<PAGE>
HARTFORD LIFE INSURANCE COMPANY
HARTFORD, CONNECTICUT 06104-2999
(a stock life insurance company, herein called "We", "Us", "Our")
We agree with the Certificate Owner to provide the benefits as described in
this certificate.
Signed for Us
/s/ Lynda Godkin /s/ Thomas M. Marra
--------------------- -----------------------------
Lynda Godkin, SECRETARY Thomas M. Marra, PRESIDENT
READ THIS CERTIFICATE CAREFULLY
This is a legal certificate between the Certificate Owner and Us.
MARKET VALUE ADJUSTMENT FORMULA
This certificate contains a Market Value Adjustment formula. The formula may
result in both upward and downward adjustments in the Gross Surrender Value.
Details of the Market Value Adjustment are described on Page 9.
The Market Value Adjustment formula will not be applied when the Certificate
Owner requests, In Writing:
a) a full or partial surrender at the end of any Guarantee Period; or
b) full or partial surrender oF any interest credited during the twelve month
period prior to the written request.
SEPARATE ACCOUNT
The purchase payment will be deposited in a non-unitized separate account. All
assets of Hartford Life Insurance Company are available to meet the guarantees
under the certificate and are available to meet the general obligations of
Hartford Life Insurance Company.
NONPARTICIPATING
GROUP SINGLE PREMIUM
DEFERRED ANNUITY CERTIFICATE
[LOGO]
HARTFORD LIFE
HL-CRCRT00 PRINTED IN
U.S.A.
U329R0.FRM
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TABLE OF CONTENTS
PAGE
Certificate Specifications 3
Definitions 4
Purchase Payment 5
Certificate Control Provisions 6
General Provisions 6
Crediting of Interest and Guarantee Periods 8
Termination Provisions 8
Distributions at Time of Death Provisions 9
Settlement Provisions 11
Annuity Tables 14
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CERTIFICATE SPECIFICATIONS
<TABLE>
<CAPTION>
<S> <C> <C> <C>
CERTIFICATE NUMBER [SAMPLE] CERTIFICATE ISSUE DATE [MARCH 1, 2000]
CONTRACT OWNER [UNITED TRUST] GROUP ANNUITY CONTRACT NUMBER [SPECIMEN]
NAME OF ANNUITANT [MATTHEW BROWN] CERTIFICATE OWNER [MATTHEW BROWN]
AGE OF ANNUITANT [35] ANNUITY COMMENCEMENT DATE [OCTOBER 1, 2030]
SEX OF ANNUITANT [MALE] PURCHASE PAYMENT [$5,000]
CONTINGENT ANNUITANT INITIAL GUARANTEE PERIOD [5 YEARS]
BENEFICIARY [KELLY BROWN] INITIAL GUARANTEE RATE [7%]
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DESCRIPTION OF BENEFITS
-----------------------
GROUP SINGLE PREMIUM DEFERRED ANNUITY CERTIFICATE
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SURRENDER CHARGE
----------------
THIS CHARGE IS A PERCENTAGE OF THE GROSS SURRENDER VALUE LESS ANY INTEREST
CREDITED DURING THE 12 MONTH PERIOD PRIOR TO THE SURRENDER DATE THAT WAS NOT
PREVIOUSLY WITHDRAWN. THIS CHARGE VARIES ACCORDING TO INITIAL AND SUBSEQUENT
GUARANTEE PERIOD AND EQUALS:
INITIAL GUARANTEE PERIOD EACH SUBSEQUENT GUARANTEE PERIOD
YEAR CHARGE YEAR CHARGE
1 6% 1 4%
2 6% 2 3%
3 5% 3 2%
4 4% 4 2%
5 3% 5 2%
Thereafter 2% Thereafter 2%
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</TABLE>
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DEFINITIONS The definitions in this section apply to the
following words and phrases whenever and wherever
they appear in this certificate.
ADMINISTRATIVE OFFICE OF THE COMPANY - Currently
located at 200 Hopmeadow St., Simsbury, CT 06089.
All correspondence concerning this certificate
should be sent to Our mailing address at Hartford
Life Insurance Company, Hartford, CT 06104-2999.
ANNUITANT - The person on whose life this
certificate is issued. The Annuitant may not
be changed. Also see Contingent Annuitant and
Joint Annuitant.
ANNUITY - A certificate issued by an insurance
company that provides, in consideration of a
purchase payment, a series of income payments.
Your certificate is a deferred Annuity
certificate in which the purchase payment, less
any Gross Surrender Values resulting from any
partial surrenders, will accumulate until a
full surrender is taken or until the Annuity
Commencement Date. Annuity payments under Your
certificate will begin as of the Annuity
Commencement Date in accordance with the
payment option elected.
ANNUITY COMMENCEMENT DATE - The date shown on
Page 3. It is the date when Annuity payments
are scheduled to begin as described under
Settlement Provisions in this certificate.
BENEFICIARY - The person(s) entitled to receive
benefits as per the terms of the certificate in
case of the death of the Annuitant or the
Certificate Owner or the joint Certificate
Owner, as applicable.
CONTINGENT ANNUITANT - The person You designate
who, upon the Annuitant's death prior to the
Annuity Commencement Date, becomes the
Annuitant.
CERTIFICATE DATE - The date shown on Page 3.
Certificate years are measured from the
Certificate Date.
CERTIFICATE OWNER(S) - The owner(s) or
holder(s) of the certificate.
CERTIFICATE VALUE - On any given date, the sum
of the purchase payment and all interest
earned, less the sum of the Gross Surrender
Value of any surrenders made.
CURRENT RATE - The applicable interest rate
contained in a schedule of rates We establish
from time to time for various Guarantee
Periods.
DUE PROOF OF DEATH - A certified death
certificate, an order of a court of competent
jurisdiction, or any other proof acceptable to
Us.
GROSS SURRENDER VALUE - That portion of the
Certificate Value You specify for a full or
partial surrender.
GUARANTEE PERIOD - The period for which either
an Initial or Subsequent Guarantee Rate will be
credited.
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DEFINITIONS INITIAL GUARANTEE RATE - The rate of interest
(CONTINUED) credited to a purchase payment as described in
the Crediting of Interest and Guarantee
Periods section. The rate, which is specified
on Page 3, will never be less than an annual
effective rate of 3%.
IN WRITING - A written form satisfactory to Us
and received at Our Administrative Office as defined.
INTERNAL REVENUE CODE - The Internal Revenue
Code of 1986, as amended.
JOINT ANNUITANT - Upon annuitization, a person
other than the Annuitant on whose continuation
of life Annuity payments may be made. The
certificate will have a Joint Annuitant only if
the settlement option selected provides for a
survivor. The Joint Annuitant may not be
changed.
NET SURRENDER VALUE - The amount payable to You
on a full or partial surrender under this
certificate after the application of any
certificate charges and/or Market Value
Adjustment. It is described in the General
Surrenders section of the Termination
Provisions.
PAYEE - The person, designated by You, to whom
Annuity payments will be made.
PREMIUM TAX - The amount of tax, if any,
charged by a federal, state or other
governmental entity on purchase payments or
Certificate Values. On any certificate subject
to a Premium Tax, We may deduct it at the time
We pay the tax to the applicable taxing
authorities, at the time the certificate is
surrendered, or on the Annuity Commencement
Date.
SUBSEQUENT GUARANTEE RATE - The rate of
interest We establish for each subsequent
Guarantee Period. The rate will never be less
than an annual effective rate of 3%.
SURRENDER DATE - The date We receive Your
written request for a surrender or the date You
request for surrender, if later.
WE, US, OUR - The company referred to on the
first page of this certificate.
YOU, YOUR - The Certificate Owner(s).
PURCHASE PAYMENT PURCHASE PAYMENT
The purchase payment is shown on Page 3. The
purchase payment is payable at Our designated
office(s). A purchase payment of $1,000,000 or
more will be subject to Administrative Office
approval.
ALLOCATION OF PURCHASE PAYMENT
The purchase payment (less applicable Premium
Taxes, if any) will be allocated to a
non-unitized separate account We establish for
Certificate Owners.
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CERTIFICATE CONTROL ANNUITANT, CONTINGENT ANNUITANT AND CERTIFICATE OWNER
PROVISIONS The Annuitant may not be changed.
The designations of Certificate Owner and
Contingent Annuitant will remain in effect
until You change them. The designation of the
Certificate Owner may be changed during the
lifetime of the Annuitant by written notice to
Us. The designation of Contingent Annuitant may
be changed at any time during the lifetime of
the Annuitant and prior to the Annuity
Commencement Date by written notice to Us. If
no Contingent Annuitant has been named, the
Certificate Owner is the Annuitant, and the
Certificate Owner/Annuitant's spouse is the
Beneficiary, the Certificate Owner/Annuitant's
spouse will be presumed to be the Contingent
Annuitant.
In any other situation, if no Contingent
Annuitant has been named, the youngest
Certificate Owner will be presumed to be the
Contingent Annuitant, providing that the
Certificate Owner is not the Annuitant. The
Certificate Owner may waive this presumption In
Writing.
OWNERSHIP
You have the sole power to exercise all rights,
options and privileges granted by this
certificate or permitted by Us and to agree
with Us to any change in or amendment to the
certificate. Your rights will be subject to the
rights of any assignee of record with Us and of
any irrevocably designated Beneficiary. In the
case of joint Certificate Owners, each
Certificate Owner alone may exercise all
rights, options and privileges, except with
respect to a full surrender, partial surrender,
selection of an Annuity option, and/or change
of Ownership or Beneficiary.
BENEFICIARY
The designated Beneficiary will remain in
effect until You change it. The designated
Beneficiary may be changed during the lifetime
of the Annuitant by written notice to Us,
received at Our Administrative Office. If the
designated Beneficiary has been designated
irrevocably, the designation cannot be changed
or revoked without such Beneficiary's written
consent. Upon receipt of written notice and
consent, if required by Us, the new designation
will take effect as of the date the notice is
signed by the Certificate Owner, whether or not
the Annuitant or Certificate Owner is alive at
the time of receipt. Any payments made or other
action taken by Us before the receipt of the
notice will not be subject to the requested
change.
GENERAL PROVISIONS THE CERTIFICATE
This certificate and any amendments,
endorsements or riders, constitute the entire
certificate.
CERTIFICATE MODIFICATION
No modification of this certificate will be
made without the signature of Our President, an
Executive Vice President, Senior Vice
President, Vice President or Assistant Vice
President. No modification will affect the
amount or term of any Annuity begun prior to
the modification, unless it is required to
conform the certificate to any federal or state
statute. No modification will affect the method
by which Your Certificate Value will be
determined.
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GENERAL PROVISIONS MINIMUM VALUE STATEMENT
(CONTINUED) Any values available under the Termination or
Surrender Provisions of this certificate equal
or exceed those required by the state in which
the certificate is issued.
NON-PARTICIPATING
This certificate is nonparticipating. It
does not earn dividends.
MISSTATEMENT OF AGE AND SEX
Prior to the Annuity Commencement Date, if the
age of the Annuitant has been misstated, the
Annuity Commencement Date may change. Once
Annuity payments begin, if the age and/or sex
of the Annuitant has been misstated, the amount
of the Annuity payable by Us will be adjusted
based on the correct information. Any
underpayments by Us will be made up immediately
and any overpayments will be charged against
future amounts becoming payable. In states
which require the crediting of interest in the
event of an underpayment, or the deduction of
interest in the event of overpayment, we will
apply an annual effective rate of 3%.
INCONTESTABILITY
We cannot contest this certificate.
ANNUAL REPORT
You will receive a report once each certificate
year showing the Certificate Value of this
certificate and any other information required
by the state in which this certificate was
issued.
TRANSFERS BETWEEN GUARANTEE PERIODS
Once each certificate year beginning after the
first year, You may elect to transfer out of
the current Guarantee Period and into a
Guarantee Period of a different duration. At
that time, a new Guarantee Period will be
established which must be 5 years or longer
unless the difference between the Annuitant's
age and the Annuity Commencement Date is less
than 5 years. At no point in time can the
Certificate Owner renew or transfer the
certificate into any Guarantee Period that
exceeds the Annuity Commencement Date as
described under the Settlement Provisions of
this certificate.
The Certificate Value at the beginning of the
new Guarantee Period will equal the Certificate
Value at the time of transfer multiplied by the
Market Value Adjustment formula determined at
the time of transfer. Transfers from the
current Guarantee Period into a Guarantee
Period of a different duration made at the end
of the current Guarantee Period are not subject
to a surrender charge or a Market Value
Adjustment. We reserve the right to charge for
any such transfer by reducing the Certificate
Value at the beginning of the new Guarantee
Period by an amount not to exceed $50.00.
Surrender charges applicable to each subsequent
Guarantee Period are measured from the
beginning of each subsequent Guarantee Period
and are shown on Page 3.
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GENERAL PROVISIONS TAX QUALIFICATION
(CONTINUED) This certificate is intended to qualify as an
Annuity certificate for federal income tax
purposes. To that end, the provisions of this
certificate are to be interpreted to ensure and
maintain such tax qualification,
notwithstanding any other provisions to the
contrary. We reserve the right to amend this
certificate to conform to any changes in the
tax qualification requirements under the
applicable provision of the Internal Revenue
Code.
CREDITING OF INTEREST The purchase payment (less the Gross
AND GUARANTEE Surrender Value of all surrenders made)
PERIODS will earn interest daily at the effective
annual Initial Guarantee Rate during the
initial Guarantee Period.
Upon expiration of the current Guarantee Period,
a subsequent Guarantee Period of the same duration
will commence, unless You have elected:
a) an Annuity option; or
b) a Guarantee Period of a different duration
from among those We offer; or
c) a surrender.
At no point in time can the duration of the
subsequent Guarantee Period exceed the Annuity
Commencement Date as described under the
Settlement Provisions of this certificate.
The Certificate Value at the beginning of any
subsequent Guarantee Period will be equal to
the Certificate Value at the end of the
Guarantee Period just expiring. The Certificate
Value will earn interest daily at the effective
annual Subsequent Guarantee Rate in the
subsequent Guarantee Period. This rate will
never be less than an annual effective rate of
3%.
Surrender charges applicable to subsequent
Guarantee Periods are measured from the
beginning of each subsequent Guarantee Period
and are shown on Page 3.
TERMINATION GENERAL SURRENDERS
PROVISIONS Full surrenders may be made under this
certificate at any time. Partial surrenders
may only be made if:
a) the Gross Surrender Value is at least $1,000; and
b) the remaining Certificate Value after the
Gross Surrender Value has been deducted is at
least $5,000.
In the case of all surrenders, the Certificate
Value will be reduced by the Gross Surrender
Value on the Surrender Date and the Net
Surrender Value will be payable to You. Except
as provided for in the Special Surrenders
section, the Net Surrender Value is determined
by Us as follows:
(A - B - C) x D + B, where:
A = the Gross Surrender Value;
B = any interest credited during the 12
month period prior to the Surrender
Date that was not previously
withdrawn;
C = the surrender charge, described on
Page 3, plus any unpaid Premium Taxes;
D = the Market Value Adjustment described on
the following page.
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TERMINATION MARKET VALUE ADJUSTMENT
PROVISIONS The formula which will be used to determine
(CONTINUED) the Market Value Adjustment is calculated by
Us on a daily basis as follows:
N/12
[ (1+I) ]
[ --- ]
[ (1+j) ]
I = Guarantee rate in effect for the current
Guarantee Period (expressed as a decimal,
e.g., 1% = .01).
J = The Current Rate (expressed as a
decimal, e.g., 1% = .01) in effect for the
duration equal to the number of years
remaining in the current Guarantee Period
(years are rounded to the next highest
number of years). If not available, We
will utilize a rate equal to the most
recent U.S. Treasury Yield less 0.5% (for
the applicable duration) at the time
current rates are set.
N = The number of complete months from the
Surrender Date to the end of the current
Guarantee Period.
SPECIAL SURRENDERS
A full or partial surrender made at the end of
a Guarantee Period is not subject to a
surrender charge or Market Value Adjustment. A
request for a surrender at the end of a
Guarantee Period must be received, In Writing,
no later than the end of the Guarantee Period.
In the event of a full surrender, We will pay
the Certificate Owner an amount equal to the
Certificate Value as of the end of the
Guarantee Period.
In the event of a full or partial surrender
made at any time other than the end of a
Guarantee Period, no surrender charge or Market
Value Adjustment will be imposed on the
withdrawal of any interest credited during the
12 month period prior to the Surrender Date
that was not previously withdrawn.
PAYMENT UPON SURRENDER - DEFERRAL OF PAYMENT
We may defer payment of a full or partial
surrender request for up to six months from the
date of the request. If payment is deferred for
more than 10 days from the date the request is
received, We will pay interest daily at an
effective annual rate of at least 3% from the
date the request is received to the date the
payment is made.
DISTRIBUTIONS AT DEATH BEFORE THE ANNUITY COMMENCEMENT DATE
TIME OF DEATH If the Certificate Owner dies, and
PROVISIONS a) the joint Certificate Owner is living, the joint
Certificate Owner will become the Beneficiary. In
this case, the rights of the designated Beneficiary
are voided;
b) there is no surviving joint Certificate Owner, the
designated Beneficiary will be the Beneficiary;
c) no Beneficiary designation is in effect, or the
designated Beneficiary has predeceased the
Certificate Owner, the Certificate Owner's estate
shall be the Beneficiary.
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DISTRIBUTIONS AT If the Annuitant dies, and
TIME OF DEATH a) is also the sole Certificate Owner, the designated
PROVISIONS Beneficiary will be the Beneficiary.
(CONTINUED) b) both the Certificate Owner and the Contingent
Annuitant are living, the Contingent Annuitant will
become the Annuitant. The certificate will continue.
c) the Certificate Owner is living, and there is no
Contingent Annuitant or the Contingent Annuitant is
not living, the Certificate Owner will be the
Beneficiary. In this case the rights of the designated
Beneficiary are voided.
d) the Certificate is owned by a corporation or other
entity, the Certificate Owner will be the Beneficiary.
In this case, the rights of the designated Beneficiary
are voided.
e) no Beneficiary designation is in effect and the
Annuitant was also the sole Certificate Owner, the
Owner's estate will be the Beneficiary.
DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE
If the Certificate Owner dies, and the Annuitant is living,
the designated Beneficiary will become the Certificate
Owner and the payments will continue as scheduled.
If the Annuitant dies, the Certificate Owner will be the
Beneficiary. Upon Our receipt of Due Proof of Death, the
rights of the designated Beneficiary are voided. If the
Annuitant (who is also the Certificate Owner) dies, the
designated Beneficiary will be the Beneficiary.
DEATH BENEFIT
The death benefit will be calculated as of the date We
receive, notification, In Writing, of Due Proof of Death.
If death occurs before the Annuity Commencement Date, the
death benefit equals the Certificate Value. If death
occurs on or after the Annuity Commencement Date, any
remaining interest in the certificate will be paid at
least as rapidly as under the method of distribution in
effect at the time of death.
SETTLEMENT OF THE DEATH BENEFIT
The death benefit may be taken in one sum or under any of
the settlement options then being offered by Us subject,
however, to the distribution requirements below.
As of the date of receipt of complete disbursement
instructions from the Beneficiary, the amount to be paid
or applied to a selected settlement option will be
computed. When there is more than one Beneficiary, the
amount will be calculated for each Beneficiary's share of
the proceeds and paid or applied to a selected settlement
option according to and upon each Beneficiary's
instructions.
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DISTRIBUTIONS AT DISTRIBUTION REQUIREMENTS
TIME OF DEATH Subject to the Alternative Election or Spouse Beneficiary
PROVISIONS provisions below:
(CONTINUED)
a) If any Certificate Owner dies before the Annuity
Commencement Date, the entire interest in the
certificate will be distributed within five years
after such death; and
b) If any Certificate Owner dies on or after the
Annuity Commencement Date and before the entire
interest in the certificate has been distributed,
the remaining portion of such interest will be
distributed at least as rapidly as under the method
of distribution being used as of the date of such
death.
If the Certificate Owner is not an individual, then for
purposes of the preceding paragraph a) or b), the primary
Annuitant will be treated as the Certificate Owner.
ALTERNATIVE ELECTION TO SATISFY DISTRIBUTION REQUIREMENTS
If any portion of the interest of a Certificate Owner
described above is payable to or for the benefit of a
designated Beneficiary, and the Beneficiary elects after
the Certificate Owner's death to have the benefit
distributed over a period that:
a) does not extend beyond such Beneficiary's life (or
life expectancy); and
b) does commence within one year of the date of death;
then for purposes of satisfying the distribution
requirements above, the benefit will be treated as
distributed entirely on the date such periodic
distributions begin.
SPOUSE BENEFICIARY
In the event of the death of a Certificate Owner and there
is no joint Certificate Owner and at least one Beneficiary
is the Certificate Owner's spouse and the Annuitant
(Contingent Annuitant, if applicable) is alive, the
spouse's portion of the certificate will continue with the
spouse as the Certificate Owner, unless the spouse elects
to be paid a death benefit option. This provision will
apply only once with respect to this certificate.
SETTLEMENT ANNUITY COMMENCEMENT DATE
PROVISIONS The Annuity Commencement Date is shown on Page 3. You may
change the date by notifying Us prior to the Annuity
Commencement Date. This date will not be deferred beyond
the end of the Guarantee Period immediately following the
later of:
a) the Annuitant's 90th birthday; or
b) the tenth certificate year;
unless the Certificate Owner elects a later Annuity
Commencement Date subject to laws and regulations then in
effect and Our approval.
ANNUITY BENEFIT
If the Annuity Commencement Date does not coincide with
the end of a Guarantee Period, We will apply Your
Certificate Value, less any applicable Premium Taxes,
multiplied by the Market Value Adjustment, if any, to
purchase the monthly income payments according to the
Annuity Option elected. If the Annuity Commencement Date
coincides with the end of any Guarantee Period, no Market
Value Adjustment will be applied in the determination of
the monthly income payments. No surrender charge will be
applied upon annuitization at any time.
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SETTLEMENT ELECTION OF ANNUITY OPTION
PROVISIONS You may elect any one of the Annuity options described
(CONTINUED) below or any other Annuity option We offer at the time of
annuitization. In the absence of such election, the Life
Annuity with 10 Years Period Certain will apply. The
Annuity option may not be changed on or after the Annuity
Commencement Date.
Election of any of these options must be made, In Writing,
to Us prior to the Annuity Commencement Date.
Some of the options may not be available if this
certificate is issued to qualify under Section 401, 403,
or 408 of the Internal Revenue Code of 1986 as amended.
The third, fifth and sixth options (Life Annuity with
Payments for a Period Certain, Joint and Last Survivor
Life Annuity with Payments for a Period Certain, and
Payment for a Period Certain) or any other option with a
period certain segment will be available only if the
guaranteed payment period is less than the life expectancy
of the Annuitant at the time the option becomes effective.
Such life expectancy will be computed under the mortality
table then in use by Us.
ELECTION OF ANNUITY PAYMENT FREQUENCY
You may elect the Annuity payment frequency. Available
Annuity payment frequencies include: monthly, quarterly,
semi-annual, and annual. In the event that You do not
elect a payment frequency, Annuity payments will be made
monthly. Annuity payments will be made according to the
Annuity payment frequency selected. You may elect to
change the Annuity payment frequency of Your payments
within 30 days prior to the scheduled Annuity Commencement
Date.
DATE OF PAYMENT
The first Annuity payment is payable on the Annuity
Commencement Date. The remaining Annuity payments are
computed and payable as of the same day of the month as
the Annuity Commencement Date, based on the elected
Annuity payment frequency.
MINIMUM PAYMENT
The first payment must be at least equal to the minimum
payment amount according to Our rules then in effect. If
at any time, payments become less than the minimum payment
amount, We have the right to change the payment frequency
to meet the minimum payment requirements. If any payment
amount is less than the minimum annual payment amount, We
may make an alternative arrangement with You.
TERMINATION AFTER THE ANNUITY COMMENCEMENT DATE
This certificate may not be surrendered after the
commencement of Annuity payments, except with respect to
the seventh option.
PROOF OF SURVIVAL
The payment of any Annuity benefit will be subject to
evidence that the Annuitant is alive on the date such
payment is otherwise due.
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SETTLEMENT DEATH OF ANNUITANT
PROVISIONS In the event of the death of the Annuitant while receiving
(CONTINUED) Annuity payments, the Beneficiary will continue to receive
the remaining guaranteed payments as scheduled.
Alternatively, the beneficiary may elect to receive a lump
sum payment of the death benefit equal to the present value
of any remaining guaranteed payments.
ANNUITY OPTIONS
FIRST OPTION - Life Annuity - An Annuity payable during the
lifetime of the Annuitant, ceasing with the last payment
due prior to the death of the Annuitant.
SECOND OPTION - Life Annuity with a Cash Refund - An
Annuity payable during the lifetime of the Annuitant. At
the death of the Annuitant any remaining value will be
paid to the Beneficiary. The remaining value equals the
Certificate Value applied on the Annuity Commencement
Date, minus the dollar amount of Annuity payments already
paid.
THIRD OPTION - Life Annuity with Payments for a Period
Certain (5 years to {100 years-age}) -An Annuity payable
for a fixed number of years and during the lifetime of the
Annuitant. If, at the death of the Annuitant, payments
have been made for less than the period selected, the
remaining payments will be made to the Beneficiary.
FOURTH OPTION - Joint and Last Survivor Life Annuity - An
Annuity payable during the joint lifetime of the Annuitant
and a Joint Annuitant, and thereafter during the remaining
lifetime of the survivor. At the time of electing this
option, the Certificate Owner may elect reduced payments
over the remaining lifetime of the survivor. Payments will
cease with the last payment prior to the death of the
survivor.
FIFTH OPTION - Joint and Last Survivor Life Annuity with
Payments for a Period Certain (5 years to {100 years-age})
- An Annuity payable for a fixed number of years and
during the lifetimes of the Annuitant and the Joint
Annuitant and thereafter during the remaining lifetime of
the survivor. At the time of electing this Annuity option,
the Certificate Owner may elect reduced payments over the
remaining lifetime of the survivor.
SIXTH OPTION - Payments for a Period Certain (5 years to
{100 years-age}) - An Annuity payable for a fixed number
of years with period of 10 years or greater available at
any time and periods of 5 to 10 years available on or
after the second certificate year. Payments will be made
for the period and frequency selected.
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<PAGE>
SETTLEMENT SEVENTH OPTION - Annuity Proceeds Settlement Option
PROVISIONS - Amounts otherwise payable as a death benefit left in the
(CONTINUED) certificate for a period not to exceed five years from the
date of any Certificate Owner or Annuitant's death prior to
the Annuity Commencement Date. The amounts otherwise
payable as a death benefit will remain in the same
Guarantee Period and continue to earn the same interest
rate as at the time of death. If the Guarantee Period ends
before the end of the five year period, the Beneficiary
may elect a new Guarantee Period with a duration closest
to, but not to exceed the time remaining in the period of
five years from the date of the Certificate Owner's or
Annuitant's death. Full or partial surrenders may be made
at any time. In the event of any surrender, the remaining
value will equal the death benefit left with Us, minus any
Gross Surrender Values, plus any interest earned. A Market
Value Adjustment will be applied to all surrenders except
those occurring at the end of a Guarantee Period.
ANNUITY TABLES DESCRIPTION OF TABLES
The attached tables show the minimum dollar amount of the
monthly payments for each $1,000 applied under the first
six options. Under the first, second or third options, the
amount of each payment will depend upon the age and sex of
the Annuitant at the time the first payment is due. Under
the fourth and fifth options, the amount of each payment
will depend upon the sex of both Annuitants and their ages
at the time the first payment is due. Sex will not be used
to determine the amount of the Annuity payable if this
certificate is issued to qualify under certain sections of
the Internal Revenue Code. If sex is used to determine the
amount of Annuity payable, the Annuity tables at the end
of this certificate will provide rates of payment for male
Annuitants and female Annuitants.
The tables for the first, second, third, fourth and fifth
options are based on the [1983a Individual Annuity
Mortality Table projected to the year 2000 using Projection
Scale G] and an interest rate of [2.5%]. The table for the
sixth option is based on an interest rate of [2.5%] per
annum.
The Annuity tables for the first through fifth options are
age dependent. The amount of the first payment will be
based on an age that is a specified number of years
younger than the Annuitant's then-attained age. The
revised age is as follows:
DATE OF FIRST PAYMENT REVISED AGE
[Prior to 2005 1 year
2005 - 2014 2 years
2015 - 2019 3 years
2020 - 2029 4 years
2030 - 2039 5 years
2040 or later 6 years]
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<PAGE>
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON 2.5% INTEREST RATE
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Fixed dollar Annuity payments will not vary and are guaranteed as to fixed
dollar amount. Payments for any available Annuity payment frequency, period
certain, age, or combination of ages not shown will be quoted upon request.
FIRST, SECOND AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
<TABLE>
<CAPTION>
----------------- --------------------------------------------------------------
MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240
----------------- --------------- --------------- --------------- --------------
<S> <C> <C> <C> <C>
35 $2.97 $2.97 $2.96 $2.95
40 3.15 3.14 3.13 3.12
45 3.36 3.35 3.34 3.31
50 3.64 3.62 3.59 3.55
51 3.70 3.68 3.65 3.60
52 3.77 3.74 3.71 3.66
53 3.84 3.81 3.77 3.72
54 3.91 3.88 3.84 3.77
55 3.99 3.96 3.91 3.83
56 4.07 4.03 3.98 3.90
57 4.16 4.11 4.05 3.96
58 4.25 4.20 4.13 4.03
59 4.35 4.29 4.21 4.09
60 4.45 4.39 4.30 4.16
61 4.56 4.49 4.38 4.23
62 4.68 4.60 4.47 4.30
63 4.81 4.71 4.57 4.36
64 4.94 4.83 4.67 4.44
65 5.08 4.95 4.76 4.51
66 5.24 5.08 4.87 4.58
67 5.40 5.22 4.97 4.64
68 5.58 5.36 5.08 4.71
69 5.76 5.51 5.19 4.77
70 5.96 5.66 5.29 4.83
75 7.20 6.53 5.82 5.07
80 8.98 7.47 6.24 5.21
</TABLE>
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
<TABLE>
<CAPTION>
AGE OF AGE OF SECOND ANNUITANT
FIRST
ANNUITANT 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
35 $2.74 $2.80 $2.84 $2.88 $2.91 $2.93 $2.94 $2.95 $2.96 $2.96 $2.97 $2.97
40 2.80 2.87 2.94 2.99 3.03 3.07 3.09 3.11 3.13 3.13 3.14 3.14
45 2.84 2.94 3.02 3.10 3.18 3.23 3.28 3.30 3.33 3.34 3.35 3.36
50 2.88 2.99 3.10 3.22 3.32 3.41 3.48 3.53 3.57 3.60 3.61 3.63
55 2.91 3.03 3.18 3.32 3.46 3.60 3.72 3.80 3.87 3.92 3.95 3.96
60 2.93 3.07 3.23 3.41 3.60 3.79 3.97 4.12 4.24 4.32 4.38 4.41
65 2.94 3.09 3.28 3.48 3.72 3.97 4.22 4.46 4.66 4.82 4.93 5.00
70 2.95 3.11 3.30 3.53 3.80 4.12 4.46 4.81 5.14 5.42 5.63 5.77
75 2.96 3.13 3.33 3.57 3.87 4.24 4.66 5.14 5.64 6.11 6.50 6.78
80 2.96 3.13 3.34 3.60 3.92 4.32 4.82 5.42 6.11 6.82 7.49 8.03
85 2.97 3.14 3.35 3.61 3.95 4.38 4.93 5.63 6.50 7.49 8.52 9.46
90 2.97 3.14 3.36 3.63 3.96 4.41 5.00 5.77 6.78 8.03 9.46 10.91
</TABLE>
CRC00USX2.5 Page 16 PRINTED IN U.S.A.
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<PAGE>
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON 2.5% INTEREST RATE
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
<TABLE>
<CAPTION>
AGE OF AGE OF SECOND ANNUITANT
FIRST
ANNUITANT 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- ------- -------- -------- -------- -------- ------- -------- -------- --------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
35 $2.74 $2.80 $2.84 $2.88 $2.91 $2.93 $2.94 $2.95 $2.96 $2.96 $2.97 $2.97
40 2.80 2.87 2.94 2.99 3.03 3.07 3.09 3.11 3.13 3.13 3.13 3.14
45 2.84 2.94 3.02 3.10 3.18 3.23 3.28 3.30 3.32 3.34 3.35 3.35
50 2.88 2.99 3.10 3.22 3.32 3.41 3.48 3.53 3.57 3.59 3.61 3.61
55 2.91 3.03 3.18 3.32 3.46 3.60 3.71 3.80 3.87 3.91 3.94 3.95
60 2.93 3.07 3.23 3.41 3.60 3.78 3.96 4.11 4.23 4.31 4.35 4.37
65 2.94 3.09 3.28 3.48 3.71 3.96 4.21 4.45 4.65 4.79 4.87 4.92
70 2.95 3.11 3.30 3.53 3.80 4.11 4.45 4.79 5.10 5.35 5.52 5.61
75 2.96 3.13 3.32 3.57 3.87 4.23 4.65 5.10 5.56 5.96 6.25 6.41
80 2.96 3.13 3.34 3.59 3.91 4.31 4.79 5.35 5.96 6.54 6.99 7.27
85 2.97 3.13 3.35 3.61 3.94 4.35 4.87 5.52 6.25 6.99 7.61 8.01
90 2.97 3.14 3.35 3.61 3.95 4.37 4.92 5.61 6.41 7.27 8.01 8.51
</TABLE>
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
<TABLE>
<CAPTION>
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- -----------
NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF
OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- -----------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
10 $9.39 15 $6.64 20 $5.27 25 $4.46 30 $3.93
11 8.64 16 6.30 21 5.08 26 4.34
12 8.02 17 6.00 22 4.90 27 4.22
13 7.49 18 5.73 23 4.74 28 4.12
14 7.03 19 5.49 24 4.60 29 4.02
</TABLE>
CRC00USX2.5 Page 17 PRINTED IN U.S.A.
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<PAGE>
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON 2.5% INTEREST RATE
AMOUNT OF FIRST MONTHLY PAYMENT FOR EACH $1,000 APPLIED
Fixed Dollar Annuity payments will not vary and are guaranteed as to fixed
dollar amount. Payments for any available Annuity payment frequency, period
certain, age, or combination of ages not shown will be quoted upon request.
FIRST, SECOND AND THIRD OPTIONS - SINGLE LIFE ANNUITIES
<TABLE>
<CAPTION>
MALE ANNUITANT FEMALE ANNUITANT
MONTHLY PAYMENTS GUARANTEED MONTHLY PAYMENTS GUARANTEED
AGE NONE 120 180 240 NONE 120 180 240
-------- -------------- -------------- ------------- --------------- -------------- ------------- -------------- -------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
35 $3.05 $3.05 $3.04 $3.03 $2.88 $2.88 $2.88 $2.87
40 3.25 3.24 3.23 3.21 3.04 3.03 3.03 3.02
45 3.49 3.48 3.45 3.42 3.23 3.22 3.22 3.20
50 3.80 3.77 3.73 3.68 3.47 3.46 3.45 3.42
51 3.87 3.84 3.79 3.73 3.53 3.52 3.50 3.47
52 3.94 3.91 3.86 3.79 3.59 3.57 3.56 3.52
53 4.02 3.98 3.93 3.85 3.65 3.64 3.61 3.58
54 4.10 4.06 4.00 3.91 3.72 3.70 3.67 3.63
55 4.19 4.14 4.07 3.97 3.79 3.77 3.74 3.69
56 4.28 4.22 4.15 4.04 3.86 3.84 3.80 3.75
57 4.37 4.31 4.23 4.10 3.94 3.91 3.87 3.81
58 4.48 4.41 4.31 4.17 4.02 3.99 3.94 3.88
59 4.59 4.51 4.40 4.23 4.10 4.07 4.02 3.94
60 4.70 4.61 4.49 4.30 4.20 4.16 4.10 4.01
61 4.83 4.72 4.58 4.37 4.29 4.25 4.18 4.08
62 4.96 4.84 4.67 4.44 4.40 4.35 4.27 4.15
63 5.10 4.96 4.77 4.50 4.51 4.45 4.36 4.22
64 5.25 5.09 4.87 4.57 4.62 4.56 4.46 4.30
65 5.41 5.23 4.97 4.64 4.75 4.67 4.55 4.37
66 5.59 5.37 5.08 4.70 4.88 4.79 4.66 4.45
67 5.77 5.51 5.18 4.76 5.03 4.92 4.76 4.52
68 5.97 5.66 5.29 4.82 5.18 5.05 4.87 4.59
69 6.18 5.82 5.39 4.87 5.34 5.19 4.98 4.66
70 6.40 5.98 5.49 4.92 5.52 5.34 5.09 4.73
75 7.76 6.85 5.97 5.12 6.64 6.21 5.67 5.02
80 9.67 7.73 6.32 5.23 8.29 7.20 6.15 5.19
</TABLE>
FOURTH OPTION - JOINT AND LAST SURVIVOR ANNUITY
<TABLE>
<CAPTION>
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- --------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
35 $2.74 $2.81 $2.87 $2.92 $2.96 $2.99 $3.01 $3.03 $3.04 $3.04 $3.05 $3.05
40 2.78 2.87 2.95 3.02 3.08 3.13 3.17 3.20 3.22 3.23 3.24 3.24
45 2.81 2.92 3.02 3.12 3.22 3.30 3.36 3.40 3.44 3.46 3.47 3.48
50 2.83 2.95 3.08 3.22 3.35 3.46 3.56 3.64 3.70 3.74 3.76 3.78
55 2.85 2.98 3.13 3.29 3.46 3.63 3.79 3.91 4.01 4.08 4.13 4.15
60 2.86 3.00 3.16 3.35 3.56 3.79 4.01 4.21 4.38 4.51 4.59 4.64
65 2.87 3.01 3.19 3.39 3.64 3.92 4.22 4.52 4.80 5.02 5.18 5.29
70 2.87 3.02 3.20 3.42 3.69 4.02 4.39 4.81 5.23 5.61 5.91 6.12
75 2.88 3.03 3.21 3.44 3.73 4.09 4.52 5.05 5.64 6.23 6.76 7.15
80 2.88 3.03 3.22 3.46 3.75 4.13 4.62 5.23 5.98 6.82 7.66 8.36
85 2.88 3.03 3.22 3.46 3.77 4.16 4.67 5.35 6.24 7.32 8.52 9.66
90 2.88 3.04 3.23 3.47 3.77 4.17 4.71 5.42 6.41 7.69 9.25 10.91
</TABLE>
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<PAGE>
ANNUITY TABLES FOR
FIXED PAYMENTS,
BASED ON 2.5% INTEREST RATE
(CONTINUED)
FIFTH OPTION - JOINT AND LAST SURVIVOR ANNUITY WITH 10 YEAR PERIOD CERTAIN
<TABLE>
<CAPTION>
AGE AGE OF FEMALE
OF
MALE 35 40 45 50 55 60 65 70 75 80 85 90
-------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- --------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
35 $2.74 $2.81 $2.87 $2.92 $2.96 $2.99 $3.01 $3.02 $3.04 $3.04 $3.05 $3.05
40 2.78 2.87 2.95 3.02 3.08 3.13 3.17 3.20 3.22 3.23 3.23 3.24
45 2.81 2.92 3.02 3.12 3.22 3.29 3.36 3.40 3.43 3.45 3.47 3.47
50 2.83 2.95 3.08 3.22 3.35 3.46 3.56 3.64 3.70 3.73 3.75 3.76
55 2.85 2.98 3.13 3.29 3.46 3.63 3.78 3.91 4.01 4.07 4.11 4.13
60 2.86 3.00 3.16 3.35 3.56 3.78 4.01 4.21 4.37 4.49 4.56 4.59
65 2.87 3.01 3.19 3.39 3.64 3.91 4.21 4.51 4.78 4.98 5.11 5.18
70 2.87 3.02 3.20 3.42 3.69 4.01 4.38 4.79 5.19 5.53 5.76 5.89
75 2.88 3.03 3.21 3.44 3.72 4.08 4.51 5.01 5.56 6.07 6.46 6.68
80 2.88 3.03 3.22 3.45 3.75 4.12 4.59 5.17 5.85 6.54 7.10 7.46
85 2.88 3.03 3.22 3.46 3.76 4.14 4.63 5.27 6.04 6.88 7.61 8.09
90 2.88 3.03 3.22 3.46 3.76 4.15 4.66 5.32 6.14 7.07 7.92 8.51
</TABLE>
SIXTH OPTION - PAYMENTS FOR A PERIOD CERTAIN
<TABLE>
<CAPTION>
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- -----------
NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF NO. AMOUNT OF
OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY OF MONTHLY
YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS YEARS PAYMENTS
---------- ------------ ------- ------------ ------- ------------ ------- ------------ -------- -----------
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
10 $9.39 15 $6.64 20 $5.27 25 $4.46 30 $3.93
11 8.64 16 6.30 21 5.08 26 4.34
12 8.02 17 6.00 22 4.90 27 4.22
13 7.49 18 5.73 23 4.74 28 4.12
14 7.03 19 5.49 24 4.60 29 4.02
</TABLE>
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