each Sub-Account plus the Policy's Fixed Account Value, plus the
Loan Account Value. Because Accumulation Value is dependent upon a
number of variables, including the investment experience of the
chosen Fund(s), the frequency and amount of premium payments,
transfers and surrenders, and charges assessed in connection with
the Policy, the Policy's Accumulation Value cannot be predetermined.
(4) INVESTMENT PERFORMANCE. The net investment factor measures
investment performance during a valuation period. Each Sub-Account
has its own distinct net investment factor. In calculating the
Sub-Account's net investment factor for a valuation period, the net
asset value for each share of the Fund in that Sub-Account at the
end of the current valuation period is increased by the amount of
the Sub-Account's share of any dividend or capital gain distribution
declared during the current valuation period and decreased by a
charge for taxes. The total is then divided by the net asset value
at the end of the preceding valuation period. A charge equivalent to
an annual rate of as much as .90% (but initially .85% during the
first
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ten policy years, .35% in policy years eleven through fifteen and
.05% thereafter) of the net daily assets for each day in the
valuation period is subtracted to compensate the Company for certain
mortality and expense risks. An additional charge equivalent to an
annual rate of as much as .30% (but initially .10%) of the net daily
assets for each day in the valuation period is subtracted to
compensate the Company for certain administrative expenses.
(5) LOAN PROVISIONS. See Item 21.
(6) PAYMENT OF BENEFITS. Death benefits will be determined at the end
of the valuation period during which the insured dies and will
ordinarily be paid within seven days after the Company receives due
proof of death. Payment of the benefits under the Policy may be
postponed whenever: (i) the New York Stock Exchange is closed other
than customary week-end and holiday closings, or trading on the New
York Stock Exchange is restricted as determined by the Commission;
(ii) the Commission by order permits postponement for the protection
of policyowners; or (iii) an emergency exists, as determined by the
Commission, as a result of which disposal of securities held by the
sub-account is not reasonably practicable or it is not reasonably
practicable to determine the value of the Account's net assets.
(7) SETTLEMENT OPTIONS. The benefits under a Policy will be paid in a
lump sum. Settlement options may be added to the Policy with a rider
which permits the Policyowners and beneficiaries, subject to a prior
action of the Policyowner, to decide the form in which the benefits
will be paid. The settlement options include: payments for a fixed
period; life income with a guaranteed fixed period; interest only;
and a fixed amount.
(8) OPTIONAL INSURANCE BENEFIT. Subject to certain requirements,
optional insurance benefits may be added to a Policy by rider. These
optional benefits include Early Withdrawal, Suicide Waiver,
Accelerated Death Benefit, Additional Insurance Benefit and Exchange
of Life. The cost of these optional insurance benefits, if any, will
be deducted as part of the monthly deduction.
INFORMATION CONCERNING THE SECURITIES UNDERLYING THE TRUST'S SECURITIES
11. Describe briefly the kind or type of securities comprising the unit of
specified securities in which security holders have an interest. (If the
unit consists of a single security issued by an investment company, name
such investment company and furnish a description of the type of securities
comprising the portfolio of such investment company.)
The Account invests, at the policyowner's option, in securities of one or
more of the Funds (see Item 10(f)), each of which is a mutual fund
registered with the Commission as an open-end diversified management
company. Each Sub-Account invests solely in shares of one of the sixteen
Funds. Each Fund is a series or portfolio of a Delaware or Massachusetts
business trust registered under the 1940 Act. See Item 12(a). The sixteen
Funds and their investment objectives are as follows:
ALGER AMERICAN SMALL CAP PORTFOLIO: Seeks long-term capital appreciation by
investing in a diversified, actively managed portfolio of equity securities,
primarily of companies with total market capitalization of less than $1
billion.
ALGER AMERICAN MIDCAP GROWTH PORTFOLIO: Seeks long-term capital
appreciation by investing in a diversified, actively managed portfolio of
equity securities, primarily of companies with total market capitalization
between $750 million and $3.5 billion.
ALGER AMERICAN GROWTH PORTFOLIO: Seeks long-term capital appreciation by
investing in a diversified, actively managed portfolio of equity securities,
primarily of companies with total market capitalization of $1 billion or
greater.
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CIGNA VARIABLE PRODUCTS MONEY MARKET FUND: Seeks to provide as high a level
of current income as is consistent with the preservation of capital and
liquidity and the maintenance of a stable $1.00 per share net asset value by
investing in short-term money market instruments.
FIDELITY HIGH INCOME PORTFOLIO: Seeks high current income by investing
primarily in all types of income-producing debt securities, preferred
stocks, and convertible securities.
FIDELITY EQUITY-INCOME PORTFOLIO: Seeks reasonable income by investing
primarily in income-producing equity securities, with some potential for
capital appreciation, seeking to exceed the composite yield on the
securities comprising the Standard and Poor's 500 Composite Stock Price
Index.
FIDELITY INVESTMENT GRADE BOND PORTFOLIO: Seeks high current income by
investing primarily in fixed-income securities such as bonds, notes and
debentures.
FIDELITY INDEX 500 PORTFOLIO: Seeks to match the total return of the
Standard and Poor's 500 Composite Stock Price Index while keeping expenses
low. The fund will normally have 80% of its assets invested in the equity
securities of companies that compose the S&P 500.
JANUS ASPEN SERIES SHORT TERM BOND PORTFOLIO: Seeks a high level of current
income while minimizing interest rate risk by investing in shorter term
fixed-income securities.
JANUS ASPEN SERIES WORLDWIDE GROWTH PORTFOLIO: Seeks long-term growth of
capital by investing primarily in common stocks of foreign and domestic
issuers.
MFS EMERGING GROWTH PORTFOLIO: Seeks to provide long-term growth of capital
by investing in common stocks of small and medium-sized companies which have
the potential for growth.
MFS TOTAL RETURN PORTFOLIO: Seeks primarily to provide above average income
(compared to a portfolio entirely invested in equity securities) consistent
with the prudent employment of capital and secondarily to provide a
reasonable opportunity for growth of capital and income.
TEMPLETON INTERNATIONAL FUND: Seeks long-term capital growth through a
flexible policy of investing in stocks and debt obligations of companies and
governments outside the United States.
OCC ACCUMULATION TRUST SMALL CAP PORTFOLIO: Seeks capital appreciation
through investments in a diversified portfolio of equity securities of
companies with market capitalization of under $1 billion.
OCC ACCUMULATION TRUST MANAGED PORTFOLIO: Seeks growth of capital over time
through investment in a portfolio of common stocks, bonds and cash
equivalents, the percentage of which will vary based on management's
assessment of relative investment values.
OCC ACCUMULATION TRUST EQUITY PORTFOLIO: Seeks long-term capital
appreciation through investment in a diversified portfolio of equity
securities on the basis of a value oriented approach to investing.
12. If the trust is the issuer of periodic payment plan certificates and if any
underlying securities were issued by another investment company, furnish the
following information for each such company:
(a)Name of Company.
Alger American Fund ("Alger Trust"), managed by Fred Alger Management,
Inc., 75 Maiden Lane, New York, NY 10038;
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CIGNA Variable Products Group ("CIGNA Funds"), managed by CIGNA
Investments, Inc., 900 Cottage Grove Road, Hartford, CT 06152;
Variable Insurance Products Fund I ("Fidelity Trust I") and Variable
Insurance Products Fund II ("Fidelity Trust II"), managed by Fidelity
Management & Research Company, 82 Devonshire Street, Boston, MA 02103;
Janus Aspen Series Trust ("Janus Trust"), managed by Janus Capital
Corporation, 100 Fillmore Street, Suite 300, Denver, CO 80206-4923;
MFS Variable Insurance Trust ("MFS Trust"), managed by Massachusetts
Financial Services Company, 500 Boylston Street, Boston, MA 02116;
OCC Accumulation Trust ("Quest for Value Trust"), managed by OpCap
Advisors, One World Financial Center, New York, NY 10281;
Templeton Variable Products Series Fund ("Templeton Series"), managed by
Templeton Investment Counsel, Inc., 500 E. Broward Blvd., Broward
Financial Centre, Suite 1200, Fort Lauderdale, Florida 33394-3091.
(b)Name and principal business address of depositor.
Not applicable.
(c)Name and principal business address of trustee or custodian.
Alger Trust: Custodial Trust Company, 101 Carnegie Center, Princeton, NY
08540-6231;
Fidelity Trust I: HIGH INCOME PORTFOLIO -- The Bank of New York, New
York, NY; EQUITY INCOME PORTFOLIO -- The Chase Manhattan Bank, N.A., 1211
Avenue of the Americas, New York, NY 10036;
Fidelity Trust II: INVESTMENT GRADE BOND PORTFOLIO -- The Bank of New
York, New York, NY; INDEX 500 PORTFOLIO -- Brown Brothers Harriman & Co.,
Boston, MA;
Janus Trust: (1) Investors Fiduciary Trust Company, 127 W. 10th Street,
Kansas City, Missouri 64105, (2) United Missouri Bank, N.A., Tenth and
Grand Streets, Kansas City, Missouri 64105, (3) State Street Bank and
Trust Company, P.O. Box 351, Boston, MA 02101;
MFS Trust: Investors Bank & Trust Company, 89 South Street Boston, MA
02110;
OCC Trust: State Street Bank and Trust Company, P.O. Box 8505, Boston, MA
02266-8505;
Templeton Series: The Chase Manhattan Bank, N.A., Chase Metrotech Center,
Brooklyn, NY 11245.
(d)Name and principal business address of principal underwriter.
Alger Trust: Fred Alger & Company, Incorporated, 30 Montgomery Street,
Jersey City, NJ 07302;
CIGNA Financial Advisors, Inc., 900 Cottage Grove Road, Hartford, CT
06152;
Fidelity Trust I & II: Fidelity Distribution Corporation, 82 Devonshire
Street, Boston, MA 02109;
Janus Trust: N/A;
MFS Trust: MFS Fund Distributors, Inc., 500 Boylston Street, Boston, MA
02116;
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OCC Trust: OCC Distributors, One World Financial Center, New York, NY
10281;
Templeton Series: Franklin Templeton Distributors, Inc., P.O. Box 33030,
St. Petersburg, Florida 33733-8030.
(e)The period during which the securities of such company have been the
underlying securities.
Not applicable.
INFORMATION CONCERNING LOAD, FEES, CHARGES AND EXPENSES
13. (a)Furnish the following information with respect to each load, fee, expense
or charge to which (1) principal payments, (2) underlying securities, (3)
distributions, (4) cumulated or reinvested distributions or income, and
(5) redeemed or liquidated assets of the trust's securities are subject:
(A) the nature of such load, fee, expense or charge;
(B) the amount thereof;
(C) the name of the person to whom such amounts are paid and his
relationship to the trust;
(D) the nature of the services performed by such person in
consideration for such load, fee, expense or charge.
(1) PRINCIPAL PAYMENTS
A deduction of 3.5% of the premium will be made from each premium
payment. The deduction represents an amount the Company currently
deems sufficient to pay state taxes and federal tax liabilities. An
additional 3.0% of each premium payment, plus 40% of the first year
premium up to one SEC Guideline Premium Amount, will be deducted to
cover sales load. In the event that the Specified Amount under the
Policy is increased, a premium load of 25% of the increase in the
SEC Guideline Premium Amount will be applied to premiums received
during the 12 months following the increase.
(2) UNDERLYING SECURITIES
No load, fee, expense or charge is assessed in connection with the
purchase of the underlying securities for the Account.
(3) DISTRIBUTIONS
No load, fee, expense or charge is assessed in connection with
distributions, except for a $25 transaction fee with respect to
partial surrenders.
(4) CUMULATED OR REINVESTED DISTRIBUTIONS OR INCOME
All income and other distributions earned by each Fund are
reinvested, without charge, at net asset value in shares of the
Fund.
(5) REDEEMED OR LIQUIDATED ASSETS
For charges associated with total surrenders, see Item 13(e)(5).
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(b)For each installment payment type of periodic payment plan certificate of
the trust, furnish the following information with respect to sales load
and other deductions from principal payments.
Not applicable.
(c)State the amount of sales load as a percentage of the net amount
invested. State the amount of total deductions as a percentage of the net
amount invested for each type of security issued by the trust.
The amount of sales load will vary, depending upon the frequency and
amount of premium payments and the specified amount of the Policy.
Expressed as a percentage of premiums, the total deferred sales charge
imposed under the Policy in the event of a total surrender will not
exceed 30% of the sum of premiums paid up to one Guideline Annual
Premium, plus 10% of premium payments between one and two times one
Guideline Annual Premium, plus 9% of premium payments in excess of two
times one Guideline Annual Premium, during the first two policy years.
(d)Explain fully the reasons for any differences in the price at which
securities are offered generally to the public, and the price at which
securities are offered for any class of transactions to any class or
group of individuals, including officers, directors or employees of the
depositor, trustee, custodian or principal underwriter.
Not applicable.
(e)Furnish a brief description of any loads, fees, expenses or charges not
covered in Item 13(a) which may be paid by security holders in connection
with the trust or its securities.
(1) MORTALITY AND EXPENSE RISK CHARGE. The Company charges the
Sub-Accounts for the mortality and expense risks the Company
assumes. The charge is made daily at an effective annual rate not to
exceed .90% (initially, .85% during the first ten policy years, .35%
in Policy Years eleven through fifteen and .05% thereafter) of the
value of each Sub-Account's assets. The Company estimates that .35%
of this charge would be for mortality risks and .55% for expense
risks. The mortality risk assumed is that insureds may live for a
shorter period of time than estimated and, therefore, a greater
amount of death benefits will be payable. The expense risk assumed
is that expenses incurred in issuing and administering the Policies
will be greater than estimated.
(2) ACCUMULATION VALUE TRANSFER CHARGE. After the fourth transfer
during any one policy year, a charge of $25 will be imposed for each
transfer and deducted from the Sub-Account or Fixed Account from
which the transfer is being made.
(3) TAXES. Currently no charge is made to the Account for Federal
income taxes that may be attributable to the Account. The Company
may, however, make such a charge in the future. Charges for other
taxes, if any, attributable to the Account may also be made.
(4) MONTHLY DEDUCTION. Charges will be deducted monthly from the
Accumulation Value of each Policy to compensate the Company for
certain administrative costs, and for the cost of insurance and
optional benefits added by rider. The monthly deduction will be
deducted on each monthly anniversary day and allocated among
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<PAGE>
the funding vehicles used (Sub-Accounts and the Fixed Account) based
on the proportionate values in each funding vehicle. The monthly
charges consist of the following:
(A) MONTHLY ADMINISTRATIVE CHARGE. The Company has responsibility
for the administration of the Policy and the Account. Annual
administrative expenses include premium billing and collection,
recordkeeping, processing death benefit claims, cash surrenders
and Policy changes, reporting and overhead costs. As
reimbursement for administrative expenses related to the
maintenance of each Policy and the Account, the Company assesses
a $250 fee on the date of issue, plus a monthly administrative
fee of $8, which will not exceed the Company's costs.
Additionally, the Company will deduct an asset-based fee from
each Sub-Account and the Fixed Account. The charge will be
assessed daily at an effective annual rate not to exceed .30%
(initially .10%).
(B) COST OF INSURANCE CHARGE. Because the cost of insurance depends
upon a number of variables, this charge can vary from month to
month. The Company will determine the monthly cost of insurance
charge by multiplying the applicable cost of insurance rate by
the Net Amount at Risk for each policy month. The Net Amount at
Risk for a policy month is (a) the death benefit at the
beginning of the policy month, less (b) the Accumulation Value
at the beginning of the policy month. The Net Amount at Risk may
be affected by changes in the Accumulation Value or the
specified amount of a Policy.
The cost of insurance rate is based on gender classification,
attained age, underwriting class and years since issue. The
actual monthly cost of insurance rates will be based on the
Company's expectations as to future experience. They will not,
however, be greater than the guaranteed cost of insurance rates
set forth in the Policy. These guaranteed rates are based on the
applicable 1980 Commissioners Standard Ordinary Mortality
Table-B and the insured's attained age at the nearest birthday.
Any change in the cost of insurance rates will apply to all
persons of the same age, gender classification and underwriting
class whose Policies have been in force for the same length of
time.
(C) OPTIONAL INSURANCE BENEFITS CHARGE. The monthly deduction will
include deductions for any optional insurance benefits added to
a Policy by rider.
(5) SURRENDER CHARGE. No surrender charge will be imposed on a full or
partial surrender; however, a $25 transaction charge will be made
against the Accumulation Value.
(f)State whether the depositor, principal underwriter, custodian or trustee,
or any affiliated person of the foregoing may receive profits or other
benefits not included in answer to Item 13(a) or 13(e) through the sale
or purchase of the trust's securities or underlying securities or
interests in underlying securities, and describe fully the nature and
extent of such profits or benefits.
Neither the Company nor any affiliated person of the Company may receive
any profit or any other benefit from premium payments under the Policies
or the investments held in the Account not included in answer to Item
13(a) or (e) through the sale or purchase of the Policies or shares of
the Funds, except that (1) the Company may receive a profit to the extent
that the cost of insurance built into a Policy exceeds the actual cost of
insurance needed to pay benefits, (2) favorable mortality or expense
experience may cause the insurance provided under a Policy to be
profitable to the Company, (3) on Policy loans, the Company may derive a
profit on the difference between interest charged and interest credited;
(4) the Company will compensate certain other persons,
15
<PAGE>
including Company agents, for services rendered in connection with the
distribution of a Policy, as described in Item 38, but such payments will
be made from the Company's General Account and (5) the Company will
receive fees from the Funds or their advisers for making the Funds
available under the Policies.
(g)State the percentage that the aggregate annual charges and deductions for
maintenance and other expenses of the trust bear to the dividend and
interest income from the trust property during the period covered by the
financial statements filed herewith.
Not applicable.
INFORMATION CONCERNING THE OPERATIONS OF THE TRUST
14. Describe the procedure with respect to applications (if any) and the
issuance and authentication of the trust's securities, and state the
substance of the provisions of any indenture or agreement pertaining
thereto.
Individuals wishing to purchase a Policy must complete an application. A
Policy may only be issued upon receipt of evidence of insurability
satisfactory to the Company. Acceptance is subject to the Company's
underwriting rules and the Company reserves the right to reject any
application. The Company generally will issue a Policy only to insureds
between the ages of 18 to 75. Policies will be issued in accordance with the
state insurance laws.
Interests in the Sub-Accounts of the Account may also be acquired by
transfers, as described in Item 10(d).
15. Describe the procedure with respect to the receipt of payments from
purchasers of the trust's securities and the handling of the proceeds
thereof, and state the substance of the provisions of any indenture or
agreement pertaining thereto.
When a person applies for the Policy, that person will be asked to select
one or more of the applicable funding vehicles to which net premium payments
are to be allocated, and the applicable percentage (a whole number, at least
10%) to be allocated to each such funding vehicle. That allocation can be
changed at any time with respect to future premium payments upon receipt of
written notice at the Center at no charge. Premiums will be allocated as the
policyowner has directed. All premiums paid, after the first premium
payment, must be sent directly to the Center and will be deemed received
when actually received at the Center.
16. Describe the procedure with respect to the acquisition of underlying
securities and the disposition thereof, and state the substance of the
provisions of any indenture or agreement pertaining thereto.
On each valuation day of each Fund, the Account purchases or redeems shares
in each Fund based on a netting of all transactions for that day, including
the amount of net premiums invested in the applicable Sub-Account,
transfers, policy loans and loan repayments, surrender payments, charges,
and payment of benefits to be effected on that day.
17. (a)Describe the procedure with respect to withdrawal or redemption by
security holders.
The procedures with respect to surrenders or redemption by security
holders are described in response to Items 10 (c), (d), (e) and (i).
(b)Furnish the names of any persons who may redeem or repurchase, or are
required to redeem or repurchase, the trust's securities or underlying
securities from security holders, and the substance of the provisions of
any indenture or agreement pertaining thereto.
16
<PAGE>
The Company is required to process all surrender requests as described in
Item 10(c). Each Fund will redeem its shares upon the Company's request
in accordance with the 1940 Act. Redeemed shares are retired although
they may later be reissued if a Fund's governing documents permit.
(c)Indicate whether repurchased or redeemed securities will be canceled or
may be resold.
A Policy, once totally surrendered, may not be resold.
18. (a)Describe the procedure with respect to the receipt, custody and
disposition of the income and other distributable funds of the trust and
state the substance of the provisions of any indenture or agreement
pertaining thereto.
All dividend and capital gains distributions (if any) of the Funds will
be automatically reinvested in additional Funds shares at their net asset
value. Pursuant to the Policy, the Company will make distributions from
the Account in connection with death benefits, policy loans, and
Accumulation Value surrenders. Applicable procedures for such
distributions are described in the answers to Items 10(c), 10(i)(6), and
21.
(b)Describe the procedure, if any, with respect to the reinvestment of
distributions to security holders and state the substance of the
provisions of any indenture or agreement pertaining thereto.
Not applicable.
(c)If any reserves or special funds are created out of income or principal,
state with respect to each such reserve or fund the purpose and ultimate
disposition thereof, and describe the manner of handling of same.
Net premium payments placed in the Account constitute reserves for
benefits under the Policies.
(d)Submit a schedule showing the periodic and special distributions which
have been made to security holders during the three years covered by the
financial statements filed herewith. State for each such distribution the
aggregate amount and amount per share. If distributions from sources
other than current income have been made, identify each such other source
and indicate whether such distribution represents the return of principal
payments to security holders. If payments other than cash were made,
describe the nature thereof, the account charged and the basis of
determining the amount of such charge.
No distributions have been made.
19. Describe the procedure with respect to the keeping of records and accounts
of the trust, the making of reports and the furnishing of information to
security holders, and the substance of the provisions of any indenture or
agreement pertaining thereto.
The Company will have primary responsibility for all administration of the
Policies and the Account. The administrative services provided include
preparation of the Policies, maintenance of policyowners' records and all
accounting, valuation, regulatory and reporting services required by the
Company.
The Company will send such reports of the Account as are presently required
by the 1940 Act and regulations promulgated thereunder. The Company will
also mail to policyowners, at the last known address of record at the
Center, any reports required by state law. Each person having a voting
interest will receive proxy material, reports, and other materials relating
to the Funds.
20. State the substance of the provisions of any indenture or agreement
concerning the trust with respect to the following:
17
<PAGE>
(a)Amendments to such indenture or agreement.
Not applicable.
(b)The extension or termination of such indenture or agreement.
Not applicable.
(c)The removal or resignation of the trustee or custodian, or the failure of
the trustee or custodian to perform its duties, obligations and
functions.
Not applicable.
(d)The appointment of a successor trustee and the procedure if a successor
trustee is not appointed.
Not applicable.
(e)The removal or resignation of the depositor, or the failure of the
depositor to perform its duties, obligations and functions.
The Company acts as depositor. There are no provisions relating to the
removal or resignation of the depositor or the failure of the depositor
to perform its duties, obligations and functions.
(f)The appointment of a successor depositor and the procedure if a successor
depositor is not appointed.
There are no provisions relating to the appointment of a successor
depositor and the procedure if a successor depositor is not appointed.
21. (a)State the substance of the provisions of any indenture or agreement with
respect to loans to security holders.
So long as the Policy remains in force, a policyowner may borrow money
from the Company using a Policy as the only security for the loan. The
maximum amount that may be borrowed is 100% of the surrender value at the
time of the loan, but the Company reserves the right to limit total
indebtedness to an amount which is 90% of the Accumulation Value. The
loan may be repaid in whole or in part at any time while the Policy is in
force. The minimum loan repayment is $100 or, if less, the amount of
indebtedness.
An amount equal to the loan plus interest will be withdrawn from the
funding vehicles being used in proportion to the value of each funding
vehicle, and transferred to the Loan Account until the loan is repaid.
The interest rate charged on policy loans will be at the rate of 5% per
year in arrears. If unpaid when due, interest will be added to the amount
of the loan and will become part of the loan and bear interest at the
same rate.
The Loan Account will be credited with interest which may vary, but will
not be less than the loan interest rate less 1.20% per year.
Indebtedness equals the total of all policy loans and accrued interest on
the loans. If at any time indebtedness exceeds the Accumulation Value
plus applicable surrender credits, a grace period will begin, and the
Company will notify a policyowner and any assignee of record at least 31
days before the end of the grace period. If a sufficient payment to
eliminate such excess indebtedness is not received by the Company within
61 days after the grace period begins, the Policy will lapse and
terminate without value. The Policy, however, may later be reinstated
subject to certain conditions.
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<PAGE>
Indebtedness may be repaid any time while the Policy is in force.
Additional net premium payments made by the policyowner while there is
indebtedness will be applied first to reduce indebtedness. If not repaid,
the Company may deduct indebtedness from any amount payable under the
Policy. As indebtedness is repaid, the value in the Loan Account securing
the indebtedness will be transferred from the Loan Account to the
Sub-Accounts and, if applicable, the Fixed Account in the same proportion
in which net premium payments are then being allocated, at the end of the
valuation period during which the repayment is received. However, the
Company reserves the right to require that amounts loaned from the Fixed
Account be allocated to the Fixed Account loan repayment.
(b)Furnish a brief description of any procedure or arrangement by which
loans are made available to security holders by the depositor, principal
underwriter, trustee or custodian, or any affiliated person of the
foregoing.
The portion of a Policy loan attributable to the Sub-Accounts will
normally be paid within seven days after receipt of written request. The
Company may postpone payment of any such policy loan whenever: (i) the
New York Stock Exchange is closed other than customary weekend and
holiday closings, or trading on the New York Stock Exchange is restricted
as determined by the Commission; (ii) the Commission by order permits
postponement for the protection of policyowners; (iii) an emergency
exists, as determined by the Commission, as a result of which disposal of
securities is not reasonably practicable or it is not reasonably
practicable to determine the value of any Sub-Account's net assets. In
addition, the Company may delay the payment of policy loans secured by
Accumulation Value that the policyowner paid by check until such time as
the check has cleared a policyowner's bank.
See also paragraph (a) of this Item.
(c)If such loans are made, furnish the aggregate amount of loans outstanding
at the end of the last fiscal year, the amount of interest collected
during the last fiscal year allocated to the depositor, principal
underwriter, trustee or custodian or affiliated person of the foregoing
and the aggregate amount of loans in default at the end of the last
fiscal year covered by financial statements filed herewith.
Not applicable.
22. State the substance of the provisions of any indenture or agreement with
respect to limitations on the liabilities of the depositor, trustee or
custodian, or any party to such indenture or agreement.
There are no such provisions.
23. Describe any bonding arrangement for officers, directors, partners or
employees of the depositor or principal underwriter of the trust, including
the amount of coverage and the type of bond.
A blanket bond for $10 million covers all of the officers and employees of
the Company.
24. State the substance of any other material provisions of any indenture or
agreement concerning the trust or its securities and a description of any
other material functions or duties of the depositor, trustee or custodian
not stated in Item 10 or Items 14 to 23 inclusive.
INCONTESTABILITY. The Company cannot contest the Policy as to the initial
specified amount after it has been in force during the lifetime of the
insured for two years from the issue date. A new two year contestability
period will apply to each increase in specified amount beginning on the
effective date of each such increase and will apply to material
misrepresentations made in the application for the increase. If the Policy
is reinstated, a new two year
19
<PAGE>
contestability period (apart from any remaining contestability period) will
apply from the date of the application for reinstatement and will apply only
to statements made in the application for reinstatement.
SUICIDE. If the Insured commits suicide, while sane or insane, within two
years from the issue date, the only benefit paid will be the sum of: a)
premiums paid, minus the amount of any partial surrenders, minus any
outstanding loan balance. In the event of lapse of a Policy, the suicide
period will be measured from the effective date of reinstatement. If the
insured, while sane or insane, commits suicide within two years after the
effective date of any increase in insurance or any reinstatement, the
Company's total liability with respect to such increase or reinstatement
will be a refund of the monthly charges for its cost of insurance.
MISSTATEMENT OF AGE. If the age of the insured is misstated, the death
benefit will be adjusted based on what the cost of insurance charge for the
most recent monthly deduction would have purchased based on the correct age.
III.
ORGANIZATION, PERSONNEL AND AFFILIATED PERSONS
OF DEPOSITOR
ORGANIZATION AND OPERATIONS OF DEPOSITOR
25. State the form or organization of the depositor of the trust, the name of
the state or other sovereign power under the laws of which the depositor was
organized and the date of organization.
The Company was incorporated under the laws of Connecticut in 1865.
26. (a)Furnish the following information with respect to all fees received by
the depositor of the trust in connection with the exercise of any
functions or duties concerning securities of the trust during the period
covered by the financial statements filed herewith.
Not applicable.
(b)Furnish the following information with respect to any fee or any
participation in fees received by the depositor from any underlying
investment company or any affiliated person or investment adviser of such
company.
Pursuant to Fund Participation Agreements with the investment advisers to
the Trusts, the depositor anticipates receiving fees of as much as .20%
per year from the advisers or their affiliated persons for providing
certain services such as individual contract recordkeeping.
27. Describe the general character of the business engaged in by the depositor
including a statement as to any business other than that of depositor of the
trust. If the depositor acts or has acted in any capacity with respect to
any investment company or companies other than the trust, state the name or
names of such company or companies, their relationship, if any, to the
trust, and the nature of the depositor's activities therewith. If the
depositor has ceased to act in such named capacity, state the date of and
circumstance surrounding such cessation.
The Company is principally engaged in offering group and individual life and
health insurance policies and annuity contracts. It is licensed to do
business in 50 states, the District of Columbia and Puerto Rico. The Company
is also the depositor of four other of its separate accounts registered with
the Commission as unit investment trusts which fund or will fund variable
annuity contracts or variable life insurance policies of the Company.
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<PAGE>
OFFICIALS AND AFFILIATED PERSONS OF DEPOSITOR
28. (a) Furnish as at latest practicable date the following information with
respect to the depositor of the trust, with respect to each officer,
director, or partner of the depositor, and with respect to each natural
person directly or indirectly owning, controlling or holding with power
to vote 5% or more of the outstanding voting securities of the
depositor.
(i) name and principal business address;
(ii) nature of relationship or affiliation with depositor or the trust;
(iii) ownership of all securities of the depositor;
(iv) ownership of all securities of the trust;
(v) other companies of which each person named above is presently
officer, director or partner.
See the table below. See also Item 29.
(b)Furnish a brief statement of the business experience during the last five
years of each officer, director or partner of the depositor.
DIRECTORS AND OFFICERS OF THE COMPANY
The following persons are Directors and officers of the Company. The
address of each is 900 Cottage Grove Road, Hartford, CT 06152 and each
has been employed by the Company or its affiliates for more than five
years except Mr. Jones, Mr. Alexander and Dr. Schaffer. Prior to
February 1994, Mr. Jones was Executive Vice President, Chief
Administrative Officer, Chief Operating Officer and Director, NAC Re
Corporation and NAC Reinsurance Corporation (Chief Operating Officer of
NAC Re Corporation beginning June 1993). Prior to December 1994, Mr.
Alexander was Director, Human Development E.I. Dupont De Nemours, Inc.
Prior to May 1993, Dr. Schaffer was Vice President, Professional
Affairs, Aetna Health Plans, Aetna Life & Casualty.
<TABLE>
<CAPTION>
POSITIONS AND OFFICES
NAME AND ADDRESS WITH THE COMPANY
- ------------------------------ -------------------------------------------
<S> <C>
Thomas C. Jones President
(Principal Executive Officer)
James T. Kohan Vice President and Actuary
(Principal Financial Officer)
Robert Moose Vice President
(Principal Accounting Officer)
David C. Kopp Corporate Secretary
Andrew G. Helming Secretary
Stephen C. Stachelek Vice President and Treasurer
Harold W. Albert Director
Martin A. Brennan Director and Senior Vice President
Robert W. Burgess Director
John G. Day Director and Chief Counsel
S. Tyrone Alexander Director and Senior Vice President
Joseph M. Fitzgerald Director and Senior Vice President
Arthur C. Reeds, III Director and Senior Vice President
Patricia L. Rowland Director and Senior Vice President
W. Allen Schaffer, M.D. Director and Senior Vice President
John Wilkinson Director, Senior Vice President and Chief
Financial Officer
</TABLE>
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<PAGE>
COMPANIES OWNING SECURITIES OF DEPOSITOR
29. Furnish as at latest practicable date the following information with respect
to each company which directly or indirectly owns, controls or holds power
to vote 5% or more of the outstanding voting securities of the depositor:
(a) name and principal business address; (b) nature of business; (c)
ownership of all securities of the depositor.
The Company is a wholly-owned subsidiary of Connecticut General Corporation
("CGC"), Bloomfield, Connecticut. CGC is a wholly-owned subsidiary of CIGNA
Holdings Inc., Philadelphia, Pennsylvania, which is in turn wholly-owned by
CIGNA Corporation, Philadelphia, Pennsylvania. CGC is the holding company of
various insurance companies, one of which is the Company.
CONTROLLING PERSONS
30. Furnish as at latest practicable date the following information with respect
to any person, other than those covered by Items 28, 29, and 42 who directly
or indirectly controls the depositor.
None.
COMPENSATION OF OFFICERS AND DIRECTORS OF DEPOSITOR
COMPENSATION OF OFFICERS
31. Furnish the following information with respect to the remuneration for
services paid by the depositor during the last fiscal year covered by
financial statements filed herewith:
(a)directly to each of the officers or partners of the depositor directly
receiving the three highest amounts of remuneration;
(b)directly to all officers or partners of the depositor as a group
exclusive of persons whose remuneration is included under Item 31(a),
stating separately the aggregate amount paid by the depositor itself and
the aggregate amount paid by all the subsidiaries;
(c)indirectly or through subsidiaries to each of the officers or partners of
the depositor.
Not applicable with respect to the Account. As of this date, the Account
had not yet commenced operations.
COMPENSATION OF DIRECTORS
32. Furnish the following information with respect to the remuneration for
services, exclusive of remuneration reported under Item 31, paid by the
depositor during the last fiscal year covered by financial statements filed
herewith:
(a)the aggregate direct remuneration to directors;
(b)indirectly or through subsidiaries to directors.
Not applicable with respect to the Account. See Item 31.
COMPENSATION TO EMPLOYEES
33. (a)Furnish the following information with respect to the aggregate amount of
remuneration for services of all employees of the depositor (exclusive of
persons whose remuneration is reported in Items 31 and 32) who received
remuneration in excess of $10,000 during the last fiscal year covered by
financial statements filed herewith from the depositor and any of its
subsidiaries.
Not applicable with respect to the Account. See Item 31.
(b)Furnish the following information with respect to the remuneration for
services paid directly during the last fiscal year covered by financial
statements filed herewith to the
22
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following classes of persons (exclusive of those persons covered by Item
33(a)): (1) Sales managers, branch managers, district managers and other
persons supervising the sale of registrant's securities; (2) Salesmen,
sales agents, canvassers and other persons making solicitations but not
in supervisory capacity; (3) Administrative and clerical employees; and
(4) Others (specify). If a person is employed in more than one capacity,
classify according to predominant type of work.
Not applicable with respect to the Account. See Item 31.
COMPENSATION TO OTHER PERSONS
34. Furnish the following information with respect to the aggregate amount of
compensation for services paid any person (exclusive of persons whose
remuneration is reported in Items 31, 32 and 33), whose aggregate
compensation in connection with services rendered with respect to the trust
in all capacities exceeded $10,000 during the last fiscal year covered by
financial statements filed herewith from the depositor and any of its
subsidiaries.
Not applicable with respect to the Account. See Item 31.
IV.
DISTRIBUTION AND REDEMPTION OF SECURITIES
DISTRIBUTION OF SECURITIES
35. Furnish the names of the states in which sales of the trust's securities (A)
are currently being made, (B) are presently proposed to be made, and (C)
have been discontinued, indicating by appropriate letter the status with
respect to each state.
No sales are currently being made. It is proposed that Policies will
initially be offered in all jurisdictions where the Company has the
authority to sell the Policies. The sale of the Policies has not been
discontinued in any states.
36. If sales of the trust's securities have at any time since January 1, 1936
been suspended for more than a month describe briefly the reasons for such
suspension.
Not applicable.
37. (a)Furnish the following information with respect to each instance where
subsequent to January 1, 1937, any federal or state governmental officer,
agency, or regulatory body denied authority to distribute securities of
the trust, excluding a denial which was merely a procedural step prior to
any determination by such officer, etc., and which denial was
subsequently rescinded.
(1) Name of officer, agency or body.
(2) Date of denial.
(3) Brief statement of reason given for revocation.
Not applicable.
(b)Furnish the following information with regard to each instance where,
subsequent to January 1, 1937, the authority to distribute securities of
the trust has been revoked by any federal or state governmental officer,
agency or regulatory body.
Not applicable.
38. (a)Furnish a general description of the method of distribution of securities
of the trust.
The Company plans to distribute the Policies through the Account's
principal underwriter, CIGNA Financial Advisors, Inc. ("CFA"), which is a
broker-dealer registered
23
<PAGE>
with the Commission, and is a member of the National Association of
Securities Dealers, Inc. ("NASD"). The Company and CFA expect to enter
into selling agreements with other broker-dealers and insurance agencies
to distribute the Policies.
(b)State the substance of any current selling agreement between each
principal underwriter and the trust or the depositor, including a
statement as to the inception and termination dates of the agreement, any
renewal and termination provisions, and any assignment provisions.
Not applicable.
(c)State the substance of any current agreements or arrangements of each
principal underwriter with dealers, agents, salesmen, etc., with respect
to commissions and overriding commissions, territories, franchises,
qualifications and revocations. If the trust is the issuer of periodic
payment plan certificates, furnish schedules of commissions and the bases
thereof. In lieu of a statement concerning schedules of commissions, such
schedules of commissions may be filed as Exhibit A(3)(c).
Not applicable.
INFORMATION CONCERNING PRINCIPAL UNDERWRITER
39. (a)State the form of organization of each principal underwriter of
securities of the trust, the name of the state of other sovereign power
under the laws of which each underwriter was organized and the date of
organization.
CFA is a Connecticut corporation incorporated in 1967.
(b)State whether any principal underwriter currently distributing securities
of the trust is a member of the National Association of Securities
Dealers, Inc.
Not applicable.
40. (a)Furnish the following information with respect to all fees received by
each principal underwriter of the trust from the sale of securities of
the trust and any other functions in connection therewith exercised by
such underwriter in such capacity or otherwise during the period covered
by the financial statements filed herewith.
Not applicable.
(b)Furnish the following information with respect to any fee or any
participation in fees received by each principal underwriter from any
underlying investment company or any affiliated person or investment
adviser of such company:
(1) The nature of such fee or participation.
(2) The name of the person making payment.
(3) The nature of the services rendered in consideration for such fee or
participation.
(4) The aggregate amount received during the last fiscal year covered by
the financial statements filed herewith.
Not applicable.
41. (a)Describe the general character of the business engaged in by each
principal underwriter, including a statement as to any business other
than the distribution of securities of the trust. If a principal
underwriter acts or has acted in any capacity with respect to any
investment company or companies other than the trust, state the name or
names of such company or companies, their relationship, if any, to the
trust and the nature of such activities. If a principal underwriter has
ceased to act in such named capacity, state the date of and the
circumstances surrounding such cessation.
24
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CFA, a registered broker-dealer and a registered investment adviser,
engages both in the distribution of securities, principally investment
company securities, and in the provision of investment advice to a
variety of clients. It is the principal underwriter for other registered
separate accounts of the Company and its affiliate CIGNA Life Insurance
Company.
(b)Furnish as at latest practicable date the address of each branch office
of each principal underwriter currently selling securities of the trust
and furnish the name and residence address of the person in charge of
such office.
Not applicable.
(c)Furnish the number of individual salesmen of each principal underwriter
through whom any of the securities of the trust were distributed for the
last fiscal year of the trust covered by the financial statements filed
herewith and furnish the aggregate amount of compensation received by
such salesmen in such year.
Not applicable.
42. Furnish as at latest practicable date the following information with respect
to each principal underwriter currently distributing securities of the trust
and with respect to each of the officers, directors or partners of such
underwriter: (a) name and principal business address; (b) position with
principal underwriter; (c) ownership of securities of the trust.
Not applicable.
43. Furnish, for the last fiscal year covered by the financial statements filed
herewith, the amount of brokerage commissions received by any principal
underwriter who is a member of a national securities exchange and who is
currently distributing the securities of the trust or effecting transactions
for the trust in the portfolio securities of the trust.
Not applicable.
OFFERING PRICE OR ACQUISITION VALUATION OF
SECURITIES OF THE TRUST
44. (a)Furnish the following information with respect to the method of valuation
used by the trust for purpose of determining the offering price to the
public of securities issued by the trust or the valuation of shares or
interests in the underlying securities acquired by the holder of a
periodic payment plan certificate:
(1) The source of quotations used to determine the value of portfolio
securities.
Each Fund's shares are valued at net asset value as supplied to the
Company by the Fund or its agent.
(2) Whether opening, closing, bid, asked or any other price is used.
See Item 44(a)(1) and 16.
(3) Whether price is as of the day of sale or as of any other time.
See Item 16.
(4) A brief description of the methods used by registrant for
determining other assets and liabilities including accrual for
expenses and taxes (including taxes on unrealized appreciation).
The Account's assets and liabilities (such as charges against the
Account) are valued in accordance with generally-accepted accounting
principles on an accrual basis. The Company does not currently
intend to create a reserve for its Federal income taxes.
25
<PAGE>
(5) Other items which registrant adds to the net asset value in
computing offering price of its securities.
Not applicable.
(6) Whether adjustments are made for fractions:
(i) before adding distributor's compensation (load); and
(ii) after adding distributor's compensation (load).
Not applicable because the Account does not compute per-unit values
and sales loads in the manner presupposed by this Item and Item
44(b). Appropriate adjustments will be made for fractions in all
computations.
(b)Furnish a specimen schedule showing the components of the offering price
of the trust's securities as the latest practicable date.
No Policies have yet been offered for sale to the public.
(c)If there is any variation in the offering price of the trust's securities
to any person or classes of persons other than underwriters, state the
nature and amount of such variation and indicate the person or classes of
persons to whom such offering is made.
The Company does not require a premium payment of a fixed amount at fixed
intervals for a specified time period. A policyowner may, subject to the
limitations set forth in Item 10(i), pay premiums at any frequency in any
amount. Nonetheless, policyowners will need to pay sufficient premiums to
maintain adequate surrender value to pay monthly charges, including the
cost of insurance. The cost of insurance will vary, depending upon the
insured's age, gender classification, underwriting classification and
years since issued. In addition, there will be additional charges if
optional insurance benefits are elected.
This Policy is available for purchase by corporations and other groups for
multiple life sales ("cases"). The Company reserves the right to reduce
premium loads, monthly administrative charges, or any other charges on such
Cases because of special circumstances that result in lower sales,
administrative, underwriting or other costs. The amount of any reductions
will reflect the reduced sales effort or administrative costs resulting from
the special circumstances which the Company believes to be relevant.
Reductions will not be unfairly discriminatory against any person including
the asset policyowners.
45. Furnish the following information with respect to any suspension of the
redemption rights of the securities issued by the trust during the three
fiscal years covered by the financial statements filed herewith.
Not applicable.
REDEMPTION VALUATION OF SECURITIES OF THE TRUST
46. (a)Furnish the following information with respect to the method of
determining the redemption or withdrawal valuation of securities issued
by the trust:
(1) The source of quotations used to determine the value of portfolio
securities.
See Item 44(a)(1).
(2) Whether opening, closing, bid, asked or any other price is used.
See Item 44(a)(2).
(3) Whether price is as of the day of sale or as of any other time.
As of the day a request for surrender is received at the Center.
26
<PAGE>
(4) A brief description of the methods used by registrant for
determining other assets and liabilities including accrual for
expenses and taxes (including taxes on unrealized appreciation).
See Item 44(a)(4) and 18(c).
(5) Other items which registrant deducts from the net asset value in
computing redemption value of its securities:
See Item 10(c).
(6) Whether adjustments are made for fractions.
Not applicable.
(b)Furnish a specimen schedule showing the components of the redemption
price to the holders of the trust's securities as at latest practicable
date.
No Policies have yet been offered for sale to the public.
PURCHASE AND SALE OF INTERESTS IN UNDERLYING SECURITIES
FROM AND TO SECURITY HOLDERS.
47. Furnish a statement as to the procedure with respect to the maintenance of a
position in the underlying securities or interests in the underlying
securities, the extent and nature thereof and the person who maintains such
a position. Include a description of the procedure with respect to the
purchase of underlying securities or interests in underlying securities from
security holders who exercise redemption or withdrawal rights and the sale
of such underlying securities and interests in the underlying securities to
other security holders. State whether the method of valuation of such
underlying securities or interests in underlying securities differs from
that set forth in Items 44 and 46. If any item of expenditure included in
the determination of the valuation is not or may not actually be incurred or
expended, explain the nature of such item and who may benefit from the
transaction.
The Company will invest net premiums, through the Account, in shares of the
underlying Funds at net asset value and allocate them to the Sub-Accounts
designated by a policyowner. Shares of the Funds are currently sold only to
the Company and to other life insurance companies to support their
obligations under variable annuity and variable life insurance contracts and
are not sold directly to the general public. The Company may redeem
sufficient shares of the appropriate Fund to pay death benefits, benefits at
maturity, or surrender proceeds, or for other purposes contemplated by the
Policies. In addition, if a policyowner elects to transfer Accumulation
Value among the Sub-Accounts, the Company may redeem shares held in any
Sub-Account from which a transfer is made and purchase shares for any
Sub-Account into which Accumulation Value is transferred. See Item 10(c).
V.
INFORMATION CONCERNING THE TRUSTEE
OR CUSTODIAN
48. Furnish the following information as to each trustee or custodian of the
trust:
(a)Name and principal business address.
(b)Form or organization.
(c)State or other sovereign power under the laws of which the trustee or
custodian was organized.
(d)Name of governmental supervising or examining authority.
27
<PAGE>
Not applicable.
49. State the basis for payment of fees or expenses of the trustee or custodian
for services rendered with respect to the trust and its securities, and the
aggregate amount thereof for the last fiscal year. Indicate the person
paying such fees or expenses. If any fees or expenses are prepaid, state the
unearned amount.
Not applicable.
50. State whether the trustee or custodian or any other person has or may create
a lien on the assets of the trust and, if so, give full particulars,
outlining the substance of the provisions of any indenture or agreement with
respect thereto.
The assets of the Account are not chargeable with liabilities arising out of
any other business that the Company may conduct except to the extent such
assets exceed liabilities arising under the variable portion of the Policy.
The income, capital gains, and capital losses of each Sub-Account are
credited to or charged against the assets held in that Sub-Account in
accordance with the terms of each Policy, without regard to the income,
capital gains and capital losses of any other Sub-Account.
VI.
INFORMATION CONCERNING INSURANCE OF
HOLDERS OF SECURITIES
51. Furnish the following information with respect to insurance of holders of
securities:
(a)The name and address of the insurance company.
The name and address of the Company are set forth in the answer to Item
2.
(b)The types of Policies and whether individual or group Policies.
The Policy is an individual flexible premium variable life insurance
policy.
Under circumstances described in Item 10(d), a Policy may be converted to
a permanent life insurance policy with death benefits that do not vary
based on the performance of a separate account. The Policies are issued
on an individual basis.
(c)The types of risks insured and excluded.
The Company assumes the risk that the deductions made for mortality risks
will prove inadequate to cover actual mortality costs. The Company also
assumes the risk that deductions for expenses may be inadequate.
(d)The coverage of the Policies.
See Paragraph (c) of this Item. The minimum specified amount is $50,000.
Death benefit proceeds will be reduced by any outstanding indebtedness
and any due and unpaid charges and increased by any unearned loan
interest.
(e)The Beneficiaries of such Policies and the uses to which the proceeds of
Policies must be put.
The recipient of the benefits of the insurance undertakings described in
Item 51(c) is either the owner or the beneficiary under a Policy. There
are no restrictions on the use of the proceeds other than those
established by a policyowner.
(f)The terms and manners of cancellation and of reinstatement.
The insurance undertakings described in Item 51(c) are an integral part
of a Policy and may not be terminated while a Policy remains in effect.
28
<PAGE>
(g)The method of determining the amount of premiums to be paid by holders of
securities.
See Items 13(a) and 13(d) for the amount of charges imposed. See Items
10(c), 10(i) and 44(c) for the manner in which the premium is determined.
(h)The amount of aggregate premiums paid to the insurance company during the
last fiscal year.
Not applicable.
(i)Whether any person other than the insurance company receives any part of
such premiums, the name of each such person and the amounts involved, and
the nature of the services rendered therefor.
No person other than the Company receives any part of the amounts
deducted for assumption of mortality and expense risks.
(j)The substance of any other material provisions of any indenture or
agreement of the trust relating to insurance.
None.
VII.
POLICY OF REGISTRANT
52. (a)Furnish the substance of the provisions of any indenture or agreement
with respect to the conditions upon which and the method of selection by
which particular portfolio securities must or may be eliminated from
assets of the trust or must or may be replaced by other portfolio
securities. If an investment adviser or other person is to be employed in
connection with such selection, elimination of substitution, state the
name of such person, the nature of any affiliation to the depositor,
trustee or custodian, and any principal underwriter, and the amount of
remuneration to be received for such services. If any particular person
is not designated in the indenture or agreement, describe briefly the
method of selection of such person.
See Items 10(g) and 10(h) as regards the Company's right to substitute
any other investment for shares of any Fund.
(b)Furnish the following information with respect to each transaction
involving the elimination of any underlying security during the period
covered by the financial statements filed herewith.
Not applicable.
(c)Describe the policy of the trust with respect to the substitution and
elimination of the underlying securities of the trust with respect to:
(1) the grounds for elimination and substitution;
(2) the type of securities which may be substituted;
(3) whether the acquisition of such substituted security or securities
would constitute the concentration of investment in a particular
industry or group of industries or would conform to a policy of
concentration of investment in a particular industry or group of
industries;
(4) whether such substituted securities may be the securities of another
investment company; and
29
<PAGE>
(5) the substance of the provisions of any indenture or agreement which
authorize or restrict the policy of the registrant in this regard.
See Items 10(g) and 10(h).
(d)Furnish a description of any policy (exclusive of policies covered by
paragraphs (a) and (b) herein) of the trust which is deemed a matter of
fundamental policy and which is elected to be treated as such.
None.
53. (a)State the taxable status of the trust.
The Company does not initially expect to incur any income tax upon the
earnings or the realized gains attributable to the Account. Accordingly,
the Company does not intend to create a reserve for its Federal income
taxes attributable to the Account. If, however, the Company determines
that it may incur such taxes, it may assess a charge for those taxes from
the Account.
Under current laws the Company may incur state and local taxes (in
addition to premium taxes) in several states, and will incur certain
federal tax liabilities in connection with the Policies. The premium load
of 3 1/2% is intended to defray such obligations.
(b)State whether the trust qualified for the last taxable year as a
regulated investment company as defined in Section 851 of the Internal
Revenue Code of 1954, and state its present intention with respect to
such qualification during the current taxable year.
Not applicable. See Item 53(a).
VIII.
FINANCIAL AND STATISTICAL INFORMATION
54. If the trust is not the issuer of periodic payment plan certificates,
furnish the following information with respect to each class or series of
its securities.
Not applicable.
55. If the trust is the issuer of periodic payment plan certificates, a
transcript of a hypothetical account shall be filed in approximately the
following form on the basis of the certificate calling for the smallest
amount of payments. The schedule shall cover a certificate of the type
currently being sold assuming that such certificate had been sold at a date
approximately ten years prior to the date of registration or at the
approximate date of organization of the trust.
Not applicable.
56. If the trust is the issuer of periodic payment plan certificates, furnish by
years for the period covered by the financial statements filed herewith in
respect of certificates sold during each period, the following information
for each fully paid type and each installment payment type of periodic
payment plan certificate currently being issued by the trust.
Not applicable.
57. If the trust is the issuer of periodic payment plan certificates, furnish by
years for the period covered by the financial statements filed herewith the
following information for each installment payment type of periodic payment
plan certificate currently being issued by the trust.
Not applicable.
30
<PAGE>
58. If the trust is the issuer of periodic payment plan certificates, furnish
the following information for each installment payment type of periodic
payment plan certificate outstanding as at the latest practicable date.
Not applicable.
59. Financial statements:
(a)FINANCIAL STATEMENTS OF THE TRUST
Not applicable. The Trust is newly organized.
(c)FINANCIAL STATEMENTS OF THE DEPOSITOR
To be furnished by amendment.
31
<PAGE>
IX.
EXHIBITS
A. (1) February 23, 1996 Resolution of the Board of Directors of the Company
authorizing establishment of the Account.
(2) Not applicable.
(3) (a) See Exhibit 3(b).
(b) Form of selling agreement among depositor, principal underwriter
and selling dealers. (to be provided by amendment)
(c) Schedule of sales commissions.
(4) Not applicable.
(5) Proposed form of Policy (Form LN 620), together with riders LR468,
LR330, LR458, B7631AA and B10194 and with sex-distinct provisions
LR469.
(6) (a) Certificate of Incorporation of the Company.*
(b) By-laws of the Company.*
(7) Not applicable.
(8) Fund participation agreements between the depositor and certain of the
underlying investment companies and affiliated persons (to be provided
by amendment).
(9) Not applicable.
(10) Corporate Master Application Form B 10163; Corporate Employee Life
Insurance Application Part I B 10162; Enrollment Form (Smoker Distinct)
B 10177; Enrollment Form (Unismoke Only) B 10178.
B. (1)Not applicable.
(2)Not applicable.
C. Not applicable.
* Incorporated by reference to Exhibits of Registration Statement on Form N-4
(File No. 33-82082) filed by CG Variable Annuity Separate Account as
registrant and the Company as depositor.
32
<PAGE>
SIGNATURE
Pursuant to the requirements of the Investment Company Act of 1940, the
depositor of the registrant has caused this registration statement on Form
N-8B-2 to be duly signed on behalf of the registrant in Bloomfield, Connecticut
on the 14th day of March, 1996.
CG CORPORATE INSURANCE VARIABLE LIFE
SEPARATE ACCOUNT 02
(Name of registrant)
By: /s/ Thomas C. Jones
---------------------------------
Thomas C. Jones
President
Connecticut General Life Insurance
Company
CONNECTICUT GENERAL LIFE INSURANCE
COMPANY
(Name of Depositor)
By: /s/ Thomas C. Jones (Seal)
---------------------------------
Thomas C. Jones
President
Attest:
/s/ Edwin L. Kerr
- -------------------------------------
Edwin L. Kerr
Counsel
33
<PAGE>
SECRETARY'S CERTIFICATE
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
The following is certified to be a true and correct copy of certain resolutions
adopted by the Board of Directors of Connecticut General Life Insurance Company
at a meeting held on February 23, 1996, a quorum being present; and such
resolutions remain in full force and effect as of the date of certification, not
having been amended, modified or rescinded since the date of their adoption.
ESTABLISHMENT OF CG CORPORATE INSURANCE VARIABLE LIFE SEPARATE ACCOUNT 02
WHEREAS, Section 38a-433 of the Connecticut Insurance Laws permits a
domestic life insurance company to establish one or more separate accounts;
and
WHEREAS, it is desired that the Company create such a separate account to
house certain of its variable life insurance products;
NOW, THEREFORE, BE IT RESOLVED: That a separate account referred to herein
as "CG Corporate Insurance Variable Life Separate Account 02" is hereby
established.
FURTHER RESOLVED: That the assets of CG Corporate Insurance Variable Life
Separate Account 02 shall be derived solely from (a) sale of variable life
insurance products, (b) funds corresponding to dividend accumulation with
respect to investment of such assets, and (c) advances made by the Company
in connection with operation of CG Corporate Insurance Variable Life
Separate Account 02.
FURTHER RESOLVED: That this Company shall maintain in CG Corporate
Insurance Variable Life Separate Account 02 assets with a fair market
value at least equal to the statutory valuation reserves for the
variable life insurance policies.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized in his or her discretion, as the Company may deem
appropriate from time to time, in accordance with applicable laws and
regulations (a) to divide CG Corporate Insurance Variable Life Separate
Account 02 into divisions and subdivisions, with each division or
subdivision investing in shares of designated classes of designated
investment companies or other appropriate securities, (b) to modify or
eliminate
<PAGE>
any such divisions or subdivisions, (c) to designate further any division
or subdivision thereof and (d) to change the designation of CG Corporate
Insurance Variable Life Separate Account 02 to another designation.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to invest cash from the Company's general account in
CG Corporate Insurance Variable Life Separate Account 02 or in any division
or subdivision thereof as may be deemed necessary or appropriate to
facilitate the commencement of the operations of CG Corporate Insurance
Variable Life Separate Account 02 or to meet any minimum capital
requirements under the Investment Company Act of 1940 and to transfer cash
or securities from time to time between the Company's general account and
CG Corporate Insurance Variable Life Separate Account 02 as deemed
necessary or appropriate so long as such transfers are not prohibited by
law and are consistent with the terms of the variable life insurance
policies issued by the Company providing for allocations to CG Corporate
Insurance Variable Life Separate Account 02.
FURTHER RESOLVED: That the income, gains, and losses (whether or not
realized) from assets allocated to CG Corporate Insurance Variable Life
Separate Account 02 shall, in accordance with any variable life insurance
policies issued by the Company providing for allocations to CG Corporate
Insurance Variable Life Separate Account 02, be credited to or charged
against CG Corporate Insurance Variable Life Separate Account 02 without
regard to the other income, gains, or losses of the Company.
FURTHER RESOLVED: That authority is hereby delegated to the President of
the Company to adopt procedures regarding, among other things, criteria by
which the Company shall afford a pass-through of voting rights to the
owners of variable life insurance policies providing for allocation to CG
Corporate Insurance Variable Life Separate Account 02 with respect to the
shares of any investment companies which are held in CG Corporate
Insurance Variable Life Separate Account 02.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized and directed to prepare and execute any necessary
agreements to enable CG Corporate Insurance Variable Life Separate Account
02 to invest or reinvest the assets of CG Corporate Insurance Variable Life
Separate Account 02 in securities issued by investment companies registered
under the Investment Company Act of 1940 or other appropriate securities as
the officers of the Company may designate pursuant to the provisions of the
variable life insurance policies
<PAGE>
providing for allocations to CG Corporate Insurance Variable Life Separate
Account 02.
FURTHER RESOLVED: That the Company may register under the Securities Act
of 1933 variable life insurance policies, or units of interest thereunder,
under which amounts will be allocated by the Company to CG Corporate
Insurance Variable Life Separate Account 02 to support reserves for such
policies and, in connection therewith, the officers of the Company be, and
each of them hereby is, authorized, to prepare, execute and file with the
Securities and Exchange Commission, in the name and on behalf of the
Company, registration statements under the Securities Act of 1933,
including prospectuses, supplements, exhibits and other documents relating
thereto, and amendments to the foregoing, in such form as the officer
executing the same may deem necessary or appropriate.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to take all actions necessary to register CG
Corporate Insurance Variable Life Separate Account 02 as a unit investment
trust under the Investment Company Act of 1940 and to take such related
actions as they deem necessary and appropriate to carry out the foregoing.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to prepare, execute and file with the Securities and
Exchange Commission, applications and amendments thereto for such
exemptions from or orders under the Investment Company Act of 1940 and the
Securities Act of 1933, and to request from the Securities and Exchange
Commission no action and interpretative letters as they may from time to
time deem necessary or desirable.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to prepare, execute and file all periodic reports
required under the Investment Company Act of 1940 and the Securities
Exchange Act of 1934.
FURTHER RESOLVED: That the Chief Counsel of the Company, or the person as
is designated by him from time to time, is hereby appointed as agent for
service under any such registration statement and is duly authorized to
receive communications and notices from the Securities and Exchange
Commission with respect thereto, and to exercise powers given to such agent
by the Securities Act of 1933 and the Rules thereunder and any other
necessary Acts.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to effect in the
<PAGE>
name and on behalf of the Company, all such registrations, filings and
qualifications under blue sky or other applicable securities laws and
regulations and under insurance securities laws and insurance laws and
regulations of such states and other jurisdictions as they may deem
necessary or appropriate, with respect to the Company, and with respect to
any variable life insurance policies under which amounts will be allocated
by the Company to CG Corporate Insurance Variable Life Separate Account 02
to support reserves for such policies; such authorization shall include
registration, filing and qualification of the Company and of said policies,
as well as registration, filing and qualification of officers, employees
and agents of the Company as brokers, dealers, agents, salespersons, or
otherwise; and such authorization shall also include, in connection
therewith, authority to prepare, execute, acknowledge and file all such
applications, applications for exemptions, certificates, affidavits,
covenants, consents to service of process and other instruments, and to
take all such action as the officer executing the same or taking such
action may deem necessary or desirable.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to execute and deliver all such documents and papers
and to do or cause to be done all such acts and things as they may deem
necessary or desirable to carry out the foregoing resolutions and the
intent and purpose thereof.
Dated: March 8, 1996 David C. Kopp
---------------- ---------------------
David C. Kopp
Corporate Secretary
(SEAL)
<PAGE>
EXHIBIT A(3)(C)
SCHEDULE OF SALES COMMISSIONS
<TABLE>
<CAPTION>
BASE EXPENSE TOTAL SALES
COMMISSION ALLOWANCE COMMISSIONS
------------- ------------ -------------
<S> <C> <C> <C>
Year 1*......................................... 40.00% 0.00 % 40.00 %
Year 2 - Year 15................................ 3.00% 0.00 % 3.00 %
Year 16+........................................ 2.00% 0.00 % 2.00 %
</TABLE>
* In Year 1, the base commission is payable up to the Guideline Annual Premium.
The amount of commission paid on the premium received in excess of the
Guideline Annual Premium is 3%.
<PAGE>
THIS POLICY IS A LEGAL CONTRACT BETWEEN YOU AND
THE CONNECTICUT GENERAL LIFE INSURANCE COMPANY.
PLEASE READ YOUR POLICY CAREFULLY.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
Home Office: 900 Cottage Grove Road A Stock Company
Bloomfiled, CT 06002
Mailing Address: Hartford, CT 06152
Telephone : 860-726-6000
INSURED JOHN DOE POLICY NUMBER SPECIMEN
INITIAL SPECIFIED AMOUNT $100,000 DATE OF ISSUE JANUARY 1, 1996
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
The Company agrees to pay the death benefit to the Beneficiary upon receipt of
due proof of the Insured's death during the continuance of the policy. Such
payment shall be made as provided under the Payment of Proceeds provision. The
Company further agrees to pay the Surrender Value to the Owner upon Surrender of
the policy.
RIGHT TO EXAMINE POLICY. The policy may be returned to the insurance agent
through whom it was purchased or to the Company within (a) 45 days from the date
the application is signed by the Owner, or (b) 10 days after its receipt (20
days after its receipt where required by law for policies issued in replacement
of other insurance), whichever is later. During this period, the premium will
be held in a Money Market Fund. If the policy is so returned, however, it will
be deemed void from the Date of Issue, and the Company will refund the premium
paid. If the policy is not returned during the Right to Examine period, the
premium payment will be processed as set forth in the Allocation of Premium
Payments provision.
ALL BENEFITS AND VALUES PROVIDED BY THIS POLICY WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE VARIABLE ACCOUNT ARE VARIABLE AND ARE NOT GUARANTEED AS TO
DOLLAR AMOUNT.
THE DEATH BENEFIT AMOUNT ON THE DATE OF ISSUE EQUALS THE INITIAL SPECIFIED
AMOUNT OF THE POLICY. THEREAFTER, THE DEATH BENEFIT MAY VARY UNDER THE
CONDITIONS DESCRIBED UNDER THE INSURANCE COVERAGE PROVISIONS.
The policy is issued and accepted subject to the terms set forth on the
following pages, which are made a part of the policy. In consideration of the
application and the payment of premiums as provided, this policy is executed by
Connecticut General Life Insurance Company as of its Date of Issue.
/s/ /s/ Thomas C. Jones
Registrar President
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
Variable life insurance payable upon death of the Insured.
Surrender Value payable upon Surrender.
Flexible Premiums. Non-Participating. Investment results
reflected in policy benefits.
1
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<PAGE>
TABLE OF CONTENTS
Policy Schedules Schedule
Policy Specifications . . . . . . . . . . . . . . . . . . . . . . . . . 1
List of Variable Account Sub-Accounts . . . . . . . . . . . . . . . . . 2
Table of Charges and Fees for This Policy . . . . . . . . . . . . . . . 3
Table of Guaranteed Maximum Cost of Insurance Rates . . . . . . . . . . 4
Table of Corridor Percentages . . . . . . . . . . . . . . . . . . . . . 5
Table of Net Single Premium Factors . . . . . . . . . . . . . . . . . . 6
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Policy Provisions Page
Premium and Reinstatement Provisions. . . . . . . . . . . . . . . . . . 3
Ownership and Beneficiary Provisions. . . . . . . . . . . . . . . . . . 3
Variable Account Provisions . . . . . . . . . . . . . . . . . . . . . . 4
Policy Value Provisions . . . . . . . . . . . . . . . . . . . . . . . . 5
Transfer Privilege Provisions . . . . . . . . . . . . . . . . . . . . . 7
Nonforfeiture and Surrender Provisions. . . . . . . . . . . . . . . . . 8
Loan Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Insurance Coverage Provisions . . . . . . . . . . . . . . . . . . . . . 9
General Provisions. . . . . . . . . . . . . . . . . . . . . . . . . . .11
Followed by Optional Methods of Settlement and any
Additional Insurance Benefits and Riders
The Policy Schedules come right after this page.
They give specific facts about this policy and its coverages.
Please refer to them while reading this policy.
Policy Schedules are intentionally blank on the back side.
2
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<PAGE>
POLICY SCHEDULE 1
POLICY SPECIFICATIONS
<TABLE>
<CAPTION>
<S><C>
POLICY NUMBER SPECIMEN DATE OF ISSUE JANUARY 1, 1996
INSURED JOHN DOE AGE AT ISSUE 35
INITIAL SPECIFIED AMOUNT $100,000 PREMIUM CLASS LIMITED UNDERWRITING - NONSMOKER
MINIMUM SPECIFIED AMOUNT [$ 1,000] DEATH BENEFIT OPTION OPTION B
_________________________________________________________________________________________________________________________________
OWNER : AS DESIGNATED IN THE APPLICATION FOR THIS POLICY
BENEFICIARY : AS DESIGNATED IN THE APPLICATION FOR THIS POLICY
BENEFIT : FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
MONTHLY ANNIVERSARY DAY : 1
PLANNED PERIODIC PREMIUM : $665.00
PAYMENT MODE : ANNUAL
SEC GUIDELINE ANNUAL PREMIUM AMOUNT :
ELECTED TEST FOR COMPLIANCE WITH : CASH VALUE ACCUMULATION
IRC DEFINITION OF LIFE INSURANCE (USE POLICY SCHEDULE 6)
LIMITS ON ALLOCATION OF NET PREMIUM PAYMENTS : The minimum allocation percentage to the Fixed Account or a Variable Account
Sub-Account is [10%]. All allocations must be made in whole percentages and in
aggregate must total 100%. Premium payments will be allocated net of the
Premium Load specified in Policy Schedule 3.
LIMITS ON TRANSFERS : Transfer(s) from the Fixed Account may only be made during the 30-day period
following each Policy Anniversary. Transfer(s) is (are) subject to a maximum
aggregate annual limit of [20%] of the Fixed Account Value as of that Policy
Anniversary. If the Fixed Account value is less than $5,000.00 as of Policy
Anniversary, however, the annual limit of 20% will not apply.
Transfer(s) into the Fixed Account may only be made during the 30 day period
immediately prior to a Policy Anniversary.
The Company has the right to limit the dollar amount of such transfers into and
from the Fixed Account.
ADDITIONAL BENEFITS : ADDITIONAL INSURANCE BENEFIT
EFFECTIVE DATE :
ADDITIONAL SPECIFIED AMOUNT :
EARLY WITHDRAWAL RIDER (LR458)
SUICIDE WAIVER RIDER (B7631AA)
ACCELERATED DEATH BENEFIT RIDER (B10191)
EXCHANGE OF LIFE RIDER (LR330)
POLICY SCHEDULE 1
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<PAGE>
GUARANTEED INTEREST RATE FOR THE FIXED ACCOUNT: The lesser of 4% or the prevailing 30 Day Treasury Bill Rate as of the last
day of the preceding calendar month.
</TABLE>
POLICY SCHEDULE 1
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<PAGE>
POLICY SCHEDULE 2
LIST OF VARIABLE ACCOUNT SUB-ACCOUNTS
FUND GROUPS FUNDS (SUB-ACCOUNTS)
Alger American Fund Alger American Small
Cap Portfolio
Alger American MidCap
Growth Portfolio
Alger American Growth
Portfolio
Variable Insurance Products Fund I High Income Portfolio
Equity-Income Portfolio
Variable Insurance Products Fund II Index 500 Portfolio
Investment Grade Bond
Portfolio
Janus Aspen Series Trust Janus Aspen Series
Short-Term Bond
Portfolio
Janus Aspen Series
Worldwide Growth
Portfolio
MFS Variable Trust MFS Emerging Growth
Portfolio
MFS Total Return
Portfolio
OCC Accumulation Trust OCC Accumulation Trust
Small Cap Portfolio
OCC Accumulation Trust
Managed Portfolio
OCC Accumulation Trust
Equity Portfolio
Templeton Variable Products Series Fund Templeton International
Fund
CIGNA Variable Products Group
CIGNA Money Market Fund
NOTE: NET PREMIUM PAYMENTS MAY ALSO BE ALLOCATED TO THE FIXED ACCOUNT
VARIABLE ACCOUNT SEPARATE ACCOUNT: Corporate Insurance Variable Life Separate
Account 02: A Connecticut General Life Insurance Company Separate Investment
Account which was established on February 23, 1996.
POLICY SCHEDULE 2
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<PAGE>
POLICY SCHEDULE 3
TABLE OF CHARGES AND FEES FOR THIS POLICY
PREMIUM LOADS.
[3.5%] of each premium payment to cover applicable state taxes and federal
income tax liabilities, plus [3.00%] of each premium payment to cover sales and
administration expenses, plus [40%] of the first year premium up to the SEC
Guideline Premium Amount as shown on Policy Schedule 1, to cover acquisition
expenses.
If this policy is surrendered during the first [12] months after issue a credit
will be paid equal to [60%] of all premium loads previously deducted. If the
policy is surrendered during the months [13 through 24], the credit will equal
[30%] of all premium loads previously deducted.
In addition, in the event that the Specified Amount is increased, a premium load
of [25%] of the increase in the SEC Guideline Premium Amount (based on the
Insured's attained age and the increase in the Specified Amount) will be applied
to premiums received during the [12] months following the increase.
ADMINISTRATIVE FEES.
[$250] deducted on the Date of Issue, plus [$8] per month, plus an asset based
fee that is deducted from each Variable Account Sub-Account and the Fixed
Account at the end of each Valuation Period. This fee may be changed by the
Company from time to time but is guaranteed not to exceed a daily rate which is
equivalent to [.30%] of the value of each account annually. As of the Date of
Issue of the policy, this charge was equal to a daily rate which is equivalent
to [.10%] annually.
MORTALITY AND EXPENSE RISK CHARGE.
For mortality and expense risk, an asset charge is deducted from each Variable
Account Sub-Account and the Fixed Account at the end of each valuation Period.
This charge may be changed by the Company from time to time, but it is
guaranteed not to exceed a daily rate which is equivalent to [.90%] annually of
a Sub-Account's Value. As of the Date of Issue of the policy, this charge was
equal to a daily rate which is equivalent to [.85%] annually during Policy Years
[1 through 10], a daily rate which is equivalent to [.35%] annually during the
[11th through 15th] Policy Years, and a daily rate which is equivalent to [.05%]
annually during the [16th and later] Policy Years.
In addition, Daily Fund Operating Expenses will be applied by each Fund as set
forth in the prospectus for the applicable Fund(s).
TRANSFER FEE.
A transaction fee of up to [$25] will apply to each transfer in excess of [4]
made during any Policy Year.
PARTIAL SURRENDER FEE. A transaction fee of [$25] will apply to each Partial
Surrender Payment.
POLICY SCHEDULE 3
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<PAGE>
POLICY SCHEDULE 4
TABLE OF GUARANTEED MAXIMUM COST OF INSURANCE RATES
PER $1000 OF THE NET AMOUNT AT RISK
SPECIAL The actual monthly Cost of Insurance is based on the attained age
NOTE : (nearest birthday), and premium class of the person insured. They
will not, however, exceed the rates shown in the table below. In
determining the Cost of Insurance, the Company will add the amount of
the flat extra monthly insurance cost or apply the risk factor, if
any, shown in the Policy Specifications. If the Insured is in a rated
premium class, the Guaranteed Maximum Life Insurance Rates will be
based on the rates shown below modified by such flat extra or risk
factor. The rates below are based on the 1980 CSO Table B.
<TABLE>
<CAPTION>
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
ATTAINED AGE MONTHLY RATE ATTAINED AGE MONTHLY RATE ATTAINED AGE MONTHLY RATE
(nearest birthday) (nearest birthday) (nearest birthday)
- --------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
-- 45 0.27174 75 4.50689
16 0.11001 46 0.29259 76 4.99567
17 0.11835 47 0.31510 77 5.51104
18 0.12252 48 0.34095 78 6.04718
19 0.12668 49 0.36764 79 6.62021
- --------------------------------------------------------------------------------------------------------------------------------
20 0.12918 50 0.39682 80 7.25222
21 0.12918 51 0.43185 81 7.96037
22 0.12668 52 0.47106 82 8.76448
23 0.12502 53 0.51610 83 9.67776
24 0.12252 54 0.56782 84 10.67951
- --------------------------------------------------------------------------------------------------------------------------------
25 0.12001 55 0.62372 85 11.75746
26 0.11751 56 0.68464 86 12.88132
27 0.11668 57 0.75056 87 14.05994
28 0.11501 58 0.82067 88 15.26708
29 0.11668 59 0.89664 89 16.52101
- --------------------------------------------------------------------------------------------------------------------------------
30 0.11668 60 0.98430 90 17.83674
31 0.11918 61 1.08117 91 19.23899
32 0.12168 62 1.19309 92 20.76665
33 0.12502 63 1.32342 93 22.49837
34 0.13168 64 1.47049 94 24.70915
- --------------------------------------------------------------------------------------------------------------------------------
35 0.13669 65 1.63183 95 27.82758
36 0.14419 66 1.80659 96 32.78845
37 0.15252 67 1.99313 97 41.45783
38 0.16336 68 2.19146 98 57.95663
39 0.17503 69 2.40745 99 90.90901
- --------------------------------------------------------------------------------------------------------------------------------
40 0.18754 70 2.65201 100+ 90.90901
41 0.20254 71 2.96795
42 0.21671 72 3.25137
43 0.23422 73 3.62728
44 0.25090 74 4.04883
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
</TABLE>
POLICY SCHEDULE 4
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<PAGE>
POLICY SCHEDULE 5
TABLE OF CORRIDOR PERCENTAGES
In the event the Guideline Premium/Corridor Percentage Test is elected for
compliance with the IRC definition of life insurance, the minimum death benefit
at any time is determined by multiplying the Accumulation Value of this policy
as of the date of calculation by the applicable Corridor Percentage. The
applicable Corridor Percentage is determined from the table below for the
Insured's attained age as of the date of the calculation.
<TABLE>
<CAPTION>
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
ATTAINED CORRIDOR ATTAINED CORRIDOR ATTAINED CORRIDOR
AGE PERCENTAGE AGE PERCENTAGE AGE PERCENTAGE
- --------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
-- 45 215 75 105
16 250 46 209 76 105
17 250 47 203 77 105
18 250 48 197 78 105
19 250 49 191 79 105
- --------------------------------------------------------------------------------------------------------------------------------
20 250 50 185 80 105
21 250 51 178 81 105
22 250 52 171 82 105
23 250 53 164 83 105
24 250 54 157 84 105
- --------------------------------------------------------------------------------------------------------------------------------
25 250 55 150 85 105
26 250 56 146 86 105
27 250 57 142 87 105
28 250 58 138 88 105
29 250 59 134 89 105
- --------------------------------------------------------------------------------------------------------------------------------
30 250 60 130 90 105
31 250 61 128 91 104
32 250 62 126 92 103
33 250 63 124 93 102
34 250 64 122 94+ 101
- --------------------------------------------------------------------------------------------------------------------------------
35 250 65 120
36 250 66 119
37 250 67 118
38 250 68 117
39 250 69 116
- --------------------------------------------------------------------------------------------------------------------------------
40 250 70 115
41 243 71 113
42 236 72 111
43 229 73 109
44 222 74 107
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
</TABLE>
POLICY SCHEDULE 5
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<PAGE>
POLICY SCHEDULE 6
TABLE OF NET SINGLE PREMIUM FACTORS
In the event the Cash Value Accumulation Test is elected for compliance with
the IRC definition of life insurance, the minimum death benefit at any time
is determined by multiplying the Accumulation Value of this policy as of the
date of calculation by the applicable factor. Factors shown are calculated
based on the 1980 CSO Table B at 4% interest.
<TABLE>
<CAPTION>
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
ATTAINED ATTAINED ATTAINED
AGE FACTOR AGE FACTOR AGE FACTOR
- --------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
-- 45 3.20722 75 1.41716
16 8.18748 46 3.10502 76 1.39137
17 7.94475 47 3.00663 77 1.36715
18 7.71199 48 2.91188 78 1.34434
19 7.48608 49 2.82074 79 1.32273
- --------------------------------------------------------------------------------------------------------------------------------
20 7.26672 50 2.73298 80 1.30218
21 7.05278 51 2.64848 81 1.28268
22 6.84294 52 2.56729 82 1.26423
23 6.63612 53 2.48932 83 1.24690
24 6.43288 54 2.41454 84 1.23076
- --------------------------------------------------------------------------------------------------------------------------------
25 6.23304 55 2.34290 85 1.21581
26 6.03678 56 2.27426 86 1.20198
27 5.84424 57 2.20849 87 1.18910
28 5.65610 58 2.14544 88 1.17704
29 5.47212 59 2.08494 89 1.16559
- --------------------------------------------------------------------------------------------------------------------------------
30 5.29328 60 2.02688 90 1.15454
31 5.11904 61 1.97126 91 1.14368
32 4.94996 62 1.91800 92 1.13276
33 4.78588 63 1.86709 93 1.12150
34 4.62684 64 1.81859 94 1.10955
- --------------------------------------------------------------------------------------------------------------------------------
35 4.47330 65 1.77245 95 1.09675
36 4.32471 66 1.72855 96 1.08300
37 4.18126 67 1.68677 97 1.06854
38 4.04283 68 1.64694 98 1.05389
39 3.90950 69 1.60889 99 1.04000
- --------------------------------------------------------------------------------------------------------------------------------
40 3.78109 70 1.57254 100+ 1.01000
41 3.65740 71 1.53787
42 3.53843 72 1.50525
43 3.42377 73 1.47404
44 3.31349 74 1.44468
- --------------------------------------------------------------------------------------------------------------------------------
- --------------------------------------------------------------------------------------------------------------------------------
</TABLE>
POLICY SCHEDULE 6
LN620
<PAGE>
POLICY SCHEDULE 7
DEFINITIONS
ACCUMULATION VALUE. The sum of (i) the then current value of the Fixed Account,
(ii) all of the then current values of the Variable Account Sub-Accounts (i.e.
the Variable Account Value), and (iii) the Loan Account Value.
DATE OF ISSUE. The date on which the policy becomes effective. The Date of
Issue is shown in the Policy Schedule 1.
DUE PROOF OF DEATH. An original certified copy of an official death
certificate, an original certified copy of a decree of a court of competent
jurisdiction as to the finding of death, or any other proof of death
satisfactory to the Company.
FIXED ACCOUNT. The account which provides for a guaranteed minimum interest
rate. The Company may, at its discretion, credit a higher current rate of
interest. Fixed Account assets are general assets of the Company and are
distinguishable from those allocated to a separate account of the Company.
FUND(S). The portfolio(s) of Fund Groups whose shares are acquired for the
Variable Account Sub-Accounts in which Net Premium Payments or transfers may be
invested.
FUND GROUPS. The open-end management investment companies (mutual funds)
registered under the Investment Company Act of 1940, as amended, (hereinafter
referred to as the "1940 Act"), one or more of whose portfolio(s)' shares are
made available as investment vehicles for the policies through the Variable
Account Sub-Accounts.
HOME OFFICE. Connecticut General Life Insurance Company, the mailing address of
which is CIGNA Individual Insurance, Routing S324, Hartford, Connecticut 06152.
IN WRITING. In a written form satisfactory to the Company and received by the
Company at its Home Office.
LOAN ACCOUNT. The account in which policy Indebtedness (outstanding loans and
interest) accrues once it is transferred out of the Fixed Account and Variable
Account Sub-Accounts. The Loan Account is part of the Company's general
account.
LOAN ACCOUNT VALUE. The value of the Loan Account, the amount which equals the
Indebtedness under the policy.
MONTHLY ANNIVERSARY DAY. The day of the month, as shown in Policy Schedule
1, when the Company deducts certain charges. If that day does not occur on a
Valuation Day or is nonexistent for that month, such charges will be deducted
on the next Valuation Day. Monthly Anniversary Days and policy months are
computed from the Date of Issue.
NET ACCUMULATION VALUE. An amount equal to the Accumulation Value less the
amount of Indebtedness, if any, in the Loan Account.
NET PREMIUM PAYMENT. The amount of a premium payment, less the premium load
shown in Policy Schedule 3. A Net Premium Payment is the amount available for
allocation to the Fixed Account and the Variable Account Sub-Accounts.
POLICY ANNIVERSARIES AND POLICY YEARS. Twelve-month periods measured from the
Date of Issue.
SEC. The Securities and Exchange Commission.
SEC GUIDELINE ANNUAL PREMIUM. The level annual amount as shown is Policy
Schedule 1. An amount calculated, on the Date of Issue, in accordance with SEC
Rule 6e-3(T) under the 1940 Act as in effect on such date.
SUB-ACCOUNT. That portion of the Variable Account which invests in share of a
specific Fund.
VALUATION DAY. Every day on which the New York Stock Exchange (NYSE) is open
for business, except any day on which trading on the NYSE is restricted, or on
which an emergency exists, as determined by the SEC, so that valuation or
disposal of securities is not practicable.
VALUATION PERIOD. The period of time for which a Fund determines its net asset
value; a Valuation Period begins on the day following a Valuation Day and ends
on the next Valuation Day. A Valuation Period may be more than one day in
length.
VARIABLE ACCOUNT. The account consisting of all Sub-Account(s) invested in
shares of the Fund(s). Variable Account assets are separate account assets of
the Company, the investment performance of which is kept separate from that of
the general assets of the Company and are not chargeable with the general
liabilities of the Company.
VARIABLE ACCUMULATION UNIT, UNIT. A unit of measure used in the calculation of
the value of each Variable Account Sub-Account.
POLICY SCHEDULE 7
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<PAGE>
PREMIUM AND REINSTATEMENT PROVISIONS
PREMIUM PAYMENT. All premiums are payable at the Home Office or to an
authorized agent of the Company. The first premium is due on the Date of Issue
and is payable in advance. Additional premium payments may be made at any time
before the Insured's age 100. Any additional premium payment will be subject to
the consent of the Company and the requirements specified under the Minimum
Premium and Additional Premiums provisions below. Receipts signed by the
President or Secretary and duly countersigned will be furnished upon request.
MINIMUM PREMIUM. The Minimum Premium for the policy is the amount necessary to
maintain a positive Surrender Value.
PLANNED PERIODIC PREMIUMS. Changes in the amounts or frequency of planned
periodic premium payments will be subject to the consent of the Company, based
on restrictions outlined in the Limits provision.
ADDITIONAL PREMIUMS. Additional premium payments of at least $500 each may be
made up to age 100 of the Insured during the continuance of the policy. The
Company reserves the right, however, to limit the amount or number of any such
additional premium payments as outlined in the Limits provision below.
Unless otherwise specified by the Owner, if there is any policy Indebtedness,
additional premiums paid will be used first as a loan repayment. Any excess
will then be applied as an additional premium.
LIMITS. The Company will set the maximum for total premiums paid in any year,
taking into account requirements in federal legislation. The Company may also
require evidence of insurability if the total premiums paid in a Policy Year
increase its net amount at risk.
ALLOCATION OF NET PREMIUM PAYMENTS. Net Premium Payments may be allocated to
the Fixed Account and/or to Variable Account Sub-Accounts under the policy.
These allocations will be subject to the Limits on Allocation of Net Premium
Payments shown in Policy Schedule 1. The Net Premium Payment associated with
the initial premium payment will be allocated within 3 business day of the
expiration of the Right to Examine Policy provision. The initial premium
payment allocation will be in accordance with the percentages specified in the
original application. Subsequent Net Premium Payments will be allocated on the
same basis as the previous Net Premium Payment unless the Company has been
instructed in writing to change the allocation percentages.
GRACE PERIOD. If the Surrender Value on any Monthly Anniversary Day is less
than the required Monthly Deduction, a Grace Period of 61 days will be granted
to pay a premium sufficient to cover the required Monthly Deduction. (The
Surrender Value and Monthly Deduction are described under Nonforfeiture
Provisions.)
At least 31 days before the end of the Grace Period the Company will send a
written notice that there is insufficient value under the policy. The notice
will show the amount of premium required to prevent the policy from lapsing. The
notice will be mailed to the last known addresses of the Owner and the assignee
of record with the Company, if any. If such premium, as billed by the Company,
is not paid within the Grace Period, all coverage under the policy will
terminate without value at the end of the Grace Period. If the Insured dies
during the Grace Period, the Company will deduct any overdue Monthly Deductions
from the benefits.
REINSTATEMENT. After the policy has lapsed due to the expiration of a Grace
Period, it may be reinstated at any time during the Insured's lifetime provided:
(a) it has not been Surrendered for cash; (b) a written application for
reinstatement is submitted to the Company; (c) evidence of insurability
satisfactory to the Company is furnished; (d) enough premium is paid to keep the
policy in force for at least 12 months; and (e) any Indebtedness against the
policy increased by any loan interest is paid or reinstated.
The effective date of the reinstated policy will be the Monthly Anniversary Day
that coincides with or next follows the date the application for reinstatement
is approved by the Company.
OWNERSHIP AND BENEFICIARY PROVISIONS
OWNER. The Owner on the Date of Issue will be the person designated in the
application. If no Owner is designated on the application, this policy is owned
by the Insured.
RIGHTS OF OWNER. While the Insured is alive, the Owner may exercise all rights
and privileges under the policy including the right to: (a) release or
Surrender the policy to the Company as described in the Surrender provision, (b)
agree with the Company to any change in or amendment to the Policy, (c) transfer
all rights and privileges to another person, and (d) change the Beneficiary.
All rights and privileges of the Owner may be exercised without the consent of
any Beneficiary if the Owner has reserved the right to change the Beneficiary.
If the Owner has not reserved the right to
3
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<PAGE>
OWNERSHIP AND BENEFICIARY PROVISIONS (CONTINUED)
change the Beneficiary, all such rights and privileges may be exercised only
with the consent of the Beneficiary.
Unless provided otherwise, if the Owner is a person other than the Insured and
dies before the Insured, all rights and privileges of the Owner will vest in the
Owner's executors, administrators, or assigns.
TRANSFER OF OWNER. The Owner may transfer all rights and privileges of the
Owner. On the effective date of transfer, the transferee will become the Owner
and will have all rights and privileges of the Owner. The Owner may revoke any
transfer prior to its effective date.
Unless provided otherwise, a transfer will not affect the interest of any
Beneficiary designated prior to the effective date of the transfer.
A transfer of Ownership must be in writing. A transfer will not take effect
until recorded in writing by the Company. When a transfer has been so recorded,
it will take effect as of the effective date specified by the Owner. Any
payment made or any action taken or allowed by the Company before the transfer
is recorded will be without prejudice to the Company.
BENEFICIARY. The Beneficiary on the Date of Issue will be as designated on
Policy Schedule 1.
Unless provided otherwise, the interest of any Beneficiary who dies before the
Insured will vest in the Owner or the Owner's executors, administrators or
assigns.
CHANGE OF BENEFICIARY. A new Beneficiary may be designated from time to time.
A request for change of Beneficiary must be in writing. The request must be
signed by the Owner. The request must also be signed by the Beneficiary if the
right to change the Beneficiary has not been reserved to the Owner.
A change of Beneficiary will not take effect until recorded in writing by the
Company. When a change of Beneficiary has been so recorded, whether or not the
Insured is then alive, it will take effect as of the date the request was
signed. Any payment made or any action taken or allowed by the Company before
the change of Beneficiary is recorded will be without prejudice to the Company.
Unless provided otherwise, the right to change any Beneficiary is reserved to
the Owner.
VARIABLE ACCOUNT PROVISIONS
VARIABLE ACCOUNT AND SUB-ACCOUNTS. Assets accumulated on a variable basis are
held in the Variable Account Separate Account designated in Policy Schedule 2.
The Variable Account Separate Account was established by a resolution of the
Company's Board of Directors as a "separate account" under governing law of
Connecticut, the Company's state of domicile. The Variable Account Separate
Account is registered as a unit investment trust under the 1940 Act. Under
Connecticut law, the Variable Account assets (except assets in excess of its
reserves and other contract liabilities) cannot be charged with the general
liabilities of the Company. The Variable Account assets are owned and
controlled exclusively by the Company. The Company is not a trustee with
respect to those assets.
The Variable Account is divided into Sub-Accounts. Each Sub-Account's assets
are invested in shares of a particular Fund of one of the Fund Groups made
available as funding vehicles under this policy. For each Sub-Account, the
Company maintains Variable Accumulation Units whose values reflect the
investment performance of the Fund whose shares are held in the Sub-Account.
Subject to any vote by persons having the right under the 1940 Act to vote
thereon, the Company may elect to (a) operate the Variable Account as a
management company rather than a unit investment trust under the 1940 Act, or
(b) if registration is no longer required, to deregister the Variable Account.
In such event, the Company may endorse this policy to reflect such change. The
Company may also take any other necessary or appropriate action to effect the
change. Any changes in Variable Account Investment policy shall have been
approved by the Connecticut Insurance Commissioner. Such changes will be also
be approved or filed, as required, in the state or other jurisdiction where this
policy was issued.
INVESTMENT RISK. Each Sub-Account's assets are always fully invested in the
shares of the particular Fund purchased for that Sub-Account. Each Sub-
Account's investment performance reflects the investment performance of that
Fund. Fund share values fluctuate, reflecting changes in the value of the
investments underlying that Sub-Account. The Owner bears the entire Investment
risk of gain or loss as to the Variable Account assets.
INVESTMENTS OF THE VARIABLE ACCOUNT SUB-ACCOUNTS. All amounts allocated to a
Variable Account Sub-Account will be used to purchase shares of the specific
Fund of a Fund Group used by that Sub-Account. Each Fund Group is registered
under the 1940 Act as an open-end management investment company. Each Fund of
that Fund Group is regulated as an open-end management investment company.
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VARIABLE ACCOUNT PROVISIONS (CONTINUED)
All Funds available as Fund vehicles under this policy as of the Date of Issue
are listed on Policy Schedule 2. The Company may add additional Fund Groups and
additional Funds at any time. The Company may change Funds or Fund Groups in
accordance with the Substituted Securities provision.
Any and all distributions made by a Fund will be reinvested in additional shares
of that Fund at net asset value. Deductions by the Company from a Sub-Account
will be made by redeeming a number of Fund shares at net asset value equal in
total value to that amount to be deducted.
SUBSTITUTED SECURITIES. Shares corresponding to a particular Fund may not
always be available for purchase. Also, the Company may decide that further
investment in such Fund is no longer appropriate in view of the purposes of the
Variable Account or in view of legal, regulatory or federal income tax
restrictions. In such event, shares of another registered open-end investment
company or unit investment trust may be substituted both for Fund shares already
purchased and/or as the securities to be purchased in the future. These
substitutions must meet applicable Internal Revenue Service diversification
guidelines. Any necessary regulatory or other approvals of such substitutions
shall be obtained. In the event of any substitution pursuant to this provision,
the Company may make appropriate endorsement(s) to this policy to reflect the
substitution.
POLICY VALUES PROVISIONS
ACCUMULATION VALUE. The Accumulation Value equals the sum of (i) the then
current value of the Fixed Account, (ii) all of the then current values of the
Variable Account Sub-Accounts (i.e. the Variable Account Value), and (iii) the
Loan Account Value. At any point in time, therefore, the Accumulation Value
reflects (a) Net Premium Payments made, (b) interest credited under the Fixed
Account, (c) the amount of any Partial Surrenders, (d) interest charged and
credited under the Loan Account, (e) any transfer fees, (f) all monthly and
other deductions as specified below, (g) the daily mortality and expense
deduction specified under Schedule 3, and (h) any increases or decreases as a
result of market performance in the Variable Account Sub-Accounts.
CALCULATION OF ACCUMULATION VALUE. On each Valuation Day after the Date of
Issue, the Accumulation Value will be equal to (1), plus (2), plus (3), minus
(4), plus or minus (5) as the case may be, minus (6), minus (7), minus (8), and
if the Valuation Day is the same as a Monthly Anniversary Day, minus (9), where:
(1) is the Accumulation Value on the preceding Valuation Day;
(2) is all premiums received since the preceding Valuation Day less the premium
load charges from Schedule 3;
(3) is the interest credited under the Fixed Account and the Loan Account since
the preceding Valuation Day;
(4) is the interest charged against the Loan Account since the preceding
Valuation Day;
(5) is the gain or loss in the Variable Account Value based on market
performance since the last Valuation Day;
(6) is the charges and fees associated with the value of the Fixed Account and
Variable Account Sub Accounts from Schedule 2;
(7) is the amount of any Partial Surrenders since the preceding Valuation Day;
(8) is any transaction fees assessed since the preceding Valuation Day; and
(9) is the monthly deduction for the month following the Monthly Anniversary
Day.
FIXED ACCOUNT VALUE. At any point in time, the Fixed Account Value, if any,
with respect to this policy, is equal to the sum of (i) the Net Premium Payments
allocated or other amounts (net of any charges) transferred to the Fixed
Account, plus (ii) interest credited to such account, less (iii) the monthly
deductions applied to such account, less (iv) the charges and fees associated
with the value of the Fixed Account, and less (v) any Partial Surrenders or
amounts transferred from the Fixed Account.
INTEREST CREDITED UNDER FIXED ACCOUNT. The Company will credit interest to the
Fixed Account daily. The interest rate applied to the Fixed Account will be a
rate determined by the Company from time to time but will never be less than the
Guaranteed Rate for the Fixed Account Value shown on Policy Schedule 1. Such
rate will be established on a prospective basis and may vary by the policy issue
year and duration.
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POLICY VALUES PROVISIONS (CONTINUED)
VARIABLE ACCOUNT VALUE. The Variable Account Value, if any, for any Valuation
is equal to the sum of the then current values of all Variable Account Sub-
Accounts under the policy. The value of each Variable Account Sub-Account is
determined by multiplying:
- the number of Variable Accumulation Units, if any, credited or debited to
such Sub-Account, by
- the then current Variable Accumulation Unit Value of that particular Sub-
Account.
CREDITING AND CANCELING VARIABLE ACCUMULATION UNITS. Upon receipt of a premium
payment, all or that portion, of the Net Premium Payment to be allocated to the
Variable Account Sub-Accounts will be credited in the form of Variable Account
Units. Upon receipt of a request for transfer of Funds from the Fixed Account
to the Variable Account Sub-Accounts, the net amount transferred will be
credited in the form of Variable Account Units. The number of Variable
Accumulation Units credited in connection with an allocation or transfer, is
determined by dividing:
- the dollar amount of the transaction, by
- the then current Variable Accumulation Unit Value of the affected Sub-
Account.
The amount of monthly deduction allocated to each Variable Account Sub-Account
will result in the cancellation of Variable Accumulation Units from that Sub-
Account. The aggregate value of the canceled Units will equal the total amount
by which the Sub-Account is reduced. The number of Units canceled in connection
with a monthly deduction is determined by dividing the dollar amount of the
transaction by the then current Unit Value of the affected Sub-Account.
VARIABLE ACCUMULATION UNIT VALUE. The Variable Accumulation Unit Value for each
Variable Account Sub-Account was established at $10.00 for the first Valuation
Period of each Sub-Account. Unit Values for subsequent Valuation Periods are
determined by multiplying:
- the most recent Unit Value of the pertinent Sub-Account, by
- the Net Investment Factor for that Sub-Account for the current Valuation
Period.
Unit Values for each Sub-Account for any Valuation Period are determined as of
the end of the Valuation Period. Unit Values may increase, decrease or remain
constant from Valuation Period to Valuation Period.
NET INVESTMENT FACTOR. The Net Investment Factor is an index applied to measure
the investment performance of a Variable Account Sub-Account from one Valuation
Period to the next. The Net Investment Factor may be greater than, less than,
or equal to 1.0. The value of a Variable Accumulation Unit may, therefore,
increase, decrease or remain the same.
The Net Investment Factor for any Variable Account Sub-Account for any Valuation
Period is determined by dividing (a) by (b) and then subtracting (c) from the
result where:
(a) is the net result of:
(1) the net asset value (as described in the prospectus for the Fund) of
a Fund share held in the Sub-Account determined as of the end of the
Valuation Period, plus
(2) the per share amount of any dividend or other distribution declared by
the Fund on the shares held in the Sub-Account if the "ex-dividend" date
occurs during the Valuation Period, plus or minus
(3) a per share credit or charge with respect to any taxes paid or reserved
for by the Company during the Valuation Period which are determined by
the Company to be attributable to the operation of the Sub-Account;
(b) is the net asset value of a Fund share held in the Variable Account Sub-
Account determined as of the end of the preceding Valuation Period; and
(c) is the asset charge factor determined by the Company for the Valuation
Period to reflect the charges for administration expenses and for assuming
the mortality and expense risks.
The asset charge factor for any Valuation Period is equal to the daily asset
charge factor multiplied by the number of 24-hour periods in the Valuation
Period. The daily asset charge factor will be determined annually by the
Company. In no event may it exceed that specified in Schedule 3.
COST OF INSURANCE RATES. Monthly cost of insurance rates will be determined
from time to time by the Company based on its expectations of future mortality.
The rates will also be based on the Insured's attained age, sex (if applicable)
and underwriting class. Any change in cost of insurance rates will apply to all
individuals of the same class as the Insured. Under no circumstances will the
cost of insurance rates ever be greater than those shown in Policy Schedule 4.
Such guaranteed maximum rates are based on the Commissioners 1980 Standard
Ordinary Mortality Table B (age nearest birthday) modified by any flat extra or
risk factors for the applicable premium class.
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POLICY VALUES PROVISIONS (CONTINUED)
COST OF INSURANCE. The cost of insurance for the Insured is determined on a
monthly basis. Such cost will be calculated as (1), multiplied by the Net
Amount at Risk which is the result of (2) minus (3), where:
1. is the current cost of insurance rate is described in the Cost of
Insurance Rates provision,
2. is the death benefit at the beginning of the policy month, and
3. is the Accumulation Value at the beginning of the policy month prior to the
deduction of the cost of insurance for the current month.
MONTHLY DEDUCTION. The Monthly Deduction for a policy month will be calculated
as Charge (1) plus Charge (2) where:
CHARGE (1) is the cost of insurance (as described in the Cost of Insurance
provision) and the cost of any additional benefits provided by
rider for the policy month.
CHARGE (2) is the sum of the premium loads and fixed administration charges
from Policy Schedule 3.
The amount of monthly deduction that will be deducted from the Fixed Account and
each Variable Account Sub-Account will be in the same proportion that the value
of each account bears to the Net Accumulation Value as of the date on which the
deduction is made.
BASIS OF COMPUTATIONS. The minimum Fixed Account Value is guaranteed to be no
less than that calculated based on the Commissioners 1980 Standard Ordinary
Mortality Table B (age nearest birthday) with interest at the lesser of 4% per
year or the 30 Day Treasury Bill Rate, compounded yearly.
All policy values are at least equal to those required on the Date of Issue by
the jurisdiction in which this policy is delivered. A detailed statement of the
method of computing values has been filed with the insurance supervisory
official of that jurisdiction.
TRANSFER PRIVILEGE PROVISION
TRANSFER PRIVILEGE. Subject to the provisions below, the Owner may:
- transfer all or part of the Variable Account Value to the Fixed Account,
and/or
- transfer all or part of the Variable Account Value to one or more of the
Variable Account Sub-Accounts then available, and/or
- transfer all or part of the Fixed Account to one or more Variable Account
Sub-Accounts,
Transfers may be made at any time the policy is in effect, other than during the
Right to Examine period. Transfers must be made in writing unless other
arrangements have been previously approved by the Company.
In order for a transfer to be processed as of the close of business on the date
the request is received (a) the NYSE must be open for business, and (b) the
transfer request must be received at the Company's Home Office prior to the time
of day set forth in the prospectus. Otherwise, the transfer will be processed
on the next business day the NYSE is open for business.
Transfers involving Variable Account Sub-Accounts will reflect the purchase or
cancellation of Variable Accumulation Units having an aggregate value equal to
the dollar amount of the transaction in the affected Sub-Account. The purchase
or cancellation of such Units shall be made using Unit Values of the affected
Sub-Account for the Valuation Period during which the transaction is effective.
Transfers to the Fixed Account will earn interest as described under the
Interest Credited Under Fixed Account provision.
Transfers shall be subject to the following conditions:
(a) Up to 4 transfers may be made during any Policy Year without charge. For
each transfer in excess of 4, a transfer fee will be deducted on a pro-
rata basis for the affected account. Transfer fees are set forth in
Schedule 3.
(b) No Partial Surrender transaction fee will be imposed on transferred
amounts.
(c) The amount being transferred may not be less than $500 unless the entire
value of the account is being transferred.
(d) The amount being transferred may not exceed the Company's maximum amount
limit then in effect.
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TRANSFER PRIVILEGE PROVISION (CONTINUED)
(e) Transfers among the Variable Account Sub-Accounts can be made at any time.
(f) Transfers to and from the Fixed Account are subject to the Limits on
Transfers as set forth in Policy Schedule 1.
(g) Any account that has a balance that is less than, or equal to,
$500 after a transfer will be allocated among the other accounts affected
by the transfer. The allocation will be based on the same proportions as
the transfer being effected.
(h) Transfers involving Variable Account Sub-Account(s) shall be subject to
such additional terms and conditions as may be imposed by the Funds.
NONFORFEITURE AND SURRENDER PROVISIONS
SURRENDER. This policy may be Surrendered during continuance of the policy and
while the Insured is alive. A Surrender will take effect on the day it is
recorded in writing by the Company. To exercise a cash Surrender, the Owner
must notify the Company in writing. Upon Surrender, all insurance in force
under this policy will terminate.
SURRENDER VALUE. The amount payable on Surrender of this policy (i.e, the
"Surrender Value") will be the Net Accumulation Value on the date of Surrender
plus any premium load credit if Surrender occurs within 24 months of the Date of
Issue.
The Surrender Value will be paid in cash or under an elected optional mode of
settlement. Any deferment of payments will be subject to the Deferment of
Payments provision.
Any Surrender from a Variable Account Sub-Account will result in the
cancellation of Variable Accumulation Units which have an aggregate value on the
effective date of the Surrender equal to the total amount by which the Sub-
Account is reduced. The cancellation of such Units will be based on the Unit
Value of the affected Sub-Account as determined at the close of the Valuation
Period during which the Surrender is effective.
PARTIAL SURRENDER. A Partial Surrender of this policy may be elected on any
Valuation Day while the Insured is alive by submitting a request in writing
unless other arrangements have been previously approved by the Company. The
amount of the Partial Surrender (a) must be at least $500.00 but (b) may not
exceed 90% of the Net Accumulation Value at the end of the Valuation Period
during which the election becomes or would become effective. A Partial
Surrender will take effect on the day it is recorded in writing by the Company.
When a Partial Surrender is made, the Accumulation Value is reduced by (a) the
amount of the Partial Surrender and (b) the transaction fee as specified in
Schedule 3. The Specified Amount of this policy will also be reduced by the
amount of the Partial Surrender. The Company reserves the right to limit any
Partial Surrender so that the Specified Amount remaining in force will not be
less than the Minimum Specified Amount.
When the Partial Surrender is processed, the amount of the Partial Surrender and
the transaction fee will be deducted from the applicable Fixed Account and/or
Variable Account Sub-Accounts in proportion to the then current account values.
Any deferment of payments will be subject to the Deferment of Payments
provision.
INSUFFICIENT VALUE. If the Surrender Value, on the day preceding a Monthly
Anniversary Day is insufficient to cover the monthly deduction for the month
following such Monthly Anniversary Day, the policy will terminate as provided in
the Grace Period provision.
LOAN PROVISIONS
POLICY LOANS. After a Surrender Value is available the Company will grant a
loan against the policy provided: (a) a proper loan agreement is executed, and
(b) a satisfactory assignment of the policy to the Company is made. The loan
may be for any amount up to 90% of the then current Net Accumulation Value.
The policy will be the sole security for the loan.
The amount borrowed will be paid within seven days of the Company's receipt of
such request, except as the Company may be permitted to defer the payment of
amounts as specified under the "Deferment of Payments" provision.
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LOAN PROVISIONS (CONTINUED)
The minimum loan amount is $500. The Company reserves the right to modify this
amount in the future. The Company will effect such loan from the Fixed Account
and each Variable Account Sub-Account in proportion to the then current account
values, unless the Owner instructs the Company otherwise.
LOAN ACCOUNT AND LOAN ACCOUNT VALUE. The amount of any loan will be transferred
out of the Fixed Account and Variable Accounts Sub-Accounts as described above.
Such amount will become part of the Loan Account Value. The outstanding loan
balance at any time includes accrued interest on the loan. The outstanding loan
balance (i.e. Indebtedness) may be repaid at any time during the lifetime of the
Insured. The minimum loan repayment is $100.00 or the amount of the outstanding
Indebtedness, if less. The Loan Account Value will be reduced by the amount of
any loan repayment. Loan repayments will be allocated to the Fixed Account and
each Variable Account Sub-Account in the proportion in which current Net Premium
Payment(s) are being allocated, unless otherwise agreed to in writing by the
Owner and the Company. However, the Company reserves the right to require that
amounts loaned from the Fixed Account be allocated to the Fixed Account upon
repayment.
Net loan interest equals the difference between interest charged and interest
credited on the Loan Account Value. Net loan interest is payable annually on
each Policy Anniversary or as otherwise agreed in writing by the Owner and the
Company. Such loan interest amount, if not paid when due, will be transferred
out of the Fixed Account and each Variable Account Sub-Account in proportion to
the then current account value, unless both the Owner and the Company agree
otherwise.
INTEREST RATE CHARGED ON LOAN ACCOUNT VALUE. Loan interest charged on the Loan
Account Value will be at a rate equivalent to 5% per year, payable in arrears.
INTEREST RATE CREDITED ON LOAN ACCOUNT VALUE. The interest rate used to credit
interest to the Loan Account Value may vary, but will not be less than 3.8% per
year.
INDEBTEDNESS. The term Indebtedness means money which is owed on this policy
because of a loan against this policy. Indebtedness includes interest accrued,
but not paid, on a policy loan. A loan, whether or not repaid, will have a
permanent effect on the Net Accumulation Value and on the death benefits. Any
Indebtedness at the time of settlement will reduce the proceeds. Indebtedness
may be repaid in whole or in part at any time during the lifetime of the
Insured. An Indebtedness will be a first lien on the policy in favor of the
Company.
If at any time the total Indebtedness against the policy, including interest
accrued but not due, equals or exceeds the then current Accumulation Value, the
policy will thereupon terminate without value subject to the conditions in the
Grace Period provision. A notice will be sent at least 31 days before the end
of the Grace Period to the Owner and to any assignees that this policy will
terminate unless the Indebtedness is repaid. After the policy has lapsed due to
the expiration of a Grace Period, it can be reinstated only if any Indebtedness
against the policy, increased by any loan interest, is paid or reinstated.
INSURANCE COVERAGE PROVISIONS
EFFECTIVE DATE OF COVERAGE. The effective date of this policy will be the Date
of Issue provided the initial premium has been paid (1) while the Insured is
alive, and (2) prior to any change in health or insurability of the Insured as
represented in the original application.
For any increase or addition to coverage, the effective date will be the Monthly
Anniversary Day that coincides with or next follows the day the supplemental
application is approved by the Company provided (a) sufficient Accumulation
Value exists under the policy to cover the cost for the increase or (b)
sufficient premium for the increase or addition has been paid.
For any insurance that has been reinstated, the effective date will be the
Monthly Anniversary Day that coincides with or next follows the day the
application for reinstatement is approved by the Company, provided the Insured
is alive on such a day.
TERMINATION OF COVERAGE. All coverage under this policy will automatically
terminate upon whichever of the following occurs first:
1. The Owner surrenders the policy.
2. The Insured dies.
3. The Grace Period ends and the necessary premium payment
has not been made prior to such time.
Any Monthly Deduction made after termination of coverage will not, by itself, be
considered a reinstatement of the policy nor a waiver by the Company of the
termination. Any such deduction will be refunded.
DEATH BENEFIT. If the Insured dies while the policy is in force, the Company
will pay a death benefit based upon the Death Benefit Option in effect on the
date of death, less (a) any Indebtedness
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INSURANCE COVERAGE PROVISIONS (CONTINUED)
against the policy, and (b) the amount of any Partial Surrenders. The Death
Benefit Options available under this policy are as follows:
OPTION A The death benefit will equal the greater of the Specified Amount plus
the Accumulation Value or the Minimum Death Benefit.
OPTION B The death benefit will equal the greater of the Specified Amount or
the Minimum Death Benefit.
OPTION C The death benefit will equal the greater of the Specified Amount
plus the sum of the premiums paid or the Minimum Death Benefit.
Unless the application for the policy indicates otherwise, or a change in the
Death Benefit Option is effected as provided below, the Company will consider
Death Benefit Option B to be the option in effect.
MINIMUM DEATH BENEFIT. The Minimum Death Benefit is an amount determined by the
Company equal to that required by the Internal Revenue Code to maintain this
contract as a life insurance policy. At the time of application, the Owner will
elect the test for determining compliance with the IRC definition of life
insurance. The selection will be designated on Policy Schedule 1 and cannot be
changed after the policy's Date of Issue. The Owner may select either:
(a) The Guideline Premium/Corridor Percentage Test: where the Accumulation
Value is multiplied by the corridor percentage (at the Insured's attained
age) shown on Policy Schedule 5, or
(b) The Cash Value Accumulation Test: where the Accumulation Value is
multiplied by the Net Single Premium Factor (at the Insured's attained
age) shown on Policy Schedule 6.
CHANGES IN AMOUNT OF DEATH BENEFIT. Unless provided otherwise, a change in
death benefit may be effected at any time while the policy is in force, subject
to (a) the consent of the Company and (b) the following conditions:
1. All such changes must be requested in writing.
2. If a decrease in the Specified Amount is requested, the decrease will become
effective on the Monthly Anniversary Day that coincides with or next follows
receipt of the request provided any requirements as determined by the Company
are met.
In such event, the Company will reduce the existing Specified
Amount against the most recent increase first. The Company will then make
reductions against the next most recent increases successively. Finally, the
Company will make reductions against insurance provided under the original
application. The Company reserves the right to limit the amount of any
decrease so that the Specified Amount will not be less than the Minimum
Specified Amount shown in the Policy Specifications.
3. If an increase in the Specified Amount is requested:
(a) a supplemental application must be submitted and evidence
of insurability satisfactory to the Company must be furnished;
and
(b) any other requirements as determined by the Company must be met.
If the Company approves the request, the increase will become effective upon
(i) the Monthly Anniversary Day that coincides with or next follows the date
the request is approved by the Company and (ii) the deduction from the
Accumulation Value (in proportion to the then current account values of the
Fixed Account and/or Variable Account Sub-Accounts) of the first month's cost
of insurance for the increase provided the Insured is alive on such a day.
4. If a request is made to change the death benefit from:
Option B to Option A:
(a) the Specified Amount will be reduced to equal the death benefit, less
the Accumulation Value, as of the effective date of change;
Option B to Option C:
(a) the Specified Amount will be changed to equal the death benefit less
premiums paid as of the effective date of change;
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INSURANCE COVERAGE PROVISIONS (CONTINUED)
Option A to Option B:
(a) the Specified Amount will be increased to equal the death benefit as of
the effective date of change;
Option A to Option C:
(a) the Specified Amount will be reduced to equal the death benefit less
premiums paid as of the effective date of change;
Option C to Option B:
(a) the Specified Amount will be increased to equal the death
benefit as of the effective date of change;
Option C to Option A:
(a) the Specified Amount will be changed to equal the death benefit less the
Accumulation Value as of the effective date of change;
and,
(b) the effective date will be the Monthly Anniversary Day that coincides
with or next follows the date of receipt of the request for change.
The Company will not allow a decrease in the amount of insurance below the
minimum amount required to maintain the contract as a life insurance policy
under the Internal Revenue Code.
EXTENSION OF COVERAGE. If the Insured is alive at age 100 and there is then a
positive Surrender Value, the Company:
a) will immediately reduce the death benefit to the Minimum Death Benefit
required for the policy to continue to qualify as life insurance under the
Internal Revenue Code, and
b) The policy will continue in force and the death benefit will be paid as
defined in the "Payment of Proceeds" provision, upon receipt of due proof of
the Insured's death.
GENERAL PROVISIONS
THE POLICY. The policy and the application for the policy (including any
supplemental applications for additional Specified Amounts) constitute the
entire contract between the parties. All statements made in the application
will, in the absence of fraud, be deemed representations and not warranties. No
statement will be used in defense of a claim under the policy unless it is
contained in the application, and a copy of the application is attached to the
policy when issued or modified.
Only the President, a Vice President, a Secretary, a Director or an Assistant
Director of the Company may make or modify this policy.
The policy is executed at the Home Office of the Company, the post office
address of which is Hartford, Connecticut 06152.
NON-PARTICIPATION. The policy is not entitled to share in surplus distribution.
NOTICE OF CLAIM. Due proof of death should be furnished to the Company within
30 days, or as soon as reasonably possible, after the death of the Insured.
Such notice shall be given by or on behalf of the Owner to the Company at its
Home Office.
PAYMENT OF PROCEEDS. Proceeds, as used in this policy, means the amount payable
(a) upon the Surrender of this policy, or (b) upon the death of the Insured.
If the policy is Surrendered, the proceeds will be the Surrender Value described
in the Nonforfeiture and Surrender Provisions section. The proceeds payable
upon the Insured's death are described in the Insurance Coverage Provisions. If
the Insured dies during the Grace Period, the Company will pay the death benefit
proceeds in effect immediately prior to the Grace Period reduced by any overdue
monthly deductions.
The proceeds are subject to the adjustments described in the following
provisions:
1. Misstatement of Age or Sex, if applicable;
2. Incontestability;
3. Suicide;
4. Grace Period;
5. Indebtedness; and
6. Partial Surrender.
When settlement is made, the Company may require return of the policy.
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GENERAL PROVISIONS (CONTINUED)
DEFERMENT OF PAYMENTS. Any amounts payable as a result of loans,
Surrender, or Partial Surrenders will be paid within 7 days of the Company's
receipt of such request. Payment of amounts from the Variable Account Sub-
Accounts, however, may be postponed when the NYSE is closed or when the SEC
declares an emergency. Additionally, the Company reserves the right to defer
the payment of such amounts from the Fixed Account for a period not to exceed 6
months from the date written request is received by the Company. During any
such deferred period the amount payable will bear interest as required by law.
Surrender payments will not be deferred if the amount is to be applied to the
payment of premiums on policies with the Company.
MISSTATEMENT OF AGE. If the age of the Insured is misstated, the Company will
adjust the death benefit and Accumulation Value. The adjustment process will
recalculate all such benefits and values to the amounts that would have been
calculated for the correct age using the rates that were in effect at the time
of each monthly anniversary. The process will begin with the recalculation
based on the rates in effect on the Issue Date. Each succeeding recalculation
will be based on the rates in effect on the corresponding monthly anniversary.
SUICIDE. Suicide of the Insured, whether sane or insane, within 2 years from
the Date of Issue, is a risk not assumed under the policy. In such an event,
the Company will pay to the Beneficiary an amount equal to the premiums paid
less any Indebtedness against the policy and any Partial Surrenders, and the
policy will no longer be in force.
Suicide of the Insured, whether sane or insane, within 2 years from the
effective date of any increase in the Specified Amount, is a risk not assumed
under the policy. In such event, the Company will pay to the Beneficiary a
refund of the monthly charges for the cost of such increase in insurance and the
death benefit will be based on the Specified Amount before such increase was
made.
INCONTESTABILITY. Except for nonpayment of Monthly Deductions, this policy will
be incontestable after it has been in force during the Insured's lifetime for 2
years from its Date of Issue. This means that the Company will not use any
misstatement in the application to challenge a claim or avoid liability after
that time. Any increase in the Specified Amount effective after the Date of
Issue will be incontestable only after such increase has been in force for 2
years during the Insured's lifetime.
The basis for contesting an increase in Specified Amount will be limited to
material misrepresentations made in the supplemental application for the
increase. The basis for contesting after reinstatement will be limited to (a) a
period of 2 years from the date of reinstatement and (b) material
misrepresentations made in the reinstatement application.
ANNUAL REPORT. The Company will send a report to the Owner at least once a year
without charge. The report will show the Accumulation Value as of the reporting
date and amounts deducted from or added to the Accumulation Value since the last
report. The report will also show (a) the current death benefit, (b) the
current policy values, (c) premiums paid and all deductions made since the last
report, and (d) outstanding policy loans.
PROJECTION OF BENEFITS AND VALUES. The Company will provide a projection of
illustrative future death benefits and Surrender Values at any time upon written
request. The first projection provided during a Policy Year will be at no
charge. Each additional projection during that Policy Year may be subject to
payment of a reasonable service fee. The fee payable will be the one then in
effect for this service. The illustration will be based on (a) assumptions as
to Specified Amount(s), type of coverage option(s) and future planned periodic
premium payments, and (b) such other assumptions (e.g. mortality and interest)
as are necessary and specified.
CHANGE OF PLAN. This policy may be exchanged for any flexible premium
adjustable life insurance policy offered by the Company's Corporate Insurance
Department subject to the following conditions: (a) evidence of insurability
satisfactory to the Company is furnished, (b) the premium for the new policy is
determined according to the Company's rates then in effect for that policy based
on the Insured's then attained age and (c) the request for the exchange is
received by the Company within 24 months from the Date of Issue of this policy.
The new policy shall have the same Specified Amount, Date of Issue, Issue Age,
and Surrender Value as this policy as of the date of exchange. The new policy
will not take effect until the date all such requirements are met.
POLICY CHANGES - APPLICABLE LAW. This policy must qualify initially and
continue to qualify as life insurance under the Internal Revenue Code in order
for the Owner to receive the tax treatment accorded to life insurance under
Federal law. Therefore, to maintain this qualification to the maximum extent
permitted by law, the Company reserves the right to return any premium payments
that would cause this policy to fail to qualify as life insurance under
applicable tax law as interpreted by the Company. Further, the Company reserves
the right to make changes in this policy or to make distributions from the
policy to the extent it deems necessary, in its sole discretion, to continue to
qualify this policy as life insurance. Any such changes will apply uniformly to
all policies that are affected. The Owner will be given advance written notice
of such changes.
12
LN620
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
HARTFORD, CONNECTICUT
ADDITIONAL INSURANCE BENEFIT
This benefit is made part of the policy to which it is attached if it is listed
in the Policy Specifications. The amount of insurance in force under this
benefit is the Additional Specified Amount for the benefit shown on the Policy
Specifications page of the Base Policy, subject to the following provisions.
DEFINITIONS:
Base Policy - the policy to which this benefit is attached
The Company - Connecticut General Life Insurance Company
Grace Period - as defined in the Base Policy
Home Office - 900 Cottage Grove Road, Hartford, CT 06152
Insured - as listed on Policy Specifications page of the
Base Policy
BENEFITS. The Company agrees to pay the Beneficiary the Additional Specified
Amount in force under this benefit on the date of the Insured's death. Payment
will be made upon receipt of due proof of the Insured's death during the
continuance of the Base Policy and this benefit.
DEATH BENEFIT. The death benefit of the Base Policy is modified to include the
Additional Specified Amount under this benefit. The death benefit options of
the Base Policy are amended as follows:
Option A The death benefit is the greater of (1) and (2) where
(1) is the Base Policy Specified Amount plus the Additional Specified
Amount plus the Base Policy Accumulation Value, and
(2) is the Minimum Death Benefit as defined in the Base Policy.
Option B The death benefit is the greater of (1) and (2) where
(1) is the Base Policy Specified Amount plus the Additional Specified
Amount, and
(2) is the Minimum Death Benefit as defined in the Base Policy.
Option C The death benefit is the greater of (1) and (2) where
(1) is the Base Policy Specified Amount plus the Additional Specified
Amount plus the sum of the premiums paid, and
(2) is the Minimum Death Benefit as defined in the Base Policy.
The company reserves the right to increase the Base Policy Specified Amount and
reduce, by an equal amount, the Additional Insurance Benefit, if such action is
required to ensure that this contract continues to meet the definition of life
insurance as defined by the Internal Revenue Code.
COST OF INSURANCE. The initial cost of insurance for the coverage provided
under this benefit will be deducted on the Effective Date of the benefit.
Subsequent cost of insurance under this benefit will be deducted on a monthly
basis. Such cost is calculated as (1) multiplied by the excess of (2) over (3)
where:
(1) is the cost of insurance rate as described in the Cost of Insurance Rates
provision.
(2) is the Additional Specified Amount in force at the beginning of the Base
Policy month.
(3) is equal to the greater of zero or the excess of (4) over (5), where
(4) is the Accumulated Value at the beginning of the policy month prior to the
deduction of the cost of insurance for the current month, and
(5) is the Specified Amount of the Base Policy.
COST OF INSURANCE RATES. Monthly cost of insurance rates will be determined by
the Company based on its expectations as to future mortality experience. Any
change in cost of insurance rates will apply to all individuals of the same
class as the Insured. Under no circumstances will the cost of insurance rates
ever be greater than those derived from the Table of Guaranteed Maximum Cost of
Insurance Rates in the Base Policy. Such guaranteed maximum rates are based on
the Commissioners 1980 Standard Ordinary Mortality Table B (age nearest
birthday) modified by any flat extra or risk factors for the applicable premium
class.
CHANGES IN AMOUNT OF DEATH BENEFIT. Unless provided otherwise, a change in the
death benefit may be effected under this benefit, subject to (a) the consent of
the Company and (b) the following conditions:
1. All such changes must be requested in writing on a form satisfactory to the
Company and filed at the Home Office.
LR468
<PAGE>
2. If a decrease in the death benefit is requested, the decrease will become
effective on the Monthly Anniversary Day that coincides with or next follows
receipt of the request provided any requirements as determined by the
Company are met.
In such event, the Company will reduce the existing Additional Specified
Amount against the most recent increase first. The Company will then make
reductions against the next most recent increases successively. Finally,
the Company will make reductions against insurance provided under the
original application.
3. If an increase in the death benefit is requested, a supplemental application
must be submitted and evidence of insurability satisfactory to the Company
must be furnished; and
If the Company approves the request, the increase will become effective upon
(i) the Monthly Anniversary Day (of the Base Policy) that coincides with or
next follows the date the request is approved by the Company and (ii) the
deduction from the cash value of the first month's cost of insurance for the
increase and Charge (3) as described under the "Monthly Deduction" provision
in the Base Policy.
TERMINATION. This benefit and all insurance provided under it will terminate
automatically upon the date the Base Policy terminates. If, however, the Base
Policy is reinstated prior to the Date of Expiry, this benefit will likewise be
reinstated.
EFFECTIVE DATE. This benefit becomes effective as of the Date of Issue of the
Base Policy unless a later date is shown on the Policy Specifications page of
the Base Policy. If the Effective Date of this benefit is later than the Date
of Issue of the Base Policy, the periods specified in the "Suicide" and
"Incontestability" provisions will be measured from the Effective Date of this
benefit.
PARTIAL SURRENDER. The Partial Surrender provision of the Base Policy is
modified such that for the purpose of this provision the Additional Specified
Amount is considered part of the Specified Amount of the Base Policy. The
Additional Specified Amount will always be decreased or eliminated before any
decrease is effected to the original Specified Amount of the Base Policy.
GENERAL PROVISIONS. Except as provided above, this benefit is subject to all
terms of the Base Policy.
/s/ Thomas C. Jones
President
LR468
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
HARTFORD, CONNECTICUT
SEX-DISTINCT RIDER
This rider is made part of the policy to which it is attached (the "Base
Policy") if it is listed in the Policy Specifications. The rider will convert
the unisex Base Policy to a sex-distinct contract.
All values in the Base Policy which are calculated using 1980 CSO Table B will,
by reason of this rider, be calculated based on the sex-distinct 1980 CSO
Tables.
Tables and/or Schedules affected by the change, and so amended, are listed
below:
Table of Guaranteed Maximum Life Insurance Rates per $1000
Table of Net Single Premium Factors
The MISTATEMENT OF AGE provision in the Base Policy shall be revised as follows:
MISSTATEMENT OF AGE OR SEX. If the age and/or sex of the Insured is
misstated, the Company will adjust the death benefit and Accumulation
Value. The adjustment process will recalculate all such benefits and
values to the amounts that would have been calculated for the correct age
and/or sex using the rates that were in effect at the time of each monthly
anniversary. The process will begin with the recalculation based on the
rates in effect on the Issue Date. Each succeeding recalculation will be
based on the rates in effect on the corresponding monthly anniversary.
This rider will be effective as of the Date of Issue of the Base Policy.
Except as amended above, this rider is subject to all terms of the Base Policy.
/s/ Thomas C. Jones
President
LR469
<PAGE>
Endorsements
13
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY
Variable life insurance payable upon death of the Insured.
Surrender Value payable upon Surrender.
Flexible Premiums. Non-Participating.
Investment results reflected in policy benefits.
LN620
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
a CIGNA company
------------------------------------------
CORPORATE MASTER APPLICATION
PLAN NUMBER: Specimen
1a. Corporation Name
- --------------------------------------------------------------------------------
b. Corporate Tax I.D.
-- -- - -- -- -- -- -- -- --
- --------------------------------------------------------------------------------
c. Address (NO., STREET, CITY, STATE & ZIP CODE)
- --------------------------------------------------------------------------------
2. Owner: / / Corporation is Owner of all policies
/ / Insured is the Owner unless otherwise designated on the
Insured's Enrollment Form
/ / Other: (SPECIFY NAME, ADDRESS & TAX I.D. NUMBER)
- --------------------------------------------------------------------------------
3. To whom shall premium notices and correspondence be sent? (SPECIFY PERSON.
ALSO INCLUDE ADDRESS IF OTHER THAN 1C.)
- --------------------------------------------------------------------------------
4. Beneficiary: / / Corporation
/ / As designated by individual policy Owner
/ / Other: (SPECIFY NAME AND ADDRESS)
- --------------------------------------------------------------------------------
5a. Plan of Insurance:
/ / Corporate UL / / Other ________________
/ / Corporate UL II
/ / Whole Life COLI # ___________
- --------------------------------------------------------------------------------
5b. Death Benefit Options:
/ / Specified Amount / / Other______________________
/ / Specified Amount Plus Fund Value
/ / Specified Amount Plus Premium
- --------------------------------------------------------------------------------
5c. Additional Benefits (IF AVAILABLE)
/ / Substitute Life Rider / / WP / / AI / / Other (PLEASE
SPECIFY)
- --------------------------------------------------------------------------------
6. Shall the Automatic Premium Loan Provision (if available) be made
effective? / / Yes / / No
- --------------------------------------------------------------------------------
7. Effective Date of Plan:
Mo. Day Yr.
- --------------------------------------------------------------------------------
8. ADDITIONAL INSTRUCTIONS
- --------------------------------------------------------------------------------
9. HOME OFFICE CHANGES OR CORRECTIONS
- --------------------------------------------------------------------------------
I (We) have read the above questions and answers and declare that they are
complete and true to the best of my (our) knowledge and belief. I (We) agree,
a) that this Corporate Master Application, the Insured's Enrollment Form and
Corporate Sponsored Life Insurance Application shall form a part of any Policy
issued, and b) that no Agent/Representative of the Company shall have the
authority to waive a complete answer to any question in this Application,
transfer insurability, make or alter any contract, or waive any of the
Company's other rights or requirements. I (We) further agree that no insurance
shall take effect unless and until the initial premium has been paid during the
lifetime of the Proposed Insureds.
Changes or corrections made by the Company and noted in Item 9 above are
ratified by the Owner upon acceptance of a contract containing this Application
with the noted changes or corrections. In those states where written consent
is required by statute or State Insurance Department regulation, amendments as
to plan, amount, age at issue, classification, or benefits will be made only
with the Owner's written consent.
Dated at on 19
---------------------- -------------------------------- -----
City and State Month Day Year
- ------------------------------- -----------------------------------------
Licensed Agent/Representative Signature of Corporate Officer
B10163
<PAGE>
CERTIFICATION BY LICENSED REPRESENTATIVE
- --------------------------------------------------------------------------------
The Licensed Representative who witnessed the signature on the Application
certifies that:
1. He/she asked all the questions on the Application and recommends this risk
to Connecticut General without reservation.
2. The insurance applied for
/ / is not intended to replace existing life Insurance.
/ / is intended to replace existing life insurance
----------------------------------- ------------------------------------
Date Signature of Licensed Representative
- --------------------------------------------------------------------------------
ALL COMMISSIONS AND FEES (IF ANY) SHALL BE PAID TO:
Name Share %
------------------------------------ --------------------
Name Share %
------------------------------------ --------------------
Name Share %
------------------------------------ --------------------
Name Share %
------------------------------------ --------------------
Name Share %
------------------------------------ --------------------
- --------------------------------------------------------------------------------
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
a CIGNA company
----------------------------------------------
CORPORATE EMPLOYEE LIFE INSURANCE APPLICATION
PART I
<TABLE>
<CAPTION>
<S><C>
1a. Full First Name Middle Initial Last Name b. Proposed Insured's SS# c. Sex
/ / M / / F
-- -- -- - -- -- - -- -- -- --
- -----------------------------------------------------------------------------------------------------------------------------------
d. Date of Birth Month Day Year e. Place of Birth City State f. Phone Home:
/ / Work:
- -----------------------------------------------------------------------------------------------------------------------------------
2a. Name of Employer b. Occupation
- -----------------------------------------------------------------------------------------------------------------------------------
3a. Plan of Insurance: / / CORP UL / / WHOLE LIFE COLI # ______________ b. Death Benefit: $__________________________
/ / CORP UL II / / Other (Please Specify)
- -----------------------------------------------------------------------------------------------------------------------------------
4. Have you ever applied for any Life or Health Insurance which Details of "Yes" answers to questions 4 - 15
resulted in your being turned down, asked to pay an extra premium ------------------------------------------------
or issued a reduced face amount? / / Yes / / No
- -----------------------------------------------------------------------------------------------------------------------------------
5. What is your exact height and weight?
ft. in. lbs.
- -----------------------------------------------------------------------------------------------------------------------------------
6. Have you ever had or consulted a physician, hospital or other
medical facility for: any disease of the heart, blood vessels
or lungs; tumor or cancer; elevated blood pressure; nervous
system disorder; mental, emotional or behavioral disorder;
diabetes, kidney or urinary disorder; disease of the stomach,
intestines, or liver; treatment for anemia or any other
blood disorder, alcoholism or drug abuse; or major
accident? / / Yes / / No
- -----------------------------------------------------------------------------------------------------------------------------------
7. Have you been diagnosed by a physician, hospital or other
medical facility or been treated for Acquired Immune
Deficiency Syndrome or an AIDS related
condition? / / Yes / / No
- -----------------------------------------------------------------------------------------------------------------------------------
8. During the last 90 days have you been actively at work on a
fulltime basis and not absent from work because of illness
or injury for more than 3 days? / / Yes / / No
- -----------------------------------------------------------------------------------------------------------------------------------
9. Do you contemplate flying, or have you flown during
the past 2 years as a pilot, student pilot,
or crew member? / / Yes / / No
IF "YES," AN AVIATION SUPPLEMENT IS REQUIRED.
- -----------------------------------------------------------------------------------------------------------------------------------
10. Do you plan to participate or have you participated within the
past 2 years in motor vehicle or boat racing, hang
gliding, or sky, skin, scuba diving or similar
sports? / / Yes / / No
IF "YES," COMPLETE AVOCATION QUESTIONNAIRE.
- -----------------------------------------------------------------------------------------------------------------------------------
11. Do you contemplate residence or travel outside of the United
States or Canada? / / Yes / / No
- -----------------------------------------------------------------------------------------------------------------------------------
12. a. Name and address of your personal physician
If none, please check / / None
b. Date and reason last consulted.
c. What treatment was given or medication prescribed?
- -----------------------------------------------------------------------------------------------------------------------------------
13. When and for what reason did you last consult any physician?
Give details and name and address of the physician in space
provided at right.
- -----------------------------------------------------------------------------------------------------------------------------------
14. Have you used tobacco in any form within the last 12 months?
/ / Yes / / No (IF "YES," DESCRIBE FREQUENCY, QUANTITY AND
KIND OF TOBACCO USED IN SPACE PROVIDED)
- -----------------------------------------------------------------------------------------------------------------------------------
15. Will you discontinue or otherwise stop paying
premiums on any Life Insurance or Annuity if this
insurance is issued? / / Yes / / No
- -----------------------------------------------------------------------------------------------------------------------------------
B10162 (Page 1)
<PAGE>
- -----------------------------------------------------------------------------------------------------------------------------------
16. ADDITIONAL INSTRUCTIONS 17. HOME OFFICE CHANGES OR CORRECTIONS
- -----------------------------------------------------------------------------------------------------------------------------------
I (We) have read the above questions and answers and declare that they are
complete and true to the best of my (our) knowledge and belief. I (We) agree,
a) that this Corporate Employee Life Insurance Application, the Insured's
Enrollment Form and the Corporate Master Application Number______________
shall form a part of the Policy issued, and b) that no Agent/Representative of
Connecticut General Life Insurance Company shall have the authority to waive a
complete answer to any questions in this Application, transfer insurability,
make or alter any contract, or waive any of Connecticut General Life Insurance
Company's other rights or requirements. I (We) further agree that no
insurance shall take effect unless and until the initial premium has been paid
during the lifetime of the Proposed Insured. I (We) understand that the
Beneficiary and Owner shall be as designated on the Corporate Master
Application and the Insured's Enrollment Form.
Changes or corrections made by Connecticut General Life Insurance Company and
noted in Item 17 above are ratified by the Owner upon acceptance of a contract
containing this Application with the noted changes or corrections. In those
states where written consent is required by statute or State Insurance
Department regulation, amendments as to plan, amount, age at issue,
classification, or benefits will be made only with the Owner's written
consent.
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR
OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM
CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF
MISLEADING, ANY INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A
FRAUDULENT INSURANCE ACT, WHICH IS A CRIME, AS DETERMINED BY A COURT OF
COMPETENT JURISDICTION.
- -----------------------------------------------------------------------------------------------------------------------------------
Dated at (City and State) Month, Day & Year
on
- -----------------------------------------------------------------------------------------------------------------------------------
Witness - Licensed Agent/Representative Signature of Proposed Insured
- -----------------------------------------------------------------------------------------------------------------------------------
Witness Signature of Applicant/Owner if other than
Proposed Insured
- ------------------------------------------------------------------------------------------------------------------------------------
B10162 (Page 2) NO. NUMBER
TAX CERTIFICATION
CERTIFICATION - Under penalties of perjury, I, the Owner of the policy applied
for, certify that:
(1) The number shown on this form is my correct Taxpayer Identification Number
(or I am waiting for a number to be issued to me), and
(2) I am not subject to backup withholding either because I have not been
notified by the Internal Revenue Service (IRS) that I am subject to backup
withholding as a result of a failure to report all interest or dividends, or
the IRS has notified me that I am no longer subject to backup
withholding.
CERTIFICATION INSTRUCTIONS - You must cross out item (2) above if you have
been notified by IRS that you are subject to backup withholding because of
underreporting interest or dividends on your tax return. However, if after
being notified by IRS that you were subject to backup withholding you received
another notification from IRS that you are no longer subject to backup
withholding, do not cross out item (2).
- -----------------------------------------------------------------------------------------------------------------------------------
Taxpayer Identification Number (of Proposed Insured Backup Withholding on Accounts Opened
or Owner if other than Proposed Insured) After 12/31/83
------------------------- -------------------------------------------------------------
Social Security Number Check the box if you are
NOT subject to backup withholding under the provisions
Enter your taxpayer identification ------------------------- of Section 3406(a)(1)(C) of the
number in the appropriate box. For Internal Revenue Code _ _ _ _ _ _ _ _ / /
most individual taxpayers, this is
their social security number. OR
-------------------------
Employer Identification
Number
-------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
Certification - Under penalties of perjury, I certify that the information
provided on this Tax Certification is true, correct and complete.
Signed on ______________________________________ , 19 ____ ___________________________________________________________
Month Day Year Signature of Owner
- ----------------------------------------------------------------------------------------------------------------------------------
</TABLE>
<PAGE>
AUTHORIZATION
The purpose of this authorization is to allow the Insurance Company to determine
your eligibility for life or health insurance coverage or claim for benefits
under a life or health policy.
I AUTHORIZE any medical professional, hospital, medical care institution,
insurer, Medical Information Bureau, Inc., consumer reporting agency, Social
Security Administration, employer, or other person having records or knowledge
of me or my family members' physical or mental health, or any other information
bearing on my insurability, to give Connecticut General Life Insurance Company,
and its reinsurers, or any consumer reporting agency acting on the Company's
behalf, any such information. This shall include all information about my
medical history, diagnosis, treatment, and prognosis including information
regarding alcohol or drug abuse.
I AUTHORIZE the Insurance Company to have a blood sample and urine sample
analyzed for the purpose of underwriting my application for insurance coverage.
The analysis of the blood and urine sample may include, but is not limited to,
tests where allowed by law for diabetes, liver function, kidney disorders,
cholesterol and related blood lipids, presence of acquired immune deficiency
syndrome antibodies, immune disorders, or the presence of medication, drugs, or
nicotine. I AUTHORIZE the Insurance Company to disclose the results of these
tests to the Medical Information Bureau described in the Important Notice.
I UNDERSTAND THAT my medical records may be protected by certain Federal
Regulations, especially as they apply to any drug or alcohol abuse data. I
understand that I may revoke this authorization at any time as it pertains to
any such drug or alcohol abuse data by written notification; however, any action
taken prior to revocation will not be affected.
This authorization shall be valid for a period of two years after the date it is
signed. A photographic copy of this authorization shall be as valid as the
original. I will be given a copy of this authorization at my request. An
investigative consumer report may be obtained and if such report is obtained, I
may request to be interviewed in connection with the preparation of that report.
If a consumer report is obtained I / / do / / do not request to be interviewed.
I ACKNOWLEDGE the receipt of the "Important Notice" containing Fair Credit
Reporting Act and Medical Information Bureau, Inc. information.
Signed on ______________, 19 ______ _______________________________
Month Day Year Signature of Proposed Insured
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
HARTFORD, CONNECTICUT 06152
ENROLLMENT FORM
(SMOKER DISTINCT)
INSURED OWNER
(Complete if other than Insured or Employer)
(If Trust, include VTA)
NAME
----------------------------------- ------------------------------------
SS/TAX ID#
----------------------------- ------------------------------------
TAX CERTIFICATION - Under penalties of perjury, we certify that our correct
Social Security and/or Tax identification Numbers are shown and that we are
not subject to back up withholding.
Address
-------------------------------- ---------------------------------
-------------------------------- ---------------------------------
-------------------------------- ---------------------------------
DATE OF BIRTH / / SEX M F
-------- -------- -------- ------ ------
YES NO Has the Insured smoked CIGARETTES within the past 12 months?
----- -----
YES NO Has the Insured been ACTIVELY-AT-WORK*? IF "NO", please
describe the nature of any absences:
- --------------------------------------------------------------------------------
* ACTIVELY-AT-WORK is defined as: Performing all normal duties of the
position on a full time basis for not less than 35 hours per week and not
absent from work due to accident, illness or other condition for more than
any three days of the ninety days prior to first becoming eligible to
participate in the life insurance program being applied for. Connecticut
General reserves the right to request recertification of the above
information for deaths occurring within two years of the enrollment date or
any increase thereafter and to contest any claim during that period.
BENEFICIARY DESIGNATION - All primary beneficiaries who survive the Insured
shall share equally, unless otherwise indicated. If no primary beneficiary
survives the Insured, benefits will be paid to the contingent beneficiaries
surviving the Insured in equal shares, unless otherwise indicated.
NAME RELATIONSHIP
PRIMARY
--------------------------- ----------------------------
--------------------------- ----------------------------
--------------------------- ----------------------------
CONTINGENT
--------------------------- ----------------------------
--------------------------- ----------------------------
--------------------------- ----------------------------
As long as I continue to work for my current Employer, Connecticut General shall
change the Specified Amount of insurance in accordance with my Employer's
written request to change such Specified Amount. Each change shall be subject
to Connecticut General's underwriting limitations and requirements then in
effect, including but not limited to, my being ACTIVELY-AT-WORK* at the time of
each change.
- ---------------------------------------------------------- --------------
INSURED'S SIGNATURE DATE
- ---------------------------------------------------------- --------------
OWNER'S SIGNATURE (IF OTHER THAN INSURED OR EMPLOYER) DATE
B10177
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
HARTFORD, CONNECTICUT 06152
ENROLLMENT FORM
(UNISMOKE ONLY)
INSURED OWNER
(Complete if other than Insured or Employer)
(If Trust, include VTA)
NAME
-------------------------------- ----------------------------
SS/TAX ID#
-------------------------- ----------------------------
TAX CERTIFICATION - Under penalties of perjury, we certify that our
correct Social Security and/or Tax Identification Numbers are shown and
that we are not subject to back up withholding.
Address
----------------------------- ---------------------------
--------------------------- ---------------------------
--------------------------- ---------------------------
DATE OF BIRTH / / SEX M F
---- ---- ---- ------ ------
YES NO Has the Insured been ACTIVELY-AT-WORK*? IF "NO", please
----- ----- describe the nature of any absences:
- --------------------------------------------------------------------------------
* ACTIVELY-AT-WORK is defined as: Performing all normal duties of the
position on a full time basis for not less than 35 hours per week and
not absent from work due to accident, illness or other condition for
more than any three days of the ninety days prior to first becoming
eligible to participate in the life insurance program being applied
for. Connecticut General reserves the right to request
recertification of the above information for deaths occurring within
two years of the enrollment date or any increase thereafter and to
contest any claim during that period.
BENEFICIARY DESIGNATION - All primary beneficiaries who survive the Insured
shall share equally, unless otherwise indicated. If no primary beneficiary
survives the Insured, benefits will be paid to the contingent beneficiaries
surviving the Insured in equal shares, unless otherwise indicated.
NAME RELATIONSHIP
PRIMARY:
-------------------------------- -------------------------------------
-------------------------------- -------------------------------------
-------------------------------- -------------------------------------
CONTINGENT:
----------------------------- -------------------------------------
----------------------------- -------------------------------------
----------------------------- -------------------------------------
As long as I continue to work for my current Employer, Connecticut General
shall change the Specified Amount of insurance in accordance with my
Employer's written request to change such Specified Amount. Each change
shall be subject to Connecticut General's underwriting limitations and
requirements then in effect, including but not limited to, my being
ACTIVELY-AT-WORK* at the time of each change.
--------------------------------------------------- --------------------
INSURED'S SIGNATURE DATE
--------------------------------------------------- --------------------
OWNER'S SIGNATURE (IF OTHER THAN INSURED OR DATE
EMPLOYER)
B10178
