Exhibit 4 (h)
Single Premium Immediate Variable Annuity Certificate
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[LOGO AIG LIFE] AIG Life Insurance Company
600 King Street
Wilmington, Delaware 19801
A capital stock company
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We issue this certificate in consideration of the application and the payment of
the Single Premium, subject to the terms of the Group Immediate Variable Annuity
Contract, Number [ ] ("Group Contract"). We will make annuity payments to the
Annuitant, and Joint Annuitant if any, as set forth in this Certificate
beginning on the Income Start Date.
READ YOUR CERTIFICATE CAREFULLY
RIGHT TO CANCEL THIS CERTIFICATE
This Certificate may be returned within 10 days after You receive it. It can be
mailed or delivered to Us. Return of this Certificate by mail is effective as of
the date of its postmark, properly addressed and postage pre-paid. As of the
return date, we will promptly refund the Single Premium adjusted by investment
performance. This may be more or less than the Single Premium paid. For all
other purposes the returned Certificate will be treated as if We had never
issued it.
This is a Variable Annuity Income Certificate. Variable Annuity Income is not
guaranteed as to dollar amount and may increase or decrease on the Income Change
Dates depending on the experience of the Variable Account identified in the
Certificate Schedule. You may also select a Fixed Annuity Income, which provides
a guaranteed income. The Fixed Annuity Income amount will remain the same unless
the Certificate requires a reduction in amount.
Signed by the Company:
/s/ Elizabeth M. Tuck [Illegible]
Secretary President
CERTIFICATE OF COVERAGE
SINGLE PREMIUM IMMEDIATE VARIABLE ANNUITY
NONPARTICIPATING
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TABLE OF CONTENTS
CERTIFICATE SCHEDULE...........................................................3
DEFINITIONS....................................................................4
CERTIFICATE....................................................................5
OWNERSHIP PROVISIONS...........................................................5
SINGLE PREMIUM PAYMENT.........................................................6
SEPARATE ACCOUNT...............................................................6
SUBACCOUNTS....................................................................7
INVESTMENT OPTIONS.............................................................7
ANNUITY UNITS..................................................................7
ANNUITY INCOME PAYMENT DATES...................................................7
DETERMINATION OF THE INITIAL ANNUITY INCOME....................................7
DETERMINATION OF SUBSEQUENT VARIABLE...........................................8
ANNUITY INCOME VALUATION DATES.................................................8
TRANSFERS AMONG INVESTMENT OPTIONS.............................................8
FIXED ANNUITY INCOME...........................................................9
DEATH BENEFITS.................................................................9
ANNUITY INCOME OPTIONS.........................................................9
DELAY OF BENEFIT PAYMENT......................................................10
GENERAL PROVISIONS............................................................10
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DEFINITIONS
In addition to the other definitions set forth in this Certificate, the
following terms shall have their respective meanings as set forth below. In
addition, the masculine form of any term shall be construed as including the
feminine form of that term.
Annuitant is the designated person shown in the Certificate Schedule who
receives annuity income.
Annuity Income Option is the type of arrangement under which annuity income
payments are made.
Annuity Income Valuation Date is the date as of which annuity income amounts are
calculated.
Annuity Unit is an accounting unit of measure used to calculate variable annuity
income amounts.
Annuity Unit Value is the value of one Annuity Unit.
Assumed Investment Return (AIR) is the net investment return that will cause
Variable Annuity Income to remain level. The AIR is shown in the Certificate
Schedule and is used in calculating the initial and subsequent variable annuity
income amounts.
Beneficiary. is the person(s) who may receive certain benefits when there is no
longer a living Annuitant or Joint Annuitant.
Certificate is a statement of benefits provided to each Owner.
Certificate Date is the date the Certificate becomes effective, and is shown in
the Certificate Schedule.
Certificate Year is the year between anniversaries based on the Certificate
Date.
Fixed Annuity Income provides a guaranteed income which amount will be the same
on each payment date unless the Certificate requires a change. The amount of the
income is set forth in the Certificate Schedule.
Income Change Dates are the dates, as specified in the Certificate Schedule, on
which the amount of Variable Annuity Income is changed.
Income Start Date is the date shown in the Certificate Schedule when the annuity
income payment begins.
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Investment Options are the available portfolios in which the Subaccounts invest.
The Separate Account is divided into Subaccounts and each Subaccount invests
exclusively in shares of a specific investment portfolio.
Joint Annuitant, if any, is named in the Certificate. If living after the death
of the Annuitant, the Joint Annuitant receives annuity income.
Net Single Premium is the Single Premium less any taxes related to the premium
payment.
Owner(s) is the person or persons shown as Owner(s) in the Certificate Schedule
and who may exercise the rights and benefits described in the Certificate.
Single Premium is the purchase payment shown in the Certificate Schedule.
Subaccount means a division of the Company's Separate Account which invests in a
particular investment portfolio.
Valuation Date means each day that the New York Stock Exchange is open for
trading, except for normal business holidays.
Valuation Period means the period between the close of business on any Valuation
Date and the close of business on the next succeeding Valuation Date.
Variable Annuity Income provides income that is not guaranteed and is related to
the investment experience of the selected Investment Option. Generally the
income amount will change on each Income Change Date
WE, OUR,US,COMPANY refers to AIG Life Insurance Company.
YOU, YOUR refers to the Owner of this Certificate.
CERTIFICATE
This Certificate shall contain a statement of the benefits to which You are
entitled. Such Certificate shall in no way void or modify any of the provisions
of the Contract.
OWNERSHIP PROVISIONS
OWNER
The Owner is named in the Certificate Schedule and is the person who exercises
all the rights contained in the Certificate, subject to the rights of:
1. any assignee under an assignment filed with the Company's administrative
office, if such assignment is permitted under the Certificate;
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2. Any irrevocably named Beneficiary.
ASSIGNMENT
Unless prohibitied by the terms of this Certificate, You may assign it by
sending a copy of the assignment to Our administrative office. We are not
responsible for the validity of the assignment. Your rights and those of any
revocably named person will be subject to the assignment. An assignment will not
affect any payments we may make or actions We may take before such assignment
has been recorded at Our administrative office. A change in ownership or an
assignment may result in adverse tax consequences.
CHANGE OF BENEFICIARY
To change a beneficiary, a written request for a change of beneficiary, dated
and signed by You, the Owner, must be received at Our administrative office.
After the change has been recorded, it will take effect as of the date the
request was signed. However, the change will not affect any benefits paid or
actions taken before the change is recorded in our administrative office. A
written consent from the Beneficiary is required for a change of an irrevocable
beneficiary.
SINGLE PREMIUM PAYMENT
SINGLE PREMIUM PAYMENT
Your Single Premium Payment is shown on the Certificate Schedule. Any taxes
related to the premium payment are deducted by the Company and the balance (the
"Net Single Premium") is available for allocation between Fixed and Variable
Annuity Income.
ALLOCATION OF THE PREMIUM
You, the Owner, determine the allocation of the Net Single Premium between Fixed
and Variable Annuity Income.The allocation is shown on the Certificate Schedule.
All of the Net Single Premium allocated for Variable Annuity Income is placed in
Subaccounts, each of which invests in a specific Investment Option. All of the
Net Single Premium allocated for Fixed Annuity Income is placed in the Company's
General Account.
SEPARATE ACCOUNT
The Separate Account is established and maintained by the Company for the
purpose of investing amounts allocated to it from variable contracts issued by
the Company. The assets of the Separate Account are owned by the Company, are
held separately from other assets of the Company and are not chargeable with
liabilities arising out of any other business of the Company. Nothing contained
in this Certificate shall be construed as to give You any rights, title or
interest in any of the assets held by the Separate Account. We have the right to
transfer to
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Our general account any assets of the Separate Account which are in excess of
the liabilities of the Separate Account.
SUBACCOUNTS
The Separate Account is made up of one or more Subaccounts, each of which
invests in a portfolio of a specific Investment Option available under the
Certificate. The Company reserves the right, subject to compliance with
applicable law, to make additions to, deletions from, or substitutions for the
shares that are held by any Subaccount or that the Subaccount may purchase.
INVESTMENT OPTIONS
The Investment Options you selected in the application are listed on the
Certificate Schedule. The Subaccount may invest in mutual funds, unit investment
trusts and other investments which the Company determines to be suitable for the
Certificate. Interests in an Investment Option are purchased at their net asset
value and valued on each Valuation Date. The Owner shares in the income, gains
and losses of the Investment Options for which the Owner's premiums have been
allocated. The Company does not guarantee the investment performance of the
Subaccounts. The Owner bears the full investment risk for amounts allocated to
Subaccounts.
ANNUITY UNITS
The Annuity Unit Value will vary from Valuation Date to Valuation Date with the
investment experience of the portfolio in which the Subaccount invests. For each
Subaccount You select, the premium amount allocated to it is converted into
Annuity Units, as follows: the number of Annuity Units is determined as of the
Valuation Date by dividing that premium amount by the Annuity Unit Value for
that Subaccount.
In determining Variable Annuity Unit values, the Company makes a Mortality and
Expense Risk Charge against the daily value of the assets of each Subaccount.
The amount of the charge is shown in the Certificate Schedule.
ANNUITY INCOME PAYMENT DATES
Variable Annuity Income will commence on the Income Start Date. Periodically, as
stated in the Certificate Schedule, the same amount is paid to the Annuitant or
Joint Annuitant if applicable, until the next Income Change Date, which is
stated in the Certificate Schedule.
If periodic benefit payments payable to any payee under the Certificate are less
than $100, the Company reserves the right to make payments less frequently, and
will make these payments in an aggregate amount not later than the first day of
the period to which the payment applies.
DETERMINATION OF THE INITIAL ANNUITY INCOME
The following factors determine the amount of the first Annuity Income payment:
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1. the amount of the premium allocated to provide Variable Annuity Income and
the Assumed Investment Return;
2. the amount of premium allocated to provide Fixed Annuity Income payments and
the prevailing interest rates;
3. the age and sex of the Annuitant, and Joint Annuitant if any;
4. the Annuity Income Option selected;
5. the frequency of Annuity Income payments;
6. the deduction of any applicable premium taxes;
7. the time period from the Certificate Date to the Income Start Date.
DETERMINATION OF SUBSEQUENT VARIABLE ANNUITY INCOME
As of an Annuity Income Valuation Date, We recalculate the Variable Annuity
Income to reflect the investment performance of the each Subaccount You
selected, adjusted by the Assumed Investment Return factor. The Variable Annuity
Income will remain level until the next Income Change Date. Subsequent Variable
Annuity Income may be more or less than the previously calculated payment
depending on whether the net investment performance of the selected Subaccount
is greater or less than the Assumed Investment Return.
ANNUITY INCOME VALUATION DATES
The initial Annuity Income Valuation Date shall be coincident with the
Certificate Date. Each subsequent Annuity Income Valuation Date shall be no
earlier than seven business days prior to the next Income Change Date and in no
event shall be later than that date. Any revision to the Variable Annuity Income
in connection with an Annuity Income Valuation Date shall be effective as of
such Income Change Date and shall remain fixed until the next following Income
Change Date thereafter.
TRANSFERS AMONG INVESTMENT OPTIONS
RIGHT TO TRANSFER
Subject to the "Transfer Restrictions" below, amounts allocated to Subaccounts
for Variable Annuity Income may be transferred among available Investment
Options at any time. The Company reserves the right to charge $10 per transfer
in excess of the first 12 transfers in any Certificate Year. Amounts allocated
for Variable Annuity Income may be reallocated for Fixed Annuity Income.
However, once amounts are allocated for Fixed Annuity Income they cannot be
reallocated for Variable Annuity Income.
METHOD USED TO EFFECT TRANSFERS
Transfers among Investment Options are effected by transfers of Annuity Units
among the Subaccounts. The number of Annuity Units is affected by such
transfers. The number of Annuity Units attributable to the Variable Annuity
Income to be transferred is multiplied by the current Annuity Unit Value of the
Subaccount from which the Owner is transferring. This value is divided by the
current Annuity Unit Value of the Subaccount into which the Variable
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Annuity Income is being transferred. The result of this division is the number
of additional Annuity Units allocated to the new Subaccount as a consequence of
the transfer. The total Variable Annuity Income, which may be affected by
investment experience after any transfer, will be calculated on the Annuity
Income Valuation Date next following the date of the transfer.
TRANSFER RESTRICTIONS
(a) The Company reserves the right to limit the number of transfers among the
Subaccounts to no more than one (1) on any Valuation Date.
(b) Transfers will take effect as of the Valuation Date next following the
date on which the Company receives the transfer request.
(c) The minimum amount that can be transferred is $50 per month of income.
(d) Amounts allocated for Fixed Annuity Income may not be reallocated for
Variable Annuity Income.
FIXED ANNUITY INCOME
Fixed Annuity Income represents obligations of the Company's General Account.
The Owner may select this payment on the application, and if so selected, the
payment amount is shown on the Certificate Schedule. At any time thereafter, an
Owner may elect to transfer any or all of the Certificate's Variable Annuity
Income to Fixed Annuity Income. Transfers may not be made from Fixed Annuity
Income to Variable Annuity Income.
DEATH BENEFITS
If neither the Annuitant nor Joint Annuitant, if any, is alive on the Income
Start Date, the Certificate will be cancelled and the Company will pay a refund
to the Owner if living, or if not, to the Owner's estate. The amount of the
refund will be equal to the sum of the following: (1) the portion of the Net
Single Premium allocated for Variable Annuity Income, adjusted up or down for
investment performance; (2) the portion of the Net Single Premium allocated for
Fixed Annuity Income, including any accumulated interest; and (3) the
difference, if any, between the Single Premium Payment and the Net Single
Premium.
If an Annuitant dies after the Income Start Date, benefit continuation will be
determined by the Annuity Income Option in effect for the Certificate.
ANNUITY INCOME OPTIONS
The Annuity Income Option is selected by the Owner and is shown on the
Certificate Schedule.
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DELAY OF BENEFIT PAYMENT
We will make any payment under this Certificate within seven (7) days of its due
date or within seven (7) days of a request received in good order. However, we
reserve the right to suspend or postpone any type of payment or reallocation
from the Separate Account for any period when:
1. The New York Stock Exchange is closed for other than customary weekend and
holiday closings:
2. Trading on the New York Stock Exchange is restricted;
3. An emergency exists as a result of which it is not reasonable or
practicable to dispose of securities held in the Separate Account or
determine their value; or
4. The Securities and Exchange Commission so permits delay for the protection
of security holders.
GENERAL PROVISIONS
NON-PARTICIPATION IN SURPLUS
This Certificate does not share in any distribution of the Company's profits or
surplus.
MISSTATEMENT OF AGE OR SEX
The Company may require proof of age and sex of the Annuitant and Joint
Annuitant, if any, before making any annuity income payments. If the Annuitant's
or Joint Annuitant's age or sex has been misstated, the Company will change the
benefits to those which the Net Single Premium would have purchased had the
correct age or sex been stated. If a misstatement is not discovered until after
the Income Start Date, the Company will take the following action: (1)
underpayments will be paid in one sum with the next annuity income payment
including interest at the annual rate of 3%, unless a higher interest rate is
legally required; (2) overpayments including interest at the annual rate of 3%,
unless a higher interest rate is legally required, will be deducted from future
annuity income payments until the total is repaid.
ENTIRE CONTRACT
The entire contract consists of the Group Contract, this Certificate, and any
attached endorsement, rider or application. Nothing in the Group Contract
invalidates or impairs any right granted to You under this Certificate. Only Our
authorized Officer may act on Our behalf to change or alter this Certificate.
Any change, modification or waiver must be made in writing.
CERTIFICATE TO CONFORM TO INTERNAL REVENUE CODE
All terms of this Certificate will be interpreted in accordance with the
applicable provisions of the Internal Revenue Code ("Code"). The Company
reserves the right to make changes to the Certificate in order to conform to the
applicable provisions of the Code.
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MODIFICATION OF CERTIFICATE
This Certificate may not be modified by Us, without Your consent except as may
be required by applicable law. If the state insurance laws or regulations, the
federal securities or tax laws or regulations under which this Certificate would
qualify as an annuity change, We may amend this Certificate to comply with these
changes.
SEVERABILITY
Should one or more provisions of this Certificate be held by a court of law to
be invalid, void or unenforceable, the remaining provisions will continue in
full force.
FACILITY OF PAYMENT
If a payee is unable to give a valid receipt for a payment made under this
Certificate, We may make payments to the person, who, in Our opinion is caring
for that payee until claim is made by his duly appointed guardian or other legal
representative.
REPORTS
If You are receiving Variable Annuity Income, We will send You a report showing
the number of Annuity Units in each Subaccount and the value of each Annuity
Unit at least once per year and each time You transfer Annuity Units among
Subaccounts or to the General Account. The reports will be sent to Your last
known address.
TAXES
Any premium related taxes paid to any governmental entity will be charged
against the Single Premium prior to it being allocated as a Net Single Premium
to the Separate Account or Guaranteed Account.
If we incur taxes due to the operation of the Separate Account, we may make
charges for such taxes.
EVIDENCE OF SURVIVAL
Where any benefits under this Certificate are contingent upon the recipient
being alive on a given date, We may require proof satisfactory to Us that the
condition has been met.
CONTINUATION OF CERTIFICATE COVERAGE
If the Group Contract under which this Certificate is issued should terminate,
coverage may be continued under this Certificate unless it is surrendered or
otherwise ends in accordance with its terms.
