<PAGE>
As filed with the Securities and Exchange Commission on April 30, 1996
Registration No. 33-87272
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SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM S-1
REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933
Amendment No. 4
GOLDEN AMERICAN LIFE INSURANCE COMPANY
(EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)
DELAWARE 6355 41-0991508
(STATE OR OTHER (PRIMARY STANDARD (I.R.S. EMPLOYER
JURISDICTION OF INDUSTRIAL IDENTIFICATION NO.)
INCORPORATION OR CLASSIFICATION CODE
ORGANIZATION) NUMBER)
1001 Jefferson Street, Suite 400
Wilmington, DE 19801
(302) 576-3400
(ADDRESS AND TELEPHONE NUMBER OF REGISTRANT'S PRINCIPAL EXECUTIVE OFFICE)
MARILYN TALMAN, ESQ. COPY TO:
Golden American Life Insurance Company Stephen Roth, Esq.
1001 Jefferson Street, Suite 400 Sutherland, Asbill & Brennan
Wilmington, DE 19801 1275 Pennsylvania Avenue, N.W.
(NAME AND ADDRESS OF AGENT FOR SERVICE Washington, D.C. 20004-2404
OF PROCESS)
Approximate date of commencement of proposed sale to the public:
As soon as practical after the effective date of the Registration Statement
If any of the Securities being registered on this Form are to be offered on a
delayed or continuous basis pursuant to Rule 415 under the Securities Act of
1933, check the following box ........................................... [X]
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CALCULATION OF REGISTRATION FEE
<TABLE>
<CAPTION>
Proposed Maximum Proposed
Title of Securities Amount Being Offering Price Maximum Aggregate Amount of
Being Registered Registered (1) Per Unit (1) Offering Price (1) Registration Fee (2)
- -----------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C>
Annuity Contracts
(Interests in N/A N/A $300,000,000 $103,500
Fixed Account)
</TABLE>
(1) The maximum aggregate offering price is estimated solely for the purpose of
determining the registration fee. The amount to be registered and the proposed
maximum offering price per unit are not applicable since these securities are
not issued in predetermined amounts or units.
(2) Previously paid.
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<PAGE>
CROSS REFERENCE SHEET
-----
Pursuant to Regulation S-K, Item 501(b)
S-1 Item Prospectus Heading
- ----------------------------- --------------------------
1. Forepart of Registration Cover Page
Statement and Outside
Front Cover Page
2. Inside Front and Outside Summary of the Contract;
Back Cover Table of Contents
3. Summary Information, Prospectus Cover; Facts
Risk Factors and Ratio Facts About the Company
of Earnings to Fixed and the Fixed Account;
Fixed Charges Summary of the Contract;
Definition of Terms
4. Use of Proceeds Facts About the Company
and the Fixed Account
5. Determination of Not Applicable
Offering Price
6. Dilution Not Applicable
7. Selling Security Holders Not Applicable
8. Plan of Distribution Facts About the Contract
9. Description of Securities Summary of the Contract;
Being Offered Facts About the Contract
10. Interest of Named Experts Experts
and Counsel
11. Information with Respect More Information of
to the Registrant Golden American Life
Insurance Company;
Directors and Executive
Officers; Legal
Proceedings
12. Disclosure of Commission Part II, Item 14
Position on
Indemnification for
Securities Act Liabilities
<PAGE>
PART I
The Prospectus contained herein does not contain all of the information
permitted by Securities and Exchange Commission Regulations. Therefore, this
Amendment No.4 on Form S-1 for Golden American Life Insurance Company ("Golden
American") incorporates by reference (i) the Prospectus, Statement of Additional
Information, and Part C (Other Information) contained in the Registration
Statement on Form N-3 (post effective amendment No. 1 filed on or about the date
hereof) for Golden American Separate Account D and (ii) the Prospectus,
Statement of Additional Information, and Part C (Other Information) contained
the in Registration Statement on Form N-4 (pre-effective amendment No. 2 filed
on or about the date hereof) for Golden American Separate Account B. This
information may be obtained free of charge from Golden American Life Insurance
Company by calling Customer Service at 800-366-0066.
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
DEFERRED COMBINATION VARIABLE AND
FIXED ANNUITY PROSPECTUS
GOLDENSELECT DVA PLUS
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This prospectus describes group and individual deferred variable annuity
Contracts (the "Contract") offered by Golden American Life Insurance Company
("Golden American," "we," "our" or "us"). The Owner ("you" or "your") purchases
the Contract with an Initial Premium and is permitted to make additional premium
payments.
The Contract is funded by three accounts, Separate Account B ("Account B") and
Separate Account D ("Account D") and the Fixed Account (collectively, the
"Accounts").
Thirteen Divisions of Account B are currently available under the Contract. The
investments available through the Divisions of Account B include mutual fund
portfolios (the "Series") of The GCG Trust (the "Trust"). Account D is an
open-end management investment company. The only Division of Account D available
for investment is The Managed Global Account (the "Global Account") which
invests directly in securities. The investments available through the Fixed
Account include various Fixed Allocations which we credit with fixed rates of
interest for the Guarantee Periods you select. We currently offer Guarantee
Periods with durations of 1, 3, 5, 7 and 10 years. We reserve the right at any
time to increase or decrease the number of Guarantee Periods offered. Not all
Guarantee Periods may be available for new allocations.
Part I of this prospectus describes the Contract and provides background
information regarding Account B, Account D and the Fixed Account. Part II of
this prospectus provides information regarding the investment activities of
Account D and the Global Account, including its investment policies. The
prospectus for the Trust, which must accompany this prospectus, provides
information regarding investment activities and policies of the Trust.
You may allocate your premiums among the fourteen Divisions and the Fixed
Allocations available under the Contract in any way you choose, subject to
certain restrictions. You may change the allocation of your Accumulation Value
during a Contract Year free of charge. We reserve the right, however, to assess
a charge for each allocation change after the twelfth allocation change in a
Contract Year.
Your Accumulation Value in Account B and Account D will vary in accordance with
the investment performance of the Divisions selected by you. Therefore, you bear
the entire investment risk for all amounts allocated to Account B and Account D.
You also bear the investment risk with respect to surrenders, partial
withdrawals, transfers and annuitization from a Fixed Allocation prior to the
end of the applicable Guarantee Period. Such surrender, partial withdrawal,
transfer or annuitization may be subject to a Market Value Adjustment, which
could have the effect of either increasing or decreasing your Accumulation
Value.
We will pay a death benefit to the Beneficiary if the Owner dies prior to the
Annuity Commencement Date or the Annuitant dies prior to the Annuity
Commencement Date when the Owner is other than an individual.
This prospectus describes your principal rights and limitations and sets forth
the information concerning the Accounts that investors should know before
investing. A Statement of Additional Information, dated May 1, 1996, about
Account B and Account D has been filed with the Securities and Exchange
Commission ("SEC") and is available without charge upon request. To obtain a
copy of this document call or write our Customer Service Center. The Table of
Contents of the Statement of Additional Information may be found on the last
page of this prospectus. The Statement of Additional Information is incorporated
herein by reference.
- --------------------------------------------------------------------------------
THESE SECURITIES HAVE NOT BEEN APPROVED OR DISAPPROVED BY THE SECURITIES AND
EXCHANGE COMMISSION OR ANY STATE SECURITIES COMMISSION NOR HAS THE SECURITIES
AND EXCHANGE COMMISSION OR ANY STATE SECURITIES COMMISSION PASSED UPON THE
ACCURACY OR ADEQUACY OF THIS PROSPECTUS. ANY REPRESENTATION TO THE CONTRARY IS A
CRIMINAL OFFENSE.
CONTRACTS AND UNDERLYING SERIES SHARES WHICH FUND THE CONTRACTS ARE NOT INSURED
BY THE FDIC OR ANY OTHER AGENCY. THEY ARE NOT DEPOSITS OR OTHER OBLIGATIONS OF
ANY BANK AND ARE NOT BANK GUARANTEED. THEY ARE SUBJECT TO MARKET FLUCTUATION,
REINVESTMENT RISK AND POSSIBLE LOSS OF PRINCIPAL INVESTED.
PLEASE READ THIS PROSPECTUS AND KEEP IT FOR FUTURE REFERENCE. IT IS NOT VALID
UNLESS ACCOMPANIED BY THE CURRENT PROSPECTUS FOR THE GCG TRUST.
THE FIXED ACCOUNT AND ENHANCED DEATH BENEFITS MAY NOT AVAILABLE IN ALL STATES.
YOU MAY CONTACT OUR CUSTOMER SERVICE CENTER TO FIND OUT ABOUT STATE
AVAILABILITY.
<TABLE>
<S> <C> <C>
ISSUED BY: DISTRIBUTED BY: ADMINISTERED AT:
Golden American Life Directed Services, Inc. Customer Service Center
Insurance Company Wilmington, Delaware 19801 Mailing Address: P.O. Box 8794
Wilmington, Delaware 19899-8794
1-800-366-0066
</TABLE>
PROSPECTUS DATED: MAY 1, 1996
<PAGE>
TABLE OF CONTENTS
<TABLE>
<CAPTION>
PAGE
<S> <C>
DEFINITION OF TERMS..................................... 3
SUMMARY OF THE CONTRACT................................. 6
FEE TABLE............................................... 8
CONDENSED FINANCIAL AND OTHER INFORMATION............... 10
Index of Investment Experience
Financial Statements
Performance Related Information
PART I
INTRODUCTION............................................ 12
FACTS ABOUT THE COMPANY AND THE ACCOUNTS................ 13
Golden American
The GCG Trust
Separate Accounts B and D
Account B Divisions
The Managed Global Account of Account D
Changes Within Account B and D
The Fixed Account
FACTS ABOUT THE CONTRACT................................ 20
The Owner
The Annuitant
The Beneficiary
Change of Owner or Beneficiary
Availability of the Contract
Types of Contracts
Your Right to Select or Change Contract Options
Premiums
Making Additional Premium Payments
Crediting Premium Payments
Restrictions on Allocation of Premium Payments
Exchange and Update Programs
Your Right to Reallocate
Dollar Cost Averaging
What Happens if a Division is Not Available
Your Accumulation Value
Accumulation Value in Each Division
Measurement of Investment Experience
Cash Surrender Value
Surrendering to Receive the Cash Surrender Value
Partial Withdrawals
Automatic Rebalancing
Proceeds Payable to the Beneficiary
Death Benefit Options
Reports to Owners
When We Make Payments
CHARGES AND FEES........................................ 30
Charge Deduction Division
Charges Deducted from the Accumulation Value
Charges Deducted from the Divisions
Trust Expenses
Operating Expenses of Account D
<CAPTION>
PAGE
<S> <C>
CHOOSING YOUR ANNUITIZATION OPTIONS..................... 33
Annuitization of Your Contract
Annuity Commencement Date Selection
Frequency Selection
The Annuity Options
Payment When Named Person Dies
OTHER CONTRACT PROVISIONS............................... 34
In Case of Errors in Application Information
Contract Changes -- Applicable Tax Law
Your Right to Cancel or Exchange Your Contract
Other Contract Changes
Group or Sponsored Arrangements
Selling the Contract
REGULATORY INFORMATION.................................. 36
Voting Rights
State Regulation
Legal Proceedings
Legal Matters
Experts
MORE INFORMATION ABOUT GOLDEN AMERICAN LIFE INSURANCE
COMPANY................................................ 37
Selected Financial Data
Management's Discussion and Analysis of Financial
Condition and Results of Operations
Directors and Executive Officers
Compensation Tables and Other Information
FEDERAL TAX CONSIDERATIONS.............................. 44
Introduction
Tax Status of Golden American
Taxation on Non-Qualified Annuities
IRA Contracts and Other Qualified Retirement Plans
Federal Income Tax Withholding
PART II
INTRODUCTION............................................ 53
THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D................. 54
The Global Account
Investment Objective and Policies of the Global
Account
Non-Diversified
Risk Factors
Board of Governors of Account D
The Manager
The Portfolio Manager
Securities and Investment Techniques
Investment Restrictions
Brokerage Services
AUDITED FINANCIAL STATEMENTS OF GOLDEN AMERICAN LIFE
INSURANCE COMPANY...................................... 65
STATEMENT OF ADDITIONAL INFORMATION..................... 77
Table of Contents
APPENDIX A.............................................. A1
Market Value Adjustment Examples
APPENDIX B.............................................. B1
GoldenSelect Service Forms
</TABLE>
THIS PROSPECTUS DOES NOT CONSTITUTE AN OFFERING IN ANY JURISDICTION IN WHICH
SUCH OFFERING MAY NOT LAWFULLY BE MADE. NO PERSON IS AUTHORIZED TO MAKE ANY
REPRESENTATIONS IN CONNECTION WITH THIS OFFERING OTHER THAN THOSE CONTAINED IN
THIS PROSPECTUS.
2
<PAGE>
DEFINITION OF TERMS
ACCOUNTS
Separate Account B, Separate Account D, and the Fixed Account.
ACCUMULATION VALUE
The total amount invested under the Contract. Initially, this amount is equal to
the premium paid. Thereafter, the Accumulation Value will reflect the premiums
paid, investment experience of the Divisions and interest credited to your Fixed
Allocations, charges deducted and any partial withdrawals.
ANNUAL RATCHET ENHANCED DEATH BENEFIT OPTION
An enhanced death benefit option that may be elected only at issue and only if
the Owner or Annuitant (when the Owner is other than an individual) is age 79 or
younger. The enhanced death benefit provided by this option is the highest
Accumulation Value on any Contract Anniversary on or prior to the Owner turning
age 80, as adjusted for additional premiums and partial withdrawals.
ANNUITANT
The person designated by the Owner to be the measuring life in determining
Annuity Payments.
ANNUITY COMMENCEMENT DATE
The date on which Annuity Payments begin.
ANNUITY OPTIONS
Options the Owner selects that determine the form and amount of Annuity
Payments.
ANNUITY PAYMENT
The periodic payment an Owner receives. It may be either a fixed or a variable
amount based on the Annuity Option chosen.
ATTAINED AGE
The Issue Age of the Owner or Annuitant plus the number of full years elapsed
since the Contract Date.
BENEFICIARY
The person designated to receive benefits in the case of the death of the Owner
or the Annuitant (when the Owner is other than an individual).
BUSINESS DAY
Any day the New York Stock Exchange ("NYSE") is open for trading, exclusive of
Federal holidays, or any day on which the SEC requires that mutual funds, unit
investment trusts or other investment portfolios be valued.
CASH SURRENDER VALUE
The amount the Owner receives upon surrender of the Contract, including any
Market Value Adjustment.
CHARGE DEDUCTION DIVISION
The Division from which all charges are deducted if so designated by you. The
Charge Deduction Division currently is the Liquid Asset Division.
CONTINGENT ANNUITANT
The person designated by the Owner who, upon the Annuitant's death prior to the
Annuity Commencement Date, becomes the Annuitant.
CONTRACT
The entire Contract consisting of the basic Contract and any riders or
endorsements.
CONTRACT ANNIVERSARY
The anniversary of the Contract Date.
CONTRACT DATE
The date on which we have received the Initial Premium and upon which we begin
determining the Contract values. It may or may not be the same as the Issue
Date. This date is used to determine Contract months, processing dates, years
and anniversaries.
CONTRACT PROCESSING DATES
The days when we deduct certain charges from the Accumulation Value. If the
Contract Processing Date is not a Valuation Date, it will be on the next
succeeding Valuation Date. The Contract Processing Dates will be once each year
on the Contract Anniversary.
CONTRACT PROCESSING PERIOD
The first Contract processing period begins with the Contract Date and ends at
the close of business on the first Contract Processing Date. All subsequent
Contract processing periods begin at the close of business on the most recent
Contract Processing Date and extend to the close of business on the next
Contract Processing Date. There is one Contract processing period each year.
CONTRACT YEAR
The period between Contract anniversaries.
3
<PAGE>
DEFINITION OF TERMS (CONTINUED)
CUSTOMER SERVICE CENTER
Where service is provided to you. The mailing address and telephone number of
the Customer Service Center are shown on the cover.
DIVISIONS
The investment options available under Account B and Account D.
ENDORSEMENTS
An endorsement changes or adds provisions to the Contract.
EXCHANGE CONTRACTS
Contracts issued by insurance companies not affiliated with Golden American.
EXPERIENCE FACTOR
The factor which reflects the investment experience of the portfolio in which a
Division invests and also reflects the charges assessed against the Division for
a Valuation Period.
FIXED ACCOUNT
An Account which contains all of our assets that support Owner Fixed Allocations
and any interest credited thereto.
FIXED ALLOCATION
An amount allocated to the Fixed Account that is credited with a Guaranteed
Interest Rate for a specified Guarantee Period.
FREE LOOK PERIOD
The period of time within which the Owner may examine the Contract and return it
for a refund.
GUARANTEED INTEREST RATE
The effective annual interest rate which we will credit for a specified
Guarantee Period. The Guaranteed Interest Rate will never be less than 3%.
GUARANTEE PERIOD
The period of time for which a rate of interest is guaranteed to be credited to
a Fixed Allocation. We currently offer Guarantee Periods with durations of 1, 3,
5, 7 and 10 years.
INDEX OF INVESTMENT EXPERIENCE
The index that measures the performance of a Division.
INITIAL PREMIUM
The payment required to put a Contract into effect.
ISSUE AGE
The Owner's or Annuitant's age on his or her last birthday on or before the
Contract Date.
ISSUE DATE
The date the Contract is issued at our Customer Service Center.
MARKET VALUE ADJUSTMENT
A positive or negative adjustment made to a Fixed Allocation. It may apply to
certain withdrawals and transfers, whether in whole or in part, and
annuitizations of all or part of a Fixed Allocation prior to the end of a
Guarantee Period.
MATURITY DATE
The date on which a Guarantee Period matures.
OWNER
The person who owns the Contract and is entitled to exercise all rights under
the Contract. This person's death also initiates payment of the death benefit.
RIDER
A rider amends the Contract, in certain instances adding benefits.
7% SOLUTION ENHANCED DEATH BENEFIT OPTION
An enhanced death benefit option that may be elected only at issue and only if
the Owner or Annuitant (when the Owner is other than an individual) is age 75 or
younger. The enhanced death benefit provided by this option is equal to an
annual rate of return of 7% on all assets, except those invested in the Liquid
Asset Division, Limited Maturity Bond Division, and the Fixed Account, as
adjusted for additional premiums and partial withdrawals. Each accumulated
initial or additional premium payment reduced by any partial withdrawals taken
will continue to grow at 7% until reaching the maximum enhanced death benefit.
SPECIALLY DESIGNATED DIVISION
The Division to which distributions from a portfolio underlying a Division in
which reinvestment is not available will be allocated unless you specify
otherwise. The Specially Designated Division currently is the Liquid Asset
Division.
4
<PAGE>
DEFINITION OF TERMS (CONTINUED)
STANDARD DEATH BENEFIT OPTION
The death benefit option that you will receive under the Contact unless one of
the enhanced death benefit options is elected. The death benefit provided by
this option is equal to the greatest of (i) Accumulation Value; (ii) total
premium payments less any partial withdrawals; and (iii) Cash Surrender Value.
VALUATION DATE
The day at the end of a Valuation Period when each Division is valued.
VALUATION PERIOD
Each business day together with any non-business days before it.
5
<PAGE>
SUMMARY OF THE CONTRACT
This prospectus has been designed to provide you with information regarding the
Contract and the Accounts which fund the Contract. Information concerning the
Divisions of Account B and the Fixed Account is set forth in Part I of this
prospectus. Part II of this prospectus pertains to Account D which invests
directly in securities.
This summary is intended to provide only a very brief overview of the more
significant aspects of the Contract. Further detail is provided in this
prospectus and in the Contract. The Contract, together with any riders or
endorsements, constitutes the entire agreement between you and us and should be
retained.
This prospectus has been designed to provide you with the necessary information
to make a decision on purchasing the Contract. You have a choice of investments.
We do not promise that your Accumulation Value will increase. Depending on the
investment experience of the Divisions and interest credited to the Fixed
Allocations in which you are invested, your Accumulation Value, Cash Surrender
Value and death benefit may increase or decrease on any day. You bear the
investment risk.
DESCRIPTION OF THE CONTRACT
The Contract is designed to establish retirement benefits for two types of
purchasers. The first type of purchaser is one who is eligible to participate
in, and purchases a Contract for use with, an individual retirement annuity
("IRA") meeting the requirements of section 408(b) of the Internal Revenue Code
of 1986 ("qualified plan"). For a Contract funding a qualified plan,
distributions may be made to you to satisfy requirements imposed by Federal tax
law. The second type of purchaser is one who purchases a Contract outside of a
qualified plan ("non-qualified plan").
The Contract also offers a choice of Annuity Options to which you may apply all
or a portion of the Accumulation Value on the annuity commencement date or the
Cash Surrender Value upon surrender of the Contract. See Choosing Your Annuity
Options.
AVAILABILITY
We can issue a Contract if both the Annuitant and the Owner are not older than
age 85 and accept additional premium payments until either the Annuitant or
Owner reaches the Attained Age of 85 for non-qualified plans (age 70 for
qualified plans, except for rollover contributions). The minimum Initial Premium
is $10,000 for a non-qualified plan and $1,500 for a qualified plan. We may
change the minimum initial or additional premium requirements for certain group
or sponsored arrangements. See Part I, Group or Sponsored Arrangements.
The minimum additional premium payment we will accept is $500 for a
non-qualified plan and $250 for a qualified plan. You must receive our prior
approval before making a premium payment that causes the Accumulation Value of
all annuities that you maintain with us to exceed $1,000,000.
THE DIVISIONS
Each of the fourteen Divisions offered under this prospectus has its own
distinct investment objectives and policies. There are thirteen Divisions of
Account B. Each Division of Account B invests in a corresponding Series of the
Trust, managed by Directed Services, Inc. ("DSI" or the "Manager"). The Trust
and DSI have retained several portfolio managers to manage the assets of each
Series. The Division of Account D is The Managed Global Account. DSI is the
Manager and Warburg, Pincus Counsellors, Inc. ("Warburg, Pincus") is the
portfolio manager (the "Portfolio Manager"). See Part I, Facts About the Company
and the Accounts, Account B Divisions, and The Managed Global Account of Account
D.
HOW THE ACCUMULATION VALUE VARIES
The Accumulation Value in the Divisions varies each day based on investment
results. You bear the risk of poor investment performance and you receive the
benefits from favorable investment performance. The Accumulation Value also
reflects premium payments, charges deducted and partial withdrawals. See Part I,
Accumulation Value in Each Division.
THE FIXED ACCOUNT
The investments available through the Fixed Account include various Fixed
Allocations which we credit with fixed rates of interest for the Guarantee
Periods you select. We reset the interest rates for new Guarantee Periods
periodically based on our sole discretion. We may offer Guarantee Periods from
one to ten years. We currently offer Guarantee Periods with durations of 1, 3,
5, 7 and 10 years.
You bear the investment risk with respect to surrenders, partial withdrawals,
transfers and annuitization from your Fixed Allocations. A surrender, partial
withdrawal, transfer or annuitization made prior to the end of a Guarantee
Period may be subject to a Market Value Adjustment, which could have the effect
of either increasing or decreasing your Accumulation Value. We will not apply a
Market Value Adjustment on a surrender, partial withdrawal, transfer or
annuitization made within 30 days prior to the Maturity Date of the applicable
Guarantee Period or certain transfers made in connection with the dollar cost
averaging program. Systematic withdrawals from a Fixed Allocation also are not
subject to a Market Value Adjustment.
MARKET VALUE ADJUSTMENT
We will apply a Market Value Adjustment, subject to certain exceptions, to a
surrender, partial withdrawal,
6
<PAGE>
SUMMARY OF THE CONTRACT (CONTINUED)
transfer or annuitization from a Fixed Allocation made prior to the end of a
Guarantee Period. The Market Value Adjustment does not apply to amounts invested
in either Account B or Account D.
SURRENDERING YOUR CONTRACT
You may surrender the Contract and receive its Cash Surrender Value at any time
while both the Annuitant and Owner are living and before the Annuity
Commencement Date. See Part I, Cash Surrender Value and Surrendering to Receive
the Cash Surrender Value.
TAKING PARTIAL WITHDRAWALS
After the Free Look Period, prior to the annuity commencement date and while the
Contract is in effect, you may take partial withdrawals from the Accumulation
Value of your Contract. You may elect in advance to take systematic partial
withdrawals on a monthly or quarterly basis. If you have an IRA Contract, you
may elect IRA partial withdrawals on a monthly, quarterly or annual basis.
Partial withdrawals are subject to certain restrictions as defined in this
prospectus, including a surrender charge and a Market Value Adjustment. Partial
withdrawals above a specified percentage of your Accumulation Value may be
subject to a surrender charge. See Part I, Partial Withdrawals.
DOLLAR COST AVERAGING
Under this program, you may choose to have a specified dollar amount transferred
from either the Limited Maturity Bond Division, Liquid Asset Division or a Fixed
Allocation with a one year Guarantee Period to the other Divisions of Account B
and Account D on a monthly basis with the objective of shielding your investment
from short term price fluctuations. See Part I, dollar cost averaging.
YOUR RIGHT TO CANCEL THE CONTRACT
You may cancel your Contract within the Free Look Period which is a ten day
period of time beginning once you receive the Contract. For purposes of
administering our allocation and certain other administrative rules, we deem
this period to end 15 days after the Contract is mailed from our Customer
Service Center. Some states may require that we provide a longer free look
period. In some states we restrict the Initial Premium allocation during the
Free Look Period. See Part I, Your Right to Cancel or Exchange Your Contract.
YOUR RIGHT TO CHANGE THE CONTRACT
The Contract may be changed to another annuity plan subject to our rules at the
time of the change. See Part I, Other Contract Changes.
DEATH BENEFIT OPTIONS
The Contract provides a death benefit to the beneficiary if the Owner dies prior
to the Annuity Commencement Date. Subject to our rules, there are three death
benefit options that may be available to you under the Contract: the Standard
Death Benefit Option; the 7% Solution Enhanced Death Benefit Option; and the
Annual Ratchet Enhanced Death Benefit Option. See Facts About the Contract,
Death Benefit Options. We may offer a reduced death benefit under certain group
and sponsored arrangements. See Part I, Group or Sponsored Arrangements.
DEDUCTIONS FOR CHARGES AND FEES
We invest the entire amount of the initial and any additional premium payments
in the Divisions and the Fixed Allocations you select, subject to certain
restrictions we impose. See Part I, Restrictions on Allocation of Premium
Payments. We then may deduct an annual Contract fee from your Accumulation
Value. See Part I, Charges and Fees. We may reduce certain charges under group
or sponsored arrangements. See Part I, Group or Sponsored Arrangements. Unless
you have elected the Charge Deduction Division, charges are deducted
proportionately from all Account B and Account D Divisions in which you are
invested. If there is no Accumulation Value in these Divisions, charges will be
deducted from your Fixed Allocations starting with Guarantee Periods nearest
their Maturity Dates until such charges have been deducted.
FEDERAL INCOME TAXES
The ultimate effect of Federal income taxes on the amounts held under an annuity
Contract, on Annuity Payments and on the economic benefits to the Owner,
Annuitant or Beneficiary depends on Golden American's tax status and upon the
tax status of the individuals concerned. In general, an Owner is not taxed on
increases in value under an annuity Contract until some form of distribution is
made under it. There may be tax penalties if you make a withdrawal or surrender
the Contract before reaching age 59 1/2. See Part I, Federal Tax Considerations.
EXCHANGE AND UPDATE PROGRAMS
From time to time, we may offer two programs that allow you to elect to exchange
or update a contract that you currently own for GoldenSelect DVA PLUS. Our
External Exchange Program is available only where your current contract was
issued by an insurance company not affiliated with us. Our DVA Update Program is
available only where your current contract is GoldenSelect DVA. See Facts About
the Contract, Exchange and Update Programs.
7
<PAGE>
FEE TABLE
TRANSACTION EXPENSES(1)
Contingent Deferred Sales Charge(2) (imposed as a percentage of premium
payments withdrawn upon excess partial withdrawal or surrender):(3)
<TABLE>
<CAPTION>
COMPLETE YEARS ELAPSED SURRENDER
SINCE PREMIUM PAYMENT CHARGE
<S> <C>
0 7%
1 7%
2 6%
3 5%
4 4%
5 3%
6 1%
7+ 0%
</TABLE>
<TABLE>
<S> <C>
Excess Allocation Charge...................................................................................$0(4)
</TABLE>
ANNUAL CONTRACT FEES:
<TABLE>
<S> <C>
Administrative Charge........................................................................................$40
(Waived if the Accumulation Value equals or exceeds $100,000 at the end of the Contract Year, or once the sum of
premiums paid equals or exceeds $100,000.)
</TABLE>
SEPARATE ACCOUNT ANNUAL EXPENSES (percentage of assets in each Division)(5):
<TABLE>
<CAPTION>
STANDARD
----------- ENHANCED DEATH BENEFIT
------------------------------------
ANNUAL RATCHET 7% SOLUTION
<S> <C> <C> <C>
Mortality and Expense Risk Charge............................ 1.10% 1.25% 1.40%
Asset Based Administrative Charge............................ 0.15% 0.15% 0.15%
----------- ------- -------
Total Separate Account Expenses.............................. 1.25% 1.40% 1.55%
</TABLE>
TRUST ANNUAL EXPENSES(6) (based on combined net assets of the indicated groups
of Series):
<TABLE>
<CAPTION>
TOTAL
SERIES FEES OTHER EXPENSES(7) EXPENSES
- ------------------------------------------------------ ---------- ----------------- -------------
<S> <C> <C> <C>
Multiple Allocation, Fully Managed, Capital
Appreciation,
Rising Dividends, All-Growth, Real Estate, Natural 1.00% 0.01% 1.01%
Resources, Value Equity, Strategic Equity, and Small
Cap Series:
Emerging Markets Series: 1.50% 0.03% 1.53%
Limited Maturity Bond and Liquid Asset Series: 0.60% 0.01% 0.61%
</TABLE>
THE MANAGED GLOBAL ACCOUNT ANNUAL EXPENSES AFTER REIMBURSEMENT (percentage of
average net assets):
<TABLE>
<CAPTION>
MANAGEMENT AND OTHER TOTAL ANNUAL
ASSETS ADVISORY FEES EXPENSES EXPENSES(8)
- --------------------------------------------------------------------- --------------------- ------------- -----------------
<S> <C> <C> <C>
$0 to $500 million................................................... 1.00% 0.25% 1.25%
in excess of $500 million............................................ 0.80% 0.25% 1.05%
</TABLE>
- ------------------------------
(1) A Market Value Adjustment, which may increase or decrease your Accumulation
Value, may apply to certain transactions. See Market Value Adjustment.
(2) We also deduct a charge for premium taxes (which can range from 0% to 3.5%
of premium) from your Accumulation Value upon surrender, excess partial
withdrawals or on the Annuity Commencement Date. See Premium Taxes.
(3) For purposes of calculating the surrender charge for the excess partial
withdrawal, (i) we treat premium payments as being withdrawn on a first-in
first-out basis, and (ii) amounts withdrawn which are not considered an
excess partial withdrawal are not treated as a withdrawal of any premium
payments. See Charges Deducted from the Accumulation Value, Surrender Charge
for Excess Partial Withdrawals.
(4) We reserve the right to impose a charge in the future at a maximum of $25
for each allocation change in excess of twelve per Contract Year. See Excess
Allocation Charge.
(5) See Facts About the Contract, Death Benefit Options, for a description of
the Contract's Standard and Enhanced Death Benefit Options.
(6) Fees decline as combined assets increase (see Part I, Account B Divisions
and the Trust prospectus for details).
(7) Other Expenses generally consist of independent trustees fees and expenses.
(8) Reflects an expense reimbursement or waiver through December 31, 1995.
8
<PAGE>
FEE TABLE (CONTINUED)
EXAMPLES:
The examples do not take into account any deduction for premium taxes. Premium
taxes currently range from 0% to 3.5% of premium payments. There may be
surrender charges if you choose to annuitize within the first three Contract
Years.
If at issue you elect the 7% Solution Enhanced Death Benefit Option and you
surrender your Contract at the end of the applicable time period, you would pay
the following expenses for each $1,000 of Initial Premium assuming a 5% annual
return on assets:
- --------------------------------------------------------------------------------
<TABLE>
<CAPTION>
DIVISION ONE YEAR THREE YEARS FIVE YEARS TEN YEARS
<S> <C> <C> <C> <C>
Multiple Allocation..................................................... $ 96.39 $ 140.94 $ 177.95 $ 292.08
Fully Managed........................................................... $ 96.39 $ 140.94 $ 177.95 $ 292.08
Capital Appreciation.................................................... $ 96.39 $ 140.94 $ 177.95 $ 292.08
Rising Dividends........................................................ $ 96.39 $ 140.94 $ 177.95 $ 292.08
All-Growth.............................................................. $ 96.39 $ 140.94 $ 177.95 $ 292.08
Real Estate............................................................. $ 96.39 $ 140.94 $ 177.95 $ 292.08
Natural Resources....................................................... $ 96.39 $ 140.94 $ 177.95 $ 292.08
Value Equity............................................................ $ 96.39 $ 140.94 $ 177.95 $ 292.08
Strategic Equity........................................................ $ 96.39 $ 140.94 $ 177.95 $ 292.08
Small Cap............................................................... $ 96.39 $ 140.94 $ 177.95 $ 292.08
Emerging Markets........................................................ $ 101.38 $ 155.80 $ 202.48 $ 339.67
Global Account.......................................................... $ 98.69 $ 147.81 $ 189.34 $ 314.34
Limited Maturity Bond................................................... $ 92.54 $ 129.40 $ 158.73 $ 253.82
Liquid Asset............................................................ $ 92.54 $ 129.40 $ 158.73 $ 253.82
</TABLE>
- --------------------------------------------------------------------------------
If at issue you elect the 7% Solution Enhanced Death Benefit Option and you do
not surrender your Contract or if you annuitize on the Annuity Commencement
Date, you would pay the following expenses for each $1,000 of initial premium
assuming a 5% annual return on assets:
- --------------------------------------------------------------------------------
<TABLE>
<CAPTION>
DIVISION ONE YEAR THREE YEARS FIVE YEARS TEN YEARS
<S> <C> <C> <C> <C>
Multiple Allocation..................................................... $ 26.39 $ 80.94 $ 137.95 $ 292.08
Fully Managed........................................................... $ 26.39 $ 80.94 $ 137.95 $ 292.08
Capital Appreciation.................................................... $ 26.39 $ 80.94 $ 137.95 $ 292.08
Rising Dividends........................................................ $ 26.39 $ 80.94 $ 137.95 $ 292.08
All-Growth.............................................................. $ 26.39 $ 80.94 $ 137.95 $ 292.08
Real Estate............................................................. $ 26.39 $ 80.94 $ 137.95 $ 292.08
Natural Resources....................................................... $ 26.39 $ 80.94 $ 137.95 $ 292.08
Value Equity............................................................ $ 26.39 $ 80.94 $ 137.95 $ 292.08
Strategic Equity........................................................ $ 26.39 $ 80.94 $ 137.95 $ 292.08
Small Cap............................................................... $ 26.39 $ 80.94 $ 137.95 $ 292.08
Emerging Markets........................................................ $ 31.38 $ 95.80 $ 162.48 $ 339.67
Global Account.......................................................... $ 28.69 $ 87.81 $ 149.34 $ 314.34
Limited Maturity Bond................................................... $ 22.54 $ 69.40 $ 118.73 $ 253.82
Liquid Asset............................................................ $ 22.54 $ 69.40 $ 118.73 $ 253.82
</TABLE>
- --------------------------------------------------------------------------------
The purpose of the Fee Table is to assist you in understanding the various costs
and expenses that you will bear directly or indirectly. For purposes of
computing the annual per Contract administrative charge, the dollar amounts
shown in the examples are based on an Initial Premium of $50,000.
In the absence of expense reimbursement or waiver from Management and Advisory
Fees, the Total Annual Expenses for the Global Account would have been 1.34% of
the Global Account's average daily net assets for 1995.
The examples reflect the election at issue of the 7% Solution Enhanced Death
Benefit Option. If the Standard Death Benefit Option or the Annual Ratchet
Enhanced Death Benefit Option is elected, the actual expenses incurred will be
less than those represented in the Examples.
In the examples, the numbers for the Global Account reflect expenses based on
assumed assets in the Global Account of $500 million or less. If the Global
Account's assets exceed $500 million, these expenses will decrease.
THIS EXAMPLE SHOULD NOT BE CONSIDERED A REPRESENTATION OF PAST OR FUTURE
EXPENSES. ACTUAL EXPENSES MAY BE GREATER OR LESS THAN THOSE SHOWN, SUBJECT TO
THE GUARANTEES UNDER THE CONTRACT.
9
<PAGE>
CONDENSED FINANCIAL AND OTHER INFORMATION
INDEX OF INVESTMENT EXPERIENCE
The upper table gives the index of investment experience for each Division of
Account B and for the Global Account available under the Contract for each death
benefit option. Except for the Small Cap Division, each Division under the
Contract commenced operations on October 2, 1995. The index of investment
experience is equal to the value of a unit for each Division of the Accounts.
The total value of each division as of the end of each period is shown in the
lower table.
<TABLE>
<CAPTION>
INDEX OF INVESTMENT EXPERIENCE
---------------------------------------------------------------
ENHANCED DEATH BENEFIT
-------------------------------------
STANDARD ANNUAL RACHET 7% SOLUTION
------------------------ ------------------------ -----------
10/2/95 12/31/95 10/2/95 12/31/95 10/2/95
----------- ----------- ----------- ----------- -----------
<S> <C> <C> <C> <C> <C>
Multiple Allocation........................................ $ 16.10 $ 16.72 $ 15.94 $ 16.55 $ 15.78
Fully Managed.............................................. 14.77 15.23 14.62 15.07 14.47
Capital Appreciation....................................... 14.31 14.71 14.23 14.63 14.16
Rising Dividends........................................... 12.16 13.24 12.12 13.19 12.09
All-Growth................................................. 13.88 14.10 13.74 13.96 13.60
Real Estate................................................ 15.06 15.94 14.91 15.78 14.76
Natural Resources.......................................... 14.86 15.11 14.71 14.96 14.57
Value Equity............................................... 12.43 13.37 12.41 13.36 12.40
Strategic Equity........................................... 10.00(1) 10.01 10.00(1) 10.01 10.00(1)
Small Cap.................................................. --(2) --(2) --(2) --(2) --(2)
Emerging Markets........................................... 9.50 9.23 9.47 9.20 9.44
Global Account............................................. 9.32 9.58 9.28 9.53 9.24
Limited Maturity Bond...................................... 14.49 14.86 14.35 14.71 14.20
Liquid Asset............................................... 12.89 13.03 12.76 12.89 12.63
<CAPTION>
12/31/95
-----------
<S> <C>
Multiple Allocation........................................ $ 16.38
Fully Managed.............................................. 14.91
Capital Appreciation....................................... 14.55
Rising Dividends........................................... 13.15
All-Growth................................................. 13.81
Real Estate................................................ 15.61
Natural Resources.......................................... 14.80
Value Equity............................................... 13.34
Strategic Equity........................................... 10.01
Small Cap.................................................. --(2)
Emerging Markets........................................... 9.17
Global Account............................................. 9.49
Limited Maturity Bond...................................... 14.56
Liquid Asset............................................... 12.76
</TABLE>
<TABLE>
<CAPTION>
TOTAL ACCUMULATION VALUE
----------------------------------------------
ENHANCED DEATH BENEFIT
-------------------------------
STANDARD ANNUAL RACHET 7% SOLUTION
------------- ---------------- -------------
12/31/95 12/31/95 12/31/95
------------- ---------------- -------------
<S> <C> <C> <C>
Multiple Allocation.......................................................... $ 1,746,847 $ 348,748 $6,068,413
Fully Managed................................................................ 748,453 210,790 2,749,555
Capital Appreciation......................................................... 354,685 239,431 4,751,529
Rising Dividends............................................................. 303,580 476,311 3,956,113
All-Growth................................................................... 308,996 231,255 3,479,441
Real Estate.................................................................. 43,296 45,908 954,578
Natural Resources............................................................ 375,257 42,591 393,850
Value Equity................................................................. 458,353 312,457 2,393,664
Strategic Equity............................................................. 761,998(1) 475,319(1) 1,527,707(1)
Small Cap.................................................................... --(2) --(2) --(2)
Emerging Markets............................................................. 144,699 114,726 1,475,334
Global Account............................................................... 255,906 261,677 1,982,653
Limited Maturity Bond........................................................ 400,999 174,099 1,988,103
Liquid Asset................................................................. 493,644 800,574 1,189,883
</TABLE>
- ------------------------------
(1) The Strategic Equity Division became available for investment on October 2,
1995 starting with an index of investment experience of $10.00.
(2) The Small Cap Equity Division became available for investment on January 2,
1996 starting with an index of investment experience of $10.00.
FINANCIAL STATEMENTS
The audited financial statements of Separate Account B for the years ended
December 31, 1995 and 1994 (as well as the auditors' report thereon) and the
audited financial statements of The Managed Global Account of separate Account D
for the years ended December 31, 1995 and 1994 (as well as the auditors' report
thereon) appear in the Statement of Additional Information. The audited
financial statements of Golden American prepared in accordance with generally
accepted accounting principles for the years ended December 31, 1995, 1994 and
1993 (as well as the auditors' report thereon) are contained in the Prospectus.
PERFORMANCE RELATED INFORMATION
Performance information for the Divisions of Account B and Account D, including
the yield and effective yield of the Liquid Asset Division, the yield of the
remaining Divisions, and the total return of all Divisions may appear in reports
and promotional literature to current or prospective Owners.
10
<PAGE>
Current yield for the Liquid Asset Division will be based on income received by
a hypothetical investment over a given 7-day period (less expenses accrued
during the period), and then "annualized" (i.e., assuming that the 7-day yield
would be received for 52 weeks, stated in terms of an annual percentage return
on the investment). "Effective yield" for the Liquid Asset Division is
calculated in a manner similar to that used to calculate yield, but when
annualized, the income earned by the investment is assumed to be reinvested. The
"effective yield" will be slightly higher than the "yield" because of the
compounding effect of earnings.
For the remaining Divisions, quotations of yield will be based on all investment
income per unit (Accumulation Value divided by the index of investment
experience, see Part I, Measurement of Investment Experience, INDEX OF
INVESTMENT EXPERIENCE AND UNIT VALUE) earned during a given 30-day period, less
expenses accrued during the period ("net investment income"). Quotations of
average annual total return for any Division will be expressed in terms of the
average annual compounded rate of return on a hypothetical investment in a
Contract over a period of one, five, and ten years (or, if less, up to the life
of the Division), and will reflect the deduction of the applicable surrender
charge, the administrative charge and the applicable mortality and expense risk
charge. See Charges and Fees. Quotations of total return may simultaneously be
shown for other periods that do not take into account certain contractual
charges, such as the surrender charge for example.
Performance information for a Division may be compared, in reports and
promotional literature, to: (i) the Standard & Poor's 500 Stock Index ("S & P
500"), Dow Jones Industrial Average ("DJIA"), Donoghue Money Market
Institutional Averages, or other indices measuring performance of a pertinent
group of securities so that investors may compare a Division's results with
those of a group of securities widely regarded by investors as representative of
the securities markets in general; (ii) other variable annuity separate accounts
or other investment products tracked by Lipper Analytical Services, a widely
used independent research firm which ranks mutual funds and other investment
companies by overall performance, investment objectives, and assets, or tracked
by other ratings services, including VARDS, companies, publications, or persons
who rank separate accounts or other investment products on overall performance
or other criteria; and (iii) the Consumer Price Index (measure for inflation) to
assess the real rate of return from an investment in the Contract. Unmanaged
indices may assume the reinvestment of dividends but generally do not reflect
deductions for administrative and management costs and expenses.
Performance information for any Division reflects only the performance of a
hypothetical Contract under which the Accumulation Value is allocated to a
Division during a particular time period on which the calculations are based.
Performance information should be considered in light of the investment
objectives and policies, characteristics and quality of the portfolio of the
Series of the Trust in which the Division invests or, the securities in which
Account D invests, and the market conditions during the given time period, and
should not be considered as a representation of what may be achieved in the
future. For a description of the methods used to determine yield and total
return for the Divisions, see the Statement of Additional Information.
Reports and promotional literature may also contain other information including
the ranking of any Division derived from rankings of variable annuity separate
accounts or other investment products tracked by Lipper Analytical Services or
by rating services, companies, publications, or other persons who rank separate
accounts or other investment products on overall performance or other criteria.
11
<PAGE>
PART I
INTRODUCTION THE FOLLOWING INFORMATION IN PART I DESCRIBES THE CONTRACT AND
THE ACCOUNTS WHICH FUND THE CONTRACT, ACCOUNT B AND ACCOUNT D AND THE FIXED
ACCOUNT. ACCOUNT B INVESTS IN MUTUAL FUND PORTFOLIOS OF THE TRUST. ACCOUNT D
INVESTS DIRECTLY IN SECURITIES. THE FIXED ACCOUNT CONTAINS ALL OF THE ASSETS
THAT SUPPORT OWNER FIXED ALLOCATIONS WHICH WE CREDIT WITH GUARANTEED INTEREST
RATES FOR THE GUARANTEE PERIODS YOU SELECT.
12
<PAGE>
FACTS ABOUT THE COMPANY AND THE ACCOUNTS
GOLDEN AMERICAN
Golden American Life Insurance Company ("Golden American") is a stock life
insurance company organized under the laws of the State of Delaware. Prior to
December 30, 1993, Golden American was a Minnesota corporation. Golden American
is a wholly owned indirect subsidiary of Bankers Trust Company. We are
authorized to do business in all jurisdictions except New York. We offer
variable annuities and variable life insurance. Administrative services for the
Contract are provided at our Customer Service Center, the address is shown on
the cover.
Bankers Trust Company is a New York banking corporation with executive offices
at 280 Park Avenue, New York, New York 10017. As of December 31, 1995, Bankers
Trust New York Corporation, parent of Bankers Trust Company, was the seventh
largest bank holding company in the United States with total assets of
approximately $104 billion. Bankers Trust Company conducts a variety of general
banking and trust activities and is a leading wholesale supplier of financial
services to the domestic and international markets.
In a transaction that closed on September 30, 1992, a wholly owned subsidiary of
Bankers Trust Company acquired all of the issued and outstanding capital stock
of Golden American and DSI, an affiliate of Golden American, and related assets.
The transaction involved settlement of pre-existing claims of Bankers Trust
Company against the former parent company of Golden American and DSI. Under
applicable banking law, stock so acquired is subject to various divestiture
requirements. Such a divestiture is likely to occur in the future. Also,
judicial or administrative decisions or interpretations, as well as changes in
either Federal or state banking statutes or regulations, could prevent Bankers
Trust Company from continuing to own the stock of Golden American or DSI.
For more information about Golden American, see Part I, More Information About
Golden American Life Insurance Company.
THE GCG TRUST
The Trust is an open-end management investment company, more commonly called a
mutual fund. The Trust's shares may also be available to certain separate
accounts funding variable life insurance policies offered by Golden American.
This is called "mixed funding."
The Trust may also sell its shares to separate accounts of other insurance
companies, both affiliated and not affiliated with Golden American. This is
called "shared funding." Although we do not anticipate any inherent difficulties
arising from either mixed or shared funding it is theoretically possible that,
due to differences in tax treatment or other considerations, the interest of
Owners of various Contracts participating in the Trust might at sometime be in
conflict. After the Trust receives the requisite order from the SEC, shares of
the Trust may also be sold to certain qualified pension and retirement plans.
The Board of Trustees of the Trust, the Trust's Manager, and we and any other
insurance companies participating in the Trust are required to monitor events to
identify any material conflicts that arise from the use of the Trust for mixed
and/or shared funding or between various policy Owners and pension and
retirement plans. For more information about the risks of mixed and shared
funding, please refer to the Trust prospectus.
You will find complete information about the Trust, including the risks
associated with each Series, in the accompanying Trust prospectus. You should
read it carefully in conjunction with this prospectus before investing.
Additional copies of the Trust prospectus may be obtained by contacting our
Customer Service Center.
SEPARATE ACCOUNTS B AND D
All obligations under the Contract are general obligations of Golden American.
Account B and Account D are separate investment accounts used to support our
variable annuity Contracts and for other purposes as permitted by applicable
laws and regulations. The assets of Account B and Account D are kept separate
from our general account and any other separate accounts we may have. We may
offer other variable annuity Contracts investing in Account B and Account D
which are not discussed in this prospectus. Account B and Account D may also
invest in other series which are not available to the Contract described in this
prospectus.
We own all the assets in Account B and Account D. Income and realized and
unrealized gains or losses from assets in each account is credited to or charged
against that account without regard to other income, gains or losses in our
other investment accounts. As required, the assets in Account B and Account D
are at least equal to the reserves and other liabilities of that account. These
assets may not be charged with liabilities from any other business we conduct.
They may, however, be subject to liabilities arising from Divisions whose assets
are attributable to other variable annuity Contracts supported by Account B
13
<PAGE>
FACTS ABOUT THE COMPANY AND THE ACCOUNTS (CONTINUED)
and Account D. If the assets exceed the required reserves and other liabilities,
we may transfer the excess to our general account.
ACCOUNT B
Account B was established on July 14, 1988, and may invest in mutual funds,
unit investment trusts or other investment portfolios which we determine to be
suitable for the Contract's purposes. Account B is treated as a unit
investment trust under Federal securities laws. It is registered with the SEC
under the Investment Company Act of 1940 (the "1940 Act") as an investment
company and meets the definition of a separate account under the Federal
securities laws. It is governed by the laws of Delaware, our state of
domicile, and may also be governed by the laws of other states in which we do
business. Registration with the SEC does not involve any supervision by the
SEC of the management or investment policies or practices of Account B.
ACCOUNT D
Account D was established on April 18, 1990 and invests directly in securities
in accordance with the investment objectives and policies of Account D.
Account D is registered with the SEC under the 1940 Act as an open-end
management investment company and meets the definition of a separate account
under the federal securities laws. It is governed by the laws of Delaware, our
state of domicile, and may also be governed by laws of other states in which
we do business. Registration with the SEC does not involve any supervision by
the SEC of the management or investment policies or practices of Account D.
ACCOUNT B DIVISIONS
Account B is divided into Divisions. Currently, each Division of Account B
offered under this prospectus invests in a portfolio of The GCG Trust (the
"Trust"). DSI serves as the Manager to each Series of the Trust. See the Trust
prospectus for details. The Trust and DSI have retained several portfolio
managers to manage the assets of each Series as indicated below. There may be
restrictions on the amount of the allocation to certain Divisions based on state
laws and regulations. The investment objectives of the various Series in the
Trust are described below. There is no guarantee that any portfolio or Series
will meet its investment objectives. Meeting objectives depends on various
factors, including, in certain cases, how well the portfolio managers anticipate
changing economic and market conditions. Account B also has other Divisions
investing in other series which are not available to the Contract described in
this prospectus.
DSI provides the overall business management and administrative services
necessary for the Series' operation and provides or procures the services and
information necessary to the proper conduct of the business of the Series. DSI
is responsible for providing or procuring, at DSI's expense, the services
reasonably necessary for the ordinary operation of the Series. DSI does not bear
the expense of brokerage fees and other transactional expenses for securities or
other assets (which are generally considered part of the cost for assets), taxes
(if any) paid by a Series, interest on borrowing, fees and expenses of the
independent trustees, and extraordinary expenses, such as litigation or
indemnification expenses. See the Trust prospectus for details.
The Trust pays DSI for its services a fee, payable monthly, based on the annual
rates of the average daily net assets of the Series shown in the table below.
DSI (and not the Trust) pays each portfolio manager a monthly fee for managing
the assets of the Series.
- --------------------------------------------------------------------------------
<TABLE>
<CAPTION>
FEES (based on combined assets of the indicated groups of
SERIES Series)
- ------------------------------------------------------------- -------------------------------------------------------------
<S> <C>
Multiple Allocation, Fully Managed, 1.00% of first $750 million;
Capital Appreciation, Rising Dividends, 0.95% of next $1.250 billion;
All-Growth, Real Estate, Natural Resources, Value Equity, 0.90% of next $1.5 billion; and
Strategic Equity, and Small Cap Series: 0.85% of amount in excess of $3.5 billion
Emerging Markets Series: 1.50% of average daily net assets
Limited Maturity Bond and 0.60% of first $200 million;
Liquid Asset Series: 0.55% of next $300 million; and
0.50% of amount in excess of $500 million
</TABLE>
- --------------------------------------------------------------------------------
14
<PAGE>
FACTS ABOUT THE COMPANY AND THE ACCOUNTS (CONTINUED)
The following Divisions invest in designated Series of the Trust.
MULTIPLE ALLOCATION DIVISION
MULTIPLE ALLOCATION SERIES
OBJECTIVE
The highest total return, consisting of capital appreciation and current
income, consistent with the preservation of capital and elimination of
unnecessary risk.
INVESTMENTS
Investment in equity and debt securities and the use of certain sophisticated
investment strategies and techniques.
PORTFOLIO MANAGER
Zweig Advisors Inc.
FULLY MANAGED DIVISION
FULLY MANAGED SERIES
OBJECTIVE
High total investment return over the long term, consistent with the
preservation of capital and prudent investment risk.
INVESTMENTS
Pursues an active asset allocation strategy whereby investments are allocated,
based upon an evaluation of economic and market trends and the anticipated
relative total return available, among three asset classes -- debt securities,
equity securities and money market instruments.
PORTFOLIO MANAGER
T. Rowe Price Associates, Inc.
CAPITAL APPRECIATION DIVISION
CAPITAL APPRECIATION SERIES
OBJECTIVE
Long-term capital growth.
INVESTMENTS
Invests in common stocks and preferred stock that will be allocated among
various categories of stocks referred to as "components" which consist of the
following: (i) The Growth Component -- Securities that the portfolio manager
believes have the following characteristics: stability and quality of earnings
and positive earnings momentum; dominant competitive positions; and
demonstrate above-average growth rates as compared to published S&P 500
earnings projections; and (ii) The Value Component -- Securities that the
portfolio manager regards as fundamentally undervalued, i.e., securities
selling at a discount to asset value and securities with a relatively low
price/earnings ratio. The securities eligible for this component may include
real estate stocks, such as securities of publicly-owned companies that, in
the portfolio manager's judgement, offer an optimum combination of current
dividend yield, expected dividend growth, and discount to current real estate
value.
PORTFOLIO MANAGER
Chancellor Trust Company
RISING DIVIDENDS DIVISION
RISING DIVIDENDS SERIES
OBJECTIVE
Capital appreciation, with dividend income as a secondary objective.
INVESTMENTS
Investment in equity securities of high quality companies that meet the
following four criteria: consistent dividend increases; substantial dividend
increases; reinvested profits; and an under-leveraged balance sheet.
PORTFOLIO MANAGER
Kayne, Anderson Investment Management, Inc.
ALL-GROWTH DIVISION
ALL-GROWTH SERIES
OBJECTIVE
Capital appreciation.
INVESTMENTS
Investment in securities selected for their long term growth prospects.
PORTFOLIO MANAGER
Warburg, Pincus Counsellors, Inc.
REAL ESTATE DIVISION
REAL ESTATE SERIES
OBJECTIVE
Capital appreciation, with current income as a secondary objective.
INVESTMENTS
Investment in publicly traded equity securities of companies in the real
estate industry listed on national exchanges or on the National Association of
Securities Dealers Automated Quotation System.
PORTFOLIO MANAGER
E.I.I. Realty Securities, Inc.
NATURAL RESOURCES DIVISION
NATURAL RESOURCES SERIES
OBJECTIVE
Long-term capital appreciation.
INVESTMENTS
Investment in equity and debt securities of companies engaged in the
exploration, development, production, and distribution of natural resources.
PORTFOLIO MANAGER
Van Eck Associates Corporation
15
<PAGE>
FACTS ABOUT THE COMPANY AND THE ACCOUNTS (CONTINUED)
VALUE EQUITY DIVISION
VALUE EQUITY SERIES
OBJECTIVE
Capital appreciation with a secondary objective of dividend income.
INVESTMENTS
Investment primarily in equity securities of U.S. and foreign issuers which,
when purchased, meet quantitative standards believed by the Portfolio Manager
to indicate above average financial soundness and high intrinsic value
relative to price.
PORTFOLIO MANAGER
Eagle Asset Management, Inc.
STRATEGIC EQUITY DIVISION
STRATEGIC EQUITY SERIES
OBJECTIVE
Long term capital appreciation.
INVESTMENTS
Investment primarily in equity securities based on various equity market
timing techniques. The amount of the Series' assets allocated to equities
shall vary from time to time to seek positive investment performance from
advancing equity markets and to reduce exposure to equities when risk/reward
characteristics are believed to be less attractive.
PORTFOLIO MANAGER
Zweig Advisors Inc.
SMALL CAP DIVISION
SMALL CAP SERIES
OBJECTIVE
Long term capital appreciation.
INVESTMENTS
Investment primarily in equity securities of companies that, at the time of
purchase, have a total market capitalization -- present market value per share
multiplied by the total number of shares outstanding -- of less than $1
billion.
PORTFOLIO MANAGER
Fred Alger Management, Inc.
EMERGING MARKETS DIVISION
EMERGING MARKETS SERIES
OBJECTIVE
Long term growth of capital.
INVESTMENTS
Investment primarily in equity securities of companies that are considered to
be in emerging market countries in the Pacific Basin and Latin America. Income
is not an objective, and any production of current income is considered
incidental to the objective of growth of capital.
PORTFOLIO MANAGER
Bankers Trust Company
LIMITED MATURITY BOND DIVISION
LIMITED MATURITY BOND SERIES
OBJECTIVE
Highest current income consistent with low risk to principal and liquidity.
Also seeks to enhance its total return through capital appreciation when
market factors indicate that capital appreciation may be available without
significant risk to principal.
INVESTMENTS
Investment primarily in a diversified portfolio of limited maturity debt
securities. No individual security will at the time of purchase have a
remaining maturity longer than seven years and the dollar-weighted average
maturity of the Series will not exceed five years.
PORTFOLIO MANAGER
Bankers Trust Company
LIQUID ASSET DIVISION
LIQUID ASSET SERIES
OBJECTIVE
High level of current income consistent with the preservation of capital and
liquidity.
INVESTMENTS
Obligations of the U.S. Government and its agencies and instrumentalities;
bank obligations; commercial paper and short-term corporate debt securities.
TERM
All issues maturing in less than one year.
PORTFOLIO MANAGER
Bankers Trust Company
THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D
The Global Account is the only portfolio of Account D available under the
Contract. The Global Account is a non-diversified investment company which
invests directly in securities. There can be no assurance that the Global
Account will meet its investment objective. Account D may also offer other
portfolios which are not available through the purchase of the Contract offered
by this prospectus. DSI serves as Manager of Account D and Warburg, Pincus
serves as Portfolio Manager of the Global Account.
THE MANAGED GLOBAL ACCOUNT DIVISION
THE MANAGED GLOBAL ACCOUNT PORTFOLIO
OBJECTIVE
High total investment return, consistent with a prudent regard for capital
preservation.
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FACTS ABOUT THE COMPANY AND THE ACCOUNTS (CONTINUED)
INVESTMENTS
Investment in a wide range of equity and debt securities and money market
instruments of both domestic and foreign issuers.
PORTFOLIO MANAGER
Warburg, Pincus Counsellors, Inc.
ADVISORY FEE
0.60% of the first $500 million of average daily net assets on an annual
basis; and 0.50% of the excess over $500 million.
The initial organizational expenses of the Global Account were advanced by
Golden American. The Global Account reimburses Golden American for such
expenses, which are amortized over five years from the date of the Global
Account's commencement of operations.
FOR MORE COMPLETE INFORMATION ABOUT THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D,
INCLUDING THE RISKS ASSOCIATED WITH ITS INVESTMENTS, SEE PART II, INVESTMENT
OBJECTIVE AND POLICIES OF THE GLOBAL ACCOUNT.
CHANGES WITHIN ACCOUNT B AND ACCOUNT D
We may from time to time make additional Divisions available. These Divisions
will invest in investment portfolios we find suitable for the Contract. We also
have the right to eliminate investment Divisions from Account B and Account D,
to combine two or more Divisions, or to substitute a new portfolio for the
portfolio in which a Division invests. A substitution may become necessary if,
in our judgment, a portfolio no longer suits the purposes of the Contract. This
may happen due to a change in laws or regulations, or a change in a portfolio's
investment objectives or restrictions, or because the portfolio is no longer
available for investment, or for some other reason. In addition, we reserve the
right to transfer assets of Account B and Account D, which we determine to be
associated with the class of Contracts to which your Contract belongs, to
another account. If necessary, we will get prior approval from the insurance
department of our state of domicile before making such a substitution or
transfer. We will also get any required approval from the SEC and any other
required approvals before making such a substitution or transfer. We will notify
you as soon as practicable of any proposed changes.
When permitted by law, We reserve the right to:
(1) deregister an account under the 1940 Act;
(2) operate an account as a management company
under the 1940 Act if it is operating as a unit investment trust;
(3) operate an account as a unit investment trust
under the 1940 Act if it is operating as a managed separate account;
(4) restrict or eliminate any voting rights as to the
accounts; and
(5) combine an account with other accounts.
THE FIXED ACCOUNT
Premium payments may be allocated to the Fixed Account at the time of the
Initial Premium payment or as subsequently made. In addition, all or part of
your Accumulation Value may be transferred to the Fixed Account. Assets
supporting amounts allocated to the Fixed Account are available to fund the
claims of all classes of our customers, Owners and other creditors. Interests
under your Contract relating to the Fixed Account are registered under the
Securities Act of 1933 but the Fixed Account is not registered under the 1940
Act.
SELECTING A GUARANTEE PERIOD
You may select one or more Fixed Allocations with specified Guarantee Periods
for investment. We currently offer Guarantee Periods with durations of 1, 3,
5, 7 and 10 years. We reserve the right at any time to decrease or increase
the number of Guarantee Periods offered. Not all Guarantee Periods may be
available for new allocations. Each Fixed Allocation will have a Maturity Date
corresponding to the last day of the calendar month of the applicable
Guarantee Period.
Your Accumulation Value in the Fixed Account equals the sum of your Fixed
Allocations plus the interest credited thereto, as adjusted for any partial
withdrawals, reallocations or other charges we may impose. Your Fixed
Allocation will be credited with the Guaranteed Interest Rate in effect on the
date we receive and accept your premium or reallocation of Accumulation Value.
The Guaranteed Interest Rate will be credited daily to yield the quoted
Guaranteed Interest Rate.
GUARANTEED INTEREST RATES
Each Guarantee Period will have an interest rate that is guaranteed. We do not
have a specific formula for establishing the Guaranteed Interest Rates for the
different Guarantee Periods. The determination made will be influenced by, but
not necessarily correspond to, interest rates available on fixed income
investments which we may acquire with the amounts we receive as premium
payments or reallocations of Accumulation Value under the
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FACTS ABOUT THE COMPANY AND THE ACCOUNTS (CONTINUED)
Contracts. These amounts will be invested primarily in investment-grade fixed
income securities including: securities issued by the United States Government
or its agencies or instrumentalities, which issues may or may not be
guaranteed by the United States Government; debt securities that have an
investment grade rating, at the time of purchase, within the four highest
grades assigned by Moody's Investor Services, Inc. (Aaa, Aa, A or Baa),
Standard & Poor's Ratings Group (AAA, AA, A or BBB) or any other nationally
recognized rating service; mortgage-backed securities collateralized by the
Federal Home Loan Mortgage Association, the Federal National Mortgage
Association or the Government National Mortgage Association, or that have an
investment grade rating at the time of purchase within the four highest grades
described above; other debt investments; commercial paper; and cash or cash
equivalents. You will have no direct or indirect interest in these
investments. We will also consider other factors in determining the Guaranteed
Interest Rates, including regulatory and tax requirements, sales commissions
and administrative expenses borne by us, general economic trends and
competitive factors. We cannot predict or guarantee the level of future
interest rates. However, no Fixed Allocation will ever have a Guaranteed
Interest Rate of less than 3% per year.
While the foregoing generally describes our investment strategy with respect
to the Fixed Account, we are not obligated to invest according to any
particular strategy, except as may be required by Delaware and other state
insurance laws.
TRANSFERS FROM A FIXED ALLOCATION
You may transfer your Accumulation Value from a Fixed Allocation to one or
more new Fixed Allocations with new Guarantee Periods of any length offered by
us or to the Divisions of Account B or Account D. Unless you specify in
writing the Fixed Allocations from which such transfers will be made, we will
transfer amounts from the Fixed Allocations starting with the Guarantee Period
nearest its Maturity Date, until we have honored your transfer request.
Transfers from a Fixed Allocation made within 30 days prior to the Maturity
Date of the applicable Guarantee Period or pursuant to the dollar cost
averaging program will not be subject to a Market Value Adjustment. All other
transfers from your Fixed Allocations will be subject to a Market Value
Adjustment. The minimum amount that can be transferred to or from any Fixed
Allocation is $250. If a transfer request would reduce the Accumulation Value
remaining in your Fixed Allocation to less than $250, we will treat such
transfer request as a request to transfer the entire Accumulation Value in
such Fixed Allocation.
At the end of a Fixed Allocation's Guarantee Period, you may transfer amounts
in that Fixed Allocation to the Divisions and one or more new Fixed
Allocations with Guarantee Periods of any length then offered by us. You may
not, however, transfer amounts to any Fixed Allocation with a Guarantee Period
that extends beyond your Annuity Commencement Date.
At least 30 calendar days prior to a Maturity Date of any of your Fixed
Allocations, or earlier if required by state law, we will send you a notice of
the Guarantee Periods then available. Prior to the Maturity Date of your Fixed
Allocations you must notify us as to which Division or new Guarantee Period
you have selected. If timely instructions are not received, we will transfer
your Accumulation Value in the maturing Fixed Allocation to a Fixed Allocation
with a Guarantee Period equal in length to the expiring Guarantee Period. If
such Guarantee Period is not available or extends beyond your annuity
commencement date, we will transfer your Accumulation Value in the maturing
Fixed Allocation to the next shortest Guarantee Period which does not extend
beyond the Annuity Commencement Date. If no such Guarantee Period is
available, we will transfer your Accumulation Value to the Specially
Designated Division.
PARTIAL WITHDRAWALS FROM A FIXED ALLOCATION
Prior to the Annuity Commencement Date and while your Contract is in effect,
you may take partial withdrawals from the Accumulation Value in a Fixed
Allocation by sending satisfactory notice to our Customer Service Center. You
may make systematic withdrawals of interest earnings only from a Fixed
Allocation under our Systematic Partial Withdrawal Option. (See, Partial
Withdrawals, Systematic Partial Withdrawal Option.) Systematic withdrawals
from a Fixed Allocation are not permitted if such Fixed Allocation
participates in the dollar cost averaging program. Withdrawals from a Fixed
Allocation taken within 30 days prior to the Maturity Date and systematic
withdrawals are not subject to a Market Value Adjustment; however, a surrender
charge may be imposed. Withdrawals may have federal income tax consequences,
including a 10% penalty tax. See Surrender Charge, Surrender Charge for Excess
Partial Withdrawals and Federal Tax Considerations.
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FACTS ABOUT THE COMPANY AND THE ACCOUNTS (CONTINUED)
If you specify a Fixed Allocation from which your partial withdrawal will be
made, we will assess the partial withdrawal against that Fixed Allocation. If
you do not specify the investment option from which the partial withdrawal
will be taken, we will not assess your partial withdrawal against any Fixed
Allocations unless the partial withdrawal exceeds the Accumulation Value in
the Divisions of Account B and Account D. If there is no Accumulation Value in
those Divisions, partial withdrawals will be deducted from your Fixed
Allocations starting with the Guarantee Periods nearest their Maturity Dates
until we have honored your request.
MARKET VALUE ADJUSTMENT
We will apply a Market Value Adjustment, determined by application of the
formula described below, in the following circumstances: (i) whenever you make
a withdrawal or transfer from a Fixed Allocation, other than withdrawals or
transfers made within 30 days prior to the Maturity Date of the applicable
Guarantee Period, systematic partial withdrawals, or pursuant to the dollar
cost averaging program; and (ii) on the Annuity Commencement Date with respect
to any Fixed Allocation having a Guarantee Period that does not end on or
within 30 days after the annuity commencement date.
The Market Value Adjustment is determined by multiplying the amount withdrawn,
transferred or annuitized by the following factor:
<TABLE>
<C> <C> <S> <C>
( 1+I )N/365
1+J+.0025 -1
</TABLE>
Where "I" is the Index Rate for a Fixed Allocation as of the first day of the
applicable Guarantee Period; "J" is the Index Rate for new Fixed Allocations
with Guarantee Periods equal to the number of years (fractional years are
rounded up to the next full year except in Pennsylvania) remaining in the
Guarantee Period at the time of the withdrawal, transfer or annuitization; and
"N" is the remaining number of days in the Guarantee Period at the time of the
withdrawal, transfer or annuitization.
The Index Rate is the average of the Ask Yields for U.S. Treasury Strips as
reported by a national quoting service for the applicable maturity. The
average currently is based on the period from the 22nd day of the calendar
month two months prior to the calendar month of the Index Rate determination
to the 21st day of the calendar month immediately prior to the month of
determination. The applicable maturity is the maturity date for these U.S.
Treasury Strips on or next following the last day of the Guarantee Period. If
the Ask Yields are no longer available, the Index Rate will be determined
using a suitable replacement method approved where required.
We currently calculate the Index Rate once each calendar month. However, we
reserve the right to calculate the Index Rate more frequently than monthly,
but in no event will such Index Rate be based upon a period of less than 28
days.
The Market Value Adjustment may result in either an increase or decrease in
the Accumulation Value of your Fixed Allocation. If a full surrender, transfer
or annuitization from the Fixed Allocation has been requested, the balance of
the Market Value Adjustment will be added to or subtracted from the amount
surrendered, transferred or annuitized. If a partial withdrawal, transfer or
annuitization has been requested, the Market Value Adjustment will be
calculated on the total amount that must be withdrawn, transferred or
annuitized in order to provide the amount requested. If a negative Market
Value Adjustment exceeds the Accumulation Value in the Fixed Allocation, such
transaction will be considered a full surrender, transfer or annuitization.
The Appendix contains several examples which illustrate the application of the
Market Value Adjustment.
Because of the Market Value Adjustment provision of the Contract, you bear the
investment risk that the Guaranteed Interest Rates offered by us at the time
you make a withdrawal or transfer from a Fixed Allocation or start receiving
annuity payments may be higher or lower than the Guaranteed Interest Rate of
the Fixed Allocation to which the Market Value Adjustment is applied, with the
result that the Accumulation Value of your Fixed Allocation may be
substantially reduced or increased. This will depend on the relationship of
(1) the Guaranteed Interest Rate credited to the Fixed Allocation from which
the withdrawal, transfer or annuitization is made to (2) the current
Guaranteed Interest Rate offered by us for the Guarantee Period equal to the
number of years remaining in the Guarantee Period as of such date. If the
Guaranteed Interest Rate of (1) is higher than the then current Guaranteed
Interest Rate of (2) plus .0025, application of the Market Value Adjustment
will result in an increase in your Accumulation Value. If the Guaranteed
Interest Rate of (1) is lower than the then current Guaranteed Interest Rate
of (2) plus .0025, application of the Market Value Adjustment will result in a
decrease in your Accumulation Value.
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FACTS ABOUT THE CONTRACT
THE OWNER
You are the Owner. You are also the Annuitant unless another Annuitant is named
in the application or enrollment form. You have the rights and options described
in the Contract. One or more persons may own the Contract. If there are multiple
Owners named, the age of the oldest Owner shall determine the applicable death
benefit.
Death of an Owner activates the death benefit provision. In the case of a sole
Owner who dies prior to the annuity commencement date, we will pay the
Beneficiary the death benefit when due. The sole Owner's estate will be the
Beneficiary if no Beneficiary designation is in effect, or if the designated
Beneficiary has predeceased the Owner. In the case of a joint Owner of the
Contract dying prior to the annuity commencement date, we will designate the
surviving Owner(s) as the Beneficiary(ies). This supersedes any previous
Beneficiary designation.
In the case where the Owner is a trust and a beneficial Owner of the trust has
been designated, the beneficial Owner will be treated as the Owner of the
Contract solely for the purpose of determining the death benefit provisions. If
a beneficial Owner is changed or added after the Contract Date, this will be
treated as a change of Owner for purposes of determining the death benefit. See
Change of Owner or Beneficiary. If no beneficial Owner of the Trust has been
designated, the availability of enhanced death benefits will be determined by
the age of the Annuitant at issue.
THE ANNUITANT
The Annuitant is the person designated by the Owner to be the measuring life in
determining Annuity Payments. The Owner will receive the annuity benefits of the
Contract if the Annuitant is living on the Annuity Commencement Date. If the
Annuitant dies before the Annuity Commencement Date, and a contingent Annuitant
has been named, the contingent Annuitant becomes the Annuitant (unless the Owner
is not an individual, in which case the death benefit becomes payable). Once
named, the Annuitant may not be changed at any time.
If there is no contingent Annuitant when the Annuitant dies prior to the Annuity
Commencement Date, the Owner will become the Annuitant. The Owner may designate
a new Annuitant within 60 days of the death of the Annuitant.
If there is no contingent Annuitant when the Annuitant dies prior to the Annuity
Commencement Date and the Owner is not an individual, we will pay the
Beneficiary the death benefit then due. The Beneficiary will be as provided in
the Beneficiary designation then in effect. If no Beneficiary designation is in
effect, or if there is no designated Beneficiary living, the Owner will be the
Beneficiary. If the Annuitant was the sole Owner and there is no Beneficiary
designation, the Annuitant's estate will be the Beneficiary.
Regardless of whether a death benefit is payable, if the Annuitant dies and any
Owner is not an individual, such death will trigger application of the
distribution rules imposed by Federal tax law.
THE BENEFICIARY
The Beneficiary is the person to whom we pay death benefit proceeds and who
becomes the successor Owner if the Owner dies prior to the annuity commencement
date. We pay death benefit proceeds to the primary Beneficiary (unless there are
joint Owners, in which case death proceeds are payable to the surviving
Owner(s)). See Proceeds Payable to the Beneficiary.
If the Beneficiary dies before the Annuitant or Owner, the death benefit
proceeds are paid to the contingent Beneficiary, if any. If there is no
surviving Beneficiary, we pay the death benefit proceeds to the Owner's estate.
One or more persons may be named as Beneficiary or contingent Beneficiary. In
the case of more than one Beneficiary, unless otherwise specified, we will
assume any death benefit proceeds are to be paid in equal shares to the
surviving beneficiaries.
You have the right to change beneficiaries during the Annuitant's lifetime
unless you have designated an irrevocable Beneficiary. When an irrevocable
Beneficiary has been designated, you and the irrevocable Beneficiary may have to
act together to exercise certain rights and options under the Contract.
CHANGE OF OWNER OR BENEFICIARY
During the Annuitant's lifetime and while your Contract is in effect, you may
transfer ownership of the Contract (if purchased in connection with a
non-qualified plan) subject to our published rules at the time of the change. A
change in Ownership may affect the amount of the death benefit and the
guaranteed death benefit. You may also change the Beneficiary. To make either of
these changes, you must send us written notice of the change in a form
satisfactory to us. The change will take effect as of the day the notice is
signed. The change will not affect any payment made or action taken by us before
recording the change at our Customer Service Center. See Federal Tax
Considerations, Transfer of Annuity Contracts, and Assignments.
AVAILABILITY OF THE CONTRACT
We can issue a Contract if both the Annuitant and the Owner are not older than
age 85.
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FACTS ABOUT THE CONTRACT (CONTINUED)
TYPES OF CONTRACTS
QUALIFIED CONTRACTS
The Contract may be issued as an Individual Retirement Annuity or in
connection with an individual retirement account. In the latter case, the
Contract will be issued without an Individual Retirement Annuity endorsement,
and the rights of the participant under the Contract will be affected by the
terms and conditions of the particular individual retirement trust or
custodial account, and by provisions of the Code and the regulations
thereunder. For example, the individual retirement trust or custodial account
will impose minimum distribution rules, which may require distributions to
commence not later than April 1st of the calendar year following the calendar
year in which you attain age 70 1/2. For both Individual Retirement Annuities
and individual retirement accounts, the minimum Initial Premium is $1,500.
IF THE CONTRACT IS PURCHASED TO FUND A QUALIFIED PLAN, DISTRIBUTION MUST
COMMENCE NOT LATER THAN APRIL 1ST OF THE CALENDAR YEAR FOLLOWING THE CALENDAR
YEAR IN WHICH YOU ATTAIN AGE 70 1/2. IF YOU OWN MORE THAN ONE QUALIFIED PLAN,
YOU SHOULD CONSULT YOUR TAX ADVISOR.
NON-QUALIFIED CONTRACTS
The Contract may fund any non-qualified plan. Non-qualified Contracts do not
qualify for any tax-favored treatment other than the benefits provided for by
annuities.
YOUR RIGHT TO SELECT OR CHANGE CONTRACT OPTIONS
Before the Annuity Commencement Date, you may change the Annuity Commencement
Date, frequency of Annuity Payments or the Annuity Option by sending a written
request to our Customer Service Center. The Annuitant may not be changed at any
time.
PREMIUMS
You purchase the Contract with an Initial Premium. After the end of the Free
Look Period, you may make additional premium payments. See Making Additional
Premium Payments. The minimum Initial Premium is $10,000 for a non-qualified
Contract and $1,500 for a qualified Contract.
You must receive our prior approval before making a premium payment that causes
the Accumulation Value of all annuities that you maintain with us to exceed
$1,000,000. We may change the minimum initial or additional premium requirements
for certain group or sponsored arrangements. See Group or Sponsored
Arrangements.
QUALIFIED PLANS
For IRA Contracts, the annual premium on behalf of any individual Contract may
not exceed $2,000. Provided your spouse does not make a contribution to an
IRA, you may set up a spousal IRA even if your spouse has earned some
compensation during the year. The maximum deductible amount for a spousal IRA
program is the lesser of $2,250 or 100% of your compensation reduced by the
contribution (if any) made by you for the taxable year to your own IRA.
However, no more than $2,000 can go to either your or your spouse's IRA in any
one year. For example, $1,750 may go to your IRA and $500 to your spouse's
IRA. These maximums are not applicable if the premium is the result of a
rollover from another qualified plan.
WHERE TO MAKE PAYMENTS
Remit premium payments to our Customer Service Center. The address is shown on
the cover. We will send you a confirmation notice.
MAKING ADDITIONAL PREMIUM PAYMENTS
You may make additional premium payments after the end of the Free Look Period.
We can accept additional premium payments until either the Annuitant or Owner
reaches the Attained Age of 85 under non-qualified plans. For qualified plans,
no contributions may be made to an IRA Contract for the taxable year in which
you attain age 70 1/2 and thereafter (except for rollover contributions). The
minimum additional premium payment we will accept is $500 for a non-qualified
plan and $250 for a qualified plan.
CREDITING PREMIUM PAYMENTS
The Initial Premium will be accepted or rejected within two business days of
receipt by us if accompanied by information sufficient to permit us to determine
if we are able to issue a Contract. We may retain an Initial Premium for up to
five business days while attempting to obtain information sufficient to enable
us to issue the Contract. If we are unable to do so within five business days,
the applicant or enrollee will be informed of the reasons for the delay and the
Initial Premium will be returned immediately unless the applicant or enrollee
consents to our retaining the Initial Premium until we have received the
information we require. Thereafter, all additional premiums will be accepted on
the day received.
In certain states we will also accept, by agreement with broker-dealers,
transmittal of initial and additional premium payments by wire order from the
broker-dealer to our Customer Service Center. Such transmittals must be
accompanied by a simultaneous telephone facsimile or other electronic data
transmission containing the essential information we require to open an
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FACTS ABOUT THE CONTRACT (CONTINUED)
account and allocate the premium payment. Contact our Customer Service Center to
find out about state availability and broker-dealer requirements.
Upon our acceptance of premium payments received via wire order and accompanied
by sufficient electronically transmitted data, we will issue the Contract,
allocate the premium payment according to your instructions, and invest the
payment at the value next determined following receipt. See Restrictions on
Allocation of Premium Payments. Wire orders not accompanied by sufficient data
to enable us to accept the premium payment may be retained for up to five
business days while we attempt to obtain information sufficient to enable us to
issue the Contract. If we are unable to do so, our Customer Service Center will
inform the broker-dealer, on behalf of the applicant or enrollee, of the reasons
for the delay and return the premium payment immediately to the broker-dealer
for return to the applicant or enrollee, unless the applicant or enrollee
specifically consents to allow us to retain the premium payment until our
Customer Service Center receives the required information.
On the date we receive and accept your initial or additional premium payment:
(1) We allocate the Initial Premium among the
Divisions and Fixed Allocations according to your instructions, subject to any
restrictions. See Restrictions on Allocation of Premium Payments. For
additional premium payments, the Accumulation Value will increase by the
amount of the premium. If we do not receive instructions from you, the
increase in the Accumulation Value will be allocated among the Divisions in
proportion to the amount of Accumulation Value in each Division as of the
date we receive and accept the additional premium payment. If there is no
Accumulation Value in the Divisions, the increase in the Accumulation Value
will be allocated to a Fixed Allocation with the shortest Guarantee Period
then available.
(2) For an Initial Premium, we calculate your
applicable death benefit. When an additional premium payment is made, we
increase your applicable death benefit in accordance with the death benefit
option in effect for your Contract.
Following receipt and acceptance of the wire order and accompanying data, and
investment of the premium payment, we will follow one of the two procedures set
forth below. The one we follow is determined by state availability and the
procedures of the broker-dealer which submitted the wire order.
(1) We will issue the Contract. However, until we
have received and accepted a properly completed application or enrollment
form, we reserve the right to rescind the Contract. If the form is not
received within fifteen days of receipt of the premium payment, we will
refund the Accumulation Value plus any charges we deducted, and the Contract
will be voided. Some states require that we return the premium paid. In
these states, different rules will apply.
(2) Based on the information provided, we will issue
the Contract. We will mail the Contract to you, together with an Application
Acknowledgement Statement. You must execute the Application Acknowledgement
Statement and return it to us at our Customer Service Center. Until we
receive the executed Application Acknowledgement Statement, neither you nor
the broker-dealer may execute any financial transactions with respect to the
Contract unless such transactions are appropriately requested in writing by
you.
RESTRICTIONS ON ALLOCATION OF PREMIUM PAYMENTS
We may require that an Initial Premium designated for a Division of either
Account B or Account D be allocated to the Specially Designated Division during
the Free Look Period for Initial Premiums received from some states. After the
Free Look Period, if your Initial Premium was allocated to the Specially
Designated Division, we will transfer the Accumulation Value to the Divisions
you previously selected based on the index of investment experience next
computed for each Division. See Part I, Measurement of Investment Experience,
Index of Investment Experience and Unit Value. Initial premiums designated for
the Fixed Account will be allocated to a Fixed Allocation with the Guarantee
Period you have chosen.
EXCHANGE AND UPDATE PROGRAMS
We may offer two programs that allow you to elect to exchange or update a
contract that you currently own for GoldenSelect DVA PLUS. Our External Exchange
Program is available only where your current contract was issued by an insurance
company not affiliated with us. Our DVA Update Program is available only to
current owners of GoldenSelect DVA contracts issued by Golden American since May
1, 1991. The External Exchange Program and the DVA Update Program (together, the
"Programs") are described below. For a more complete description of the
Programs, including any restrictions and limits that may apply, please call our
Customer Service Center.
Both Programs are available through participating broker-dealers only where
permitted by applicable law and certain restrictions may apply. We reserve the
right to modify, suspend, or terminate either or both of the Programs at any
time or from time to time without notice. You should consult with your tax
advisor as to
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FACTS ABOUT THE CONTRACT (CONTINUED)
the tax consequences of participating in either of the Programs. See Federal Tax
Considerations. Different rules may apply in connection with qualified plans.
EXTERNAL EXCHANGE PROGRAM
When available, the External Exchange Program allows you to exchange contracts
issued by insurance companies not affiliated with us ("Exchange Contracts")
for GoldenSelect DVA PLUS. Under the External Exchange Program you may elect
to receive external exchange credits ("Credits") in an amount equal to any
surrender charge you pay, currently up to 5.00% (for issue ages 0-79) and
2.50% (for issue ages 80 and over) of the amount transferred to GoldenSelect
DVA PLUS. Such Credits are added to the amount applied from the Exchange
Contract with funds from our general account in a manner specified by our
rules. In effect, such Credits permit a Contract issued pursuant to the
External Exchange Program to have an Accumulation Value equal to that of the
Exchange Contract, subject to our current rules as to the amount and
availability of Credits. Credits are not considered premium for purposes of
calculating your guaranteed death benefit but will be treated as premium with
respect to all applicable fees, charges (including surrender charges), and
taxes. Credits added to the amount applied from the Exchange Contract will not
be returned to you if you surrender your Contract during the Free Look Period.
You should carefully evaluate whether the External Exchange Program benefits
you more than if you continue to hold your Exchange Contract. Factors to
consider include, but are not limited to: (a) the amount of surrender charges
under your Exchange Contract; (b) the time remaining under your Exchange
Contract during which surrender charges apply; (c) the on-going charges, if
any, under your Exchange Contract versus the on-going charges under our
Contract; (d) the surrender charges under our Contract; (e) the amount and
timing of any benefits under the External Exchange Program; (f) the
potentially greater cost to you if the surrender charge on our Contract or the
surrender charge on your Exchange Contract exceeds the benefits under the
External Exchange Program; and (g) the loss of tax benefits that are not
available to newly issued Contracts under the Federal tax laws.
DVA UPDATE PROGRAM
The DVA Update Program is available only to current owners of GoldenSelect
DVA. Under the DVA Update Program owners of existing GoldenSelect DVA
contracts issued by Golden American since May 1, 1991 may elect to update
their current contract to receive the additional benefits described below
contained in GoldenSelect DVA PLUS. Such benefits are only effective upon the
date your contract is modified and are not retroactive.
By electing to participate in the DVA Update Program you will receive the
following benefits offered by GoldenSelect DVA PLUS:
(1) your unaccrued Distribution Fee (annual sales
load) of 1.00% per year payable over six years will be eliminated;
(2) your current Administrative Charge of $40 will
be waived if your Accumulation Value equals or exceeds $100,000 at the end
of the contract year or once the sum of premiums paid equals or exceeds
$100,000;
(3) your current Excess Allocation Charge of $25
for each allocation change in excess of five per contact year is waived,
subject to our reserved right to charge $25 if more than 12 allocation
changes are made per contract year;
(4) your current Partial Withdrawal Charge of
2.0% of the amount withdrawn for each additional conventional partial
withdrawal after the first in a contract year up to $25 is eliminated; and
(5) you will be eligible for the waiver of surrender
charge described in this prospectus under caption, Charges and Fees,
Charges Deducted From Accumulation Value, Surrender Charge.
If you participate in the DVA Update Program your Separate Account Annual
Expenses will be adjusted based on your guaranteed death benefit. If your
current GoldenSelect DVA was issued to you with a death benefit that included a
guaranteed death benefit interest rate calculated at an annual rate of 7%, your
Mortality and Expense Risk Charge will be increased from 0.90% to 1.40% and your
Asset Based Administrative Charge will be increased from 0.10% to 0.15%. If your
current GoldenSelect DVA was issued without a guaranteed death benefit interest
rate, your Mortality and Expense Risk Charge will be increased from 0.90% to
1.10% and your Asset Based Administrative Charge will be increased from 0.10% to
0.15%.
Except as detailed in the two paragraphs above, all terms and conditions of your
GoldenSelect DVA remain in full force and effect, and you should refer to your
GoldenSelect DVA prospectus for a description of
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FACTS ABOUT THE CONTRACT (CONTINUED)
your contract. Additionally please note that your surrender charge schedule
remains the same and the issue date of your GoldenSelect DVA contract for
purposes of calculating any surrender charge is unchanged.
YOUR RIGHT TO REALLOCATE
You may reallocate your Accumulation Value among the Divisions and Fixed
Allocations at the end of the free look period. We currently do not assess a
charge for allocation changes made during a Contract Year. We reserve the right,
however, to assess a $25 charge for each allocation change after the twelfth
allocation change in a Contract Year. We require that each reallocation of your
Accumulation Value equal at least $250 or, if less, your entire Accumulation
Value within a Division or Fixed Allocation. We reserve the right to limit, upon
notice, the maximum number of reallocations you may make within a Contract Year.
In addition, we reserve the right to defer the reallocation privilege at any
time we are unable to purchase or redeem shares of The GCG Trust or Account D.
We also reserve the right to modify or terminate your right to reallocate your
Accumulation Value at any time in accordance with applicable law. Reallocations
from the Fixed Account are subject to the Market Value Adjustment unless taken
as part of the dollar cost averaging program or within 30 days prior to the
Maturity Date of the applicable Guarantee Period. To make a reallocation change,
you must provide us with satisfactory notice at our Customer Service Center.
We reserve the right to limit the number of reallocations of your Accumulation
Value among the Divisions and Fixed Allocations or refuse any reallocation
request if we believe that: (a) excessive trading by you or a specific
reallocation request may have a detrimental effect on unit values or the share
prices of the underlying Series; or (b) we are informed by The GCG Trust or
Account D that the purchase or redemption of shares is to be restricted because
of excessive trading or a specific reallocation or group of reallocations is
deemed to have a detrimental effect on share prices of The GCG Trust or Account
D.
Where permitted by law, we may accept your authorization of third party
reallocation on your behalf, subject to our rules. We may suspend or cancel such
acceptance at any time. We will notify you of any such suspension or
cancellation. We may restrict the Divisions and Fixed Allocations that will be
available to you for reallocations of premiums during any period in which you
authorize such third party to act on your behalf. We will give you prior
notification of any such restrictions. However, we will not enforce such
restrictions if we are provided evidence satisfactory to us that: (a) such third
party has been appointed by a court of competent jurisdiction to act on your
behalf; or (b) such third party has been appointed by you to act on your behalf
for all your financial affairs.
Some restrictions may apply based on the free look provisions of the state where
the Contract is issued. See Your Right to Cancel or Exchange Your Contract.
DOLLAR COST AVERAGING
If you have at least $10,000 of Accumulation Value in the Limited Maturity Bond
Division, the Liquid Asset Division or a Fixed Allocation with a one year
Guarantee Period, you may elect the dollar cost averaging program and have a
specified dollar amount transferred from those Divisions or such Fixed
Allocation on a monthly basis.
The main objective of dollar cost averaging is to attempt to shield your
investment from short term price fluctuations. Since the same dollar amount is
transferred to other Divisions each month, more units are purchased in a
Division if the value per unit is low and less units are purchased if the value
per unit is high.
Therefore, a lower than average value per unit may be achieved over the long
term. This plan of investing allows investors to take advantage of market
fluctuations but does not assure a profit or protect against a loss in declining
markets.
Dollar cost averaging may be elected at issue or at a later date. The minimum
amount that may be transferred each month is $250. The maximum amount which may
be transferred is equal to your Accumulation Value in the Limited Maturity Bond
Division, the Liquid Asset Division or a Fixed Allocation with a one year
Guarantee Period when you elect the dollar cost averaging program, divided by
12.
The transfer date will be the same calendar day each month as the Contract Date.
The dollar amount will be allocated to the Divisions in which you are invested
in proportion to your Accumulation Value in each Division unless you specify
otherwise. If, on any transfer date, your Accumulation Value is equal to or less
than the amount you have elected to have transferred, the entire amount will be
transferred and the program will end. You may change the transfer amount once
each Contract Year, or cancel this program by sending satisfactory notice to our
Customer Service Center at least seven days before the next transfer date. Any
allocation under this program will not be included in determining if the excess
allocation charge will apply. We currently do not permit transfers under the
dollar cost averaging program from Fixed Allocations with other than one year
Guarantee Periods. Transfers from a Fixed Allocation under the dollar cost
averaging program will not be subject to a Market Value
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FACTS ABOUT THE CONTRACT (CONTINUED)
Adjustment. See, Market Value Adjustment. A Fixed Allocation may not participate
simultaneously in both the dollar cost averaging program and the Systematic
Partial Withdrawal Option.
WHAT HAPPENS IF A DIVISION IS NOT AVAILABLE
When a distribution is made from an investment portfolio supporting a Division
of Account B or The Managed Global Account Division of Account D in which
reinvestment is not available, we will allocate the distribution, unless you
specify otherwise, to the Specially Designated Division.
Such a distribution can occur when (a) an investment portfolio matures, or (b) a
distribution from a portfolio or Division cannot be reinvested in the portfolio
or Division due to the unavailability of securities for acquisition. When an
investment portfolio matures, we will notify you in writing 30 days in advance
of that date. To elect an allocation of the distribution to other than the
Specially Designated Division, you must provide satisfactory notice to us at
least seven days prior to the date the portfolio matures. Such allocations are
not counted for purposes of the number of free allocation changes permitted.
When a distribution from a portfolio or Division cannot be reinvested in the
portfolio due to the unavailability of securities for acquisition, we will
notify you promptly after the allocation has occurred. If within 30 days you
allocate the Accumulation Value from the Specially Designated Division to other
Divisions or Fixed Allocations of your choice, such allocations will not be
included in determining if the excess allocation charge will apply.
YOUR ACCUMULATION VALUE
Your Accumulation Value is the sum of the amounts in each of the Divisions and
the Fixed Allocations in which you are invested, and is the amount available for
investment at any time. You select the Divisions and Fixed Allocations to which
to allocate your Accumulation Value. We adjust your Accumulation Value on each
Valuation Date to reflect the Divisions' investment performance and interest
credited to your Fixed Allocations, any additional premium payments or partial
withdrawals since the previous Valuation Date, and on each Contract processing
date to reflect any deduction of the annual Contract fee. Your Accumulation
Value is applied to your choice of an Annuity Option on the Annuity Commencement
Date subject to our published rules at such time. See Choosing an Income Plan.
ACCUMULATION VALUE IN EACH DIVISION
ON THE CONTRACT DATE
On the Contract Date, your Accumulation Value is allocated to each Division as
you have specified, unless the Contract is issued in a state that requires the
return of premium payments during the Free Look Period, in which case, the
portion of your Initial Premium not allocated to a Fixed Allocation will be
allocated to the Specially Designated Division during the Free Look Period.
See Your Right to Cancel or Exchange Your Contract.
ON EACH VALUATION DATE
At the end of each subsequent Valuation Period, the amount of Accumulation
Value in each Division will be calculated as follows:
(1) We take the Accumulation Value in the Division
at the end of the preceding Valuation Period.
(2) We multiply (1) by the Division's net rate of
return for the current Valuation Period.
(3) We add (1) and (2).
(4) We add to (3) any additional premium
payments allocated to the Division during the current Valuation Period.
(5) We add or subtract allocations to or from that
Division during the current Valuation Period.
(6) We subtract from (5) any partial withdrawals
and any associated charges allocated to that Division during the current
Valuation Period.
(7) We subtract from (6) the amounts allocated to
that Division for:
(a) any Contract fees; and
(b) any charge for premium taxes.
All amounts in (7) are allocated to each Division in the proportion that (6)
bears to the Accumulation Value in Account B and Account D, unless the Charge
Deduction Division has been specified. See Charges Deducted from the
Accumulation Value.
MEASUREMENT OF INVESTMENT EXPERIENCE
INDEX OF INVESTMENT EXPERIENCE
AND UNIT VALUE
The investment experience of a Division is determined on each Valuation Date.
We use an index to measure changes in each Division's experience during a
Valuation Period. We set the index at $10 when the first investments in a
Division are made. The index for a current Valuation Period equals the index
for the preceding Valuation Period multiplied by the experience factor for the
current Valuation Period.
We may express the value of amounts allocated to the Divisions in terms of
units. We determine the number of units for a given amount on a Valuation Date
by dividing the dollar value of that amount by
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FACTS ABOUT THE CONTRACT (CONTINUED)
the index of investment experience for that date. The index of investment
experience is equal to the value of a unit.
HOW WE DETERMINE THE EXPERIENCE FACTOR
For Divisions of Account B the experience factor reflects the investment
experience of the Series of the Trust in which a Division invests as well as
the charges assessed against the Division for a Valuation Period. The factor
is calculated as follows:
(1) We take the net asset value of the portfolio in
which the Division invests at the end of the current Valuation Period.
(2) We add to (1) the amount of any dividend or
capital gains distribution declared for the investment portfolio and
reinvested in such portfolio during the current Valuation Period. We
subtract from that amount a charge for our taxes, if any.
(3) We divide (2) by the net asset value of the
portfolio at the end of the preceding Valuation Period.
(4) We subtract the applicable daily mortality and
expense risk charge from each Division for each day in the valuation
period.
(5) We subtract the daily asset based
administrative charge from each Division for each day in the valuation period.
Calculations for Divisions investing in a Series are made on a per share
basis.
For the Global Account the experience factor reflects the investment
experience of the Global Account as well as the charges assessed against the
Global Account for a valuation period. The factor is calculated as follows:
(1) We take the value of the assets in the Global
Account at the end of the preceding Valuation Period.
(2) We add to (1) any investment income and
capital gains, realized or unrealized, credited to the assets during the current
Valuation Period.
(3) We subtract from (2) any capital losses, realized
or unrealized, charged against the assets during the current Valuation
Period.
(4) We subtract from (3) any amount charged
against the Global Account for any taxes.
(5) We divide (4) by the value of the assets in the
Global Account at the end of the preceding Valuation Period.
(6) We subtract from (5) the daily charge for
management and investment advice for each day in the valuation period.
(7) We subtract from (6) a daily charge for
estimated operating expenses for each day in the valuation period.
(8) We subtract from (7) the applicable daily charge
for mortality and expense risks for each day in the Valuation Period.
(9) We subtract from (8) the daily asset based
administrative charge for each day in the valuation period.
NET RATE OF RETURN FOR A DIVISION
The net rate of return for a Division during a valuation period is the
experience factor for that Valuation Period minus one.
CASH SURRENDER VALUE
Your Contract's Cash Surrender Value fluctuates daily with the investment
results of the Divisions, interest credited to Fixed Allocations and any Market
Value Adjustment. We do not guarantee any minimum Cash Surrender Value. On any
date before the Annuity Commencement Date while the Contract is in effect, the
cash surrender value is calculated as follows:
(1) We take the Contract's Accumulation Value;
(2) We deduct from (1) any surrender charge and
any charge for premium taxes;
(3) We deduct from (2) any charges incurred but
not yet deducted; and
(4) We adjust (3) for any Market Value Adjustment.
SURRENDERING TO RECEIVE THE CASH SURRENDER VALUE
The Contract may be surrendered by the Owner at any time while the Annuitant is
living and before the Annuity Commencement Date.
A surrender will be effective on the date your written request and the Contract
are received at our Customer Service Center. The Cash Surrender Value is
determined and all benefits under the Contract will then be terminated, as of
that date. You may receive the Cash Surrender Value in a single sum payment or
apply it under one or more Annuity Options. See The Annuity Options. We will
usually pay the Cash Surrender Value within seven days but we may delay payment.
See When We Make Payments.
PARTIAL WITHDRAWALS
Prior to the Annuity Commencement Date, while the Annuitant is living and the
Contract is in effect, you
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FACTS ABOUT THE CONTRACT (CONTINUED)
may take partial withdrawals from the Accumulation Value by sending satisfactory
notice to our Customer Service Center. Unless you specify otherwise, the amount
of the withdrawal, including any surrender charge and Market Value Adjustment,
will be taken in proportion to the amount of Accumulation Value in each Division
in which you are invested. If there is no Accumulation Value in those Divisions,
partial withdrawals will be deducted from your Fixed Allocations starting with
the Guarantee Periods nearest their Maturity Dates until we have honored your
request.
There are three options available for selecting partial withdrawals, the
Conventional Partial Withdrawal Option, the Systematic Partial Withdrawal Option
and the IRA Partial Withdrawal Option. All three options are described below.
The maximum amount you may withdraw each Contract Year without incurring a
surrender charge is 15% of your Accumulation Value. See Surrender Charge for
Excess Partial Withdrawals. Partial withdrawals may not be repaid. A partial
withdrawal request for an amount in excess of 90% of the Cash Surrender Value
will be treated as a request to surrender the Contract.
CONVENTIONAL PARTIAL WITHDRAWAL OPTION
After the Free Look Period, you may take conventional partial withdrawals. The
minimum amount you may withdraw under this option is $1,000. A conventional
partial withdrawal from a Fixed Allocation may be subject to a Market Value
Adjustment.
SYSTEMATIC PARTIAL WITHDRAWAL OPTION
This option may be elected at the time you apply for a Contract, or at a later
date. This option may be elected to commence in a Contract Year where a
conventional partial withdrawal has been taken. However, it may not be elected
while the IRA Partial Withdrawal Option is in effect.
You may choose to receive systematic partial withdrawals on a monthly or
quarterly basis from your Accumulation Value in the Divisions or the Fixed
Allocations. The commencement of payments under this option may not be elected
to start sooner than 28 days after the Contract Issue Date. You select the
date of the quarter or month when the withdrawals will be made but no later
than the 28th day of the month. If no date is selected, the withdrawals will
be made on the same calendar day of each month as the Contract Date.
You may select a dollar amount or a percentage of the Accumulation Value from
the Divisions in which you are invested as the amount of your withdrawal
subject to the following maximums, but in no event can a payment be less than
$100:
<TABLE>
<CAPTION>
FREQUENCY MAXIMUM PERCENTAGE
- ------------ -----------------------
<S> <C>
Monthly 1.25%
Quarterly 3.75%
</TABLE>
If a dollar amount is selected and the amount to be systematically withdrawn
would exceed the applicable maximum percentage of your Accumulation Value on
the withdrawal date, the amount withdrawn will be reduced so that it equals
such percentage. For example, if a $500 monthly withdrawal was elected and on
the withdrawal date 1.25% of the Accumulation Value equaled $300, the
withdrawal amount would be reduced to $300. If a percentage is selected and
the amount to be systematically withdrawn based on that percentage would be
less than the minimum of $100, we would increase the amount to $100 provided
it does not exceed the maximum percentage. If it is below the maximum
percentage we will send the minimum. If it is above the maximum percentage we
will send the amount and then cancel the option. For example, if you selected
1.0% to be systematically withdrawn on a monthly basis and that amount equaled
$90, and since $100 is less than 1.25% of the Accumulation Value, we would
send $100. If 1.0% equaled $75, and since $100 is more than 1.25% of the
Accumulation Value we would send $75 and then cancel the option. In such a
case, in order to receive systematic partial withdrawals in the future, you
would be required to submit a new notice to our Customer Service Center.
Systematic Partial Withdrawals from Fixed Allocations are limited to interest
earnings during the prior month or quarter, depending on whether you have
chosen a monthly or quarterly frequency, respectively. Systematic withdrawals
are not subject to a Market Value Adjustment. A Fixed Allocation, however, may
not participate simultaneously in both the dollar cost averaging program and
the Systematic Partial Withdrawal Option.
You may change the amount or percentage of your withdrawal once each Contract
Year or cancel this option at any time by sending satisfactory notice to our
Customer Service Center at least seven days prior to the next scheduled
withdrawal date. However, you may not change the amount or percentage of your
withdrawals in any Contract Year during which you have previously taken a
conventional partial withdrawal.
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FACTS ABOUT THE CONTRACT (CONTINUED)
IRA PARTIAL WITHDRAWAL OPTION
If you have an IRA Contract and will attain age 70 1/2 in the current calendar
year, distributions may be made to you to satisfy requirements imposed by
Federal tax law. IRA partial withdrawals provide payout of amounts required to
be distributed by the Internal Revenue Service rules governing mandatory
distributions under qualified plans. See Federal Tax Considerations. We will
send you a notice before your distributions commence, and you may elect this
option at that time, or at a later date. You may not elect IRA partial
withdrawals while the Systematic Partial Withdrawal Option is in effect. If
you do not elect the IRA Partial Withdrawal Option, and distributions are
required by Federal tax law, distributions adequate to satisfy the
requirements imposed by Federal tax law may be made. Thus, if the Systematic
Partial Withdrawal Option is in effect, distributions under that option must
be adequate to satisfy the mandatory distribution rules imposed by Federal tax
law.
You may choose to receive IRA partial withdrawals on a monthly, quarterly or
annual frequency. You select the day of the month when the withdrawals will be
made, but it cannot be later than the 28th day of the month. If no date is
selected, the withdrawals will be made on the same calendar day of the month
as the Contract Date.
At your request, we will determine the amount that is required to be withdrawn
from your Contract each year based on the information you give us and various
choices you make. For information regarding the calculation and choices you
have to make, see the Statement of Additional Information. The minimum dollar
amount you can withdraw is $100. At the time we determine the required partial
withdrawal amount for a taxable year based on the frequency you select, if
that amount is less than $100, we will pay $100. At any time where the partial
withdrawal amount is greater than the Accumulation Value, we will cancel the
Contract and send you the amount of the Cash Surrender Value.
You may change the payment frequency of your withdrawals once each Contract
Year or cancel this option at any time by sending us satisfactory notice to
our Customer Service Center at least seven days prior to the next scheduled
withdrawal date.
An IRA partial withdrawal in excess of the amount allowed under the Systematic
Partial Withdrawal Option may be subject to a Market Value Adjustment.
PARTIAL WITHDRAWALS IN GENERAL
CONSULT YOUR TAX ADVISOR REGARDING THE TAX CONSEQUENCES ASSOCIATED WITH TAKING
PARTIAL WITHDRAWALS. A partial withdrawal made before the taxpayer reaches age
59 1/2 may result in imposition of a tax penalty of 10% of the taxable portion
withdrawn. See Federal Tax Considerations for more details.
AUTOMATIC REBALANCING
If you have at least $10,000 of Accumulation Value invested in the Divisions,
you may elect to participate in our automatic rebalancing program. Automatic
rebalancing provides you with an easy way to maintain the particular asset
allocation that you and your financial advisor have determined are most suitable
for your individual long-term investment goals. We do not charge a fee for
participating in our automatic rebalancing program.
Under the program you may elect to have all your allocations among the Divisions
rebalanced on a quarterly, semi-annual, or annual calendar basis. The minimum
size of an allocation to a Division must be in full percentage points.
Rebalancing does not affect any amounts that you have allocated to the Fixed
Account. The program may be used in conjunction with the systematic partial
withdrawal option only where such withdrawals are taken pro rata. Automatic
rebalancing is not available if you participate in dollar cost averaging.
Automatic rebalancing will not take place during the free look period.
To participate in automatic rebalancing you must submit to our Customer Service
Center written notice in a form satisfactory to us. We will begin the program on
the last Valuation Date of the applicable calendar period in which we receive
the notice. You may cancel the program at any time. The program will
automatically terminate if you choose to reallocate your Accumulation Value
among the Divisions or if you make an additional premium payment or partial
withdrawal on other than a pro rata basis. Additional premium payments and
partial withdrawals effected on a pro rata basis will not cause the automatic
rebalancing program to terminate.
PROCEEDS PAYABLE TO THE BENEFICIARY
If the Owner or the Annuitant (when the Owner is other than an individual) dies
prior to the annuity commencement date, we will pay the Beneficiary the death
benefit proceeds under the Contract. Such amount may be received in a single sum
or applied to any of the Annuity Options. See The Annuity Options. If we do not
receive a request to apply the death benefit proceeds to an Annuity Option, a
single sum distribution will be made. Any distributions from non-qualified
Contracts must comply with applicable Federal tax law distribution requirements.
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FACTS ABOUT THE CONTRACT (CONTINUED)
DEATH BENEFIT OPTIONS
Subject to our rules, there are three death benefit options that may be elected
by you at issue under the Contract: the Standard Death Benefit Option; the 7%
Solution Enhanced Death Benefit Option; and the Annual Ratchet Enhanced Death
Benefit Option.
The 7% Solution enhanced Death Benefit Option may only be elected at issue and
only if the Owner or Annuitant (when the Owner is other than an individual) is
age 75 or younger at issue. The 7% Solution Enhanced Death Benefit Option may
not be available where a Contract is held by joint Owners. The Annual Ratchet
Enhanced Death Benefit Option may only be elected at issue and only if the Owner
or Annuitant (when the Owner is other than an individual) is age 79 or younger
at issue.
If an enhanced death benefit is elected, the death benefit under the Contract is
equal to the greatest of: (i) the Accumulation Value; (ii) total premium
payments less any partial withdrawals; (iii) the Cash Surrender Value; and (iv)
the enhanced death benefit (see below).
We may offer a reduced death benefit under certain group and sponsored
arrangements. See Part I, Group or Sponsored Arrangements.
STANDARD DEATH BENEFIT OPTION
You will automatically receive the Standard Death Benefit Option unless you
elect one of the enhanced death benefits. The Standard Death Benefit Option
for the Contract is equal to the greatest of: (i) your Accumulation Value;
(ii) total premiums less any partial withdrawals; and (iii) the Cash Surrender
Value.
7% SOLUTION ENHANCED DEATH BENEFIT OPTION
(1) We take the enhanced death benefit from the
prior Valuation Date. On the Contract Date, the enhanced death benefit is
equal to the Initial Premium.
(2) We calculate interest on (1) for the current
Valuation Period at THE ENHANCED DEATH BENEFIT INTEREST RATE, which rate is an
annual rate of 7%; except that with respect to amounts in the Liquid Asset
Division and Limited Maturity Bond Division, the interest rate applied to
such amounts will be the respective net rate of return for such Divisions
during the current Valuation Period, if it is less than an annual rate of
7%; and except with respect to amounts in a Fixed Allocation, the interest
rate applied to such amounts will be the interest credited to such Fixed
Allocation during the current Valuation Period, if it is less than an annual
rate of 7%.
Each accumulated initial or additional premium payment reduced by any
partial withdrawals (including any associated Market Value Adjustment and
surrender charge incurred) allocated to such premium will continue to grow
at the enhanced death benefit interest rate until reaching the maximum
enhanced death benefit. Such maximum enhanced death benefit is equal to two
times the initial or each additional premium paid, as reduced by partial
withdrawals. Each partial withdrawal reduces the maximum enhanced death
benefit as follows: first, the maximum enhanced death benefit is reduced by
the amount of any partial withdrawal of earnings; second, the maximum
enhanced death benefit is reduced in proportion to the reduction in the
Accumulation Value for any partial withdrawal of premium (in each case,
including any associated market value adjustment and surrender charge
incurred). To the extent that partial withdrawals in a Contract Year do not
exceed 7% of cumulative Premiums, and did not exceed 7% of cumulative
premiums in any prior Contract Year, such withdrawals will reduce the
maximum enhanced death benefit by the amount of such withdrawals.
(3) We add (1) and (2).
(4) We add to (3) any additional premiums paid
during the current Valuation Period.
(5) We subtract from (4) any partial withdrawals
(including any Market Value Adjustments and surrender charges incurred) made
during the current Valuation Period.
ANNUAL RATCHET ENHANCED DEATH BENEFIT OPTION
(1) We take the enhanced death benefit from the
prior Valuation Date. On the Contract Date, the enhanced death benefit is
equal to the Initial Premium.
(2) We add to (1) any additional premiums paid since
the prior Valuation Date and subtract from (1) any partial withdrawals
(including any Market Value Adjustments and surrender charges incurred)
taken since the prior Valuation Date.
(3) On a Valuation Date that occurs on or prior to the
Owner's Attained Age 80 which is also a Contract Anniversary, we set the
enhanced death benefit equal to the greater of (2) or the Accumulation Value
as of such date.
On all other Valuation Dates, the enhanced death benefit is equal to (2).
HOW TO CLAIM PAYMENTS TO BENEFICIARY
We must receive due proof of the death of the Owner or the Annuitant (if the
Owner is other than an
29
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FACTS ABOUT THE CONTRACT (CONTINUED)
individual) (such as an official death certificate) at our Customer Service
Center before we will make any payments to the Beneficiary. We will calculate
the death benefit as of the date we receive due proof of death. The
Beneficiary should contact our Customer Service Center for instructions.
REPORTS TO OWNERS
We will send you a report once each calendar quarter within 31 days after the
end of each calendar quarter. The report will show the Accumulation Value, the
Cash Surrender Value, and the death benefit as of the end of the calendar
quarter. The report will also show the allocation of your Accumulation Value as
of such date and the amounts deducted from or added to the Accumulation Value
since the last report. The report will also include any other information that
may be currently required by the insurance supervisory official of the
jurisdiction in which the Contract is delivered.
We will also send you copies of any shareholder reports of the portfolios or
securities in which Account B and Account D invest, as well as any other
reports, notices or documents required by law to be furnished to Owners.
WHEN WE MAKE PAYMENTS
We will generally pay death benefit proceeds and the cash surrender value within
seven days after our Customer Service Center receives all the information needed
to process the payment.
However, we may delay payment of amounts derived from the Divisions if it is not
practical for us to value or dispose of shares of Account B or Account D
because:
(1) The NYSE is closed for trading;
(2) The SEC determines that a state of emergency
exists;
(3) An order or pronouncement of the SEC permits a
delay for the protection of Owners; or,
(4) The check used to pay the premium has not
cleared through the banking system. This may take up to 15 days.
During such times, as to amounts allocated to the Divisions, we may delay:
(1) Determination and payment of any Cash
Surrender Value;
(2) Determination and payment of any death benefit
if death occurs before the Annuity Commencement Date;
(3) Allocation changes of the Accumulation Value; or,
(4) Application under an Annuity Option of the
Accumulation Value.
We reserve the right to delay payment of amounts from the Fixed Account for up
to six months.
CHARGES AND FEES
CHARGE DEDUCTION DIVISION
You may specify at issue if you wish to have all charges against the
Accumulation Value deducted from the Liquid Asset Division. We call this the
Charge Deduction Division Option, and within this context refer to the Liquid
Asset Division as the Charge Deduction Division. If you do not elect this
option, or if the amount of the charges is greater than the amount in the
Division, the charges will be deducted as discussed below. You may also choose
to elect or cancel this option while the Contract is in force by sending
satisfactory notice to our Customer Service Center.
CHARGES DEDUCTED FROM THE ACCUMULATION VALUE
We invest the entire amount of the initial and any additional premium payments
in the Divisions and the Fixed Allocations you select, subject to certain
restrictions. See Restrictions on Allocation of Premium Payments. We then may
deduct certain amounts from your Accumulation Value. We may reduce certain fees
and charges, including any surrender, administration, and mortality and expense
risk charges, under group or sponsored arrangements. See Group or Sponsored
Arrangements. Unless you have elected the Charge Deduction Division, charges are
deducted proportionately from all affected Divisions in which you are invested.
If there is no Accumulation Value in those Divisions, we will deduct charges
from your Fixed Allocations starting with the Guarantee Periods nearest their
Maturity Dates until such charges have been paid. The charges we deduct are:
SURRENDER CHARGE
A contingent deferred sales charge ("Surrender Charge") is imposed as a
percentage of each premium payment if the Contract is surrendered or an excess
partial withdrawal is taken during the seven year period from the date we
receive and accept such premium payment. The percentage of premium payments
deducted at the time of surrender
30
<PAGE>
CHARGES AND FEES (CONTINUED)
or excess partial withdrawal depends upon the number of complete years that
have elapsed since that premium payment was made. We determine the surrender
charge as a percentage of each premium payment as follows:]
<TABLE>
<CAPTION>
COMPLETE YEARS ELAPSED SURRENDER
SINCE PREMIUM PAYMENT CHARGE
- ----------------------------------------- -----------------
<S> <C>
0 7%
1 7%
2 6%
3 5%
4 4%
5 3%
6 1%
7+ 0%
</TABLE>
Subject to our rules and as described in the Contract, the surrender charge
arising from a surrender or excess partial withdrawal will be waived in the
following events:
(1) you begin receiving qualified extended medical
care on or after the first certificate anniversary for at least 45 days
during any continuous sixty-day period, and your request for the surrender
or withdrawal, together with all required proof of such qualified extended
medical care, must be received at our Customer Service Center during the
term of such care or within ninety days after the last day upon which you
received such care.
(2) you are first diagnosed by a qualifying medical
professional, on or after the first Certificate Anniversary, as having a
Qualifying Terminal Illness. Written proof of terminal illness,
satisfactory to us, must be received at our Customer Service Center. We
reserve the right to require an examination by a physician of our choice.
See your Contract for more information. The waiver of surrender charge may not
be available in all states.
SURRENDER CHARGE FOR EXCESS PARTIAL WITHDRAWALS
There is considered to be an excess partial withdrawal in any Contract Year in
which the amount withdrawn exceeds 15% of your Accumulation Value on the date
of the withdrawal minus any amount withdrawn during that Contract Year. Where
you are receiving systematic partial withdrawals, any combination of
conventional partial withdrawals taken and any systematic partial withdrawals
expected to be received in a Contract Year will be considered in determining
the amount of the excess partial withdrawal. Such a withdrawal will be
considered a partial surrender of the Contract and we will impose a surrender
charge and any associated premium tax. See Facts About the Contract, The Fixed
Account, Market Value Adjustment. Such charges will be deducted from the
Accumulation Value in proportion to the Accumulation Value in each Division or
Fixed Allocation from which the excess partial withdrawal was taken. In
instances where the excess partial withdrawal equals the entire Accumulation
Value in each such Division or Fixed Allocation, charges will be deducted
proportionately from all other Divisions and Fixed Allocations in which you
are invested.
For purposes of calculating the surrender charge for the excess partial
withdrawal, (i) we treat premium payments as being withdrawn on a first-in
first-out basis, and (ii) amounts withdrawn which are not considered an excess
partial withdrawal are not treated as a withdrawal of any premium payments.
Although we treat premium payments as being withdrawn before earnings for
purposes of calculating the surrender charge for excess partial withdrawals,
the Federal income tax law treats earnings as withdrawn first. See Federal Tax
Considerations, Taxation of Non-Qualified Annuities.
For example, the following assumes an Initial Premium payment of $10,000 and
additional premium payments of $10,000 in each of the second and third
Contract Years, for total premium payments under the Contract of $30,000. It
also assumes a partial withdrawal at the beginning of the fourth Contract Year
of 20% of the Accumulation Value of $35,000.
In this example, $5,250 ($35,000 x .15) is the maximum partial withdrawal that
may be withdrawn during the Contract Year without the imposition of a
surrender charge. The total partial withdrawal would be $7,000 ($35,000 x .2).
Therefore, $1,750 ($7,000 - $5,250) is considered an excess partial withdrawal
of a part of the Initial Premium payment of $10,000 and would be subject to a
5% surrender charge of $87.50 ($1,750 x .05). This example does not take into
account any Market Value Adjustment or deduction of any premium taxes.
PREMIUM TAXES
We make a charge for state and local premium taxes in certain states which can
range from 0% to 3.5% of premium. The charge depends on the Owner's state of
residence. We reserve the right to change this amount to conform with changes
in the law or if the Owner changes state of residence.
Premium taxes are generally incurred on the annuity commencement date and a
charge for such premium taxes is then deducted from your Accumulation Value on
such date. However, some jurisdictions impose a premium tax at the time that
initial and additional premiums are paid, regardless of the Annuity
Commencement Date. In those states we may initially defer collection of the
amount of the charge for premium taxes from your
31
<PAGE>
CHARGES AND FEES (CONTINUED)
Accumulation Value and deduct it against Accumulation Value on surrender of
the Contract, excess partial withdrawals or on the Annuity Commencement Date.
ADMINISTRATIVE CHARGE
The administrative charge is incurred at the beginning of the Contract
processing period and deducted at the end of each Contract processing period.
We deduct this charge when determining the Cash Surrender Value payable if you
surrender the Contract prior to the end of a Contract processing period. If
the Accumulation Value at the end of the Contract processing period equals or
exceeds $100,000 or the sum of the premiums paid equals or exceeds $100,000,
the charge is zero. Otherwise, the amount deducted is $40 per Contract Year.
This charge is to cover a portion of our administrative expenses. See ASSET
BASED ADMINISTRATIVE CHARGE, below.
EXCESS ALLOCATION CHARGE
We currently do not assess a charge for allocation changes made during a
Contract Year. We reserve the right, however, to assess a $25 charge for each
allocation change after the twelfth allocation change in a Contract Year. This
amount represents the maximum we will charge. The charge would be deducted
from the Divisions and the Fixed Allocations from which each such reallocation
is made in proportion to the amount being transferred from each such Division
and Fixed Allocation unless you have chosen to use the Charge Deduction
Division. The excess allocation charge is set at a level that is not designed
to produce profit for Golden American or any affiliate. Any allocations or
transfers due to the election of dollar cost averaging and reallocation under
the provision WHAT HAPPENS IF A DIVISION IS NOT AVAILABLE will not be included
in determining if the excess allocation charge should apply.
CHARGES DEDUCTED FROM THE DIVISIONS
MORTALITY AND EXPENSE RISK CHARGE
The amount of the mortality and expense risk charge depends on the death
benefit option that has been elected. If the Standard Death Benefit Option is
elected, the charge is equivalent, on an annual basis, to 1.10% of the assets
in each Division. The charge is deducted on each Valuation Date at the rate of
.003030% for each day in the Valuation Period. Approximately .75% is allocated
to the mortality risk and .35% is allocated to the expense risk. If an
enhanced death benefit is elected, the charge is equivalent, on an annual
basis, to 1.25% for the Annual Ratchet Death Benefit Option, or 1.40% for the
7% Solution Death Benefit Option, of the assets in each Division. The charge
is deducted on each Valuation Date at the rate of .003446% or .003863%,
respectively, for each day in the Valuation Period. For the Annual Ratchet
approximately .90%, or for the 7% Solution approximately 1.05%, is allocated
to the mortality risk.
This charge will compensate us for mortality and expense risks we assume under
the Contract. We will realize a gain from this charge to the extent it is not
needed to provide for benefits and expenses under the Contract. We will use
any gain for any lawful purpose including any shortfalls on paying
distribution expenses.
The mortality risk assumed is the risk that Annuitants as a group will live
for a longer time than our actuarial tables predict. As a result, we would be
paying more in annuity income than we planned. Golden American also assumes a
risk under the Contract for paying a guaranteed death benefit.
The expense risk assumed is the risk that it will cost us more to issue and
administer the Contract than we expect.
ASSET BASED ADMINISTRATIVE CHARGE
We will deduct a daily charge from the assets in each Division, to compensate
us for a portion of the administrative expenses under the Contract. The daily
charge is at a rate of 0.000411% (equivalent to an annual rate of 0.15%) on
the assets in each Division.
This asset based administrative charge plus the administrative charge above
will not exceed the cost of the services to be provided over the life of the
Contract.
TRUST EXPENSES
There are fees and charges deducted from each Series. Please read the Trust
prospectus for details.
OPERATING EXPENSES OF ACCOUNT D
There are additional fees and charges to the Global Account in Account D for
management and advisory services as well as other operational expenses of the
Global Account. DSI as the Manager of Account D receives a monthly fee equal to
an annual rate based upon the following percentages of the Global Account's
average daily net assets: 0.40% of the first $500 million and 0.30% of the
amount over $500 million. Warburg, Pincus as the Portfolio Manager receives a
monthly fee equal to an annual rate based upon the following percentages of the
Global Account's average daily net assets: 0.60% of the first
32
<PAGE>
CHARGES AND FEES (CONTINUED)
$500 million and 0.50% of the amount over $500 million. The total fees for
management and advisory services exceed the fees for similar services paid by
some other registered investment companies with similar objectives.
The Global Account bears the expenses of its investment management operations,
including expenses associated with custody of securities, portfolio accounting,
the Board of Governors, and legal and auditing services.
The initial organizational expenses of the Global Account were advanced by
Golden American. The Global Account reimburses Golden American for such
expenses, which are amortized over five years from the date of the Global
Account's commencement of operations.
The Global Account and DSI have agreed to limit the total expenses of the Global
Account. See Part I, The Managed Global Account of Account D.
CHOOSING YOUR ANNUITIZATION OPTIONS
ANNUITIZATION OF YOUR CONTRACT
If the Annuitant and Owner are living on the Annuity Commencement Date, we will
begin making payments to the Owner under an income plan. We will make these
payments under the Annuity Option chosen. You may change an Annuity Option by
making a written request to us at least 30 days prior to the Annuity
Commencement Date of the Contract. The amount of the payments will be determined
by applying your Accumulation Value adjusted for any applicable Market Value
Adjustment on the Annuity Commencement Date in accordance with The Annuity
Options section below, subject to our published rules at such time. See When We
Make Payments.
You may also elect an Annuity Option on surrender of the Contract for its Cash
Surrender Value or you may choose one or more Annuity Options for the payment of
death benefit proceeds while it is in effect and before the Annuity Commencement
Date. If, at the time of the Owner's death or the Annuitant's death (if the
Owner is not an individual), no option has been chosen for paying death benefit
proceeds, the Beneficiary may choose an option within 60 days. In all events,
payments of death benefit proceeds must comply with the distribution
requirements of applicable Federal tax law.
The minimum monthly annuity income payment that we will make is $20. We may
require that a single sum payment be made if the Accumulation Value is less than
$2,000 or if the calculated monthly annuity income payment is less than $20.
For each option we will issue a separate written agreement putting the option
into effect. Before we pay any annuity benefits, we require the return of the
Contract. If your Contract has been lost, we will require that you complete and
return the applicable Contract form. Various factors will affect the level of
annuity benefits including the Annuity Option chosen, the applicable payment
rate used and the investment results of the Divisions and interest credited to
the Fixed Allocations in which the Accumulation Value has been invested.
Some annuity options may provide only for fixed payments. Fixed Annuity Payments
are regular payments, the amount of which is fixed and guaranteed by us. The
amount of the payments will depend only on the form and duration of payments
chosen, the age of the Annuitant or Beneficiary (and sex, where appropriate),
the total Accumulation Value applied to purchase the fixed option, and the
applicable payment rate.
Our approval is needed for any option where:
(1) The person named to receive payment is other
than the Owner or Beneficiary;
(2) The person named is not a natural person, such as
a corporation; or
(3) Any income payment would be less than the
minimum annuity income payment allowed.
ANNUITY COMMENCEMENT DATE SELECTION
You select the Annuity Commencement Date. You may select any date following the
third Contract Anniversary but before the Contract Processing Date in the month
following the Annuitant's 90th birthday. If, on the Annuity Commencement Date, a
Surrender Charge remains, the elected Annuity Option must include a period
certain of at least five years duration. If you do not select a date, the
annuity commencement date will be in the month following the Annuitant's 90th
birthday. However, in the state of Pennsylvania the annuity commencement date
may not be later than in the month following the Annuitant's 85th birthday for
Annuitants with an Issue Age of 80 and under. If the Annuity Commencement Date
occurs when the Annuitant is at an advanced age, such as over age 85, it is
possible that the Contract will not be considered an annuity for Federal tax
purposes. See Federal Tax Considerations. For a Contract purchased in connection
with a qualified plan, distribution must
33
<PAGE>
CHOOSING YOUR ANNUITIZATION OPTIONS (CONTINUED)
commence not later than April 1st of the calendar year following the calendar
year in which you attain age 70 1/2. Consult your tax advisor.
FREQUENCY SELECTION
You choose the frequency of the Annuity Payments. They may be monthly,
quarterly, semi-annually or annually. If we do not receive written notice from
you, the payments will be made monthly. There may be certain restrictions on
minimum payments that we will allow.
THE ANNUITIZATION OPTIONS
There are four options to choose from as shown below. Options 1 through 3 are
fixed and option 4 may be fixed or variable. For a fixed option, the
Accumulation Value in the Divisions is transferred to the general account.
OPTION 1. INCOME FOR A FIXED PERIOD
Payment is made in equal installments for a fixed number of years based on the
Accumulation Value as of the annuity commencement date. We guarantee that each
monthly payment will be at least the amount set forth in the Contract.
Guaranteed amounts for annual, semi-annual and quarterly payments are
available upon request. Illustrations are available upon request. If the Cash
Surrender Value or Accumulation Value is applied under this option, a 10%
penalty tax may apply to the taxable portion of each income payment until the
Owner reaches age 59 1/2.
OPTION 2. INCOME FOR LIFE
Payment is made in equal monthly installments and guaranteed for at least a
period certain. The period certain can be 10 or 20 years. Other periods
certain may be available on request. A refund certain may be chosen instead.
Under this arrangement, income is guaranteed until payments equal the amount
applied. If the person named lives beyond the guaranteed period, payments
continue until his or her death. We guarantee that each payment will be at
least the amount set forth in the Contract corresponding to the person's age
on his or her last birthday before the option's effective date. Amounts for
ages not shown in the Contract are available upon request.
OPTION 3. JOINT LIFE INCOME
This option is available if there are two persons named to receive payments.
At least one of the persons named must be either the Owner or Beneficiary of
the Contract. Monthly payments are guaranteed and are made as long as at least
one of the named persons is living. There is no minimum number of payments.
Monthly payment amounts are available upon request.
OPTION 4. ANNUITY PLAN
An amount can be used to buy any single premium annuity we offer on the
option's effective date.
PAYMENT WHEN NAMED PERSON DIES
When the person named to receive payment dies, we will pay any amounts still due
as provided by the option agreement. The amounts still due are determined as
follows:
(1) For option 1, or any remaining guaranteed
payments under option 2, payments will be continued. Under options 1 and 2, the
discounted values of the remaining guaranteed payments may be paid in a
single sum. This means we deduct the amount of the interest each remaining
guaranteed payment would have earned had it not been paid out early. The
discount interest rate is never less than 3% for option 1 and 3.50% for
option 2 per year. We will, however, base the discount interest rate on the
interest rate used to calculate the payments for options 1 and 2 if such
payments were not based on the tables in the Contract.
(2) For option 3, no amounts are payable after both
named persons have died.
(3) For option 4, the annuity agreement will state the
amount due, if any.
OTHER CONTRACT PROVISIONS
IN CASE OF ERRORS IN APPLICATION INFORMATION
If an age or sex given in the application or enrollment form is misstated, the
amounts payable or benefits provided by the Contract shall be those that the
premium payment would have bought at the correct age or sex.
SENDING NOTICE TO US
Any written notices, inquiries or requests should be sent to our Customer
Service Center. Please include your name, your Contract number and, if you are
not the Annuitant, the name of the Annuitant.
ASSIGNING THE CONTRACT AS COLLATERAL
You may assign a non-qualified Contract as collateral security for a loan or
other obligation. This does not change the Ownership. However, your rights and
any Beneficiary's rights are subject to the terms
34
<PAGE>
OTHER CONTRACT PROVISIONS (CONTINUED)
of the assignment. See Transfer of Annuity Contracts, and Assignments. An
assignment may have Federal tax consequences. See Federal Tax Considerations.
You must give us satisfactory written notice at our Customer Service Center in
order to make or release an assignment. We are not responsible for the
validity of any assignment.
NON-PARTICIPATING
The Contract does not participate in the divisible surplus of Golden American.
AUTHORITY TO MAKE AGREEMENTS
All agreements made by us must be signed by our president or a vice president
and by our secretary or an assistant secretary. No other person, including an
insurance agent or broker, can change any of the Contract's terms, make any
agreements binding on us or extend the time for premium payments.
CONTRACT CHANGES -- APPLICABLE TAX LAW
We reserve the right to make changes in the Contract to the extent we deem it
necessary to continue to qualify the Contract as an annuity. Any such changes
will apply uniformly to all Contracts that are affected. You will be given
advance written notice of such changes.
YOUR RIGHT TO CANCEL OR EXCHANGE YOUR CONTRACT
CANCELLING YOUR CONTRACT
You may cancel your Contract within your Free Look Period, which is ten days
after you receive your Contract. For purposes of administering our allocation
and administrative rules, we deem this period to expire 15 days after the
Contract is mailed to you. Some states may require a longer Free Look Period.
If you decide to cancel, you may mail or deliver the Contract to our Customer
Service Center. We will refund the Accumulation Value plus any charges we
deducted, and the Contract will be voided as of the date we receive the
Contract and your request. Some states require that we return the premium
paid. In these states, we require your premiums designated for investment in
the Divisions of Account B and Account D be allocated to the Specially
Designated Division during the Free Look Period. Premiums designated for the
Fixed Account will be allocated to a Fixed Allocation with the Guarantee
Period you have chosen. If you do not choose to exercise your right to cancel
during the Free Look Period, then at the end of the Free Look Period your
money will be invested in the Divisions chosen by you, based on the index of
investment experience next computed for each Division. See Measurement of
Investment Experience, INDEX OF EXPERIENCE AND UNIT VALUE.
EXCHANGING YOUR CONTRACT
For information regarding Section1035 exchanges, see Federal Tax
Considerations.
OTHER CONTRACT CHANGES
You may change the Contract to another annuity plan subject to our rules at the
time of the change.
GROUP OR SPONSORED ARRANGEMENTS
For certain group or sponsored arrangements, we may reduce any surrender,
administration, and mortality and expense risk charges. We may also change the
minimum initial and additional premium requirements, or offer a reduced death
benefit. Group arrangements include those in which a trustee or an employer, for
example, purchases Contracts covering a group of individuals on a group basis.
Sponsored arrangements include those in which an employer allows us to sell
Contracts to its employees on an individual basis.
Our costs for sales, administration, and mortality generally vary with the size
and stability of the group among other factors. We take all these factors into
account when reducing charges. To qualify for reduced charges, a group or
sponsored arrangement must meet certain requirements, including our requirements
for size and number of years in existence. Group or sponsored arrangements that
have been set up solely to buy Contracts or that have been in existence less
than six months will not qualify for reduced charges.
We will make these and any similar reductions according to our rules in effect
when an application or enrollment form for a Contract is approved. We may change
these rules from time to time. Any variation in the administrative charge will
reflect differences in costs or services and will not be unfairly
discriminatory.
SELLING THE CONTRACT
DSI is also principal underwriter and distributor of the Contract as well as for
other Contracts issued through Account B and Account D and other separate
accounts of Golden American. We pay DSI for acting as principal underwriter
under a distribution agreement. The offering of the Contract will be continuous.
DSI has entered into and will continue to enter into sales agreements with
broker-dealers to solicit for the sale of the Contract through registered
representatives who are licensed to sell securities and variable insurance
products including variable annuities.
35
<PAGE>
OTHER CONTRACT PROVISIONS (CONTINUED)
These agreements provide that applications for Contracts may be solicited by
registered representatives of the broker-dealers appointed by Golden American to
sell its variable life insurance and variable annuities. These broker-dealers
are registered with the SEC and are members of the National Association of
Securities Dealers, Inc. ("NASD"). The registered representatives are authorized
under applicable state regulations to sell variable life insurance and variable
annuities. The writing agent will receive commissions of up to 6.0% of any
initial or additional premium payments made.
REGULATORY INFORMATION
VOTING RIGHTS
ACCOUNT B
We will vote the shares of the Trust owned by Account B according to your
instructions. However, if the Investment Company Act of 1940 or any related
regulations should change, or if interpretations of it or related regulations
should change, and we decide that we are permitted to vote the shares of the
Trust in our own right, we may decide to do so.
We determine the number of shares that you have in a Division by dividing the
Contract's Accumulation Value in that Division by the net asset value of one
share of the portfolio in which a Division invests. Fractional votes will be
counted. We will determine the number of shares you can instruct us to vote
180 days or less before the Trust's meeting. We will ask you for voting
instructions by mail at least 10 days before the meeting.
If we do not get your instructions in time, we will vote the shares in the
same proportion as the instructions received from all Contracts in that
Division.We will also vote shares we hold in Account B which are not
attributable to Owners in the same proportion.
ACCOUNT D
Owners with Accumulation Value in the Global Account have certain voting
rights. Each such Owner will be given one vote for every $1.00 of Accumulation
Value in the Global Account with fractional interests counted, unless a
different allocation of voting rights is required under applicable law for an
investment medium for variable annuity Contracts. Account D's rules do not
require Account D to hold annual meetings of Owners of interests in Account D,
although special meetings may be called for Account D for purposes such as
electing or removing members of the Board of Governors, changing fundamental
policies, or approving a Contract for investment advisory services. When
required, "the vote of a majority of the outstanding voting securities" of the
Global Account of Account D means the lesser of:
(1) The holders of more than 50% of all votes
entitled to be cast in respect to Account D; or,
(2) The holders of at least 67% of the votes which
are present at a meeting of such persons are the holders of more than 50%
of all votes entitled to be cast in respect to Account D are present or
represented by proxy.
We will determine the number of votes you can instruct us to vote 90 days or
less before Account D's meeting. We will ask you for voting instructions by mail
at least 14 days before the meeting.
STATE REGULATION
We are regulated and supervised by the Insurance Department of the State of
Delaware, which periodically examines our financial condition and operations. We
are also subject to the insurance laws and regulations of all jurisdictions
where we do business. The variable Contract offered by this prospectus has been
approved by the Insurance Department of the State of Delaware and by the
Insurance Departments of other jurisdictions. We are required to submit annual
statements of our operations, including financial statements, to the Insurance
Departments of the various jurisdictions in which we do business to determine
solvency and compliance with state insurance laws and regulations.
LEGAL PROCEEDINGS
Golden American, as an insurance company, is ordinarily involved in litigation.
We do not believe that any current litigation is material and we do not expect
to incur significant losses from such actions.
LEGAL MATTERS
The legal validity of the Contract described in this prospectus has been passed
on by Myles R. Tashman, Esquire, Executive Vice President and Secretary of
Golden American. Sutherland, Asbill & Brennan of Washington, D.C. has provided
advice on certain matters relating to Federal securities laws.
EXPERTS
The audited financial statements of Golden American Life Insurance Company,
Separate Account B and The Managed Global Account of Separate Account D
appearing or incorporated by reference in the Statement of Additional
Information and Registration Statement have been audited by Ernst & Young LLP,
independent auditors, as set forth in their reports thereon appearing
36
<PAGE>
or incorporated by reference in the Statement of Additional Information and in
the Registration Statement and are included or incorporated by reference in
reliance upon such reports given upon the authority of such firm as experts in
accounting and auditing.
MORE INFORMATION ABOUT GOLDEN AMERICAN LIFE INSURANCE COMPANY
SELECTED FINANCIAL DATA
The following selected financial data prepared in accordance with generally
accepted accounting principles ("GAAP") for Golden American should be read in
conjunction with the financial statements and notes thereto included in this
Prospectus.
<TABLE>
<CAPTION>
SELECTED GAAP FINANCIAL DATA
(IN THOUSANDS)
--------------------------------------------
FOR THE FISCAL YEARS ENDED DECEMBER 31
--------------------------------------------
1995 1994 1993 1992(A)
---------- ---------- --------- ---------
<S> <C> <C> <C> <C>
Variable Life and Annuity Product Fees and Policy Changes..................... $ 18,388 $ 17,519 $ 10,192 $ 694
Net Income before Federal Income Tax.......................................... $ 3,364 $ 2,222 $ (1,793) $ (508)
Net Income (Loss)............................................................. $ 3,364 $ 2,222 $ (1,793) $ (508)
Total Assets.................................................................. $1,197,688 $1,044,760 $ 886,155 $ 320,539
Total Liabilities............................................................. $1,099,563 $ 955,254 $ 857,558 $ 306,197
Total Stockholder's Equity.................................................... $ 98,125 $ 89,506 $ 28,597 $ 14,342
</TABLE>
(a) Results for 1992 are for the period September 30, 1992 (date of
acquisition) to December 31, 1992.
The following selected financial data was prepared on the basis of statutory
accounting practices ("SAP"), which have been prescribed or permitted by the
Department of Insurance of the State of Delaware and the National Association of
Insurance Commissioners. These practices differ in certain respects from GAAP.
<TABLE>
<CAPTION>
SELECTED STATUTORY FINANCIAL DATA
(IN THOUSANDS)
------------------------------------------------------
FOR THE FISCAL YEARS ENDED DECEMBER 31
------------------------------------------------------
1995 1994 1993 1992 1991
---------- --------- --------- --------- ---------
<S> <C> <C> <C> <C> <C>
Premiums & Annuity Considerations.................................... $ 124,687 $ 294,550 $ 505,465 $ 191,039 $ 41,615
Net Income before Federal Income Tax................................. $ (4,117) $ (11,260) $ (9,417) $ (4,225) $ (2,086)
Net Income (Loss).................................................... $ (4,117) $ (11,260) $ (9,401) $ (3,986) $ (1,752)
Total Assets......................................................... $1,124,840 $ 988,180 $ 834,123 $ 302,200 $ 119,652
Total Liabilities.................................................... $1,058,483 $ 921,888 $ 815,301 $ 289,995 $ 106,199
Total Capital & Surplus.............................................. $ 66,357 $ 66,292 $ 18,822 $ 12,205 $ 13,453
</TABLE>
MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF
OPERATIONS
This Management's Discussion and Analysis of Financial Condition and Results of
Operations should be read in conjunction with the Financial Statements and Notes
to Financial Statements included herein.
BUSINESS ENVIRONMENT
The current business and regulatory environment remains challenging for the
insurance industry. Increasing competition from traditional insurance carriers
as well as banks and mutual fund companies means that investors have many more
choices. However, overall demand for variable annuity product remains strong
for several reasons: (1) dynamic stock market performance over the last 3
years; (2) relatively low interest rates; and (3) baby boomers reaching ages
where they are beginning to put aside large amounts for retirement.
In 1995 Golden American experienced a significant decline in sales, due to a
number of factors. First, some portfolio managers performed poorly in 1993 and
1994. Second, as more products came to market the cost structure of the DVA
product became less competitive. Third, because no fixed interest rate options
were available in 1994 during a time of rising interest rates and flat or
declining equity markets, market share was lost. Consequently, the Company
took steps to respond to these business challenges. Several portfolio managers
were replaced and new funds were added to give contractholders more options.
In October of 1995, the Company introduced the Combination Deferred Variable
and Fixed Annuity (GoldenSelect DVA PLUS) and the GoldenSelect Genesis I and
Genesis Flex life insurance products. These actions have proven successful, as
these new products generated higher sales since their introduction, a trend
which management expects will continue in 1996.
RESULTS OF OPERATIONS
1995 COMPARED TO 1994
Net income for 1995 was $3.4 million, an increase of $1.1 million or 51%
from 1994.
Variable life and annuity product fees and policy charges were $18.4 million
in 1995, an increase of
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$0.9 million or 5% from 1994. This increase is due to an additional $0.9
million in fees earned from the increasing block of business under
management in the Separate Accounts, an increase of $1.5 million in the
collection of surrender charges, and a decrease of $1.5 million in the
revenue recognition of net distribution fees.
Net investment income was $2.8 million for 1995, an increase of $2.3 million
or 403% over the comparable 1994 period. Approximately $1.5 million of the
increase was due to the additional investment income earned on invested
assets held to back the fixed interest divisions that were introduced in
1995. The balance of the increase in investment income is attributable to an
increase in the investment income on surplus.
In 1995, the service agreement between DSI and Golden American was amended
to provide for a management fee from DSI to Golden American for certain
managerial and supervisory services provided by Golden American. This fee,
calculated as a percentage of average assets in the variable separate
accounts, was $1.0 million for 1995.
Policy benefits were $3.2 million for 1995, an increase of $3.1 million from
1994. In 1995, benefit expenses increased $1.3 million as a result of
interest credited to policyholders related to the fixed interest divisions
introduced in 1995. Additionally, death benefit costs net of reinsurance
increased by $.3 million in 1995 as compared to 1994. Additionally, 1994
policy benefits reflected a $1.5 million decrease in mortality reserves.
Commissions and overrides were $7.7 million in 1995, a decrease of $9.1
million or 54% from 1994. The decrease in commissions resulted from the
decrease in new business premium receipts which went from $310.7 million in
1994 to $130.5 million in 1995, a decrease of 55%.
Employee related expenses and general administrative and operating expenses
were a combined $13.7 million for 1995, an increase of $.3 million or 2.5%
from 1994.
Interest expense was $0 for 1995 as compared to $2.0 million in 1994. The
elimination of interest expense in 1995 resulted from the retirement of the
Company's debt in December 1994 with the proceeds from the issuance of
preferred stock. In 1995, the Company paid dividends on preferred stock of
$3.4 million. There were no preferred stock dividends in 1994.
Amortization of intangible assets, deferred policy acquisition costs and
unamortized cost assigned to insurance contracts in force, was $4.3 million
for 1995, a decrease of $2.5 million or 37% from the prior year. The
intangible assets are being amortized over the lives of the policies in
relation to the present value of estimated future gross profits. The
relatively strong performance of the funds in 1995 has slowed the
amortization in 1995 as compared to 1994. Additionally, amortization was
increased in 1994 due to the decrease in mortality reserves during 1994.
1994 COMPARED TO 1993
Golden American realized net GAAP income (loss) of $2.22 million and $(1.79)
million for 1994 and 1993, respectively. The increase in net GAAP earnings
for 1994 is attributable to the increase in average Separate Account assets
in 1994, as compared to 1993.
Variable life and annuity product fees and policy charges were $17.52
million for 1994 as compared to $10.19 million for 1993. The increase is
primarily attributable to increased fees from the increasing block of
business under management in the Separate Accounts. Separate Account assets
have increased from $295 million at December 31, 1992 to $810 million at
December 31, 1993 to $950 million at December 31, 1994. The increase in
Separate Account assets and liabilities of $515 million during 1993 was
primarily due to 1993 premiums and annuity considerations of $505 million.
Golden American's earnings are principally derived from the charges imposed on
variable annuity products and, to a lesser extent, variable life products. The
primary revenues from these products consist of charges for mortality and
expense risk, the cost of insurance and Contract administration charges that
have been assessed against account balances during the period. In addition, a
sales load ranging from 3% to 7.5% is assessed to premium payments and
collected over a number of years for certain other GoldenSelect variable
annuity and life products. These sales loads are earned over the life of the
insurance Contract in relation to estimated future gross profits. Sales loads
that have been deducted but not yet earned are not recognized in current
income and are reported as unearned revenue. The costs associated with
acquiring new business are deferred at issue and amortized over the lives of
the policies in relation to the present value of estimated future gross
profits. Golden American also incurs expenses associated with the maintenance
of in-force Contracts.
Cash required to fund the acquisition costs associated with deferred sales
load products written in 1992, 1993 and 1994 was provided by short-term
borrowings with
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MORE INFORMATION ABOUT GOLDEN AMERICAN LIFE INSURANCE COMPANY (CONTINUED)
an unaffiliated bank. Accordingly, the cost of these borrowed funds increased
in line with the general increase in the Federal Funds rates.
Beginning in 1994, the insurance industry saw a slow-down in the recent trend
of individuals moving away from traditional fixed products and into variable
products. Golden American experienced a similar slow-down as sales for 1995
were down 55% compared to 1994, following sales for 1994 which were down 39%
compared to 1993.
LIQUIDITY AND CAPITAL RESOURCES
Golden American's liquidity requirements include the payment of sales
commissions, and other acquisition and underwriting expenses on the annuity
and life business that it writes. Overall, the Company had negative cash flow
from operations in 1994 because it sold variable products exclusively; total
premiums received were invested immediately in the Company's Separate Accounts
which purchased shares of portfolios of The GCG Trust, an open-end, management
investment company, or directly purchased portfolio securities. Because 100%
of the premium was invested as described above, the payment of commissions and
other acquisition costs resulted in negative cash flow from operations during
the Company's early growth years.
Positive cash flow elements from operations are produced primarily from two
sources. Fees are collected from the in-force book of business. In addition,
during 1995, Golden American began to distribute a fixed account option with
its variable annuity product. Premium amounts directed to the fixed account
option produce positive cash flow from operations as amounts are retained
within the general account of the Company and are used to fund an investment
portfolio that finances future benefit payments. Investments are made in
fixed-rate investments such as bonds, and short-term investments in order to
provide a sufficient return as well as to match the duration of the obligation
for future benefit payments. Golden American products also contain surrender
charge features which reward persistency and penalize the early withdrawal of
funds.
Golden American has developed and utilizes a projection system which forecasts
cash flow. Cash flow from operations will vary depending on the amount of
premium written and the product mix. The Company also periodically performs
asset/liability matching in the management of its asset and liability
portfolios. Those matching practices involve the monitoring of asset and
liability durations for various product lines, cash flow testing under various
interest rate scenarios, and the continuous rebalancing of assets and
liabilities with respect to yield, risk, and cash flow characteristics.
Golden American has funded those past expenses described above for its
variable annuity and life business currently in-force at the beginning of 1995
by the issuance of $50 million redeemable preferred stock with its immediate
parent, BT Variable, Inc. on December 30, 1994. This $50 million preferred
stock transaction accounts for a majority of the large increase in total
Stockholder's Equity (as reported on a GAAP basis) from 1993 to 1994. The
short-term debt discussed previously in the Results of Operations was retired
by Golden American and assumed by BT Variable, Inc. as of December 30, 1994.
Dividends on this preferred stock issue are payable on the last business day
of each quarter, beginning March 31, 1995. For 1995, $3.35 million of
preferred stock dividends have been paid. To the extent that Golden American
has funds available, Golden American may redeem at its option the preferred
stock in cash. Any redemption requires the prior approval of the California
Department of Insurance and may require approval of the Delaware Department of
Insurance. Funds will become available for redemptions from future statutory
earnings as well as the collection of deferred sales loads. The outstanding
amount of deferred sales load to be collected as of December 31, 1995 was
$43.2 million.
The NAIC has developed and implemented the Risk Based Capital "RBC" adequacy
monitoring system. The RBC calculates the amount of adjusted capital which a
life insurance company should have based upon that company's risk profile. The
NAIC has established four different levels of regulatory action with respect
to the RBC adequacy monitoring system. Each of these levels may be triggered
if an insurer's total adjusted capital is less than a corresponding level of
RBC. As of December 31, 1995, based on the RBC formula, Golden American's
total adjusted capital level exceeded the minimum amount of capital required
to avoid regulatory action. Under currently effective funding agreements,
expected RBC levels will remain well in excess of levels required to avoid
regulatory actions. There is no assurance, however, that Golden American will
continue to maintain its current RBC level.
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During 1995, BT Variable, Inc. made capital contributions to Golden American of
$7.94 million. Golden American believes that it will be able to fund the capital
and surplus required for projected new business from existing statutory capital
and surplus, statutory earnings on the existing book of business as well as
future surplus contributions from its parent. Golden American also believes that
it will be able to fund the above liquidity requirements of sales commissions
and acquisition costs of projected new business from affiliated borrowings
and/or borrowings with non-affiliated banks. Golden American expects to continue
to receive capital contributions from BT Variable if necessary. Golden
American's future marketing efforts could be hampered should its parent and/or
affiliates be unable to provide additional funding.
Pursuant to the terms of an escrow agreement entered into in connection with the
purchase of Golden American from Mutual Benefit by Bankers Trust Company, Golden
American is obligated to fund up to $5.0 million into an escrow account pending
final resolution of a dispute concerning the final terms of the agreements
consummating the purchase of Golden American, which dispute is before the
Chancery Court of New Jersey. Any amounts assessed against Golden American upon
final adjudication of such dispute would be paid from the escrow account.
Management believes that the likelihood of any judgment against Golden American
with respect to the escrow account is unlikely and would not have a material
impact on Golden American. As of December 31, 1995, $3.90 million has been
deposited into the escrow account. Golden American's obligation is secured by a
pledge of its right to receive certain deferred sales loads. Bankers Trust has
estimated that the contingent liability due from Golden American amounted to
$.44 million at December 31, 1995 and 1994, and has been so accrued in the
accompanying financial statements.
SEGMENT INFORMATION
During the period since the acquisition by Bankers Trust, September 30, 1992
to date of this Prospectus, Golden American's operations consisted of one
business segment, the sale of annuity and life insurance products. Golden
American and its affiliate Directed Services, Inc., are party to in excess of
140 sales agreements with broker-dealers. Two of those broker-dealers sell a
substantial portion of its business.
REINSURANCE
Golden American reinsures its mortality risk associated with the Contract's
guaranteed death benefit with one or more appropriately licensed insurance
companies. Golden American also, effective June 1, 1994, entered into a
reinsurance agreement on a modified coinsurance basis with an affiliate of a
broker-dealer which distributes Golden American's products with respect to 25%
of the business produced by that broker-dealer.
RESERVES
In accordance with the life insurance laws and regulations under which Golden
American operates, it is obligated to carry on its books, as liabilities,
actuarially determined reserves to meet its obligations on outstanding
Contracts. Reserves, based on valuation mortality tables in general use in the
United States, where applicable, are computed to equal amounts which, together
with interest on such reserves computed annually at certain assumed rates,
make adequate provision according to presently accepted actuarial standards of
practice, for the anticipated cash flows required by the contractual
obligations and related expenses of Golden American.
INVESTMENTS
Golden American's assets are invested in accordance with applicable state
laws. These laws govern the nature and the quality of investments that may be
made by life insurance companies and the percentage of their assets that may
be committed to any particular type of investment. In general, these laws
permit investments, within specified limits subject to certain qualifications,
in federal, state, and municipal obligations, corporate bonds, preferred or
common stocks, real estate mortgages, real estate and certain other
investments. All of Golden American's assets, except for assets held in escrow
and variable separate account assets supporting variable products, are
available to meet its obligations under the Contracts.
Golden American makes investments in accordance with investment guidelines
that take into account investment quality, liquidity and diversification, and
invests assets supporting the Contract guarantees primarily in fixed income
assets issued or guaranteed by the U.S. government or its agencies and
instrumentalities. At December 31, 1995, Golden American had invested assets
of $67.29 million consisting of $49.63 million of bonds and $15.61 million of
short-term securities and $2.0 million of policy loans.
At December 31, 1995, 100% of Golden American's invested assets and cash
equivalents supporting Contract guarantees consisted of liquid and readily
marketable securities.
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At December 31, 1995, 100% of the total invested assets were invested in
investment grade bonds and 0% were invested in non-investment grade
securities. Golden American defines non-investment grade as unsecured
corporate debt obligations which do not have a rating equivalent to Standard &
Poor's (or similar rating agency) BBB or higher and are not guaranteed by an
agency of the federal government.
COMPETITION
Golden American is engaged in a business that is highly competitive because of
the large number of stock and mutual life insurance companies and other
entities marketing insurance products comparable to those of Golden American.
There are approximately 2,350 stock, mutual and other types of insurers in the
life insurance business in the United States, a substantial number of which
are significantly larger than Golden American.
CERTAIN AGREEMENTS
Beginning in 1994 and continuing through 1995, Bankers Trust (Delaware), a
subsidiary of Bankers Trust New York Corporation, and Golden American became
parties to a service agreement pursuant to which Bankers Trust (Delaware) has
agreed to provide certain accounting, actuarial, tax, underwriting, sales,
management and other services to Golden American. Expenses incurred by Bankers
Trust (Delaware) in relation to this service agreement are reimbursed by
Golden American on an allocated cost basis. Charges billed to Golden American
by Bankers Trust (Delaware) pursuant to the service agreement for 1995 and
1994 were $816,264 and $290,248, respectively.
Prior to 1994, Golden American had arranged with BT Variable to perform
services related to the development and adminstration of its products. For the
year 1993, fees earned by BT Variable from Golden American for these services
aggregated $2,701,000. The agreement was terminated as of January 1, 1994.
In addition, BT Variable provided to Golden American certain of its personnel
to perform management, administrative and clerical services and the use of
certain of its facilities. BT Variable charged Golden American for such
expenses and all other general and administrative costs, first on the basis of
direct charges when identifiable, and second allocated based on the estimated
amount of time spent by BT Variable's employees on behalf of Golden American.
For the year 1993, BT Variable allocated to Golden American $1,503,000. The
agreement was terminated on January 1, 1994. During 1994, such expenses were
allocated directly by BT New York Corporation to Golden American and totaled
$1,395,966 for the year.
DISTRIBUTION AGREEMENT
Prior to 1994, Golden American had entered into agreements with DSI to perform
services related to the management of its investments and the distribution of
its products. For the year 1993, Golden American incurred $311,000 for such
services. The agreement was terminated as of January 1, 1994.
DSI acts as the principal underwriter (as defined in the Securities Act of
1933 and the Investment Company Act of 1940, as amended) of the variable
insurance products issued by Golden American which, as of December 31, 1995,
are sold primarily through two broker/dealer institutions. For the years ended
1995, 1994 and 1993, commissions paid by Golden American to DSI aggregated
$8,440,000, $17,569,000 and $34,260,000, respectively.
Golden American provided to DSI certain of its personnel to perform
management, administrative and clerical services and the use of certain
facilities. Golden American charged DSI for such expenses and all other
general and adminstrative costs, first on the basis of direct charges when
identifiable, and the remainder allocated based on the estimated amount of
time spent by Golden American's employees on behalf of DSI. In the opinion of
management, this method of cost allocation is reasonable. For the years ended
December 31, 1994 and 1993, expenses allocated to DSI were $1,983,000 and
$2,013,000, respectively, which were comprised of allocated salary charges,
premise and equipment charges, and other expenses.
In 1995, the service agreement between DSI and Golden American was amended to
provide for a management fee from DSI to Golden American for managerial and
supervisory services provided by Golden American. This fee, calculated as a
percentage of average assets in the variable separate accounts, was $987,000
for 1995.
EMPLOYEES
Golden American, as a result of its Service Agreements with each of Bankers
Trust (Delaware) and BT Variable, has very few direct employees. Instead,
various management services are provided by Bankers Trust (Delaware), BT
Variable and Bankers Trust New York Corporation, as described above under
"Certain Agreements." The cost of these services is allocated to Golden
American.
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Certain officers of Golden American are also officers of BT Variable and DSI,
and their salaries are allocated among the three companies. One officer of
Golden American is also an officer of Bankers Trust New York Corporation, and
his salary is allocated solely to Bankers Trust New York Corporation. See
"Directors and Executive Officers."
PROPERTIES
Golden American's principal office is located at 1001 Jefferson Street, Suite
400, Wilmington, Delaware 19801, where all of Golden American's records are
maintained. This office space is sub-leased from Bankers Trust (Delaware)
under the service agreement described above.
DIRECTORS AND EXECUTIVE OFFICERS
<TABLE>
<CAPTION>
NAME (AGE) POSITIONS(S) WITH THE COMPANY
- ---------------------------- -----------------------------
<S> <C>
Terry L. Kendall (49) Chairman, President and Chief
Executive Officer
Paul Daniel Borge (49) Director
Richard A. Marin (42) Director
Barnett Chernow (46) Executive Vice President
Mitchell R. Katcher (42) Executive Vice President
David L. Jacobson (46) Senior Vice President and
Assistant Secretary
Stephen J. Preston (38) Senior Vice President, Chief
Actuary and Controller
Myles R. Tashman (53) Executive Vice President and
Secretary
Mary B. Wilkinson (39) Senior Vice President and
Treasurer
Edward C. Wilson (51) Executive Vice President
</TABLE>
Each director is elected to serve for one year or until the next annual meeting
of shareholders or until his or her successor is elected. Some directors are
directors of insurance company subsidiaries of Golden American's ultimate
parent, Banker's Trust, New York.
The principal positions of Golden American's directors and senior executive
officers for the past five years are listed below:
MR. KENDALL joined Bankers Trust Company in September 1993 as Managing Director.
He is Chairman of the Board, President and Chief Executive Officer of the Golden
American. From 1982 through June 1993, he was President and Chief Executive
Officer of United Pacific Life Insurance Company.
MR. BORGE joined Bankers Trust Company in 1978 and is a Managing Director. He
has been a director of Golden American since December 1995.
MR. MARIN joined Bankers Trust Company in 1978 and is a Managing Director. He
has been a director of Golden American since 1992.
MR. CHERNOW joined Golden American in October 1993 as Executive Vice President.
From 1977 through 1993 he held various positions with Reliance Insurance
Companies and was Senior Vice President and Chief Financial Officer of United
Pacific Life Insurance Company from 1984 through 1993.
MR. KATCHER joined Golden American in July 1993 as Executive Vice President.
From 1991 through 1993 he was a Consulting Actuary for Tillinghast. Prior to
1991 he was Senior Vice President and Chief Actuary with Monarch Financial
Services, Inc.
MR. JACOBSON joined Golden American in November 1993 as Senior Vice President
and Assistant Secretary. From April 1974 through November 1993 he held various
positions with United Pacific Life Insurance Company and was Vice President upon
leaving.
MR. PRESTON joined Golden American in December 1993 as Senior Vice President,
Chief Actuary and Controller. From September 1993 through November 1993 he was
Senior Vice President and Actuary for Mutual of America Insurance Company. From
July 1987 through August 1993 he held various positions with United Pacific Life
Insurance Company and was Vice President and Actuary upon leaving.
MR. TASHMAN joined Golden American in August 1994 as Senior Vice President and
was named Executive Vice President and Secretary effective January 1, 1996. From
1986 through 1993 he was Senior Vice President and General Counsel of United
Pacific Life Insurance Company.
MS. WILKINSON joined Golden American in November 1993 as Senior Vice President
and Treasurer. From August 1993 through October 1993 she was an Assistant Vice
President with CIGNA Insurance Companies. From January 1987 through July 1993
she held various positions with United Pacific Life Insurance Company and was
Vice President and Controller upon leaving.
MR. WILSON joined Golden American in December 1995 as Executive Vice President.
From August 1994 to December 1995 he was Senior Managing Director at Van Eck
Global Investors. From July 1990 to August 1994 he was Vice President and
National Sales Manager at Keyport Life Insurance Company.
COMPENSATION TABLES AND OTHER INFORMATION
The following sets forth information with respect to the Chief Executive Officer
of Golden American as well as the annual salary and bonus for the next five most
highly compensated executive officers for the fiscal year ended December 31,
1995. Certain executive officers of Golden American are also officers of
Directed Services, Inc. ("DSI"). The salaries of such individuals are allocated
between Golden American and DSI. With the exception of Mr. Kendall, executive
officers of Golden American are also officers of BT Variable and DSI. The
salaries of such individuals are allocated between Golden American, BT Variable
and
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MORE INFORMATION ABOUT GOLDEN AMERICAN LIFE INSURANCE COMPANY (CONTINUED)
DSI pursuant to an arrangement among these companies. Mr. Kendall also serves as
a Managing Director at Bankers Trust New York Corporation. Compensation amounts
for Mr. Kendall which are reflected throughout these tables are not charged to
Golden American, but are instead absorbed by Bankers Trust New York Corporation.
EXECUTIVE COMPENSATION TABLE
The following table sets forth information with respect to the annual salary and
bonus for Golden American's Chief Executive Officer and the next five most
highly compensated executive officers for the fiscal year ended December 31,
1995.
<TABLE>
<CAPTION>
LONG-TERM COMPENSATION
ANNUAL COMPENSATION ------------------------------
SECURITIES
NAME AND ---------------------- RESTRICTED UNDERLYING ALL OTHER
PRINCIPAL POSITION YEAR SALARY BONUS (1) STOCK AWARDS(2) OPTIONS COMPENSATION
- ------------------------- ----- --------- ----------- --------------- ------------- ---------------
<S> <C> <C> <C> <C> <C> <C>
Terry Lee Kendall, ...... 1994 $ 250,000 $ 200,000 $ 103,551 8,000 $6,706(4)
Chairman, President and 1995 $ 250,000 $ 400,000 8,000
Chief Executive
Officer(3) (September
1993 to Present)
Barnett Chernow, ........ 1994 $ 185,000 $ 35,000 $98,212(5)
Executive Vice President 1995 $ 190,000 $ 165,000 $15,444(4)(5)
Mitchell R. Katcher, .... 1994 $ 175,000 $ 62,500 $9,389(4)
Executive Vice President 1995 $ 175,000 $ 150,000
Robert Benjamin 1994 $ 150,000 $ 289,000 $18,750(4)
Langel, ................ 1995 $ 150,000 $ 90,200 $9,000(4)
Former Executive Vice
President
Myles R. Tashman, ....... 1994 $ 66,667 $ 25,000
Executive Vice President 1995 $ 160,000
and Secretary
Stephen J. Preston, ..... 1994 $ 131,667 $ 50,000 $4,721(5)
Senior Vice President 1995 $ 140,000
and Chief Actuary and
Controller
</TABLE>
- ------------------------------
(1) The amount shown relates to bonuses paid in 1995 and 1994. Mr. Chernow's
bonus paid in 1994 represents a signing bonus.
(2) The number of shares underlying the restricted stock award granted in 1994
represented 1,870 shares of Bankers Trust New York Corporation. The value
shown above was computed using the price of common stock of Bankers Trust
New York Corporation at the end of 1994. The number and value of restricted
stock holdings of the common stock of Bankers Trust New York Corporation at
the end of 1995 are: Mr. Kendall 3,000 shares, value $199,500; Mr. Chernow
500 shares, value $33,250. For these purposes, the stated values of
restricted stock holdings are the current market values at December 31, 1995
without giving effect to the diminution of values attributable to the
restrictions on such stock. Dividends are paid quarterly on the above
restricted stock.
(3) Mr. Kendall has served as Chairman, President and Chief Executive Officer of
Golden American Life since September of 1993. Mr. Kendall's salary and
bonuses are paid directly by Bankers Trust New York Corporation.
(4) Contributions are made by the Company on behalf of the employee to
PartnerShare, the deferred compensation plan sponsored by Bankers Trust New
York Corporation and its affiliates for the benefit of all Bankers Trust
employees, in February of the current year to employees on record as of
December 31 of the previous year, after the employee completes one year of
service with the company. This contribution may be in the form of deferred
compensation and/or a cash payment. In 1995, Mr. Kendall received $2,956 of
deferred compensation and $3,750 of cash payment from the plan. Mr. Chernow
received $1,013 of deferred compensation and $1,267 of cash payment. Mr.
Katcher received $4,139 of deferred compensation and $5,250 of cash payment.
Mr. Langel received $9,000 of cash payment. Mr. Tashman and Mr. Preston were
not eligible for contributions to the PartnerShare Plan in 1995. In 1994,
Mr. Langel received $16,495 of deferred compensation and $2,250 of cash
payment from the plan. All other executives listed above were not eligible
for contributions to the PartnerShare Plan in 1994.
(5) Amounts shown for 1994 and 1995 represent relocation expenses paid on behalf
of the employee.
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OPTION GRANTS IN LAST FISCAL YEAR
<TABLE>
<CAPTION>
POTENTIAL
REALIZABLE
VALUE AT
ASSUMED
ANNUAL
RATES OF
STOCK
PRICE
APPRECIATION
NUMBER OF FOR
SECURITIES % OF TOTAL OPTIONS OPTION
UNDERLYING GRANTED TO TERM (4)
OPTIONS EMPLOYEES IN FISCAL EXERCISE EXPIRATION ---------
NAME GRANTED (1) YEAR PRICE (2) DATE (3) 5%
- ---------------------------------------------- --------------- ------------------- ----------- ------------ ---------
<S> <C> <C> <C> <C> <C>
Terry Kendall................................. 8,000 .302 $ 62.1875 6/21/2005 $ 312,900
<CAPTION>
NAME 10%
- ---------------------------------------------- ---------
<S> <C>
Terry Kendall................................. $ 792,900
</TABLE>
- ------------------------------
(1) Stock options granted on June 6, 1995 by Bankers Trust New York Corporation
to the Chief Executive Officer of Golden American Life become exercisable
one year after grant.
(2) The exercise price was equal to the fair market value of the Common Stock on
the date of grant. The exercise price may be paid in cash, or by delivery of
already-owned shares subject to certain conditions. Tax withholding
obligations relating to the exercise may be paid in cash or by offset of the
underlying shares, subject to certain conditions.
(3) Incentive Stock Options have a term of ten years. They are subject to
earlier termination in certain events related to termination of employment.
(4) Total dollar gains based on indicated rates of appreciation of share price
over a ten-year term. Assumed future share prices for the indicated rates of
appreciation of 5% and 10%, are $101.30 and $161.30, respectively.
OPTION EXERCISES AND FISCAL YEAR END VALUE TABLE
AGGREGATED OPTION EXERCISES IN LAST FISCAL YEAR AND FISCAL YEAR END OPTION
VALUE
<TABLE>
<CAPTION>
VALUE OF
UNEXERCISED
NUMBER OF SECURITIES UNDERLYING IN-THE- MONEY
UNEXERCISED OPTIONS AT FISCAL YEAR OPTIONS AT FISCAL
END YEAR END (2)
SHARES ACQUIRED ---------------------------------- -----------------
NAME ON EXERCISE VALUE REALIZED ($) (1) EXERCISABLE UNEXERCISABLE EXERCISABLE
- ----------------------- ----------------- ----------------------------- --------------- ----------------- -----------------
<S> <C> <C> <C> <C> <C>
Terry Kendall.......... 0 0 8,000 8,000 $ 0
<CAPTION>
NAME UNEXERCISABLE
- ----------------------- ---------------
<S> <C>
Terry Kendall.......... $ 34,500
</TABLE>
- ------------------------------
(1) Market value of underlying securities at exercise minus option price.
(2) Market value of underlying securities at year end minus option price. The
value of unexercised in-the-money stock options at December 31, 1995, shown
above, are presented pursuant to SEC rules. The actual amount, if any,
realized upon exercise of stock options will depend upon the market value of
the Common Stock relative to the exercise price per share of Common Stock of
the stock option at the time the stock option is exercised. There is no
assurance that the values of unexercised in-the-market stock options
reflected in the table will be realized.
Directors of Golden American receive no additional compensation for serving as a
director.
OTHER COMPENSATION
On November 29, 1993, Mr. Jerome Golden resigned as President of Golden
American. He had served as President from July 1987 through November 29, 1993.
In accordance with the terms of a Separation Agreement between Mr. Golden and
the Company, Mr. Golden was paid $425,000 in 1994 and again in 1995. The
amounts represent a full settlement with no future payments required.
FEDERAL TAX CONSIDERATIONS
INTRODUCTION
The following discussion of the federal income tax treatment of the Contract is
not exhaustive, does not purport to cover all situations, and is not intended as
tax advice. The federal income tax treatment of the Contract is unclear in
certain circumstances, and a qualified tax adviser should always be consulted
with regard to the application of the tax law to individual circumstances. This
discussion is based on the Internal Revenue Code of 1986, as amended ("Code").
Treasury Department regulations, and interpretations existing on the date of
this prospectus. These authorities, however, are subject to change by Congress,
the Treasury Department, and judicial decisions.
This discussion does not address state or local tax consequences associated with
the purchase of the contract. In addition, GOLDEN AMERICAN MAKES NO
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FEDERAL TAX CONSIDERATIONS (CONTINUED)
GUARANTEE REGARDING ANY TAX TREATMENT -- FEDERAL, STATE OR LOCAL -- OF ANY
CONTRACT OR OF ANY TRANSACTION INVOLVING A CONTRACT.
TAX STATUS OF GOLDEN AMERICAN
Golden American is taxed as a life insurance company under the Code. Since the
operations of Account B and Account D are a part of, and are taxed with, the
operations of Golden American, Account B and Account D are not separately taxed
as "regulated investment companies" under the Code. Under existing federal
income tax laws, investment income and capital gains of Account B and Account D
are not taxed to Golden American to the extent they are applied to increase
reserves under a contract. Since, under the contracts, investment income and
realized capital gains of Account B and Account D attributable to contract
obligations are automatically applied to increase reserves, Golden American does
not anticipate that it will incur any federal income tax liability in Account B
or Account D attributable to contract obligations, and therefore Golden American
does not intend to make provision for any such taxes. If Golden American is
taxed on investment income or capital gains of Account B or Account D, then
Golden American may impose a charge against Account B or Account D, as
appropriate, in order to make provision for such taxes.
TAXATION OF NON-QUALIFIED ANNUITIES
TAX DEFERRAL DURING ACCUMULATION PERIOD
Under existing provisions of the Code, except as described below, any increase
in an owner's Accumulation Value is generally not taxable to the owner until
amounts are received from the Contract, either in the form of annuity payments
as contemplated by the Contract, or in some other form of distribution.
However, this rule allowing deferral applies only if (1) the investments of
Account B and Account D are "adequately diversified" in accordance with
Treasury Department regulations, (2) Golden American, rather than the owner,
is considered the owner of the assets of Account B and Account D for federal
income tax purposes, and (3) the owner is an individual. In addition to the
foregoing, if the Contract's annuity commencement date occurs at a time when
the annuitant is at an advanced age, such as over age 85, it is possible that
the owner will be taxable currently on the annual increase in the Accumulation
Value.
DIVERSIFICATION REQUIREMENTS. The Code and Treasury Department
regulations prescribe the manner in which the investments of a segregated
asset account, such as the Divisions of Account B and Account D, are to be
"adequately diversified." If a Division of Account B or Account D failed
to comply with these diversification standards, contracts based on that
segregated asset account would not be treated as an annuity contract for
federal income tax purposes and the owner would generally be taxable
currently on the income on the contract (as defined in the tax law)
beginning with the period of non-diversification. Golden American expects
that the Divisions of Account B and Account D will comply with the
diversification requirements prescribed by the Code and Treasury
Department regulations.
OWNERSHIP TREATMENT. In certain circumstances, variable annuity contract
owners may be considered the owners, for federal income tax purposes, of
the assets of a segregated asset account, such as the Divisions of Account
B or Account D, used to support their contracts. In those circumstances,
income and gains from the segregated asset account would be includible in
the contract owners' gross income. The Internal Revenue Service (the
"IRS") has stated in published rulings that a variable contract owner will
be considered the owner of the assets of a segregated asset account if the
owner possesses incidents of ownership in those assets, such as the
ability to exercise investment control over the assets. In addition, the
Treasury Department announced, in connection with the issuance of
regulations concerning investment diversification, that those regulations
"do not provide guidance concerning the circumstances in which investor
control of the investments of a segregated asset account may cause the
investor, rather than the insurance company, to be treated as the owner of
the assets in the account." This announcement also stated that guidance
would be issued by way of regulations or rulings on the "extent to which
policyholders may direct their investments to particular sub-accounts (of
a segregated asset account) without being treated as owners of the
underlying assets." As of the date of this prospectus, no such guidance
has been issued.
The ownership rights under the Contract are similar to, but different in
certain respects from, those described by the IRS in rulings in which it
was determined that contract owners were not owners of the assets of a
segregated
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FEDERAL TAX CONSIDERATIONS (CONTINUED)
asset account. For example, the owner of this Contract has the choice of
more investment options to which to allocate purchase payments and the
Accumulation Value, and may be able to transfer among investment options
more frequently, than in such rulings. These differences could result in
the owner being treated as the owner of all or a portion of the assets of
Account B and Account D. In addition, Golden American does not know what
standards will be set forth in the regulations or rulings which the
Treasury Department has stated it expects to issue. Golden American
therefore reserves the right to modify the Contract as necessary to
attempt to prevent Contract owners from being considered the owners of the
assets of Account B or Account D. However, there is no assurance that such
efforts would be successful.
Frequently, if the IRS or the Treasury Department sets forth a new
position which is adverse to taxpayers, the position is applied on a
prospective basis only. Thus, if the IRS or the Treasury Department were
to issue regulations or a ruling which treated an owner of this Contract
as the owner of Account B or Account D, that treatment might apply on a
prospective basis. However, if the regulations or ruling were not
considered to set forth a new position, an owner might retroactively be
determined to be the owner of the assets of Account B and Account D.
NON-NATURAL OWNER. As a general rule, contracts held by "non-natural
persons" such as a corporation, trust or other similar entity, as opposed
to a natural person, are not treated as annuity contracts for federal tax
purposes. The income on such contracts (as defined in the tax law) is
taxed as ordinary income that is received or accrued by the owner of the
contract during the taxable year. There are several exceptions to this
general rule for non-natural owners. First, contracts will generally be
treated as held by a natural person if the nominal owner is a trust or
other entity which holds the contract as an agent for a natural person.
However, this special exception will not apply in the case of any employer
who is the nominal owner of a contract under a non-qualified deferred
compensation arrangement for its employees.
In addition, exceptions to the general rule for non-natural owners will
apply with respect to (1) contracts acquired by an estate of a decedent by
reason of the death of the decedent, (2) certain contracts issued in
connection with qualified retirement plans, (3) contracts purchased by
employers upon the termination of certain qualified retirement plans, (4)
certain contracts used in connection with structured settlement
agreements, and (5) contracts purchased with a single purchase payment
when the annuity starting date (as defined in the tax law) is no later
than a year from purchase of the contract and substantially equal periodic
payments are made, not less frequently than annually, during the annuity
period.
The remainder of this discussion assumes that the Contract will be treated
as an annuity contract for federal income tax purposes.
TAXATION OF PARTIAL WITHDRAWALS AND SURRENDERS
In the case of a partial withdrawal prior to the annuity commencement date,
amounts received generally are includible in income to the extent the owner's
cash value (determined without regard to any surrender charge, within the
meaning of the tax law) before the surrender exceeds his or her "investment in
the contract." In the case of a surrender of the Contract for the cash
surrender value, amounts received are includible in income to the extent they
exceed the "investment in the contract." For these purposes, the investment in
the Contract at any time equals the total of the premium payments made under
the Contract to that time (to the extent such payments were neither deductible
when made nor excludable from income as, for example, in the case of certain
contributions to IRAs and other qualified retirement plans) less any amounts
previously received from the Contract which were not includible in income.
In the case of systematic partial withdrawals, the amount of each withdrawal
will generally be taxed in the same manner as a partial withdrawal made prior
to the annuity commencement date, as described above. However, there is some
uncertainty regarding the tax treatment of systematic partial withdrawals, and
it is possible that additional amounts may be includible in income.
The Contract provides a death benefit that in certain circumstances may exceed
the greater of the premium payments and the Accumulation Value. As described
elsewhere in this prospectus, Golden American imposes certain charges with
respect to the death benefit. It is possible that some portion of those
charges could be treated for federal tax purposes as a partial withdrawal from
the Contract.
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FEDERAL TAX CONSIDERATIONS (CONTINUED)
In certain circumstances, surrender charges may be waived because of the
owner's need for extended medical care or because of the owner's terminal
illness. Distributions made in respect of which surrender charges are waived
are treated as partial withdrawals or surrenders, as the case may be, for
income tax purposes.
TAXATION OF ANNUITY PAYMENTS
Normally, the portion of each annuity payment taxable as ordinary income is
equal to the excess of the payment over the exclusion amount. In the case of
fixed annuity payments, the exclusion amount is the amount determined by
multiplying (1) the fixed annuity payment by (2) the ratio of the "investment
in the contract" (defined above), adjusted for any period certain or refund
feature, allocated to the fixed annuity option to the total expected amount of
fixed annuity payments for the period of the Contract (determined under
Treasury Department regulations). In the case of variable annuity payments,
the exclusion amount for each variable annuity payment is a specified dollar
amount equal to the investment in the Contract allocated to the variable
annuity option when payments begin divided by the number of variable payments
expected to be made (determined by Treasury Department regulations).
Once the total amount of the investment in the Contract is excluded using
these formulas, annuity payments will be fully taxable. If annuity payments
cease because of the death of the annuitant and before the total amount of the
investment in the Contract is recovered, the unrecovered amount generally will
be allowed as a deduction to the annuitant or beneficiary (depending upon the
circumstances).
If any amount is constructively received, within the meaning of the tax law,
from a contract (which may occur when a death benefit becomes payable), such
amount will be treated as a partial withdrawal or surrender for federal income
tax purposes unless it is applied under an annuity option within 60 days after
the time when such amount was constructively received. In any event, however,
payments must comply with applicable Federal tax law distribution
requirements.
TAXATION OF DEATH BENEFIT PROCEEDS
Prior to the annuity commencement date, amounts may be distributed from a
contract because of the death of an owner or, in certain circumstances, the
death of the annuitant. Such death benefit proceeds are includible in income
as follows: (1) if distributed in a lump sum, they are taxed in the same
manner as a surrender, as described above, or (2) if distributed under an
annuity option, they are taxed in the same manner as annuity payments, as
described above. After the annuity commencement date, where a guaranteed
period exists under an annuity option and the annuitant dies before the end of
that period, payments made to the beneficiary for the remainder of that period
are includible in income as follows: (1) if received in a lump sum, they are
includible in income to the extent that they exceed the unrecovered investment
in the contract at that time, or (2) if distributed in accordance with the
existing annuity option selected, they are fully excludable from income until
the remaining investment in the contract is deemed to be recovered, and all
annuity payments thereafter are fully includible in income.
ASSIGNMENTS, PLEDGES, AND GRATUITOUS TRANSFERS
Other than in the case of contracts issued as IRAs or in connection with
certain other qualified retirement plans (which generally cannot be assigned
or pledged), any assignment or pledge (or agreement to assign or pledge) of
any portion of the value of the contract is treated for federal income tax
purposes as a partial withdrawal of such amount or portion. The investment in
the Contract is increased by the amount includible as income with respect to
such assignment or pledge, though it is not affected by any other aspect of
the assignment or pledge (including its release). If an owner transfers a
contract without adequate consideration to a person other than the owner's
spouse (or to a former spouse incident to divorce), the owner will be taxed on
the difference between the cash surrender value (within the meaning of the tax
law) and the investment in the contract at the time of transfer. In such case,
the transferee's investment in the contract will be increased to reflect the
increase in the transferor's income.
SECTION 1035 EXCHANGES
Code section 1035 provides that no gain or loss is recognized when an annuity
contract is received in exchange for a life, endowment, or annuity contract,
provided that no cash or other property is received in the exchange
transaction. Special rules and procedures apply in order for an exchange to
meet the requirements of section 1035. Also, there are additional tax
considerations involved when the contracts are issued in connection with
qualified retirement plans. Prospective owners of this Contract should consult
a tax advisor before entering into a section 1035 exchange (with respect to
non-qualified annuity contracts) or a trustee-to-trustee transfer or rollover
(with respect to qualified annuity contracts).
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FEDERAL TAX CONSIDERATIONS (CONTINUED)
PENALTY TAX ON PREMATURE DISTRIBUTIONS
Where a contract has not been issued as an IRA or in connection with another
qualified retirement plan, there generally is a 10% penalty tax on the taxable
amount of any payment from the contract unless the payment is: (a) received on
or after the owner reaches age 59 1/2; (b) attributable to the owner's
becoming disabled (as defined in the tax law); (c) made on or after the death
of the owner or, if the owner is not an individual, on or after the death of
the primary annuitant (as defined in the tax law); (d) made as a series of
substantially equal periodic payments (not less frequently than annually) for
the life (or life expectancy) of the owner or the joint lives (or joint life
expectancies) of the owner and a designated beneficiary (as defined in the tax
law), or (e) made under a contract purchased with a single purchase payment
when the annuity starting date (as defined in the tax law) is no later than a
year from purchase of the contract and substantially equal periodic payments
are made, not less frequently than annually, during the annuity period.
In the case of systematic partial withdrawals, it is unclear whether such
withdrawals will qualify for exception (d) above. (For reporting purposes, we
currently treat such withdrawals as if they do not qualify for this
exception). In addition, if withdrawals are of interest amounts only, as is
the case with systematic partial withdrawals from a Fixed Allocation,
exception (d) will not apply.
AGGREGATION OF CONTRACTS
In certain circumstances, the amount of an annuity payment, withdrawal or
surrender from a contract that is includible in income is determined by
combining some or all of the annuity contracts owned by an individual not
issued in connection with qualified retirement plans. For example, if a person
purchases two or more deferred annuity contracts from the same insurance
company (or its affiliates) during any calendar year, all such contracts will
be treated as one contract for purposes of determining whether any payment not
received as an annuity (including withdrawals and surrenders prior to the
annuity commencement date) is includible in income. In addition, if a person
purchases a Contract offered by this prospectus and also purchases at
approximately the same time an immediate annuity, the IRS may treat the two
contracts as one contract. The effects of such aggregation are not clear,
however, it could affect the time when income is taxable and the amount which
might be subject to the 10% penalty tax described above.
IRA CONTRACTS AND OTHER QUALIFIED RETIREMENT PLANS
IN GENERAL
In addition to issuing the Contracts as non-qualified annuities, Golden
American also currently issues the Contracts as IRAs. (As indicated above, in
this prospectus, IRAs are referred to as "qualified plans.") Golden American
may also issue the Contracts in connection with certain other types of
qualified retirement plans which receive favorable treatment under the Code.
Numerous special tax rules apply to the owners under IRAs and other qualified
retirement plans and to the contracts used in connection with such plans.
These tax rules vary according to the type of plan and the terms and
conditions of the plan itself. For example, for both surrenders and annuity
payments under certain contracts issued in connection with qualified
retirement plans, there may be no "investment in the contract" and the total
amount received may be taxable. Also, special rules apply to the time at which
distributions must commence and the form in which the distributions must be
paid. Therefore, no attempt is made to provide more than general information
about the use of contracts with the various types of qualified retirement
plans. A qualified tax advisor should be consulted before purchase of a
Contract in connection with a qualified retirement plan.
When issued in connection with a qualified retirement plan, a Contract will be
amended as necessary to conform to the requirements of the plan. However,
owners, annuitants, and beneficiaries are cautioned that the rights of any
person to any benefits under qualified retirement plans may be subject to the
terms and conditions of the plans themselves, regardless of the terms and
conditions of the Contract. In addition, Golden American is not bound by terms
and conditions of qualified retirement plans to the extent such terms and
conditions contradict the Contract, unless Golden American consents.
INDIVIDUAL RETIREMENT ANNUITIES
As indicated above, Golden American currently issues the Contract as an IRA.
If the Contract is used for this purpose, the owner must be the annuitant.
PREMIUM PAYMENTS. Both the premium payments that may be paid, and the tax
deduction that the owner may claim for such premium payments, are limited
under an IRA. In general, the premium payments that may be made for an IRA
for any year are limited to the lesser of $2,000 or 100% of the owner's
earned income for the year. Also, in the case of an individual who has a
noncompensated spouse, premium
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FEDERAL TAX CONSIDERATIONS (CONTINUED)
payments may be made into an IRA for the benefit of the spouse. In such a
case, however, the premium payments that may be made for the spouse's IRA
for any year are limited to the lesser of $2,000 or the excess of (1)
$2,250 (or, if less, 100% of the individual's earned income) over (2) the
individual's premium payments for his or her own IRA. An excise tax is
imposed on IRA contributions that exceed the law's limits.
The deductible amount of the premium payments made for an IRA for any
taxable year (including a contract for a noncompensated spouse) is limited
to the amount of premium payments that may be paid for the contract for
that year, or a lesser amount where the individual or his or her spouse is
an active participant in certain qualified retirement plans. For a single
person who is an active participant in a qualified retirement plan
(including a qualified pension, profit-sharing, or annuity plan, a
simplified employee pension plan, or a "section 403(b)" annuity plan, as
discussed below) and who has adjusted gross income in excess of $35,000
may not deduct premium payments, and such a person with adjusted gross
income between $25,000 and $35,000 may deduct only a portion of such
payments. Also, married persons who file a joint return, one of whom is an
active participant in a qualified retirement plan, and who have adjusted
gross income in excess of $50,000 may not deduct premium payments, and
those with adjusted gross income between $40,000 and $50,000 may deduct
only a portion of such payments. Married persons filing separately may not
deduct premium payments if either the taxpayer or the taxpayer's spouse is
an active participant in a qualified retirement plan.
In applying these and other rules applicable to an IRA, all individual
retirement accounts and IRAs owned by an individual are treated as one
contract, and all amounts distributed during any taxable year are treated
as one distribution.
TAX DEFERRAL DURING ACCUMULATION PERIOD. Until distributions are made from
an IRA, increases in the Accumulation Value of the contract are not taxed.
IRAs and individual retirement accounts (that may invest in this contract)
generally may not invest in life insurance contracts, but an annuity
contract that is issued as an IRA (or that is purchased by an individual
retirement account) may provide a death benefit that equals the greater of
the premiums paid and the contract's cash value. The Contract provides a
death benefit that in certain circumstances may exceed the greater of the
premium payments and the Accumulation Value. It is possible that an
enhanced death benefit could be viewed as violating the prohibition on
investment in life insurance contracts with the result that the Contract
would not be viewed as satisfying the requirements of an IRA.
TAXATION OF DISTRIBUTIONS AND ROLLOVERS. If all premium payments made to
an IRA were deductible, all amounts distributed from the Contract are
included in the recipient's income when distributed. However, if
nondeductible premium payments were made to an IRA (within the limits
allowed by the tax laws), a portion of each distribution from the Contract
typically is includible in income when it is distributed. In such a case,
any amount distributed as an annuity payment or in a lump sum upon death
or surrender is taxed as described above in connection with such a
distribution from a non-qualified contract, treating as the investment in
the contract the sum of the nondeductible premium payments at the end of
the taxable year in which the distribution commences or is made (less any
amounts previously distributed that were excluded from income). Also, in
such a case, any amount distributed upon a partial withdrawal is partially
includible in income. The includible amount is the excess of the
distribution over the exclusion amount, which in turn equals the
distribution multiplied by the ratio of the investment in the Contract to
the Accumulation Value.
In any event, subject to the direct rollover and mandatory withholding
requirements (discussed below), amounts may be "rolled over" from certain
qualified retirement plans to an IRA (or from one IRA or individual
retirement account to an IRA) without incurring current income tax if
certain conditions are met. Only certain types of distributions to
eligible individuals from qualified retirement plans, individual
retirement accounts, and IRAs may be rolled over.
PENALTY TAXES. Subject to certain exceptions, a penalty tax is imposed on
distributions from an IRA equal to 10% of the amount of the distribution
includible in income. (Amounts rolled over from an IRA generally are
excludable from income.) The exceptions provide, however, that this
penalty tax does not apply to distributions made to the owner (1) on or
after age 59 1/2,
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FEDERAL TAX CONSIDERATIONS (CONTINUED)
(2) on or after death or because of disability (as defined in the tax
law), or (3) as part of a series of substantially equal periodic payments
over the life (or life expectancy) of the owner or the joint lives (or
joint life expectancies) of the owner and his or her beneficiary (as
defined in the tax law). In addition to the foregoing, failure to comply
with a minimum distribution requirement will result in the imposition of a
penalty tax of 50% of the amount by which a minimum required distribution
exceeds the actual distribution from an IRA. Under this requirement,
distributions of minimum amounts from an IRA as specified in the tax law
must generally commence by April 1 of the calendar year following the
calendar year in which the owner attains age 70 1/2.
OTHER TYPES OF QUALIFIED RETIREMENT PLANS
The following sections describe tax considerations of contracts used in
connection with various types of qualified retirement plans other than IRAs.
Golden American does not currently offer all of the types of qualified
retirement plans described and may not offer them in the future. Prospective
purchasers of contracts for use in connection with such qualified retirement
plans should therefore contact Golden American's Customer Service Center to
ascertain the availability of the Contract for qualified retirement plans at
any given time.
SIMPLIFIED EMPLOYEE PENSIONS (SEP-IRAS). Section 408(k) of the Code allows
employers to establish simplified employee pension plans for their
employees, using the employees' IRAs for such purposes, if certain
criteria are met. Under these plans the employer may, within specified
limits, make deductible contributions on behalf of the employees to IRAs.
Employers intending to use the contract in connection with such plans
should seek competent advice.
CORPORATE AND SELF-EMPLOYED ("H.R. 10" OR
"KEOGH") PENSION AND PROFIT-SHARING PLANS. Sections 401(a) and 403(a) of
the Code permit corporate employers to establish various types of
tax-favored retirement plans for employees. The Self-Employed Individuals'
Tax Retirement Act of 1962, as amended, commonly referred to as "H.R. 10"
or "Keogh," permits self-
employed individuals also to establish such tax-favored retirement plans
for themselves and their employees. Such retirement plans may permit the
purchase of the Contract in order to provide benefits under the plans. The
contract provides a death benefit that in certain circumstances may exceed
the greater of the premium payments and the Accumulation Value. It is
possible that such death benefit could be characterized as an incidental
death benefit. There are limitations on the amount of incidental benefits
that may be provided under pension and profit sharing plans. In addition,
the provision of such benefits may result in currently taxable income to
participants. Employers intending to use the contract in connection with
such plans should seek competent advice.
SECTION 403(B) ANNUITY CONTRACTS. Section 403(b) of the Code permits
public school employees, employees of certain types of charitable,
educational and scientific organizations exempt from tax under section
501(c)(3) of the Code, and employees of certain types of State educational
organizations specified in section 170(b)(l)(A)(ii), to have their
employers purchase annuity contracts for them and, subject to certain
limitations, to exclude the amount of premium payments from gross income
for federal income tax purposes. Purchasers of the contracts for use as a
"Section 403(b) Annuity Contract" should seek competent advice as to
eligibility, limitations on permissible amounts of premium payments and
other tax consequences associated with such contacts. In particular,
purchasers and their advisors should consider that this contract provides
a death benefit that in certain circumstances may exceed the greater of
the premium payments and the Accumulation Value. It is possible that such
death benefit could be characterized as an incidental death benefit. If
the death benefit were so characterized, this could result in currently
taxable income to purchasers. In addition, there are limitations on the
amount of incidental death benefits that may be provided under a Section
403(b) Annuity Contract. Even if the death benefit under the contract were
characterized as an incidental death benefit, it is unlikely to violate
those limits unless the purchaser also purchases a life insurance contract
as part of his or her Section 403(b) Annuity Contract.
Section 403(b) Annuity Contracts contain restrictions on withdrawals of
(i) contributions made pursuant to a salary reduction agreement in years
beginning after December 31, 1988, (ii) earnings on those contributions,
and (iii) earnings after 1988 on amounts attributable to salary reduction
contributions (and earnings on those contributions) held as of the last
year beginning before January 1, 1989. These amounts can be paid only if
the employee has reached age 59 1/2, separated from service, died,
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FEDERAL TAX CONSIDERATIONS (CONTINUED)
become disabled (within the meaning of the tax law), or in the case of
hardship. Amounts permitted to be distributed in the event of hardship are
limited to actual contributions; earnings thereon cannot be distributed on
account of hardship. (These limitations on withdrawals do not apply to the
extent Golden American is directed to transfer some or all of the
Accumulation Value as a tax-free direct transfer to the issue of another
Section 403(b) Annuity Contract or into a section 403(b)(7) custodial
account subject to withdrawal restrictions which are at least as
stringent.)
ELIGIBLE DEFERRED COMPENSATION PLANS OF STATE AND LOCAL GOVERNMENTS AND
TAX-EXEMPT ORGANIZATIONS. Section 457 of the Code permits employees of
state and local governments and tax-exempt organizations to defer a
portion of their compensation without paying current federal income taxes.
The employees must be participants in an eligible deferred compensation
plan. To the extent the contract is used in connection with an eligible
plan, the employer as owner of the contract has the sole right to the
proceeds of the contract, until paid or made available to the participant
or other recipient, subject only to the claims of the employer's general
creditors. Generally, a contract purchased by a state or local government
or a tax-exempt organization will not be treated as an annuity contract
for federal income tax purposes. Those who intend to use the contracts in
connection with such plans should seek competent advice.
DIRECT ROLLOVERS AND FEDERAL INCOME TAX WITHHOLDING FOR "ELIGIBLE ROLLOVER
DISTRIBUTIONS"
In the case of an annuity contract used in connection with a pension,
profit-sharing, or annuity plan qualified under sections 401(a) or 403(a) of
the Code, or that is a Section 403(b) Annuity Contract, any "eligible rollover
distribution" from the contract will be subject to direct rollover and
mandatory withholding requirements. An eligible rollover distribution
generally is the taxable portion of any distribution from a qualified pension
plan under section 401(a) of the Code, qualified annuity plan under Section
403(a) of the Code, or Section 403(b) Annuity or custodial account, excluding
certain amounts (such as minimum distributions required under section
401(a)(9) of the Code and distributions which are part of a "series of
substantially equal periodic payments" made for the life (or life expectancy)
of the employee, or for the joint lives (or joint life expectancies) of the
employee and the employee's designated beneficiary (within the meaning of the
tax law), or for a specified period of 10 years or more).
Under these new requirements, federal income tax equal to 20% of the eligible
rollover distribution will be withheld from the amount of the distribution.
Unlike withholding on certain other amounts distributed from the contract,
discussed below, the taxpayer cannot elect out of withholding with respect to
an eligible rollover distribution. However, this 20% withholding will not
apply to that portion of the eligible rollover distribution which, instead of
receiving, the taxpayer elects to have directly transferred to certain
eligible retirement plans (such as to this contract when issued as an IRA).
If this contract is issued in connection with a pension, profit-sharing, or
annuity plan qualified under sections 401(a) or 403(a) of the Code, or is a
Section 403(b) Annuity Contract, then, prior to receiving an eligible rollover
distribution, the owner will receive a notice (from the plan administrator or
Golden American) explaining generally the direct rollover and mandatory
withholding requirements and how to avoid the 20% withholding by electing a
direct transfer.
FEDERAL INCOME TAX WITHHOLDING
Golden American will withhold and remit to the federal government a part of the
taxable portion of each distribution made under the Contract unless the
distributee notifies Golden American at or before the time of the distribution
that he or she elects not to have any amounts withheld. In certain
circumstances, Golden American may be required to withhold tax, as explained
above. The withholding rates applicable to the taxable portion of periodic
annuity payments (other than eligible rollover distributions) are the same as
the withholding rates generally applicable to payments of wages. In addition,
the withholding rate applicable to the taxable portion of non-periodic payments
(including surrenders prior to the annuity commencement date) is 10%. Regardless
of whether you elect to have federal income tax withheld, you are still liable
for payment of federal income tax on the taxable portion of the payment. As
discussed above, the withholding rate applicable to eligible rollover
distributions is 20%.
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PART II
THE MANAGED GLOBAL
ACCOUNT OF ACCOUNT D
INTRODUCTION PART II GIVES FURTHER BACKGROUND INFORMATION ON ACCOUNT D AND
THE GLOBAL ACCOUNT, INCLUDING ITS INVESTMENT POLICIES AND ACTIVITIES.
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THE GLOBAL ACCOUNT
The Global Account is a non-diversified investment company which invests
directly in securities. There can be no assurance that the Global Account will
meet its investment objective. Account D may also offer other divisions which
are not available through the purchase of the Contract offered by this
prospectus. DSI serves as the Manager of Account D and Warburg, Pincus serves as
the Portfolio Manager of the Global Account.
INVESTMENT OBJECTIVE AND POLICIES OF THE GLOBAL ACCOUNT
The Global Account's investment objective is to seek high total investment
return consistent with a prudent regard for capital preservation. In seeking
this objective, the Global Account employs an asset allocation strategy
involving shifts among a wide range of investments and market sectors throughout
the world. The Global Account may invest in the following classes of securities:
equity securities of domestic and foreign issuers, including common stocks,
preferred stocks, convertible securities, and warrants; debt securities of
domestic and foreign issuers, including bonds, debentures, asset-backed
securities, and notes; and money market instruments of domestic and foreign
issuers. The Global Account may also use various investment strategies and
techniques in pursuing its investment objective including entering into forward
currency Contracts; purchasing and writing put and call options on securities,
securities indexes, and currencies; purchasing and selling futures Contracts
including interest rate futures Contracts, stock index futures Contracts,
futures Contracts based upon securities, which may be domestic or foreign and
corporate or governmental, foreign exchange futures Contracts, and other
financial futures Contracts; purchasing and writing put and call options on
financial futures Contracts; engaging in short sales of securities; and entering
into repurchase agreements and reverse repurchase agreements.
The total investment return that the Global Account seeks may consist (i) of
capital appreciation from several possible sources, including appreciation in
the value of securities held by the Global Account, the sale of securities whose
market value has changed, the use of futures and options, and the use of forward
currency Contracts; (ii) of interest from underlying securities; and (iii) of
income received from the writing of options. Changes in the value of securities
denominated in foreign currencies may be attributable in whole or in part to
changes in the value of the underlying currency relative to the U.S. dollar.
In pursuing the Global Account's investment objective, the Portfolio Manager
will use an opportunistic approach to allocating the Global Account's assets
through varying economic and financial conditions. The Portfolio Manager
believes that a successful investment approach in the current global environment
must be based upon careful analysis of the global economic and geopolitical
environment with a view to capitalizing upon sector and market opportunities and
to quickly adapting to changing circumstances. Thus, the Portfolio Manager will
allocate the Global Account's assets among securities and currencies based upon
the Portfolio Manager's assessment of the most favorable markets, currencies,
and issuers. In this regard, the percentage of the Global Account's assets
invested in a particular country or denominated in a particular currency will
vary in accordance with the Portfolio Manager's assessment of the appreciation
potential of such assets and the relationship of the country's currency to the
U.S. dollar.
The Portfolio Manager may allocate the Global Account's assets among the various
types of securities and other assets and among issuers located in various
countries and regions as the Portfolio Manager deems appropriate, except that
the Global Account's assets normally will be invested in securities of issuers
domiciled or primarily traded in at least three different countries, which may
include the United States. (Certain additional foreign diversification
requirements apply as described below.) The Portfolio Manager is free to
allocate the Global Account's assets such that, at any time, the Global Account
may be primarily invested in equity securities or, alternatively, the Global
Account may have little or no assets in equity securities. Similarly, at any
time, the Global Account may be primarily invested in securities of issuers
domiciled or primarily traded in one region, such as the United States, Europe,
or the Pacific Basin, or the Global Account may have little or no assets
committed to that region.
In considering equity securities, the Portfolio Manager will emphasize large,
well-capitalized companies with strong balance sheets. The Portfolio Manager may
also consider other factors in selecting equity securities, including
price-earnings ratios, cash flows, and the relationship of an issuer's book
value to its market value.
In selecting debt instruments for the Global Account, the Portfolio Manager
emphasizes credit quality. The Global Account will invest only in the following:
(1) fixed-income instruments issued or guaranteed by the U.S. Government, its
agencies, or instrumentalities ("U.S. Government Securities"); (2) obligations
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issued or guaranteed by a foreign government or any of its political
subdivisions, authorities, agencies, or instrumentalities, or by supranational
entities ("foreign government securities"), which, at the time of investment,
are rated A or better by Standard & Poor's Corporation ("S&P") or A or better by
Moody's Investors Services, Inc. ("Moody's") or, if not rated by S&P or Moody's,
determined by the Portfolio Manager to be of equivalent quality; and (3) debt
securities of domestic or foreign issuers which, at the time of investment, are
rated A or better by S&P or A or better by Moody's or, if not rated by S&P or
Moody's, determined by the Portfolio Manager to be of equivalent quality. In the
event that a debt security held by the Global Account is downgraded to a rating
that would render the security ineligible for purchase by the Global Account,
the Global Account may nonetheless retain the security.
Debt securities purchased by the Global Account may be of any maturity. It is
anticipated that the weighted average maturity of the debt securities in the
portfolio (excluding money market instruments) generally will be between 5 and
15 years, but may be shorter or longer at the discretion of the Portfolio
Manager.
The Global Account invests only in high-quality money market instruments. These
include the following: (1) short-term U.S. Government securities; (2) short-term
foreign government securities which, at the time of investment, are rated AA or
better by S&P or Aa or better by Moody's or, if not rated by S&P or Moody's,
determined by the Portfolio Manager to be of equivalent quality; (3)
certificates of deposit, time deposits, bankers' acceptances, and short-term
obligations of banks and other depository institutions, both U.S. and foreign,
that have total assets of at least $10 billion (U.S.) and are determined by the
Portfolio Manager to be of high quality; and (4) commercial paper and other
short-term corporate obligations which, at the time of investment, are rated A-2
or better by S&P or P-2 or better by Moody's or, if not rated by S&P or Moody's,
determined by the Portfolio Manager to be of equivalent quality.
The Global Account may employ various investment strategies involving
currencies, including entering into forward currency Contracts, foreign exchange
futures Contracts, and options on currencies. (See "Securities and Investment
Techniques," below.) These strategies may be employed for purposes of exposing
the Global Account to a foreign (or domestic) currency or to shift exposure to
foreign currency fluctuations from one country to another. These strategies may
also be employed as hedging techniques to help pro-
tect against declines in the U.S. dollar (or other currency) value of the Global
Account's assets that might result from adverse changes in currency exchange
rates. The Global Account may engage in forward currency transactions in
anticipation of or to protect itself against fluctuations in currency exchange
rates. The Global Account may purchase put and call options on foreign
currencies as a hedge against changes in the value of the U.S. dollar (or
another currency) in relation to a foreign currency in which securities of the
Global Account may be denominated. Hedging against a change in the value of a
foreign currency in the foregoing manner does not eliminate fluctuations in the
prices of portfolio securities or prevent losses if the prices of such
securities decline. Furthermore, such hedging transactions may reduce or
preclude the opportunity for gain if the value of the hedged currency should
change relative to the U.S. dollar.
NON-DIVERSIFIED
The Global Account is classified as a "non-diversified" investment company under
the 1940 Act, as amended, which means that the Global Account is not limited by
the 1940 Act in the amount of its assets that it may invest in the securities of
a single issuer. However, the Global Account will meet the diversification
requirements of Code Section817 (h) and the Treasury Department Regulations
issued thereunder. Under applicable state law requirements, the Global Account
may not acquire the securities of any issuer if, as a result of such investment,
more than 10% of the Global Account's total assets would be invested in the
securities of any one issuer, except that this restriction shall not apply to
U.S. Government securities or foreign government securities, and the Global
Account will not invest in a security if, as a result of such investment, it
would hold more than 10% of the outstanding voting securities of any one issuer.
Nonetheless, because the Global Account, as a non-diversified investment company
under the 1940 Act, may invest in a smaller number of individual issuers than a
diversified investment company, an investment in the Global Account may, under
certain circumstances, present greater risk to an investor than an investment in
a diversified company. This risk may include greater exposure to the risk of
poor earnings or default of one issuer than would be the case for a more
diversified fund.
The Global Account is also subject to the following guidelines for
diversification of foreign security investments. If the Global Account has less
then 20% of its assets in foreign issuers, then all of such investment may be in
issuers domiciled or primarily traded in one country. If the Global Account has
at least 20% but less than 40% of its assets in foreign issuers, then
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THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D (CONTINUED)
such investment must be allocated to issuers domiciled or primarily traded in at
least two different countries. Similarly, if the Global Account has at least 40%
but less than 60% of its assets in foreign issuers, such investment must be
allocated in at least three different countries. Foreign investments must be
allocated to at least four different countries if at least 60% of the Global
Account's assets is in foreign issuers, and to at least five different countries
if at least 80% of its assets is in foreign issuers.
The Global Account may have no more than 20% of its net assets invested in
securities of issuers domiciled or primarily traded in any one country, except
that the Global Account may have an additional 15% of its net assets invested in
securities of issuers domiciled or primarily traded in any one of the following
countries: Australia, Canada, France, Germany, Japan and The United Kingdom. The
Global Account's investments in U.S. issuers are not subject to these foreign
country diversification guidelines.
RISK FACTORS
The Global Account's investment policies and certain of the investment
techniques in which the Global Account may engage involve certain risks. For
instance, the Global Account will invest in non-U.S. dollar-denominated
securities of foreign issuers. Investing in such securities involves different
risk considerations than investing in securities of U.S. issuers, including the
risks of investment in foreign countries, foreign exchange rate fluctuations,
exchange controls, and others. The Global Account may also engage in
transactions in financial futures Contracts, both domestic and foreign, and in
various put and call options. The Global Account may also engage in foreign
currency transactions and options on foreign currencies. Risks associated with
these techniques are described more fully under "Securities and Investment
Techniques."
In general, because investment in foreign issuers will usually involve
currencies of foreign countries, and because the Global Account may be exposed
to currency risk independent of its securities positions, the value of the
assets of the Global Account as measured in U.S. dollars will be affected by
changes in foreign currency exchange rates. To the extent that the Global
Account's assets consist of investments denominated in a particular currency,
the Global Account's exposure to adverse developments affecting the value of
that currency will increase. Foreign currency exchange rates may fluctuate
significantly over short periods of time. They generally are determined by the
forces of supply and demand in the foreign exchange markets and the relative
merits of investment in different countries, actual or perceived changes in
interest rates, and other complex factors, as seen from an international
perspective. Currency exchange rates also can be affected unpredictably by
intervention by U.S. or foreign governments or central banks in the availability
of money or interest rates, by the failure to intervene, by currency controls,
or by political and economic developments in the U.S. or abroad. The market in
forward foreign currency exchange Contracts and other privately negotiated
currency instruments offers less protection against defaults by the other party
to such instruments than is available for currency instruments traded on an
exchange. To the extent that a substantial portion of the Global Account's total
assets, adjusted to reflect the Global Account's net position after giving
effect to currency transactions, is denominated in the currencies of foreign
countries, the Global Account will be more susceptible to the risk of adverse
economic and political developments within those countries.
In addition, because of the Global Account's flexible investment policy,
portfolio turnover may be greater than for a portfolio that does not allocate
assets among various types of securities and among various countries and
regions. A higher rate of portfolio turnover involves correspondingly greater
brokerage expenses which must be borne by the Global Account (and indirectly by
investors allocating Accumulation Value to the Global Account), and may under
certain circumstances make it more difficult for the Global Account to qualify
as a regulated investment company under the Code.
There can be no assurance that the Global Account will achieve its investment
objective. Investors should be aware that the value of the Global Account's
assets will fluctuate and a Contract Owner's Accumulation Value will increase
and decrease in value as the market value of the securities and other assets in
which the Global Account invests fluctuates.
The Global Account is intended for long-term investors who can accept the risks
involved in investments in foreign securities. The Global Account does not
purport to offer a complete investment program to which a prudent investor would
commit all of his or her investment capital, nor is it intended for investors
whose principal objective is income.
BOARD OF GOVERNORS OF ACCOUNT D
The business and affairs of Account D are managed under the direction of a Board
of Governors, which
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THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D (CONTINUED)
currently consists of five members. The Board of Governors has responsibility
for the investment management-related operations of Account D and matters
arising under the 1940 Act. The Board of Governors does not have responsibility
for the payment of obligations under the Contract and administration of the
Contract. These matters are Golden American's responsibility. The business and
affairs of Account D are governed under a set of rules adopted by the Board of
Governors called "Rules and Regulations of Separate Account D."
THE MANAGER
DSI serves as Manager to Account D pursuant to a Management Agreement with
Account D. The Manager is a corporation organized under the laws of the State of
New York. Its address is 1001 Jefferson Street, Wilmington, DE 19801. DSI is a
wholly owned subsidiary of BT Variable, Inc., which is an indirect subsidiary of
Bankers Trust Company. DSI's business activities include those of a distributor
and underwriter of variable insurance products, broker-dealer and investment
manager. DSI is registered with the SEC as a broker-dealer and investment
adviser and is a member of the NASD. It is also registered as a broker-dealer
and/or investment adviser in various states.
U.S. banking laws and regulations, including the Glass-Steagall Act as currently
interpreted by the Board of Governors of the Federal Reserve System (the
"Board"), prohibit a bank holding company registered under the Bank Holding
Company Act of 1956, or any affiliate thereof, from sponsoring, organizing,
controlling, or distributing the shares of a registered open-end investment
company, which may for these purposes include the Global Account, continuously
engaged in the issuance of its securities and, except as otherwise provided by
order of the Board, prohibit banks generally from issuing, underwriting,
selling, or distributing securities. The same laws and regulations generally
permit a bank or bank affiliate to act as investment adviser, transfer, dividend
disbursing, and shareholder servicing agent and custodian to an investment
company and to purchase such shares as agent for and upon the order of a
customer.
Golden American and DSI perform the activities described above in this
prospectus and in Part I, under the caption "Selling the Contracts." As
discussed in Part I, under the caption "Golden American," Bankers Trust is
likely to divest its ownership of the stock of Golden American and DSI in the
future. In addition, judicial or administrative decisions or interpretations, as
well as changes in either U.S. Federal or state banking statutes or regulations,
could prevent Golden American from performing activities with respect to Account
D, prevent DSI from performing the activities described in this prospectus, or
prevent Bankers Trust Company from continuing to own the stock of Golden
American or DSI. If any such event were to occur, changes in the operation of
Account D and the Global Account might occur. It is not expected, however, that
Account D or the Global Account would suffer adverse financial consequences as a
result of such occurrence.
As discussed in Part I, DSI also currently provides management and
administrative services to the Trust. DSI's officers have extensive experience
in the development and distribution of investment products, specifically,
variable life insurance policies, variable annuity Contracts, and management
investment companies that serve as investment media for such policies and
Contracts.
Under the Management Agreement, DSI has overall responsibility, subject to the
supervision of the Board of Governors, for administering all operations of the
Global Account and for monitoring and evaluating the management of the assets of
the Global Account by the Portfolio Manager. The Manager is also responsible for
monitoring and evaluating the Portfolio Manager on a periodic basis, and will
consider its performance record with respect to the investment objective and
policies of the Global Account. The Management Agreement may be terminated
without penalty by the vote of the Board of Governors or the Contract Owners of
the Global Account, or by the Manager, on 60 days' written notice by the Board
or the Manager and will terminate automatically if assigned as that term is
described in the 1940 Act.
As Manager, DSI provides the overall business management and administrative
services necessary for the Global Account's operation. The Manager furnishes or
procures on behalf of the Global Account the services and information necessary
to the proper conduct of the Global Account's business. The Manager also acts as
liaison among the various service providers to the Global Account, including the
custodian, portfolio accounting personnel, Portfolio Manager, counsel, and
auditors. The Manager is also responsible for ensuring that the Global Account
operates in compliance with applicable legal requirements and for monitoring the
Portfolio Manager for compliance with requirements under applicable law and with
the investment policies and restrictions of the Global Account.
Pursuant to the Management Agreement, the Manager is authorized to exercise full
investment discretion and make all determinations with respect to the
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THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D (CONTINUED)
investment of the Global Account's assets and the purchase and sale of
securities for the Global Account in the event that at any time a portfolio
manager is not engaged to manage the assets of the Global Account. In such
event, the Management Agreement provides that the Manager will be entitled to,
in addition to its usual compensation for services as Manager, as described
below, a fee that would otherwise be paid to the Portfolio Manager. For more
information on the Management Agreement, see the Statement of Additional
Information.
For operating expenses under the Management Agreement see Part I, Charges and
Fees, Operating Expenses of Account D.
The Global Account and DSI have entered into an agreement to limit the total
expenses of the Global Account, excluding mortality and expense risk charges,
asset based administrative charges and other contractual charges, through
December 31, 1996, so that such expenses do not exceed on an annual basis: 1.25%
of the first $500 million of average daily net assets and 1.05% of the excess
over $500 million.
The initial organizational expenses of the Global Account were advanced by
Golden American. The Global Account reimburses Golden American for such
expenses, which are amortized over five years from the date of the Global
Account's commencement of operations.
THE PORTFOLIO MANAGER
Warburg, Pincus serves as the Portfolio Manager of the Global Account and in
that capacity provides investment advisory services for the Global Account,
including asset allocation and security selection. The Portfolio Manager's
address is 466 Lexington Avenue, New York, New York 10017. The Global Account,
the Manager, and the Portfolio Manager have entered into a Portfolio Management
Agreement under which the Portfolio Manager has full investment discretion and
makes all determinations with respect to the investment of the Global Account's
assets and the purchase and sale of securities and other investments. The
Portfolio Management Agreement may be terminated without penalty by the vote of
the Board of Governors or the Contract Owners of the Global Account, by the
Portfolio Manager, or by the Manager, on 60 days' written notice by any party to
the Portfolio Management Agreement and will terminate automatically if assigned
as that term is described in the 1940 Act.
Warburg, Pincus was incorporated in Delaware on December 15, 1970. Warburg,
Pincus is a professional investment counselling firm which provides investment
services to investment companies, employee benefit plans, endowment funds,
foundations and other institutions and individuals. The Portfolio Manager is
registered with the SEC as an investment adviser.
The individual primarily in charge of portfolio management decisions for the
Global Account is Richard H. King. Mr. King, a Senior Managing Director of E.M.
Warburg, Pincus & Co., Inc. ("EMW"), has been with Warburg, Pincus since 1989,
before which time he was chief investment officer and director of Fiduciary
Trust Company International. P. Nicholas Edwards, Nicholas P.W. Horsley, Harold
W. Ehrlich and Vincent J. McBride also exercise significant portfolio management
responsibilities with respect to the Global Account. Mr. Edwards, a Senior Vice
President of Warburg, Pincus, has been with Warburg Pincus since August 1995,
before which time he was a director at Jardine Fleming Investment Advisers,
Tokyo. Mr. Horsley, a Senior Vice President of Warburg, Pincus, has been with
Warburg, Pincus since 1993, before which time he was a director, portfolio
manager and analyst at Barclays DeZoete Wedd in New York City. Mr. Ehrlich, a
Senior Vice President with Warburg, Pincus, has been with Warburg, Pincus since
February 1995, before which time he was a senior vice president, portfolio
manager and analyst at Templeton Investment Counsel Inc. Mr. McBride has been
with Warburg, Pincus since 1994. Prior to joining Warburg, Pincus, Mr. McBride
was an international equity analyst at Smith Barney Inc. from 1993 to 1994 and
at General Electric Investment Corporation from 1992 to 1993. From 1989 to 1992
he was a portfolio manager/analyst at United Jersey Bank.
As of February 29, 1996, Warburg, Pincus managed approximately $14.0 billion of
assets, including approximately $7.7 billion of investment company assets. The
Portfolio Manager is a wholly-owned subsidiary of Warburg, Pincus Counsellors
G.P., a New York general partnership which has no business other than being a
holding company of Warburg, Pincus and its subsidiaries. EMW is deemed to
control Warburg, Pincus through its ownership of a class of voting preferred
stock of Warburg, Pincus.
From the commencement of operations of the Global Account through June 30, 1994,
Zulauf Asset Management AG served as portfolio manager for the Global Account.
Warburg, Pincus assumed management of the Global Account on July 1, 1994.
For operating expenses under the Portfolio Management Agreement see Part I,
Charges and Fees, Operating Expenses of Account D.
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THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D (CONTINUED)
CUSTODIAN
The Custodian for the Global Account is Bankers Trust Company. FirstData
Corporation provides portfolio accounting services for the Global Account.
SECURITIES AND INVESTMENT TECHNIQUES
The following discussion describes different types of securities and investment
techniques that may be used by the Global Account, as well as the risks
associated with such securities and techniques. For more detailed information on
these securities and investment techniques, and for information on other
securities and investment techniques that may be used by the Global Account,
including U.S. Government securities, debt securities, foreign securities,
repurchase agreements, short sales, futures Contracts, options on securities and
foreign currency transactions, see the discussion in the Statement of Additional
Information on "Securities and Investment Techniques."
FOREIGN SECURITIES
The Global Account may invest in equity and debt securities of foreign
issuers, in American Depository Receipts ("ADRs"), in foreign government
securities that are denominated in either U.S. dollars or foreign currencies,
and in foreign branches of commercial banks and foreign banks.
Investments in foreign securities offer potential benefits not available
solely in securities of domestic issuers by offering the opportunity to invest
in foreign issuers that appear to offer growth potential, or in foreign
countries with economic policies or business cycles different from those of
the United States, or to reduce fluctuations in portfolio value by taking
advantage of foreign stock markets that may not move in a manner parallel to
U.S. markets. Investments in securities of foreign issuers involve certain
risks not ordinarily associated with investments in securities of domestic
issuers. Such risks include fluctuations in foreign exchange rates, future
political and economic developments, and the possible imposition of exchange
controls, restrictions on investment or the flow of capital, or other foreign
governmental laws or restrictions. Since the Global Account may invest in
securities denominated or quoted in currencies other than the U.S. dollar,
changes in foreign currency exchange rates will affect the value of securities
in the portfolio and the unrealized appreciation or depreciation of
investments as denominated in U.S. dollars. While the Global Account may
employ certain investment techniques to hedge its foreign currency exposure,
such techniques also entail certain risks. In addition, with respect to
certain countries, there is the possibility of expropriation of assets,
confiscatory taxation, other foreign taxation, political or social
instability, or diplomatic developments that could adversely affect
investments in those countries.
There may be less publicly available information about a foreign company than
about a U.S. company, and foreign companies may not be subject to accounting,
auditing, and financial reporting standards and requirements comparable to or
as uniform as those of U.S. companies. Foreign securities markets, while
growing in volume, have, for the most part, substantially less volume than
U.S. markets. Securities of many foreign companies are less liquid and their
prices more volatile than securities of comparable U.S. companies.
Transactional costs in non-U.S. securities markets are generally higher than
in U.S. securities markets. There is generally less government supervision and
regulation of exchanges, brokers, and issuers than there is in the United
States. The Global Account might have greater difficulty taking appropriate
legal action with respect to foreign investments in non-U.S. courts than with
respect to domestic issuers in U.S. courts. In addition, transactions in
foreign securities may involve greater time from the trade date until
settlement than domestic securities transactions. Clearance and settlement
procedures in certain foreign countries have not developed at the same pace as
the related securities markets, making it difficult to execute desired
transactions. Delays in settlement could result in temporary periods when a
portion of the assets of the Global Account are uninvested and no return is
earned thereon. The inability of the Global Account to make intended
investments due to settlement problems could cause it to miss attractive
investment opportunities. Inability to dispose of securities or other
investments due to settlement problems could result either in losses to the
Global Account due to subsequent declines in value of the investment, or
possible liability to a purchaser. Foreign investments also involve the risk
of possible losses through the holding of securities by custodians and
securities depositories in foreign countries.
Interest income and gains from foreign securities may generally be subject to
withholding taxes by the country in which the issuer is located.
SHORT SALES
The Global Account may make short sales of securities. A short sale is a
transaction in which the Global
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Account sells a security it does not own in anticipation of a decline in
market price. The Global Account may make short sales to offset a potential
decline in a long position or a group of long positions, or if the Portfolio
Manager believes that a decline in the price of a particular security or group
of securities is likely.
The Global Account's obligation to replace a security borrowed in connection
with the short sale will be secured by collateral deposited with the broker,
consisting of cash or U.S. Government securities or other securities
acceptable to the broker. In addition, with respect to any short sale, other
than short sales against the box, the Global Account will be required to
deposit collateral consisting of cash, cash items, or U.S. Government
securities in a segregated account with its custodian in an amount such that
the value of the sum of both collateral deposits (not including the proceeds
from the short sale) is at all times equal to at least 100% of the current
market value of the securities sold short. The deposits do not necessarily
limit the Global Account's potential loss on a short sale, which may exceed
the entire amount of the collateral.
If the price of the security sold short increases between the time of the
short sale and the time the Global Account replaces the borrowed security, the
Global Account will incur a loss, and if the price declines during this
period, the Global Account will realize a capital gain. Any realized gain will
be decreased, and any incurred loss increased, by the amount of transactional
costs and any premium, dividend, or interest which the Global Account may have
to pay in connection with such short sale. Account D may have to pay a premium
to borrow the securities sold short and must pay any dividends or interest
payable on the securities until they are replaced. Possible losses from short
sales differ from losses that could be incurred from a purchase of a security,
because losses from short sales may be unlimited, whereas losses from
purchases of a security can equal only the total amount invested.
The Global Account may make a short sale only if, at the time the short sale
is made and after giving effect thereto, the market value of all securities
sold short is 25% or less of the value of its net assets. The Global Account
is not required to liquidate an existing short sale position solely because a
change in market values has caused this percentage limitation to be exceeded.
FUTURES CONTRACTS
The Global Account may purchase and sell stock index futures Contracts,
interest rate futures Contracts, and futures Contracts based upon securities,
which may be domestic or foreign, and corporate or governmental, foreign
exchange futures Contracts and other financial futures Contracts, and may
purchase and write options on such Contracts.
The Global Account may engage in such futures transactions as an adjunct to
its securities activities. The Global Account's transactions in futures
transactions must constitute bona fide hedging or other permissible
transactions under regulations promulgated by the Commodity Futures Trading
Commission ("CFTC"), under which a fund engaging in futures transactions would
not be deemed a "commodity pool." Under these regulations, the Global Account
may enter into futures and options (1) for "bona fide hedging" purposes,
without regard to the percentage of assets committed to initial margin and
options premiums, or (2) for other strategies, provided that the aggregate
initial margin and premiums required to establish such positions do not exceed
5% of the liquidation value of the Global Account's portfolio, after taking
into account unrealized profits and unrealized gains on any such Contracts
entered into. Transactions in futures Contracts and options on futures
Contracts may also be limited by the requirements of the Code for
qualification as a regulated investment company. Other requirements are
described in the Statement of Additional Information.
There are several risks associated with the use of futures and futures
options. While the Global Account's hedging transactions may protect the
Global Account against adverse movements in the general level of interest
rates, securities prices, currency exchange rates, or other economic
conditions, such transactions could also preclude the Global Account from the
opportunity to benefit from favorable movements in the level of interest
rates, securities prices, currency exchange rates, or other economic
conditions. There can be no guarantee that there will be correlation between
price movements in the hedging vehicle and in the portfolio securities or
currency being hedged. An incorrect correlation could result in a loss on both
the hedged securities in the Global Account and the hedging vehicle so that
the Global Account's return might have been better if hedging had not been
attempted. The loss that could be incurred by the Global Account in writing
options on futures is potentially unlimited.
60
<PAGE>
THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D (CONTINUED)
There can be no assurance that a liquid market will exist at a time when the
Global Account seeks to close out a futures Contract or a futures option
position. Most futures exchanges and boards of trade limit the amount of
fluctuation permitted in futures Contract prices during a single day; once the
daily limit has been reached on a particular Contract, no trades may be made
that day at a price beyond that limit. In addition, certain of these
instruments are relatively new and without a significant trading history. As a
result, there is no assurance that an active secondary market will develop or
continue to exist. The daily limit governs only price movements during a
particular trading day and therefore does not limit potential losses because
the limit may work to prevent the liquidation of unfavorable positions. For
example, futures prices have occasionally moved to the daily limit for several
consecutive trading days with little or no trading, thereby preventing prompt
liquidation of positions and subjecting some holders of futures Contracts to
substantial losses. Lack of a liquid market for any reason may prevent the
Global Account from liquidating an unfavorable position and the Global Account
would remain obligated to meet margin requirements and continue to incur
losses until the position is closed.
The Global Account will only enter into futures Contracts or futures options
which are standardized and traded on a U.S. or foreign exchange or board of
trade, or similar entity, or quoted on an automated quotation system, or in
the case of futures options, for which an established over-the-counter market
exists.
The Global Account may engage in futures Contracts and options on futures
Contracts not only on U.S. domestic markets, but also on exchanges and other
markets outside of the United States. Foreign markets may offer advantages
such as trading in indices that are not currently traded in the United States.
Foreign markets, however, may have greater risk potential than domestic
markets. Unlike trading on domestic commodity exchanges, trading on foreign
commodity markets is not regulated by the CFTC and may be subject to greater
risk than trading on domestic exchanges. For example, some foreign exchanges
are principal markets so that no common clearing facility exists and a trader
may look only to the broker for performance of the Contract. Trading in
foreign futures or foreign options Contracts may not be afforded certain of
the protective measures provided by the Commodity Exchange Act, the CFTC's
regulations, and the rules of the National Futures Association and any
domestic exchange, including the right to use reparations proceedings before
the CFTC and arbitration proceedings provided by the National Futures
Association or any domestic futures exchange. Amounts received for foreign
futures or foreign options transactions may not be provided the same
protections as funds received in respect of transactions on United States
futures exchanges. In addition, the Global Account could incur losses or lose
any profits that had been realized in trading by adverse changes in the
exchange rate of the currency in which the transaction is denominated.
Transactions on foreign exchanges may include both commodities that are traded
on domestic exchanges and boards of trade and those that are not.
OPTIONS ON SECURITIES AND SECURITIES INDICES
The Global Account may purchase and write put and call options on securities
and on securities indices. The Global Account will purchase and write only
options that are standardized and traded on a U.S. or foreign exchange or
board of trade, or for which an established over-the-counter market exists.
The ability to terminate over-the-counter options is more limited than with
exchange-traded options, and may involve the risk that broker-dealers
participating in such transactions will not fulfill their obligations. Until
such time as the staff of the SEC changes its position, the Global Account
will treat purchased over-the-counter options and all assets used to cover
written over-the-counter options as illiquid securities. However, for options
written with primary dealers in U.S. Government securities pursuant to an
agreement requiring a closing purchase transaction at a formula price, the
amount of illiquid securities may be calculated with reference to a formula
approved by the SEC staff.
The Global Account may write a call or put option only if the option is
"covered" by the Global Account holding a position in the underlying
securities or by other means that would permit immediate satisfaction of the
Global Account's obligation as writer of the option, typically deposit with
the Global Account's custodian of cash, U.S. Government securities, or other
high grade liquid debt securities with a value at least equal to the exercise
price of the put option, or the price at which a security underlying a call
option can be acquired.
The purchase and writing of options involves certain risks. During the option
period, the covered call writer has, in return for the premium on the option,
given up the opportunity to profit from a price increase in the underlying
securities above the exercise price, but, as long as its obligation as a
writer
61
<PAGE>
THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D (CONTINUED)
continues, has retained the risk of loss should the price of the underlying
security decline. The writer of an option has no control over the time when it
may be required to fulfill its obligation as a writer of the option. Once an
option writer has received an exercise notice, it cannot effect a closing
purchase transaction in order to terminate its obligation under the option and
must deliver the underlying securities at the exercise price. If a put or call
option purchased by the Global Account is not sold when it has remaining
value, and if the market price of the underlying security, in the case of a
put, remains equal to or greater than the exercise price or, in the case of a
call, remains less than or equal to the exercise price, the Global Account
will lose its entire investment in the option. Also, where a put or call
option on a particular security is purchased to hedge against price movements
in a related security, the price of the put or call option may move more or
less than the price of the related security.
There can be no assurance that a liquid market will exist when the Global
Account seeks to close out an option position. Furthermore, if trading
restrictions or a suspension is imposed on the options markets, the Global
Account may be unable to close out a position. If the Global Account cannot
effect a closing transaction, it will not be able to sell the underlying
security while the previously written option remains outstanding, even though
it might otherwise be advantageous to do so. The Global Account pays brokerage
commissions or spreads in connection with its options transactions. The
writing of options could significantly increase portfolio turnover rate.
FOREIGN CURRENCY TRANSACTIONS
The Global Account may enter into forward currency Contracts and enter into
currency exchange transactions on a spot (i.e., cash) basis. A forward
currency Contract is an obligation to purchase or sell a currency against
another currency at a future date and price as agreed upon by the parties. The
Global Account may either accept or make delivery of the currency at the
maturity of the forward Contract or, prior to maturity, enter into a closing
transaction involving the purchase or sale of an offsetting Contract. The
Global Account may engage in forward currency transactions in anticipation of
or to protect itself against fluctuations in currency exchange rates, and
entering into a forward currency Contract will expose the Global Account to
the risk of adverse changes in the exchange rate of the currency that is
subject to the Contract. The Global Account may also enter into a forward
currency Contract for non-hedging purposes. Forward currency Contracts are
further described in the Statement of Additional Information.
If the Global Account engages in an offsetting transaction to terminate its
contractual obligation under a forward currency Contract, the Global Account
will incur a gain or a loss to the extent that there has been movement in
forward Contract prices. For more information on closing a forward currency
position, including information on associated risks, see the Statement of
Additional Information.
In hedging transactions, the precise matching of forward currency Contracts
and the value of the securities involved will not generally be possible since
the future value of the securities in foreign currencies will change as a
consequence of market movements in the value of those securities between the
date the forward Contract is entered into and the date it matures. Projection
of short-term currency market movements is extremely difficult, and the
successful execution of a short-term hedging strategy is highly uncertain.
While forward foreign currency Contracts tend to minimize the risk of loss due
to a decline in the value of a hedged currency, at the same time, they tend to
limit any potential gain which might result should the value of such currency
increase.
Forward Contracts are not traded on regulated commodities exchanges. There can
be no assurance that a liquid market will exist when the Global Account seeks
to enter into or close out a forward currency position, in which case the
Global Account might not be able to effect a closing purchase transaction at
any particular time. In addition, the Global Account entering a forward
foreign currency Contract incurs the risk of default by the counter party to
the transaction. Forward currency Contracts offer less protection against
defaults than is available when trading in currencies on an exchange. Because
a forward currency Contract is not guaranteed by an exchange or clearinghouse,
a default on the Contract would deprive the Global Account of unrealized
profits or force the Global Account to cover its commitments for purchase or
resale, if any, at the current market price.
Although the Global Account values its assets daily in terms of U.S. dollars,
it does not intend physically to convert its holdings of foreign currencies
into U.S. dollars on a daily basis. The Global Account may do so from time to
time, and investors should be aware of the costs of currency conversion.
Although foreign exchange dealers do not charge a fee for conversion, they do
realize a profit based on the
62
<PAGE>
THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D (CONTINUED)
difference (the "spread") between the prices at which they are buying and
selling various currencies. Thus, a dealer may offer to sell a foreign
currency to the Global Account at one rate, while offering a lesser rate of
exchange should the Global Account desire to resell that currency to the
dealer.
The Global Account will place cash or high grade liquid debt securities into a
segregated account in an amount equal to the value of the Global Account's
total assets committed to the consummation of forward currency Contracts
requiring the Global Account to purchase foreign currencies or forward
Contracts entered into for non-hedging purposes. If the value of the
securities placed in the segregated account declines, additional cash or
securities will be placed in the account on a daily basis so that the value of
the account will equal the amount of the Global Account's commitments with
respect to such Contracts. The segregated account will be marked-to-market on
a daily basis. Although the Contracts are not presently regulated by the CFTC,
the CFTC may in the future assert authority to regulate these Contracts. In
such event, the Global Account's ability to utilize forward currency Contracts
may be restricted.
OPTIONS ON FOREIGN CURRENCIES
The Global Account may purchase and write call and put options on foreign
currencies. Such options will expose the Global Account to the risk of adverse
changes in the exchange rate of the currency that is subject to the option.
The Global Account may employ options on foreign currencies to increase or
shift exposure to a currency and as a hedge against changes in the value of
the U.S. dollar (or another currency) in relation to a foreign currency in
which portfolio securities of the Global Account may be denominated. Hedging
against a change in the value of a foreign currency with an option on the
foreign currency does not eliminate fluctuations in the prices of portfolio
securities or prevent losses if the prices of such securities decline.
Furthermore, such hedging transactions reduce or preclude the opportunity for
gain if the value of the hedged currency should change relative to the U.S.
dollar. The Global Account may use options on currency to cross-hedge, which
involves writing or purchasing options on one currency to hedge against
changes in exchange rates for a different currency, if there is a pattern of
correlation between the two currencies.
Currency options traded on U.S. or other exchanges may be subject to position
limits that may limit the ability of the Global Account to reduce foreign
currency risk using such options. Over-the-counter options differ from traded
options in that they are two-party Contracts with price and other terms
negotiated between buyer and seller and generally do not have as much market
liquidity as exchange-traded options. There is no assurance that a liquid
secondary market will exist for any particular option, or at any particular
time. In the event no liquid secondary market exists, it might not be possible
to effect closing transactions in particular currency options. If the Global
Account cannot close out an option that it holds, it would have to exercise
its option in order to realize any profit and would incur transactional costs
on the sale of the underlying assets.
BORROWING
The Global Account may borrow up to 10% of the value of its net assets. For
temporary purposes, such as to facilitate redemptions, the Global Account may
increase its borrowings up to 25% of its net assets. Reverse repurchase
agreements, short sales of securities, and sales of securities against the box
will be included as borrowing subject to the borrowing limitations described
above, except that the Global Account is permitted to engage in short sales of
securities with respect to an additional 15% of the Global Account's net
assets in excess of the limits otherwise applicable to borrowing. Securities
purchased on a when-issued or delayed delivery basis will not be subject to
the Global Account's borrowing limitations to the extent that the Global
Account establishes and maintains liquid assets in a segregated account with
the Global Account's custodian equal to the Global Account's obligations under
the when-issued or delayed delivery arrangement.
INVESTMENT RESTRICTIONS
The Global Account is subject to investment restrictions that are described in
the Statement of Additional Information. Those investment restrictions so
designated and the investment objective are "fundamental policies" of the Global
Account, which means that they may not be changed without a majority vote of the
Contract Owners with Accumulation Value allocated to the Global Account. Except
for those restrictions specifically identified as fundamental and the Global
Account's investment objective, all other investment policies and practices
described in this prospectus and Statement of Additional Information are not
fundamental, meaning that the Board of Governors may change them without
Contract Owner approval.
63
<PAGE>
THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D (CONTINUED)
BROKERAGE SERVICES
Pursuant to the Portfolio Management Agreement, the Portfolio Manager places
orders for the purchase and sale of portfolio investments for the Global Account
with brokers or dealers selected by the Portfolio Manager in its discretion. In
executing transactions, the Portfolio Manager will attempt to obtain the best
execution. In transactions on stock exchanges in the United States, payment of
brokerage commissions are negotiated. In effecting purchases and sales of
portfolio securities in transactions on U.S. stock exchanges, the Global Account
may pay higher commission rates than the lowest available when the Portfolio
Manager believes it is reasonable to do so in light of the value of the
brokerage and research services provided by the broker effecting the
transaction. In the case of securities traded on some foreign stock exchanges,
brokerage commissions may be fixed and the Portfolio Manager may be unable to
negotiate commission rates for these transactions. In the case of securities
traded on the over-the-counter markets, there is generally no stated commission,
but the price includes an undisclosed commission or markup.
Some securities considered for investment by the Global Account may also be
appropriate for other clients served by the Portfolio Manager and/or its
affiliates. If a purchase or sale of securities consistent with the investment
policies of the Global Account and one or more of these clients served by the
Portfolio Manager and/or its affiliates is considered at or about the same time,
transactions in such securities will be allocated among the Global Account and
clients in a manner deemed fair and reasonable by the Portfolio Manager and/or
its affiliates. Although there is no specified formula for allocating such
transactions, the various allocation methods used by the Portfolio Manager, and
the results of such allocations, are subject to periodic review by the Manager
and Account D's Board of Governors.
The Portfolio Manager may place orders for the purchase of portfolio securities
with an affiliated broker-dealer where, in the judgment of the Portfolio
Manager, such firm will be able to obtain a price and execution at least as
favorable as other qualified brokers. Counsellors Securities Inc. is a
registered broker-dealer and an affiliate of the Portfolio Manager.
PORTFOLIO TURNOVER
It is anticipated that the Global Account's annual rate of portfolio turnover
normally will not exceed 100%. Portfolio turnover for the Global Account will
vary from year to year, and depending on market conditions, the portfolio
turnover rate could be greater in periods of unusual market movement. A higher
turnover rate would result in heavier brokerage commissions or other
transactional expenses which must be borne, directly or indirectly, by the
Global Account and ultimately by the Global Account's Contract Owners. For
information on the calculation of the portfolio turnover rate, see the
Statement of Additional Information.
64
<PAGE>
REPORT OF INDEPENDENT AUDITORS
Board of Directors and Stockholder
Golden American Life Insurance Company
We have audited the accompanying balance sheets of Golden American Life
Insurance Company (the "Company") as of December 31, 1995 and 1994 and the
related statements of operations, changes in stockholder's equity, and cash
flows for each of the three years in the period ended December 31, 1995. These
financial statements are the responsibility of the Company's management. Our
responsibility is to express an opinion on these financial statements based on
our audits.
We conducted our audits in accordance with generally accepted auditing
standards. Those standards require that we plan and perform the audit to obtain
reasonable assurance about whether the financial statements are free of material
misstatement. An audit includes examining, on a test basis, evidence supporting
the amounts and disclosures in the financial statements. An audit also includes
assessing the accounting principles used and significant estimates made by
management, as well as evaluating the overall financial statement presentation.
We believe that our audits provide a reasonable basis for our opinion.
In our opinion, the financial statements referred to above present fairly,
in all material respects, the financial position of Golden American Life
Insurance Company at December 31, 1995 and 1994, and the results of its
operations and its cash flows for each of the three years in the period ended
December 31, 1995, in conformity with generally accepted accounting principles.
/s/ ERNST & YOUNG LLP
February 12, 1996
65
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
BALANCE SHEETS
(IN THOUSANDS, EXCEPT SHARE AMOUNT)
<TABLE>
<CAPTION>
DECEMBER 31
-----------------------------
1995 1994
-------------- -------------
<S> <C> <C>
ASSETS
Investments:
Fixed maturities at market value (amortized cost $48,671 and $ --)............... $ 49,629 $ --
Fixed maturities held to maturity, at amortized cost (market -- $2,659).......... -- 2,749
Short-term investments, at cost, which approximates market....................... 15,614 13,933
Equity securities, at market (cost $27 and $17).................................. 29 16
Policy loans..................................................................... 2,021 513
-------------- -------------
Total investments.............................................................. 67,293 17,211
Cash............................................................................... (323) 3,316
Accrued investment income.......................................................... 768 92
Due from affiliates and separate accounts.......................................... 1,127 963
Deferred policy acquisition costs.................................................. 67,314 60,662
Unamortized cost assigned to insurance contracts in force.......................... 6,057 7,620
Funds held in escrow pursuant to an Exchange Agreement............................. 4,150 2,757
Due from reinsurers................................................................ 2,062 1,713
Other assets....................................................................... 287 134
Separate account assets............................................................ 1,048,953 950,292
-------------- -------------
Total assets................................................................... $ 1,197,688 $ 1,044,760
-------------- -------------
-------------- -------------
LIABILITIES AND STOCKHOLDER'S EQUITY
Liabilities:
Insurance and annuity reserves (including $1,641 and $17 of unamortized deferred
sales load)..................................................................... $ 33,673 $ 1,051
Due to affiliates and separate accounts.......................................... 675 660
Accrued expenses and other liabilities........................................... 1,329 1,053
Payable for investment purchases................................................. 7,938 --
Unearned revenue................................................................. 6,556 1,759
Adjustable principal amount promissory note, 7.50%, due 1997..................... 439 439
Separate account liabilities (including $41,566 and $48,924 of unamortized
deferred sales load)............................................................ 1,048,953 950,292
-------------- -------------
Total liabilities.............................................................. 1,099,566 955,254
Commitments and contingencies
STOCKHOLDER'S EQUITY
Common stock, par value $10 per share, authorized, issued, and outstanding 250,000
shares............................................................................ 2,500 2,500
Redeemable preferred stock, par value $5,000 per share, 50,000 shares authorized,
10,000 issued and outstanding in.................................................. 50,000 50,000
Additional paid-in capital......................................................... 45,030 37,086
Net unrealized appreciation/(depreciation) of securities........................... 658 (1)
Retained earnings (deficit)........................................................ (63) (79)
-------------- -------------
Total stockholder's equity....................................................... 98,125 89,506
-------------- -------------
Total liabilities and stockholder's equity..................................... $ 1,197,688 $ 1,044,760
-------------- -------------
-------------- -------------
</TABLE>
SEE ACCOMPANYING NOTES.
66
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
STATEMENT OF OPERATIONS
(IN THOUSANDS)
<TABLE>
<CAPTION>
YEAR ENDED DECEMBER 31
--------------------------------
1995 1994 1993
---------- --------- ---------
<S> <C> <C> <C>
REVENUES
Variable life and annuity product fees and policy charges..................... $ 18,388 $ 17,519 $ 10,192
Management fee revenue........................................................ 987 -- --
Net investment income......................................................... 2,818 560 216
Realized capital gain (loss).................................................. 297 65 35
---------- --------- ---------
Total revenues................................................................ 22,490 18,144 10,443
EXPENSES
Policy benefits............................................................... 3,146 35 1,747
Commissions and overrides..................................................... 7,653 16,741 34,260
Salaries, benefits and other employee-related costs........................... 6,601 5,866 --
Financing charges and interest................................................ -- 1,962 726
Other general, administrative, and operating expenses......................... 7,628 7,665 9,248
Deferral of policy acquisition costs.......................................... (9,804) (23,119) (37,129)
Amortization of deferred policy acquisition costs............................. 2,710 4,608 2,027
Amortization of cost assigned to insurance contracts in force................. 1,552 2,164 1,357
---------- --------- ---------
Total expenses................................................................ 19,126 15,922 12,236
---------- --------- ---------
Net income (loss)............................................................. $ 3,364 $ 2,222 $ (1,793)
---------- --------- ---------
---------- --------- ---------
</TABLE>
SEE ACCOMPANYING NOTES.
67
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
STATEMENTS OF CHANGES IN STOCKHOLDER'S EQUITY
YEARS ENDED DECEMBER 31, 1995, 1994 AND 1993
(IN THOUSANDS, EXCEPT SHARE AMOUNT)
<TABLE>
<CAPTION>
SHARES SHARES
COMMON PREFERRED COMMON PREFERRED
STOCK STOCK STOCK STOCK
----------- ----------- ----------- -----------
<S> <C> <C> <C> <C>
Balances at January 1, 1993............................................. 150,000 $ 1,500
Issuance of common stock................................................ 100,000 1,000
Contribution of capital.................................................
Net loss................................................................
Change in unrealized appreciation of equity securities..................
----------- ----------- ----------- -----------
Balances at December 31, 1993........................................... 250,000 -- 2,500 --
Issuance of preferred stock............................................. 10,000 50,000
Contribution of capital.................................................
Net income..............................................................
Change in unrealized depreciation of equity securities..................
----------- ----------- ----------- -----------
Balances at December 31, 1994........................................... 250,000 10,000 2,500 50,000
Contribution of capital.................................................
Net income..............................................................
Preferred stock dividends...............................................
Change in unrealized depreciation of equity securities..................
----------- ----------- ----------- -----------
Balances at December 31, 1995........................................... 250,000 10,000 $ 2,500 $ 50,000
----------- ----------- ----------- -----------
----------- ----------- ----------- -----------
<CAPTION>
ADDITIONAL UNREALIZED RETAINED
PAID-IN APPRECIATION OF EARNINGS
CAPITAL EQUITY SECURITIES (DEFICIT)
----------- ------------------- -----------
<S> <C>
Balances at January 1, 1993............................................. $ 13,336 $ 14 $ (508)
Issuance of common stock................................................
Contribution of capital................................................. 15,000
Net loss................................................................ (1,793)
Change in unrealized appreciation of equity securities.................. 48 --
----------- ----- -----------
Balances at December 31, 1993........................................... 28,336 62 (2,301)
Issuance of preferred stock.............................................
Contribution of capital................................................. 8,750
Net income.............................................................. 2,222
Change in unrealized depreciation of equity securities.................. (63)
----------- ----- -----------
Balances at December 31, 1994........................................... 37,086 (1) (79)
Contribution of capital................................................. 7,944
Net income.............................................................. 3,364
Preferred stock dividends............................................... (3,348)
Change in unrealized depreciation of equity securities.................. 659
----------- ----- -----------
Balances at December 31, 1995........................................... $ 45,030 $ 658 $ (63)
----------- ----- -----------
----------- ----- -----------
<CAPTION>
TOTAL
STOCKHOLDER'S
EQUITY
---------------
Balances at January 1, 1993............................................. $ 14,342
Issuance of common stock................................................ 1,000
Contribution of capital................................................. 15,000
Net loss................................................................ (1,793)
Change in unrealized appreciation of equity securities.................. 48
---------------
Balances at December 31, 1993........................................... 28,597
Issuance of preferred stock............................................. 50,000
Contribution of capital................................................. 8,750
Net income.............................................................. 2,222
Change in unrealized depreciation of equity securities.................. (63)
---------------
Balances at December 31, 1994........................................... 89,506
Contribution of capital................................................. 7,944
Net income.............................................................. 3,364
Preferred stock dividends............................................... (3,348)
Change in unrealized depreciation of equity securities.................. 659
---------------
Balances at December 31, 1995........................................... $ 98,125
---------------
---------------
</TABLE>
SEE ACCOMPANYING NOTES.
68
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
STATEMENT OF CASH FLOWS
(IN THOUSANDS)
<TABLE>
<CAPTION>
YEAR ENDED DECEMBER 31
-----------------------------------
1995 1994 1993
----------- ---------- ----------
<S> <C> <C> <C>
OPERATING ACTIVITIES
Net income (loss).......................................................... $ 3,364 $ 2,222 $ (1,793)
Adjustments to reconcile net income (loss) to net cash used in operating
activities:
Amortization of deferred policy acquisition costs........................ 2,710 4,608 2,027
Amortization of cost assigned to insurance contracts in force............ 1,552 2,164 1,357
Change in unearned revenue............................................... 4,949 1,594 (1,141)
Increase in accrued investment income.................................... (676) (24) (1)
Change in due to/from affiliates and separate accounts................... (149) (3,299) 2,976
Changes in other assets, accrued expenses and other liabilities.......... (226) (1,552) 42
Policy acquisition costs deferred........................................ (9,804) (23,119) (37,129)
Change in insurance and annuity reserves................................. 4,664 (1,370) 550
Amortization of premium (discount) on fixed maturity investments and
funds held in escrow.................................................... (142) 13 --
----------- ---------- ----------
Net cash provided by (used in) operating activities........................ 6,242 (18,763) (33,112)
INVESTING ACTIVITIES
Purchases of fixed maturities.............................................. (61,723) (857) (543)
Sales of fixed maturities.................................................. 23,729 319 552
Purchases of common stock.................................................. (10) (7) (260)
Sales of common stock...................................................... -- 250 240
(Increase) decrease in policy loans........................................ (1,508) (369) 202
Funds held in escrow pursuant to an Exchange Agreement..................... (1,242) (1,382) (1,375)
----------- ---------- ----------
Net cash used in investing activities...................................... (40,754) (2,046) (1,184)
FINANCING ACTIVITIES
(Retirement) issuances of short-term debt.................................. -- (40,000) 33,600
Investment contract deposits............................................... 29,501 -- --
Investment contract withdrawals............................................ (1,543) -- --
Issuance of common stock................................................... -- -- 1,000
Issuance of preferred stock................................................ -- 50,000 --
Preferred stock dividend paid.............................................. (3,348) -- --
Contribution of capital by parent.......................................... 7,944 8,750 15,000
----------- ---------- ----------
Net cash provided by financing activities.................................. 32,554 18,750 49,600
----------- ---------- ----------
Net (decrease) increase in cash and short-term investments................. (1,958) (2,059) 15,304
Cash and short-term investments at beginning of year....................... 17,249 19,308 4,004
----------- ---------- ----------
Cash and short-term investments at end of year............................. $ 15,291 $ 17,249 $ 19,308
----------- ---------- ----------
----------- ---------- ----------
</TABLE>
SEE ACCOMPANYING NOTES.
69
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
NOTES TO FINANCIAL STATEMENTS
DECEMBER 31, 1995
1. ORGANIZATION
Effective September 30, 1992, Golden American Life Insurance Company
("Golden American") became a wholly-owned subsidiary of BT Variable, Inc.
("BTV"), an indirect wholly-owned subsidiary of Bankers Trust Company ("Bankers
Trust"). Previously, Golden American was owned by Mutual Benefit Life Insurance
Company in Rehabilitation ("Mutual Benefit"). Golden American is primarily
engaged in the issuance of variable insurance products and is licensed as a life
insurance company in the District of Columbia and all states except New York.
Effective December 30, 1993, Golden American was redomesticated from the State
of Minnesota to the State of Delaware.
In a transaction that closed on September 30, 1992, Bankers Trust acquired
from Mutual Benefit, in accordance with the terms of an Exchange Agreement, all
of the issued and outstanding capital stock of Golden American and Directed
Services, Inc. ("DSI"), an affiliate of Golden American, and certain related
assets and contributed them to BTV. The portion of the aggregate consideration
exchanged by Bankers Trust, allocable to Golden American, was valued at
approximately $11,600 thousand, subject to subsequent adjustment pursuant to the
Exchange Agreement. This allocation was based primarily on the estimated value
of insurance contracts in force and also included the acquisition of net
tangible assets of $400 thousand. The transaction involved settlement of pre-
existing claims of Bankers Trust against Mutual Benefit. The ultimate value of
these claims has not yet been determined by the Superior Court of New Jersey and
is contingently supported by a $5,000 thousand note payable from Golden American
and a $6,000 thousand letter of credit from Bankers Trust. The Golden American
note is secured by a pledge of Golden American's right to receive certain
deferred sales loads. Bankers Trust has estimated that the contingent liability
due from Golden American amounted to $439 thousand at December 31, 1995 and
1994. Golden American deposited with an escrow agent $1,225 thousand and $1,300
thousand in 1995 and 1994, respectively, pursuant to certain provisions of the
Exchange Agreement.
In addition, concurrent with the closing, Bankers Trust entered into an
agreement with Golden American to cause Golden American, commencing with the
closing and for so long as Bankers Trust continues to own, directly or
indirectly, all the issued and outstanding capital stock of Golden American, to
have at all times statutory capital and surplus of no less than the sum of (i)
$5,000 thousand and (ii) an amount equal to 1% of the statutory-basis separate
account liabilities of Golden American. During 1995, 1994, and 1993 BTV
contributed additional capital and paid-in surplus of $7,944 thousand, $8,750
thousand, and $16,000 thousand, respectively, to Golden American. In 1994,
Golden American issued $50,000 thousand of preferred stock that was purchased by
BTV for $50,000 thousand in cash.
2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
The preparation of the financial statements in conformity with generally
accepted accounting principles requires management to make estimates and
assumptions that affect the amounts reported in the financial statements and
accompanying notes. Actual results could differ from those estimates.
BASIS OF PRESENTATION
The accompanying financial statements have been presented in accordance with
generally accepted accounting principles ("GAAP"). The acquisition of Golden
American has been accounted for as a purchase by Bankers Trust and, accordingly,
the acquired assets and liabilities were recorded at their estimated fair values
at September 30, 1992. In accordance with requirements of the Securities and
Exchange Commission, this new basis of accounting has been "pushed down" to
Golden American.
INVESTMENTS
Fixed maturities are considered available for sale and are carried at market
in 1995. Previously fixed maturities were treated as held until maturity and
carried at cost. Short-term investments are carried at cost, which approximates
market. Equity securities, principally investments in mutual
70
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
NOTES TO FINANCIAL STATEMENTS -- (CONTINUED)
DECEMBER 31, 1995
2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
funds, are carried at market based on quoted market prices. Net unrealized
appreciation of equity securities is included as a component of stockholder's
equity. The cost of investments sold is determined by using the specific
identification method.
VARIABLE LIFE AND ANNUITY PRODUCTS
Variable life and annuity products include individual and group flexible
premium variable life insurance policies and annuity products. Golden American
provides for variable accumulation and benefits under the policies and contracts
by crediting life and annuity considerations in accordance with contractholder
direction to one or more divisions within various variable separate accounts or
fixed interest divisions. Golden American's fixed interest divisions include the
Guaranteed Interest Division, the Fixed Interest Division, and the Market Value
Adjusted Fixed Interest separate account.
SEPARATE ACCOUNTS
Variable separate accounts assets and liabilities reported in the
accompanying balance sheets represent funds that are separately administered
principally for variable life policies and annuity contracts and for which the
policyholders and contractholders rather than Golden American bear the
investment risk. At the direction of the policyowners and contractholders, the
separate accounts invest the premium and annuity considerations from the sale of
variable life and annuity products either in shares of specified mutual funds or
directly in other investments. The assets and liabilities of Golden American's
separate accounts are clearly identified and segregated from other assets and
liabilities of Golden American. The portion of the separate account assets
applicable to variable life policies and variable annuity contracts cannot be
charged with liabilities arising out of any other business Golden American may
conduct.
Variable separate account assets carried at fair value of the underlying
investments generally represent policyowner and contractholder investment values
maintained in the accounts. Variable separate account liabilities represent
account balances for the variable life policies and annuity contracts invested
in the separate accounts. Net investment income and realized and unrealized
capital gains and losses related to separate account assets are not reflected in
the accompanying statements of operations of Golden American.
REVENUE RECOGNITION
Revenues from variable life and annuity products consists of charges for
mortality and expense risk, cost of insurance, contract administration, and
surrender charges, as applicable to each contract. In addition, most life and
annuity contracts provide for a distribution fee collected for a limited number
of years after each premium deposit, as defined in each applicable contract. For
life contracts, the distribution fee is based on the premiums collected, the
face amount issued, and the underwriting characteristics of each insured. For
annuity contracts, the distribution fee is based on the amount of premiums
collected and allocated to the variable separate accounts. Revenue recognition
of collected distribution fees is amortized over the life of the contract in
proportion to its expected gross profits. The balance of unrecognized revenue
related to the distribution fees is reported as unearned revenue.
COSTS ASSIGNED TO INSURANCE CONTRACTS IN FORCE
The costs assigned to insurance contracts in force represents the value of
the right to receive future profits from the life insurance and annuity policies
existing at the date of acquisition from Mutual Benefit. Such value is the
actuarially-determined present value of projected future profits from the
acquired contracts discounted at an interest rate of 15%. Costs assigned to
insurance contracts in force is being amortized over the estimated life of the
applicable insurance contracts in relation to estimated future gross profits.
71
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
NOTES TO FINANCIAL STATEMENTS -- (CONTINUED)
DECEMBER 31, 1995
2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
The following is a reconciliation of the costs assigned to insurance
contracts in force for the years ended December 31, 1995, 1994 and 1993.
<TABLE>
<CAPTION>
YEAR ENDED DECEMBER 31
--------------------------------
1995 1994 1993
---------- --------- ---------
(IN THOUSANDS)
<S> <C> <C> <C>
Beginning balance.................................................... $ 7,620 $ 9,784 $ 11,140
Interest accrued..................................................... 548 696 942
Amortization......................................................... (2,100) (2,860) (2,298)
---------- --------- ---------
Ending Balance....................................................... $ 6,068 $ 7,620 $ 9,784
---------- --------- ---------
---------- --------- ---------
</TABLE>
COSTS ASSIGNED TO INSURANCE CONTRACTS IN FORCE
The following table presents the expected amortization of the costs assigned
to insurance contracts in force over the next five years. The amortization may
be adjusted based on periodic evaluation of the expected gross profits.
<TABLE>
<CAPTION>
(IN THOUSANDS)
<S> <C>
1996.................................................................................. $ 1,424
1997.................................................................................. 1,200
1998.................................................................................. 918
1999.................................................................................. 559
2000.................................................................................. 430
</TABLE>
DEFERRED POLICY ACQUISITION COSTS
Deferred policy acquisition costs consist primarily of commissions, certain
underwriting expenses and the costs of issuing policies that vary with and are
directly related to the production of new and renewal business. Acquisition
costs for variable life and annuity products are being amortized over the lives
of the policies in relation to the present value of estimated future gross
profits. The future gross profit estimates are subject to periodic evaluation
with necessary revisions applied against amortization to date.
INSURANCE AND ANNUITY RESERVES
Insurance and annuity reserves represent variable life and annuity account
balances invested in the fixed interest divisions, policy loan balances on
variable life policies, and supplementary contract reserves on annuitized
policies. Interest credited rates for the fixed interest divisions ranged from
4% to 7% during 1995 and 1994.
POLICY BENEFITS
Policy benefits that are charged to expense include benefits incurred in the
period in excess of the related policy account balances and interest credited to
policy account balances invested in the fixed interest divisions.
REINSURANCE
Included in the accompanying financial statements are net considerations to
reinsurers of $2,800 thousand and $2,400 thousand and net policy benefits
recoveries of $3,500 thousand and $1,900 thousand in 1995 and 1994,
respectively. Effective September 30, 1992, Golden American terminated all
reinsurance agreements with Mutual Benefit. Subsequently, Golden American
entered into agreements covering substantially all of the mortality risks under
both life policies and annuity contracts with unaffiliated reinsurers. Golden
American remains liable to the extent that its reinsurers do not meet their
obligations under the reinsurance agreements. Reinsurance in-force for life
mortality risks were $24,700 thousand and $23,000 thousand at December 31, 1995
and 1994 and for annuity mortality risks were $83,500 thousand and $149,600
thousand at December 31, 1995 and 1994, respectively.
72
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
NOTES TO FINANCIAL STATEMENTS -- (CONTINUED)
DECEMBER 31, 1995
2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (CONTINUED)
Effective June 1, 1994, Golden American entered into a reinsurance agreement
on a modified coinsurance basis with an unaffiliated reinsurer. The accompanying
financial statements are presented net of the effects of the treaty which
reduced net income by $109 thousand and $27 thousand in 1995 and 1994,
respectively.
CASH EQUIVALENTS
The Company considers all short-term investments (including commercial
paper, money markets, and certificates of deposit) with a maturity of three
months or less when purchased to be cash equivalents.
3. FAIR VALUE OF FINANCIAL INSTRUMENTS
Golden American has evaluated its financial instruments, principally
short-term investments, policy loans, the adjustable principal amount promissory
note, and insurance and annuity reserves and determined that carrying amounts
reported in the balance sheets approximate fair value.
4. INVESTMENTS
The major categories of investment income for 1995, 1994 and 1993 are
summarized as follows:
<TABLE>
<CAPTION>
1995 1994 1993
--------- --------- ---------
(IN THOUSANDS)
<S> <C> <C> <C>
Fixed maturities............................................................. $ 1,610 $ 142 $ 114
Short-term investments....................................................... 899 226 90
Equity securities............................................................ -- 1 1
Policy loans................................................................. 56 11 11
Cash......................................................................... 148 99 --
Funds held in escrow......................................................... 166 83 --
--------- --------- ---------
Gross investment income...................................................... 2,879 562 216
Investment expenses.......................................................... (61) (2) --
--------- --------- ---------
Net investment income........................................................ $ 2,818 $ 560 $ 216
--------- --------- ---------
--------- --------- ---------
</TABLE>
A summary of investments in debt securities, including fixed maturities and
short-term investments, at December 31, 1995 and 1994 is as follows:
<TABLE>
<CAPTION>
GROSS
UNREALIZED ESTIMATED
AMORTIZED GAINS MARKET
COST (LOSSES) VALUE
----------- ------------- -----------
(IN THOUSANDS)
<S> <C> <C> <C>
At December 31, 1995:
U.S. Treasury securities..................................... $ 17,832 $ 92 $ 17,924
U.S. Government-backed securities............................ 2,037 86 2,123
Corporate securities......................................... 44,416 780 45,196
----------- ----- -----------
$ 64,285 $ 958 $ 65,243
----------- ----- -----------
----------- ----- -----------
At December 31, 1994:
U.S. Treasury securities..................................... $ 16,682 $ (90) $ 16,592
----------- ----- -----------
----------- ----- -----------
</TABLE>
73
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
NOTES TO FINANCIAL STATEMENTS -- (CONTINUED)
DECEMBER 31, 1995
4. INVESTMENTS (CONTINUED)
<TABLE>
<CAPTION>
1995 1994
------------------------ ------------------------
ESTIMATED ESTIMATED
AMORTIZED MARKET AMORTIZED MARKET
COST VALUE COST VALUE
----------- ----------- ----------- -----------
(IN THOUSANDS)
<S> <C> <C> <C> <C>
Due in one year or less........................... $ 17,398 $ 17,408 $ 14,634 $ 14,622
Due after one year through five years............. 39,023 39,467 850 827
Due after five years through ten years............ 6,818 7,201 1,198 1,143
Due after ten years through twenty years.......... 1,046 1,167 -- --
----------- ----------- ----------- -----------
$ 64,285 $ 65,243 $ 16,682 $ 16,592
----------- ----------- ----------- -----------
----------- ----------- ----------- -----------
</TABLE>
At December 31, 1995 and 1994, gross unrealized (depreciation) appreciation
of marketable equity securities recognized directly in stockholder's equity was
$3 thousand and $(1) thousand, respectively.
At December 31, 1995 and 1994, $2,711 thousand and $2,695 thousand,
respectively, in principal amount of fixed maturity investments were on deposit
with regulatory authorities pursuant to certain statutory requirements.
5. STOCKHOLDER'S EQUITY
The payment of cash dividends by Golden American is subject to statutory
restrictions equal to the higher of 10% of surplus as regards policyholders or
100% of the prior year's net gain, not to exceed unassigned surplus. The maximum
dividend payout which may be made without prior approval in 1996 is $6,636
thousand. Golden American is required to maintain a minimum total
statutory-basis capital and surplus of not less than $5,000 thousand under the
provisions of the insurance laws of certain states in which it is presently
licensed to sell variable life and annuity products.
A reconciliation of Golden American's GAAP-basis stockholder's equity as of
December 31, 1995 and 1994 and net loss for the years ended December 31, 1995
and 1994 to its statutory-basis capital and surplus and net loss included in the
accompanying financial statements is as follows:
<TABLE>
<CAPTION>
CAPITAL AND SURPLUS NET INCOME (LOSS)
--------------------- ----------------------
1995 1994 1995 1994
---------- --------- ---------- ----------
(IN THOUSANDS)
<S> <C> <C> <C> <C>
GAAP-basis............................................. $ 98,125 $ 89,506 $ 3,364 $ 2,222
Asset variation reserve/interest maintenance reserve... (506) (42) 28 3
Fixed maturities from acquisition...................... (2) (76) 74 14
Deferred policy acquisition costs...................... (67,314) (60,662) (7,094) (18,511)
Cost assigned to insurance contracts in force.......... (6,057) (7,620) 1,552 2,164
Deferred sales loads, surrender charges and policy
changes............................................... 40,150 49,223 (9,073) 7,000
Reserves............................................... (1,972) (4,985) 3,013 (5,017)
Unearned revenue....................................... 6,556 1,759 4,949 1,594
Other.................................................. (1,665) (811) (930) (729)
Unrealized appreciation of fixed maturity
investments........................................... (958) -- -- --
---------- --------- ---------- ----------
Statutory-basis........................................ $ 66,357 $ 66,292 $ (4,117) $ (11,260)
---------- --------- ---------- ----------
---------- --------- ---------- ----------
</TABLE>
During 1992, the NAIC approved certain Risk-Based Capital ("RBC")
requirements for life/ health insurance companies. Those requirements were
effective beginning in 1993 and require that
74
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
NOTES TO FINANCIAL STATEMENTS -- (CONTINUED)
DECEMBER 31, 1995
5. STOCKHOLDER'S EQUITY (CONTINUED)
the amount of capital maintained by an insurance company is to be determined
based on the various risk factors related to it. At December 31, 1995 and 1994,
Golden American met the RBC requirements.
On December 30, 1994, Golden American issued 10,000 shares of Redeemable
Preferred Stock. Dividends declared and paid on the Redeemable Preferred Stock
were $3.35 million or $334.79 per share in 1995. As of December 31, 1994,
Dividends in Arrears on the Redeemable Preferred Stock were $17.9 thousand or
$1.79 per share. The dividends are cumulative and are calculated based on a rate
not to exceed the sum of the Prime Rate and 1.5%. The Redeemable Preferred Stock
is redeemable at the option of Golden American at the redemption price of $5
thousand per share subject to appropriate regulatory approvals.
6. RELATED PARTY TRANSACTIONS
DSI acts as the principal underwriter (as defined in the Securities Act of
1933 and the Investment Company Act of 1940, as amended) of the variable
insurance products issued by Golden American which as of December 31, 1995, are
sold primarily through two broker/dealer institutions. For the years ended
December 31, 1995, 1994 and 1993, commissions paid by Golden American to DSI
aggregated $8,440 thousand, $17,569 thousand, and $34,260 thousand,
respectively.
Golden American provided to DSI certain of its personnel to perform
management, administrative and clerical services and the use of certain
facilities. Golden American charged DSI for such expenses and all other general
and administrative costs, first on the basis of direct charges when
identifiable, and the remainder allocated based on the estimated amount of time
spent by Golden American's employees on behalf of DSI. In the opinion of
management, this method of cost allocation is reasonable. For the years ended
December 31, 1994 and 1993, expenses allocated to DSI were $1,983 thousand and
$2,013 thousand, respectively, which were comprised of allocated salary charges,
premise and equipment charges, and other expenses.
In 1995, the service agreement between DSI and Golden American was amended
to provide for a management fee from DSI to Golden American. This fee, for
managerial and supervisory services provided by Golden American calculated as a
percentage of average assets in the variable separate accounts, was $987
thousand for 1995.
Prior to 1994, Golden American had entered into agreements with DSI to
perform services related to the management of its investments and the
distribution of its products. For the year 1993, Golden American incurred $311
thousand for such services. The agreement was terminated as of January 1, 1994.
Prior to 1994, Golden American had arranged with BTV to perform services
related to the development and administration of its products. For the year
1993, fees earned by BTV from Golden American for these services aggregated
$2,701 thousand. The agreement was terminated as of January 1, 1994.
In addition, prior to 1994, BTV provided to Golden American certain of its
personnel to perform management, administrative and clerical services and the
use of certain of its facilities. BTV charged Golden American for such expenses
and all other general and administrative costs, first on the basis of direct
charges when identifiable, and second allocated based on the estimated amount of
time spent by BTV's employees on behalf of Golden American. For the year 1993,
BTV allocated to Golden American $1,503 thousand. The agreement was terminated
on January 1, 1994.
Golden American maintains cash on deposit at Bankers Trust.
7. INCOME TAXES
Golden American is taxed, on a separate company basis, as a life insurance
company pursuant to applicable provisions of the Internal Revenue Code (the
"Code"). At December 31, 1995 and 1994,
75
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
NOTES TO FINANCIAL STATEMENTS -- (CONTINUED)
DECEMBER 31, 1995
7. INCOME TAXES (CONTINUED)
Golden American had net operating loss ("NOL") carryforwards for federal income
tax purposes of approximately $22,600 thousand and $17,400 thousand,
respectively. Approximately $2,400 thousand of these NOL's, relating to
operations prior to ownership by Mutual Benefit, can be used to offset future
taxable income of Golden American only through the year 2005, subject to annual
limitations. Approximately $800 thousand, $4,100 thousand, $10,100 thousand and
$5,200 thousand are available through the years 2007, 2008, 2009, and 2010,
respectively.
Significant components of Golden American's deferred tax liabilities and
assets are as follows:
<TABLE>
<CAPTION>
DECEMBER 31
---------------------
1995 1994
---------- ---------
(IN THOUSANDS)
<S> <C> <C>
Deferred tax liabilities:
Deferred policy acquisition costs............................................. $ 23,560 $ 21,200
Unamortized cost assigned to insurance contracts in force..................... 2,120 2,700
Other......................................................................... 598 --
---------- ---------
26,278 23,900
Deferred tax assets:
Net operating loss carryforwards.............................................. 7,891 6,000
Insurance liabilities......................................................... 15,520 15,200
Deferred policy acquisition costs proxy tax................................... 3,666 3,700
Other......................................................................... 57 700
---------- ---------
27,134 25,600
Valuation allowance for deferred tax assets..................................... 856 1,700
---------- ---------
Net deferred tax liabilities................................................ $ -- $ --
---------- ---------
---------- ---------
</TABLE>
The following is an analysis of the difference between the U.S. Federal
statutory income tax rate and the effective tax rate on income (loss) before
income taxes:
<TABLE>
<CAPTION>
1995 1994 1993
----------- ----------- -----------
<S> <C> <C> <C>
Federal statutory rate............................................... 35% 35% 35%
----------- ----- -----------
----------- ----- -----------
<CAPTION>
(IN THOUSANDS)
<S> <C> <C> <C>
Taxes at statutory rate.............................................. $ 1,177 $ 778 $ (627)
Dividends received deduction......................................... (350) (368) (194)
Other, net........................................................... 17 (210) (379)
Valuation allowance.................................................. (844) (200) 1,200
----------- ----- -----------
Taxes based on income (loss)..................................... $ -- $ -- $ --
----------- ----- -----------
----------- ----- -----------
</TABLE>
8. SHORT-TERM DEBT
All short-term debt was repaid as of December 30, 1994. Interest paid during
1994 and 1993 was $1,962 thousand and $726 thousand, respectively. The repayment
of amounts borrowed under this loan had been guaranteed by Bankers Trust.
9. PENSION AND PROFIT SHARING PLAN AND OTHER EMPLOYEE BENEFITS
The Company's employees are covered under the Parent's benefit plans. The
noncontributory pension plan and the profit sharing plan of the Parent are also
available to eligible employees of the Company. Total 1995 and 1994 expenses
relating to these Parent company benefit plans were $200 thousand and $200
thousand, respectively.
76
<PAGE>
----------------------------------------------------------------------
STATEMENT OF ADDITIONAL INFORMATION
- --------------------------------------------------------------------------------
TABLE OF CONTENTS
<TABLE>
<CAPTION>
ITEM PAGE
<S> <C>
INTRODUCTION............................................................................................. 2
PART I
Description of Golden American Life Insurance Company.................................................... 2
Safekeeping of Assets.................................................................................... 2
The Administrator........................................................................................ 2
Independent Auditors..................................................................................... 3
Reinsurance.............................................................................................. 3
Distribution of Contracts................................................................................ 3
Performance Information.................................................................................. 3
IRA Partial Withdrawal Option............................................................................ 7
Other Information........................................................................................ 8
PART II
Securities and Investment Techniques..................................................................... 8
U.S. Government Securities............................................................................. 8
Debt Securities........................................................................................ 9
Short Sales Against the Box............................................................................ 9
Futures Contracts and Options on Futures Contracts..................................................... 10
Options on Securities.................................................................................. 11
Options of Securities Indexes.......................................................................... 12
Foreign Currency Transactions.......................................................................... 13
Options on Foreign Currencies.......................................................................... 14
Repurchase Agreements.................................................................................. 15
Banking Industry and Savings Industry Obligations...................................................... 15
Commercial Paper....................................................................................... 16
When Issued or Delayed Delivery Securities............................................................. 17
Investment Restrictions.................................................................................. 17
Management of Separate Account D......................................................................... 19
The Manager.............................................................................................. 20
Portfolio Manager........................................................................................ 21
Custodian and Portfolio Accounting Agent................................................................. 22
Portfolio Transactions and Brokerage..................................................................... 22
Purchase and Pricing of the Global Account............................................................... 24
Financial Statements of Separate Account B............................................................... 25
Financial Statements of The Managed Global Account of Separate Account D................................. 25
Appendix -- Description of Bond Ratings
</TABLE>
77
<PAGE>
- --------------------------------------------------------------------------------
STATEMENT OF ADDITIONAL INFORMATION (CONTINUED)
- --------------------------------------------------------------------------------
PLEASE TEAR OFF, COMPLETE AND RETURN THE FORM BELOW TO ORDER A FREE STATEMENT OF
ADDITIONAL INFORMATION FOR THE CONTRACTS OFFERED UNDER THE PROSPECTUS. ADDRESS
THE FORM TO OUR CUSTOMER SERVICE CENTER, THE ADDRESS IS SHOWN ON THE COVER.
...............................................................................
PLEASE SEND ME A FREE COPY OF THE STATEMENT OF ADDITIONAL INFORMATION FOR
SEPARATE ACCOUNT B AND THE MANAGED GLOBAL ACCOUNT OF ACCOUNT D.
PLEASE PRINT OR TYPE
<TABLE>
<CAPTION>
<S> <C> <C>
--------------------------------------------
NAME
--------------------------------------------
SOCIAL SECURITY NUMBER
--------------------------------------------
STREET ADDRESS
--------------------------------------------
CITY, STATE, ZIP
</TABLE>
(IN 6050 DVA PLUS 9/95)
...............................................................................
78
<PAGE>
(This page has been left blank intentionally.)
<PAGE>
APPENDIX A
MARKET VALUE ADJUSTMENT EXAMPLES
EXAMPLE #1: FULL SURRENDER -- EXAMPLE OF A NEGATIVE MARKET VALUE ADJUSTMENT
Assume $100,000 was allocated to a Fixed Allocation with a Guarantee Period
of ten years, a Guaranteed Interest Rate of 7.50%, an initial Index Rate ("I")
of 7.00%; that a full surrender is requested three years into the Guarantee
Period; that the then Index Rate for a seven year Guarantee Period ("J") is
8.0%; and that no prior transfers or partial withdrawals affecting this Fixed
Allocation have been made.
CALCULATE THE MARKET VALUE ADJUSTMENT
1. The Accumulation Value of the Fixed Allocation on the date of surrender
is $124,230
($100,000 X 1.075**(3))
2. N = 2,555 (365 X 7)
3. Market Value Adjustment
= $124,230*[(1.07/1.0825)**(2,555/365)-1]
= $9,700
Therefore, the amount paid to you on full surrender ignoring any surrender
charge is $114,530 ($124,230 - $9,700).
EXAMPLE #2: FULL SURRENDER -- EXAMPLE OF A POSITIVE MARKET VALUE ADJUSTMENT
Assume $100,000 was allocated to a Fixed Allocation with a Guarantee Period
of ten years, a Guaranteed Interest Rate of 7.5%, an initial Index Rate ("I") of
7.00%; that a full surrender is requested three years into the Guarantee Period;
that the then Index Rate for a seven year Guarantee Period ("J") is 6.0%; and
that no prior transfers or partial withdrawals affecting this Fixed Allocation
have been made.
CALCULATE THE MARKET VALUE ADJUSTMENT
1. The Accumulation Value of the Fixed Allocation on the date of surrender
is $124,230
($100,000 X 1.075**3)
2. N = 2,555 (365 X 7)
3. Market Value Adjustment
= $124,230*[(1.07/1.0625)**(2,555/365)]-1)
= $6,270
Therefore, the amount paid to you on full surrender ignoring any surrender
charge is $130,500 ($124,230 + $6,270).
EXAMPLE #3: PARTIAL WITHDRAWAL -- EXAMPLE OF A NEGATIVE MARKET VALUE ADJUSTMENT
Assume $200,000 was allocated to a Fixed Allocation with a Guarantee Period
of ten years, a Guaranteed Interest Rate of 7.5%, an initial Index Rate ("I") of
7.00%; that a partial withdrawal of $114,530 is requested three years into the
Guarantee period; that the then Index Rate ("J") for a seven year Guarantee
Period is 8.0%; and that no prior transfers or partial withdrawals affecting
this Fixed Allocation have been made.
First calculate the amount that must be withdrawn from the Fixed Allocation
to provide the amount requested.
1. The Accumulation Value of the Fixed Allocation on the date of withdrawal
is $248,459
($200,000 X 1.075**3)
2. N = 2,555 (365 X 7)
3. Amount that must be withdrawn
= [$114,530/(1.07/1.0825)**(2,555/365)]
= $124,230
A1
<PAGE>
Then calculate the Market Value Adjustment on that amount
4. Market Value Adjustment
= $124,230*[(1.07/1.0825)**(2,555/365)-1]
= $9,700
Therefore, the amount of the partial withdrawal paid to you is $114,530, as
requested. The Fixed Allocation will be reduced by the amount of the partial
withdrawal, $114,530, and also reduced by the Market Value Adjustment of $9,700,
for a total reduction in the Fixed Allocation of $124,230.
EXAMPLE #4: PARTIAL WITHDRAWAL -- EXAMPLE OF A POSITIVE MARKET VALUE ADJUSTMENT
Assume $200,000 was allocated to a Fixed Allocation with a Guarantee Period
of ten years, a Guaranteed Interest Rate of 7.5%, an initial Index Rate of 7.0%;
that a partial withdrawal of $130,500 requested three years into the Guarantee
Period; that the then Index Rate ("J") for a seven year Guarantee Period is
6.0%; and that no prior transfers or partial withdrawals affecting this Fixed
Allocation have been made.
First calculate the amount that must be withdrawn from the Fixed Allocation
to provide the amount requested.
1. The Accumulation Value of Fixed Allocation on the date of surrender is
$248,459
($200,000 X 1.075**3)
2. N = 2,555 (365 X 7)
3. Amount that must be withdrawn
= [$130,500/(1.07/1.0625)**(2,555/365)]
= $124,230
Then calculate the Market Value Adjustment on that amount
4. Market Value Adjustment
= $124,230*[(1.07/1.0625)**(2,555/365)]-1)
= $6,270
Therefore, the amount of the partial withdrawal paid to you is $130,500, as
requested. The Fixed Allocation will be reduced by the amount of the partial
withdrawal, $130,500, but increased by the Market Value Adjustment of $6,270,
for a total reduction in the Fixed Allocation of $124,230.
A2
<PAGE>
APPENDIX B
GOLDENSELECT SERVICE FORMS
- - Deferred Variable Annuity Application -- Use in all states except FL, KS, KY,
MD, MI, MN, NC, NH, NJ, NV, OR, PA, UT, and WA. Contact our Sales Desk at
1-800-243-3706 for the Special Form to be used in these states.
- - Request for Automatic Rebalancing Form
- - Financial Services Form
(GoldenSelect DVA Plus is currently Not Available in ME and NY; consult your
financial adviser to determine if the Fixed Account is available in your
state.)
- - Absolute Assignment to Effect Section 1035(a) Exchange
- - Request to Effect IRA Or Other Qualified Account Transfer
- - Certificate of Deposit Transfer Form
Submit all forms (with all other necessary documents) to the Customer Service
Center
WITHHOLDING ELECTION INSTRUCTIONS (BEFORE THE WITHHOLDING ELECTION SECTION ON
THE APPLICATION IS COMPLETED, PLEASE HAVE THE OWNER READ THE FOLLOWING
CAREFULLY)
Your withdrawals under annuity Contracts may be subject to Federal income tax
withholding unless you elect not to have withholding apply. You may elect not to
have withholding apply by checking the box by line A and signing in the
signature section. Check the box by line B to make an election to have
withholding apply. If you want additional withholding made, check the box by
line C.
Withholding will only apply to the portion of your withdrawal that is subject to
Federal income tax and it will be like wage withholding. Thus, there will be no
withholding on the portion of each payment representing a return of your
premium. You may change your withholding as often as you wish by sending in IRS
Form W-4P to Golden American. Your election will remain in effect until you
revoke it. You may revoke it at any time.
If you elect not to have withholding apply to your withdrawals, or if you do not
have enough Federal income tax withheld from your withdrawal payments, you may
be responsible for payment of estimated tax. You may incur penalties under the
estimated tax rules if your withholding and estimated tax payments are not
sufficient.
By signing the application and completing the withholding election, you certify
that no bankruptcy proceeding, attachment or other lien or claims are pending
against you.
(page left blank)
B1
<PAGE>
<TABLE>
<S><C>
GOLDEN AMERICAN LIFE INSURANCE COMPANY DEFERRED VARIABLE ANNUITY
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN WILMINGTON, DELAWARE ENROLLMENT FORM
1. OWNER(S)
Name Male Female Soc. Sec. #
/ / / / or Tax ID.# - -
Permanent Phone
Address ( )
City State Zip Date of Birth
2. ANNUITANT (IF OTHER THAN OWNER)
Name Male Female Soc. Sec. #
/ / / / or Tax ID.# - -
Permanent Phone
Address ( )
City State Zip Date of Birth Relation
to Owner
CONTINGENT ANNUITANT (OPTIONAL)
Name Address Relation
to Owner
3. PRIMARY BENEFICIARY(IES) (IF MORE THAN ONE - INDICATE %)
Name(s) Relation
to Owner
CONTINGENT BENEFICIARY(IES) Name Relation
to Owner
4. PLAN (CHECK ONE)
/ / DVA / / Other -------------------
5. DEATH BENEFIT OPTIONS
1. / / 7% SOLUTION -- ENHANCED #1 2. / / ANNUAL RATCHET -- ENHANCED #2 3. / / STANDARD
6. INITIAL PREMIUM AND ALLOCATION INFORMATION
(A) INITIAL PREMIUM PAID $__________ MAKE CHECK PAYABLE TO GOLDEN AMERICAN LIFE INSURANCE COMPANY
Fill in percentages for Premium allocation below (see (A) INITIAL.)
(B) DOLLAR COST AVERAGING (DCA): Optional. PLEASE CHECK BOX TO ELECT. / /
Amount to be transferred monthly $_________________ (minimum $250)
Division or Allocation Transferred From: / / Limited Maturity Bond Division / / Liquid Asset Division
/ / 1 Year Fixed Allocation
(MINIMUM OF $10,000 MUST BE ALLOCATED TO THE DIVISION OR FIXED ALLOCATION CHECKED)
Divisions Transferred To: Fill in percentages for allocation of DCA below (see (B) DCA).
ACCOUNT DIVISION INVESTMENT ADVISER (A) INITIAL (B) DCA
MULTIPLE ALLOCATION ZWEIG ADVISORS, INC. % %
FULLY MANAGED T. ROWE PRICE ASSOCIATES INC. % %
SMALL CAP FRED ALGER MANAGEMENT % %
ALL-GROWTH WARBURG, PINCUS COUNSELLORS,INC. % %
CAPITAL APPRECIATION CHANCELLOR TRUST % %
VALUE EQUITY EAGLE ASSET MANAGEMENT % %
RISING DIVIDENDS KAYNE, ANDERSON % %
STRATEGIC EQUITY ZWEIG ADVISORS % %
REAL ESTATE EII REALTY SECURITIES, INC. % %
NATURAL RESOURCES VAN ECK ASSOCIATES CORP. % %
EMERGING MARKETS BANKERS TRUST COMPANY % %
THE MANAGED GLOBAL ACCOUNT WARBURG, PINCUS COUNSELLORS, INC. % %
LIMITED MATURITY BOND BANKERS TRUST COMPANY %
LIQUID ASSET BANKERS TRUST COMPANY %
FIXED ALLOCATION ELECTION 1 YEAR %
FIXED ALLOCATION ELECTION 3 YEAR %
FIXED ALLOCATION ELECTION 5 YEAR %
FIXED ALLOCATION ELECTION 7 YEAR %
FIXED ALLOCATION ELECTION 10 YEAR %
TOTAL 100% 100%
GOLDEN AMERICAN LIFE INSURANCE COMPANY, CUSTOMER SERVICE CENTER, PO Box 8794, Wilmington, DE 19899-8794
</TABLE>
B2
GA-EA-1007-12/95
<PAGE>
7. OPTIONAL SYSTEMATIC PARTIAL WITHDRAWALS
If you want to receive Systematic Partial Withdrawals, your request must be
received in writing. For the appropriate form, please call our Customer
Service Center: 1-800-366-0066.
8. TELEPHONE REALLOCATION AUTHORIZATION ________________ OWNER'S INITIALS
I authorize Golden American to act upon reallocation instructions given by
telephone from __________________________
(name of your registered representative) upon furnishing his/her social
security number. Neither Golden American nor any person authorized by
Golden American will be responsible for any claim, loss, liability or
expense in connection with reallocation instructions received by telephone
from such person if Golden American or such other person acted on such
telephone instructions in good faith in reliance upon this authorization.
Golden American will continue to act upon this authorization until
such time as the person indicated above is no longer affiliated with the
broker/dealer under which my contract was purchased or until such time that
I notify Golden American otherwise in writing.
9. TAX-QUALIFIED PLANS If you are funding a qualified plan, please specify
type:
/ / IRA / / IRA Rollover / / SEP/IRA / / Other __________________
10. REPLACEMENT
Will the coverage applied for replace any existing annuity or life
insurance policies on the annuitant's life?
/ / Yes (If yes, please complete following) / / No
Company Name Policy Number Face Amount
11. READ THE FOLLOWING STATEMENTS CAREFULLY AND SIGN BELOW:
- BY SIGNING BELOW, I ACKNOWLEDGE RECEIPT OF THE PROSPECTUS. I AGREE
THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL STATEMENTS AND
ANSWERS IN THIS ENROLLMENT FORM ARE COMPLETE AND TRUE AND MAY BE
RELIED UPON IN DETERMINING WHETHER TO ISSUE THE CERTIFICATE. MY
ANSWERS WILL FORM A PART OF ANY CERTIFICATE TO
BE ISSUED, AND ONLY THE OWNER AND GOLDEN AMERICAN HAVE THE AUTHORITY
TO MODIFY THIS ENROLLMENT FORM.
- CONTRACTS AND POLICIES AND UNDERLYING SERIES SHARES OR SECURITIES
WHICH FUND CONTRACTS AND POLICIES ARE NOT INSURED BY THE FDIC OR ANY
OTHER AGENCY. THEY ARE NOT DEPOSITS OR OTHER OBLIGATIONS OF ANY BANK
AND ARE NOT BANK GUARANTEED. ALSO, THEY ARE SUBJECT TO MARKET
FLUCTUATION, INVESTMENT RISK AND POSSIBLE LOSS OF PRINCIPAL INVESTED.
- I UNDERSTAND THAT THIS CERTIFICATE'S CASH SURRENDER VALUE, WHEN
BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT DIVISION,
MAY INCREASE OR DECREASE ON ANY DAY AND THAT NO MINIMUM VALUE IS
GUARANTEED. THIS CERTIFICATE IS IN ACCORD WITH MY ANTICIPATED
FINANCIAL NEEDS.
- I UNDERSTAND THAT ANY AMOUNT ALLOCATED TO THE FIXED ACCOUNT MAY BE
SUBJECT TO A MARKET VALUE ADJUSTMENT, WHICH MAY CAUSE THE VALUES TO
INCREASE OR DECREASE, PRIOR TO A SPECIFIED DATE OR DATES AS SPECIFIED
IN THE CERTIFICATE.
- --------------------------------------- ------------------------------
Signature of Owner Signed at (City, State)Date
- --------------------------------------- ------------------------------
Signature of Joint Owner (if applicable) Signed at (City, State)Date
- --------------------------------------- ------------------------------
Signature of Annuitant (if other than Owner) Signed at (City, State)Date
Client Account No. (if applicable)_____________________
FOR AGENT USE ONLY
DO YOU HAVE REASON TO BELIEVE THAT THE COVERAGE APPLIED FOR WILL REPLACE ANY
EXISTING ANNUITY OR LIFE INSURANCE
ON THE ANNUITANT'S LIFE? / / YES / / NO
- ----------------------- ----------------------- -------------------
Agent Signature Print Agent Name & No. Social Security No.
- ----------------------
Broker/Dealer/Branch
-----------------------------------
Florida License ID# (Florida Only)
GOLDEN AMERICAN LIFE INSURANCE COMPANY, CUSTOMER SERVICE CENTER, PO Box
8794, Wilmington, DE 19899-8794
1-800-366-0066
B3
GA-EA-1007-12/95
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
REQUEST FOR AUTOMATIC ALLOCATION REBALANCING
- --------------------------------------------------------------------------------
- - GOLDENSELECT OFFERS AN EASY WAY TO MAINTAIN A PARTICULAR ASSET ALLOCATIONS
THROUGH AUTOMATIC ALLOCATION REBALANCING.
- - Because each Division through which you invest is unique, individual growth
rates tend to vary. As the investment experience of each division will also
vary, your asset allocations over time will change from the asset mix you
initially selected.
- - Automatic Allocation Rebalancing will return your portfolio mix to the
allocation that you and your Financial Adviser find most suitable for your
long-term investment goals.
- --------------------------------------------------------------------------------
Automatic Allocation Rebalancing will occur on the last business day of the
appropriate calendar quarter. Please consult your prospectus for details
regarding this feature as well as restrictions, minimum or maximum limitations,
fees and other applicable information. Automatic Allocation Rebalancing does not
apply to the Fixed Interest Division(s) and cannot be elected if you participate
in Dollar Cost Averaging. Any subsequent reallocation, add-on, or partial
withdrawal you direct not on a pro-rata basis will terminate this program.
- --------------------------------------------------------------------------------
<TABLE>
<S><C>
TYPE OF PLAN / / Deferred Variable Annuity / / Variable Annuity Certain / / Variable Life Insurance
(VERY IMPORTANT)
</TABLE>
Contract, Policy or Certificate Number:
---------------------------------------
Owner(s): Annuitant/Insured(s):
---------------------------- ------------------
Owner's(s') Social Security Number: Owner's Tel. No.:
------------- -------------
- --------------------------------------------------------------------------------
Please indicate the percentage you wish to allocate to each series or, record
the actual investment dollars to allocate below. These allocations must be in
whole percentages. For the Automatic Allocation Rebalancing program, we will
round dollar amounts that do not equal whole percentage points to the nearest
point for rebalancing. The percentages will be proportionally recalculated for
subsequent reallocations if you have chosen a Fixed Allocation Election. This
will serve as your automatic rebalancing allocation and will supersede all prior
allocation instructions, including those on your application, if different.
<TABLE>
<CAPTION>
DIVISION SERIES PORTFOLIO MANAGER ALLOCATIONS
-------- ------------------------ -----------
<S> <C> <C>
Multiple Allocation Zweig Advisors ___________
Fully Managed T. Rowe Price ___________
Small Cap Fred Alger Management ___________
All-Growth Warburg, Pincus Counsellors ___________
Capital Appreciation Chancellor Trust ___________
Value Equity Eagle Asset Management ___________
Rising Dividends Kayne, Anderson Investment Mgmt. ___________
Strategic Equity Zweig Advisors ___________
The Managed Global Account Warburg, Pincus Counsellors ___________
(Not available under Golden Select Genesis I or Genesis Flex, our variable life products.)
Emerging Markets Bankers Trust Company ___________
Real Estate E.I.I Realty Securities ___________
Natural Resources Van Eck ___________
Limited Maturity Bond Fund Bankers Trust Company ___________
Liquid Asset Bankers Trust Company ___________
Note: not applicable for Automatic Allocation Rebalancing:
-----------------------------------------------------------------------------------------------------------------------
Fixed Allocation Election 1 Year
Fixed Allocation Election 3 Year
Fixed Allocation Election 5 Year
Fixed Allocation Election 7 Year
Fixed Allocation Election 10 Year
(Fixed Allocation Elections may not be available in all states and may not be available under GoldenSelect Genesis I or
Genesis Flex, our variable life products.)
-----------------------------------------------------------------------------------------------------------------------
TOTAL: ___________
</TABLE>
- --------------------------------------------------------------------------------
FREQUENCY
Please rebalance my portfolio to the above allocations: \ \ Quarterly
\ \ Semi-Annually \ \ Annually
- --------------------------------------------------------------------------------
SIGNATURES (PLEASE BE SURE TO SIGN BELOW)
- ------------------------------------------------- --------------------
Signature of Owner (If owned by Co. Show Title) Date
GOLDEN AMERICAN LIFE INSURANCE COMPANY, CUSTOMER SERVICE CENTER, PO Box 8794,
Wilmington, DE 19899-8794 1-800-366-0066
GAL-REBAL-12/95
B4
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
Golden American Life Insurance Company
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
REQUEST FOR FINANCIAL SERVICE: FOR VARIABLE CONTRACTS
This form is for additional payments, cash surrenders, partial withdrawals,
annuity payment allocations, reallocations, dollar cost averaging, telephone
reallocation authorization, loans and withholding elections. All transactions
will be processed effective with the date this form is received in the Customer
Service Center. Please consult your prospectus for restrictions, minimum or
maximum limitations, fees, and other applicable information pertaining to your
request. Make sure to check off which variable contract (Annuity or Life) the
transaction is for.
Type of Plan: / / Deferred Variable Annuity / / Variable Annuity Certain
/ / Variable Life Insurance
Contract, Policy or Certificate Number: _____________________________________
Owner(s): ______________________ Annuitant/Insured(s): ______________________
Owner's(s') Soc. Sec. No.: ______________ Owner's Tel. No.: _________________
1. / / ADDITIONAL PAYMENT
A. AMOUNT $ __________________
B. ALLOCATION If you leave the following section blank:
- The payment will be allocated on a pro-rata basis among the divisions
in which your Accumulation Value is currently invested.
DIVISION % OR $
___________________________________ ____________________________________
___________________________________ ____________________________________
___________________________________ ____________________________________
___________________________________ ____________________________________
___________________________________ ____________________________________
C. If your annuity certificate or contract is an IRA check one:
/ / Contribution for 19___ OR / / Rollover
2. / / CASH SURRENDER
By surrendering the variable contract, I understand that Golden American is
discharged from all other obligations under the variable contract and that
the variable contract is no longer in force.
A. / / The variable contract and any other forms required by Golden
American are enclosed with this request.
B. / / The original variable contract has been lost or destroyed.
3. / / PARTIAL WITHDRAWAL
A. / / CONVENTIONAL PARTIAL WITHDRAWAL
%___________________________ or Amount $_____________________________
B. / / OPTIONAL SYSTEMATIC PARTIAL WITHDRAWALS
(NOT AVAILABLE UNDER VARIABLE ANNUITY CERTAIN)
(The maximum Systematic Partial Withdrawal is 1.25% and 3.75% quarterly of
the Accumulation Value.)
Amount $______________ or _____________% Day each month_________________
/ / Cancel Systematic Partial Withdrawal Option
C. ALLOCATION If you leave the following section blank, partial
withdrawal(s) will be processed on a pro-rata basis among the divisions in
which your Accumulation Value is currently invested.
DIVISION % OR $
___________________________________ ____________________________________
___________________________________ ____________________________________
___________________________________ ____________________________________
___________________________________ ____________________________________
___________________________________ ____________________________________
4. / / ANNUITY PAYMENT ALLOCATION
(AVAILABLE UNDER VARIABLE ANNUITY CERTAIN ONLY)
Specify division from which annuity payments will be taken
Division:_______________________________________________________________
ANY SURRENDER OR WITHDRAWAL MUST BE ACCOMPANIED BY A TAX WITHHOLDING ELECTION
FROM THE OWNER(S)
PLEASE MAKE YOUR WITHHOLDING ELECTION IN ITEM 9.
If you are surrendering a qualified contract, unless the amount is paid
directly to another qualified plan, such amount is subject to Federal income
tax withholding at a 20% rate.
5. / / REALLOCATION PLEASE TRANSFER:
$ _________________ OR _______________% FROM_______________ TO _______________
$ _________________ OR _______________% FROM_______________ TO _______________
$ _________________ OR _______________% FROM_______________ TO _______________
$ _________________ OR _______________% FROM_______________ TO _______________
$ _________________ OR _______________% FROM_______________ TO _______________
Golden American Life Insurance Company, Customer Service Center, PO Box
8794, Wilmington, DE 19899-8794 1-800-366-0066
B5
GAL-RFS-12/95
<PAGE>
6. DOLLAR COST AVERAGING (MINIMUM OF $10,000 MUST BE ALLOCATED TO THE DIVISION
CHECKED BELOW)
Amount of Monthly Transfer $___________________ (MINIMUM $250)
DIVISION TRANSFERRED FROM: / / Limited Maturity Bond / / Liquid Asset or
/ / 1 Yr. Guarantee Period
DIVISIONS TRANSFERRED TO: Fill in percentage below:
<TABLE>
<CAPTION>
ACCOUNT DIVISION INVESTMENT ADVISER (A) INITIAL (B) DCA
----------------------- --------------------------------- ------------ --------
<S> <C> <C> <C>
MULTIPLE ALLOCATION ZWEIG ADVISORS, INC. % %
FULLY MANAGED T. ROWE PRICE ASSOCIATES, INC. % %
SMALL CAP FRED ALGER MANAGEMENT % %
ALL-GROWTH WARBURG, PINCUS COUNSELLORS, INC. % %
CAPITAL APPRECIATION CHANCELLOR TRUST % %
VALUE EQUITY EAGLE ASSET MANAGEMENT % %
RISING DIVIDENDS KAYNE, ANDERSON % %
STRATEGIC EQUITY ZWEIG ADVISORS % %
REAL ESTATE EII REALTY SECURITIES, INC. % %
NATURAL RESOURCES VAN ECK ASSOCIATES CORP. % %
THE MANAGED GLOBAL ACCOUNT WARBURG, PINCUS COUNSELLORS, INC. % %
EMERGING MARKETS BANKERS TRUST COMPANY % %
LIMITED MATURITY BOND BANKERS TRUST COMPANY %
LIQUID ASSET BANKERS TRUST COMPANY %
OTHER %
OTHER %
OTHER %
GoldenSelect offers a fixed investment option. Please call our Customer Service Center for current rates.
TOTAL 100% 100%
</TABLE>
7. / / TELEPHONE REALLOCATION AUTHORIZATION _____ OWNER'S INITIALS
I authorize Golden American Life Insurance Company ("Golden American") to act
upon reallocation instructions given by telephone from
______________________(name of your registered representative) upon furnishing
his/her social security number. Neither Golden American nor any person
authorized by Golden American will be responsible for any claim, loss, liability
or expense in connection with reallocation instructions received by telephone
from such person if Golden American or such other person acted on such telephone
instructions in good faith in reliance upon this authorization. Golden American
will continue to act upon this authorization until such time as the person
indicated above is no longer affiliated with the broker/dealer under which my
contract was purchased or until such time that I notify Golden American
otherwise in writing.
8. / / LOAN (AVAILABLE UNDER LIFE ONLY)
A. AMOUNT $ __________ OR __________%
B. ALLOCATION - If you leave the following section blank, the amount of the loan
will be taken from the Accumulation Value in proportion to the amount of
investment value in each division in which you are currently invested.
DIVISION % or $ DIVISION % or $
__________________ __________________ __________________ __________________
__________________ __________________ __________________ __________________
__________________ __________________ __________________ __________________
9. / / WITHHOLDING ELECTION FORM (PLEASE READ CAREFULLY)
Instructions: Your withdrawals under annuity contracts or withdrawals and loans
under a modified endowment contract may be subject to Federal income tax
withholding unless you elect not to have withholding apply. You may elect not to
have withholding apply by checking the box by line A and signing below. Check
the box by line B to make an election to have withholding apply. If you want
additional withholding made, check the box by line C.
A / / I do not want Federal income tax withheld.
B. / / I want to have Federal income tax withheld from each withdrawal or loan
using the number of allowances and marital status indicated. (You may also
designate an additional amount in line C, below.)
C / / I want the following additional amount withheld from each withdrawal or
loan (You must complete line B.) $ ____________________ Withholding will only
apply to the portion of your withdrawal or loan that is subject to Federal
income tax and it will be like wage withholding. Thus, there will be no
withholding on the portion of each payment representing a return of your
premium. You may change your withholding as often as you wish by sending in IRS
Form W-4P to Golden American. Your election will remain in effect until you
revoke it. You may revoke it at any time.
If you elect not to have withholding apply to your withdrawals or loans, or if
you do not have enough Federal income tax withheld from your withdrawal or
loans, you may be responsible for payment of estimated tax. You may also incur
penalties under the estimated tax rules if your withholding and estimated tax
payments are not sufficient.
I (We) hereby certify that no bankruptcy proceeding, attachment or other lien or
claims is now pending against the Owner.
10. SIGNATURES (PLEASE BE SURE TO SIGN BELOW FOR ANY TRANSACTION)
X
---------------------------------------------------- -------------------------
SIGNATURE OF OWNER (If owned by Co. Show Title) Date SIGNATURE OF WITNESS
X
---------------------------------------------------- -------------------------
SIGNATURE OF IRREVOCABLE BENEFICIARY (If any) Date SIGNATURE OF WITNESS OR
AUTHORIZED
X REPRESENTATIVE(Include
---------------------------------------------------- title)
SIGNATURE OF SPOUSE (COMMUNITY PROPERTY STATES) Date
Golden American Life Insurance Company, Customer Service Center,
PO Box 8794, Wilmington, DE 19899-8794 1-800-366-0066
B6
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
REQUEST TO EFFECT IRA OR OTHER QUALIFIED ACCOUNT TRANSFER
- --------------------------------------------------------------------------------
<TABLE>
<S> <C> <C>
TO: -------------------------------------
PRESENT SPONSOR
------------------------------------- ACCOUNT NO. -------------------------------------
ADDRESS
------------------------------------- -----------------------------------------------------
ADDRESS PARTICIPANT'S NAME
RE: IRA OR OTHER QUALIFIED ACCOUNT TRANSFER
</TABLE>
ATTN: QUALIFIED TRANSFER DEPARTMENT
Dear Sirs:
I wish to transfer the entire value of my present Qualified Account to the
"GoldenSelect IRA" sponsored by Golden American Life Insurance Company.
I adopted the "GoldenSelect IRA" on ____________________________________________
DATE OF APPLICATION
Please make the check payable to GoldenSelect/Golden American Life Insurance
Company. As indicated below, Golden American has already indicated its
willingness to accept from you all my Qualified Account assets.
Please send all such proceeds and details to:
Golden American Life Insurance Company
IRA and Pension Operations
P.O. Box 8794
Wilmington, DE 19899-8794
Your prompt attention to this matter is appreciated.
<TABLE>
<S> <C> <C>
Sincerely, (Signature Guarantee if Required)
X -------------------------------------- ----------------------------------------
PARTICIPANT'S SIGNATURE (NAME OF BANK/FIRM)
----------------------------------------
(SIGNATURE OF OFFICER/TITLE)
</TABLE>
- --------------------------------------------------------------------------------
GOLDEN AMERICAN APPROVAL FOR QUALIFIED ACCOUNT TRANSFER
Golden American Life Insurance Company has established the "GoldenSelect IRA"
application number
- ------------------------- for the participant named above. We are willing to
accept the transfer. Please forward all proceeds accordingly.
<TABLE>
<S> <C>
By: -------------------------------------- Date: ----------------------------------------------
Name: ----------------------------------- Title: ----------------------------------------------
</TABLE>
Golden American Life Insurance Company, Customer Service Center, P.O. Box 8794,
Wilmington, DE 19899-8974 1-800-366-0066
B7
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
ABSOLUTE ASSIGNMENT TO EFFECT SECTION 1035(A) EXCHANGE
- --------------------------------------------------------------------------------
<TABLE>
<S> <C>
OWNER: ------------------------------------- ANNUITANT OR INSURED: ---------------------
CURRENT CONTRACT NO.: -------------------- EXISTING INSURANCE CO.: -------------------
</TABLE>
I hereby make a complete and absolute assignment and transfer all rights, titles
and interest of every nature and character in and to the above Contract to
Golden American Life Insurance Company ("Golden American") in an exchange
intended to qualify under Section 1035 of the Internal Revenue Code.
Upon receipt, Golden American is directed to surrender the above Contract and
apply the value to the GoldenSelect product for which I have submitted an
application.
I understand that, by executing this assignment, I irrevocably waive all rights,
claims and demands under the above Contract.
I acknowledge that Golden American is furnishing this form and participating in
this transaction as an accommodation to me, and that Golden American assumes no
responsibility or liability for my tax treatment under Section 1035 of the
Internal Revenue Code or otherwise.
Signed this ______________ day of ________________, 19 __________ at ___________
<TABLE>
<S> <C>
X ---------------------------------------------- X -----------------------------------------------
WITNESS SIGNATURE OF OWNER
</TABLE>
- --------------------------------------------------------------------------------
NOTIFICATION OF ASSIGNMENT AND SURRENDER
<TABLE>
<S> <C>
To (Existing Insurance Company): Re: Contract No. ------------------------------
- ------------------------------------------------
- ------------------------------------------------
</TABLE>
This is to notify you that an absolute assignment of all rights, title and
interest in and to the above Contract has been made to Golden American Life
Insurance Company, for the purpose of making an exchange under Section 1035 of
the Internal Revenue Code. Golden American, Owner of the above Contract, hereby
surrenders it and requests its full surrender value for the purpose of an
exchange under Section 1035 of the Internal Revenue Code. Upon surrender of this
Contract, please issue a check for its cash value to Golden American Life
Insurance Company, and mail to Golden American Life Insurance Company, Customer
Service Center, P.O. Box 8794, Wilmington, DE, 19899-8794, Attn: New Business
Department. Please provide Golden American with the cost basis, Issue Date and
other payment information along with your check.
<TABLE>
<S> <C>
-------------------------------------------------
GOLDEN AMERICAN LIFE INSURANCE COMPANY
- ------------------------------------------------ By: ---------------------------------------------
DATE OFFICER OF ABOVE-NAMED INSURANCE COMPANY
</TABLE>
Golden American Life Insurance Company, Customer Service Center, P.O. Box 8794,
Wilmington, DE 19899-8974 1-800-366-0066
B8
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
CERTIFICATE OF DEPOSIT TRANSFER FORM
- --------------------------------------------------------------------------------
APPOINTMENT OF ATTORNEY-IN-FACT TO SURRENDER CERTIFICATE OF DEPOSIT
(NON-QUALIFIED ONLY)
CERTIFICATE(S) OF DEPOSIT
Issued By: _____________________________________________________________________
INSTITUTION
Address: _______________________________________________________________________
Certificate Number(s): _________________________ Issued to: ____________________
Maturity Date(s): ______________________________________________________________
Estimated Amount(s): ___________________________________________________________
I/We do hereby name and appoint Golden American Life Insurance Company ("Golden
American") through its duly authorized officers as lawful agent and
attorney-in-fact for me/us, to surrender the above Certificate(s) of Deposit
upon the respective Maturity Date(s).
I/We request that upon maturity all funds available be transferred to Golden
American. Golden American will apply all such funds received to a variable
Contract issued to me/us.
I/We understand that Golden American assumes no responsibility for the tax
treatment of this matter and that I/ we shall be responsible for the payment of
all federal, state and local taxes and any other fees and charges incurred with
respect to the Certificate(s).
I/We acknowledge that the investment earnings credited under the variable
Contract will begin to accrued when Golden American receives the proceeds from
the Certificate(s). Golden American has the responsibility only to present the
Certificate(s) for payment upon maturity and shall not be responsible for the
solvency of the issuing Financial Institution.
Dated at ______________________________ on this ______ day of
____________________, 19________________________________________________________
<TABLE>
<S> <C>
X ----------------------------------------- X ---------------------------------------------------
Witness Signature of Certificate Owner
X ----------------------------------------- X ---------------------------------------------------
Witness Signature of Joint Certificate Owner
</TABLE>
Special Handling Instructions: _________________________________________________
________________________________________________________________________________
ACKNOWLEDGMENT
Golden American will accept any and all funds which discharge the obligation
listed above and request that such funds be sent to: Golden American Life
Insurance Company, Customer Service Center, P.O. Box 8794, Wilmington, DE
19899-8794
By _____________________________________________________________________________
Name Title Date
Golden American Life Insurance Company, Customer Service Center, P.O. Box 8794,
Wilmington, DE 19899-8974 1-800-366-0066
B9
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A Subsidiary of Bankers Trust Company
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY
DOMICILED IN WILMINGTON, DELAWARE
IN 3306 DVA PLUS 5/96
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PART II
INFORMATION NOT REQUIRED IN PROSPECTUS
ITEM 13. OTHER EXPENSES OF ISSUANCE AND DISTRIBUTION
Not applicable.
ITEM 14. INDEMNIFICATION OF DIRECTORS AND OFFICERS.
The following provisions regarding the Indemnification of Directors and Officers
of the Registrant are applicable:
INDEMNIFICATION OF DIRECTORS, OFFICERS, EMPLOYEES AND INCORPORATORS
Delaware General Corporation Law, title 8, Section 145 provides that
corporations incorporated in Delaware may indemnify their officers,
directors, employees or agents for threatened, pending or past legal action
by reason of the fact he/she is or was a director, officer, employee or
agent. Such indemnification is provided for under the Company's By-Laws
under Article VI. Indemnification includes all liability and loss suffered
and expenses (including attorneys' fees) reasonably incurred by such
indemnitee. Prepayment of expenses is permitted, however, reimbursement is
required if it is ultimately determined that indemnification should not
have been given.
DIRECTORS' AND OFFICERS' INSURANCE
The directors, officers, and employees of the registrant, in addition to
the indemnifications described above, are indemnified through the blanket
liability insurance policy of Bankers Trust Company, an affiliate of
Registrant, for liabilities not covered through the indemnification
provided under the By-Laws.
SECURITIES AND EXCHANGE COMMISSION POSITION ON INDEMNIFICATION
Insofar as indemnification for liabilities arising under the Securities Act
of 1933 may be permitted to directors, officers and controlling persons of
the Registrant pursuant to the foregoing provisions, or otherwise, the
Registrant has been advised that in the opinion of the Securities and
Exchange Commission such indemnification is against public policy as
expressed in the Act and is, therefore, unenforceable. In the event that a
claim for indemnification against such liabilities (other than the payment
by the Registrant of expenses incurred or paid by a director, officer or
controlling person of the Registrant in the successful
1
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defense of any action, suit or proceeding) is asserted by such director,
officer or controlling person in connection with the securities being
registered, the Registrant will, unless in the opinion of its counsel the
matter has been settled by controlling precedent, submit to a court of
appropriate jurisdiction the question whether such indemnification by it is
against public policy as expressed in the Act and will be governed by the
final adjudication of such issue.
ITEM 16. EXHIBITS AND FINANCIAL STATEMENT SCHEDULES
(a) EXHIBITS
1 Underwriting Agreement Between Golden American Life Insurance
Company and Directed Services, Inc. (Incorporated by reference to
registrant's pre-effective amendment No. 1 to the Registration
Statement Filed with the Securities and Exchange Commission on
October 6, 1988 (File No. 33-23351)).
3(a) Articles of Incorporation of Golden American Life Insurance
Company (Incorporated herein by reference to the depositor's
post-effective amendment No.17 to the registration statement on
Form N-4 filed with the Securities and Exchange Commission on May
2, 1994 (File No. 33-23351)).
3(b) (i) By-laws of Golden American Life Insurance Company
(Incorporated herein by reference to the depositor's initial
registration statement on Form N-4 filed with the Securities and
Exchange commission on July 27, 1988 (File No. 33-23351)).
(ii) By-laws of Golden American Life Insurance Company, as
amended (Incorporated herein by reference to the depositor's
post-effective amendment No.5 to the registration statement on
Form N-4 filed with the Securities and Exchange Commission on May
2, 1991 (File No. 33-23351)).
(iii) Certificate of Amendment of the By-laws of MB Variable
Life Insurance Company as amended (Incorporated herein by
reference to the depositor's registration statement on Form N-3
filed with the Securities and Exchange Commission on August 19,
1992 (File No. 33-23351)).
(iv) By-laws of Golden American, as amended (12/21/93)
(Incorporated herein to the depositor's post-effective
amendment No. 17 to the registration statement filed with
the Securities and Exchange statement filed with the Securities
and Exchange Commission on May 2, 1994 (File No. 33-23351)).
2
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4(a) Individual Deferred Variable and Fixed Annuity Contract.(1)
4(b) Discretionary Group Deferred Variable and Fixed Annuity
Contract.(1)
4(c) Individual Deferred Variable and Fixed Annuity Application. (1)
4(d) Group Deferred Variable and Fixed Annuity Enrollment Form. (1).
4(e) Individual Deferred Combination Variable and Fixed Annuity
Contract
4(f) Discretionary Group Deferred Combination Variable and Fixed
Annuity Contract.
4(g) Individual Deferred Variable Annuity Contract.
4(h) External Exchange Program Endorsement. (2)
4(i) DVA Update Program Schedule Page. (2)
4(j) Individual Retirement Annuity Rider Page. (2)
4(k) Individual Deferred Combination Variable and Fixed Annuity
Application.
4(l) Group Deferred Combination Variable and Fixed Annuity Enrollment
Form.
4(m) Individual Deferred Variable Annuity Application.
5 Opinion and Consent of Myles R. Tashman, Esq.
23(a) Written Consent of Sutherland, Asbill & Brennan.
23(b) Written Consent of Ernst & Young LLP, independent certified
public accountants.
24 Powers of Attorney.
- -------------------
(1) Incorporated herein by reference to Pre-Effective Amendment No. 1 of this
registration statement filed with the Securities and Exchange Commission on
February 13, 1995.
(2) Incorporated herein by reference to Amendment No. 3 of this registration
statement filed with the Securities and Exchange Commission on September 7,
1995.
3
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(b) FINANCIAL STATEMENT SCHEDULES
See Prospectus.
ITEM 17. UNDERTAKINGS
The undersigned registrant hereby undertakes:
(1) To file, during any period in which offers or sales are being made, a
post-effective amendment to this registration statement:
(i) To include any prospectus required by Section 10(a)(3) of the
Securities Act of 1933;
(ii) To reflect in the prospectus any facts or events arising after
the effective date of the registration statement (or the most
recent post-effective amendment thereof) which, individually or
in the aggregate, represent a fundamental change in the
information set forth in the registration statement; and
(iii) To include any material information with respect to the plan of
distribution not previously disclosed in the registration
statement or any material change to such information in the
registration statement.
(2) That, for the purpose of determining any liability under the Securities Act
of 1933, each such post-effective amendment shall be deemed to be a new
registration statement relating to the securities offered therein, and the
offering of such securities at that time shall be deemed to be the initial
bona fide offering thereof.
(3) To remove from registration by means of a post-effective amendment any of
the securities being registered which remain unsold at the termination of
the offering.
(4) That, for purposes of determining any liability under the Securities Act of
1933, each filing of the registrant's annual report pursuant to Section
13(a) or Section 15(d) of the Securities Exchange Act of 1934 (and, where
applicable, each filing of an employee benefit plan's annual report
pursuant to Section 15(d) of the Securities Exchange Act of 1934) that is
incorporated by reference in the registration statement shall be deemed to
be a new registration statement relating to the securities offered therein,
and the offering of such securities at that time shall be deemed to be the
initial bona fide offering thereof.
4
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SIGNATURES
As required by the Securities Act of 1933, the Registrant has duly caused this
amendment to its Registration Statement to be signed on its behalf by the
undersigned, thereunto duly authorized, in the City of Wilmington and State of
Delaware, on the 29th day of April, 1996.
GOLDEN AMERICAN LIFE
INSURANCE COMPANY
(Registrant)
By: ---------------------------
Terry L. Kendall*
Chairman, President and
Chief Executive Officer
Attest: /s/ Marilyn Talman
Marilyn Talman
Vice President; Assistant Secretary
and Associate General Counsel
As required by the Securities Act of 1933, this Registration Statement has been
signed below by the following persons in the capacities indicated on April 29,
1996.
Signature Title
---------- ------
---------------------- Chairman, President and
Terry L. Kendall* Chief Executive
Officer of
Depositor
---------------------- Chief Financial Officer
Stephen J. Preston*
---------------------- Director of Depositor
Paul Danial Borge*
---------------------- Director of Depositor
Richard A. Marin*
By: /s/ Myles R. Tashman Attorney-in-Fact
Myles R. Tashman
- --------------------------------
*Executed by Myles R. Tashman on behalf of those indicated pursuant to Power of
Attorney.
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EXHIBIT INDEX
ITEM EXHIBIT ................................................. PAGE #
4(e) Individual Deferred Combination Variable and
Fixed Annuity Contract ..................................
4(f) Discretionary Group Deferred Combination
Variable and Fixed Annuity Contract .....................
4(g) Individual Deferred Variable Annuity Contract ...........
4(k) Individual Deferred Combination Variable and
Fixed Annuity Application................................
4(l) Group Deferred Combination Variable and Fixed
Annuity Enrollment Form .................................
4(m) Individual Deferred Variable Annuity
Application .............................................
5 Opinion and Consent of Myles R. Tashman, Esq.............
23(a) Written Consent of Sutherland, Asbill & Brennan .........
23(b) Written Consent of Ernst & Young LLP ....................
24 Powers of Attorney ......................................
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4(e) INDIVIDUAL DEFERRED COMBINATION VARIABLE
AND FIXED ANNUITY CONTRACT
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GOLDEN
AMERICAN
[LOGO] LIFE INSURANCE Deferred Combination
COMPANY Variable and Fixed
Annuity Contract
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock Company domiciled in Wilmington, Delaware
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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This is a legal Contract between its Owner and us. Please read it
carefully. In this Contract you or your refers to the Owner shown above.
We, our or us refers to Golden American Life Insurance Company. You may
allocate this Contract's Accumulation Value among the Separate Account
Divisions and the Fixed Account (the Market Value Adjusted Fixed Account)
as shown in the Schedule.
If this Contract is in force, we will make income payments to you starting
on the Annuity Commencement Date. If the Owner dies prior to the Annuity
Commencement Date, we will pay a death benefit to the Beneficiary. The
amount of such benefits are subject to the terms of this Contract.
RIGHT TO EXAMINE THIS CONTRACT: You may return this Contract to us or the
agent through whom you purchased it within 10 days after you receive it. If
so returned, we will treat the Contract as though it were never issued.
Upon receipt we will promptly refund the Accumulation Value plus any
charges we have deducted as of the date the returned Contract is received
by us.
All payments and values, when based on the investment experience of a
Separate Account Division, may increase or decrease, depending on the
Contract's investment results. All payments and values based on the Fixed
Account may be subject to a Market Value Adjustment, the operation of which
may cause such payments and values to increase or decrease.
Signed for Golden American Life Insurance Company on the Contract Issue
Date.
Customer Service Center Secretary:
1001 Jefferson Street, Suite 400
Wilmington, Delaware 19801 President:
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Deferred Combination Variable and Fixed Annuity Contract - No Dividends
Variable Cash Surrender Values while the Owner is living and prior to the
Annuity Commencement Date. Death benefit subject to guaranteed minimum.
Additional Premium Payment Option. Partial Withdrawal Option.
Non-participating. Investment results reflected in values.
GA-IA-1007-04/95
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Table of Contents
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The Schedule ........................................ 3
Premium Payment and Investment Information
The Variable Separate Accounts
Contract Facts
Charges
Income Plan Factors
Introduction to this Contract ....................... 4
The Contract
The Owner
The Annuitant
The Beneficiary
Change of Owner or Beneficiary
Premium Payments and Allocation Changes ............. 6
Initial Premium Payment
Additional Premium Payment Option
Your Right to Change Allocation of
Accumulation Value
What Happens if a Division is Not Available
How We Measure the Contract's
Accumulation Value ................................. 7
The Variable Separate Accounts
Valuation Period
Accumulation Value
Accumulation Value in each Division and Fixed
Allocation
Fixed Account
Measurement of Investment Experience
Charges Deducted from Accumulation Value on
each Contract Processing Date
Your Contract Benefits .............................. 12
Cash Value Benefit
Partial Withdrawal Option
Death Benefit Proceeds .............................. 13
Proceeds Payable to the Beneficiary
Choosing an Income Plan ............................. 14
Annuity Benefits
Annuity Commencement Date Selection
Frequency Selection
The Income Plan
The Annuity Options
Payments When Named Person Dies
Other Important Information ......................... 16
Sending Notice to Us
Reports to Owner
Assignment -- Using this Contract as
Collateral Security
Changing this Contract
Contract Changes - Applicable Tax Law
Misstatement of Age or Sex
Non-Participating
Payments We May Defer
Authority to Make Agreements
Required Note on Our Computations
Copies of any application form and any additional Riders and Endorsements
are at the back of this Contract.
Schedule Pages
The Schedule pages give specific facts about this Contract and its
coverage. Please refer to them while reading this Contract.
GA-IA-1007-04/95
2
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The Schedule
Payment And Investment Information
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Annuitant's Issue Age Annuitant's Sex Owner's Issue Age
[35] [Male] [55]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Contract Date Issue Date Residence State
[January 1, 1994] [January 1, 1994] [Delaware]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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Premium Payment and Investment Information
Initial Premium Payment received: [$10,000]
Your initial Accumulation Value has been invested as follows:
Percentage of
Divisions Accumulation Value
--------- ------------------
[Multiple Allocation 10%
Fully Managed 10%
Capital Appreciation 10%
Rising Dividends 10%
All-Growth 10%
Real Estate 10%
Value Equity 5%
Natural Resources 5%
Emerging Markets 5%
The Managed Global Account 5%
Limited Maturity Bond 5%
Liquid Asset 5%]
Fixed
Allocations
-----------
[1-Year Guarantee Period 5%
3-Year Guarantee Period 5%]
--------
Total 100%
========
Additional Premium Payment Information
[We will accept additional premium payments until either the Annuitant or the
Owner reaches the Attained Age of [85]. The minimum additional payment which may
be made is [$500.00].
Accumulation Value Allocation Rules
The maximum number of Divisions in which you may be invested at any one time is
[twelve]. You are allowed unlimited allocation changes per Contract Year without
charge. We reserve the right to impose a charge for any allocation change in
excess of [twelve] per Contract Year. We also reserve the right to limit, upon
notice, the maximum number of allocation changes you may make within a Contract
Year. The Excess Allocation Charge is shown in the Charges section of the
Schedule.
GA-IA-1007-04/95
3A1
<PAGE>
The Schedule
Payment And Investment Information (continued)
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Annuitant's Issue Age Annuitant's Sex Owner's Issue Age
[35] [Male] [55]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Contract Date Issue Date Residence State
[January 1, 1994] [January 1, 1994] [Delaware]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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Allocation Changes by Telephone
You may request allocation changes by telephone during our telephone request
business hours. You may call our Customer Service Center at 1-800-366-0066 to
make allocation changes by using the personal identification number you will
receive. You may also mail any notice or request for allocation changes to our
Customer Service Center.
GA-IA-1007-04/95
3A2
<PAGE>
The Schedule
The Variable Separate Accounts
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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Divisions Investing in Shares of a Mutual Fund
Separate Account B (the "Account") is a unit investment trust Separate
Account, organized in and governed by the laws of the State of Delaware,
our state of domicile. The Account is divided into Divisions.
Each Division listed below invests in shares of the mutual fund portfolio
(the "Series") designated. Each portfolio is a part of The GCG Trust (the
"Trust") managed by Directed Services, Inc.
[MULTIPLE MULTIPLE ALLOCATION SERIES
ALLOCATION Objective -The highest total return, consisting of
DIVISION capital appreciation and current income,
consistent with the preservation of capital
and elimination of unnecessary risk.
Investments -Investment in equity and debt securities and
the use of certain sophisticated investment
strategies and techniques.
Portfolio Manager -Zweig Advisors Inc.
FULLY FULLY MANAGED SERIES
MANAGED Objective -High total investment return over the long
DIVISION term, consistent with the preservation of
capital and prudent investment risk.
Investments -Pursues an active asset allocation strategy
whereby investments are allocated, based
upon an evaluation of economic and market
trends and the anticipated relative total
return available, among three asset classes
-- debt securities, equity securities and
money market instruments.
Portfolio Manager -T. Rowe Price Associates, Inc.]
GA-IA-1007-04/95
3Bl
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The Schedule
The Variable Separate Accounts (continued)
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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[CAPITAL CAPITAL APPRECIATION SERIES
APPRECIATION Objective -Long-term capital growth.
DIVISION
Investments -Invests in common stocks and preferred stock
that will be allocated among various
categories of stocks referred to as
"components" which consist of the following:
(i) The Growth Component - Securities that
the portfolio manager believes have the
following characteristics: stability and
quality of earnings and positive earnings
momentum; dominant competitive positions;
and demonstrate above-average growth rates
as compared to published S&P 500 earnings
projections; and (ii) The Value Component -
Securities that the portfolio manager
regards as fundamentally undervalued, i.e.,
securities selling at a discount to asset
value and securities with a relatively low
price/earnings ratio. The securities
eligible for this component may include real
estate stocks, such as securities of
publicly-owned companies that, in the
portfolio manager's judgement, offer an
optimum combination of current dividend
yield, expected dividend growth, and
discount to current real estate value.
Portfolio Manager -Chancellor Trust Company
RISING RISING DIVIDENDS SERIES
DIVIDENDS Objective -Capital appreciation, with dividend income
DIVISION as a secondary objective.
Investments -Investment in equity securities of high
quality companies that meet the following
four criteria: consistent dividend
increases; substantial dividend increases;
reinvested profits; and an under-leveraged
balance sheet.
Portfolio Manager -Kayne, Anderson Investment Management, Inc.
ALL-GROWTH ALL-GROWTH SERIES
DIVISION Objective - Capital appreciation.
Investments -Investment in securities selected for their
long term growth prospects.
Portfolio Manager -Warburg, Pincus Counsellors, Inc.
REAL REAL ESTATE SERIES
ESTATE Objective -Capital appreciation, with current income as
DIVISION a secondary objective.
Investments -Investment in publicly-traded equity
securities of companies in the real estate
industry listed on national exchanges or on
the National Association of Securities
Dealers Automated Quotation System.
Portfolio Manager -E.I.I. Realty Securities, Inc.]
GA-IA-1007-04/95
3B2
<PAGE>
The Schedule
The Variable Separate Accounts (continued)
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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[NATURAL NATURAL RESOURCES SERIES
RESOURCES Objective -Long-term capital appreciation.
DIVISION
Investments -Investment in equity and debt securities of
companies engaged in the exploration,
development, production, and distribution of
natural resources.
Portfolio Manager -Van Eck Associates Corporation
EMERGING EMERGING MARKETS SERIES
MARKETS Objective -Long-term growth of capital.
DIVISION
Investments -Investment primarily in equity securities of
companies that are considered to be in
emerging market countries in the Pacific
Basin and Latin America. Income is not an
objective, and any production of current
income is considered incidental to the
objective of growth of capital.
Portfolio Manager -Bankers Trust Company
LIMITED LIMITED MATURITY BOND SERIES
MATURITY Objective -Highest current income consistent with low
BOND risk to principal and liquidity. Also seeks
DIVISION to enhance its total return through capital
appreciation when market factors indicate
that capital appreciation may be available
without significant risk to principal.
Investments -Investment primarily in a diversified
portfolio of limited maturity debt
securities.
Portfolio Manager -Bankers Trust Company
LIQUID LIQUID ASSET SERIES
ASSET Objective -High level of current income consistent with
DIVISION the preservation of capital and liquidity.
Investments -Obligations of the U.S. Government and its
agencies and instrumentalities; bank
obligations; commercial paper and short-term
corporate debt securities.
Term -All issues maturing in less than one year.
Portfolio Manager -Bankers Trust Company]
GA-IA-1007-04/95
3B3
<PAGE>
The Schedule
The Variable Separate Accounts (continued)
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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[VALUE VALUE EQUITY SERIES
EQUITY Objective -Capital appreciation.
DIVISION
Investments -Investment primarily in equity securities
which meet quantitative standards considered
to indicate above-average financial
soundness and high intrinsic value relative
to price.
Portfolio Manager -Eagle Asset Management, Inc.
NOTE: PLEASE REFER TO THE PROSPECTUSES FOR THE CONTRACT AND THE GCG TRUST
FOR MORE DETAILS.
The Managed Global Account of Account D
The Managed Global Account (the "Global Account") is a non-diversified
investment company which invests directly in securities. DSI serves as
manager of Separate Account D and Warburg, Pincus Counsellors, Inc. serves
as portfolio manager of the Global Account.
THE MANAGED THE MANAGED GLOBAL ACCOUNT PORTFOLIO
GLOBAL ACCOUNT Objective -High total investment return, consistent
DIVISION with a prudent regard for capital
preservation.
Investments -Investment in a wide range of equity and
debt securities and money market instruments
of both domestic and foreign issuers.
Portfolio Manager -Warburg, Pincus Counsellors, Inc.
NOTE: PLEASE REFER TO THE PROSPECTUS FOR THE CONTRACT AND THE MANAGED
GLOBAL ACCOUNT OF ACCOUNT D FOR MORE DETAILS.]
GA-IA-1007-04/95
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<PAGE>
The Schedule
Contract Facts
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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Contract Facts
Contract Processing Date
The Contract Processing Date for your Contract is [April 1] of each year.
Specially Designated Division
When a distribution is made from an investment portfolio underlying a
Separate Account Division in which reinvestment is not available, we will
allocate the amount of the distribution to the [Liquid Asset Division]
unless you specify otherwise.
Partial Withdrawals
[The maximum amount that can be withdrawn in a Contract Year without being
considered an Excess Partial Withdrawal is 15% of the Accumulation Value as
of the date of the withdrawal. We will collect a Surrender Charge for
Excess Partial Withdrawals and a charge for any unrecovered premium taxes.
In no event may a Partial Withdrawal be greater than 90% of the Cash
Surrender Value.
Conventional Partial Withdrawals
Minimum Withdrawal Amount: $1,000
Any Conventional Partial Withdrawal from a Fixed Allocation is subject to a
Market Value Adjustment unless taken from a Fixed Allocation within the
thirty days prior to the Maturity Date of such Fixed Allocation.
Systematic Partial Withdrawal
Systematic Partial Withdrawals may be elected to commence after 28 days
from the Contract Issue Date and may be taken on a monthly or quarterly
basis. You select the day withdrawals will be made, but no later than the
28th day of the month. If you do not elect a day, the Contract Date will be
used.
Minimum Withdrawal Amount: $100.00
Maximum Withdrawal Amounts:
Separate Account Divisions: 1.25% monthly or 3.75% quarterly of
Accumulation Value.
Fixed Allocations: Interest earned on Fixed Allocation
in prior month (for monthly
withdrawals) or prior quarter (for
quarterly withdrawals).
A Systematic Partial Withdrawal from a Fixed Allocation is not subject to
Market Value Adjustment.]
GA-IA-1007-04/95
3C1
<PAGE>
The Schedule
Contract Facts (continued)
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Annuitant Owner
[Thomas J. Doe] [John Q. Public]
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Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
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Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
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Death Benefit
[IF DEATHBEN="1": The Death Benefit is the greatest of (i) the Accumulation
Value, (ii) the Guaranteed Death Benefit, (iii) the Cash Surrender Value, and
(iv) the sum of premiums paid, less any partial withdrawals.
IF DEATHBEN="2": The Death Benefit is the greatest of (i) the Accumulation
Value, (ii) the Guaranteed Death Benefit, (iii) the Cash Surrender Value, and
(iv) the sum of premiums paid, less any partial withdrawals.
IF DEATHBEN="3": The Death Benefit is the greater of (i) the Cash Surrender
Value, (ii) the Accumulation Value, and (iii) the sum of the premiums paid, less
any Partial Withdrawals.]
Guaranteed Death Benefit
[On the Contract Date, the Guaranteed Death Benefit is the initial premium. On
subsequent Valuation Dates, the Guaranteed Death Benefit is calculated as
follows:
IF DEATHBEN="1": Option 1:
(1) Start with the Guaranteed Death Benefit from the prior Valuation Date;
(2) Calculate interest on (1) if the Owner is living (the Annuitant if
the Owner is not an individual) for the current Valuation Period at
the Guaranteed Death Benefit Interest Rate;
(3) Add (1) and (2);
(4) Add any additional premiums paid during the current Valuation Period
to (3);
(5) Subtract Partial Withdrawals made during the current Valuation Period
from (4);
Each accumulated initial or additional premium payment, reduced by any Partial
Withdrawals (including any associated Market Value Adjustment and Surrender
Charge incurred) allocated to such premium, will continue to grow at the
Guaranteed Death Benefit Interest Rate until reaching its Maximum Guaranteed
Death Benefit.
Guaranteed Death Benefit Interest Rate
The Guaranteed Death Benefit is accumulated at a rate of 7% compounded annually,
except:
(1) Amounts in the Liquid Asset Division are accumulated at the net rate
of return for the Liquid Asset Division during the current Valuation
Period if less than 7%; and
(2) Amounts in Limited Maturity Bond Division are accumulated at the net
rate of return for the Limited Maturity Bond Division during the
current Valuation Period if less than 7%; and
(3) Amounts in a Fixed Allocation are accumulated at the interest rate
being credited to such Fixed Allocation during the current Valuation
Period if less than 7%.]
Maximum Guaranteed Death Benefit
The Maximum Guaranteed Death Benefit is initially equal to two times the initial
or additional premium paid. Thereafter, the Maximum Guaranteed Death Benefit as
of the effective date of a partial withdrawal is reduced first by the amount of
any partial withdrawal representing earnings and second in proportion to the
reduction in Accumulation Value for any partial withdrawal representing premium
(in each case, including any associated Market Value Adjustment and Surrender
Charge incurred). If withdrawals do not exceed 7% of premium paid in a
Contract Year, the Maximum Gauranteed Death Benefit will be reduced only by
the amount of such withdrawals. Once withdrawals exceed 7% in a contract Year
all withdrawals of premium will be treated as proportion in relation to the
amount of Accumulation Value for any Partial Withdrawal (including any Market
Value Adjustment or Surrender Charge incurred).
GA-IA-1007-04/95
3C2
<PAGE>
The Schedule
Contract Facts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
- --------------------------------------------------------------------------------
Option 2:
(1) Start with the Guaranteed Death Benefit from the prior Valuation Date;
(2) Add to (1) any additional premium paid since the prior Valuation Date
and subtract from (1) any Partial Withdrawals taken since the prior
Valuation Date;
(3) On a Valuation Date which occurs through the Contract Year in which
the Owner's Attained Age is 80 and which is also a Contract
Anniversary, if the Owner is living (the Annuitant if the Owner is
not an individual), we set the Guaranteed Death Benefit equal to the
greater of (2) or the Accumulation Value as of such date. On all other
Valuation Dates, the Guaranteed Death Benefit is equal to (2).
Option 3:
(1) Start with the Guaranteed Death Benefit from the prior Valuation Date;
(2) Add any additional premiums paid during the current Valuation Period
to (1);
(3) Subtract any Partial Withdrawals made during the current Valuation
Period from (2).]
GA-IA-1007-04/95
3C3
<PAGE>
The Schedule
Contract Facts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
- --------------------------------------------------------------------------------
Change of Owner
[When the ownership changes, the new Owner's age at the time of the change
will be used as the basis for the death benefit. The new Owner's death will
determine when a death benefit is payable.
IF DEATHBEN="1": If the new Contractowner's age is less than or equal to
75, the Guaranteed Death Benefit Option in effect prior to the change of
Contractowner will remain in effect. If the new Contractowner's age is
greater than 75, the Guaranteed Death Benefit will be zero and the Death
Benefit shall be the greatest of the Cash Surrender Value, the Accumulation
Value, and the sum of the premiums paid, less any Partial Withdrawals.
IF DEATHBEN="2": If the new Contractowner's age is less than or equal to
79, the Guaranteed Death Benefit Option in effect prior to the change of
Contractowner will remain in effect. If the new Contractowner's age is
greater than 79, the Guaranteed Death Benefit will be zero and the Death
Benefit shall be the greatest of Cash Surrender Value, the Accumulation
Value, and the sum of premiums paid, less any Partial Withdrawals.
IF DEATHBEN="3": The Guaranteed Death Benefit Option after the change of
Contractowner will remain the same as before the change.]
Choosing an Income Plan
Required Date of Annuity Commencement
[The Annuity Commencement Date is required to be the same date as
the Contract Processing Date in the month following the Annuitant's [90th]
birthday. If, on the Annuity Commencement Date, a Surrender Charge
remains, your elected Annuity Option must include a period certain
of at least five years duration. In applying the Accumulation Value, we may
first collect any Premium Taxes due us.]
Minimum Annuity Income Payment
The minimum monthly annuity income payment that we will make is [$20.]
Optional Benefit Riders - [None.]
Attained Age
The Issue Age of the Annuitant or Owner plus the number of full years
elapsed since the Contract Date.
GA-IA-1007-04/95
3C4
<PAGE>
The Schedule
Contract Facts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
- --------------------------------------------------------------------------------
Fixed Account
Minimum Fixed Allocation
The minimum allocation to the Fixed Account in any one Fixed Allocation is
[$250.00].
Guaranteed Minimum Interest Rate - [3%].
Guarantee Periods
We currently offer Guarantee Periods of [1, 3, 5, 7 and 10] years. We
reserve the right to offer Guarantee Periods of durations other than those
available on the Contract Date. We also reserve the right to cease offering
a particular Guarantee Period or Periods.
Index Rate
The Index Rate is the average of the Ask Yields for the U.S. Treasury
Strips as reported by a national quoting service for the applicable
maturity. The average is based on the period from the 22nd day of the
calendar month two months prior to the calendar month of Index Rate
determination to the 21st day of the calendar month immediately prior to
the month of determination. The applicable maturity date for these U.S.
Treasury Strips is on or next following the last day of the Guarantee
Period. If these Ask Yields are no longer available, the Index Rate will be
determined using a suitable replacement method.
We currently set the Index Rate once each calendar month. However, we
reserve the right to set the Index Rate more frequently than monthly, but
in no event will such Index Rate be based on a period less than 28 days.
GA-IA-1007-04/95
3C5
<PAGE>
The Schedule
Charges
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
- --------------------------------------------------------------------------------
Charge Deduction Division
[All charges against the Accumulation Value in this Contract will be deducted
from the [Liquid Asset Division].]
Deductions from Premiums - [None.]
Deductions from Accumulation Value
Initial Administrative Charge - [None.]
Administrative Charge - [We charge [$40] to cover a portion of our ongoing
administrative expenses for each Contract Processing Period. The charge is
incurred at the beginning of the Contract Processing Period and deducted on the
Contract Processing Date at the end of the period. At the time of deduction,
this charge will waived if:
(1) The Accumulation Value is at least $100,000; or
(2) The sum of premiums paid to date is at least $100,000.]
Excess Allocation Charge - Currently none, however, we reserve the right to
charge t$25] for a change if you make more than [twelve] allocation changes per
Contract Year. Any charge will be deducted from the Divisions and Fixed
Allocations from which each such allocation is made in proportion to the amount
being transferred from each such Division and Fixed Allocation.
Surrender Charge - A Surrender Charge is imposed as a percentage of premium if
the Contract is surrendered or an Excess Partial Withdrawal is taken. The
percentage imposed at time of surrender or Excess Partial Withdrawal depends on
the number of complete years that have elapsed since a premium payment was made.
The Surrender Charge expressed as a percentage of each premium payment is as
follows:
Complete Years Elapsed Surrender
Since Premium Payment Charges
--------------------- -------
[0 7%
1 7%
2 6%
3 5%
4 4%
5 3%
6 1%
7+ 0%]
For the purpose of calculating the Surrender Charge for an Excess Partial
Withdrawal; a) we treat premiums as being withdrawn on a first-in, first-out
basis, and b) amounts withdrawn which are not considered an Excess Partial
Withdrawal are not considered a withdrawal of any premium payments.
GA-IA-1007-04/95
3D1
<PAGE>
The Schedule
Charges (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
- --------------------------------------------------------------------------------
[Premium Taxes - We deduct from the Accumulation Value the amount of any premium
or other state and local taxes levied by any state or governmental entity when
such taxes are incurred.
We reserve the right to defer collection of premium taxes until surrender or
until application of Accumulation Value to an Annuity Option. An Excess Partial
Withdrawal will result in the deduction of any premium tax then due us on such
amount We reserve the right to change the amount we charge for premium tax
charges on future premium payments to conform with changes in the law or if the
Owner changes state of residence.
Deductions from the Divisions
Mortality and Expense Risk Charge - We deduct 0.003030% of the assets in the
Separate Account Division on a daily basis (equivalent to an annual rate of
1.10%) for mortality and expense risks. This charge is not deducted from the
Fixed Account values.
Asset-Based Administrative Charge - [We deduct 0.000411% of the assets in each
Separate Account Division on a daily basis (equivalent to an annual rate of
0.15%) to compensate us for a portion of our ongoing administrative expenses.
This charge is not deducted from the Fixed Account.]
GA-IA-1007-04/95
3D2
<PAGE>
The Schedule
Income Plan Factors
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life-10 Year Certain] [January 1, 2024]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B, Separate Account D and the Fixed Account] [123456]
- --------------------------------------------------------------------------------
[Values for other payment periods, ages, or joint life combinations are
available on request. Monthly payments are shown for each $1,000 applied.
Table for Income for a Fixed Period
Fixed Period Monthly Fixed Period Monthly Fixed Period Monthly
of Years Income of Years Income of Years Income
------------ -------- ------------ ------- ------------ -------
11 $8.88 21 $5.33
2 $42.96 12 8.26 22 5.16
3 29.06 13 7.73 23 5.00
4 22.12 14 7.28 24 4.85
5 17.95 15 6.89 25 4.72
6 15.18 16 6.54 26 4.60
7 13.20 17 6.24 27 4.49
8 11.71 18 5.98 28 4.38
9 10.56 19 5.74 29 4.28
10 9.64 20 5.53 30 4.19
Table for Income for Life
Male/Female Male/Female Male/Female
Age 10 Years Certain 20 Years Certain Refund Certain
- --- ---------------- ---------------- --------------
50 $4.53/4.19 $4.38/4.13 $4.40/4.12
55 4.93/4.52 4.68/4.40 4.74/4.42
60 5.45/4.96 4.99/4.72 5.16/4.79
65 6.11/5.52 5.30/5.07 5.75/5.29
70 6.91/6.26 5.54/5.40 6.52/5.97
75 7.79/7.18 5.68/5.62 7.33/6.74
80 8.61/8.18 5.75/5.73 8.61/7.90
85 & Over 9.24/9.01 5.77/5.76 10.43/9.50]
GA-IA-1007-04/95
3E
<PAGE>
Introduction to this Contract
- --------------------------------------------------------------------------------
The Contract
This is a legal Contract between you and us. We provide benefits as stated
in this Contract. In return, you supply us with the Initial Premium Payment
required to put this Contract in effect.
This Contract, together with any Riders or Endorsements, constitutes the
entire Contract. Riders and Endorsements add provisions or change the terms
of the basic Contract.
The Owner
You are the Owner of this Contract. You are also the Annuitant unless
another Annuitant has been named in the application and is shown in the
Schedule. You have the rights and options described in this Contract,
including but not limited to the right to receive the Annuity Benefits on
the Annuity Commencement Date.
One or more people may own this Contract. If there are multiple Owners
named, the age of the oldest Owner shall be used to determine the
applicable death benefit. In the case of a sole Owner who dies prior to the
Annuity Commencement Date, we will pay the Beneficiary the death benefit
then due. If the sole Owner is not an individual, we will treat the
Annuitant as Owner for the purpose of determining when the Owner dies under
the death benefit provision (if there is no Contingent Annuitant), and the
Annuitant's issue age will determine the applicable death benefit payable
to the Beneficiary. The sole Owner's estate will be the Beneficiary if no
Beneficiary designation is in effect, or if the designated Beneficiary has
predeceased the Owner. In the case of a joint Owner of the Contract dying
prior to the Annuity Commencement Date, the surviving Owner(s) shall be
deemed as the Beneficiary(ies).
The Annuitant
The Annuitant is the measuring life of the Annuity Benefits provided under
this Contract. You may name a Contingent Annuitant. The Annuitant may not
be changed during the Annuitant's lifetime.
If the Annuitant dies before the Annuity Commencement Date, the Contingent
Annuitant becomes the Annuitant. You will be the Contingent Annuitant
unless you name someone else. The Annuitant must be a natural person. If
the Annuitant dies and no Contingent Annuitant has been named, we will
allow you sixty days to designate someone other than yourself as Annuitant.
If all Owners are not individuals and, through the operation of this
provision, an Owner becomes Annuitant, we will pay the death proceeds to
the Beneficiary. If there are joint Owners, we will treat the youngest of
the Owners as the Contingent Annuitant designated, unless you elect
otherwise.
The Beneficiary
The Beneficiary is the person to whom we pay death proceeds if any Owner
dies prior to the Annuity Commencement Date. See Death Benefit Proceeds for
more information. We pay death proceeds to the primary Beneficiary (unless
there are joint Owners in which case death benefit proceeds are payable to
the surviving Owner). If the primary Beneficiary dies before the Owner, the
death proceeds are paid to the contingent Beneficiary, if any. If there is
no surviving Beneficiary, we pay the death proceeds to the Owner's estate.
One or more persons may be named as primary Beneficiary or contingent
Beneficiary. In the case of more than one Beneficiary, we will assume any
death proceeds are to be paid in equal shares to the surviving
Beneficiaries. You can specify other than equal shares.
You have the right to change Beneficiaries, unless you designate the
primary Beneficiary irrevocable. When an irrevocable Beneficiary has been
designated, you and the irrevocable Beneficiary may have to act together to
exercise the rights and options under this Contract.
GA-IA-1007-04/95
4
<PAGE>
Introduction to this Contract (continued)
- --------------------------------------------------------------------------------
Change of Owner or Beneficiary
During your lifetime and while this Contract is in effect you can transfer
ownership of this Contract or change the Beneficiary. To make any of these
changes, you must send us written notice of the change in a form
satisfactory to us. The change will take effect as of the day the notice is
signed. The change will not affect any payment made or action taken by us
before recording the change at our Customer Service Center. A Change of
Owner may affect the amount of death benefit payable under this Contract.
See Proceeds Payable to Beneficiary.
GA-IA-1007-04/95
5
<PAGE>
Premium Payments and Allocation Changes
- --------------------------------------------------------------------------------
Initial Premium Payment
The Initial Premium Payment is required to put this Contract in effect. The
amount and allocation of the Initial Premium Payment is shown in the
Schedule.
Additional Premium Payment Option
You may make additional premium payments at any time before the Annuity
Commencement Date. Satisfactory notice to us must be given for additional
premium payments. Restrictions on additional premium payments, such as the
Attained Age of the Annuitant or Owner and the timing and amount of each
payment, are shown in the Schedule. We reserve the right to defer
acceptance of or to return any additional premium payments.
As of the date we receive and accept your additional premium payment:
(1) The Accumulation Value will increase by the amount of the premium
payment less any premium deductions as shown in the Schedule.
(2) The increase in the Accumulation Value will be allocated among
the Divisions and the Fixed Allocations in accordance with your
instructions. If you do not provide such instructions, allocation
will be among the Divisions in proportion to the amount of
Accumulation Value in each Division as of the date we receive and
accept your additional premium payment. Allocations to the Fixed
Account will be made only upon specific written request.
Where to Make Payments
Remit the premium payments to our Customer Service Center. On request we
will give you a receipt signed by one of our officers.
Your Right to Change Allocation of Accumulation Value
The Accumulation Value may be reallocated among the Divisions and the Fixed
Allocations prior to the Annuity Commencement Date. The number of free
allocation changes each Contract Year that we will allow is shown in the
Schedule. To make an allocation change, you must provide us with
satisfactory notice at our Customer Service Center. The change will take
effect when we receive the notice. Restrictions for reallocation into and
out of the Divisions are shown in the Schedule. An allocation from the
Fixed Allocation may be subject to a Market Value Adjustment. See Market
Value Adjustment.
What Happens if a Division is Not Available
When a distribution is made from an investment portfolio supporting a unit
investment trust Division or from a Division of a Managed Separate Account
in which reinvestment is not available, we will allocate the distribution
to the Specially Designated Division shown in the Schedule unless you
specify otherwise.
Such a distribution may occur when an investment portfolio or Division
matures, when distribution from a portfolio or Division cannot be
reinvested in the portfolio or Division due to the unavailability of
securities, or for other reasons. When this occurs because of maturity, we
will send written notice to you thirty days in advance of such date. To
elect an allocation to other than the Specially Designated Division shown
in the Schedule, you must provide satisfactory notice to us at least seven
days prior to the date the investment matures. Such allocations will not be
counted as an allocation change of the Accumulation Value for purposes of
the number of free allocation changes permitted.
GA-IA-1007-04/95
6
<PAGE>
How We Measure the Contract's Accumulation Value
- --------------------------------------------------------------------------------
The variable Annuity Benefits under this Contract are provided through
investments which may be made in our Separate Accounts.
The Variable Separate Ac(counts
These accounts, which are designated in the Schedule, are kept separate
from our General Account and any other Separate Accounts we may have. They
are used to support Variable Annuity Contracts and may be used for other
purposes permitted by applicable laws and regulations. We own the assets in
the Variable Separate Accounts. Assets equal to the reserves and other
liabilities of the accounts will not be charged with liabilities that arise
from any other business we conduct; but, we may transfer to our General
Account assets which exceed the reserves and other liabilities of the
Variable Separate Accounts. Income and realized and unrealized gains or
losses from assets in these Separate Accounts are credited to or charged
against the account without regard to other income, gains or losses in our
other investment accounts.
One type of Variable Separate Account will invest in mutual funds, unit
investment trusts and other investment portfolios which we determine to be
suitable for the group contract's purposes. This Separate Account is
treated as a unit investment trust under Federal securities laws. It is
registered with the Securities and Exchange Commission ("SEC") under the
Investment Company Act of 1940. This Separate Account is also governed by
state laws as designated in the Schedule.
Another type of Variable Separate Account will invest directly in portfolio
securities deemed appropriate by the investment adviser or the committee
managing a Separate Account. This Separate Account is treated as an open
end, diversified management investment company under Federal securities
laws. It is registered with the SEC under the Investment Company Act of
1940. This Separate Account is also governed by state laws as designated in
the Schedule.
We may offer certain non-registered Series or Variable Separate Accounts.
Any such Series or Variable Separate Account is shown in the Schedule.
Divisions of the Variable Separate Account
A Unit Investment Trust Variable Separate Account includes Divisions, each
investing in a designated investment portfolio. The Divisions and the
investment portfolios in which they invest, if applicable, are specified in
the Schedule. Some of the portfolios designated may be managed by a
separate investment adviser. Such adviser may be registered under the
Investment Advisers Act of 1940.
A Managed Variable Separate Account includes Divisions, each investing
directly in portfolios of securities designed to meet the objectives of the
Division. The Divisions, if applicable, and their objectives are specified
in the Schedule. Some of the Divisions designated may be managed by a
separate investment adviser. Such adviser may be registered under the
Investment Advisers Act of 1940.
Changes Within the Separate Accounts
We may, from time to time, make additional Separate Account Divisions
available to you. These Divisions will invest in investment portfolios we
find suitable for this Contract. We also have the right to eliminate
Divisions from a Separate Account, to combine two or more Divisions or to
substitute a new portfolio for the portfolio in which a Division invests. A
substitution may become necessary if, in our judgment, a portfolio or
Division no longer suits the purposes of this Contract. This may happen due
to a change in laws or regulations, or a change in a portfolio's investment
objectives or restrictions, or because the portfolio or Division is no
longer available for investment, or for some other reason. We will get
prior approval from the insurance department of our state of domicile
before making such a substitution.
This approval process is on file with the insurance department of the
jurisdiction in which this Contract is delivered. We will also get any
required approval from the SEC and any other required approvals before
making such a substitution.
GA-IA-1007-04/95
7
<PAGE>
How We Measure the Contract's Accumulation Value (continued)
- --------------------------------------------------------------------------------
Subject to any required regulatory approvals, we reserve the right to
transfer assets of the Divisions of the Variable Separate Account, which we
determine to be associated with the class of Contracts to which this
Contract belongs, to another Variable Separate Account or Division.
When permitted by law, we reserve the right to:
(1) Deregister a Separate Account under the Investment Company Act of
1940;
(2) Operate a Separate Account as a management company under the
Investment Company Act of 1940, if it is operating as a unit
investment trust;
(3) Operate a Separate Account as a unit investment trust under the
Investment Company Act of 1940, if it is operating as a Managed
Separate Account;
(4) Restrict or eliminate any voting rights of Owners, or other
persons who have voting rights as to a Separate Account; and,
(5) Combine a Separate Account with other Separate Accounts.
Valuation Period
Each Division will be valued at the end of each Valuation Period on a
Valuation Date. A Valuation Period is each Business Day together with any
non-Business Days before it. A Business Day is any day the New York Stock
Exchange (NYSE) is open for trading, and the SEC requires mutual funds,
unit investment trusts, or other investment portfolios to value their
securities.
Accumulation Value
The Accumulation Value of this Contract is equal to the sum of the amounts
that you have in each Division and the Fixed Allocations. You select how
your Accumulation Value is allocated. The maximum number of Divisions and
Fixed Allocations to which you may allocate Accumulation Value at any one
time is shown in the Schedule.
Accumulation Value in each Division and Fixed Allocation
On the Contract Date
On the Contract Date, the Accumulation Value is allocated to each Division
and the Fixed Allocations as shown in the Schedule.
On each Valuation Date
At the end of each subsequent Valuation Period, the amount of Accumulation
Value in each Division and Fixed Allocation will be calculated as follows:
(1) We take the Accumulation Value in the Division or Fixed
Allocation at the end of the preceding Valuation Period.
(2) We multiply (1) by the Division's Net Rate of Return for the
current Valuation Period, or we calculate the interest to be
credited to a Fixed Allocation for the current Valuation Period.
(3) We add (1) and (2).
(4) We add to (3) any additional premium payments (less any premium
deductions as shown in the Schedule) allocated to the Division or
Fixed Allocation during the current Valuation Period.
(5) We add or subtract allocations to or from that Division or Fixed
Allocation during the current Valuation Period.
(6) We subtract from (5) any Partial Withdrawals which are allocated
to the Division or Fixed Allocation during the current Valuation
Period.
GA-IA-1007-04/95
8
<PAGE>
How We Measure the Contract's Accumulation Value (continued)
- --------------------------------------------------------------------------------
(7) We subtract from (6) the amounts allocated to that Division
or Fixed Allocation for:
(a) any charges due for Optional Benefit Riders as shown in
the Schedule;
(b) any Contract fees as shown in the Schedule;
All amounts in (7) are allocated to each Division or Fixed Allocation as
explained in Charges Deducted from Accumulation Value.
Fixed Account
The Fixed Account is a Separate Account under state insurance law and is
not required to be registered with the Securities and Exchange Commission
under the Investment Company Act of 1940. The Fixed Account includes
various Fixed Allocations which we credit with fixed rates of interest for
the Guarantee Period or Periods you select. We reset the interest rates for
new Fixed Allocations periodically based on our sole discretion.
Guarantee Periods
Each Fixed Allocation is guaranteed an interest rate for a period, a
Guarantee Period. The Guaranteed Interest Rate for a Fixed Allocation is
effective for the entire period. The Maturity Date of a Guarantee Period
will be on the last day of the calendar month in which the Guarantee Period
ends. Withdrawals and transfers made during a Guarantee Period may be
subject to a Market Value Adjustment unless made within thirty days of the
Maturity Date.
Upon the expiry of a Guarantee Period, we will transfer the Accumulation
Value of the expiring Fixed Allocation to a Fixed Allocation with a
Guarantee Period equal in length to the expiring Guarantee Period, unless
you select another period prior to a Maturity Date. We will notify you at
least thirty days prior to a Maturity Date of your options for renewal. If
the period remaining from the expiry of the previous Guarantee Period to
the Annuity Commencement Date is less than the period you have elected or
the period expiring, the next shortest period then available that will not
extend beyond the Annuity Commencement Date will be offered to you. If a
period is not available, the Accumulation Value will be transferred to the
Specifically Designated Division.
We will declare Guaranteed Interest Rates for the then available Fixed
Allocation Guarantee Periods. These interest rates are based solely on our
expectation as to our future earnings. Declared Guaranteed Interest Rates
are subject to change at any time prior to application to specific Fixed
Allocations, although in no event will the rates be less than the Minimum
Guaranteed Interest Rate shown in the Schedule.
Market Value Adjustments
A Market Value Adjustment will be applied to a Fixed Allocation upon
withdrawal, transfer or application to an Income Plan if made more than
thirty days prior to such Fixed Allocation's Maturity Date, except on
Systematic Partial Withdrawals and IRA Partial Withdrawals. The Market
Value Adjustment is applied to each Fixed Allocation separately.
The Market Value Adjustment is determined by multiplying the amount of the
Accumulation Value withdrawn, transferred or applied to an Income Plan by
the following factor:
(((1+I)/(1+J+.0025)) (N/365))-1
Where I is the Index Rate for a Fixed Allocation on the first day of the
applicable Guarantee Period: J is the Index Rate for new Fixed Allocations
with Guarantee Periods equal to the number of years (fractional years
rounded up to the next full year) remaining in the Guarantee Period at the
time of calculation; and N is the remaining number of days in the Guarantee
Period at the time of calculation. (The Index Rate is described in the
Schedule.)
GA-IA-1007-04/95
9
<PAGE>
How We Measure the Contract's Accumulation Value (continued)
- --------------------------------------------------------------------------------
Market Value Adjustments will be applied as follows:
(1) The Market Value Adjustment will be applied to the amount
withdrawn before deduction of any applicable Surrender
Charge.
(2) For a partial withdrawal, partial transfer or in the case
where a portion of a Fixed Allocation is applied to an
Income Plan, the Market Value Adjustment will be calculated
on the total amount that must be withdrawn, transferred or
applied to an Income Plan in order to provide the amount
requested.
(3) If the Market Value Adjustment is negative, it will be
assessed first against any remaining Accumulation Value in
the particular Fixed Allocation. Any remaining Market Value
Adjustment will be applied against the amount withdrawn,
transferred or applied to an Income Plan.
(4) If the Market Value Adjustment is positive, it will be
credited to any remaining Accumulation Value in the
particular Fixed Allocation. If a cash surrender, full
transfer or full application to an Income Plan has been
requested, the Market Value Adjustment is added to the
amount withdrawn, transferred or applied to an Income Plan.
Measurement of Investment Experience
Index of Investment Experience
The Investment Experience of a Division is determined on each Valuation
Date. We use an Index to measure changes in each Division's experience
during a Valuation Period. We set the Index at $10 when the first
investments in a Division are made. The Index for a current Valuation
Period equals the Index for the preceding Valuation Period multiplied by
the Experience Factor for the current Valuation Period.
How We Determine the Experience Factor
For Divisions of a Unit Investment Trust Separate Account, the Experience
Factor reflects the Investment Experience of the portfolio in which the
Division invests as well as the charges assessed against the Division for a
Valuation Period. The factor is calculated as follows:
(1) We take the net asset value of the portfolio in which the
Division invests at the end of the current Valuation Period.
(2) We add to (1) the amount of any dividend or capital gains
distribution declared for the investment portfolio and
reinvested in such portfolio during the current Valuation
Period. We subtract from that amount a charge for our taxes,
if any.
(3) We divide (2) by the net asset value of the portfolio at the
end of the preceding Valuation Period.
(4) We subtract the daily Mortality and Expense Risk Charge for
each Division shown in the Schedule for each day in the
Valuation Period.
(5) We subtract the daily Asset-Based Administrative Charge
shown in the Schedule for each day in the Valuation Period.
For Divisions of a Managed Separate Account which invest directly in
portfolio securities, the Experience Factor reflects the investment
experience of the Division as well as the charges assessed against the
Division. The factor is calculated as follows:
(1) Take the value of the assets in the Division at the end of
the preceding Valuation Period.
(2) Add to (1) any investment income and capital gains, realized
or unrealized, credited to the assets during the current
Valuation Period.
(3) Subtract from (2) any capital losses, realized or
unrealized, charged against the assets during the current
Valuation Period.
(4) Subtract from (3) any amount charged against the Division
for any taxes.
(5) Divide (4) by the value of the assets in the Division at the
end of the preceding Valuation Period.
(6) Subtract from (5) a daily charge for operating expenses
actually incurred.
GA-IA-1007-04/95
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<PAGE>
How We Measure the Contract's Accumulation Value (continued)
- --------------------------------------------------------------------------------
(7) Subtract from (6) the daily charge for investment advice for
each day in the Valuation Period as shown in the Schedule.
(8) Subtract from (7) the daily charge for mortality and expense
risks for each day in the Valuation Period as shown in the
Schedule.
(9) Subtract from (8) the daily asset based administrative
charge for each day in the Valuation Period as shown in the
Schedule.
Calculations for Divisions investing in mutual fund portfolios are made on
a per share basis. Calculations for Divisions investing in unit investment
trusts are on a per unit basis.
Net Rate of Return for a Separate Account Division
The Net Rate of Return for a Division during a Valuation Period is the
Experience Factor for that Valuation Period minus one.
Interest Credited to a Fixed Allocation
A Fixed Allocation will be credited with the Guaranteed Interest Rate for
the Guarantee Period in effect on the date the premium or reallocation is
applied. Once applied, such rate will be guaranteed until that Fixed
Allocation's Maturity Date. Interest will be credited daily at a rate to
yield the declared annual Guaranteed Interest Rate.
We periodically declare Guaranteed Interest Rates for then available
Guarantee Periods. No Guaranteed Interest Rate will be less than the
Minimum Guaranteed Interest Rate shown in the Schedule.
Charges Deducted from Accumulation Value on each Contract Processing Date
All charges and fees are shown in the Schedule.
Charge Deduction Division Option
We will deduct all charges against the Accumulation Value of this Contract
from the Charge Deduction Division if you elected this option (see the
Schedule). If you did not elect this option or if the charges are greater
than the amount in the Charge Deduction Division, the charges against the
Accumulation Value will be deducted as follows:
(1) If these charges are less than the Accumulation Value in the
Divisions, they will be deducted proportionately from all
Divisions.
(2) If these charges exceed the Accumulation Value in the
Divisions, any excess over such value will be deducted from
the Fixed Account.
Any charges deducted from the Fixed Account will be taken from Fixed
Allocations starting with the Guarantee Period nearest its Maturity Date
until such charges have been paid.
At any time while this Contract is in effect, you may change your election
of this option. To do this you must send a written request to our Customer
Service Center. Any change will take effect within seven days of the date
we receive your request.
GA-IA-1007-04/95
11
<PAGE>
Your Contract Benefits
- --------------------------------------------------------------------------------
While this Contract is in effect, there are important rights and benefits
that are available to you. We discuss these rights and benefits in this
section.
Cash Value Benefit
Cash Surrender Value
The Cash Surrender Value before the Annuity Commencement Date, is
determined as follows:
(1) We take the Contract's Accumulation Value;
(2) We deduct any Surrender Charges;
(3) We deduct any charges shown in the Schedule that have been
incurred but not yet deducted, including:
(a) any first-year administrative fee that has not yet been
deducted;
(b) any quarterly administrative fee to be deducted on the
next Contract Processing Date;
(c) the pro rata part of any charges for Optional Benefit
Riders; and
(d) any applicable premium or similar tax.
(4) We adjust for any applicable Market Value Adjustment.
Cancelling to Receive the Cash Surrender Value
At any time before the Annuity Commencement Date, you may surrender this
Contract to us. To do this, you must return this Contract with a signed
request for cancellation to our Customer Service Center.
The Cash Surrender Value will vary daily. We will determine the Cash
Surrender Value as of the date we receive the Contract and your signed
request in our Customer Service Center. All benefits under this Contract
will then end.
We will usually pay the Cash Surrender Value within seven days; but, we may
delay payment as described in the Payments We May Defer provision.
Partial Withdrawal Option
After the first Contract Anniversary, you may make a Partial Withdrawal
once in each Contract Year without incurring a Partial Withdrawal Charge.
Any additional Partial Withdrawals in a Contract Year are subject to a
Partial Withdrawal Charge. The minimum amount that may be withdrawn is
shown in the Schedule. The maximum amount that may be withdrawn is shown in
the Schedule. Any withdrawal you make will not be treated as premium only
for the purposes of calculating the Surrender Charge. To take a Partial
Withdrawal, you must provide us with satisfactory notice at our Customer
Service Center.
GA-IA-1007-04/95
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<PAGE>
Death Benefit Proceeds
- --------------------------------------------------------------------------------
Proceeds Payable to the Beneficiary
Prior to the Annuity Commencement Date
If the sole Owner dies prior to the Annuity Commencement Date, we will pay
the Beneficiary the death benefit. If there are joint Owners and any Owner
dies, we will pay the surviving Owners the death benefit. We will pay the
amount on receipt of due proof of the Owner's death at our Customer Service
Center. Such amount may be received in a single lump sum or applied to any
of the Annuity Options (see Choosing an Income Plan). When the Owner (or
all Owners where there are joint Owners) is not an individual, the death
benefit will become payable on the death of the Annuitant prior to the
Annuity Commencement Date (unless a Contingent Annuitant survived the
Annuitant). Only one death benefit is payable under this Contract. In all
events, distributions under the Contract must be made as required by
applicable law.
How to Claim Payments to Beneficiary
We must receive proof of the Owner's (or Annuitant's) death before we will
make any payments to the Beneficiary. We will calculate the death benefit
as of the date we receive due proof of death. The Beneficiary should
contact our Customer Service Center for instructions.
Guaranteed Death Benefit
On the Contract Date, the Guaranteed Death Benefit is equal to the premium
paid. On subsequent Valuation Dates, the Guaranteed Death Benefit is
calculated as shown in the Schedule. A Change of Owner will affect the
Guaranteed Death Benefit, as shown in the Schedule.
GA-IA-1007-04/95
13
<PAGE>
Choosing an Income Plan
- --------------------------------------------------------------------------------
Annuity Benefits
If the Annuitant and Owner are living on the Annuity Commencement Date, we
will begin making payments to the Owner. We will make these payments under
the Annuity Option (or Options) as chosen in the application or as
subsequently selected. You may choose or change an Annuity Option by making
a written request at least 30 days prior to the Annuity Commencement Date.
Unless you have chosen otherwise, Option 2 on a 10-year period certain
basis will become effective. The amount of the payments will be determined
by applying the Accumulation Value on the Annuity Commencement Date in
accordance with the Annuity Options section below (See Payments We May
Defer). See the Schedule for certain restrictions which may apply. Before
we pay any Annuity Benefits, we require the return of this Contract. If
this Contract has been lost, we require the applicable lost Contract form.
Annuity Commencement Date Selection
You select the Annuity Commencement Date. You may select any date following
the third Contract Anniversary but before the required date of Annuity
Commencement as shown in the Schedule. If you do not select a date, the
Annuity Commencement Date will be in the month following the required date
of Annuity Commencement.
Frequency Selection
You choose the frequency of the Annuity Payments. They may be monthly,
quarterly, semi-annually, or annually. If we do not receive written notice
from you, the payments will be made monthly.
The Income Plan
While this Contract is in effect and before the Annuity Commencement Date,
you may choose one or more Annuity Options to which death benefit proceeds
may be applied. If, at the time of the Owner's death, no Option has been
chosen for paying death benefit proceeds, the Beneficiary may choose an
Option within one year. You may also elect an Annuity Option on surrender
of the Contract for its Cash Surrender Value. For each Option we will issue
a separate written agreement putting the Option into effect.
Our approval is needed for any Option where:
(1) The person named to receive payment is other than the Owner
or Beneficiary; or
(2) The person named is not a natural person, such as a
corporation; or
(3) Any income payment would be less than the minimum annuity
income payment shown in the Schedule.
The Annuity Options
There are four Options to choose from. They are:
Option 1. Income for a Fixed Period
Payment is made in equal installments for a fixed number of years. We
guarantee each monthly payment will be at least the Income For Fixed Period
amount shown in the Schedule. Values for annual, semiannual or quarterly
payments are available on request.
Option 2. Income for Life
Payment is made to the person named in equal monthly installments and
guaranteed for at least a period certain. The period certain can be 10 or
20 years. Other periods certain are available on request. A refund certain
may be chosen instead. Under this arrangement, income is guaranteed until
payments equal the amount applied. If the person named lives beyond the
guaranteed period, payments continue until his or her death.
GA-IA-1007-04/95
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<PAGE>
Choosing an Income Plan (continued)
- --------------------------------------------------------------------------------
We guarantee each payment will be at least the amount shown in the Table
for Income for Life in the Schedule. By age, we mean the named person's age
on his or her last birthday before the Option's effective date. Amounts for
ages not shown are available on request.
Option 3. Joint Life Income
This Option is available if there are two persons named to receive
payments. At least one of the persons named must be either the Owner or
Beneficiary of this Contract. Monthly payments are guaranteed and are made
as long as at least one of the named persons is living. The monthly payment
amounts are available upon request. Such amounts are guaranteed and will be
calculated on the same basis as the Table for Income for Life, however, the
amounts will be based on two lives.
Option 4. Annuity Plan
An amount can be used to buy any single premium annuity we offer on the
Option's effective date.
Payment When Named Person Dies
When the person named to receive payment dies, we will pay any amounts
still due as provided by the Option agreement. The amounts still due are
determined as follows:
(1) For Option 1 or for any remaining guaranteed payments in
Option 2, payments will be continued. Under Options 1 and 2,
the discounted values of the remaining guaranteed payments
may be paid in a single sum. This means we deduct the amount
of the interest each remaining guaranteed payment would have
earned had it not been paid out early. The discount interest
rate is 3.00% for Option 1 and 3.50% for Option 2. We will,
however, base the discount interest rate on the interest
rate used to calculate the payments for Options 1 and 2 if
such payments were not based on the Tables in this Contract.
(2) For Option 3, no amounts are payable after both named
persons have died.
(3) For Option 4, the annuity agreement will state the amount
due, if any.
GA-IA-1007-04/95
15
<PAGE>
Other Important Information
- --------------------------------------------------------------------------------
Sending Notice to Us
Whenever written notice is required, send it to our Customer Service
Center. The address of our Customer Service Center is shown on the cover
page. Please include your Contract number in all correspondence.
Reports to Owner
We will send you a report, at least once during each Contract Year, within
31 days of each calendar quarter showing the Accumulation Value and the
Cash Surrender Value of your Contract as of the end of the Contract
Processing Period. The report will also show the allocation of the
Accumulation Value as of such date and the amounts deducted from or added
to the Accumulation Value since the last report. The report will also
include any other information that may be currently required by the
insurance supervisory official of the jurisdiction in which this Contract
is delivered.
We will also send you copies of any shareholder reports of the portfolios
in which the Divisions of the Separate Accounts invest, as well as any
other reports, notices or documents required by law to be furnished to
Contractowners.
Assignment - Using this Contract as Collateral Security
You can assign this Contract as collateral security for a loan or other
obligation. This does not change the ownership. Your rights and any
Beneficiary's rights are subject to the terms of the assignment. To make or
release an assignment we must receive written notice satisfactory to us at
our Customer Service Center. We are not responsible for the validity of any
assignment.
Changing this Contract
This Contract or any additional Benefit Riders may be changed to another
Annuity Plan according to our rules at the time of the change.
Contract Changes - Applicable Tax Law
We reserve the right to make changes in this Contract or its Riders to the
extent we deem it necessary to continue to qualify this Contract as an
annuity. Any such changes will apply uniformly to all Contracts that are
affected. You will be given advance written notice of such changes.
Misstatement of Age or Sex
If an age or sex has been misstated, the amounts payable or benefits
provided by this Contract shall be those that the premium payment made
would have bought at the correct age or sex.
Non-Participating
This Contract does not participate in the divisible surplus of Golden
American Life Insurance Company.
GA-IA-1007-04/95
16
<PAGE>
Other Important Information (continued)
- --------------------------------------------------------------------------------
Payments We May Defer
We may not be able to determine the value of the assets of the Divisions
because:
(1) The NYSE is closed for trading;
(2) The SEC determines that a state of emergency exists; or
(3) An order or pronouncement of the SEC permits a delay for the
protection of Contractowners.
(4) The check used to pay the premium has not cleared through
the banking system. This may take up to 15 days.
During such times, as to amounts allocated to the Divisions, we may delay:
(1) Determination and payment of the Cash Surrender Value;
(2) Determination and payment of any death benefit if death
occurs before the Annuity Commencement Date;
(3) Allocation changes of the Accumulation Value; or,
(4) Application of the Accumulation Value under an income plan.
We reserve the right to delay payment of amounts allocated to the Fixed
Account for up to six months.
Authority to Make Agreements
All agreements made by us must be signed by one of our officers. No other
person, including an insurance agent or broker, can
(1) Change any of this Contract's terms;
(2) Extend the time for premium payments; or
(3) Make any agreement binding on us.
Required Note on Our Computations
We have filed a detailed statement of our computations with the insurance
supervisory official in the appropriate jurisdictions. The values are not
less than those required by the law of that state or jurisdiction. Any
benefit provided by an attached Optional Benefit Rider will not increase
these values unless otherwise stated in that Rider.
GA-IA-1007-04/95
17
<PAGE>
GOLDEN
[LOGO] AMERICAN Section 72 Rider
LIFE INSURANCE
COMPANY
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock company domiciled in Wilmington, Delaware
- --------------------------------------------------------------------------------
Required Distribution of Proceeds on Death of Owner
This Rider is required to qualify the Contract to which it is attached as
an annuity contract under Section 72 of the Internal Revenue Code of 1986,
as amended (the "Code"). Where the terms of this Rider are in conflict with
the terms of the Contract, the Rider will control. Golden American Life
Insurance Company reserves the right to amend or administer the Contract
and Rider as necessary to comply with applicable tax requirements. This
Rider and the Contract should be construed so that they comply with
applicable tax requirements.
Death of Owner On Or After Annuity Commencement Date
IF ANY OWNER DIES ON OR AFTER the Annuity Commencement Date but prior
to the time the entire interest in the Contract has been distributed, the
remaining portion will be distributed at least as rapidly as under the
method of distribution being used as of the date of the Owner's death.
Death of Owner Prior to Annuity Commencement Date
IF ANY OWNER DIES PRIOR TO the Annuity Commencement Date, the entire
interest in the Contract will be distributed within five years of the
Owner's death.
However, this distribution requirement will be considered satisfied as
to any portion of the Owner's interest in the Contract which is payable to
or for the benefit of a Designated Beneficiary and which will be
distributed over the life of such Designated Beneficiary or over a period
not extending beyond the life expectancy of that Designated Beneficiary,
provided such distributions begin within one year of the Owner's death. If
the Designated Beneficiary is the surviving spouse of the decedent, the
Contract may be continued in the name of the spouse as Owner and these
distribution rules are applied by treating the spouse as the Owner.
However, on the death of the surviving spouse, this provision regarding
spouses may not be used again.
If any Owner is not an individual, the death or change (where
permitted) of the Annuitant will be treated as the death of an Owner.
The Designated Beneficiary is the person entitled to ownership rights
under the Contract. Thus, where no death benefit has become payable, the
Designated Beneficiary, for the purposes of applying this Rider, will be
the Owner(s). Where a death benefit has become payable, the Designated
Beneficiary, for the purposes of applying this Rider, is the person(s)
entitled to the death benefit, generally the Beneficiary or surviving
Owners, as appropriate. Upon the death of any Owner, the Designated
Beneficiary will become the Owner and, if an individual, will become the
Annuitant.
* * *
An Owner may notify Golden American as to the manner of payment under this
Rider. If such Owner has not so notified Golden American prior to his or
her death, the Designated Beneficiary under the Contract may so notify
Golden American.
GOLDEN AMERICAN LIFE INSURANCE COMPANY
President /s/Terry T. Kendall Secretary
GA-RA-1001-12/94
<PAGE>
GOLDEN
[LOGO] AMERICAN
LIFE INSURANCE
COMPANY Waiver of Surrender Charge Rider
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock company domiciled in Wilmington, Delaware
- --------------------------------------------------------------------------------
Golden American Life Insurance Company ("we" or "us") will waive any
Surrender Charge incurred due to a surrender or Excess Partial Withdrawal
under the Contract in the event the Owner ("you") is subject to Qualified
Extended Medical Care or suffers from a Qualifying Terminal Illness subject
to the terms and conditions stated below:
Extended Medical Care
To qualify for this waiver, you must first begin receiving Qualified
Extended Medical Care on or after the first Contract Anniversary for at
least 45 days during any continuous sixty-day period, and your request for
the surrender or withdrawal, together with proof of such Qualified Extended
Medical Care, must be received at our Customer Service Center during the
term of such care or within ninety days after the last day upon which you
received such care.
"Qualified Extended Medical Care" means confinement in a Qualified
Licensed Hospital or Nursing Care Facility prescribed by a Qualifying
Medical Professional.
"Qualifying Licensed Hospital or Nursing Care Facility" means a
state-licensed hospital or state-licensed skilled or intermediate care
nursing facility at which medical treatment is available on a daily basis;
and daily medical records are kept on each patient. This does not include a
facility whose purpose is to provide accommodations, board or personal care
services to individuals who do not need medical or nursing care; nor a
place mainly for rest.
"Qualifying Medical Professional" means a legally-qualified
practitioner of the healing arts who is acting within the scope of his or
her license; is not a resident of your household or that of the Annuitant;
and is not related to you or the Annuitant by blood or marriage.
Terminal Illness
To qualify for this waiver, you must be first diagnosed by a
Qualifying Medical Professional, on or after the first Contract
Anniversary, as having a Qualifying Terminal Illness. Written proof of
terminal illness, satisfactory to us, must be received at our Customer
Service Center. We reserve the right to require an examination by a
physician of our choice.
"Qualifying Terminal Illness" means an illness or accident, the result
of which results in a life expectancy of twelve months or less, as measured
from the date of diagnosis.
Claims
Evidence, satisfactory to us, must be submitted to qualify for waiver
of Surrender Charge pursuant to this Rider. This evidence will be in
writing and, where applicable, be attested to by a Qualified Medical
Professional.
This Rider is attached to and becomes part of the Contract to which it
is attached. The provisions of this Rider shall supersede the provisions of
the Contract where applicable.
GOLDEN AMERICAN LIFE INSURANCE COMPANY
President /s/Terry T. Kendall Secretary
GA-RA-1004-12/94
<PAGE>
Deferred Combination Variable and Fixed Annuity Contract - No Dividends
Variable Cash Surrender Values while the Owner is living and prior to the
Annuity Commencement Date. Death benefit subject to guaranteed minimum.
Additional Premium Payment Option. Partial Withdrawal Option.
Non-participating. Investment results reflected in values.
GA-IA-1007-04/95
<PAGE>
4(f) DISCRETIONARY GROUP DEFERRED COMBINATION VARIABLE
AND FIXED ANNUITY CONTRACT
<PAGE>
GOLDEN Deferred
AMERICAN Combination
[LOGO] LIFE INSURANCE Variable and Fixed
COMPANY Annuity Certificate
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock Company domiciled in Wilmington, Delaware
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Contractholder Group Contract Number
[Golden Investors Trust] [G000010-OE]
- --------------------------------------------------------------------------------
Annuitant Certificateowner
[Thomas J. Doe] [John Q. Public]
[Jane Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Certificate Number
[Separate Account B, Separate Account D and the Fixed Amount] [123456]
- --------------------------------------------------------------------------------
In this Certificate "you" or "your" refers to the Certificateowner
shown above. "We", "our", or "us" refers to Golden American Life Insurance
Company. You may allocate this Certificate's Accumulation Value among the
Separate Account Divisions and the Fixed Account shown in the Schedule.
This Certificate describes the benefits and provisions of the group
contract. The group contract, as issued to the Contractholder by us with
any Riders or Endorsements, alone makes up the agreement under which
benefits are paid. The group contract may be inspected at the office of the
Contractholder. In consideration of any application for this Certificate
and the payment of premiums, we agree, subject to the terms and conditions
of the group contract, to provide the benefits described in this
Certificate to the Certificateowner. The Annuitant under this Certificate
must be eligible under the terms of the group contract. If the group
contract and this Certificate are in force, we will make income payments to
the Certificateowner starting on the Annuity Commencement Date as shown in
the Schedule. If the Certificateowner dies prior to the Annuity
Commencement Date, we will pay a death benefit to the Beneficiary. The
amount of such benefit is subject to the terms of this Certificate.
The benefits of the Certificate will be paid according to the
provisions of the Certificate and group contract.
RIGHT TO EXAMINE CERTIFICATE: You may return this Certificate to us or
the agent through whom you purchased it within 10 days after you receive
it. If so returned, we will treat the Certificate as though it were never
issued. Upon receipt we will promptly refund the Accumulation Value plus
any charges we have deducted as of the date the returned Certificate is
received by us.
All payments and values, when based on the investment experience of a
Separate Account Division, may increase or decrease, depending on the
Certificate's investment results. All payments and values based on the
Fixed Account may be subject to a Market Value Adjustment, the operation of
which may cause such payments and values to increase or decrease.
Signed for Golden American Life Insurance Company on the group Contract Issue
Date.
President: Secretary:
- --------------------------------------------------------------------------------
Deferred Combination Variable and Fixed Annuity Certificate - No Dividends
Variable Cash Surrender Values while the Certificateowner is living and
prior to the Annuity Commencement Date. Death benefit subject to guaranteed
minimum. Additional premium payment pption. Partial Withdrawal Option.
Non-participating. Investment results reflected in values.
GA-CA-1007-04/95 1
<PAGE>
Table of Contents
- --------------------------------------------------------------------------------
The Schedule ........................................ 3
Premium Payment and Investment Information
The Separate Accounts
Certificate Facts
Charges
Income Plan Factors
Important Terms ..................................... 4
Introduction to this Certificate..................... 6
The Certificate
The Certificateowner
The Annuitant
The Beneficiary
Change of Certificateowner or Beneficiary
Premium Payments and Allocation Changes ............. 7
Initial Premium Payment
Additional Premium Payment Option
Your Right to Change Allocation of
Accumulation Value
What Happens if a Division is Not Available
How We Measure the Certificate's
Accumulation Value ................................. 7
The Variable Separate Accounts
Valuation Period
Accumulation Value
Accumulation Value in each Division and Fixed
Allocation
Fixed Account
Measurement of Investment Experience
Charges Deducted from Accumulation Value on
each Certificate Processing Date
Your Certificate Benefits ........................... 13
Cash Value Benefit
Partial Withdrawal Option
Death Benefit Proceeds .............................. 14
Proceeds Payable to the Beneficiary
Choosing an Income Plan ............................. 15
Annuity Benefits
Annuity Commencement Date Selection
Frequency Selection
The Income Plan
The Annuity Options
Payments When Named Person Dies
Other Important Information ......................... 17
Entire Contract
Sending Notice to Us
Reports to Certificateowner
Assignment - Using this Certificate as
Collateral Security
Changing this Contract
Contract Changes - Applicable Tax Law
Misstatement of Age or Sex
Non-Participating
Payments We May Defer
Authority to Make Agreements
Required Note on Our Computations
Facility of Payment
Incontestability
A copy of any enrollment form and any additional Riders and Endorsements
are at the back of this Certificate.
Schedule Pages
The Schedule Pages give specific facts about this Certificate and its
coverage. Please refer to them while reading this Certificate.
GA-CA-1007-04/95 2
<PAGE>
The Schedule
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Contractholder Group Contract Number
[Golden Investors Trust] [G000010-OE]
- --------------------------------------------------------------------------------
Annuitant Certificateowner
[Thomas J. Doe] [John Q. Public]
[Jane Q. Public]
- --------------------------------------------------------------------------------
Annuitant's Issue Age Annuitant's Sex Certificateowner's Issue Age
[35] [Male] [55]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Certificate Date Certificate Issue Date Certificate Number
[January 1, 1994] [January 1, 1994] [123456]
- --------------------------------------------------------------------------------
Separate Account(s)
[Separate Account B, Separate Account D and the Fixed Account]
- --------------------------------------------------------------------------------
Premium Payment and Investment Information
Initial premium payment received: [$10,000]
Your initial Accumulation Value has been invested as follows:
Percentage of
Divisions Accumulation Value
--------- ------------------
[Multiple Allocation 10%
Fully Managed 10%
Capital Appreciation 10%
Rising Dividends 10%
All-Growth 10%
Real Estate 10%
Value Equity 5%
Natural Resources 5%
Emerging Markets 5%
The Managed Global Account 5%
Limited Maturity Bond 5%
Liquid Asset 5%]
Fixed
Allocations
-----------
[1-Year Guarantee Period 5%
3-Year Guarantee Period 5%]
--------
Total 100%
========
Additional Premium Payment Information
We will accept additional premium payments until either the Annuitant or the
Certificateowner reaches the Attained Age of [85]. The minimum additional
payment which may be made is [$500.00].
GA-CA-1007-04/95 3A1
<PAGE>
The Schedule (continued)
- --------------------------------------------------------------------------------
Accumulation Value Allocation Rules
The maximum number of Divisions in which you may be invested at any one time is
[twelve]. You are allowed unlimited allocation changes per Certificate Year
without charge. We reserve the right to impose a charge for any allocation
change in excess of [twelve] per Certificate Year. We also reserve the right to
limit, upon notice, the maximum number of allocation changes you may make within
a Certificate Year. The Excess Allocation Charge is shown in the Charges section
of the Schedule.
Allocation Changes by Telephone
You may request allocation changes by telephone during our telephone request
business hours. You may call our Customer Service Center at 1-800-366-0066 to
make allocation changes by using the personal identification number you will
receive. You may also mail any notice or request for allocation changes to our
Customer Service Center.
GA-CA-1007-04/95 3A2
<PAGE>
The Schedule (continued)
- --------------------------------------------------------------------------------
The Variable Separate Accounts
Divisions Investing in Shares of Mutual Funds
Separate Account B is a Unit Investment Trust Separate Account, organized
in and governed by the laws of the State of Delaware, our state of
domicile. Separate Account B is divided into Divisions. Each Division
listed below invests in shares of the mutual fund portfolio designated.
Each portfolio is a part of The GCG Trust managed by Directed Services,
Inc.
[MULTIPLE MULTIPLE ALLOCATION SERIES
ALLOCATION Objective -The highest total return, consisting of
DIVISION capital appreciation and current income,
consistent with the preservation of capital
and elimination of unnecessary risk.
Investments -Investment in equity and debt securities and
the use of certain sophisticated investment
strategies and techniques.
Portfolio Manager -Zweig Advisors Inc.
FULLY FULLY MANAGED SERIES
MANAGED Objective -High total investment return over the long
DIVISION term, consistent with the preservation of
capital and prudent investment risk.
Investments -Pursues an active asset allocation strategy
whereby investments are allocated, based
upon an evaluation of economic and market
trends and the anticipated relative total
return available, among three asset classes
-- debt securities, equity securities and
money market instruments.
Portfolio Manager -T. Rowe Price Associates, Inc.
CAPITAL CAPITAL APPRECIATION SERIES
APPRECIATION Objective -Long-term capital growth.
DIVISION
Investments -Invests in common stocks and preferred stock
that will be allocated among various
categories of stocks referred to as
"components" which consist of the following:
(i) The Growth Component - Securities that
the portfolio manager believes have the
following characteristics: stability and
quality of earnings and positive earnings
momentum; dominant competitive positions;
and demonstrate above-average growth rates
as compared to published S&P 500 earnings
projections; and (ii) The Value Component -
Securities that the portfolio manager
regards as fundamentally undervalued, i.e.,
securities selling at a discount to asset
value and securities with a relatively low
price/earnings ratio. The securities
eligible for this component may include real
estate stocks, such as securities of
publicly-owned companies that, in the
portfolio manager's judgement, offer an
optimum combination of current dividend
yield, expected dividend growth, and
discount to current real estate value.
Portfolio Manager -Chancellor Trust Company]
GA-CA-1007-04/95 3Bl
<PAGE>
The Schedule (continued)
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[RISING RISING DIVIDENDS SERIES
DIVIDENDS Objective -Capital appreciation, with dividend income
DIVISION as a secondary objective.
Investments -Investment in equity securities of high
quality companies that meet the following
four criteria: consistent dividend
increases; substantial dividend increases;
reinvested profits; and an under-leveraged
balance sheet.
Portfolio Manager -Kayne, Anderson Investment Management, Inc.
ALL-GROWTH ALL-GROWTH SERIES
DIVISION Objective - Capital appreciation.
Investments -Investment in securities selected for their
long term growth prospects.
Portfolio Manager -Warburg, Pincus Counsellors, Inc.
REAL REAL ESTATE SERIES
ESTATE Objective -Capital appreciation, with current income as
DIVISION a secondary objective.
Investments -Investment in publicly-traded equity
securities of companies in the real estate
industry listed on national exchanges or on
the National Association of Securities
Dealers Automated Quotation System.
Portfolio Manager -E.I.I. Realty Securities, Inc.
NATURAL NATURAL RESOURCES SERIES
RESOURCES Objective -Long-term capital appreciation.
DIVISION
Investments -Investment in equity and debt securities of
companies engaged in the exploration,
development, production, and distribution of
natural resources.
Portfolio Manager -Van Eck Associates Corporation
EMERGING EMERGING MARKETS SERIES
MARKETS Objective -Long-term growth of capital.
DIVISION
Investments -Investment primarily in equity securities of
companies that are considered to be in
emerging market countries in the Pacific
Basin and Latin America. Income is not an
objective, and any production of current
income is considered incidental to the
objective of growth of capital.
Portfolio Manager -Bankers Trust Company
LIMITED LIMITED MATURITY BOND SERIES
MATURITY Objective -Highest current income consistent with low
BOND risk to principal and liquidity. Also seeks
DIVISION to enhance its total return through capital
appreciation when market factors indicate
that capital appreciation may be available
without significant risk to principal.
Investments -Investment primarily in a diversified
portfolio of limited maturity debt
securities.
Portfolio Manager -Bankers Trust Company]
GA-CA-1007-04/95 3B2
<PAGE>
The Schedule (continued)
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[LIQUID LIQUID ASSET SERIES
ASSET Objective -High level of current income consistent with
DIVISION the preservation of capital and liquidity.
Investments -Obligations of the U.S. Government and its
agencies and instrumentalities; bank
obligations; commercial paper and short-term
corporate debt securities.
Term -All issues maturing in less than one year.
Portfolio Manager -Bankers Trust Company
VALUE VALUE EQUITY SERIES
EQUITY Objective -Capital appreciation.
DIVISION
Investments -Investment primarily in equity securities
which meet quantitative standards considered
to indicate above-average financial
soundness and high intrinsic value relative
to price.
Portfolio Manager -Eagle Asset Management, Inc.
NOTE: PLEASE REFER TO THE PROSPECTUSES FOR THE GROUP CONTRACT AND THE GCG
TRUST FOR MORE DETAILS.
The Managed Global Account of Account D
The Managed Global Account (the "Global Account") is a non-diversified
investment company which invests directly in securities. DSI serves as
manager of Separate Account D and Warburg, Pincus Counsellors, Inc. serves
as portfolio manager of the Global Account.
THE MANAGED THE MANAGED GLOBAL ACCOUNT PORTFOLIO
GLOBAL ACCOUNT Objective -High total investment return, consistent
DIVISION with a prudent regard for capital
preservation.
Investments -Investment in a wide range of equity and
debt securities and money market instruments
of both domestic and foreign issuers.
Portfolio Manager -Warburg, Pincus Counsellors, Inc.
NOTE: PLEASE REFER TO THE PROSPECTUS FOR THE GROUP CONTRACT AND THE
MANAGED GLOBAL ACCOUNT OF ACCOUNT D FOR MORE DETAILS.]
GA-CA-1007-04/95 3B3
<PAGE>
The Schedule (continued)
- --------------------------------------------------------------------------------
Certificate Facts
Certificate Processing Date
The Certificate Processing Date for your Certificate is [April 1] of each
year.
Specially Designated Division
When a distribution is made from an investment portfolio underlying a
Separate Account Division in which reinvestment is not available, we will
allocate the amount of the distribution to the [Liquid Asset Division]
unless you specify otherwise.
Partial Withdrawals
[The maximum amount that can be withdrawn each Certificate Year without
being considered an Excess Partial Withdrawal is 15% of the Accumulation
Value as of the date of the withdrawal. We will collect a Surrender Charge
for excess Partial Withdrawals and a charge for any unrecovered premium
taxes. In no event may a Partial Withdrawal be greater than 90% of the Cash
Surrender Value.
Conventional Partial Withdrawals
Minimum Withdrawal Amount: $1,000
Any Conventional Partial Withdrawal from a Fixed Allocation is subject to a
Market Value Adjustment unless taken from a Fixed Allocation within the
thirty days prior to the Maturity Date of such Fixed Allocation.
Systematic Partial Withdrawals
Systematic Partial Withdrawals may be elected to commence after 28 days
from the Certificate Issue Date and may be taken on a monthly or quarterly
basis. You select the day withdrawals will be made, but no later than the
28th day of the month. If you do not elect a day, the Certificate Date will
be used.
Minimum Withdrawal Amount: $100.00
Maximum Withdrawal Amounts:
Separate Account Divisions: 1.25% monthly or 3.75% quarterly
of Accumulation Value.
Fixed Allocations: Interest earned on Fixed Allocation
in prior month (for monthly
withdrawals) or prior quarter
(for quarterly withdrawals).
A Systematic Partial Withdrawal from a Fixed Allocation is not subject to
Market Value Adjustment.]
Death Benefit
[IF DEATHBEN="1" Option 1: The Death Benefit is the greatest of (i) the
Accumulation Value, (ii) the Guaranteed Death Benefit, (iii) the Cash
Surrender Value, and (iv) the sum of premiums paid, less any partial
withdrawals.
IF DEATHBEN="2" Option 2: The Death Benefit is the greatest of (i) the
Accumulation Value, (ii) the Guaranteed Death Benefit, (iii) the Cash
Surrender Value, and (iv) the sum of premiums paid, less any partial
withdrawals.
IF DEATHBEN="3" Option 3: The Death Benefit is the greater of (i) the Cash
Surrender Value, (ii) the Accumulation Value, and (iii) the sum of the
premiums paid, less any Partial Withdrawals.]
GA-CA-1007-04/95 3C1
<PAGE>
The Schedule (continued)
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Guaranteed Death Benefit
[On the Certificate Date, the Guaranteed Death Benefit is the initial
premium. On subsequent Valuation Dates, the Guaranteed Death Benefit is
calculated as follows:
Option 1:
(1) Start with the Guaranteed Death Benefit from the prior Valuation
Date;
(2) Calculate interest on (l) if the Owner is living (the
Annuitant if the Owner is not an individual) for the current
Valuation Period at the Guaranteed Death Benefit Interest Rate;
(3) Add (l) and (2);
(4) Add any additional premiums paid during the current Valuation
Period to (3);
(5) Subtract Partial Withdrawals made during the current Valuation
Period from (4);
Each accumulated initial or additional premium payment, reduced by any
Partial Withdrawals (including any associated Market Value Adjustment and
Surrender Charge incurred) allocated to such premium, will continue to grow
at the Guaranteed Death Benefit Interest Rate until reaching its Maximum
Guaranteed Death Benefit.
Guaranteed Death Benefit Interest Rate
The Guaranteed Death Benefit is accumulated at a rate of 7% compounded
annually, except:
(l) Amounts in the Liquid Asset Division are accumulated at the net
rate of return for the Liquid Asset Division during the current
Valuation Period if less than 7%; and
(2) Amounts in Limited Maturity Bond Division are accumulated at the
net rate of return for the Limited Maturity Bond Division during
the current Valuation Period if less than 7%; and
(3) Amounts in a Fixed Allocation are accumulated at the interest
rate being credited to such Fixed Allocation during the current
Valuation Period if less than 7%.
Maximum Guaranteed Death Benefit
The Maximum Guaranteed Death Benefit is initially equal to two times the
initial or additional premium paid. Thereafter, the Maximum Guaranteed
Death Benefit as of the effective date of a partial withdrawal is reduced
first by the amount of any partial withdrawal representing earnings and
second in proportion to the reduction in Accumulation Value for any partial
withdrawal representing premium (in each case, including any associated
Market Value Adjustment and Surrender Charge incurred). If withdrawals
do not exceed 7% of premium paid in a Certificate Year, and did not exceed
7% of premiums paid in any prior Certificate Year, the Maximum Gauranteed
Death Benefit will be reduced only by the amount of such withdrawals. Once
withdrawals exceed 7% in a Certificate Year all withdrawals of premium will
be treated as proportional in relation to the amount of Accumulation Value
for any Partial Withdrawal (including any Market Value Adjustment or
Surrender Charge incurred).
Option 2:
(l) Start with the Guaranteed Death Benefit from the prior Valuation
Date;
(2) Add to (1) any additional premium paid since the prior Valuation
Date and subtract from (l) any Partial Withdrawals taken since
the prior Valuation Date;
(3) On a Valuation Date which occurs through the Certificate Year in
which the Certificateowner's Attained Age is 80 and which is also
a Certificate Anniversary, if the Owner is living (the Annuitant
if the Owner is not an individual), we set the Guaranteed Death
Benefit equal to the greater of (2) or the Accumulation Value as
of such date. On all other Valuation Dates, the Guaranteed Death
Benefit is equal to (2).
Option 3:
(l) Start with the Guaranteed Death Benefit from the prior Valuation
Date;
(2) Add any additional premiums paid during the current Valuation
Period to (l);
(3) Subtract any Partial Withdrawals made during the current
Valuation Period from (2).]
Change of Certificateowner
[When the ownership changes, the new Certificateowner's age at the time of
the change will be used as the basis for the death benefit. The new
Certificateowner's death will determine when a death benefit is payable.
IF DEATHBEN="l": If the new Certificateowner's age is less than or equal
to 75, the Guaranteed Death Benefit Option in effect prior to the change of
Certificateowner will remain in effect. If the new Certificateowner's age
is greater than 75, the Guaranteed Death Benefit will be zero and the Death
Benefit shall be the greatest of the Cash Surrender Value, the Accumulation
Value, and the sum of the premiums paid, less any Partial Withdrawals.]
GA-CA-1007-04/95 3C2
<PAGE>
The Schedule (continued)
- --------------------------------------------------------------------------------
IF DEATHBEN="2": If the new Certificateowner's age is less than or equal to
79, the Guaranteed Death Benefit Option in effect prior to the change of
Certificateowner will remain in effect. If the new Certificateowner's age
is greater than 79, the Guaranteed Death Benefit will be zero and the Death
Benefit shall be the greater of Cash Surrender Value, the Accumulation
Value, and the sum of premiums paid, less any Partial Withdrawals.]
IF DEATHBEN="3": The Guaranteed Death Benefit Option after the change of
Certificateowner will remain the same as before the change.]
Choosing an Income Plan
Required Date of Annuity Commencement
[The required date of annuity commencement is the same date as the
Certificate Processing Date in the month following the Annuitant's [85th]
birthday. If, on the Annuity Commencement Date, a surrender charge remains,
your elected Annuity Option must include a period certain of at least five
years duration. In applying the Accumulation Value, we may first collect
any premium taxes due us.]
Minimum Annuity Income Payment
The minimum monthly annuity income payment that we will make is [$20].
Optional Benefit Riders - [None.]
GA-CA-1007-04/95 3C3
<PAGE>
The Schedule (continued)
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Fixed Account
Minimum Fixed Allocation
The minimum allocation to the Fixed Account in any one Fixed Allocation is
[$250.00].
Guaranteed Minimum Interest Rate - [3%]
Guarantee Periods
We currently offer Guarantee Periods of [l, 3, 5, 7 and l0] years. We
reserve the right to offer Guarantee Periods of durations other than those
available on the Certificate Date. We also reserve the right to cease
offering a particular Guarantee Period or Periods.
Index Rate
The Index Rate is the average of the Ask Yields for U.S. Treasury Strips as
reported by a national quoting service for the applicable maturity. The
average is based on the period from the 22nd day of the calendar month two
months prior to the calendar month of Index Rate determination to the 21st
day of the calendar month immediately prior to the month of determination.
The applicable maturity date for these U.S. Treasury Strips is on or next
following the last day of the Guarantee Period. If these Ask Yields are no
longer available, the Index Rate will be determined using a suitable
replacement method.
We currently set the Index Rate once each calendar month. However, we
reserve the right to set the Index Rate more frequently than monthly, but
in no event will such Index Rate be based on a period of less than 28 days.
Charges
Charge Deduction Division
[All charges against the Accumulation Value in this Certificate will be
deducted from the [Liquid Asset Division].]
Deductions from Premiums - [None.]
Deductions from Accumulation Value
Initial Administrative Charge - [None.]
Administrative Charge - [We charge [$40] to cover a portion of our ongoing
administrative expenses for each Certificate Processing Period. The charge
is incurred at the beginning of the Certificate Processing Period and
deducted on the Certificate Processing Date at the end of the period.
At the time of deduction, this charge will be waived if:
(1) The Accumulation Value is at least $100,000; or
(2) The sum of premiums paid to date is at least $100,000.]
Excess Allocation Charge - Currently none, however, we reserve the right to
charge [$25.00] for a change if you make more than [twelve] allocation
changes per Certificate Year. Any charge will be deducted from the
Divisions and Fixed Allocations from which each such allocation is made in
proportion to the amount being transferred from each such Division and
Fixed Allocation.
GA-CA-1007-04/95 3D1
<PAGE>
The Schedule (continued)
- --------------------------------------------------------------------------------
Surrender Charge - A Surrender Charge is imposed as a percentage of premium
if the Certificate is surrendered or an Excess Partial Withdrawal is taken.
The percentage imposed at time of surrender or Excess Partial Withdrawal
depends on the number of complete years that have elapsed since a premium
payment was made. The Surrender Charge expressed as a percentage of each
premium payment is as follows:
Complete Years Elapsed Surrender
Since Premium Payment Charges
--------------------- -------
[0 7%
1 7%
2 6%
3 5%
4 4%
5 3%
6 1%
7+ 0%]
For the purpose of calculating the Surrender Charge for an Excess Partial
Withdrawal; a) we treat premiums as being withdrawn on a first-in,
first-out basis, and b) amounts withdrawn which are not considered an
Excess Partial Withdrawal are not considered a withdrawal of any premium
payments.
[Premium Taxes - We deduct from the Accumulation Value the amount of any
premium or other state and local taxes levied by any state or governmental
entity when such taxes are incurred.
We reserve the right to defer collection of premium taxes until surrender
or until application of Accumulation Value to an Annuity Option. An Excess
Partial Withdrawal will result in the deduction of any premium tax then due
us on such amount. We reserve the right to change the amount we charge for
premium tax charges on future premium payments to conform with changes in
the law or if the Certificateowner changes state of residence.]
Deductions from the Divisions
Mortality and Expense Risk Charge - [We deduct [0.003863%] of the assets in
the Separate Account Division on a daily basis (equivalent to an annual
rate of [1.40%]) for mortality and expense risks. This charge is not
deducted from the Fixed Account values.]
Asset-Based Administrative Charge - [We deduct 0.000411% of the assets in
each Separate Account Division on a daily basis (equivalent to an annual
rate of 0.15%) to compensate us for a portion of our ongoing administrative
expenses. This charge is not deducted from the Fixed Account.]
GA-CA-1007-04/95 3D2
<PAGE>
The Schedule (continued)
- --------------------------------------------------------------------------------
Income Plan Factors
[Values for other payment periods, ages, or joint life combinations are
available on request. Monthly payments are shown for each $1,000 applied.
Table for Income for a Fixed Period
Fixed Period Monthly Fixed Period Monthly Fixed Period Monthly
of Years Income of Years Income of Years Income
------------ -------- ------------ ------- ------------ -------
11 $8.88 21 $5.33
2 $42.96 12 8.26 22 5.16
3 29.06 13 7.73 23 5.00
4 22.12 14 7.28 24 4.85
5 17.95 15 6.89 25 4.72
6 15.18 16 6.54 26 4.60
7 13.20 17 6.24 27 4.49
8 11.71 18 5.98 28 4.38
9 10.56 19 5.74 29 4.28
10 9.64 20 5.53 30 4.19
Table for Income for Life
Male/Female Male/Female Male/Female
Age 10 Years Certain 20 Years Certain Refund Certain
- --- ---------------- ---------------- --------------
50 $4.53/4.19 $4.38/4.13 $4.40/4.12
55 4.93/4.52 4.68/4.40 4.74/4.42
60 5.45/4.96 4.99/4.72 5.16/4.79
65 6.11/5.52 5.30/5.07 5.75/5.29
70 6.91/6.26 5.54/5.40 6.52/5.97
75 7.79/7.18 5.68/5.62 7.33/6.74
80 8.61/8.18 5.75/5.73 8.61/7.90
85 & Over 9.24/9.01 5.77/5.76 10.43/9.50]
GA-CA-1007-04/95 3E
<PAGE>
Important Terms
- --------------------------------------------------------------------------------
Accumulation Value - The amount that a Certificate provides for investment
at any time. Initially, this amount is equal to the premium paid.
Annuitant - The person designated by the Certificateowner to be the
measuring life in determining Annuity Payments.
Annuity Commencement Date - For each Certificate, the date on which Annuity
Payments begin.
Annuity Options - Options the Certificateowner selects that determine the
form and amount of annuity payments.
Annuity Payment - The periodic payment a Certificateowner receives. It may
be either a fixed or a variable amount based on the Annuity Option
chosen.
Attained Age - The Issue Age of the Annuitant or Certificateowner plus the
number of full years elapsed since the Certificate Date.
Beneficiary - The person designated to receive benefits in the case of the
death of the Certificateowner.
Business Day - Any day the New York Stock Exchange ("NYSE") is open for
trading, exclusive of federal holidays, or any day on which the
Securities and Exchange Commission ("SEC") requires that mutual funds,
unit investment trusts or other investment portfolios be valued.
Cash Surrender Value - The amount the Certificateowner receives upon
surrender of the Certificate.
Certificate - This is a summary of the benefits and provisions provided by
the group contract.
Certificate Anniversary - The anniversary of the Certificate Date.
Certificate Date - The date we received the initial premium and upon which
we begin determining the Certificate values. It may or may not be the
same as the Certificate Issue Date. This date is used to determine
Certificate months, processing dates, years, and anniversaries.
Certificate Issue Date - The date the Certificate is issued at our Customer
Service Center.
Certificate Processing Dates - The days when we deduct certain charges from
the Accumulation Value. If the Certificate Processing Date is not a
Valuation Date, it will be on the next succeeding Valuation Date. The
Certificate Processing Date will be on the Certificate Anniversary of
each year.
Certificate Processing Period - The period between successive Certificate
Processing Dates unless it is the first Certificate Processing Period.
In that case, it is the period from the Certificate Date to the first
Certificate Processing Date.
Certificate Year - The period between Certificate Anniversaries.
Certificateowner - The person who owns a Certificate and is entitled to
exercise all rights of the Certificate. This person's death also
initiates payment of the death benefit.
Charge Deduction Division - The Division from which all charges are
deducted if so designated on the enrollment form or later elected by
the Certificateowner.
Contingent Annuitant - The person designated by the Certificateowner who,
upon the Annuitant's death prior to the Annuity Commencement Date,
becomes the Annuitant.
GA-CA-1007-04/95 4
<PAGE>
Important Terms (continued)
- --------------------------------------------------------------------------------
Contract Issue Date - The date the group contract is issued at our Customer
Service Center.
Contractholder - The entity to whom the group contract is issued.
Customer Service Center - The entity that provides service to our
Contractholders and Certificateowners. It is located at l001 Jefferson
Street, Suite 400, Wilmington, Delaware 19801 and may be reached by
phone at 1-800-366-0066.
Division - An investment option available in the Variable Separate Accounts
shown on the Schedule.
Endorsements - Endorsements add provisions or change the terms of the group
contract or Certificate.
Experience Factor - The factor which reflects the investment experience of
the portfolio in which a Division invests and also reflects the
charges assessed against the Division for a Valuation Period.
Fixed Account - This is the Separate Account established to support Fixed
Allocations.
Fixed Allocation - An amount allocated to the Fixed Account that is
credited with a Guaranteed Interest Rate for a specified Guarantee
Period.
General Account - The account which contains all of our assets other than
those held in our Separate Accounts.
Guaranteed Death Benefit Interest Rate - The annual rate at which the
Guaranteed Death Benefit is calculated.
Guarantee Period - The period of years a rate of interest is guaranteed to
be credited to a Fixed Allocation.
Guaranteed Interest Rate - The effective annual interest rate which we will
credit for a specified Guarantee Period.
Guaranteed Minimum Interest Rate - The minimum interest rate which can be
declared by Us for Fixed Allocations.
Index of Investment Experience - The index that measures the performance of
a Division.
Initial Premium - The payment amount required to put each Certificate in
effect.
Issue Age - The Annuitant's or Certificateowner's age on the last birthday
on or before the Certificate Date.
Market Value Adjustment - A positive or negative adjustment to a Fixed
Allocation. It may apply if all or part of a Fixed A]location is
withdrawn, transferred, or applied to an Annuity Option prior to the
end of the Guarantee Period.
Maturity Date - The date on which a Guarantee Period matures.
Specially Designated Division - Distributions from a portfolio underlying a
Division in which reinvestment is not available will be allocated to
this Division unless you specify otherwise.
Valuation Date - The day at the end of a Valuation Period when each
Division is valued.
Valuation Period - Each Business Day together with any non-business days
before it.
GA-CA-1007-04/95 5
<PAGE>
Introduction to the Certificate
- --------------------------------------------------------------------------------
The Certificate
You supply us with necessary information and the Initial Premium
payment required to put this Certificate in effect. In return, we provide
benefits as stated in the group contract and described in this Certificate.
The Certificateowner
You are the Certificateowner of this Certificate. You are also the
Annuitant unless another Annuitant has been named by you and is shown in
the Schedule. You have the rights and options described in this
Certificate, including but not limited to the right to receive the annuity
benefits on the Annuity Commencement Date.
One or more people may own a Certificate. If there are multiple
Certificateowners named, the age of the oldest Certificateowner shall be
used to determine the applicable death benefit. In the case of a sole
Certificateowner who dies prior to the Annuity Commencement Date, we will
pay the Beneficiary the death benefit then due. The sole Certificateowner's
estate will be the Beneficiary if no beneficiary designation is in effect,
or if the sole designated Beneficiary has predeceased the Certificateowner.
If the sole Certificateowner is not an individual, we will treat the
Annuitant as the Certificateowner for purposes of determining when the
Certificateowner dies under the death benefit provision (if there is no
Contingent Annuitant), and the Annuitant's issue age shall determine the
applicable death benefit payable to the Beneficiary. In the case of a joint
Certificateowner dying prior to the Annuity Commencement Date, the
surviving Certificateowner(s) shall be deemed the Beneficiary(ies).
The Annuitant
The Annuitant is the measuring life of the annuity benefits provided under
this Certificate. The Annuitant may not be changed during the Annuitant's
lifetime. You may name a Contingent Annuitant. The Contingent Annuitant
becomes the Annuitant if the Annuitant dies while this Certificate is in
effect prior to the Annuity Commencement Date. You will be the Contingent
Annuitant unless you name someone else. The Annuitant must be a natural
person. If the Annuitant dies and no Contingent Annuitant has been named,
we will allow you sixty days to designate someone other than yourself as
Annuitant. If all Certificateowners are not individuals and, through
operation of this provision, a Certificateowner becomes the Annuitant, we
will pay the death proceeds to the Beneficiary. If there are joint
Certificateowners, we will treat the youngest of the Certificateowners as
the Contingent Annuitant designated, unless you elect otherwise.
The Beneficiary
The Beneficiary is the person to whom we pay death proceeds if any
Certificateowner dies prior to the Annuity Commencement Date. See Proceeds
Payable to Beneficiary for more information. We pay death proceeds to the
primary Beneficiary (unless there are joint Certificateowners in which case
death benefit proceeds are payable to the surviving Certificateowner). If
the primary Beneficiary dies before the Certificateowner, the death
proceeds are paid to the contingent Beneficiary, if any. If there is no
surviving Beneficiary, we pay the death proceeds to the Certificateowner's
estate.
One or more persons may be named as primary Beneficiary or contingent
Beneficiary. In the case of more than one Beneficiary we will assume any
death proceeds are to be paid in equal shares to the surviving
Beneficiaries. You can specify other than equal shares.
You have the right to change Beneficiaries during your lifetime,
unless you designate the primary Beneficiary irrevocable. When an
irrevocable beneficiary has been designated, you and the irrevocable
beneficiary may have to act together to exercise the rights and options
under this Certificate.
Change of Certificateowner or Beneficiary
During your lifetime and while this Certificate is in effect you can
transfer ownership of this Certificate or change the Beneficiary. To make
any of these changes, you must send us written notice of the change in a
form satisfactory to us. The change will take effect as of the day the
notice is signed. The change will not affect any payment made or action
taken by us before recording the change at our Customer Service Center. A
change of Certificateowner may affect the amount of death benefit payable
under this Certificate. See Proceeds Payable to Beneficiary.
GA-CA-1007-04/95 6
<PAGE>
Premium Payments and Allocation Changes
- --------------------------------------------------------------------------------
Initial Premium Payment
The amount and allocation of the Initial Premium payment is shown in the
Schedule.
Additional Premium Payment Option
You may make additional premium payments at any time before the Annuity
Commencement Date. Satisfactory notice to us must be given for additional
premium payments. Restrictions on additional premium payments, such as the
Attained Age of the Annuitant or Certificateowner and the timing and amount
of each payment, are shown in the Schedule. We reserve the right to defer
acceptance of or to return any additional premium payments
As of the date we receive and accept your additional premium payment:
(1) The Accumulation Value will increase by the amount of the premium
payment less any premium deductions as shown in the Schedule.
(2) The increase in the Accumulation Value will be allocated among
the Divisions and the Fixed Allocations in accordance with your
instructions. If you do not provide such instructions, allocation
will be among the Divisions in proportion to the amount of
Accumulation Value in each Division as of the date we receive and
accept your additional premium payment. Allocations to the Fixed
Account will be made only upon specific written request.
Where to Make Payments
Remit the premium payments to our Customer Service Center. On request we
will give you a receipt signed by one of our officers.
Your Right to Change Allocation of Accumulation Value
The Accumulation Value may be reallocated among the Divisions and the Fixed
Allocations prior to the Annuity Commencement Date. The number of free
allocation changes each Certificate Year that we will allow is shown in the
Schedule. To make an allocation change, you must provide us with
satisfactory notice at our Customer Service Center. The change will take
effect when we receive the notice. Restrictions for reallocation into and
out of the Divisions are shown in the Schedule. An allocation from the
Fixed Allocation may be subject to a Market Value Adjustment. See Market
Value Adjustment.
What Happens if a Division is Not Available
When a distribution is made from an investment portfolio supporting a unit
investment trust Division or from a Division of a Managed Separate Account
in which reinvestment is not available, we will allocate the distribution
to the Specially Designated Division shown in the Schedule unless you
specify otherwise.
Such a distribution only occur when an investment portfolio or Division
matures, when distribution from a portfolio or Division cannot be
reinvested in the portfolio or Division due to the unavailability of
securities, or for other reasons. When this occurs because of maturity, we
will send written notice to you 30 days in advance of such date. To elect
an allocation to other than the Specially Designated Division shown in the
Schedule, you must provide satisfactory notice to us at least seven days
prior to the date the investment matures. Such allocations will not be
counted as an allocation change of the Accumulation Value for purposes of
the number of free allocation changes permitted.
GA-CA-1007-04/95 7
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How We Measure the Certificate's Accumulation Value
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The Variable Separate Accounts
These accounts, which are designated in the Schedule, are kept separate
from our General Account and any other Separate Accounts we may have. They
are used to support variable annuity contracts and may be used for other
purposes permitted by applicable laws and regulations. We own the assets in
the Variable Separate Accounts. Assets equal to the reserves and other
liabilities of the accounts will not be charged with liabilities that arise
from any other business we conduct; but, we may transfer to our General
Account assets which exceed the reserves and other liabilities of the
Variable Separate Accounts. Income and realized and unrealized gains or
losses from assets in these Separate Accounts are credited to or charged
against the account without regard to other income, gains or losses in our
other investment accounts
One type of Variable Separate Account will invest in mutual funds, unit
investment trusts and other investment portfolios which we determine to be
suitable for the group contract's purposes. This Separate Account is
treated as a unit investment trust under Federal securities laws. It is
registered with the SEC under the Investment Company Act of 1940. This
Separate Account is also governed by state laws as designated in the
Schedule.
Another type of Variable Separate Account will invest directly in portfolio
securities deemed appropriate by the investment adviser or the committee
managing the Separate Account. This Separate Account is treated as an open
end, diversified investment company under Federal securities laws. It is
registered with the SEC under the Investment Company Act of 1940. The
Separate Account is also governed by state laws as designated in the
Schedule.
We may offer certain non-registered Series or Variable Separate Accounts.
Any such Series or Variable Separate Account is shown in the Schedule.
Divisions of the Variable Separate Account
A Unit Investment Trust Variable Separate Account includes Divisions, each
investing in a designated investment portfolio. The Divisions and the
investment portfolios in which they invest, if applicable, are specified in
the Schedule. Some of the portfolios designated may be managed by a
separate investment adviser. Such adviser will be registered under the
Investment Advisers Act of 1940 if required.
A Managed Variable Separate Account includes Divisions, each investing
directly in portfolios of securities designed to meet the objectives of the
Division. The Divisions, if applicable, and their objectives are specified
in the Schedule. Some of the Divisions designated may be managed by a
separate investment adviser. Such adviser may be registered under the
Investment Advisers Act of 1940.
Changes Within the Variable Separate Accounts
We may, from time to time, make additional Separate Account Divisions
available to you. These Divisions will invest in investment portfolios we
find suitable for the group contract. We also have the right to eliminate
Divisions from a Separate Account, to combine two or more Divisions or to
substitute a new portfolio for the portfolio in which a Division invests. A
substitution may become necessary if, in our judgment, a portfolio or
Division no longer suits the purposes of the group contract. This may
happen due to a change in laws or regulations, or a change in a portfolio's
investment objectives or restrictions, or because the portfolio or Division
is no longer available for investment, or for some other reason. We will
get prior approval from the insurance department of our state of domicile
before making such a substitution.
This approval process is on file with the insurance department of the
jurisdiction in which the group contract is delivered. We will also get any
required approval from the SEC and any other required approvals before
making such a substitution.
Subject to any required regulatory approvals, we reserve the right to
transfer assets of the Divisions of the Variable Separate Account, which we
determine to be associated with the class of contracts to which the group
contract belongs, to another Variable Separate Account or Division.
GA-CA-1007-04/95 8
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How We Measure the Certificate's Accumulation Value (continued)
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When permitted by law, we reserve the right to:
(1) Deregister a Separate Account under the Investment Company Act
of 1940;
(2) Operate a Separate Account as a management company under the
Investment Company Act of 1940, if it is operating as a unit
investment trust;
(3) Operate a Separate Account as a unit investment trust under the
Investment Company Act of 1940, if it is operating as a Managed
Separate Account;
(4) Restrict or eliminate any voting rights of Certificateowners, or
other persons who have voting rights as to a Separate Account;
and,
(5) Combine a Separate Account with other Separate Accounts.
Valuation Period
Each Division will be valued at the end of each Valuation Period on a
Valuation Date. A Valuation Period is each Business Day together with any
non-business days before it. A Business Day is any day the NYSE is open for
trading and the SEC requires mutual funds, unit investment trusts, or other
investment portfolios to value their securities.
Accumulation Value
The Accumulation Value of this Certificate is equal to the sum of the
amounts that you have in each Division and the Fixed Allocations. You
select how your Accumulation Value is allocated. The maximum number of
Divisions and Fixed Allocations to which you may allocate Accumulation
Value at any one time is shown in the Schedule.
Accumulation Value in each Division and Fixed Allocation
On the Certificate Date
On the Certificate Date, the Accumulation Value is allocated to each
Division and the Fixed Allocations as shown in the Schedule.
On each Valuation Date
At the end of each subsequent Valuation Period, the amount of Accumulation
Value in each Division and Fixed Allocation will be calculated as follows:
(1) We take the Accumulation Value in the Division or Fixed
Allocation at the end of the preceding Valuation Period.
(2) We multiply (1) by the Division's net rate of return for the
current Valuation Period, or we calculate the interest to be
credited to a Fixed Allocation for the current Va1uation
Period.
(3) We add (1) and (2).
(4) We add to (3) any additional premium payments (less any premium
deductions as shown in the Schedule) allocated to the Division or
Fixed Allocation during the current Valuation Period.
(5) We add or subtract allocations to or from that Division or
Fixed Allocation during the current Valuation Period.
(6) We subtract from (5) any Partial Withdrawals which are allocated
to the Division or Fixed Allocation during the current Valuation
Period.
(7) We subtract from (6) the amounts allocated to that Division or
Fixed Allocation for:
(a) any charges due for optional benefit riders as shown in the
Schedule;
(b) any certificate fees as shown in the Schedule;
All amounts in (7) are allocated to each Division or Fixed Allocation as
explained in Charges Deducted from Accumulation Value.
GA-CA-1007-04/95 9
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How We Measure the Certificate's Accumulation Value (continued)
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Fixed Account
The Fixed Account is a Separate Account under state insurance law and is
not required to be registered with the Securities and Exchange Commission
under the Investment Company Act of 1940. The Fixed Account includes
various Fixed Allocations which we credit with fixed rates of interest for
the Guarantee Period or Periods you select. We reset the interest rates for
new Fixed Allocations periodically based on our sole discretion.
Guarantee Periods
Each Fixed Allocation is guaranteed an interest rate for a period, a
Guarantee Period. The Guaranteed Interest Rate for a Fixed Allocation is
effective for the entire period. The Maturity Date of a Guarantee Period
will be on the last day of the calendar month in which the Guarantee Period
ends. Withdrawals and transfers made during a Guarantee Period may be
subject to a Market Value Adjustment unless made within thirty days of the
Maturity Date.
Upon the expiry of a Guarantee Period, we will transfer the Accumulation
Value of the expiring Fixed Allocation to a Fixed Allocation with a
Guarantee Period equal in length to the expiring Guarantee Period, unless
you select another period prior to a Maturity Date. We will notify you at
least thirty days prior to a Maturity Date of your options for renewal. If
the period remaining from the expiry of the previous Guarantee Period to
the Annuity Commencement Date is less than the period you have elected or
the period expiring, the next shortest period then available that will not
extend beyond the Annuity Commencement Date will be offered to you. If a
period is not available, the Accumulation Value will be transferred to the
Specifically Designated Division.
We will declare Guaranteed Interest Rates for the then available Fixed
Allocation Guarantee Periods. These interest rates are based solely on our
expectation as to our future earnings. Declared Guaranteed Interest Rates
are subject to change at any time prior to application to specific Fixed
Allocations, although in no event will the rates be less than the Minimum
Guaranteed Interest Rate shown in the Schedule.
Market Value Adjustments
A Market Value Adjustment will be applied to a Fixed Allocation upon
withdrawal, transfer or application to an Income Plan if made more than
thirty days prior to such Fixed Allocation's Maturity Date, except on
Systematic Partial Withdrawals and IRA Partial Withdrawals. The Market
Value Adjustment is applied to each Fixed Allocation separately
The Market Value Adjustment is determined by multiplying the amount of the
Accumulation Value withdrawn, transferred or applied to an Income Plan by
the following factor:
(((1+I)/(1+J+.0025)) (N/365))-1
Where I is the Index Rate for a Fixed Allocation on the first day of the
applicable Guarantee Period: J is the Index Rate for new Fixed Allocations
with Guarantee Periods equal to the number of years (fractional years
rounded up to the next full year) remaining in the Guarantee Period at the
time of calculation; and N is the remaining number of days in the Guarantee
Period at the time of calculation. (The Index Rate is described in the
Schedule.)
Market Value Adjustments will be applied as follows:
(1) The Market Value Adjustment will be applied to the amount
withdrawn before deduction of any applicable Surrender Charge.
(2) For a partial withdrawal, partial transfer or in the case where a
portion of a fixed allocation is applied to an Income Plan, the
Market Value Adjustment will be calculated on the total amount
that must be withdrawn, transferred or applied to an Income Plan
in order to provide the amount requested.
GA-CA-1007-04/95 10
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How We Measure the Certificate's Accumulation Value (continued)
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(3) If the Market Value Adjustment is negative, it will be assessed
first against any remaining Accumulation Value in the particular
Fixed Allocation. Any remaining Market Value Adjustment will be
applied against the amount withdrawn, transferred or applied to
an Income Plan.
(4) If the Market Value Adjustment is positive, it will be credited
to any remaining Accumulation Value in the particular Fixed
Allocation. If a cash surrender, full transfer or full
application to an Income Plan has been requested, the Market
Value Adjustment is added to the amount withdrawn, transferred or
applied to an Income Plan.
Measurement of Investment Experience
Index of Investment Experience
The investment experience of a Division is determined on each Valuation
Date. We use an index to measure changes in each Division's experience
during a Valuation Period. We set the index at $10 when the first
investments in a Division are made. The index for a current Valuation
Period equals the index for the preceding Valuation Period multiplied by
the Experience Factor for the current Valuation Period.
How We Determine the Experience Factor
For Divisions of a Unit Investment Trust Separate Account, the Experience
Factor reflects the investment experience of the portfolio in which the
Division invests as well as the charges assessed against the Division for a
Valuation Period. The factor is calculated as follows:
(1) We take the net asset value of the portfolio in which the
Division invests at the end of the current Valuation Period.
(2) We add to (1) the amount of any dividend or capital gains
distribution declared for the investment portfolio and
reinvested in such portfolio during the current Valuation Period.
We subtract from that amount a charge for our taxes, if any.
(3) We divide (2) by the net asset value of the portfolio at the end
of the preceding Valuation Period.
(4) We subtract the daily mortality and expense risk charge for each
Division shown in the Schedule for each day in the Valuation
Period.
(5) We subtract the daily asset based administrative charge shown in
the Schedule for each day in the Valuation Period.
For Divisions of a Managed Separate Account which invest directly in
portfolio securities, the Experience Factor reflects the investment
experience of the Division as well as the charges assessed against the
Division. The factor is calculated as follows:
(1) Take the value of the assets in the Division at the end of the
preceding Valuation Period.
(2) Add to (1) any investment income and capital gains, realized or
unrealized, credited to the assets during the current Valuation
Period.
(3) Subtract from (2) any capital losses, realized or unrealized,
charged against the assets during the current Valuation Period.
(4) Subtract from (3) any amount charged against the Division for any
taxes.
(5) Divide (4) by the value of the assets in the Division at the end
of the preceding Valuation Period.
(6) Subtract from (5) a daily charge for operating expenses actually
incurred.
(7) Subtract from (6) the daily charge for investment advice for each
day in the Valuation Period as shown in the Schedule.
(8) Subtract from (7) the daily charge for mortality and expense
risks for each day in the Valuation Period as shown in the
Schedule.
(9) Subtract from (8) the daily asset based administrative charge for
each day in the Valuation Period as shown in the Schedule.
Calculations for Divisions investing in mutual fund portfolios are made on
a per share basis. Calculations for Divisions investing in unit investment
trusts are on a per unit basis.
GA-CA-1007-04/95 11
<PAGE>
How We Measure the Certificate's Accumulation Value (continued)
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Net Rate of Return for a Separate Account Division
The net rate of return for a Division during a Valuation Period is the
Experience Factor for that Valuation Period minus one.
Interest Credited to a Fixed Allocation
A Fixed Allocation will be credited with the Guaranteed Interest Rate for
the Guarantee Period in effect on the date the premium or reallocation is
applied. Once applied, such rate will be guaranteed until that Fixed
Allocation's Maturity Date. Interest will be credited daily at a rate to
yield the declared annual Guaranteed Interest Rate.
We periodically declare Guaranteed Interest Rates for then available
Guarantee Periods. No Guaranteed Interest Rate will be less than the
Minimum Guaranteed Interest Rate shown in the Schedule.
Charges Deducted from Accumulation Value on each Certificate Processing Date
All charges and fees are shown in the Schedule.
Charge Deduction Division Option
We will deduct all charges against the Accumulation Value of this
Certificate from the Charge Deduction Division if you elected this option
(see the Schedule). If you did not elect this option or if the charges are
greater than the amount in the Charge Deduction Division, the charges
against the Accumulation Value will be deducted as follows:
(1) If these charges are less than the Accumulation Value in the
Divisions, they will be deducted proportionately from all
Divisions.
(2) If these charges exceed the Accumulation Value in the Divisions,
any excess over such value will be deducted from the Fixed
Account.
Any charges deducted from the Fixed Account will be taken from Fixed
Allocations starting with the Guarantee Period nearest its Maturity Date
until such charges have been paid.
At any time while this Certificate is in effect, you may change your
election of this option. To do this you must send a written request to our
Customer Service Center. Any change will take effect within seven days of
the date we receive your request.
GA-CA-1007-04/95 12
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Your Certificate Benefits
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While this Certificate is in effect, there are important rights and
benefits that are available to you. We discuss these rights and benefits in
this section.
Cash Value Benefit
Cash Surrender Value
The Cash Surrender Value before the Annuity Commencement Date, is
determined as follows:
(1) We take the Certificate's Accumulation Value;
(2) We deduct any Surrender Charges;
(3) We deduct any charges shown in the Schedule that have been
incurred but not yet deducted, including:
(a) any first-year administrative fee that has not yet been
deducted;
(b) any quarterly administrative fee to be deducted on the next
Certificate Processing Date;
(c) the pro rata part of any charges for optional benefit
riders; and
(d) any applicable premium or similar tax.
(4) We adjust for any applicable Market Value Adjustment.
Cancelling to Receive the Cash Surrender Value
At any time before the Annuity Commencement Date, you may surrender this
Certificate to us. To do this, you must return this Certificate with a
signed request for cancellation to our Customer Service Center.
The Cash Surrender Value will vary daily. We will determine the Cash
Surrender Value as of the date we receive the Certificate and your signed
request in our Customer Service Center. All benefits under this Certificate
will then end.
We will usually pay the Cash Surrender Value within seven days; but, we
may delay payment as described in the Payments We May Defer provision.
Partial Withdrawal Option
After the first Certificate Anniversary, you may make a Partial Withdrawal
once in each Certificate Year, without incurring a Partial Withdrawal
Charge. Any additional Partial Withdrawals in a Certificate Year are
subject to a Partial Withdrawal Charge. The minimum amount that may be
withdrawn is shown in the Schedule. The maximum amount that may be
withdrawn is shown in the Schedule. Any withdrawal you make will not be
treated as premium only for the purposes of calculating the Surrender
Charge. To take a Partial Withdrawal, you must provide us with satisfactory
notice at our Customer Service Center.
GA-CA-1007-04/95 13
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Death Benefit Proceeds
- --------------------------------------------------------------------------------
Proceeds Payable to the Beneficiary
Prior to the Annuity Commencement Date
If the sole Certificateowner dies prior to the Annuity Commencement Date,
we will pay the Beneficiary the death benefit. If there are joint
Certificateowners and any Certificateowner dies, we will pay the surviving
Certificateowners the death benefit. We will pay the amount on receipt of
due proof of the Certificateowner's death at our Customer Service Center.
Such amount may be received in a single lump sum or applied to any of the
Annuity Options (see Choosing an Income Plan). When the Certificateowner
(or all Certificateowners where there are joint Certificateowners) is not
an individual, the death benefit will become payable on the death of the
Annuitant prior to the Annuity Commencement Date (unless a Contingent
Annuitant survived the Annuitant). Only one death benefit is payable under
this Certificate. In all events, distributions under the Certificate must
be made as required by applicable law.
How to Claim Payments to Beneficiary
We must receive proof of the Certificateowner's (or Annuitant's) death
before we will make any payments to the Beneficiary. We will calculate the
death benefit as of the date we receive due proof of death. The Beneficiary
should contact our Customer Service Center for instructions.
Guaranteed Death Benefit
On the Certificate Date, the Guaranteed Death Benefit is equal to the
premium paid. On subsequent Valuation Dates, the Guaranteed Death Benefit
is calculated as shown in the Schedule. A change of Certificateowner will
affect the Guaranteed Death Benefit. See the Schedule.
GA-CA-1007-04/95 14
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Choosing an Income Plan
- --------------------------------------------------------------------------------
Annuity Benefits
If the Annuitant and Certificateowner are living on the Annuity
Commencement Date, we will begin making payments to the Certificateowner.
We will make these payments under the Annuity Option (or Options) as chosen
initially or as subsequently selected. You may choose or change an Annuity
Option by making a written request at least 30 days prior to the Annuity
Commencement Date. Unless you have chosen otherwise, Option 2 on a 10-year
period certain basis will become effective. The amount of the payments will
be determined by applying the Accumulation Value on the Annuity
Commencement Date in accordance with the Annuity Options section below (See
Payments We May Defer). See Schedule for certain restrictions which may
apply. Before we pay any annuity benefits, we require the return of this
Certificate. If this Certificate has been lost, we require the applicable
lost certificate form.
Annuity Commencement Date Selection
You select the Annuity Commencement Date. You may select any date following
the third Certificate Anniversary but before the required date of annuity
commencement as shown in the Schedule. If you do not select a date, the
Annuity Commencement Date will be in the month following the required date
of annuity commencement.
Frequency Selection
You choose the frequency of the Annuity Payments. They may be monthly,
quarterly, semi-annually, or annually. If we do not receive written notice
from you, the payments will be made monthly.
The Income Plan
While this Certificate is in effect and before the Annuity Commencement
Date, you may choose one or more Annuity Options to which death benefit
proceeds may be applied. If, at the time of the Certificateowner's death,
no option has been chosen for paying death benefit proceeds, the
Beneficiary may choose an option within one year. You may also elect an
Annuity Option on surrender of the Certificate for its Cash Surrender
Value. For each option we will issue a separate written agreement putting
the option into effect.
Our approval is needed for any option where:
(1) The person named to receive payment is other than the
Certificateowner or Beneficiary; or
(2) The person named is not a natural person, such as a corporation;
or
(3) Any income payment would be less than the minimum annuity income
payment shown in the Schedule.
The Annuity Options
There are four options to choose from. They are:
Option 1. Income for a Fixed Period
Payment is made in equal installments for a fixed number of years. We
guarantee each monthly payment will be at least the Income For Fixed Period
amount shown in the Schedule. Values for annual, semiannual or quarterly
payments are available on request.
Option 2. Income for Life
Payment is made to the person named in equal monthly installments and
guaranteed for at least a period certain. The period certain can be 10 or
20 years. Other periods certain are available on request. A refund certain
may be chosen instead. Under this arrangement, income is guaranteed until
payments equal the amount applied. If the person named lives beyond the
guaranteed period, payments continue until his or her death.
GA-CA-1007-04/95 15
<PAGE>
Choosing an Income Plan (continued)
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We guarantee each pavment will be at least the amount shown in the Income
for Life Table in the Schedule. By age we mean the named person's age on
his or her last birthday before the option's effective date. Amounts for
ages not shown are available on request.
Option 3. Joint Life Income
This option is available if there are two persons named to receive
payments. At least one of the persons named must be either the
Certificateowner or Beneficiary of this Certificate. Monthly payments are
guaranteed and are made as long as at least one of the named persons is
living. The monthly payment amounts are available upon request. Such
amounts are guaranteed and will be calculated on the same basis as the
Income for Life Table, however, the amounts will be based on two lives.
Option 4. Annuity Plan
An amount can be used to buy any single premium annuity we offer on the
option's effective date.
Payment When Named Person Dies
When the person named to receive payment dies, we will pay any amounts
still due as provided by the option agreement. The amounts still due are
determined as follows:
(1) For Option 1 or any remaining guaranteed payments under Option 2,
payments will be continued. Under Options 1 and 2, the discounted
values of the remaining guaranteed payments may be paid in a
single sum. This means we deduct the amount of the interest each
remaining guaranteed payment would have earned had it not been
paid out early. The discount interest rate is 3% for Option 1
and 3.50% for Option 2. We will, however, base the discount
interest rate on the interest rate used to calculate the payments
for Options 1 and 2 if such payments were not based on the tables
in this Certificate.
(2) For Option 3, no amounts are payable after both named persons
have died.
(3) For Option 4, the annuity agreement will state the amount due, if
any.
GA-CA-1007-04/95
16
<PAGE>
Other Important Information
- --------------------------------------------------------------------------------
Entire Contract
The group contract, including any attached rider, Endorsement, amendment
and the application of the Contractholder, constitute the entire contract
between the Contractholder and us. All statements made by the
Contractholder, any Certificateowner or any Annuitant will be deemed
representations and not warranties. No such statement will be used in any
contest unless it is contained in the application signed by the
Contractholder or in a written instrulnent signed by the Certificateowner,
a copy of which has been furnished to the Certificateowner, the Beneficiary
or to the Contractholder.
Sending Notice to Us
Whenever written notice is required, send it to our Customer Service
Center. The address of our Customer Service Center is shown in Important
Terms. Please include your Certificate number in all correspondence.
Reports to Certificateowner
We will send you a report, at least once during each Certificate Year,
showing the Accumulation Value and the Cash Surrender Value of your
Certificate as of the end of the Certificate Processing Period. The report
will also show the allocation of the Accumulation Value as of such date and
the amounts deducted from or added to the Accumulation Value since the last
report. The report will also include any other information that may be
currently required by the insurance supervisory official of the
jurisdiction in which this Certificate is delivered.
We will also send you copies of any shareholder reports of the portfolios
in which the Divisions of the Separate Accounts invest, as well as any
other reports, notices or documents required by law to be furnished to
Certificateowners.
Assignment - Using this Certificate as Collateral Security
You can assign this Certificate as collateral security for a loan or other
obligation. This does not change the Certificate ownership. Your rights and
any beneficiary's rights are subject to the terms of the assignment. To
make or release an assignment, we must receive written notice satisfactory
to us, at our Customer Service Center. We are not responsible for the
validity of any assignment.
Changing the Group Contract
The group contract or any additional benefit riders may be changed to
another annuity plan according to our rules at the time of the change.
Contract Changes - Applicable Tax Law
We reserve the right to make changes in the group contract, the
Certificate, and their Riders to the extent we deem it necessary to
continue to qualify the group contract as an annuity. Any such changes will
apply uniformly to all Certificates that are affected. You will be given
advance written notice of such changes.
Misstatement of Age or Sex
If an age or sex has been misstated, the amounts payable or benefits
provided by this Certificate shall be those that the premium payment made
would have bought at the correct age or sex.
Non-Participating
This Certificate does not participate in the divisible surplus of Golden
American Life Insurance Company.
GA-CA-1007-04/95 17
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Other Important Information (continued)
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Payments We May Defer
We may not be able to determine the value of the assets of the Divisions
because:
(1) The NYSE is closed for trading;
(2) The SEC determines that a state of emergency exists; or
(3) An order or pronouncement of the SEC permits a delay for the
protection of Certificateowners.
(4) The check used to pay the premium has not cleared through the
banking system. This may take up to 15 days.
During such times, as to amounts allocated to the Divisions, we may delay:
(1) Determination and payment of the Cash Surrender Value;
(2) Determination and payment of any death benefit if death occurs
before the Annuity Commencement Date;
(3) Allocation changes of the Accumulation Value; or,
(4) Application of the Accumulation Value under an income plan.
We reserve the right to delay payment of amounts allocated to the Fixed
Account for up to six months.
Authority to Make Agreements
All agreements made by us must be signed by one of our officers. No other
person, including an insurance agent or broker, can:
(1) Change any of this Certificate's terms;
(2) Extend the time for premium payments; or
(3) Make any agreement binding on us.
Required Note on Our Computations
We have filed a detailed statement of our computations with the insurance
supervisory official in appropriate jurisdictions. The values are not less
than those required by the law of that state or jurisdiction. Any benefit
provided by an attached optional benefit rider will not increase these
values unless otherwise stated in that rider.
Facility of Payment
If no Beneficiary is named, we reserve the right to pay an amount not to
exceed $2,000 to any person we determine to be entit1ed to such amount by
reason of incurred expenses incident to the last illness or death of a
Certificateowner.
Incontestability
The benefits under the group contract vrill not be contested, except for
nonpayment of premiums, after it has been in effect during the Annuitant's
lifetime for two years from the Certificate Date.
GA-CA-1007-04/95 18
<PAGE>
GOLDEN
[LOGO] AMERICAN Section 72 Rider
LIFE INSURANCE
COMPANY
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock company domiciled in Wilmington, Delaware
- --------------------------------------------------------------------------------
Required Distribution of Proceeds on Death of Certificateowner
This Rider is required to qualify the Contract or Certificate to which
it is attached as an annuity Contract or Certificate under Section 72 of
the Internal Revenue Code of 1986, as amended (the "Code"). Where the terms
of this Rider are in conflict with the terms of the Contract or
Certificate, the Rider will control. Golden American Life Insurance Company
reserves the right to amend or administer the Contract, Certificate and
Rider as necessary to comply with applicable tax requirements. This Rider
and the Contract or Certificate should be construed so that they comply
with applicable tax requirements.
Death of Certificateowner on or after Annuity Commencement Date
IF ANY CERTIFICATEOWNER DIES ON OR AFTER the Annuity Commencement Date
but prior to the time the entire interest in the Certificate has been
distributed, the remaining portion will be distributed at least as rapidly
as under the method of distribution being used as of the date of the
Certificateowner's death.
Death of Certificateowner Prior to Annuity Commencement Date
IF ANY CERTIFICATEOWNER DIES PRIOR TO the Annuity Commencement Date,
the entire interest in the Certificate will be distributed within five
years of the Certificateowner's death.
However, this distribution requirement will be considered satisfied as
to any portion of the Certificateowner's interest in the Certificate which
is payable to or for the benefit of a Designated Beneficiary and which will
be distributed over the life of such Designated Beneficiary or over a
period not extending beyond the life expectancy of that Designated
Beneficiary, provided such distributions begin within one year of the
Certificateowner's death. If the Designated Beneficiary is the surviving
spouse of the decedent, the Certificate may be continued in the name of the
spouse as Certificateowner and these distribution rules are applied by
treating the spouse as the Certificateowner. However, on the death of the
surviving spouse, this provision regarding spouses may not be used again.
If any Certificateowner is not an individual, the death or change
(where permitted) of the Annuitant will be treated as the death of a
Certificateowner.
The Designated Beneficiary is the person entitled to ownership rights
under the Certificate. Thus, where no death benefit has become payable, the
Designated Beneficiary, for the purposes of applying this Rider, will be
the Certificateowner(s). Where a death benefit has become payable, the
Designated Beneficiary, for the purposes of applying this Rider, is the
person(s) entitled to the death benefit, generally the Beneficiary or
surviving Certificateowners, as appropriate. Upon the death of any
Certificateowner, the Designated Beneficiary will become the
Certificateowner and, if an individual, will become the Annuitant.
A Certificateowner may notify Golden American as to the manner of payment
under this Rider. If such Certificateowner has not so notified Golden
American prior to his or her death, the Designated Beneficiary under the
Certificate may so notify Golden American.
GOLDEN AMERICAN LIFE INSURANCE COMPANY
President Secretary
GA-RA-1002-12/94
<PAGE>
GOLDEN
[LOGO] AMERICAN Waiver of Surrender Charge Rider
LIFE INSURANCE
COMPANY
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock company domiciled in Wilmington, Delaware
- --------------------------------------------------------------------------------
Golden American Life Insurance Company ("we" or "us") will waive any
Surrender Charge incurred due to a surrender or Excess Partial Withdrawal
under the Certificate in the event the Certificateowner ("you") is subject
to Qualified Extended Medical Care or suffers from a Qualifying Terminal
Illness subject to the terms and conditions stated below:
Extended Medical Care
To qualify for this waiver, you must first begin receiving Qualified
Extended Medical Care on or after the first Certificate Anniversary for at
least 45 days during any continuous sixty-day period, and your request for
the surrender or withdrawal, together with proof of such Qualified
Extended Medical Care, must be received at our Customer Service Center
during the term of such care or within ninety days after the last day upon
which you received such care.
"Qualified Extended Medical Care" means confinement in a Qualified
Licensed Hospital or Nursing Care Facility prescribed by a Qualifying
Medical Professional.
"Qualifying Licensed Hospital or Nursing Care Facility" means a
state-licensed hospital or state-licensed skilled or intermediate care
nursing facility at which medical treatment is available on a daily basis;
and daily medical records are kept on each patient. This does not include a
facility whose purpose is to provide accommodations, board or personal care
services to individuals who do not need medical or nursing care; nor a
place mainly for rest.
"Qualifying Medical Professional" means a legally-qualified
practitioner of the healing arts who is acting within the scope of his or
her license; is not a resident of your household or that of the Annuitant;
and is not related to you or the Annuitant by blood or marriage.
Terminal Illness
To qualify for this waiver, you must be first diagnosed by a
Qualifying Medical Professional, on or after the first Certificate
Anniversary, as having a Qualifying Terminal Illness. Written proof of
terminal illness, satisfactory to us, must be received at our Customer
Service Center. We reserve the right to require an examination by a
physician of our choice.
"Qualifying Terminal Illness" means an illness or accident, the result
of which results in a life expectancy of twelve months or less, as
measured from the date of diagnosis.
Claims
Evidence, satisfactory to us, must be submitted to qualify for waiver
of Surrender Charge pursuant to this Rider. This evidence will be in
writing and, where applicable, be attested to by a Qualified Medical
Professional.
This Rider is attached to and becomes part of the Certificate to which
it is attached. The provisions of this Rider shall supersede the provisions
of the Certificate where applicable.
GOLDEN AMERICAN LIFE INSURANCE COMPANY
President Secretary
GA-RA-1003-12/94
<PAGE>
Deferred Combination Variable and Fixed Annuity Certificate - No Dividends
Variable Cash Surrender Values while the Certificateowner is living and
prior to the Annuity Commencement Date. Death benefit subject to guaranteed
minimum. Additional premium payment option. Partial Withdrawal option.
Non-participating. Investment results reflected in values.
GA-CA-1007-04/95
<PAGE>
4(g) INDIVIDUAL DEFERRED VARIABLE ANNUITY CONTRACT
<PAGE>
GOLDEN
AMERICAN
[LOGO] LIFE INSURANCE Deferred Variable
COMPANY Annuity Contract
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock Company domiciled in Wilmington, Delaware
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
This is a legal Contract between its Owner and us. Please read it
carefully. In this Contract you or your refers to the Owner shown above.
We, our or us refers to Golden American Life Insurance Company. You may
allocate this Contract's Accumulation Value among the Separate Account
Divisions shown in the Schedule.
If this Contract is in force, we will make income payments to you starting
on the Annuity Commencement Date. If the Owner dies prior to the Annuity
Commencement Date, we will pay a death benefit to the Beneficiary. The
amount of such benefits are subject to the terms of this Contract.
All payments and values, when based on the Investment Experience of a
Separate Account, may increase or decrease, depending on the Contract's
investment results.
RIGHT TO EXAMINE THIS CONTRACT: You may return this Contract to us or the
agent through whom you purchased it within 10 days after you receive it. If
so returned, we will treat the Contract as though it were never issued.
Upon receipt we will promptly refund the Accumulation Value plus any
charges we have deducted as of the date the returned Contract is received
by us.
Customer Service Center Secretary:
1001 Jefferson Street, Suite 400
Wilmington, Delaware 19801 President:
- --------------------------------------------------------------------------------
Deferred Variable Annuity Contract - No Dividends
Variable Cash Surrender Values while the Annuitant and Owner is living and
prior to the Annuity Commencement Date. Death benefit subject to guaranteed
minimum. Additional Premium Payment Option. Partial Withdrawal Option.
Non-participating. Investment results reflected in values.
GA-IA-1008-04/95
<PAGE>
Table of Contents
- --------------------------------------------------------------------------------
Specification Pages
Payment and Investment Information ................ 3A
The Separate Accounts ............................. 3B
The General Account ............................... 3C
Contract Facts .................................... 3D
Charges and Fees................................... 3E
Income Plan Factors ............................... 3F
Introduction to this Contract ....................... 4
The Contract
The Owner
The Annuitant
The Beneficiary
Change of Owner or Beneficiary
Premium Payments and Allocation Changes ............. 6
Initial Premium Payment
Additional Premium Payment Option
Your Right to Change Allocation of
Accumulation Value
What Happens if a Separate Account Division
is Not Available
How We Measure the Contract's
Accumulation Value ................................. 7
The Separate Accounts
The General Account
Valuation Period
Accumulation Value
Accumulation Value in each Division
Measurement of Investment Experience
Charges Deducted from Accumulation Value on
each Contract Processing Date
Your Contract Benefits .............................. 11
Cash Value Benefit
Partial Withdrawal Option
Proceeds Payable to the Beneficiary
Choosing an Income Plan ............................. 13
Annuity Benefits
Annuity Commencement Date Selection
Frequency Selection
The Income Plan
The Annuity Options
Payments When Named Person Dies
Other Important Information ......................... 15
Sending Notice to Us
Reports to Owner
Assignment - Using this Contract as
Collateral Security
Changing this Contract
Contract Changes - Applicable Tax Law
Misstatement of Age or Sex
Non-Participating
Payments We May Defer
Authority to Make Agreements
Required Note on Our Computations
A copy of any application and any additional Riders and Endorsements
are at the back of this Contract.
Specification Pages
The Specification Pages give specific facts about this Contract and its
coverage. Please refer to them while reading this Contract.
GA-IA-1008-04/95 2
<PAGE>
The Schedule
Payment And Investment Information
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Annuitant's Issue Age Annuitant's Sex Owner's Issue Age
[35] [Male] [55]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Contract Date Issue Date Residence State
[January 1, 1994] [January 1, 1994] [Delaware]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Initial Investment
Initial Premium Payment received: [$10,000]
As requested in the application, your Accumulation Value has been invested
as follows:
Percentage of
Division Accumulation Value
-------- ------------------
[Multiple Allocation 10%
Fully Managed 10%
Capital Appreciation 10%
Rising Dividends 10%
All-Growth 10%
Real Estate 10%
Natural Resources 10%
Emerging Markets 5%
The Managed Global Account 5%
Limited Maturity Bond 5%
Liquid Asset 5%
Value Equity 5%
Fixed Interest 5%]
--------
Total 100%
Additional Premium Payment Information
We will accept additional premium payments until either the Annuitant or
the Owner reaches the Attained Age of [85]. The minimum additional payment
which may be made is [$500.00].
Accumulation Value Allocation Rules
The maximum number of Divisions in which you may be invested at any one
time is [twelve]. You are allowed unlimited allocation changes per Contract
Year without charge. We reserve the right to impose a charge for any
allocation change in excess of [twelve] per Contract Year. The Excess
Allocation Charge is shown in the Schedule.
GA-IA-1008-04/95 3A1
<PAGE>
The Schedule
Payment And Investment Information (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Annuitant's Issue Age Annuitant's Sex Owner's Issue Age
[35] [Male] [55]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Contract Date Issue Date Residence State
[January 1, 1994] [January 1, 1994] [Delaware]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Allocation Changes by Telephone
You may request allocation changes by telephone during our telephone
request business hours. You may call our Customer Service Center at
1-800-366-0066 to make allocation changes by using the personal
identification number you will receive. You may also mail any notice or
request for allocation changes to our Customer Service Center at the
address shown on the cover page.
GA-IA-1008-04/95 3A2
<PAGE>
The Schedule
The Separate Accounts
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Divisions Investing in Shares of a Mutual Fund
Separate Account B (the "Account") is a unit investment trust Separate
Account, organized in and governed by the laws of the State of Delaware,
our state of domicile. The Account is divided into Divisions.
Each Division listed below invests in shares of the mutual fund portfolio
(the "Series") designated. Each portfolio is a part of The GCG Trust (the
"Trust") managed by Directed Services, Inc.
[MULTIPLE MULTIPLE ALLOCATION SERIES
ALLOCATION Objective -The highest total return, consisting of
DIVISION capital appreciation and current income,
consistent with the preservation of capital
and elimination of unnecessary risk.
Investments -Investment in equity and debt securities and
the use of certain sophisticated investment
strategies and techniques.
Portfolio Manager -Zweig Advisors Inc.
FULLY FULLY MANAGED SERIES
MANAGED Objective -High total investment return over the long
DIVISION term, consistent with the preservation of
capital and prudent investment risk.
Investments -Pursues an active asset allocation strategy
whereby investments are allocated, based
upon an evaluation of economic and market
trends and the anticipated relative total
return available, among three asset classes
-- debt securities, equity securities and
money market instruments.
Portfolio Manager -T. Rowe Price Associates, Inc.]
GA-IA-1008-04/95 3Bl
<PAGE>
The Schedule
The Separate Accounts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
[CAPITAL CAPITAL APPRECIATION SERIES
APPRECIATION Objective -Long-term capital growth.
DIVISION
Investments -Invests in common stocks and preferred stock
that will be allocated among various
categories of stocks referred to as
"components" which consist of the following:
(i) The Growth Component - Securities that
the portfolio manager believes have the
following characteristics: stability and
quality of earnings and positive earnings
momentum; dominant competitive positions;
and demonstrate above-average growth rates
as compared to published S&P 500 earnings
projections; and (ii) The Value Component -
Securities that the portfolio manager
regards as fundamentally undervalued, i.e.,
securities selling at a discount to asset
value and securities with a relatively low
price/earnings ratio. The securities
eligible for this component may include real
estate stocks, such as securities of
publicly-owned companies that, in the
portfolio manager's judgement, offer an
optimum combination of current dividend
yield, expected dividend growth, and
discount to current real estate value.
Portfolio Manager -Chancellor Trust Company
RISING RISING DIVIDENDS SERIES
DIVIDENDS Objective -Capital appreciation, with dividend income
DIVISION as a secondary objective.
Investments -Investment in equity securities of high
quality companies that meet the following
four criteria: consistent dividend
increases; substantial dividend increases;
reinvested profits; and an under-leveraged
balance sheet.
Portfolio Manager -Kayne, Anderson Investment Management, Inc.
ALL-GROWTH ALL-GROWTH SERIES
DIVISION Objective - Capital appreciation.
Investments -Investment in securities selected for their
long term growth prospects.
Portfolio Manager -Warburg, Pincus Counsellors, Inc.
REAL REAL ESTATE SERIES
ESTATE Objective -Capital appreciation, with current income as
DIVISION a secondary objective.
Investments -Investment in publicly-traded equity
securities of companies in the real estate
industry listed on national exchanges or on
the National Association of Securities
Dealers Automated Quotation System.
Portfolio Manager -E.I.I. Realty Securities, Inc.]
GA-IA-1008-04/95 3B2
<PAGE>
The Schedule
The Separate Accounts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
[NATURAL NATURAL RESOURCES SERIES
RESOURCES Objective -Long-term capital appreciation.
DIVISION
Investments -Investment in equity and debt securities of
companies engaged in the exploration,
development, production, and distribution of
natural resources.
Portfolio Manager -Van Eck Associates Corporation
EMERGING EMERGING MARKETS SERIES
MARKETS Objective -Long-term growth of capital.
DIVISION
Investments -Investment primarily in equity securities of
companies that are considered to be in
emerging market countries in the Pacific
Basin and Latin America. Income is not an
objective, and any production of current
income is considered incidental to the
objective of growth of capital.
Portfolio Manager -Bankers Trust Company
LIMITED LIMITED MATURITY BOND SERIES
MATURITY Objective -Highest current income consistent with low
BOND risk to principal and liquidity. Also seeks
DIVISION to enhance its total return through capital
appreciation when market factors indicate
that capital appreciation may be available
without significant risk to principal.
Investments -Investment primarily in a diversified
portfolio of limited maturity debt
securities.
Portfolio Manager -Bankers Trust Company
LIQUID LIQUID ASSET SERIES
ASSET Objective -High level of current income consistent with
DIVISION the preservation of capital and liquidity.
Investments -Obligations of the U.S. Government and its
agencies and instrumentalities; bank
obligations; commercial paper and short-term
corporate debt securities.
Term -All issues maturing in less than one year.
Portfolio Manager -Bankers Trust Company]
GA-IA-1008-04/95 3B3
<PAGE>
The Schedule
The Separate Accounts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
[VALUE VALUE EQUITY SERIES
EQUITY Objective -Capital appreciation.
DIVISION
Investments -Investment primarily in equity securities
which meet quantitative standards considered
to indicate above-average financial
soundness and high intrinsic value relative
to price.
Portfolio Manager -Eagle Asset Management, Inc.
NOTE: PLEASE REFER TO THE PROSPECTUSES FOR THE CONTRACT AND THE GCG TRUST
FOR MORE DETAILS.
The Managed Global Account of Account D
The Managed Global Account (the "Global Account") is a non-diversified
investment company which invests directly in securities. DSI serves as
manager of Separate Account D and Warburg, Pincus Counsellors, Inc. serves
as portfolio manager of the Global Account.
THE MANAGED THE MANAGED GLOBAL ACCOUNT PORTFOLIO
GLOBAL ACCOUNT Objective -High total investment return, consistent
DIVISION with a prudent regard for capital
preservation.
Investments -Investment in a wide range of equity and
debt securities and money market instruments
of both domestic and foreign issuers.
Portfolio Manager -Warburg, Pincus Counsellors, Inc.
NOTE: PLEASE REFER TO THE PROSPECTUS FOR THE CONTRACT AND THE MANAGED
GLOBAL ACCOUNT OF ACCOUNT D FOR MORE DETAILS.]
GA-IA-1008-04/95 3B4
<PAGE>
The Schedule
The General Account
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Guaranteed Division
[Fixed Interest Division
The Fixed Interest Division provides a minimum of 3% annual interest rate.
At our sole discretion, we may periodically declare higher interest rates.
Such rates will apply to periods following the date of declaration. Any
such declaration will be by class and will be based on our future
expectations.
Limitations on Allocations
We reserve the right to restrict allocations into the General Account. Such
limits may be dollar restrictions on allocations into the General Account
or we may restrict reallocations into the General Account.
Guarantee Periods
Each allocation to the Fixed Interest Division will be guaranteed an
interest rate for the entire Initial Guaranteed Period elected. We
currently offer Initial Guarantee Periods of one, three, five, seven and
ten years. The Initial Guarantee Period starts on the day an allocation is
made to the Fixed Interest Division and ends on the last day of the
calendar month following one, three, five, seven or ten years as
appropriate, the Maturity Date.
At the end of a Guarantee Period, you may transfer the Accumulation Value
in such Guarantee Period to the Divisions or to a Guarantee Period we then
offer. If we do not receive notification by the Maturity Date, your
Accumulation Value in the maturing Guarantee Period will automatically be
transferred to a one year Guarantee Period. Upon such automatic transfer
you will have thirty days to reallocate any of your Accumulation Value to
the Divisions.
Deductions for Charges
We do not deduct the Mortality and Expense Charge and the Asset-Based
Administrative Charge with respect to that amount of Accumulation Value
allocated to the Fixed Interest Division while such Accumulation Value
remains allocated to the Fixed Interest Division.
Transfers from the Fixed Interest Division
You may transfer your Accumulation Value from a Guarantee Period to the
Divisions of Separate Account B or Separate Account D (the "Divisions"), or
to a different Guarantee Period, subject to the following restrictions:
The maximum amount which may be transferred from the Fixed Interest
Division during a Contract Year is 15% of the Accumulation Value in your
Fixed Interest Division. In addition, no more than 15% of the Accumulation
Value allocated to a particular Guarantee Period may be transferred during
any one year period beginning on the date such allocation was initially
allocated or transferred to such Guarantee Period. On a Maturity Date, 100%
of the Accumulation Value in the maturing Guarantee Period may be
transferred.]
GA-IA-1008-04/95 3C1
<PAGE>
The Schedule
The General Account (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Guaranteed Division (continued)
[We currently require that an amount allocated to a one year Guarantee
Period not be transferred until held in such Guarantee Period for at least
one year, except pursuant to our published rules. This means that amounts
allocated to a one year Guarantee Period cannot be transferred prior to the
end of the Guarantee Period. We reserve the right to have such a
requirement for other Guarantee Periods as well. We also reserve the right
not to allow amounts previously transferred from the Fixed Interest
Division to the Divisions to be transferred back to the Fixed Interest
Division for a period of at least six months from the date of transfer.
We reserve the right to reduce the amount otherwise available for transfer
from the Fixed Interest Division by any amounts previously withdrawn from
the Fixed Interest Division.
Systematic Withdrawals
Up to the interest earned in the prior month or quarter may be withdrawn
monthly or quarterly, depending whether you have chosen a monthly or
quarterly frequency, respectively.
Conventional Partial Withdrawals
Amounts withdrawn from a Fixed Interest Division may be subject to
surrender charge if such amounts cause the total amount withdrawn from the
Contract in a Contract Year to exceed 15% of the Contract's Accumulation
Value.]
GA-IA-1008-04/95 3C2
<PAGE>
The Schedule
Contract Facts
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Contract Processing Dates
The Contract Processing Dates are the days when we deduct charges from the
Accumulation Value. The Contract Processing Date for your Contract is
[April 1] of each year.
Contract Processing Periods
The period between successive Contract Processing Dates unless it is the
first Contract Processing Period. In that case, it is the period from the
Contract Date to the first Contract Processing Date.
Specially Designated Division
When a distribution is made from an investment portfolio underlying a
Separate Account Division or from a Division of a managed Separate Account
in which reinvestment is not available, we will allocate the amount of the
distribution to the [Liquid Asset Division] unless you specify otherwise.
Partial Withdrawals
[The maximum amount that can be withdrawn in a Contract Year without being
considered an Excess Partial Withdrawal is 15% of the Accumulation Value as
of the date of the withdrawal. We will collect a Surrender Charge for
Excess Partial Withdrawals. In no event may a Partial Withdrawal be greater
than 90% of the Cash Surrender Value.
Conventional Partial Withdrawals
Minimum Withdrawal Amount: $1,000
Systematic Partial Withdrawals
Systematic Partial Withdrawals may be elected to commence after 28 days
from the Contract Issue Date.
Systematic Partial Withdrawals may be taken on a monthly or quarterly
basis. You select the day withdrawals will be made, but no later than the
28th day of the month. If you do not elect a day, the Contract Date will be
used.
Minimum Withdrawal Amount: $100.00
Maximum Percentage: 1.25% Monthly or 3.75% Quarterly]
GA-IA-1008-04/95 3D1
<PAGE>
The Schedule
Contract Facts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Death Benefit
IF DEATHBEN="1": The Death Benefit is the greatest of (i) the Accumulation
Value, (ii) the Guaranteed Death Benefit, (iii) the Cash Surrender Value, and
(iv) the sum of premiums paid, less any partial withdrawals.
IF DEATHBEN="2": The Death Benefit is the greatest of (i) the Accumulation
Value, (ii) the Guaranteed Death Benefit, (iii) the Cash Surrender Value, and
(iv) the sum of premiums paid, less any partial withdrawals.
IF DEATHBEN="3": The Death Benefit is the greater of (i) the Cash Surrender
Value, (ii) the Accumulation Value, and (iii) the sum of the premiums paid, less
any Partial Withdrawals.
Guaranteed Death Benefit
[On the Contract Date, the Guaranteed Death Benefit is the Initial Premium. On
subsequent Valuation Dates, the Guaranteed Death Benefit is calculated as
follows:
Option 1:
(1) Start with the Guaranteed Death Benefit from the prior Valuation Date;
(2) Calculate interest on (1) if the Owner is living (the Annuitant if
the Owner is not an individual) for the current Valuation Period at the
Guaranteed Death Benefit Interest Rate;
(3) Add (1) and (2);
(4) Add any additional premiums paid during the current Valuation Period to
(3);
(5) Subtract Partial Withdrawals made during the current Valuation Period
from (4);
Each accumulated initial or additional premium payment, reduced by any Partial
Withdrawals (including any associated Market Value Adjustment and Surrender
Charge incurred) allocated to such premium, will continue to grow at the
Guaranteed Death Benefit Interest Rate until reaching its Maximum Guaranteed
Death Benefit.
Guaranteed Death Benefit Interest Rate
The Guaranteed Death Benefit is accumulated at a rate of 7% compounded annually,
except:
(1) Amounts in the Liquid Asset Division are accumulated at the net rate
of return for the Liquid Asset Division during the current Valuation
Period if less than 7%; and
(2) Amounts in Limited Maturity Bond Division are accumulated at the net
rate of return for the Limited Maturity Bond Division during the
current Valuation Period if less than 7%; and
(3) Amounts in a Fixed Allocation are accumulated at the interest rate
being credited to such Fixed Allocation during the current Valuation
Period if less than 7%.
Maximum Guaranteed Death Benefit
The Maximum Guaranteed Death Benefit is initially equal to two times the initial
or additional premium paid. Thereafter, the Maximum Guaranteed Death Benefit as
of the effective date of a partial withdrawal is reduced first by the amount of
any partial withdrawal representing earnings and second in proportion to the
reduction in Accumulation Value for any partial withdrawal representing premium
(in each case, including any Surrender Charge). If withdrawals do not exceed
7% of premium paid in a Contract Year, and did not exceed 7% of premiums paid
in any prior Contract Year, the Maximum Guaranteed Death Benefit will be
reduced only by the amount of such withdrawals. Once withdrawals exceed 7% in
a Contract Year all withdrawals of premium will be treated as proportional in
relation to the amount of Accumulation Value for any Partial Withdrawal
(including any Surrender Charge incurred).
GA-IA-1008-04/95 3D2
<PAGE>
The Schedule
Contract Facts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
[Option 2:
(1) Start with the Guaranteed Death Benefit from the prior Valuation Date;
(2) Add to (1) any additional premium paid since the prior Valuation Date
and subtract from (1) any Partial Withdrawals taken since the prior
Valuation Date;
(3) On a Valuation Date which occurs through the Certificate Year in which
the Certificateowner's Attained Age is 80 and which is also a
Certificate Anniversary, if the Owner is living (the Annuitant if
the Owner is not an individual), we set the Guaranteed Death Benefit
equal to the greater of (2) or the Accumulation Value as of such date.
On all other Valuation Dates, the Guaranteed Death Benefit is equal
to (2).]
Option 3:
(1) Start with the Guaranteed Death Benefit from the prior Valuation Date;
(2) Add any additional premiums paid during the current Valuation Period
to (1);
(3) Subtract any Partial Withdrawals made during the current Valuation
Period from (2).]
GA-IA-1008-04/95 3D3
<PAGE>
The Schedule
Contract Facts (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Change of Owner
[When the ownership changes, the new Owner's age at the time of the change
will be used as the basis for the death benefit. The new Owner's death will
determine when a death benefit is payable.
IF DEATHBEN="1": If the new Contractowner's age is less than or equal to
75, the Guaranteed Death Benefit Option in effect prior to the change of
Contractowner will remain in effect. If the new Contractowner's age is
greater than 75, the Guaranteed Death Benefit will be zero and the Death
Benefit shall be the greatest of the Cash Surrender Value, the Accumulation
Value, and the sum of the premiums paid, less any Partial Withdrawals.
IF DEATHBEN="2": If the new Contractowner's age is less than or equal to
79, the Guaranteed Death Benefit Option in effect prior to the change of
Contractowner will remain in effect. If the new Contractowner's age is
greater than 79, the Guaranteed Death Benefit will be zero and the Death
Benefit shall be the greater of Cash Surrender Value, the Accumulation
Value, and the sum of premiums paid, less any Partial Withdrawals.
IF DEATHBEN="3": The Guaranteed Death Benefit Option after the change of
Contractowner will remain the same as before the change.]
Choosing an Income Plan
Required Date of Annuity Commencement
[The Annuity Commencement Date is required to be the same date as the
Contract Processing Date in the month following the Annuitant's [9Oth]
birthday. If, on the Annuity Commencement Date, a Surrender Charge remains,
your elected Annuity Option must include a period certain of at least five
years duration. In applying the Accumulation Value, we may first collect
any Premium Taxes due us.]
Minimum Annuity Income Payment
The minimum monthly annuity income payment that we will make is [$20].
Optional Benefit Riders - [None.]
Attained Age
The Issue Age of the Annuitant or Owner plus the number of full years
elapsed since the Contract Date.
GA-IA-1008-04/95 3D4
<PAGE>
The Schedule
Charges and Fees
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
Deductions from Premiums
[None.]
Deductions from Accumulation Value
Initial admistrative Charge
[None.]
Administrative Charge
[We charge [$40] to cover a portion of our ongoing administrative expenses
for each Contract Processing Period. The charge is incurred at the
beginning of the Contract Processing Period and deducted on the Contract
Processing Date at the end of the period. At the time of deduction, this
charge will be waived if:
(1) The Accumulation Value is at least $100,000; or
(2) The sum of premiums paid to date is at least $100,000.]
Excess Allocation Charge
Currently none, however, we reserve the right to charge [$25] for a change
if you make more than [twelve] allocation changes per Contract Year. Any
charge will be deducted in proportion to the amount being transferred from
each Division.
Surrender Charge - A Surrender Charge is imposed as a percentage of premium
if the Contract is surrendered or an Excess Partial Withdrawal is taken.
The percentage imposed at time of surrender or Excess Partial Withdrawal
depends on the number of complete years that have elapsed since a premium
payment was made. The Surrender Charge expressed as a percentage of each
premium payment is as follows:
Complete Years Elapsed Surrender
Since Premium Payment Charges
--------------------- -------
[0 7%
1 7%
2 6%
3 5%
4 4%
5 3%
6 1%
7+ 0%]
For the purpose of calculating the Surrender Charge for an Excess Partial
Withdrawal; a) we treat premiums as being withdrawn on a first-in, first-out
basis, and b) amounts withdrawn which are not considered an Excess Partial
Withdrawal are not considered a withdrawal of any premium payments.
GA-IA-1008-04/95 3E1
<PAGE>
The Schedule
Charges and Fees (continued)
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
[Premium Taxes - We deduct the amount of any premium or other state and
local taxes levied by any state or governmental entity when such taxes are
incurred.
We reserve the right to defer collection of Premium Taxes until surrender
or until application of Accumulation Value to an Annuity Option. An Excess
Partial Withdrawal will result in the deduction of any Premium Tax then due
us on such amount. We reserve the right to change the amount we charge for
Premium Tax charges on future premium payments to conform with changes in
the law or if the Owner changes state of residence.]
Deductions from the Divisions
Mortality and Expense Risk Charge - [We deduct [0.003863%] of the assets in
the Separate Account Division on a daily basis (equivalent to an annual
rate of [1.40%]) for mortality and expense risks. This charge is not
deducted from the Fixed Account values.]
Asset Based Administrative Charge - [We deduct 0.000411% of the assets in
each Separate Account Division on a daily basis (equivalent to an annual
rate of 0.15%) to compensate us for a portion of our ongoing administrative
expenses.]
Charge Deduction Division
[All charges against the Accumulation Value in this Contract will be
deducted from the [Liquid Asset Division].]
GA-IA-1008-04/95 3E2
<PAGE>
The Schedule
Income Plan Factors
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
Annuitant Owner
[Thomas J. Doe] [John Q. Public]
- --------------------------------------------------------------------------------
Initial Premium Annuity Option Annuity Commencement Date
[$10,000] [Life 10 Year Certain] [January 1, 2053]
- --------------------------------------------------------------------------------
Separate Account(s) Contract Number
[Separate Account B and Separate Account D] [123456]
- --------------------------------------------------------------------------------
[Values for other payment periods, ages, or joint life combinations are
available on request. Monthly payments are shown for each $1,000 applied.
Table for Income for a Fixed Period
Fixed Period Monthly Fixed Period Monthly Fixed Period Monthly
of Years Income of Years Income of Years Income
------------ -------- ------------ ------- ------------ -------
11 $8.88 21 $5.33
2 $42.96 12 8.26 22 5.16
3 29.06 13 7.73 23 5.00
4 22.12 14 7.28 24 4.85
5 17.95 15 6.89 25 4.72
6 15.18 16 6.54 26 4.60
7 13.20 17 6.24 27 4.49
8 11.71 18 5.98 28 4.38
9 10.56 19 5.74 29 4.28
10 9.64 20 5.53 30 4.19
Table for Income for Life
Male/Female Male/Female Male/Female
Age 10 Years Certain 20 Years Certain Refund Certain
- --- ---------------- ---------------- --------------
50 $4.53/4.19 $4.38/4.13 $4.40/4.12
55 4.93/4.52 4.68/4.40 4.74/4.42
60 5.45/4.96 4.99/4.72 5.16/4.79
65 6.11/5.52 5.30/5.07 5.75/5.29
70 6.91/6.26 5.54/5.40 6.52/5.97
75 7.79/7.18 5.68/5.62 7.33/6.74
80 8.61/8.18 5.75/5.73 8.61/7.90
85 & Over 9.24/9.01 5.77/5.76 10.43/9.50]
GA-IA-1008-04/95 3F
<PAGE>
Introduction to this Contract
- --------------------------------------------------------------------------------
The Contract
This is a legal Contract between you and us. We provide benefits as stated
in this Contract. In return, you supply us with the Initial Premium Payment
required to put this Contract in effect.
This Contract, together with any Riders or Endorsements, constitutes the
entire Contract. Riders and endorsements add provisions or change the terms
of the basic Contract.
The Owner
You are the Owner of this Contract. You are also the Annuitant unless
another Annuitant has been named in the application and is shown in the
Schedule. You have the rights and options described in this Contract,
including but not limited to the right to receive the Annuity Benefits on
the Annuity Commencement Date.
One or more people may own this Contract. If there are multiple Owners
named, the age of the oldest Owner shall be used to determine the
applicable death benefit. In the case of a sole Owner who dies prior to the
Annuity Commencement Date, we will pay the Beneficiary the death benefit
then due. If the sole Owner is not an individual, we will treat the
Annuitant as Owner for the purpose of determining when the Owner dies under
the death benefit provision (if there is no Contingent Annuitant), and the
Annuitant's age will determine the applicable death benefit payable to the
Beneficiary. The sole Owner's estate will be the Beneficiary if no
Beneficiary designation is in effect, or if the designated Beneficiary has
predeceased the Owner. In the case of a joint Owner of the Contract dying
prior to the Annuity Commencement Date, the surviving Owner(s) shall be
deemed as the Beneficiary(ies).
The Annuitant
The Annuitant is the measuring life of the Annuity Benefits provided under
this Contract. You may name a Contingent Annuitant. The Annuitant may not
be changed during the Annuitant's lifetime.
If the Annuitant dies before the Annuity Commencement Date, the Contingent
Annuitant becomes the Annuitant. You will be the Contingent Annuitant
unless you name someone else. The Annuitant must be a natural person. If
the Annuitant dies and no Contingent Annuitant has been named, we will
allow you sixty days to designate someone other than yourself as Annuitant.
If all Owners are not individuals and, through the operation of this
provision, an Owner becomes Annuitant, we will pay the death proceeds to
the Beneficiary. If there are joint Owners, we will treat the youngest of
the Owners as the Contingent Annuitant designated, unless you elect
otherwise.
The Beneficiary
The Beneficiary is the person to whom we pay death proceeds if any Owner
dies prior to the Annuity Commencement Date. See Death Benefit Proceeds for
more information. We pay death proceeds to the primary Beneficiary (unless
there are joint Owners in which case death benefit proceeds are payable to
the surviving Owner). If the primary Beneficiary dies before the Owner, the
death proceeds are paid to the contingent Beneficiary, if any. If there is
no surviving Beneficiary, we pay the death proceeds to the Owner's estate.
One or more persons may be named as primary Beneficiary or contingent
Beneficiary. In the case of more than one Beneficiary, we will assume any
death proceeds are to be paid in equal shares to the surviving
Beneficiaries. You can specify other than equal shares.
You have the right to change Beneficiaries, unless you designate the
primary Beneficiary irrevocable. When an irrevocable Beneficiary has been
designated, you and the irrevocable Beneficiary may have to act together to
exercise the rights and options under this Contract.
GA-IA-1008-04/95 4
<PAGE>
Introduction to this Contract (continued)
- --------------------------------------------------------------------------------
Change of Owner or Beneficiary
During your lifetime and while this Contract is in effect you can transfer
ownership of this Contract or change the Beneficiary. To make any of these
changes, you must send us written notice of the change in a form
satisfactory to us. The change will take effect as of the day the notice is
signed. The change will not affect any payment made or action taken by us
before recording the change at our Customer Service Center. A Change of
Owner may affect the amount of death benefit payable under this Contract.
See Proceeds Payable to Beneficiary.
GA-IA-1008-04/95 5
<PAGE>
Premium Payments and Allocation Changes
- --------------------------------------------------------------------------------
Initial Premium Payment
The Initial Premium Payment is required to put this Contract in effect. The
amount of the Initial Premium Payment is shown in the Schedule.
Additional Premium Payment Option
You may make additional premium payments under this Contract after the end
of the free look period. Restrictions on additional premium payments, such
as the Attained Age of the Annuitant or Owner and the timing and amount of
each payment, are shown in the Schedule. We reserve the right to defer
acceptance of or to return any additional premium payments.
As of the date we receive and accept your additional premium payment:
(1) The Accumulation Value will increase by the amount of the premium
payment less any premium deductions as shown in the Schedule.
(2) The increase in the Accumulation Value will be allocated among
the Separate and General Account Divisions in accordance with
your instructions. If you do not provide such instructions,
allocation will be among the Separate and General Account
Divisions in proportion to the amount of Accumulation Value in
each Division as of the date we receive and accept your
additional premium payment. Some General Account Divisions may
have restrictions on allocations. See the Schedule.
Where to Make Payments
Remit the premium payments to our Customer Service Center at the address
shown on the cover page. On request we will give you a receipt signed by
our treasurer.
Your Right to Change Allocation of Accumulation Value
You may change the allocation of the Accumulation Value among the Divisions
after the end of the free look period. The number of free allocation
changes each year that we will allow is shown in the Schedule. To make an
allocation change, you must provide us with satisfactory notice at our
Customer Service Center. The change will take effect when we receive the
notice. Some General Account Divisions may have restrictions on
reallocations. See the Schedule.
What Happens if a Separate Account Division is Not Available
When a distribution is made from an investment portfolio supporting a unit
investment trust Separate Account Division or from a Division of a managed
Separate Account in which reinvestment is not available, we will allocate
the distribution to the Specially Designated Division shown in the Schedule
unless you specify otherwise.
Such a distribution may occur when an investment portfolio or Division
matures, when distribution from a portfolio or Division cannot be
reinvested in the portfolio or Division due to the unavailability of
securities, or for other reasons. When this occurs because of maturity, we
will send written notice to you thirty days in advance of such date. To
elect an allocation to other than the Specially Designated Division shown
in the Schedule, you must provide satisfactory notice to us at least seven
days prior to the date the investment matures. Such allocations will not be
counted as an allocation change of the Accumulation Value for purposes of
the number of free allocations permitted.
GA-IA-1008-04/95 6
<PAGE>
How We Measure the Contract's Accumulation Value
- --------------------------------------------------------------------------------
The variable Annuity Benefits under this Contract are provided through
investments which may be made in our Separate Accounts.
The Separate Accounts
These accounts, which are designated in the Schedule, are kept separate
from our General Account and any other Separate Accounts we may have. They
are used to support Variable Annuity Contracts and may be used for other
purposes permitted by applicable laws and regulations. We own the assets in
the Separate Accounts. Assets equal to the reserves and other liabilities
of the accounts will not be charged with liabilities that arise from any
other business we conduct; but, we may transfer to our General Account
assets which exceed the reserves and other liabilities of the Separate
Accounts. Income and realized and unrealized gains or losses from assets in
these Separate Accounts are credited to or charged against the account
without regard to other income, gains or losses in our other investment
accounts.
One type of Separate Account will invest in mutual funds, unit investment
trusts and other investment portfolios which we determine to be suitable
for this Contract's purposes. This Separate Account is treated as a unit
investment trust under Federal securities laws. It is registered with the
Securities and Exchange Commission ("SEC") under the Investment Company Act
of 1940. This Separate Account is also governed by state law as designated
in the Schedule. The trust may offer non-registered series.
Another type of Separate Account will invest directly in portfolio
securities deemed appropriate by the investment adviser or the committee
managing a Separate Account. This Separate Account is treated as an open
end, diversified management investment company under Federal securities
laws. It is registered with the SEC under the Investment Company Act of
1940. This Separate Account is also governed by state laws as designated in
the Schedule. We may offer certain non-registered Series or Separate
Accounts. Any such Series or Separate Account is shown in the Schedule.
Separate Account Divisions
A unit investment trust Separate Account includes Divisions, each investing
in a designated investment portfolio. The Divisions and the investment
portfolios in which they invest, if applicable, are specified in the
Schedule. Some of the portfolios designated may be managed by a separate
investment adviser. Such adviser may be registered under the Investment
Advisers Act of 1940.
A managed Separate Account includes Divisions, each investing directly in
portfolios of securities designed to meet the objectives of the Division.
The Divisions, if applicable, and their objectives are specified in the
Schedule. Some of the Divisions designated may be managed by a separate
investment adviser. Such adviser may be registered under the Investment
Advisers Act of 1940.
Changes Within the Separate Accounts
We may, from time to time, make additional Separate Account Divisions
available to you. These Divisions will invest in investment portfolios we
find suitable for this Contract. We also have the right to eliminate
Divisions from a Separate Account, to combine two or more Divisions or to
substitute a new portfolio for the portfolio in which a Division invests. A
substitution may become necessary if, in our judgment, a portfolio or
Division no longer suits the purposes of this Contract. This may happen due
to a change in laws or regulations, or a change in a portfolio's investment
objectives or restrictions, or because the portfolio or Division is no
longer available for investment, or for some other reason. We will get
prior approval from the insurance department of our state of domicile
before making such a substitution. This approval process is on file with
the insurance department of the jurisdiction in which this Contract is
delivered. We will also get any required approval from the SEC and any
other required approvals before making such a substitution.
Subject to any required regulatory approvals, we reserve the right to
transfer assets of the Separate Account, which we determine to be
associated with the class of Contracts to which this Contract belongs, to
another Separate Account or Division.
GA-IA-1008-04/95 7
<PAGE>
How We Measure the Contract's Accumulation Value (continued)
- --------------------------------------------------------------------------------
When permitted by law, we reserve the right to:
(1) deregister a Separate Account under the Investment Company Act of
1940;
(2) operate a Separate Account as a management company under the
Investment Company Act of 1940, if it is operating as a unit
investment trust;
(3) operate a Separate Account as a unit investment trust under the
Investment Company Act of 1940, if it is operating as a managed
Separate Account;
(4) restrict or eliminate any voting rights of Owners, or other
persons who have voting rights as to a Separate Account; and,
(5) combine a Separate Account with other Separate Accounts.
The General Account
The General Account contains all assets of the company other than those in
the Separate Accounts we establish. The General Account Divisions available
for investment are shown in the Schedule. We may, from time to time, offer
other Divisions where assets are held in our General Account.
Valuation Period
Each Division will be valued at the end of each Valuation Period on a
Valuation Date. A Valuation Period is each Business Day together with any
non-Business Days before it. A Business Day is any day the New York Stock
Exchange (NYSE) is open for trading, and the SEC requires mutual funds,
unit investment trusts, or other investment portfolios to value their
securities.
Accumulation Value
The Accumulation Value of this Contract is the sum of the amounts in each
of the Separate and General Account Divisions. You select the Separate and
General Account Divisions to which to allocate the Accumulation Value. The
maximum number of Divisions to which the Accumulation Value may be
allocated at any one time is shown in the Schedule.
Accumulation Value in each Division
On the Contract Date
On the Contract Date, the Accumulation Value is allocated to each Division
as shown in the Schedule.
On each Valuation Date
At the end of each subsequent Valuation Period, the amount of Accumulation
Value in each Division will be calculated as follows:
(1) We take the Accumulation Value in the Division at the end of the
preceding Valuation Period.
(2) We multiply (1) by the Division's Net Rate of Return for the
current Valuation Period.
(3) We add (1) and (2).
(4) We add to (3) any additional premium payments (less any premium
deductions as shown in the Schedule) allocated to the Division
during the current Valuation Period.
(5) We add or subtract allocations to or from that Division during
the current Valuation Period.
(6) We subtract from (5) any Partial Withdrawals which are allocated
to the Division during the current Valuation Period.
GA-IA-1008-04/95 8
<PAGE>
How We Measure the Contract's Accumulation Value (continued)
- --------------------------------------------------------------------------------
(7) We subtract from (6) the amounts allocated to that Division for:
(a) any charges due for Optional Benefit Riders as shown in the
Schedule;
(b) any Contract fees as shown in the Schedule;
All amounts in (7) are allocated to each Division in the proportion that
(6) bears to the Accumulation Value unless the Charge Deduction Division
has been specified (See the Schedule).
Measurement of Investment Experience
Index of Investment Experience
The Investment Experience of a Separate Account Division is determined on
each Valuation Date. We use an Index to measure changes in each Division's
experience during a Valuation Period. We set the lndex at $10 when the
first investments in a Division are made. The Index for a current Valuation
Period equals the Index for the preceding Valuation Period multiplied by
the Experience Factor for the current Valuation Period.
How We Determine the Experience Factor
For Divisions of a unit investment trust Separate Account the Experience
Factor reflects the Investment Experience of the portfolio in which the
Division invests as well as the charges assessed against the Division for a
Valuation Period. The factor is calculated as follows:
(1) We take the net asset value of the portfolio in which the
Division invests at the end of the current Valuation Period.
(2) We add to (1) the amount of any dividend or capital gains
distribution declared for the investment portfolio and reinvested
in such portfolio during the current Valuation Period. We
subtract from that amount a charge for our taxes, if any.
(3) We divide (2) by the net asset value of the portfolio at the end
of the preceding Valuation Period.
(4) We subtract the daily Mortality and Expense Risk Charge for each
Division shown in the Schedule for each day in the Valuation
Period.
(5) We subtract the daily Asset Based Administrative Charge shown in
the Schedule for each day in the Valuation Period.
For Divisions of a managed Separate Account which invest directly in
portfolio securities the Experience Factor reflects the Investment
Experience of the Division as well as the charges assessed against the
Division. The factor is calculated as follows:
(1) Take the value of the assets in the Division at the end of the
preceding Valuation Period.
(2) Add to (1) any investment income and capital gains, realized or
unrealized, credited to the assets during the current Valuation
Period.
(3) Subtract from (2) any capital losses, realized or unrealized,
charged against the assets during the current Valuation Period.
(4) Subtract from (3) any amount charged against the Division for any
taxes.
(5) Divide (4) by the value of the assets in the Division at the end
of the preceding Valuation Period.
(6) Subtract from (5) a daily charge for operating expenses actually
incurred.
(7) Subtract from (6) the daily charge for investment advice for each
day in the Valuation Period as shown in the Schedule.
(8) Subtract from (7) the daily charge for mortality and expense
risks for each day in the Valuation Period as shown in the
Schedule.
(9) Subtract from (8) the daily Asset Based Administrative Charge for
each day in the Valuation Period as shown in the Schedule.
Calculations for Divisions investing in mutual fund portfolios are made on
a per share basis. Calculations for Divisions investing in unit investment
trusts are on a per unit basis.
GA-IA-1008-04/95 9
<PAGE>
How We Measure the Contract's Accumulation Value (continued)
- --------------------------------------------------------------------------------
Net Rate of Return for a Separate Account Division
The Net Rate of Return for a Separate Account Division during a Valuation
Period is the Experience Factor for that Valuation Period minus one.
Net Rate of Return for a General Account Division
The Net Rate of Return for a General Account Division during a Valuation
Period is the rate for the number of days in the Valuation Period
equivalent to the effective annual rate declared for that Division.
Charges Deducted from Accumulation Value on each Contract Processing Date
Expense charges and fees are shown in the Schedule.
Charge Deduction Division Option
We will deduct all charges against the Accumulation Value of this Contract
from the Charge Deduction Division if you elected this Option on the
application (see the Schedule) We will deduct these charges proportionately
from all of the Divisions in which you are invested if you did not elect
this Option or if the charges are greater than the amount in the Charge
Deduction Division.
At any time while this Contract is in effect, you may change your election
of this Option. To do this you must send us a written request to our
Customer Service Center. Any change will take effect within seven days of
the date we receive your request.
GA-IA-1008-04/95 10
<PAGE>
Your Contract Benefits
- --------------------------------------------------------------------------------
While this Contract is in effect, there are important rights and benefits
that are available to you. We discuss these rights and benefits in this
section.
Cash Value Benefit
Cash Surrender Value
The Cash Surrender Value, while the Annuitant is living and before the
Annuity Commencement Date, is determined as follows:
(1) We take the Contract's Accumulation Value;
(2) We deduct any Surrender Charges;
(3) We deduct any charges shown in the Schedule that have been
incurred but not yet deducted, including:
(a) any first year administrative fee that has not yet been
deducted;
(b) any quarterly administrative fee to be deducted on the next
Contract Processing Date;
(c) the pro rata part of any charges for Optional Benefit
Riders; and
(d) any applicable premium or similar tax.
Cancelling to Receive the Cash Surrender Value
At any time while the Annuitant is living and before the Annuity
Commencement Date, you may surrender this Contract to us. To date this, you
must return this Contract with a signed request for cancellation to our
Customer Service Center.
The Cash Surrender Value will vary daily. We will determine the Cash
Surrender Value as of the date we receive the Contract and your signed
request in our Customer Service Center. All benefits under this Contract
will then end.
We will usually pay the Cash Surrender Value within seven days; but, we may
delay payment as described in the Payments We May Defer provision.
Partial Withdrawal Option
After the first Contract Anniversary, you may make a Partial Withdrawal
once in each Contract Year without incurring a Partial Withdrawal Charge.
Any additional Partial Withdrawals in a Contract Year are subject to a
Partial Withdrawal Charge. The minimum amount that may be withdrawn is
shown in the Schedule. The maximum amount that may be withdrawn is
determined by multiplying the Cash Surrender Value by the maximum
withdrawal percentage factor shown in the Schedule. Any withdrawal you make
will not be treated as premium only for the purposes of calculating the
deferred charges against the Accumulation Value. To take a Partial
Withdrawal, you must provide us with satisfactory notice at our Customer
Service Center.
Proceeds Payable to the Beneficiary
Prior to the Annuity Commencement Date
If the sole Owner dies prior to the Annuity Commencement Date, we will pay
the Beneficiary the death benefit. If there are joint Owners and any Owner
dies, we will pay the surviving Owners the death benefit. We will pay the
amount on receipt of due proof of the Owner's death at our Customer Service
Center. Such amount may be received in a single ]ump sum or applied to any
of the Annuity Options (see Choosing an Income Plan). When the Owner (or
all Owners where there are joint Owners) is not an individual, the death
benefit will become payable on the death of the Annuitant prior to the
Annuity Commencement Date (unless a Contingent Annuitant survived the
Annuitant). Only one death benefit is payable under this Contract. In all
events, distributions under the Contract must be made as required by
applicable law.
GA-IA-1008-04/95 11
<PAGE>
Your Contract Benefits (continued)
- --------------------------------------------------------------------------------
How to Claim Payments to Beneficiary
We must receive proof of the Owner's (or Annuitant's) death before we will
make any payments to the Beneficiary. We will calculate the death benefit
as of the date we receive due proof of death. The Beneficiary should
contact our Customer Service Center for instructions.
Guaranteed Death Benefit
On the Contract Date the Guaranteed Death Benefit is equal to the premium
paid. On subsequent Valuation Dates, the Guaranteed Death Benefit is
calculated as shown in the Schedule. A Change of Owner will affect the
Guaranteed Death Benefit, as shown in the Schedule.
GA-IA-1008-04/95 12
<PAGE>
Choosing an Income Plan
- --------------------------------------------------------------------------------
Annuity Benefits
If the Annuitant and Owner are living on the Annuity Commencement Date, we
will begin making payments to the Owner. We will make these payments under
the Annuity Option (or Options) as chosen in the application or as
subsequently selected. You may choose or change an Annuity Option by making
a written request at least 30 days prior to the Annuity Commencement Date.
Unless you have chosen otherwise, Option 2 on a 10 year period certain
basis will become effective. The amount of the payments will be determined
by applying the Accumulation Value on the Annuity Commencement Date in
accordance with the Annuity Options section below (See Payments We May
Defer). Before we pay any Annuity Benefits, we require the return of this
Contract. If this Contract has been lost, we require the applicable lost
Contract form.
Annuity Commencement Date Selection
You select the Annuity Commencement Date. You may select any date following
the third Contract Anniversary but before the required date of Annuity
Commencement as shown in the Schedule. If you do not select a date, the
Annuity Commencement Date will be in the month following the required date
of Annuity Commencement.
Frequency Selection
You choose the frequency of the Annuity Payments. They may be monthly,
quarterly, semi-annually, or annually. If we do not receive written notice
from you, the payments will be made monthly.
The Income Plan
While this Contract is in effect and before the Annuity Commencement Date,
you may choose one or more Annuity Options for the payment of death benefit
proceeds. If, at the time of the Owner's death, no Option has been chosen
for paying death benefit proceeds, the Beneficiary may choose an Option
within one year. You may also elect an Annuity Option on surrender of the
Contract for its Cash Surrender Value. For each Option we will issue a
separate written agreement putting the Option into effect.
Our approval is needed for any Option where:
(1) the person named to receive payment is other than the Owner or
Beneficiary; or
(2) the person named is not a natural person, such as a corporation;
or
(3) any income payment would be less than the minimum annuity income
payment shown in the Schedule.
The Annuity Options
There are four Options to choose from. They are:
Option 1. Income for a Fixed Period
Payment is made in equal installments for a fixed number of years. We
guarantee each monthly payment will be at least the Income For Fixed Period
amount shown in the Schedule. Values for annual, semiannual or quarterly
payments are available on request.
Option 2. Income for Life
Payment is made to the person named in equal monthly installments and
guaranteed for at least a period certain. The period certain can be 10 or
20 years. Other periods certain are available on request. A refund certain
may be chosen instead. Under this arrangement, income is guaranteed until
payments equal the amount applied. If the person named lives beyond the
guaranteed period, payments continue until his or her death.
We guarantee each payment will be at least the amount shown in the
Schedule. By age, we mean the named person's age on his or her last
birthday before the Option's effective date. Amounts for ages not shown are
available on request.
GA-IA-1008-04/95 13
<PAGE>
Choosing an Income Plan (continued)
- --------------------------------------------------------------------------------
Option 3. Joint Life Income
This Option is available if there are two persons named to receive
payments. At least one of the persons named must be either the Owner or
Beneficiary of this Contract. Monthly payments are guaranteed and are made
as long as at least one of the named persons is living. The monthly payment
amounts are available upon request. Such amounts are guaranteed and will be
calculated on the same basis as the Table for Income for Life, however, the
amounts will be based on two lives.
Option 4. Annuity Plan
An amount can be used to buy any single premium annuity we offer on the
Option's effective date.
Payment When Named Person Dies
When the person named to receive payment dies, we will pay any amounts
still due as provided by the Option agreement. The amounts still due are
determined as follows:
(1) For Option 1 or for any remaining guaranteed payments in Option
2, payments will be continued. Under Options 1 and 2, the
discounted values of the remaining guaranteed payments may be
paid in a single sum. This means we deduct the amount of the
interest each remaining guaranteed payment would have earned had
it not been paid out early. The discount interest rate is 3.00%
for Option 1 and 3.50% for Option 2. We will however, base the
discount interest rate on the interest rate used to calculate the
payments for Options 1 and 2 if such payments were not based on
the Tables in this Contract.
(2) For Option 3, no amounts are payable after both named persons
have died.
(3) For Option 4, the annuity agreement will state the amount due, if
any.
GA-IA-1008-04/95 14
<PAGE>
Other Important Information
- --------------------------------------------------------------------------------
Sending Notice to Us
Whenever written notice is required, send it to our Customer Service
Center. The address of our Customer Service Center is shown on the cover
page. Please include your Contract number in all correspondence.
Reports to Owner
We will send you a report within 31 days of each calendar quarter. The
report will show the Accumulation Value and the Cash Surrender Value as of
the end of the Contract Processing Period. The report will also show the
allocation of the Accumulation Value as of such date and the amounts
deducted from or added to the Accumulation Value since the last report. The
report will also include any other information that may be currently
required by the insurance supervisory official of the jurisdiction in which
this Contract is delivered.
We will also send you copies of any shareholder reports of the portfolios
in which the Divisions of the Separate Accounts invest, as well as any
other reports, notices or documents required by law to be furnished to
Contractowners.
Assignment - Using this Contract as Collateral Security
You can assign this Contract as collateral security for a loan or other
obligation. This does not change the ownership. Your rights and any
Beneficiary's rights are subject to the terms of the assignment. To make or
release an assignment, we must receive written notice satisfactory to us,
at our Customer Service Center. We are not responsible for the validity of
any assignment.
Changing this Contract
This Contract or any additional Benefit Riders may be changed to another
Annuity Plan according to our rules at the time of the change.
Contract Changes - Applicable Tax Law
We reserve the right to make changes in this Contract or its Riders to the
extent we deem it necessary to continue to qualify this Contract as an
annuity. Any such changes will apply uniformly to all Contracts that are
affected. You will be given advance written notice of such changes.
Misstatement of Age or Sex
If an age or sex has been misstated, the amounts payable or benefits
provided by this Contract shall be those that the premium payment made
would have bought at the correct age or sex.
Non-Participating
This Contract does not participate in the divisible surplus of Golden
American Life Insurance Company.
GA-IA-1008-04/95 15
<PAGE>
Other Important Information (continued)
- --------------------------------------------------------------------------------
Payments We May Defer
We may not be able to determine the value of the assets of the Separate
Account Divisions because:
(1) The NYSE is closed for trading;
(2) the SEC determines that a state of emergency exists; or
(3) an order or pronouncement of the SEC permits a delay for the
protection of Contractowners.
(4) the check used to pay the premium has not cleared through the
banking system. This may take up to 15 days.
During such times, as to amounts allocated to the Divisions of the Separate
Account, we may delay:
(1) determination and payment of the Cash Surrender Value;
(2) determination and payment of any death benefit if death occurs
before the Annuity Commencement Date;
(3) allocation changes of the Accumulation Value; or,
(4) application of the Accumulation Value under an income plan.
As to amounts allocated to a General Account Division, we may, at any time,
defer payment of the Cash Surrender Value for up to six months after we
receive a request for it. We will allow interest of at least 3.00% a year
on any Cash Surrender Value payment derived from the General Account
Divisions that we defer 30 days or more.
Authority to Make Agreements
All agreements made by us must be signed by one of our officers. No other
person, including an insurance agent or broker, can:
(1) change any of this Contract's terms;
(2) extend the time for premium payments; or
(3) make any agreement binding on us.
Required Note on Our Computations
We have filed a detailed statement of our computations with the insurance
supervisory official in the jurisdiction where this Contract is delivered.
The values are not less than those required by the law of that state or
jurisdiction. Any benefit provided by an attached Optional Benefit Rider
will not increase these values unless otherwise stated in that Rider.
GA-IA-1008-04/95 16
<PAGE>
GOLDEN
[LOGO] AMERICAN Section 72 Rider
LIFE INSURANCE
COMPANY
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock company domiciled in Wilmington, Delaware
- --------------------------------------------------------------------------------
Required Distribution of Proceeds on Death of Owner
This Rider is required to qualify the Contract to which it is attached as
an annuity contract under Section 72 of the Internal Revenue Code of 1986,
as amended (the "Code"). Where the terms of this Rider are in conflict with
the terms of the Contract, the Rider will control. Golden American Life
Insurance Company reserves the right to amend or administer the Contract
and Rider as necessary to comply with applicable tax requirements. This
Rider and the Contract should be construed so that they comply with
applicable tax requirements.
Death of Owner On Or After Annuity Commencement Date
IF ANY OWNER DIES ON OR AFTER the Annuity Commencement Date but prior to
the time the entire interest in the Contract has been distributed, the
remaining portion will be distributed at least as rapidly as under the
method of distribution being used as of the date of the Owner's death.
Death of Owner Prior to Annuity Commencement Date
IF ANY OWNER DIES PRIOR TO the Annuity Commencement Date, the entire
interest in the Contract will be distributed within five years of the
Owner's death.
However, this distribution requirement will be considered satisfied as
to any portion of the Owner's interest in the Contract which is payable to
or for the benefit of a Designated Beneficiary and which will be
distributed over the life of such Designated Beneficiary or over a period
not extending beyond the life expectancy of that Designated Beneficiary,
provided such distributions begin within one year of the Owner's death. If
the Designated Beneficiary is the surviving spouse of the decedent, the
Contract may be continued in the name of the spouse as Owner and these
distribution rules are applied by treating the spouse as the Owner.
However, on the death of the surviving spouse, this provision regarding
spouses may not be used again.
If any Owner is not an individual, the death or change (where
permitted) of the Annuitant will be treated as the death of an Owner.
The Designated Beneficiary is the person entitled to ownership rights
under the Contract. Thus, where no death benefit has become payable, the
Designated Beneficiary, for the purposes of applying this Rider, will be
the Owner(s). Where a death benefit has become payable, the Designated
Beneficiary, for the purposes of applying this Rider, is the person(s)
entitled to the death benefit, generally the Beneficiary or surviving
Owners, as appropriate. Upon the death of any Owner, the Designated
Beneficiary will become the Owner and, if an individual, will become the
Annuitant.
* * *
An Owner may notify Golden American as to the manner of payment under this
Rider. If such Owner has not so notified Golden American prior to his or
her death, the Designated Beneficiary under the Contract may so notify
Golden American.
GOLDEN AMERICAN LIFE INSURANCE COMPANY
President /s/Tery T. Kendall Secretary
GA-RA-1001-12/94
<PAGE>
GOLDEN
[LOGO] AMERICAN Waiver of Surrender Charge Rider
LIFE INSURANCE
COMPANY
A Subsidiary of [LOGO] Bankers Trust Company
Golden American is a stock company domiciled in Wilmington, Delaware
- --------------------------------------------------------------------------------
Golden American Life Insurance Company ("we" or "us") will waive any
Surrender Charge incurred due to a surrender or Excess Partial Withdrawal
under the Contract in the event the Owner ("you") is subject to Qualified
Extended Medical Care or suffers from a Qualifying Terminal Illness subject
to the terms and conditions stated below:
Extended Medical Care
To qualify for this waiver, you must first begin receiving Qualified
Extended Medical Care on or after the first Contract Anniversary for at
least 45 days during any continuous sixty-day period, and your request for
the surrender or withdrawal, together with proof of such Qualified Extended
Medical Care, must be received at our Customer Service Center during the
term of such care or within ninety days after the last day upon which your
received such care.
"Qualified Extended Medical Care" means confinement in a Qualified
Licensed Hospital or Nursing Care Facility prescribed by a Qualifying
Medical Professional.
"Qualifying Licensed Hospital or Nursing Care Facility" means a
state-licensed hospital or state-licensed skilled or intermediate care
nursing facility at which medical treatment is available on a daily basis;
and daily medical records are kept on each patient. This does not include a
facility whose purpose is to provide accommodations, board or personal care
services to individuals who do not need medical or nursing care; nor a
place mainly for rest.
"Qualifying Medical Professional" means a legally-qualified
practitioner of the healing arts who is acting within the scope of hls or
her license; is not a resident of your household or that of the Annuitant;
and is not related to you or the Annuitant by blood or marriage.
Terminal Illness
To qualify for this waiver, you must be first diagnosed by a
Qualifying Medical Professional, on or after the first Contract
Anniversary, as having a Qualifying Terminal Illness. Written proof of
terminal illness, satisfactory to us, must be received at our Customer
Service Center. We reserve the right to require an examination by a
physician of our choice.
"Qualifying Terminal Illness" means an illness or accident, the result
of which results in a life expectancy of twelve months or less, as measured
from the date of diagnosis.
Claims
Evidence, satisfactory to us, must be submitted to qualify for waiver
of Surrender Charge pursuant to this Rider. This evidence will be in
writing and, where applicable, be attested to by a Qualified Medical
Professional.
This Rider is attached to and becomes part of the Contract to which it
is attached. The provisions of this Rider shall supersede the provisions of
the Contract where applicable.
GOLDEN AMERICAN LIFE INSURANCE COMPANY
President /s/Tery T. Kendall Secretary
GA-RA-1004-12/94
<PAGE>
Deferred Variable Annuity Contract - No Dividends
Variable Cash Surrender Values while the Annuitant and Owner are living and
prior to the Annuity Commencement Date. Death benefit subject to guaranteed
minimum. Additional Premium Payment Option. Partial Withdrawal Option.
Non-participating. Investment results reflected in values.
GA-IA-1008-04/95
<PAGE>
4(k) INDIVIDUAL DEFERRED COMBINATION VARIABLE AND FIXED ANNUITY APPLICATION
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A SUBSIDIARY OF BANKERS TRUST COMPANY
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
DEFERRED VARIABLE ANNUITY APPLICATION
1. OWNER(S)
Name Male Female Soc. Sec. # or Tax ID.#
/ / / /
Permanent Address Phone ( )
City State Zip Date of Birth
2. ANNUITANT (IF OTHER THAN OWNER)
Name Male Female Soc. Sec. # or Tax ID.#
/ / / /
Permanent Address Phone ( )
City State Zip Date of Birth Relation to Owner
CONTINGENT ANNUITANT (OPTIONAL)
Name Address Relation to Owner
3. PRIMARY BENEFICIARY(IES) (IF MORE THAN ONE - INDICATE %)
Name(s) Relation to Owner
CONTINGENT BENEFICIARY(IES) Name Relation to Owner
4. PLAN (Check one)
/ / DVA
/ / Other __________________
5. DEATH BENEFIT OPTIONS
1. / / 7% Solution -- Enhanced #1
2. / / Annual Ratchet -- Enhanced #2
3. / / Standard
6. INITIAL PREMIUM AND ALLOCATION INFORMATION
(A) INITIAL PREMIUM PAID $__________ MAKE CHECK PAYABLE TO GOLDEN AMERICAN
LIFE INSURANCE COMPANY
Fill in percentages for Premium allocation below (see (A) INITIAL.)
(B) DOLLAR COST AVERAGING (DCA): OPTIONAL. PLEASE CHECK BOX TO ELECT. / /
Amount to be transferred monthly $_________________ (minimum $250)
Division or Allocation Transferred From:
/ / Limited Maturity Bond Division
/ / Liquid Asset Division
/ / 1 Year Fixed Allocation
(MINIMUM OF $10,000 MUST BE ALLOCATED TO THE DIVISION OR FIXED
ALLOCATION CHECKED)
Divisions Transferred To: Fill in percentages for allocation of DCA
below (see (B) DCA).
<TABLE>
<CAPTION>
ACCOUNT DIVISION INVESTMENT ADVISER (A) INITIAL (B) DCA
<S> <C> <C> <C>
MULTIPLE ALLOCATION ZWEIG ADVISORS, INC. % %
FULLY MANAGED T. ROWE PRICE ASSOCIATES INC. % %
SMALL CAP FRED ALGER MANAGEMENT % %
ALL-GROWTH WARBURG, PINCUS COUNSELLORS, INC. % %
CAPITAL APPRECIATION CHANCELLOR TRUST CO. % %
VALUE EQUITY EAGLE ASSET MANAGEMENT, INC. % %
RISING DIVIDENDS KAYNE, ANDERSON INV. MGMT., L.P. % %
STRATEGIC EQUITY ZWEIG ADVISORS, INC. % %
REAL ESTATE EII REALTY SECURITIES, INC. % %
NATURAL RESOURCES VAN ECK ASSOCIATES CORP. % %
EMERGING MARKETS BANKERS TRUST COMPANY % %
THE MANAGED GLOBAL ACCOUNT WARBURG, PINCUS COUNSELLORS, INC. % %
LIMITED MATURITY BOND BANKERS TRUST COMPANY %
LIQUID ASSET BANKERS TRUST COMPANY %
FIXED ALLOCATION ELECTION 1 YEAR %
FIXED ALLOCATION ELECTION 3 YEAR %
FIXED ALLOCATION ELECTION 5 YEAR %
FIXED ALLOCATION ELECTION 7 YEAR %
FIXED ALLOCATION ELECTION 10 YEAR %
TOTAL 100% 100%
</TABLE>
Golden American Life Insurance Company, Customer Service Center,
PO Box 8794, Wilmington, DE 19899-8794
GA-AA-1007-12/95
<PAGE>
7. OPTIONAL SYSTEMATIC PARTIAL WITHDRAWALS
If you want to receive Systematic Partial Withdrawals, your request must be
received in writing. For the appropriate form, please call our Customer
Service Center: 1-800-366-0066.
8. TELEPHONE REALLOCATION AUTHORIZATION ________________ OWNER'S INITIALS
I authorize Golden American to act upon reallocation instructions given by
telephone from __________________________ (name of your registered
representative) upon furnishing his/her social security number. Neither
Golden American nor any person authorized by Golden American will be
responsible for any claim, loss, liability or expense in connection with
reallocation instructions received by telephone from such person if Golden
American or such other person acted on such telephone instructions in good
faith in reliance upon this authorization. Golden American will continue to
act upon this authorization until such time as the person indicated above
is no longer affiliated with the broker/dealer under which my contract was
purchased or until such time that I notify Golden American otherwise in
writing.
9. TAX-QUALIFIED PLANS IF YOU ARE FUNDING A QUALIFIED PLAN, PLEASE SPECIFY
TYPE:
/ / IRA
/ / IRA Rollover
/ / SEP/IRA
/ / Other ________________________
10. REPLACEMENT
Will the contract applied for replace any existing annuity or life
insurance policies on the annuitant's life?
/ / Yes (If yes, please complete following)
/ / No
Company Name Policy Number Face Amount
11. READ THE FOLLOWING STATEMENTS CAREFULLY AND SIGN BELOW:
- BY SIGNING BELOW, I ACKNOWLEDGE RECEIPT OF THE PROSPECTUS. I AGREE THAT,
TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL STATEMENTS AND ANSWERS IN THIS
APPLICATION ARE COMPLETE AND TRUE AND MAY BE RELIED UPON IN DETERMINING
WHETHER TO ISSUE THE CONTRACT. MY ANSWERS WILL FORM A PART OF ANY CONTRACT
TO BE ISSUED, AND ONLY THE OWNER AND GOLDEN AMERICAN HAVE THE AUTHORITY TO
MODIFY THIS APPLICATION.
- CONTRACTS AND POLICIES AND UNDERLYING SERIES SHARES OR SECURITIES WHICH
FUND CONTRACTS AND POLICIES ARE NOT INSURED BY THE FDIC OR ANY OTHER
AGENCY. THEY ARE NOT DEPOSITS OR OTHER OBLIGATIONS OF ANY BANK AND ARE NOT
BANK GUARANTEED. ALSO, THEY ARE SUBJECT TO MARKET FLUCTUATION, INVESTMENT
RISK AND POSSIBLE LOSS OF PRINCIPAL INVESTED.
- I UNDERSTAND THAT THIS CONTRACT'S CASH SURRENDER VALUE, WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT DIVISION, MAY INCREASE OR
DECREASE ON ANY DAY AND THAT NO MINIMUM VALUE IS GUARANTEED. THIS
CERTIFICATE IS IN ACCORD WITH MY ANTICIPATED FINANCIAL NEEDS.
- I UNDERSTAND THAT ANY AMOUNT ALLOCATED TO THE FIXED ACCOUNT MAY BE
SUBJECT TO A MARKET VALUE ADJUSTMENT, WHICH MAY CAUSE THE VALUES TO
INCREASE OR DECREASE, PRIOR TO A SPECIFIED DATE OR DATES AS SPECIFIED IN
THE CONTRACT.
____________________________________________ _____________________________
Signature of Owner Signed at (City, State) Date
____________________________________________ _____________________________
Signature of Joint Owner (IF APPLICABLE) Signed at (City, State) Date
____________________________________________ _____________________________
Signature of Annuitant (IF OTHER THAN OWNER) Signed at (City, State) Date
Client Account No. (IF APPLICABLE)_____________________
FOR AGENT USE ONLY
DO YOU HAVE REASON TO BELIEVE THAT THE CONTRACT APPLIED FOR WILL REPLACE ANY
EXISTING ANNUITY OR LIFE INSURANCE ON THE ANNUITANT'S LIFE? / / YES / / NO
__________________________________
Agent Signature
__________________________________
Print Agent Name & No.
__________________________________
Social Security No.
__________________________________
Broker/Dealer/Branch
__________________________________
Florida License ID# (Florida Only)
Golden American Life Insurance Company, Customer Service Center,
PO Box 8794, Wilmington, DE 19899-8794
1-800-366-0066
GA-AA-1007-12/95
<PAGE>
4(l) GROUP DEFERRED COMBINATION VARIABLE AND FIXEDANNUITY ENROLLMENT FORM
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A SUBSIDIARY OF BANKERS TRUST COMPANY
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
DEFERRED VARIABLE ANNUITY ENROLLMENT FORM
1. OWNER(S)
Name Male Female Soc. Sec. # or Tax ID.#
/ / / /
Permanent Address Phone ( )
City State Zip Date of Birth
2. ANNUITANT (IF OTHER THAN OWNER)
Name Male Female Soc. Sec. # or Tax ID.#
/ / / /
Permanent Address Phone ( )
City State Zip Date of Birth Relation to Owner
CONTINGENT ANNUITANT (OPTIONAL)
Name Address Relation to Owner
3. PRIMARY BENEFICIARY(IES) (IF MORE THAN ONE - INDICATE %)
Name(s) Relation to Owner
CONTINGENT BENEFICIARY(IES) Name Relation to Owner
4. PLAN (Check one)
/ / DVA
/ / Other __________________
5. DEATH BENEFIT OPTIONS
1. / / 7% Solution -- Enhanced #1
2. / / Annual Ratchet -- Enhanced #2
3. / / Standard
6. INITIAL PREMIUM AND ALLOCATION INFORMATION
(A) INITIAL PREMIUM PAID $__________ MAKE CHECK PAYABLE TO GOLDEN AMERICAN
LIFE INSURANCE COMPANY
Fill in percentages for Premium allocation below (see (A) INITIAL.)
(B) DOLLAR COST AVERAGING (DCA): OPTIONAL. PLEASE CHECK BOX TO ELECT. / /
Amount to be transferred monthly $_________________ (minimum $250)
Division or Allocation Transferred From:
/ / Limited Maturity Bond Division
/ / Liquid Asset Division
/ / 1 Year Fixed Allocation
(MINIMUM OF $10,000 MUST BE ALLOCATED TO THE DIVISION OR FIXED
ALLOCATION CHECKED)
Divisions Transferred To: Fill in percentages for allocation of DCA
below (see (B) DCA).
<TABLE>
<CAPTION>
ACCOUNT DIVISION INVESTMENT ADVISER (A) INITIAL (B) DCA
<S> <C> <C> <C>
MULTIPLE ALLOCATION ZWEIG ADVISORS, INC. % %
FULLY MANAGED T. ROWE PRICE ASSOCIATES INC. % %
SMALL CAP FRED ALGER MANAGEMENT % %
ALL-GROWTH WARBURG, PINCUS COUNSELLORS, INC. % %
CAPITAL APPRECIATION CHANCELLOR TRUST CO. % %
VALUE EQUITY EAGLE ASSET MANAGEMENT, INC. % %
RISING DIVIDENDS KAYNE, ANDERSON INV. MGMT., L.P. % %
STRATEGIC EQUITY ZWEIG ADVISORS, INC. % %
REAL ESTATE EII REALTY SECURITIES, INC. % %
NATURAL RESOURCES VAN ECK ASSOCIATES CORP. % %
EMERGING MARKETS BANKERS TRUST COMPANY % %
THE MANAGED GLOBAL ACCOUNT WARBURG, PINCUS COUNSELLORS, INC. % %
LIMITED MATURITY BOND BANKERS TRUST COMPANY %
LIQUID ASSET BANKERS TRUST COMPANY %
FIXED ALLOCATION ELECTION 1 YEAR %
FIXED ALLOCATION ELECTION 3 YEAR %
FIXED ALLOCATION ELECTION 5 YEAR %
FIXED ALLOCATION ELECTION 7 YEAR %
FIXED ALLOCATION ELECTION 10 YEAR %
TOTAL 100% 100%
</TABLE>
Golden American Life Insurance Company, Customer Service Center,
PO Box 8794, Wilmington, DE 19899-8794
GA-EA-1007-12/95
<PAGE>
7. OPTIONAL SYSTEMATIC PARTIAL WITHDRAWALS
If you want to receive Systematic Partial Withdrawals, your request must be
received in writing. For the appropriate form, please call our Customer
Service Center: 1-800-366-0066.
8. TELEPHONE REALLOCATION AUTHORIZATION ________________ OWNER'S INITIALS
I authorize Golden American to act upon reallocation instructions given by
telephone from __________________________ (name of your registered
representative) upon furnishing his/her social security number. Neither
Golden American nor any person authorized by Golden American will be
responsible for any claim, loss, liability or expense in connection with
reallocation instructions received by telephone from such person if Golden
American or such other person acted on such telephone instructions in good
faith in reliance upon this authorization. Golden American will continue to
act upon this authorization until such time as the person indicated above
is no longer affiliated with the broker/dealer under which my contract was
purchased or until such time that I notify Golden American otherwise in
writing.
9. TAX-QUALIFIED PLANS IF YOU ARE FUNDING A QUALIFIED PLAN, PLEASE SPECIFY
TYPE:
/ / IRA
/ / IRA Rollover
/ / SEP/IRA
/ / Other ________________________
10. REPLACEMENT
Will the contract applied for replace any existing annuity or life
insurance policies on the annuitant's life?
/ / Yes (If yes, please complete following)
/ / No
Company Name Policy Number Face Amount
11. READ THE FOLLOWING STATEMENTS CAREFULLY AND SIGN BELOW:
- BY SIGNING BELOW, I ACKNOWLEDGE RECEIPT OF THE PROSPECTUS. I AGREE THAT,
TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL STATEMENTS AND ANSWERS IN THIS
ENROLLMENT FORM ARE COMPLETE AND TRUE AND MAY BE RELIED UPON IN DETERMINING
WHETHER TO ISSUE THE CERTIFICATE. MY ANSWERS WILL FORM A PART OF ANY
CERTIFICATE TO BE ISSUED, AND ONLY THE OWNER AND GOLDEN AMERICAN HAVE THE
AUTHORITY TO MODIFY THIS ENROLLMENT FORM.
- CONTRACTS AND POLICIES AND UNDERLYING SERIES SHARES OR SECURITIES WHICH
FUND CONTRACTS AND POLICIES ARE NOT INSURED BY THE FDIC OR ANY OTHER
AGENCY. THEY ARE NOT DEPOSITS OR OTHER OBLIGATIONS OF ANY BANK AND ARE NOT
BANK GUARANTEED. ALSO, THEY ARE SUBJECT TO MARKET FLUCTUATION, INVESTMENT
RISK AND POSSIBLE LOSS OF PRINCIPAL INVESTED.
- I UNDERSTAND THAT THIS CERTIFICATE'S CASH SURRENDER VALUE, WHEN BASED ON
THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT DIVISION, MAY INCREASE OR
DECREASE ON ANY DAY AND THAT NO MINIMUM VALUE IS GUARANTEED. THIS
CERTIFICATE IS IN ACCORD WITH MY ANTICIPATED FINANCIAL NEEDS.
- I UNDERSTAND THAT ANY AMOUNT ALLOCATED TO THE FIXED ACCOUNT MAY BE
SUBJECT TO A MARKET VALUE ADJUSTMENT, WHICH MAY CAUSE THE VALUES TO
INCREASE OR DECREASE, PRIOR TO A SPECIFIED DATE OR DATES AS SPECIFIED IN
THE CERTIFICATE.
____________________________________________ _____________________________
Signature of Owner Signed at (City, State) Date
____________________________________________ _____________________________
Signature of Joint Owner (IF APPLICABLE) Signed at (City, State) Date
____________________________________________ _____________________________
Signature of Annuitant (IF OTHER THAN OWNER) Signed at (City, State) Date
Client Account No. (IF APPLICABLE)_____________________
FOR AGENT USE ONLY
DO YOU HAVE REASON TO BELIEVE THAT THE CONTRACT APPLIED FOR WILL REPLACE ANY
EXISTING ANNUITY OR LIFE INSURANCE ON THE ANNUITANT'S LIFE? / / YES / / NO
__________________________________
Agent Signature
__________________________________
Print Agent Name & No.
__________________________________
Social Security No.
__________________________________
Broker/Dealer/Branch
__________________________________
Florida License ID# (Florida Only)
Golden American Life Insurance Company, Customer Service Center,
PO Box 8794, Wilmington, DE 19899-8794
1-800-366-0066
GA-EA-1007-12/95
<PAGE>
4(m) INDIVIDUAL DEFERRED VARIABLE ANNUITY APPLICATION
<PAGE>
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A SUBSIDIARY OF BANKERS TRUST COMPANY
GOLDEN AMERICAN LIFE INSURANCE COMPANY IS A STOCK COMPANY DOMICILED IN
WILMINGTON, DELAWARE
DEFERRED VARIABLE ANNUITY APPLICATION
1. OWNER(S)
Name Male Female Soc. Sec. # or Tax ID.#
/ / / /
Permanent Address Phone ( )
City State Zip Date of Birth
2. ANNUITANT (IF OTHER THAN OWNER)
Name Male Female Soc. Sec. # or Tax ID.#
/ / / /
Permanent Address Phone ( )
City State Zip Date of Birth Relation to Owner
CONTINGENT ANNUITANT (OPTIONAL)
Name Address Relation to Owner
3. PRIMARY BENEFICIARY(IES) (IF MORE THAN ONE - INDICATE %)
Name(s) Relation to Owner
CONTINGENT BENEFICIARY(IES) Name Relation to Owner
4. PLAN (Check one)
/ / DVA
/ / Other __________________
5. DEATH BENEFIT OPTIONS
1. / / 7% Solution -- Enhanced #1
2. / / Annual Ratchet -- Enhanced #2
3. / / Standard
6. INITIAL PREMIUM AND ALLOCATION INFORMATION
(A) INITIAL PREMIUM PAID $__________ MAKE CHECK PAYABLE TO GOLDEN AMERICAN
LIFE INSURANCE COMPANY
Fill in percentages for Premium allocation below (see (A) Initial.)
(B) DOLLAR COST AVERAGING (DCA): OPTIONAL. PLEASE CHECK BOX TO ELECT. / /
Amount to be transferred monthly $_________________ (minimum $250)
Division or Allocation Transferred From:
/ / Limited Maturity Bond Division
/ / Liquid Asset Division
/ / 1 Year Fixed Interest Division
(MINIMUM OF $10,000 MUST BE ALLOCATED TO THE DIVISION CHECKED)
Divisions Transferred To: Fill in percentages for allocation of DCA
below (see (B) DCA).
<TABLE>
<CAPTION>
ACCOUNT DIVISION INVESTMENT ADVISER (A) INITIAL (B) DCA
<S> <C> <C> <C>
MULTIPLE ALLOCATION ZWEIG ADVISORS, INC. % %
FULLY MANAGED T. ROWE PRICE ASSOCIATES INC. % %
STRATEGIC EQUITY ZWEIG ADVISORS, INC. % %
ALL-GROWTH WARBURG, PINCUS COUNSELLORS, INC. % %
CAPITAL APPRECIATION CHANCELLOR TRUST CO. % %
VAlUE EQUITY EAGLE ASSET MANAGEMENT, INC. % %
RISING DIVIDENDS KAYNE, ANDERSON INV. MGMT., L.P. % %
REAL ESTATE EII REALTY SECURITIES, INC. % %
NATURAL RESOURCES VAN ECK ASSOCIATES CORP. % %
THE MANAGED GLOBAL ACCOUNT WARBURG, PINCUS COUNSELLORS, INC. % %
EMERGING MARKETS BANKERS TRUST COMPANY % %
LIMITED MATURITY BOND BANKERS TRUST COMPANY %
LIQUID ASSET BANKERS TRUST COMPANY %
FIXED ALLOCATION ELECTION 1 YEAR %
FIXED ALLOCATION ELECTION 3 YEAR %
FIXED ALLOCATION ELECTION 5 YEAR %
TOTAL 100% 100%
</TABLE>
Golden American Life Insurance Company, Customer Service Center,
PO Box 8794, Wilmington, DE 19899-8794
GA-AA-1008-4/95
<PAGE>
7. OPTIONAL SYSTEMATIC PARTIAL WITHDRAWALS
If you want to receive Systematic Partial Withdrawals, your request must be
received in writing. For the appropriate form, please call our Customer
Service Center: 1-800-366-0066.
8. TELEPHONE REALLOCATION AUTHORIZATION ________________ OWNER'S INITIALS
I authorize Golden American to act upon reallocation instructions given by
telephone from __________________________ (name of your registered
representative) upon furnishing his/her social security number. Neither
Golden American nor any person authorized by Golden American will be
responsible for any claim, loss, liability or expense in connection with
reallocation instructions received by telephone from such person if Golden
American or such other person acted on such telephone instructions in good
faith in reliance upon this authorization. Golden American will continue to
act upon this authorization until such time as the person indicated above
is no longer affiliated with the broker/dealer under which my contract was
purchased or until such time that I notify Golden American otherwise in
writing.
9. TAX-QUALIFIED PLANS IF YOU ARE FUNDING A QUALIFIED PLAN, PLEASE SPECIFY
TYPE:
/ / IRA
/ / IRA Rollover
/ / SEP/IRA
/ / Other ________________________
10. REPLACEMENT
Will the contract applied for replace any existing annuity or life
insurance policies on the annuitant's life?
/ / Yes (If yes, please complete following)
/ / No
Company Name Policy Number Face Amount
11. READ THE FOLLOWING STATEMENTS CAREFULLY AND SIGN BELOW:
- BY SIGNING BELOW, I ACKNOWLEDGE RECEIPT OF THE PROSPECTUS. I UNDERSTAND
THAT THIS CONTRACT'S CASH SURRENDER VALUE MAY INCREASE OR DECREASE ON ANY
DAY AND THAT NO MINIMUM VALUE IS GUARANTEED.
- I AGREE THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL STATEMENTS AND
ANSWERS IN THIS APPLICATION ARE COMPLETE AND TRUE AND MAY BE RELIED UPON IN
DETERMINING WHETHER TO ISSUE THE CONTRACT. MY ANSWERS WILL FORM A PART OF
ANY CONTRACT TO BE ISSUED, AND ONLY THE OWNER AND GOLDEN AMERICAN HAVE THE
AUTHORITY TO MODIFY THIS APPLICATION.
- CONTRACTS AND POLICIES AND UNDERLYING SERIES SHARES OR SECURITIES WHICH
FUND CONTRACTS AND POLICIES ARE NOT INSURED BY THE FDIC OR ANY OTHER
AGENCY. THEY ARE NOT DEPOSITS OR OTHER OBLIGATIONS OF ANY BANK AND ARE NOT
BANK GUARANTEED. ALSO, THEY ARE SUBJECT TO MARKET FLUCTUATION, INVESTMENT
RISK AND POSSIBLE LOSS OF PRINCIPAL INVESTED.
____________________________________________ _____________________________
Signature of Owner Signed at (City, State) Date
____________________________________________ _____________________________
Signature of Joint Owner (IF APPLICABLE) Signed at (City, State) Date
____________________________________________ _____________________________
Signature of Annuitant (IF OTHER THAN OWNER) Signed at (City, State) Date
Client Account No. (IF APPLICABLE)_____________________
FOR AGENT USE ONLY
DO YOU HAVE REASON TO BELIEVE THAT THE CONTRACT APPLIED FOR WILL REPLACE ANY
EXISTING ANNUITY OR LIFE INSURANCE ON THE ANNUITANT'S LIFE? / / YES / / NO
__________________________________
Agent Signature
__________________________________
Print Agent Name & No.
__________________________________
Social Security No.
__________________________________
Broker/Dealer/Branch
__________________________________
Florida License ID# (Florida Only)
Golden American Life Insurance Company, Customer Service Center,
PO Box 8794, Wilmington, DE 19899-8794
1-800-366-0066
GA-AA-1008-12/95
<PAGE>
Exhibit 5
GOLDEN AMERICAN LIFE INSURANCE COMPANY
A subsidiary of Bankers Trust Company
1001 Jefferson Street, Suite 400,
Wilmington, DE 19801
Tel: 302-576-3400
Fax: 302-576-3450
April 29, 1996
Board of Directors
Golden American Life Insurance Company
1001 Jefferson Street, Suite 400
Wilmington, DE 19801
Gentlemen:
In my capacity as Executive Vice President and Secretary of Golden American
Life Insurance Company, a Delaware domiciled corporation ("Company"), I have
supervised the preparation of the registration statement for the Deferred
Combination Variable and Fixed Annuity Contract ("Contract") to be filed by
the Company with the Securities and Exchange Commission under the Securities
Act of 1933.
I am of the following opinion:
(1) The Company was organized in accordance with the laws of the State
of Delaware and is a duly authorized stock life insurance company under the
laws of Delaware and the laws of those states in which the Company is
admitted to do business;
(2) The Company is authorized to issue to the Contracts in those states in
which it is admitted and upon compliance with applicable local law;
(3) The Contracts, when issued in accordance with the prospectus contained
in the aforesaid registration statement and upon compliance with applicable
local law, will be legal and binding obligations of the Company in accordance
with their terms.
In arriving at the foregoing opinion, I have made such examination of law and
examined such records and other documents as in my judgment are necessary or
appropriate.
I hereby consent to the filing of this opinion as an exhibit to the aforesaid
registration statement and to the
<PAGE>
reference to me under the caption "Legal Matters" in the prospectus contained
in said registration statement. In giving this consent I do not thereby
admit that I come within the category of persons whose consent is required
under section 7 of the Securities Act of 1933 or the Rules and Regulations of
the Securities and Exchange Commission thereunder.
Sincerely,
/s/ Myles R. Tashman
Myles R. Tashman
Executive Vice President and Secretary
<PAGE>
Exhibit 23(a)
[TRANSMITTED ON SA&B LETTERHEAD]
April 26, 1996
VIA EDGARLINK
Board of Directors
Golden American Life Insurance Company
1001 Jefferson Street, Suite 400
Wilmington, DE 19801
Ladies and Gentlemen:
We hereby consent to the reference to our name under the caption "Legal
Matters" in the Prospectus filed as part of Post-Effective Amendment No. 4 to
the registration statement of Form S-1 (File No. 33-87272). In giving this
consent, we do not admit that we are in the category of persons whose consent is
required under Section 7 of the Securities Act of 1933.
Very Truly yours,
SUTHERLAND, ASBILL & BRENNAN
By: /s/ Stephen E. Roth
-------------------------
Stephen E. Roth
<PAGE>
CONSENT OF INDEPENDENT AUDITORS
We consent to the reference to our firm under the caption "Independent
Auditors" and to the use of our report dated February 12, 1996, with respect
to the financial statements of Separate Account B and to the use of our
report dated February 12, 1996, with respect to the financial statements of
The Managed Global Account of Separate Account D in the Statement of
Additional Information incorporated by reference from registration statements
(Form N-4 No. 33-23351 and Form N-3 No. 33-51028) filed with the Securities
and Exchange Commission contemporaneously with this registration statement.
We also consent to the use of our report dated February 12, 1996 with respect
to the financial statements of Golden American Life Insurance Company
prepared in accordance with generally accepted accounting principles and to
the reference to our firm under the captions "Experts" and "Financial
Statements" in the Prospectus included in this Amendment No. 4 to the
Registration Statement (Form S-1 No. 33-87272) of Golden American Life
Insurance Company.
Ernst & Young LLP
Philadelphia, Pennsylvania
April 30, 1996
<PAGE>
Exhibit 24
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that the undersigned, being the duly
elected Chairman, President and Chief Executive Officer of Golden American
Life Insurance Company ("Golden American"), constitutes and appoints Myles R.
Tashman, and Marilyn Talman, and each of them, his true and lawful
attorneys-in-fact and agents with full power of substitution and
resubstitution for him in his name, place and stead, in any and all
capacities, to sign Golden American's registration statements and
applications for exemptive relief, and any and all amendments thereto, and to
file the same, with all exhibits thereto, and other documents in connection
therewith, with the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents full power and authority to do and perform each
and every act and thing requisite and necessary to be done, as fully to all
intents and purposes as he might or could do in person, hereby ratifying and
affirming all that said attorneys-in-fact and agents, or any of them, or his
or her substitute or substitutes, may lawfully do or cause to be done by
virtue thereof.
Date: April 12, 1996
/s/ Terry L. Kendall
---------------------------
Terry L. Kendall
Chairman, President and
Chief Executive Officer
<PAGE>
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that the undersigned, being a duly
elected Senior Vice President, Chief Actuary and Controller (Chief Financial
Officer) of Golden American Life Insurance Company ("Golden American"),
constitutes and appoints Myles R. Tashman, and Marilyn Talman, and each of
them, his true and lawful attorneys-in-fact and agents with full power of
substitution and resubstitution for him in his name, place and stead, in any
and all capacities, to sign Golden American's registration statements and
applications for exemptive relief, and any and all amendments thereto, and to
file the same, with all exhibits thereto, and other documents in connection
therewith, with the Securities and Exchange Commission, granting unto said
attorneys-in-fact and agents full power and authority to do and perform each
and every act and thing requisite and necessary to be done, as fully to all
intents and purposes as he might or could do in person, hereby ratifying and
affirming all that said attorneys-in-fact and agents, or any of them, or his
or her substitute or substitutes, may lawfully do or cause to be done by
virtue thereof.
Date: April 22, 1996
/s/ Stephen J. Preston
---------------------------
Stephen J. Preston
Senior Vice President, Chief
Actuary and Controller
(Chief Financial Officer)
<PAGE>
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that the undersigned, being a duly
elected Director of Golden American Life Insurance Company ("Golden
American"), constitutes and appoints Myles R. Tashman, and Marilyn Talman,
and each of them, his true and lawful attorneys-in-fact and agents with full
power of substitution and resubstitution for him in his name, place and
stead, in any and all capacities, to sign Golden American's registration
statements and applications for exemptive relief, and any and all amendments
thereto, and to file the same, with all exhibits thereto, and other documents
in connection therewith, with the Securities and Exchange Commission,
granting unto said attorneys-in-fact and agents full power and authority to
do and perform each and every act and thing requisite and necessary to be
done, as fully to all intents and purposes as he might or could do in person,
hereby ratifying and affirming all that said attorneys-in-fact and agents, or
any of them, or his or her substitute or substitutes, may lawfully do or
cause to be done by virtue thereof.
Date: April 22, 1996
/s/ Paul Borge
---------------------------
Paul Daniel Borge
Director
<PAGE>
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that the undersigned, being a duly
elected Director of Golden American Life Insurance Company ("Golden
American"), constitutes and appoints Myles R. Tashman, and Marilyn Talman,
and each of them, his true and lawful attorneys-in-fact and agents with full
power of substitution and resubstitution for him in his name, place and
stead, in any and all capacities, to sign Golden American's registration
statements and applications for exemptive relief, and any and all amendments
thereto, and to file the same, with all exhibits thereto, and other documents
in connection therewith, with the Securities and Exchange Commission,
granting unto said attorneys-in-fact and agents full power and authority to
do and perform each and every act and thing requisite and necessary to be
done, as fully to all intents and purposes as he might or could do in person,
hereby ratifying and affirming all that said attorneys-in-fact and agents, or
any of them, or his or her substitute or substitutes, may lawfully do or
cause to be done by virtue thereof.
Date: April 22, 1996
/s/ Richard A. Marin
---------------------------
Richard A. Marin
Director
