<PAGE>
As filed with the Securities and Exchange Commission on January 13, 2000.
File No.
SECURITIES AND EXCHANGE COMMISSION
Washington, D. C. 20549
FORM S-6
FOR REGISTRATION UNDER THE SECURITIES ACT OF 1933 OF
SECURITIES OF UNIT INVESTMENT TRUSTS REGISTERED ON
FORM N-8B-2
A. Exact name of trust: Separate Account VL I
B. Name of depositor: Hartford Life Insurance Company
C. Complete address of depositor's principal executive offices:
P. O. Box 2999
Hartford, CT 06104-2999
D. Name and complete address of agent for service:
Marianne O'Doherty, Esq.
Hartford Life Insurance Company
P. O. Box 2999
Hartford, CT 06104-2999
It is proposed that this filing will become effective:
____ immediately upon filing pursuant to paragraph (b) of Rule 485
____ on __________, 2000 pursuant to paragraph (b) of Rule 485
____ 60 days after filing pursuant to paragraph (a)(1) of Rule 485
____ on __________, 2000 pursuant to paragraph (a)(1) of Rule 485
____ this post-effective amendment designates a new effective date for
a previously filed post-effective amendment.
E. Title and amount of securities being registered: Pursuant to Rule 24f-2
under the Investment Company Act of 1940, the Registrant has registered
an indefinite amount of securities.
F. Proposed maximum aggregate offering price to the public of the
securities being registered: Not yet determined.
G. Amount of filing fee: Not applicable.
H. Approximate date of proposed public offering: As soon as practicable
after the effective date of this registration statement.
The registrant hereby amends this registration statement on such date or
dates as may be necessary to delay its effective date until the registrant
shall file a further amendment which specifically states that this
registration statement shall thereafter become effective in accordance with
Section 8(a) of the Securities Act of 1933 or until the registration shall
become effective on such date as the Commission, acting pursuant to
Section 8(a) may determine.
<PAGE>
RECONCILIATION AND TIE BETWEEN
FORM N-8B-2 AND PROSPECTUS
<TABLE>
<CAPTION>
Item No. of Form N-8B-2 Caption In Prospectus
- ----------------------- ---------------------
<S> <C>
1. Cover Page
2. Cover Page
3. Not Applicable
4. Statement of Additional Information - Distribution of
the Policies
5. About Us - Separate Account VL I
6. About Us - Separate Account VL I
7. Not required by Form S-6
8. Not required by Form S-6
9. Legal Proceedings
10. About Us - Separate Account VL I; The Funds
11. About Us - Separate Account VL I; The Funds
12. About Us - The Funds
13. Fee Table; Charges and Deductions
14. Premiums
15. Premiums
16. Premiums
17. Making Withdrawals From Your Policy
18. About Us - The Funds; Charges and Deductions
19. Your Policy - Contract Rights
20. Not Applicable
21. Loans
22. Not Applicable
23. Not Applicable
24. Not Applicable
25. About Us - Hartford Life Insurance Company
26. Not Applicable
27. About Us - Hartford Life Insurance Company
28. Statement of Additional Information - General
Information and History
29. About Us - Hartford Life Insurance Company
30. Not Applicable
31. Not Applicable
32. Not Applicable
33. Not Applicable
34. Not Applicable
35. Statement of Additional Information - Distribution of
the Policies
36. Not required by Form S-6
37. Not Applicable
38. Statement of Additional Information - Distribution of
the Policies
39. Statement of Additional Information - Distribution of
the Policies
40. Not Applicable
41. Statement of Additional Information - Distribution of
the Policies
42. Not Applicable
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
Item No. of Form N-8B-2 Caption In Prospectus
- ----------------------- ---------------------
<S> <C>
43. Not Applicable
44. Premiums
45. Not Applicable
46. Premiums; Making Withdrawals From Your Policy
47. About Us - The Funds
48. Cover Page; About Us - Hartford Life
Insurance Company
49. Not Applicable
50. About Us - Separate Account VL I
51. Not Applicable
52. About Us - The Funds
53. Taxes
54. Not Applicable
55. Not Applicable
56. Not Required by Form S-6
57. Not Required by Form S-6
58. Not Required by Form S-6
59. Not Required by Form S-6
</TABLE>
<PAGE>
PART A
<PAGE>
<TABLE>
<S> <C>
STAG PROTECTOR VARIABLE UNIVERSAL LIFE
SEPARATE ACCOUNT VL I
HARTFORD LIFE INSURANCE COMPANY
P.O. BOX 2999
HARTFORD, CT 06104-2999
TELEPHONE: (800) 231-5453 [LOGO]
</TABLE>
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
This prospectus describes information you should know before you purchase the
Stag Protector Variable Universal Life insurance policy. Please read it
carefully.
Stag Protector Variable Universal Life is a contract between you and Hartford
Life Insurance Company. You agree to make sufficient premium payments to us, and
we agree to pay a death benefit to your beneficiary. The policy is a flexible
premium variable universal life insurance policy. It is:
x Flexible premium, because you may add payments to your policy after the first
payment.
x Variable, because the value of your life insurance policy will fluctuate with
the performance of the investment options you select and the Fixed Account.
- --------------------------------------------------------------------------------
The following Sub-Accounts are available under the policy:
<TABLE>
<CAPTION>
<S> <C>
SUB-ACCOUNT PURCHASES SHARES OF:
<CAPTION>
<S> <C>
Hartford Advisers Fund Sub-Account Class IA of Hartford Advisers HLS Fund, Inc.
Hartford Bond Fund Sub-Account Class IA of Hartford Bond HLS Fund, Inc.
Hartford Capital Appreciation Fund Sub-Account Class IA of Hartford Capital Appreciation HLS
Fund, Inc.
Hartford Dividend and Growth Fund Sub-Account Class IA of Hartford Dividend and Growth HLS
Fund, Inc.
Hartford Growth and Income Fund Sub-Account Class IA of Hartford Growth and Income HLS Fund of
Hartford Series Fund, Inc.
Hartford Index Fund Sub-Account Class IA of Hartford Index HLS Fund, Inc.
Hartford International Advisers Fund Sub-Account Class IA of Hartford International Advisers HLS
Fund, Inc.
Hartford International Opportunities Fund Sub-Account Class IA of Hartford International Opportunities
HLS Fund, Inc.
Hartford MidCap Fund Sub-Account Class IA of Hartford MidCap HLS Fund, Inc.
Hartford Mortgage Securities Fund Sub-Account Class IA of Hartford Mortgage Securities HLS
Fund, Inc.
Hartford Money Market Fund Sub-Account Class IA of Hartford Money Market HLS Fund, Inc.
Hartford Small Company Fund Sub-Account Class IA of Hartford Small Company HLS Fund, Inc.
Hartford Stock Fund Sub-Account Class IA of Hartford Stock HLS Fund, Inc.
Putnam VT Asia Pacific Growth Fund Sub-Account Class IA of Putnam VT Asia Pacific Growth Fund of
the Putnam Variable Trust
Putnam VT Diversified Income Fund Sub-Account Class IA of Putnam VT Diversified Income Fund of
Putnam Variable Trust
Putnam VT Global Asset Allocation Fund Sub-Account Class IA of Putnam VT Global Asset Allocation Fund
of Putnam Variable Trust
Putnam VT Global Growth Fund Sub-Account Class IA of Putnam VT Global Growth Fund of Putnam
Variable Trust
Putnam VT Growth and Income Fund Sub-Account Class IA of Putnam VT Growth and Income Fund of
Putnam Variable Trust
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
<S> <C>
SUB-ACCOUNT PURCHASES SHARES OF:
<CAPTION>
<S> <C>
Putnam VT Health Sciences Fund Sub-Account Class IA of Putnam VT Health Sciences Fund of
Putnam Variable Trust
Putnam VT High Yield Fund Sub-Account Class IA of Putnam VT High Yield Fund of Putnam
Variable Trust
Putnam VT Income Fund Sub-Account Class IA of Putnam VT Income Fund of Putnam
Variable Trust
Putnam VT International Growth Fund Sub-Account Class IA of Putnam VT International Growth Fund of
Putnam Variable Trust
Putnam VT International Growth and Income Fund Sub-Account Class IA of Putnam VT International Growth and
Income Fund of Putnam Variable Trust
Putnam VT International New Opportunities Fund Sub-Account Class IA of Putnam VT International New
Opportunities Fund of Putnam Variable Trust
Putnam VT Investors Fund Sub-Account Class IA of Putnam VT Investors Fund of Putnam
Variable Trust
Putnam VT Money Market Fund Sub-Account Class IA of Putnam VT Money Market Fund of Putnam
Variable Trust
Putnam VT New Opportunities Fund Sub-Account Class IA of Putnam VT New Opportunities Fund of
Putnam Variable Trust
Putnam VT New Value Fund Sub-Account Class IA of Putnam VT New Value Fund of Putnam
Variable Trust
Putnam VT OTC & Emerging Growth Fund Sub-Account Class IA of Putnam VT OTC & Emerging Growth Fund
of Putnam Variable Trust
Putnam VT The George Putnam Fund of Boston Sub-Account Class IA of Putnam VT The George Putnam Fund of
Boston of Putnam Variable Trust
Putnam VT Utilities Growth and Income Fund Sub-Account Class IA of Putnam VT Utilities Growth and Income
Fund of Putnam Variable Trust
Putnam VT Vista Fund Sub-Account Class IA of Putnam VT Vista Fund of Putnam
Variable Trust
Putnam VT Voyager Fund Sub-Account Class IA of Putnam VT Voyager Fund of Putnam
Variable Trust
Fidelity VIP Equity-Income Portfolio Sub-Account Fidelity VIP Equity-Income Portfolio of Variable
Insurance Products Fund
Fidelity VIP Overseas Portfolio Sub-Account Fidelity VIP Overseas Portfolio of Variable
Insurance Products Fund
Fidelity VIP II Asset Manager Portfolio Sub-Account Fidelity VIP II Asset Manager Portfolio of
Variable Insurance Products Fund II
</TABLE>
Neither the Securities and Exchange Commission nor any state securities
commission has approved or disapproved these securities, or determined if this
Prospectus is truthful or complete. Any representation to the contrary is a
criminal offense.
The policy may not be available for sale in all states.
This Prospectus can also be obtained from the Securities and Exchange
Commission's website (HTTP://WWW.SEC.GOV).
This life insurance policy IS NOT:
- a bank deposit or obligation
- federally insured
- endorsed by any bank or governmental agency
- --------------------------------------------------------------------------------
PROSPECTUS DATED: , 2000
<PAGE>
HARTFORD LIFE INSURANCE COMPANY 3
- --------------------------------------------------------------------------------
TABLE OF CONTENTS
<TABLE>
<CAPTION>
PAGE
<S> <C>
- ----------------------------------------------------------------------
SUMMARY OF BENEFITS AND RISKS 5
- ----------------------------------------------------------------------
FEE TABLES 6
- ----------------------------------------------------------------------
ABOUT US 8
- ----------------------------------------------------------------------
Hartford Life Insurance Company 8
- ----------------------------------------------------------------------
Separate Account VL I 8
- ----------------------------------------------------------------------
The Funds 8
- ----------------------------------------------------------------------
The Fixed Account 11
- ----------------------------------------------------------------------
CHARGES AND DEDUCTIONS 11
- ----------------------------------------------------------------------
Deductions from Premium 11
- ----------------------------------------------------------------------
Deductions from Account Value 11
- ----------------------------------------------------------------------
Charges For the Funds 12
- ----------------------------------------------------------------------
YOUR POLICY 12
- ----------------------------------------------------------------------
Contract Rights 12
- ----------------------------------------------------------------------
Contract Limitations 13
- ----------------------------------------------------------------------
Changes to Contract or Separate Account 13
- ----------------------------------------------------------------------
Other Benefits 13
- ----------------------------------------------------------------------
Class of Purchasers 14
- ----------------------------------------------------------------------
PREMIUMS 15
- ----------------------------------------------------------------------
DEATH BENEFITS AND POLICY VALUES 16
- ----------------------------------------------------------------------
MAKING WITHDRAWALS FROM YOUR POLICY 17
- ----------------------------------------------------------------------
LOANS 17
- ----------------------------------------------------------------------
LAPSE AND REINSTATEMENT 18
- ----------------------------------------------------------------------
TAXES 19
- ----------------------------------------------------------------------
General 19
- ----------------------------------------------------------------------
Taxation of Hartford and the Separate Account 19
- ----------------------------------------------------------------------
Income Taxation of Policy Benefits -- Generally 19
- ----------------------------------------------------------------------
Modified Endowment Contracts 20
- ----------------------------------------------------------------------
Estate and Generation Skipping Taxes 20
- ----------------------------------------------------------------------
Diversification Requirements 20
- ----------------------------------------------------------------------
Ownership of the Assets in the Separate Account 21
- ----------------------------------------------------------------------
Tax Deferral During Accumulation Period 21
- ----------------------------------------------------------------------
Life Insurance Purchased for Use in Split Dollar
Arrangements 21
- ----------------------------------------------------------------------
Federal Income Tax Withholding 22
- ----------------------------------------------------------------------
Non-Individual Ownership of Policies 22
- ----------------------------------------------------------------------
Other 22
- ----------------------------------------------------------------------
Life Insurance Purchases by Nonresident Aliens and Foreign
Corporations 22
- ----------------------------------------------------------------------
</TABLE>
<PAGE>
4 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
<TABLE>
<CAPTION>
PAGE
<S> <C>
- ----------------------------------------------------------------------
LEGAL PROCEEDINGS 22
- ----------------------------------------------------------------------
GLOSSARY OF SPECIAL TERMS 23
- ----------------------------------------------------------------------
WHERE YOU CAN FIND MORE INFORMATION 24
- ----------------------------------------------------------------------
STATEMENT OF ADDITIONAL INFORMATION
- ----------------------------------------------------------------------
</TABLE>
<PAGE>
HARTFORD LIFE INSURANCE COMPANY 5
- --------------------------------------------------------------------------------
SUMMARY OF BENEFITS AND RISKS
BENEFITS OF YOUR POLICY
FLEXIBILITY -- The policy is designed to be flexible to meet your specific life
insurance needs. You have the flexibility to choose death benefit options,
investment options, and premiums you pay.
DEATH BENEFIT -- While the policy is inforce and when the insured dies, we pay a
death benefit to your beneficiary. You select one of three death benefit
options:
- Level Option: The death benefit equals the current Face Amount.
- Return of Account Value Option: The death benefit is the current Face Amount
plus the Account Value of your policy.
- Return of Premium Option: The death benefit is the current Face Amount plus
the sum of premiums paid. However, it will be no more than the current Face
Amount plus the Option C limit, which is currently $2.5 million.
The death benefit is reduced by any money you owe us, such as outstanding loans,
loan interest, or unpaid charges. You may change your death benefit option under
certain circumstances. You may increase or decrease the Face Amount on your
policy under certain circumstances.
INVESTMENT CHOICES -- You may invest in up to 9 different investment choices
within your policy, from a choice of 36 investment options and a Fixed Account.
You may transfer money among your investment choices, subject to restrictions.
PREMIUM PAYMENTS -- You have the flexibility to choose how you pay premiums. You
can choose a planned premium when you purchase the policy. You may change your
planned premium, subject to certain limitations.
RIGHT TO EXAMINE YOUR POLICY -- You have a limited right to return the policy
for cancellation after purchase. See "Your Policy -- Contract Rights -- Right to
Examine a Policy."
SURRENDER -- You may surrender your policy at any time prior to the maturity
date for its Cash Surrender Value. (See "Risks of Your Policy," below).
LOANS -- You may take a loan on the policy. The policy secures the loan.
SETTLEMENT OPTIONS -- You or your beneficiary may choose to receive the proceeds
of the policy over a period of time by using one of several settlement options.
OPTIONAL COVERAGE -- You may add other coverages to your policy. See "Your
Policy-Other Benefits."
WHAT DOES YOUR PREMIUM PAY FOR?
Your premium pays for three things. It pays for insurance coverage, it acts as
an investment in the Sub-Accounts, and it pays for sales loads and other
charges.
RISKS OF YOUR POLICY
INVESTMENT PERFORMANCE -- The value of your policy will fluctuate with the
performance of the investment options you choose. Your investment options may
decline in value, or they may not perform to your expectations. Your policy
values in the Sub-Accounts are not guaranteed.
UNSUITABLE FOR SHORT-TERM SAVINGS -- The policy is designed for long term
financial planning. You should not purchase the policy if you will need the
premium payment in a short time period.
RISK OF LAPSE -- Your policy could terminate if the value of the policy becomes
too low to support the policy's monthly charges. If this occurs, we will notify
you in writing. You will then have a 61-day grace period to pay additional
amounts to prevent the policy from terminating.
WITHDRAWAL LIMITATIONS -- One partial withdrawal is allowed each month. The
minimum allowed is $500, and the maximum allowed is the Cash Surrender Value
minus $1,000. Withdrawals will reduce your policy's death benefit, and may be
subject to a surrender charge.
TRANSFER LIMITATIONS -- We reserve the right to limit the size of transfers and
remaining balances, and to limit the number and frequency of transfers among
your investment options and the Fixed Account.
LOANS -- Taking a loan from your policy may increase the risk that your policy
will lapse, will have a permanent effect on the policy's Account Value, and will
reduce the death proceeds.
ADVERSE TAX CONSEQUENCES -- You may be subject to income tax if you receive any
loans, withdrawals or other amounts from the policy, and you may be subject to a
10% penalty tax. See "Taxes."
<PAGE>
6 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
FEE TABLES
The following tables describe the MAXIMUM fees and expenses that you will pay
when buying, owning, and surrendering the policy. The first table describes the
maximum fees and expenses that you will pay at the time that you buy the policy,
surrender the policy, or transfer cash value between investment options. Your
specific fees and charges are described on the specification page of your
policy.
TRANSACTION FEES
<TABLE>
CHARGE WHEN CHARGE IS DEDUCTED AMOUNT DEDUCTED
- ------------------------------------------------------------------------------------------------
<S> <C> <C>
Front-end sales load When you pay premium. Policy Years Amount
Year 1 8%
Policy Years 2 + 4%
- ------------------------------------------------------------------------------------------------
Tax Charge on Premium When you pay premium. A percent of premium which varies
Payments by your state and municipality of
residence. The range of tax charge
is generally between 0% and 4%.
This rate will change if your state
or municipality changes its tax
charges. It may change if you
change your state or municipality
of residence.
- ------------------------------------------------------------------------------------------------
Surrender Charge When you surrender your policy. The Surrender Charge varies based
When you make certain Face Amount on the Insured's age, sex, and
decreases. insurance class on the date of
When you take certain withdrawals. issue.
The initial charge will be at least
$2.09 per 1,000 of initial face
amount but will not exceed $50.60
per 1,000 of initial face amount.
- ------------------------------------------------------------------------------------------------
Face Amount Increase Each month for 12 months beginning The rate is a per $1,000 amount
Fee on the effective date of any that varies by attained age of the
unscheduled increase in Face Amount Insured.
you request. The monthly fee will be at least
$.17 per 1,000 of increase but will
not exceed $.50 per 1,000 of
increase.
- ------------------------------------------------------------------------------------------------
Transfer Fees When you make a transfer after the $25 per transfer.
first transfer in any month.
- ------------------------------------------------------------------------------------------------
Withdrawal Charge When you take a withdrawal. $10 per withdrawal.
<S> <C>
POLICIES FROM WHICH CHARGE IS
CHARGE DEDUCTED
- ----------------------
Front-end sales load All
- ----------------------
Tax Charge on Premium All
Payments
- ----------------------
Surrender Charge Policies surrendered during the first
nine policy years.
Policies where the Face Amount is
reduced below the initial Face Amount
during the first nine policy years.
- ----------------------
Face Amount Increase Policies where the owner has made an
Fee unscheduled increase.
- ----------------------
Transfer Fees Those policies with more than one
transfer per month.
- ----------------------
Withdrawal Charge Those policies where the owner has
made a withdrawal.
</TABLE>
The next table describes the MAXIMUM fees and expenses that you will pay
periodically during the time that you own the policy, not including Fund fees
and expenses.
ANNUAL CHARGES OTHER THAN FUND OPERATING EXPENSES
<TABLE>
CHARGE WHEN CHARGE IS DEDUCTED AMOUNT DEDUCTED
- ------------------------------------------------------------------------------------------------
<S> <C> <C>
Cost of Insurance Monthly. The charge is the maximum cost of
Charges insurance rate times the net amount
at risk. Maximum cost of insurance
rates are individualized, depending
on issue age, sex, insurance class,
Initial Face Amount, substandard
rating, and age of policy.
The maximum monthly coi's for
unrated individuals ranges from a
minimum of $.0567 per 1,000 per
month to a maximum of $83.333 per
1,000 per month.
- ------------------------------------------------------------------------------------------------
Mortality and Expense Monthly. Per the Sub-Account accumulated
Risk Charge value:
- 1/12 of 0.75% per month for
policy years 1-10.
- 1/12 of 0.40% per month after the
10th policy year.
Per $1000 of initial Face Amount
during the first 10 policy years:
- individualized based on insured's
initial Face Amount, issue age,
sex, insurance class.
The monthly charge will be at least
$.0458 per 1,000 of initial face
amount but will not exceed $.6917
per 1,000 of initial face amount.
- ------------------------------------------------------------------------------------------------
Administrative Charge Monthly. $10, if your initial Face Amount is
below $100,000.
$7.50, if your initial Face Amount
is equal to or greater than
$100,000.
- ------------------------------------------------------------------------------------------------
Rider Charges Monthly. Individualized based on optional
rider selected.
<S> <C>
POLICIES FROM WHICH CHARGE IS
CHARGE DEDUCTED
- ----------------------
Cost of Insurance All
Charges
- ----------------------
Mortality and Expense All
Risk Charge
- ----------------------
Administrative Charge All
- ----------------------
Rider Charges Only those policies with benefits
provided by rider.
</TABLE>
<PAGE>
HARTFORD LIFE INSURANCE COMPANY 7
- --------------------------------------------------------------------------------
The next table is an example of the Fund fees and expenses that you will pay
periodically during the time that you own the policy. The table shows the actual
annual fees and expenses charged by the Funds for the year ended December 31,
1998. More detail concerning each Fund's fees and expenses is contained in the
prospectus for each Fund.
ANNUAL FUND OPERATING EXPENSES
<TABLE>
<CAPTION>
TOTAL FUND
MANAGEMENT FEES OTHER OPERATING EXPENSES
(INCLUDING WAIVERS) EXPENSES (INCLUDING WAIVERS)
<S> <C> <C> <C>
- ------------------------------------------------------------------------------------------------------------------
Fidelity VIP Equity-Income Portfolio 0.48% 0.09% 0.57%
- ------------------------------------------------------------------------------------------------------------------
Fidelity VIP II Asset Manager Portfolio 0.53% 0.10% 0.63%
- ------------------------------------------------------------------------------------------------------------------
Fidelity VIP Overseas Portfolio 0.72% 0.17% 0.89%
- ------------------------------------------------------------------------------------------------------------------
Hartford Advisers HLS Fund 0.62% 0.02% 0.63%
- ------------------------------------------------------------------------------------------------------------------
Hartford Bond HLS Fund 0.48% 0.02% 0.50%
- ------------------------------------------------------------------------------------------------------------------
Hartford Capital Appreciation HLS Fund 0.62% 0.02% 0.64%
- ------------------------------------------------------------------------------------------------------------------
Hartford Dividend & Growth HLS Fund 0.64% 0.02% 0.66%
- ------------------------------------------------------------------------------------------------------------------
Hartford Growth and Income HLS Fund 0.77% 0.04% 0.81%
- ------------------------------------------------------------------------------------------------------------------
Hartford Index HLS Fund 0.38% 0.02% 0.40%
- ------------------------------------------------------------------------------------------------------------------
Hartford International Advisers HLS Fund 0.76% 0.11% 0.86%
- ------------------------------------------------------------------------------------------------------------------
Hartford International Opportunities HLS Fund 0.68% 0.09% 0.77%
- ------------------------------------------------------------------------------------------------------------------
Hartford MidCap HLS Fund 0.76% 0.03% 0.79%
- ------------------------------------------------------------------------------------------------------------------
Hartford Money Market HLS Fund 0.43% 0.02% 0.45%
- ------------------------------------------------------------------------------------------------------------------
Hartford Mortgage Securities HLS Fund 0.43% 0.03% 0.46%
- ------------------------------------------------------------------------------------------------------------------
Hartford Small Company HLS Fund 0.75% 0.02% 0.77%
- ------------------------------------------------------------------------------------------------------------------
Hartford Stock HLS Fund 0.44% 0.02% 0.46%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Asia Pacific Growth Fund 0.80% 0.32% 1.12%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Diversified Income Fund 0.67% 0.11% 0.78%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Global Asset Allocation Fund 0.65% 0.13% 0.78%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Global Growth Fund 0.60% 0.12% 0.72%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Growth and Income Fund 0.46% 0.04% 0.50%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Health Sciences Fund 0.40% 0.21% 0.61%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT High Yield Fund 0.64% 0.07% 0.71%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Income Fund 0.60% 0.07% 0.67%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT International Growth Fund 0.80% 0.27% 1.07%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT International Growth and Income Fund 0.80% 0.19% 0.99%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT International New Opportunities Fund 1.18% 0.42% 1.60%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Investors Fund 0.39% 0.18% 0.57%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Money Market Fund 0.45% 0.08% 0.53%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT New Opportunities Fund 0.56% 0.05% 0.61%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT New Value Fund 0.70% 0.11% 0.81%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT OTC & Emerging Growth Fund 0.00% 0.60% 0.60%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT The George Putnam Fund of Boston 0.16% 0.41% 0.57%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Utilities Growth and Income Fund 0.65% 0.07% 0.72%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Vista Fund 0.65% 0.12% 0.77%
- ------------------------------------------------------------------------------------------------------------------
Putnam VT Voyager Fund 0.54% 0.04% 0.58%
- ------------------------------------------------------------------------------------------------------------------
</TABLE>
<PAGE>
8 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
ABOUT US
HARTFORD LIFE INSURANCE COMPANY
Hartford Life Insurance Company is a stock life insurance company engaged in the
business of writing life insurance, both individual and group, in all states of
the United States as well as the District of Columbia. We were originally
incorporated under the laws of Massachusetts on June 5, 1902, and subsequently
redomiciled to Connecticut. Our offices are located in Simsbury, Connecticut;
however, our mailing address is P.O. Box 5085, Hartford, CT 06104-5085. We are
ultimately controlled by The Hartford Financial Services Group, Inc., one of the
largest financial service providers in the United States.
HARTFORD'S RATINGS
<TABLE>
<CAPTION>
EFFECTIVE DATE
RATING AGENCY OF RATING RATING BASIS OF RATING
<S> <C> <C> <C>
- ----------------------------------------------------------------------------
A.M. Best and
Company, Inc. 1/1/99 A+ Financial performance
- ----------------------------------------------------------------------------
Standard & Poor's 6/1/98 AA Insurer financial strength
- ----------------------------------------------------------------------------
Duff & Phelps 12/21/98 AA+ Claims paying ability
- ----------------------------------------------------------------------------
</TABLE>
SEPARATE ACCOUNT VL I
The Sub-Accounts are subdivisions of our separate account, called Separate
Account VL I. The Separate Account exists to keep your life insurance policy
assets separate from our company assets. As such, the investment performance of
the Separate Account is independent from the investment performance of
Hartford's other assets. Hartford's other assets are utilized to pay you
insurance obligations under the policy. Your assets in the Separate Account are
held exclusively for your benefit and may not be used for any other liability of
Hartford. Separate Account VL I was established on September 18, 1992 under the
laws of Connecticut.
THE FUNDS
The Sub-Accounts of the Separate Account purchase shares of mutual funds set up
exclusively for variable annuity and variable life insurance products. These
funds are not the same mutual funds that you buy through your stockbroker or
through a retail mutual fund, but they may have similar investment strategies
and the same portfolio managers as retail mutual funds. You choose the
Sub-Accounts that meet your investment style.
We do not guarantee the investment results of any of the underlying Funds. Since
each underlying Fund has different investment objectives, each is subject to
different risks. These risks and the Funds' expenses are described in the
prospectuses for the Funds, which are attached to this Prospectus, and the
Funds' Statements of Additional Information, which may be ordered from us. You
should read the following investment objectives and the prospectuses for each of
the Funds listed below for detailed information about each Fund before
investing. All Funds may not be available in all states.
You may also allocate some or all of your premium payments to the "Fixed
Account," which pays a declared interest rate. See "The Fixed Account."
HARTFORD ADVISERS HLS FUND -- Seeks maximum long-term total rate of return by
investing in common stocks and other equity securities, bonds and other debt
securities, and money market instruments. Sub-advised by Wellington Management.
HARTFORD BOND HLS FUND -- Seeks maximum current income consistent with
preservation of capital by investing primarily in investment grade fixed-income
securities. Up to 20% of the total assets of this Fund may be invested in debt
securities rated in the highest category below investment grade ("Ba" by Moody's
Investor Services, Inc. or "BB" by Standard & Poor's) or, if unrated, are
determined to be of comparable quality by the Fund's investment adviser.
Securities rated below investment grade are commonly referred to as "high
yield-high risk securities" or "junk bonds." For more information concerning the
risks associated with investing in such securities, please refer to the section
in the accompanying prospectus for the Funds entitled "Hartford Bond HLS
Fund, Inc." Sub-advised by HIMCO.
HARTFORD CAPITAL APPRECIATION HLS FUND -- Seeks growth of capital by investing
in equity securities selected solely on the basis of potential for capital
appreciation. Sub-advised by Wellington Management.
HARTFORD DIVIDEND AND GROWTH HLS FUND -- Seeks a high level of current income
consistent with growth of capital by investing primarily in dividend paying
equity securities. Sub-advised by Wellington Management.
HARTFORD GROWTH AND INCOME HLS FUND -- Seeks growth of capital and current
income by investing primarily in equity securities with earnings growth
potential and steady or rising dividends. Sub-advised by Wellington Management.
HARTFORD INDEX HLS FUND -- Seeks to provide investment results which approximate
the price and yield performance of publicly-traded common stocks in the
aggregate, as represented by the Standard & Poor's 500 Composite Stock Price
Index.* Sub-advised by HIMCO.
HARTFORD INTERNATIONAL ADVISERS HLS FUND -- Seeks maximum long-term total return
by investing in a portfolio of equity, debt and money market securities.
Securities in which the Fund invests primarily will be denominated in non-U.S.
currencies and will be traded in non-U.S. markets. Sub-advised by Wellington
Management.
* "Standard & Poor's-Registered Trademark-," "S&P-Registered Trademark-," "S&P
500-Registered Trademark-," "Standard & Poor's 500," and "500" are trademarks of
The McGraw-Hill Companies, Inc. and have been licensed for use by Hartford Life
Insurance Company. The Hartford Index Fund, Inc. ("Index Fund") is not
sponsored, endorsed, sold or promoted by Standard & Poor's and Standard & Poor's
makes no representation regarding the advisability of investing in the Index
Fund.
<PAGE>
HARTFORD LIFE INSURANCE COMPANY 9
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HARTFORD INTERNATIONAL OPPORTUNITIES HLS FUND -- Seeks growth of capital by
investing primarily in equity securities issued by non-U.S. companies.
Sub-advised by Wellington Management.
HARTFORD MIDCAP HLS FUND -- Seeks to achieve long-term capital growth through
capital appreciation by investing primarily in equity securities of companies
with market capitalizations within the range represented by the Standard &
Poor's MidCap 400 Index. Sub-advised by Wellington Management.
HARTFORD MONEY MARKET HLS FUND -- Seeks maximum current income consistent with
liquidity and preservation of capital. Sub-advised by HIMCO.
HARTFORD MORTGAGE SECURITIES HLS FUND -- Seeks maximum current income consistent
with safety of principal and maintenance of liquidity by investing primarily in
mortgage-related securities, including securities issued by the Government
National Mortgage Association. Sub-advised by HIMCO.
HARTFORD SMALL COMPANY HLS FUND -- Seeks growth of capital by investing
primarily in equity securities within a range represented by the Russell 2000
Index selected on the basis of potential for capital appreciation. Sub-advised
by Wellington Management.
HARTFORD STOCK HLS FUND -- Seeks long-term growth of capital by investing
primarily in equity securities. Sub-advised by Wellington Management.
PUTNAM VT ASIA PACIFIC GROWTH FUND -- Seeks capital appreciation by investing
primarily in securities of companies located in Asia and in the Pacific Basin.
The fund's investments will normally include common stocks, preferred stocks,
securities convertible into common stocks or preferred stocks, and warrants to
purchase common stocks or preferred stocks.
PUTNAM VT DIVERSIFIED INCOME FUND -- Seeks high current income consistent with
capital preservation by investing in the following three sectors of the fixed
income securities markets: a U.S. Government and Investment Grade Sector, a High
Yield Sector (which invests primarily in securities commonly known as "junk
bonds"), and an International Sector. See the special considerations for
investments in high yield securities described in the Fund prospectus.
PUTNAM VT THE GEORGE PUTNAM FUND OF BOSTON -- Seeks to provide a balanced
investment composed of a well-diversified portfolio of stocks and bonds which
will produce both capital growth and current income.
PUTNAM VT GLOBAL ASSET ALLOCATION FUND -- Seeks a high level of long-term total
return consistent with preservation of capital by investing in U.S. equities,
international equities, U.S. fixed income securities, and international fixed
income securities.
PUTNAM VT GLOBAL GROWTH FUND -- Seeks capital appreciation through a globally
diversified portfolio of common stocks.
PUTNAM VT GROWTH AND INCOME FUND -- Seeks capital growth and current income by
investing primarily in common stocks that offer potential for capital growth,
current income, or both.
PUTNAM VT HEALTH SCIENCES FUND -- Seeks capital appreciation by investing
primarily in common stocks and other securities of companies in the health
sciences industries.
PUTNAM VT HIGH YIELD FUND -- Seeks high current income and, when consistent with
this objective, a secondary objective of capital growth, by investing primarily
in high-yielding, lower-rated fixed income securities, constituting a portfolio
which Putnam Management believes does not involve undue risk to income or
principal. See the special considerations for investments in high yield
securities described in the Fund prospectus.
PUTNAM VT INCOME FUND -- Seeks high current income consistent with what Putnam
Management believes to be prudent risk. The Fund will normally invest mostly in
bonds and other debt securities, and, to a lesser degree, in preferred stocks.
PUTNAM VT INTERNATIONAL GROWTH FUND -- Seeks capital appreciation by investing
primarily in equity securities of companies located in a country other than the
United States.
PUTNAM VT INTERNATIONAL GROWTH AND INCOME FUND -- Seeks capital growth, and a
secondary objective of high current income by investing primarily in common
stocks that Putnam Management believes offer potential for capital growth and
may, when consistent with its investment objectives, invest in common stocks
that Putnam Management believes offer potential for current income. Under normal
market conditions, the fund expects to invest substantially all of its assets in
securities principally traded on markets outside the United States.
PUTNAM VT INTERNATIONAL NEW OPPORTUNITIES FUND -- Seeks long term capital
appreciation by investing in companies that have above-average growth prospects
due to the fundamental growth of their market sector. Under normal market
conditions, the fund expects to invest substantially all of its total assets,
other than cash or short-term investments held pending investment, in common
stocks, preferred stocks, convertible preferred stocks, convertible bonds and
other equity securities principally traded in securities markets outside the
United States.
PUTNAM VT INVESTORS FUND -- Seeks long-term growth of capital and any increased
income that results from this growth by investing primarily in common stocks
that Putnam Management believes afford the best opportunity for capital growth
over the long term.
PUTNAM VT MONEY MARKET FUND -- Seeks as high a rate of current income as Putnam
Management believes is consistent with preservation of capital and maintenance
of liquidity by investing in high-quality money market instruments.
PUTNAM VT NEW OPPORTUNITIES FUND -- Seeks long-term capital appreciation by
investing principally in common stocks of companies in sectors of the economy
which Putnam Management believes possess above-average long-term growth
potential.
<PAGE>
10 HARTFORD LIFE INSURANCE COMPANY
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PUTNAM VT NEW VALUE FUND -- Seeks long-term capital appreciation by investing
primarily in common stocks that Putnam Management believes are undervalued at
the time of purchase and have the potential for long-term capital appreciation.
PUTNAM VT OTC & EMERGING GROWTH FUND -- Seeks capital appreciation by investing
primarily in common stocks that Putnam Management believes have potential for
capital appreciation significantly greater than that of market averages.
PUTNAM VT UTILITIES GROWTH AND INCOME FUND -- Seeks capital growth and current
income by concentrating its investments in debt and equity securities issued by
companies in the public utilities industries.
PUTNAM VT VISTA FUND -- Seeks capital appreciation by investing in a diversified
portfolio of common stocks which Putnam Management believes have the potential
for above-average capital appreciation.
PUTNAM VT VOYAGER FUND -- Seeks capital appreciation by investing primarily in
common stocks of companies that Putnam Management believes have potential for
capital appreciation that is significantly greater than that of market averages.
FIDELITY VIP EQUITY-INCOME PORTFOLIO -- Seeks reasonable income by investing
primarily in income-producing equity securities. In choosing these securities,
the Portfolio Manager will also consider the potential for capital appreciation.
The Portfolio's goal is to achieve a yield which exceeds the composite yield on
the securities comprising the Standard & Poor's Index 500.
In addition, the Portfolio may invest in high yield, lower-rated securities
(commonly referred to as "junk bonds") which are subject to greater risk than
investments in higher-rated securities. For a further discussion of lower-rated
securities, see "Risks of Lower-Rated Debt Securities" in the Fidelity
prospectus for this Portfolio.
FIDELITY VIP OVERSEAS PORTFOLIO -- Seeks long-term growth of capital primarily
through investments in foreign securities and provides a means for aggressive
investors to diversify their own portfolios by participating in companies and
economies outside of the United States.
International funds have increased economic and political risks as they are
exposed to events and factors in the various world markets. These risks may be
greater for funds that invest in emerging markets.
FIDELITY VIP II ASSET MANAGER PORTFOLIO -- Seeks high total return with reduced
risk over the long-term by allocating its assets among stocks, bonds and
short-term money market instruments.
In addition, the Portfolio may invest in high yield, lower-rated securities
(commonly referred to as "junk bonds") which are subject to greater risk than
investments in higher-rated securities. For a further discussion of lower-rated
securities, see "Risks of Lower-Rated Debt Securities" in the Fidelity
prospectus for this Portfolio.
INVESTMENT ADVISERS -- HL Investment Advisors, LLC is investment adviser for the
Hartford Funds. Wellington Management Company, LLP ("Wellington Management") is
investment sub-adviser for Hartford Advisers HLS Fund, Inc., Hartford Capital
Appreciation HLS Fund, Inc., Hartford Dividend and Growth HLS Fund, Inc.,
Hartford Growth and Income HLS Fund, Hartford International Advisers HLS Fund,
Inc., Hartford International Opportunities HLS Fund, Inc., Hartford MidCap HLS
Fund, Inc., Hartford Small Company HLS Fund, Inc., and Hartford Stock HLS Fund,
Inc. The Hartford Investment Management Company, Inc. ("HIMCO") is investment
sub-adviser for Hartford Bond HLS Fund, Inc., Hartford Index HLS Fund, Inc.,
Hartford Mortgage Securities HLS Fund, Inc., and Hartford Money Market HLS Fund,
Inc. Each Hartford Fund, except for the Hartford Growth and Income HLS Fund, is
a separate Maryland corporation registered with the Securities and Exchange
Commission as an open-end management investment company. The Hartford Growth and
Income HLS Fund is a diversified series of Hartford Series Fund, Inc., a
Maryland corporation, also registered with the Securities and Exchange
Commission as an open-end management investment company. The shares of each Fund
have been divided into Class IA and Class IB. Only Class IA shares are available
in this policy.
Putnam Investment Management, Inc. ("Putnam Management") serves as the
investment manager for the Putnam Funds. Putnam Management is ultimately
controlled by Marsh & McLennan Companies, Inc., a publicly owned holding company
whose principal businesses are international insurance brokerage and employee
benefit consulting.
Fidelity Management & Research Company is investment adviser for the Fidelity
VIP Funds.
MIXED AND SHARED FUNDING -- Shares of the Funds may be sold to our other
separate accounts and our insurance company affiliates or other unaffiliated
insurance companies to serve as the underlying investment for both variable
annuity contracts and variable life insurance policies, a practice known as
"mixed and shared funding." As a result, there is a possibility that a material
conflict may arise between the interests of policy owners, and of owners of
other contracts whose contract values are allocated to one or more of these
other separate accounts investing in any one of the Funds. In the event of any
such material conflicts, we will consider what action may be appropriate,
including removing the Fund from the Separate Account or replacing the Fund with
another underlying fund. There are certain risks associated with mixed and
shared funding, as disclosed in the prospectuses for the Funds.
VOTING RIGHTS -- For Sub-Accounts in which you have invested, we will notify you
of shareholder's meetings of the Funds purchased by those Sub-Accounts. We will
send you proxy materials and instructions for you to vote the shares held for
your benefit by those Sub-Accounts. We will arrange for the handling and
tallying of proxies received from you or other policy owners. If you give no
instructions, we will vote those shares in the same proportion as shares for
which we received instructions.
<PAGE>
HARTFORD LIFE INSURANCE COMPANY 11
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THE FIXED ACCOUNT
You may allocate amounts to the Fixed Account. The Fixed Account is not a part
of the Separate Account, but is a part of our general assets. As such, the Fixed
Account (and this description of the Fixed Account) is not subject to the same
securities laws as the Separate Account.
The Fixed Account credits at least 3.5% per year. We are not obligated to, but
may, credit more than 3.5% per year. If we do, such rates are determined at our
sole discretion. You assume the risk that, at any time, the Fixed Account may
credit no more than 3.5%.
CHARGES AND DEDUCTIONS
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DEDUCTIONS FROM PREMIUM
Before your premium is allocated to the Sub-Accounts and/or the Fixed Account,
we deduct a percentage from your premium for a sales load and a tax charge. The
amount allocated after the deductions is called your Net Premium.
FRONT-END SALES LOAD -- We deduct a front-end sales load from each premium you
pay. The current and maximum sales load in policy year 1 is 8%. The current and
maximum sales load after policy year 1 is 4%.
TAX CHARGE -- We deduct a tax charge from each premium you pay. The tax charge
covers taxes assessed against us by a state and/or other governmental entity.
The range of such charge generally is between 0% and 4%.
DEDUCTIONS FROM ACCOUNT VALUE
MONTHLY DEDUCTION AMOUNTS -- Each month we will deduct an amount from your
Account Value to pay for the benefits provided by your policy. This amount is
called the Monthly Deduction Amount and equals the sum of:
(1) the charge for the cost of insurance;
(2) the monthly administrative charge;
(3) the mortality and expense risk charge;
(4) any Face Amount increase fee;
(5) the charges for additional benefits provided by rider, if any.
COST OF INSURANCE CHARGE -- The charge for the cost of insurance equals:
(i) the cost of insurance rate per $1,000, multiplied by
(ii) the amount at risk, divided by
(iii) $1,000.
On any Monthly Activity Date, the amount at risk equals the Death Benefit less
the Account Value on that date, prior to assessing the Monthly Deduction Amount.
Cost of insurance rates will be determined on each policy anniversary based on
our future expectations of such factors as mortality, expenses, interest,
persistency and taxes. The cost of insurance rates will not exceed those based
on the 1980 Commissioners' Standard Ordinary Mortality Table (ALB), Male or
Female, Nonsmoker or Smoker Table, age last birthday (unisex rates may be
required in some states). A table of guaranteed cost of insurance rates per
$1,000 will be included in your policy, however, we reserve the right to use
rates less than those shown in the table. The maximum rates that can be charged
are shown on the Policy Specification pages in your contract. Substandard risks
will be charged higher cost of insurance rates that will not exceed rates based
on a multiple of 1980 Commissioners' Standard Ordinary Mortality Table (ALB),
Male or Female, Nonsmoker or Smoker Table, age last birthday (unisex rates may
be required in some states) plus any flat extra amount assessed. The multiple
will be based on the insured's substandard rating.
Any changes in the cost of insurance rates will be made uniformly for all
insureds of the same issue ages, sexes, risk classes and whose coverage has been
in-force for the same length of time. No change in insurance class or cost will
occur on account of deterioration of the insured's health.
Because your Account Value and death benefit may vary from month to month, the
cost of insurance may also vary on each Monthly Activity Date. The cost of
insurance depends on your policy's amount at risk. Items which may affect the
amount at risk include the amount and timing of premium payments, investment
performance, fees and charges assessed, rider charges, policy loans and changes
to the Face Amount.
MONTHLY ADMINISTRATIVE CHARGE -- We deduct a monthly administrative charge from
your Account Value to compensate us for issue and administrative costs of the
policy. The current and maximum monthly administrative charge is $7.50 for
initial Face Amounts of $100,000 and above. The current and maximum charge for
initial Face Amounts below $100,000 is $10 per month.
MORTALITY AND EXPENSE RISK CHARGE -- We deduct a mortality and expense risk
charge each month from your Account Value. There are two components to the
mortality and expense risk charge. Part of the charge is assessed according to
your Account Value attributable to the Sub-Accounts, and the other part is
assessed based on the initial Face Amount of your policy. The mortality and
expense risk charge each month is equal to the sum of (a) and (b) where
(a) equals:
(i) the monthly accumulated value mortality and expense risk rate; multiplied
by
(ii) the sum of your accumulated values in the Sub-Accounts on the Monthly
Activity Date, prior to assessing the Monthly Deduction Amount.
and
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12 HARTFORD LIFE INSURANCE COMPANY
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(b) equals:
(i) the monthly mortality and expense risk rate per $1,000; multiplied by
(ii) the initial Face Amount; divided by
(iii) $1,000.
During the first 10 years, the current and maximum accumulated value mortality
and expense risk rate is 1/12 of 0.75% per month. Thereafter, the current and
maximum rate is 1/12 of 0.40% per month.
During the first 10 years, the Face Amount mortality and expense risk rate per
$1,000 of initial Face Amount is individualized based on the Insured's initial
Face Amount, issue age, sex, and insurance class. The charge is on the Policy
Specification pages of the contract. Thereafter, there is no charge.
The mortality and expense risk charge compensates us for mortality and expense
risks assumed under the policies. The mortality risk assumed is that the cost of
insurance charges are insufficient to meet actual claims. The expense risk
assumed is that the expense incurred in issuing, distributing and administering
the policies exceed the administrative charges and sales loads collected.
Hartford may keep any difference between cost it incurs and the charges it
collects.
FACE AMOUNT INCREASE FEE -- We deduct a dollar amount from your Account Value
for an unscheduled increase of the Face Amount on your policy. We deduct the fee
each month for twelve months after the increase. The fee is a per $1,000 amount
that varies by the attained age of the Insured. The monthly increase per 1,000
is on the Policy Specification pages of the contract.
RIDER CHARGE -- If your policy includes riders, a charge applicable to the
riders is made from the Account Value each month. The charge applicable to these
riders is to compensate Hartford for the anticipated cost of providing these
benefits and is specified on the applicable rider. The maximum charge for any
rider chosen is shown on the Policy Specification pages of the contract. For a
description of the riders available, see "Your Policy -- Supplemental Benefits."
SURRENDER CHARGE -- During the first 9 policy years, surrender charges will be
deducted from your Account Value if
- you surrender your policy;
- you decrease the Face Amount to an amount lower than it has ever been; or
- you take a withdrawal that causes the Face Amount to fall below the lowest
previous Face Amount.
The amount of surrender charge is individualized based on the Insured's age,
sex, and insurance class on the date of issue. The surrender charges by policy
year are on the Policy Specification pages of the contract. The charge
compensates us for expenses incurred in issuing the policy and the recovery of
acquisition costs. Hartford may keep any difference between cost it incurs and
the charges it collects. For partial surrender charges applicable to a decrease
in the Face Amount or withdrawal, see "Unscheduled Increases and Decreases in
the Face Amount."
CHARGES FOR THE FUNDS
The investment performance of each Fund reflects the management fee that the
Fund pays to its investment manager as well as other operating expenses that the
Fund incurs. Investment management fees are generally daily fees computed as a
percentage of a Fund's average daily net assets as an annual rate. Please read
the prospectus for each Fund for complete details.
YOUR POLICY
- --------------------------------------------------------------------------------
CONTRACT RIGHTS
POLICY OWNER, OR "YOU" -- As long as your policy is in force, you may exercise
all rights under the policy while the insured is alive and no beneficiary has
been irrevocably named.
BENEFICIARY -- You name the beneficiary in your application for the policy. You
may change the beneficiary (unless irrevocably named) while the insured is alive
by notifying us in writing. If no beneficiary is living when the insured dies,
the death benefit will be paid to you if living; or, otherwise, to your estate.
ASSIGNMENT -- You may assign your policy. Until you notify us in writing, no
assignment will be effective against us. We are not responsible for the validity
of any assignment.
STATEMENTS -- We will send you a statement at least once each year, showing:
- the current Account Value, Cash Surrender Value and Face Amount;
- the premiums paid, monthly deduction amounts and any loans since your last
statement;
- the amount of any Indebtedness;
- any notifications required by the provisions of your policy; and
- any other information required by the Insurance Department of the state
where your policy was delivered.
RIGHT TO EXAMINE A POLICY -- You have a limited right to return your policy for
cancellation. You may deliver or mail the policy to us or to the agent from whom
it was purchased any time during your free look period. Your free look period
begins on the day you get your policy and ends ten days after you get it (or
longer in some states). In such event, the policy will be rescinded and we will
pay an amount equal to the greater of the premiums paid for the policy less any
Indebtedness or the sum of: i) the Account Value less any Indebtedness, on the
date the returned policy is received by us or the agent from whom it was
<PAGE>
HARTFORD LIFE INSURANCE COMPANY 13
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purchased; and, ii) any deductions under the policy or charges associated with
the Separate Account. If your policy is replacing another policy, your free look
period and the amount paid to you upon the return of your policy vary by state.
CONTRACT LIMITATIONS
ALLOCATIONS TO SUB-ACCOUNTS AND THE FIXED ACCOUNT -- You may allocate amounts to
a maximum of nine (9) Sub-Accounts, or eight (8) Sub-Accounts and the Fixed
Account.
TRANSFERS OF ACCOUNT VALUE -- You may transfer amounts among the Fixed Account
and the Sub-Accounts subject to a charge described below. You may request
transfers in writing or by calling us at 1-800-231-5453. Transfers by telephone
may be made by your agent of record or by your attorney-in-fact pursuant to a
power of attorney. Telephone transfers may not be permitted in some states. We
will not be responsible for losses that result from acting upon telephone
requests reasonably believed to be genuine. We will employ reasonable procedures
to confirm that instructions communicated by telephone are genuine. The
procedures we follow for transactions initiated by telephone include requiring
callers to provide certain identifying information. All transfer instructions
communicated to us by telephone are tape recorded.
You may make one transfer per calendar month free of charge, excluding any
transfers made pursuant to your enrollment in the Dollar Cost Averaging Program.
Each subsequent transfer in excess of one per calendar month will be subject to
a transfer charge of up to $25. We reserve the right to limit at a future date
the size of transfers and remaining balances and to limit the number and
frequency of transfers.
TRANSFERS FROM THE FIXED ACCOUNT -- Except for transfers made under the Dollar
Cost Averaging Program, any transfers from the Fixed Account must occur during
the 30-day period following each policy anniversary, and, the maximum amount
transferred in any Policy Year will be the greater of $1,000 or 25% of the
Accumulated Value in the Fixed Account on the date of the transfer.
DEFERRAL OF PAYMENTS -- We may defer payment of any Cash Surrender Values,
withdrawals and loan amounts which are not attributable to the Sub-Accounts for
up to six months from the date of the request. If we defer payment for more than
30 days, we will pay you interest.
CHANGES TO CONTRACT OR SEPARATE ACCOUNT
MODIFICATION OF POLICY -- The only way the policy may be modified is by a
written agreement signed by our President, or one of our Vice Presidents,
Secretaries, or Assistant Secretaries.
SUBSTITUTION OF FUNDS -- We reserve the right to substitute the shares of any
other registered investment company for the shares of any Fund already purchased
or to be purchased in the future by the Separate Account provided that the
substitution has been approved by the Securities and Exchange Commission.
CHANGE IN OPERATION OF THE SEPARATE ACCOUNT -- The operation of the Separate
Account may be modified to the extent permitted by law, including deregistration
under the securities laws.
SEPARATE ACCOUNT TAXES -- Currently, no charge is made to the Separate Account
for federal, state and local taxes that may be allocable to the Separate
Account. A change in the applicable federal, state or local tax laws which
impose tax on Hartford and/ or the Separate Account may result in a charge
against the policy in the future. Charges for other taxes, if any, allocable to
the Separate Account may also be made.
OTHER BENEFITS
DOLLAR COST AVERAGING PROGRAM -- You may elect to allocate your Net Premiums
among the Sub-Accounts and the Fixed Account pursuant to the Dollar Cost
Averaging (DCA) program. If you choose the DCA program, your Net Premiums will
be deposited into the Hartford Money Market HLS Fund Sub-Account or the Fixed
Account. Amounts will be transferred monthly to the other investment options in
accordance with your premium allocation instructions. The dollar amount will be
allocated to the investment options that you specify, in the proportions that
you specify. If, on any transfer date, your Account Value allocated to the
Dollar Cost Averaging program is less than the amount you have elected to
transfer, your DCA program will terminate.
You may cancel your DCA election by notice in writing or by calling us at
1-800-231-5453. We reserve the right to change or discontinue the DCA program.
The main objective of a DCA program is to minimize the impact of short-term
price fluctuations. The DCA program allows you to take advantage of market
fluctuations. Since the same dollar amount is transferred to your selected
investment options at set intervals, the DCA program allows you to purchase more
accumulation units when prices are low and fewer accumulation units when prices
are high. Therefore, a lower average cost per accumulation unit may be achieved
over the long term. However, it is important to understand that the DCA program
does not assure a profit or protect against loss in a declining market.
SUPPLEMENTAL BENEFITS -- The following supplemental benefits are among the
options that may be included in a policy by rider, subject to the restrictions
and limitations set forth in the rider.
- TERM LIFE RIDER -- While the rider is in force, we will pay the term life
insurance amount upon receipt of due proof of death of the designated
insured, subject to the conditions stated in the rider.
- DEDUCTION AMOUNT WAIVER RIDER -- We will waive the Monthly Deduction
Amount in the event of total disability prior to the insured reaching age
65 and continuing for at least six months. If the Deduction Amount
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14 HARTFORD LIFE INSURANCE COMPANY
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Waiver Rider is added to your policy, the Monthly Deduction Amounts will
be increased to include the charges for the rider.
- WAIVER OF SPECIFIED AMOUNT DISABILITY BENEFIT RIDER -- If the insured
becomes totally disabled, we will credit the policy with an amount equal
to the Specified Amount Disability Benefit as defined in your policy, for
as long as the insured remains totally disabled.
- ACCIDENTAL DEATH BENEFIT RIDER -- We will increase in the amount paid upon
the death of the insured if the death results from an accident.
SETTLEMENT OPTIONS -- Proceeds under your policy may be paid in a lump sum or
may be applied to one of our four settlement options. The minimum amount that
may be placed under a settlement option is $5,000 (unless we consent to a lesser
amount), subject to our then-current rules. Once payments under the Second
Option, the Third Option or the Fourth Option begin, no surrender may be made
for a lump sum settlement in lieu of the life insurance payments. The following
payment options are available to you or your beneficiary. If a payment option is
not selected, proceeds will be paid in a lump sum. Your beneficiary may choose a
settlement option.
FIRST OPTION -- Interest Income
Payments of interest at the rate we declare (but not less than 3% per year) on
the amount applied under this option.
SECOND OPTION -- Income of Fixed Amount
Equal payments of the amount chosen until the amount applied under this option
(with interest of not less than 3% per year) is exhausted. The final payment
will be for the balance remaining.
THIRD OPTION -- Payments for a Fixed Period
An amount payable monthly for the number of years selected, which may be from
one to 30 years.
FOURTH OPTION -- Life Income
- LIFE ANNUITY -- An annuity payable monthly during the lifetime of the
annuitant and terminating with the last monthly payment due preceding the
death of the annuitant.
- LIFE ANNUITY WITH 120 MONTHLY PAYMENTS CERTAIN -- An annuity providing
monthly income to the annuitant for a fixed period of 120 months and for as
long thereafter as the annuitant shall live.
The policy provides for guaranteed dollar amounts of monthly payments for each
$1,000 applied under the four payment options. Under the Fourth Option, the
amount of each payment will depend upon the age of the Annuitant at the time the
first payment is due. If any periodic payment due any payee is less than $200,
we may make payments less often.
The table for the Fourth Option is based on the 1983a Individual Annuity
Mortality Table, set back one year and with a net investment rate of 3% per
annum. The tables for the First, Second and Third Options are based on a net
investment rate of 3% per annum. We may, however, from time to time, at our
discretion if mortality appears more favorable and interest rates justify, apply
other tables which will result in higher monthly payments for each $1,000
applied under one or more of the four payment options.
Other arrangements for income payments may be agreed upon.
BENEFITS AT MATURITY -- The scheduled maturity date is the last date on which
you may elect to make premium payments. Unless you elect to continue the policy
beyond this date, the policy will terminate and any Cash Surrender Value will be
paid to you.
If elected, the policy may continue in force after the scheduled maturity date
if (a) the policy was in force on the scheduled maturity date; and (b) the owner
of the policy (including any assignee of record) agrees in writing to this
continuation.
At the scheduled maturity date:
- - the death benefit will be reduced to the Account Value;
- - the Account Value, if any, will continue to fluctuate with investment
performance;
- - any loans will continue to accrue interest and become part of Indebtedness;
- - no future Monthly Deduction Amounts will be deducted;
- - no further premium payments will be accepted.
All additional benefits provided by rider will deem to have terminated at the
scheduled maturity date.
Otherwise, the policy will terminate on the scheduled maturity date.
CLASS OF PURCHASERS
REDUCED CHARGES FOR ELIGIBLE GROUPS -- Certain of the charges and deductions
described above may be reduced for policies issued in connection with a specific
plan, in accordance with our rules in effect as of the date the application for
a policy is approved. To qualify for such a reduction, a plan must satisfy
certain criteria, e.g., as to size of the plan, expected number of participants
and anticipated premium payment from the plan. Generally, the sales contacts and
effort, administrative costs and mortality cost per policy vary, based on such
factors as the size of the plan, the purposes for which policies are purchased
and certain characteristics of the plan's members. The amount of reduction and
the criteria for qualification will be reflected in the reduced sales effort and
administrative costs resulting from, and the different mortality experience
expected as a result of, sales to qualifying plans. We may modify, from time to
time on a uniform basis, both the amounts of reductions and the criteria for
qualification. Reductions in these charges will not be unfairly discriminatory
against any person, including the affected policy owners invested in the
Separate Account.
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HARTFORD LIFE INSURANCE COMPANY 15
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PREMIUMS
APPLICATION FOR A POLICY -- To purchase a policy you must submit an application
to us. Within limits, you may choose the initial Face Amount. Policies generally
will be issued only on the lives of insureds age 85 and under who supply
evidence of insurability satisfactory to us. Acceptance is subject to our
underwriting rules and we reserve the right to reject an application for any
reason. No change in the terms or conditions of a policy will be made without
your consent. The minimum initial premium is the amount required to keep the
policy in force for one month, but not less than $50.
Your policy will be effective on the policy date only after we receive all
outstanding delivery requirements and the initial premium payment. The policy
date is the date used to determine all future cyclical transactions on the
policy, such as Monthly Activity Date and policy years.
PREMIUM PAYMENT FLEXIBILITY -- You have flexibility as to when and in what
amounts you pay premiums. Prior to policy issue, you can choose a planned
premium, within a range we determined, based on the Face Amount and the
insured's sex (except where unisex rates apply), issue age and risk
classification. We will send you premium notices for planned premium. Such
notices may be sent on an annual, semi-annual or quarterly basis. You may also
have premium payments automatically deducted monthly from your checking account.
The planned premium and payment mode you select are shown on your policy's
specifications page. You may change the planned premium at any time, subject to
our minimum amount rules then in effect.
After the first premium has been paid, your subsequent premium payments are
flexible. The actual amount and frequency of payment will affect the Account
Value and could affect the amount and duration of insurance provided by the
policy. Your policy may lapse if the value of your policy becomes insufficient
to cover the Monthly Deduction Amounts. In such case you may be required to pay
additional premiums in order to prevent the policy from terminating. For details
see, "Lapse and Reinstatement."
You may pay additional premiums at any time prior to the scheduled maturity
date, subject to the following limitations:
- - The minimum premium that we will accept is $50 or the amount required to keep
the policy in force.
- - We reserve the right to refund any excess premiums that would cause the
policy to fail to meet the definition of life insurance under the Internal
Revenue Code.
- - We reserve the right to require evidence of insurability for any premium
payment that results in an increase in the death benefit greater than the
amount of the premium.
- - Any premium payment in excess of $1,000,000 is subject to our approval.
ALLOCATION OF PREMIUM PAYMENTS -- The initial Net Premium (and any additional
Net Premiums received by us before the end of the right to examine period) will
be allocated to the Hartford Money Market HLS Fund Sub-Account on the later of
the policy date or the date we receive the initial premium payment. We will then
allocate the value in the Hartford Money Market HLS Fund Sub-Account to the
Fixed Account and the Sub-Accounts according to the premium allocation specified
in the policy application upon the expiration of the right to examine policy
period, or the date we receive the final requirement to put the policy in force,
whichever is later.
You may change your premium allocation upon request in writing. Subsequent Net
Premiums will be allocated to the Fixed Account and the Sub-Accounts according
to your most recent written instructions as long as the number of investment
choices you are allocated to does not exceed nine (9), and the percentage you
allocate to each Sub-Account and/or the Fixed Account is in whole percentages.
If we receive a premium payment with a premium allocation instruction that does
not comply with the above rules, we will allocate the Net Premium pro rata based
on the values of your existing investment choices.
You will receive several different types of notifications as to what your
current premium allocation is. Each transaction confirmation received after we
receive a premium payment will show how a Net Premium has been allocated.
Additionally, each quarterly statement summarizes the current premium allocation
in effect for such policy.
ACCUMULATION UNITS -- Net Premiums allocated to the Sub-Accounts are used to
credit accumulation units to such Sub-Accounts.
The number of accumulation units in each Sub-Account to be credited to a policy
(including the initial allocation to the Hartford Money Market HLS Fund
Sub-Account) and the amount to be credited to the Fixed Account will be
determined, first, by multiplying the Net Premium by the appropriate allocation
percentage in order to determine the portion of Net Premiums or transferred
Account Value to be invested in the Fixed Account or the Sub-Account. Each
portion of the Net Premium or transferred Account Value to be invested in a
Sub-Account is then divided by the accumulation unit value in a particular Sub-
Account next computed following its receipt. The resulting figure is the number
of accumulation units to be credited to each Sub-Account.
ACCUMULATION UNIT VALUES -- The accumulation unit value for each Sub-Account
will vary to reflect the investment experience of the applicable Fund and will
be determined on each Valuation Day by multiplying the accumulation unit value
of the particular Sub-Account on the preceding Valuation Day by the net
investment factor for that Sub-Account for the Valuation Period then ended. The
net investment factor for each of the Sub-Accounts is equal to the net asset
value per share of the corresponding Fund at the end of the Valuation Period
(plus the per share amount of any dividend or capital gain distributions paid by
that Fund in the Valuation Period then ended) divided by
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16 HARTFORD LIFE INSURANCE COMPANY
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the net asset value per share of the corresponding Fund at the beginning of the
Valuation Period.
All valuations in connection with a policy, e.g., with respect to determining
Account Value, in connection with policy loans, or in calculation of death
benefits, or with respect to determining the number of accumulation units to be
credited to a policy with each premium payment other than the initial premium
payment will be made on the date the request or payment is received by us at the
National Service Center, provided such date is a Valuation Day; otherwise such
determination will be made on the next succeeding date which is a Valuation Day.
ACCOUNT VALUES -- Each policy will have an Account Value. There is no minimum
guaranteed Account Value.
The Account Value of a policy changes on a daily basis and will be computed on
each Valuation Day. The Account Value will vary to reflect the investment
experience of the Sub-Accounts, the interest credited to the Fixed Account and
the Loan Account, and the Monthly Deduction Amounts, Net Premiums paid, and any
withdrawals taken.
A policy's Account Value is related to the net asset value of the Funds
associated with the Sub-Accounts, if any, to which Net Premiums on the policy
have been allocated. The Account Value in the Sub-Accounts on any Valuation Day
is calculated by, first, multiplying the number of accumulation units in each
Sub-Account as of the Valuation Day by the then current value of the
accumulation units in that Sub-Account and then totaling the result for all of
the Sub-Accounts. A policy's Account Value equals the policy's value in all of
the Sub-Accounts, the Fixed Account, and the Loan Account. A policy's Cash Value
is equal to the Account Value less any applicable surrender charges. A policy's
Cash Surrender Value, which is the net amount available upon surrender of the
policy, is the Cash Value less any Indebtedness. See "Accumulation Unit Values,"
above.
We will pay death proceeds, Cash Surrender Values, partial withdrawals, and loan
amounts allocable to the Sub-Accounts within seven days after we receive all the
information needed to process the payment, unless the New York Stock Exchange is
closed for other than a regular holiday or weekend, trading is restricted by the
Commission or the Commission declares that an emergency exists.
DEATH BENEFITS AND POLICY VALUES
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DEATH BENEFIT -- Your policy provides for the payment of the death proceeds to
the named beneficiary upon receipt of due proof of the death of the insured.
Your policy will be effective on the policy date only after we receive all
outstanding delivery requirements and the initial premium payment. You must
notify us in writing as soon as possible after the death of the insured. The
death proceeds payable to the beneficiary equal the death benefit less any
Indebtedness and less any due and unpaid Monthly Deduction Amount occurring
during a grace period. The death benefit depends on the death benefit option you
select.
DEATH BENEFIT OPTIONS -- There are three death benefit options: the Level Death
Benefit Option ("Option A"), the Return of Account Value Death Benefit Option
("Option B") and the Return of Premium Death Benefit Option ("Option C").
Subject to the minimum death benefit described below, the death benefit under
each option is as follows:
- - Under Option A, the current Face Amount.
- - Under Option B, the current Face Amount plus the Account Value.
- - Under Option C, the current Face Amount plus the sum of premiums paid.
However, it will be no more than the current Face Amount plus the Option C
limit, which is currently $2.5 million.
OPTION CHANGE -- You may change your death benefit option by notifying us in
writing. Any change will become effective on the Monthly Activity Date following
the date we receive your request. If you elect to change to Option A, the Face
Amount will become that amount available as a death benefit immediately prior to
such option change. If you elect to change to Option B, the Face Amount will
become the amount available as a death benefit immediately prior to such option
change, minus the then-current Account Value. Changing your death benefit option
may result in a Surrender Charge. You should consult a tax adviser regarding the
possible adverse tax consequences resulting from a change in your death benefit
option.
MINIMUM DEATH BENEFIT -- Your policy has a minimum death benefit. We will
automatically increase the death benefit so that it will never be less than the
Account Value multiplied by the minimum death benefit percentage for the then
current year. This percentage varies according to the policy year and insured's
issue age, sex (where unisex rates are not used) and insurance class.
EXAMPLES OF MINIMUM DEATH BENEFIT
<TABLE>
<CAPTION>
A B
<S> <C> <C>
- -----------------------------------------------------
Face Amount $100,000 $100,000
- -----------------------------------------------------
Account Value 46,500 34,000
- -----------------------------------------------------
Specified Percentage 250% 250%
- -----------------------------------------------------
Death Benefit Option Level Level
- -----------------------------------------------------
</TABLE>
In Example A, the death benefit equals $116,250, i.e., the greater of $100,000
(the Face Amount) or $116,250 (the Account Value at the date of death of
$46,500, multiplied by the specified percentage of 250%). This amount, less any
outstanding Indebtedness, constitutes the death proceeds payable to the
beneficiary.
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HARTFORD LIFE INSURANCE COMPANY 17
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In Example B, the death benefit is $100,000, i.e., the greater of $100,000 (the
Face Amount) or $85,000 (the Account Value of $34,000, multiplied by the
specified percentage of 250%).
UNSCHEDULED INCREASES AND DECREASES IN FACE AMOUNT -- At any time after the
first policy year, you may request in writing to change the Face Amount. The
minimum amount by which the Face Amount can be increased or decreased is based
on our rules then in effect.
We reserve the right to limit the number of increases or decreases made under a
policy to no more than one in any 12 month period.
All requests to increase the Face Amount must be applied for on a new
application and accompanied by your policy. All requests will be subject to
evidence of insurability satisfactory to us. Any increase approved by us will be
effective on the Monthly Activity Date shown on the new policy specifications
page, provided that the Monthly Deduction Amount for the first month after the
effective date of the increase is made. We deduct a dollar amount from your
Account Value for an unscheduled increase of the Face Amount of your policy. We
deduct the fee each month for twelve months after the increase. The fee is a per
$1,000 amount that varies by the attained age of the insured.
A decrease in the Face Amount will be effective on the Monthly Activity Date
following the date we receive your request in writing. The remaining Face Amount
must not be less than that specified in our minimum rules then in effect. If
during the surrender charge period, you decrease your Face Amount to an amount
lower than it has ever been, a partial surrender charge will be assessed.
The surrender charge assessed will be:
(a) the surrender charge applicable to the then current policy year, if any;
multiplied by
(b) the percentage described below.
The percentage will be determined by:
(i) subtracting the new Face Amount from the lowest previous Face Amount; and
(ii) dividing that difference by the lowest previous Face Amount.
The surrender charge assessed will be deducted from your Account Value on the
Monthly Activity Date on which the decrease becomes effective. We will also
reduce the surrender charges applicable to future policy years and provide you a
revised schedule of surrender charges.
CHARGES AND CONTRACT VALUES -- Your contract values decrease due to the
deduction of policy charges. Contract values may increase or decrease depending
on investment performance. Investment expenses and fees reduce the investment
performance of the Sub-Accounts. Fluctuations in your account value may have an
effect on your death benefit. If your contract lapses, the contract terminates
and no death benefit will be paid.
MAKING WITHDRAWALS FROM YOUR POLICY
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SURRENDER -- Provided your policy has a Cash Surrender Value, you may surrender
your policy to us. We will pay you the Cash Surrender Value. Our liability under
the policy will cease as of the date of your request for surrender, or the date
you request to have your policy surrendered, if later.
WITHDRAWALS -- One withdrawal is allowed per calendar month. Withdrawals may be
subject to a surrender charge, see "Surrender Charge." You may request a
withdrawal in writing. The minimum withdrawal allowed is $500. The maximum
partial withdrawal is the Cash Surrender Value, minus $1,000. If the death
benefit option then in effect is Option A or Option C, the Face Amount will be
reduced by the amount of any partial withdrawal. Unless specified, the
withdrawal will be deducted on a pro rata basis from the Fixed Account and the
Sub-Accounts. You may be assessed a charge of up to $10 for each partial
withdrawal.
LOANS
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AVAILABILITY OF LOANS -- At any time while the policy is in force, you may
borrow against the policy by assigning it as sole security to us. Any new loan
taken together with any existing Indebtedness may not exceed the Cash Surrender
Value on the date we grant a loan. The minimum loan amount that we will allow is
$500.
Unless you specify otherwise, all loan amounts will be transferred on a pro rata
basis from the Fixed Account and each of the Sub-Accounts to the Loan Account.
If total Indebtedness equals or exceeds the Cash Value on any Monthly Activity
Date, the policy will then go into default. See "Lapse and Reinstatement."
PREFERRED INDEBTEDNESS -- If, at any time after the tenth (10th) policy
anniversary, your Account Value exceeds the total of all premiums paid since
issue, a portion of your Indebtedness may qualify as preferred. Preferred
Indebtedness is charged a lower interest rate than non-preferred Indebtedness,
if any. The maximum amount of preferred Indebtedness is the amount by which the
Account Value exceeds the total premiums paid and is determined on each Monthly
Activity Date.
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18 HARTFORD LIFE INSURANCE COMPANY
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LOAN REPAYMENTS -- You can repay all or any part of a loan at any time while
your policy is in force and the insured is alive. The amount of your policy loan
repayment will be deducted from the Loan Account. It will be allocated among the
Fixed Account and Sub-Accounts in the same percentage as premiums are allocated.
EFFECT OF LOANS ON ACCOUNT VALUE -- A loan, whether or not repaid, will have a
permanent effect on your Account Value. This effect occurs because the
investment results of each Sub-Account will apply only to the amount remaining
in such Sub-Accounts. In addition, the rate of interest credited to the Fixed
Account will usually be different than the rate credited to the Loan Account.
The longer a loan is outstanding, the greater the effect on your Account Value
is likely to be. Such effect could be favorable or unfavorable. If the Fixed
Account and the Sub-Accounts earn more than the annual interest rate for funds
held in the Loan Account, your Account Value will not increase as rapidly as it
would have had no loan been made. If the Fixed Account and the Sub-Accounts earn
less than the Loan Account, then your Account Value will be greater than it
would have been had no loan been made. Additionally, if not repaid, the
aggregate amount of the outstanding Indebtedness will reduce the death proceeds
and the Cash Surrender Value otherwise payable.
CREDITED INTEREST -- Any amounts in the Loan Account will be credited with
interest at an annual rate of 3.5%.
INTEREST CHARGED ON INDEBTEDNESS -- Interest will accrue daily on the
Indebtedness at the policy loan rate. Because the interest charged on
Indebtedness may exceed the rate credited to the Loan Account, the Indebtedness
may grow faster than the Loan Account. If this happens, any difference between
the value of the Loan Account and the Indebtedness will be transferred on each
Monthly Activity Date from the Fixed Account and Sub-Accounts to the Loan
Account on a pro rata basis.
POLICY LOAN RATES -- The table below shows the interest rates we will charge on
your Indebtedness.
<TABLE>
<CAPTION>
INTEREST RATE
PORTION OF CHARGED
DURING POLICY YEARS INDEBTEDNESS EQUALS 3.5% PLUS:
<S> <C> <C>
- ----------------------------------------------------------
1-10 All 2%
- ----------------------------------------------------------
11 and later Preferred 0%
Non-Preferred 1%
- ----------------------------------------------------------
</TABLE>
LAPSE AND REINSTATEMENT
- --------------------------------------------------------------------------------
LAPSE AND GRACE PERIOD -- During the first three policy years, your policy will
be in default on any Monthly Activity Date on which the Account Value less
Indebtedness is not sufficient to cover the Monthly Deduction Amount.
During the fourth policy year and thereafter, your policy will be in default on
any Monthly Activity Date if the Cash Surrender Value is not sufficient to cover
the Monthly Deduction Amount.
A 61-day "Grace Period" will begin from the date of any policy default. Upon
default, we will mail you and any assignee written notice of the amount of
premium that will be required to continue the policy in force. The premium
required will be no greater than the amount required to pay three Monthly
Deduction Amounts as of the date the Policy Grace period began. If the No-Lapse
Guarantee is available and sufficient premium has not been paid by the end of
the Grace Period, the death benefit option will become level, any policy riders
will terminate and any future unscheduled increases are cancelled. If the
insured dies during the Grace Period, we will pay the death proceeds.
NO-LAPSE GUARANTEE DEFAULT AND GRACE PERIOD -- On every Monthly Activity Date
during the No-Lapse Guarantee period, we will compare the cumulative premium
payments received, less Indebtedness and less withdrawals, to the Cumulative
No-Lapse Guarantee Premium.
If the cumulative premium payments received, less Indebtedness and less
withdrawals, are less than the Cumulative No-Lapse Guarantee Premium, the
No-Lapse Guarantee will be deemed to be in default as of that Monthly Activity
Date and the No-Lapse Guarantee Grace Period will begin. We will mail you and
any assignee written notice of the amount of premium required to continue the
No-Lapse Guarantee.
The No-Lapse Guarantee will be removed from the policy at the end of the
No-Lapse Guarantee Grace Period if we have not received the amount of premium
required to continue such guarantee.
NO-LAPSE GUARANTEE -- The policy will remain in force at the end of the policy
Grace Period as long as the No-Lapse Guarantee is available, as described below.
The No-Lapse Guarantee is available so long as:
(a) the policy is in the No-Lapse Guarantee Period; and
(b) on each Monthly Activity Date during that period, the cumulative premiums
paid into the policy, less Indebtedness and less withdrawals from the
policy, equal or exceed an amount known as the Cumulative No-Lapse Guarantee
Premium.
The length of the No-Lapse Guarantee Period is the lesser of 5 years and to age
80. The Cumulative No-Lapse Guarantee Premium is the premium required to
maintain the No-Lapse Guarantee.
If the No-Lapse Guarantee is available and you fail to pay the required premium
as defined in your lapse notice by the end of the policy grace period, the
No-Lapse Guarantee will then go into effect. The policy will remain in force,
however:
(a) all riders will terminate;
(b) the Death Benefit Option becomes Level;
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HARTFORD LIFE INSURANCE COMPANY 19
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(c) The Death Benefit will equal the current Face Amount; and
(d) Any future scheduled Increases in the Face Amount will be canceled.
As long as the policy remains in default and the No-Lapse Guarantee is
available, the No-Lapse Guarantee will remain in effect on each subsequent
Monthly Activity Dates. You may be required to make premium payments to keep the
No-Lapse Guarantee available, as described above.
If during the No-Lapse Guarantee Period, the Face Amount is increased or
decreased, or riders are added or increased, deleted or reduced, a new monthly
No-Lapse Guarantee Premium will be calculated. We will send you a notice of the
new Monthly No-Lapse Guarantee Premium, which will be used in calculating the
Cumulative No-Lapse Guarantee Premium in subsequent months.
REINSTATEMENT -- Prior to the death of the insured, a policy may be reinstated
prior to the maturity date, provided such policy has not been surrendered for
cash, and provided further that:
1. You request reinstatement in writing within five years after termination;
2. You submit satisfactory evidence of insurability to us;
3. Any Indebtedness existing at the time the policy was terminated is repaid or
carried over to the reinstated policy; and
4. You pay a premium sufficient to cover (a) all Monthly Deduction Amounts that
are due and unpaid during the Grace Period and (b) the sum of Monthly
Deduction Amounts for the next three months after the date the policy is
reinstated.
The Account Value on the reinstatement date equals:
1. The Cash Value at the time of policy termination; plus
2. Net Premiums derived from premiums paid at the time of policy reinstatement;
minus
3. the Monthly Deduction Amounts that were due and unpaid during the Grace
Period; plus
4. the Surrender Charge at the time of policy reinstatement. The Surrender
Charge is based on the duration from the original policy date.
TAXES
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GENERAL
Since federal tax law is complex, the tax consequences of purchasing this policy
will vary depending on your situation. You may need tax or legal advice to help
you determine whether purchasing this policy is right for you.
Our general discussion of the tax treatment of this policy is based on our
understanding of federal income tax laws as they are currently interpreted. A
detailed description of all federal income tax consequences regarding the
purchase of this policy cannot be made in the prospectus. We also do not discuss
state, municipal or other tax laws that may apply to this policy. For detailed
information, you should consult with a qualified tax adviser familiar with your
situation.
TAXATION OF HARTFORD AND THE SEPARATE ACCOUNT
The Separate Account is taxed as a part of Hartford which is taxed as a life
insurance company under Subchapter L of the Internal Revenue Code of 1986, as
amended (the "Code"). Accordingly, the Separate Account will not be taxed as a
"regulated investment company" under Subchapter M of the Code. Investment income
and realized capital gains on the assets of the Separate Account (the underlying
Funds) are reinvested and are taken into account in determining the value of the
Accumulation Units. As a result, such investment income and realized capital
gains are automatically applied to increase reserves under the policy. (See
"Premiums -- Accumulation Unit Values").
Hartford does not expect to incur any federal income tax on the earnings or
realized capital gains attributable to the Separate Account. Based upon this
expectation, no charge is currently being made to the Separate Account for
federal income taxes. If Hartford incurs income taxes attributable to the
Separate Account or determines that such taxes will be incurred, it may assess a
charge for such taxes against the Separate Account.
INCOME TAXATION OF POLICY BENEFITS -- GENERALLY
For federal income tax purposes, the Policies should be treated as life
insurance contracts under Section 7702 of the Code. The death benefit under a
life insurance contract is generally excluded from the gross income of the
beneficiary. Also, a life insurance policy owner is generally not taxed on
increments in the contract value until the policy is partially or completely
surrendered. Section 7702 limits the amount of premiums that may be invested in
a policy that is treated as life insurance. Hartford intends to monitor premium
levels to assure compliance with the Section 7702 requirements.
Hartford also believes that any loan received under a policy will be treated as
Indebtedness of the policy owner, and that no part of any loan under a policy
will constitute income to the policy owner. A surrender or assignment of the
policy may have tax consequences depending upon the circumstances. Policy owners
should consult a qualified tax adviser concerning the effect of such changes.
During the first fifteen policy years, an "income first" rule generally applies
to distributions of cash required to be made under Code Section 7702 because of
a reduction in benefits under the policy.
<PAGE>
20 HARTFORD LIFE INSURANCE COMPANY
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The Maturity Date Extension Provision allows a policy owner to extend the
Maturity Date to the date of the death of the insured. If the Maturity Date of
the policy is extended, Hartford believes that the policy will continue to be
treated as a life insurance contract for federal income tax purposes after the
scheduled Maturity Date. However, due to the lack of specific guidance on this
issue, the result is not certain. If the policy is not treated as a life
insurance contract for federal income tax purposes after the scheduled Maturity
Date, among other things, the Death Proceeds may be taxable to the recipient.
The policy owner should consult a qualified tax adviser regarding the possible
adverse tax consequences resulting from an extension of the scheduled Maturity
Date.
MODIFIED ENDOWMENT CONTRACTS
Code Section 7702A applies an additional test, the "seven-pay" test, to life
insurance contracts. The seven-pay test provides that premiums cannot be paid at
a rate more rapidly than that allowed by the payment of seven annual premiums
using specified computational rules described in Section 7702A(c). A modified
endowment contract ("MEC") is a life insurance policy that either:
(i) satisfies the Section 7702 definition of life insurance, but fails the
seven-pay test of Section 7702A or (ii) is exchanged for a MEC.
If the policy satisfies the seven-pay test at issuance, distributions and loans
made thereafter will not be subject to the MEC rules, unless the policy is
changed materially. The seven-pay test will be applied anew at any time the
policy undergoes a material change, which includes an increase in the Face
Amount. In addition, if there is a reduction in benefits under the policy within
the first seven years, the seven-pay test is applied as if the policy had
initially been issued at the reduced benefit level. Any reduction in benefits
attributable to the nonpayment of premiums will not be taken into account for
purposes of the seven-pay test if the benefits are reinstated within 90 days
after the reduction.
A policy that is classified as a MEC is eligible for certain aspects of the
beneficial tax treatment accorded to life insurance. That is, the death benefit
is excluded from income and increments in value are not subject to current
taxation. However, if the contract is classified as a MEC then withdrawals from
the contract will be considered first as withdrawals of income and then as a
recovery of premium payments. Thus, withdrawals will be includible in income to
the extent the contract value exceeds the investment in the contract. The amount
of any loan (including unpaid interest thereon) under the contract will be
treated as a withdrawal from the contract for tax purposes. In addition, if the
owner assigns or pledges any portion of the value of a contract (or agrees to
assign or pledge any portion), then such portion will be treated as a withdrawal
from the contract for tax purposes. Taxable withdrawals are subject to an
additional 10% tax, with certain exceptions. The owner's investment in the
contract is increased by the amount includible in income with respect to such
assignment, pledge, or loan, though it is not affected by any other aspect of
the assignment, pledge, or loan (including its release or repayment).
Generally, only distributions and loans made in the first year in which a policy
becomes a MEC, and in subsequent years, are taxable. However, distributions and
loans made in the two years prior to a policy's failing the seven-pay test are
deemed to be in anticipation of failure and are subject to tax.
Before assigning, pledging, or requesting a loan under a policy that is a MEC,
an owner should consult a qualified tax adviser.
All MEC policies that are issued within any calendar year to the same policy
owner by one company or its affiliates are treated as one MEC policy for the
purpose of determining the taxable portion of any loan or distribution.
Hartford has instituted procedures to monitor whether a policy may become
classified as a MEC after issue.
ESTATE AND GENERATION SKIPPING TAXES
When the Insured dies, the death proceeds will generally be includible in the
policy owner's estate for purposes of federal estate tax if the Insured owned
the policy. If the policy owner was not the Insured, the fair market value of
the policy would be included in the policy owner's estate upon the policy
owner's death. The policy would not be includible in the Insured's estate if the
Insured neither retained incidents of ownership at death nor had given up
ownership within three years before death.
The federal estate tax is integrated with the federal gift tax under a unified
rate schedule and unified credit which shelters up to $650,000 (for 1999) from
the estate and gift tax. The Taxpayer Relief Act of 1997 gradually raises the
credit over the next seven years to $1,000,000. In addition, an unlimited
marital deduction may be available for federal estate and gift tax purposes. The
unlimited marital deduction permits the deferral of taxes until the death of the
surviving spouse.
If the policy owner (whether or not he or she is the Insured) transfers
ownership of the policy to someone two or more generations younger, the transfer
may be subject to the generation skipping transfer tax, the taxable amount being
the value of the policy. The generation-skipping transfer tax provisions
generally apply to transfers which would be subject to the gift and estate tax
rules. Individuals are generally allowed an aggregate generation skipping
transfer exemption of $1 million as adjusted for inflation. Because these rules
are complex, the policy owner should consult with a qualified tax adviser for
specific information if ownership is passing to younger generations.
DIVERSIFICATION REQUIREMENTS
The Code requires that investments supporting your policy be adequately
diversified. Code Section 817 provides that a variable life insurance contract
will not be treated as a life insurance contract for any period during which the
investments made by the separate account or underlying fund are not adequately
diversified. If a contract is not treated as a life insurance contract, the
policy owner will be subject to income tax on annual increases in cash value.
<PAGE>
HARTFORD LIFE INSURANCE COMPANY 21
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The Treasury Department's diversification regulations require, among other
things, that:
- - no more than 55% of the value of the total assets of the segregated asset
account underlying a variable contract is represented by any one investment,
- - no more than 70% is represented by any two investments,
- - no more than 80% is represented by any three investments and
- - no more than 90% is represented by any four investments.
In determining whether the diversification standards are met, all securities of
the same issuer, all interests in the same real property project, and all
interests in the same commodity are each treated as a single investment. In the
case of government securities, each government agency or instrumentality is
treated as a separate issuer.
A separate account must be in compliance with the diversification standards on
the last day of each calendar quarter or within 30 days after the quarter ends.
If an insurance company inadvertently fails to meet the diversification
requirements, the company may still comply within a reasonable period and avoid
the taxation of contract income on an ongoing basis. However, either the company
or the policy owner must agree to pay the tax due for the period during which
the diversification requirements were not met.
We monitor the diversification of investments in the separate accounts and test
for diversification as required by the Code. We intend to administer all
policies subject to the diversification requirements in a manner that will
maintain adequate diversification.
OWNERSHIP OF THE ASSETS IN THE SEPARATE ACCOUNT
In order for a variable life insurance contract to qualify for tax deferral,
assets in the separate accounts supporting the contract must be considered to be
owned by the insurance company and not by the policy owner. It is unclear under
what circumstances an investor is considered to have enough control over the
assets in the separate account to be considered the owner of the assets for tax
purposes.
The IRS has issued several rulings discussing investor control. These rulings
say that certain incidents of ownership by the policy owner, such as the ability
to select and control investments in a separate account, will cause the policy
owner to be treated as the owner of the assets for tax purposes.
In its explanation of the diversification regulations, the Treasury Department
recognized that the temporary 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." The explanation further
indicates that "the temporary regulations provide that in appropriate cases a
segregated asset account may include multiple sub-accounts, but do not specify
the extent to which policyholders may direct their investments to particular
sub-accounts without being treated as the owners of the underlying assets.
Guidance on this and other issues will be provided in regulations or revenue
rulings under Section 817(d), relating to the definition of variable contract."
The final regulations issued under Section 817 did not provide guidance
regarding investor control, and as of the date of this prospectus, guidance has
yet to be issued. We do not know if additional guidance will be issued. If
guidance is issued, we do not know if it will have a retroactive effect.
Due to the lack of specific guidance on investor control, there is some
uncertainty about when a policy owner is considered the owner of the assets for
tax purposes. We reserve the right to modify the policy, as necessary, to
prevent you from being considered the owner of assets in the separate account.
TAX DEFERRAL DURING ACCUMULATION PERIOD
Under existing provisions of the Code, except as described below, any increase
in an owner's Investment Value is generally not taxable to the policy owner
unless amounts are received (or are deemed to be received) under the policy
prior to the insured's death. If the policy is surrendered or matures, the
amount received will be includable in the policy owner's income to the extent
that it exceeds the policy owner's "investment in the contract." (If there is
any debt at the time of a surrender, then such debt will be treated as an amount
distributed to the owner.) The "investment in the contract" is the aggregate
amount of premium payments and other consideration paid for the policy, less the
aggregate amount received previously under the policy to the extent such amounts
received were excluded from gross income. Whether partial withdrawals (or other
such amounts deemed to be distributed) from the policy constitute income to the
policy owner depends, in part, upon whether the policy is considered a modified
endowment contract for Federal income tax purposes.
LIFE INSURANCE PURCHASED FOR USE IN SPLIT DOLLAR ARRANGEMENTS
On January 26, 1996, the IRS released a technical advice memorandum ("TAM") on
the taxability of life insurance policies used in certain split dollar
arrangements. A TAM, issued by the National Office of the IRS, provides advice
as to the internal revenue laws, regulations, and related statutes with respect
to a specific set of facts and a specific taxpayer. In the TAM, among other
things, the IRS concluded that an employee was subject to current taxation on
the excess of the cash surrender value of the policy over the premiums to be
returned to the employer. Purchasers of life insurance policies to be used in
split dollar arrangements are strongly advised to consult with a qualified tax
adviser to determine the tax treatment resulting from such an arrangement.
<PAGE>
22 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
FEDERAL INCOME TAX WITHHOLDING
If any amounts are deemed to be current taxable income to the policy owner, such
amounts will be subject to federal income tax withholding and reporting,
pursuant to the Code.
NON-INDIVIDUAL OWNERSHIP OF POLICIES
In certain circumstances, the Code limits the application of specific tax
advantages to individual owners of life insurance contracts. Prospective policy
owners which are not individuals should consult a qualified tax adviser to
determine the potential impact on the purchaser.
OTHER
Federal estate tax, state and local estate, inheritance and other tax
consequences of ownership, or receipt of policy proceeds depend on the
circumstances of each policy owner or beneficiary. A qualified tax adviser
should be consulted to determine the impact of these taxes.
LIFE INSURANCE PURCHASES BY NONRESIDENT ALIENS AND FOREIGN CORPORATIONS
The discussion above provides general information regarding U.S. federal income
tax consequences to life insurance purchasers that are U.S. citizens or
residents. Purchasers that are not U.S. citizens or residents will generally be
subject to U.S. federal income tax and withholding on taxable distributions from
life insurance policies at a 30% rate, unless a lower treaty rate applies. In
addition, purchasers may be subject to state and/or municipal taxes and taxes
that may be imposed by the purchaser's country of citizenship or residence.
Prospective purchasers are advised to consult with a qualified tax adviser
regarding U.S. state, and foreign taxation with respect to a life insurance
policy purchase.
LEGAL PROCEEDINGS
- --------------------------------------------------------------------------------
There are no pending material legal proceedings to which the Separate Account is
a party.
<PAGE>
HARTFORD LIFE INSURANCE COMPANY 23
- --------------------------------------------------------------------------------
GLOSSARY OF SPECIAL TERMS
ACCOUNT VALUE: the total of all amounts in the Fixed Account, Loan Account and
Sub-Accounts.
CASH SURRENDER VALUE: the Cash Value less all Indebtedness
CASH VALUE: the Account Value less any applicable Surrender Charges.
CUMULATIVE NO-LAPSE GUARANTEE PREMIUM: the premium required to maintain the
No-Lapse guarantee. Initially, the Cumulative No-Lapse Guarantee Premium is the
No-Lapse Guarantee Premium. On each Monthly Activity Date thereafter, the
Cumulative No-Lapse Guarantee Premium is: (a) the Cumulative No-Lapse Guarantee
Premium on the previous Monthly Activity Date; plus (b) the current No-Lapse
Guarantee Premium.
FACE AMOUNT: an amount we use to determine the Death Benefit. On the policy
date, the Face Amount equals the initial Face Amount shown in your policy.
Thereafter, it may change under the terms of the policy.
FIXED ACCOUNT: part of our general account to which all or a portion of the
Account Value may be allocated.
FUNDS: the registered open-end management companies in which assets of the
Separate Account may be invested.
INDEBTEDNESS: all loans taken on the policy, plus any interest due or accrued
minus any loan repayments.
LOAN ACCOUNT: an account established for any amounts transferred from the Fixed
Account and Sub-Accounts as a result of loans. The amounts in the Loan Account
are credited with interest and are not subject to the investment experience of
any Sub-Accounts.
MONTHLY ACTIVITY DATE: the policy date and the same date in each succeeding
month as the policy date. However, whenever the Monthly Activity Date falls on a
date other than a Valuation Day, the Monthly Activity Date will be deemed to be
the next Valuation Day.
NET PREMIUM: the amount of premium credited to Account Value. It is premium paid
minus the sales load and tax charge.
NO-LAPSE GUARANTEE PREMIUM: the amount of monthly premium required to keep the
No-Lapse guarantee available, as shown in the policy's specifications page, and
used to calculate the Cumulative No-Lapse Guarantee Premium.
SEPARATE ACCOUNT: an account which has been established by us to separate the
assets funding the variable benefits for the class of contracts to which the
policy belongs from our other assets.
SUB-ACCOUNT: the subdivisions of the Separate Account
SURRENDER CHARGE: a charge that may be assessed if you surrender your policy or
the Face Amount is decreased.
VALUATION DAY: the date on which a Sub-Account is valued. This occurs every day
the New York Stock Exchange is open for trading.
WE, US, OUR: Hartford Life Insurance Company.
YOU, YOUR: the owner of the policy.
<PAGE>
24 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
WHERE YOU CAN FIND MORE INFORMATION
You can call us at 1-800-231-5453 to ask us questions, or to get a Statement of
Additional Information, free of charge. The Statement of Additional Information
contains more information about this life insurance policy and, like this
prospectus, is filed with the Securities and Exchange Commission. You should
read the Statement of Additional Information because you are bound by the terms
contained in it.
We file other information with the Securities and Exchange Commission. You may
read and copy any document we file at the SEC's public reference room in
Washington, DC 20549-6009. Please call the SEC at 1-800-SEC-0330 for further
information. Our SEC filings are also available to the public at the SEC's web
site at http://www.sec.gov.
<PAGE>
HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
STATEMENT OF ADDITIONAL INFORMATION
SEPARATE ACCOUNT VL I
This Statement of Additional Information is not a prospectus. We will send you a
prospectus if you write us at P.O. Box 2999, Hartford, CT 06104-2999, or if you
call us at 1-800-231-5453.
DATE OF PROSPECTUS: , 2000
DATE OF STATEMENT OF ADDITIONAL INFORMATION: , 2000
<PAGE>
2 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
TABLE OF CONTENTS
<TABLE>
<CAPTION>
PAGE
----
<S> <C>
GENERAL INFORMATION AND HISTORY 3
- ----------------------------------------------------------------------
SERVICES 5
- ----------------------------------------------------------------------
EXPERTS 5
- ----------------------------------------------------------------------
DISTRIBUTION OF THE POLICIES 6
- ----------------------------------------------------------------------
ADDITIONAL INFORMATION ABOUT CHARGES 6
- ----------------------------------------------------------------------
ILLUSTRATION OF BENEFITS 8
- ----------------------------------------------------------------------
FINANCIAL STATEMENTS
- ----------------------------------------------------------------------
</TABLE>
<PAGE>
STATEMENT OF ADDITIONAL INFORMATION 3
- --------------------------------------------------------------------------------
GENERAL INFORMATION AND HISTORY
HARTFORD LIFE INSURANCE COMPANY -- Hartford Life Insurance Company is a stock
life insurance company engaged in the business of writing life insurance, both
individual and group, in all states of the United States and the District of
Columbia. We were originally incorporated under the laws of Massachusetts on
June 5, 1902, and subsequently redomiciled to Connecticut. Our offices are
located in Simsbury, Connecticut; however, our mailing address is P.O. Box 2999,
Hartford, CT 06104-2999. We are ultimately controlled by The Hartford Financial
Services Group, Inc., one of the largest financial service providers in the
United States.
The following table shows a brief description of the business experience of
officers and directors of Hartford Life Insurance Company:
<TABLE>
<CAPTION>
POSITION WITH OTHER BUSINESS PROFESSION,
HARTFORD; VOCATION OR EMPLOYMENT FOR PAST
NAME YEAR OF ELECTION FIVE YEARS; OTHER DIRECTORSHIPS
<S> <C> <C>
Wendell J. Bossen Vice President, 1992** Vice President (1992-Present), Hartford Life and Accident
Insurance Company; President (1992-Present), International
Corporate Marketing Group, Inc.; Executive Vice President
(1984-1992), Mutual Benefit.
Gregory A. Boyko Senior Vice President, Vice President and Controller (1995-1997), Hartford Life
Director 1997 Insurance Company; Director (1997-Present); Senior Vice
President (1997-Present), Chief Financial Officer &
Treasurer (1997-1998); Vice President & Controller
(1995-1997), Hartford Life and Accident Insurance Company;
Senior Vice President, Chief Financial Officer & Treasurer
(1997-Present), Hartford Life, Inc.; Chief Financial Officer
(1994-1995), IMG American Life; Senior Vice President
(1992-1994), Connecticut Mutual Life Insurance Company.
Peter W. Cummins Senior Vice President, Vice President (1989-1997); Director of Broker Dealer Sales-
1997 ILAD (1989-1992), Hartford; Senior Vice President
(1997-Present) Vice President (1989-1997); Director of
Broker Dealer Sales-ILAD (1989-1991), Hartford Life and
Accident Insurance Company.
Timothy M. Fitch Vice President, 1995 Assistant Vice President (1992-1995), Hartford; Vice
President (1995-Present); Actuary (1994-Present); Assistant
Vice President (1992-1995), Hartford Life and Accident
Insurance Company.
Mary Jane B. Fortin Vice President & Chief Vice President & Chief Accounting Officer, (1998-Present),
Accounting Officer, Hartford Life & Annuity Insurance Company; Vice President &
1998 Chief Accounting Officer, (1998-Present), Royal Life
Insurance Company of America; Vice President & Chief
Accounting Officer (1998-Present) Alpine Life Insurance
Company; Chief Accounting Officer (1997-Present), Hartford
Life, Inc.; Director, Finance (1995-1997), Value
Health, Inc.; Senior Manager (1993-1995), Coopers and
Lybrand; Audit Manager (1993-1996) Arthur Andersen & Co.
David T. Foy Senior Vice President Senior Vice President (1998-Present), Vice President (1998),
and Assistant Vice President (1995-1998), Hartford; Senior Vice
Treasurer, 1998 President (1998-Present), Hartford Life and Accident
Insurance Company; Director, Strategic Planning Corporate
Finance (1995-1996), IA Product Development (1994-1995),
Hartford; Various Actuarial Roles (1989-1993), Milliman &
Robertson.
</TABLE>
<PAGE>
4 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
<TABLE>
<S> <C> <C>
Lynda Godkin Senior Vice President, Associate General Counsel (1995-1996); Assistant General
1997 Counsel and Secretary (1994-1995); Counsel (1990-1994),
General Counsel, 1996 Hartford; Director (1997-Present); Senior Vice President
Corporate Secretary, (1997-Present); General Counsel (1996-Present); Corporate
1995 Secretary (1995-Present); Associate General Counsel
Director, 1997 (1995-1996); Assistant General Counsel and Secretary
(1994-1995); Counsel (1990-1994), Hartford Life and Accident
Insurance Company; Vice President and General Counsel
(1997-Present), Hartford Life, Inc.
Lois W. Grady Senior Vice President, Vice President (1993-1998); Assistant Vice President
1998 (1987-1993), Hartford; Senior Vice President, 1998); Vice
President (1993-1997); Assistant Vice President (1987-1993),
Hartford Life and Accident Insurance Company.
Stephen T. Joyce Vice President, 1997 Assistant Vice President (1994-1997), Hartford; Assistant
Vice President (1994-1997), Hartford Life and Accident
Insurance Company.
Michael D. Keeler Vice President, 1998 Vice President (1998-Present); Hartford Life and Accident
Insurance Company; Vice President (1995-1997), Providian
Insurance; Supervisor/Manager (1985-1995), U.S. West
Communications.
Robert A. Kerzner Senior Vice President, Vice President, (1995-1998); Regional Vice President
1998 (1991-1994), Hartford; Vice President (1994-1997), Hartford
Life and Accident Insurance Company.
Thomas M. Marra Executive Vice Senior Vice President (1994-1995); Vice President
President, (1989-1994); Actuary (1987-1995), Hartford; Director
1995 (1994-Present); Executive Vice President (1995-Present);
Director, 1994* Senior Vice President (1994-1995); Director, Individual Life
and Annuity Division (1994-Present); Actuary (1987-1997),
Hartford Life and Accident Insurance Company; Executive Vice
President, Individual Life and Annuities (1997-Present),
Hartford Life, Inc.
Joseph J. Noto Vice President, 1989 Executive Vice President & Chief Operating Officer
(1997-Present); Director (1994-Present); President
(1994-1997), American Maturity Life Insurance Company; Vice
President (1989-1997), Hartford Life and Accident Insurance
Company.
Craig R. Raymond Senior Vice President, Vice President (1993-1997); Assistant Vice President
1997 (1992-1993); Actuary (1990-1994), Hartford; Senior Vice
Chief Actuary, 1994 President (1997-Present); Chief Actuary (1995-Present); Vice
President (1993-1997); Actuary (1990-1995), Hartford Life
and Accident Insurance Company; Vice President and Chief
Actuary (1997-Present), Hartford Life, Inc.
Donald A. Salama Vice President, 1997 Vice President (1997-Present), Hartford Life and Accident
Insurance Company; Principal and Director Institutional
Sales (1995-1998), The Vanguard Group; Senior Vice President
(1994-1995), Mercantile Ban-corporation; Vice President
(1988-1994), Bankers Trust Company.
Lowndes A. Smith President, 1989 Chief Operating Officer (1989-1997), Hartford; Director
Chief Executive (1981-Present); President (1989-Present); Chief Executive
Officer, Officer (1997-Present); Chief Operating Officer (1989-1997),
1997 Hartford Life and Accident Insurance Company; Chief
Director, 1981* Executive Officer and President and Director (1997-Present),
Hartford Life, Inc.
</TABLE>
<PAGE>
STATEMENT OF ADDITIONAL INFORMATION 5
- --------------------------------------------------------------------------------
<TABLE>
<S> <C> <C>
David M. Znamierowski Senior Vice President, Vice President (1997), Hartford; Director (1998-Present);
1997 Senior Vice President (1997-Present); Hartford Life and
Director, 1998* Accident Insurance Company; Vice President, Investment
Strategy (1997-Present), Hartford Life, Inc.; Vice
President, Investment Strategy & Policy (1991-1996), Aetna
Life and Casualty.
</TABLE>
- ---------
* Denotes date of election to Board of Directors of Hartford.
** Affiliated Company of The Hartford Financial Services Group, Inc.
Unless otherwise indicated, the principal business address of each of the above
individuals is P.O. Box 2999, Hartford, CT 06104-2999.
SEPARATE ACCOUNT VL I -- was established as a separate account under
Connecticut law on September 18, 1992. The Separate Account is classified as a
unit investment trust registered with the Securities and Exchange Commission
under the Investment Company Act of 1940.
SERVICES
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SAFEKEEPING OF ASSETS -- Title to the assets of the Separate Account is held by
Hartford. The assets are kept physically segregated and are held separate and
apart from Hartford's general corporate assets. Records are maintained of all
purchases and redemptions of Fund shares held in each of the Sub-Accounts.
EXPERTS
- --------------------------------------------------------------------------------
INDEPENDENT PUBLIC ACCOUNTANTS -- The audited financial statements and
financial statement schedules included in this registration statement have been
audited by Arthur Andersen LLP, independent public accountants, as indicated in
their reports with respect thereto, and are included herein in reliance upon the
authority of said firm as experts in giving said reports. The principal business
address of Arthur Andersen LLP is One Financial Plaza, Hartford, Connecticut
06103.
ACTUARIAL EXPERT -- The hypothetical Policy illustrations included in this
Statement of Additional Information and the registration statement with respect
to the Separate Account have been approved by Kenneth A. McCullum, FSA, MAAA,
Assistant Vice President and Director, Individual Life Product Development, for
Hartford, and are included in reliance upon his opinion as to their
reasonableness.
DISTRIBUTION OF THE POLICIES
- --------------------------------------------------------------------------------
Hartford Equity Sales Company, Inc. ("HESCO") serves as principal underwriter
for the policies and will offer the policies on a continuous basis. HESCO is
controlled by Hartford and is located at the same address as Hartford. HESCO is
registered with the Securities and Exchange Commission under the Securities
Exchange Act of 1934 as a broker-dealer and is a member of the National
Association of Securities Dealers, Inc. ("NASD").
The policies will be sold by salespersons who represent Hartford as insurance
agents and who are registered representatives of HESCO or certain other
registered broker-dealers who have entered into distribution agreements with
HESCO.
Broker-dealers or financial institutions are compensated according to a schedule
set forth by HESCO and any applicable rules or regulations for variable
insurance compensation. The compensation payable may vary with the distribution
agreements with HESCO. Compensation is generally based on premium payments. This
compensation is usually paid from the sales charges described in the Prospectus.
During the first Policy Year, the most common schedule of commission we pay is
70% of the premium paid up to the Target Premium and 2.0% of the premium in
excess of the Target Premium. The Target Premium is an amount used to calculate
sales commissions where the Target Premium amounts vary by the: (1) age; (2)
sex; and (3) insurance class of the Insured. In Policy Years 2 and later, this
schedule allows for a commission of 2% of Premiums paid. A sales representative
may be required to return all or a portion of the commissions paid if the Policy
terminates prior to the Policy's first Policy Anniversary.
In addition, a broker-dealer or financial institution may also receive
additional compensation for, among other things, training, marketing or other
services provided. HESCO, its affiliates or Hartford may also make compensation
arrangements with certain broker-dealers or other financial institutions based
on total sales by the broker-dealer or financial institution of insurance
products. These payments, which may be different for broker-dealers or financial
institutions, will be made by HESCO, its affiliates or Hartford out of their
assets and will not effect the amounts paid by the policy owner to purchase,
hold or surrender variable insurance products.
<PAGE>
6 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
The following table shows officers and directors of HESCO:
<TABLE>
- ------------------------------------------------------------------
<CAPTION>
NAME AND PRINCIPAL
BUSINESS ADDRESS POSITIONS AND OFFICES
<S> <C>
Lowndes A. Smith President and Chief Executive Officer,
Director
- ------------------------------------------------------------------
Thomas M. Marra Executive Vice President, Director
- ------------------------------------------------------------------
Peter W. Cummins Senior Vice President
- ------------------------------------------------------------------
Lynda Godkin Senior Vice President, General Counsel
and Corporate Secretary
- ------------------------------------------------------------------
Donald E. Waggaman, Jr. Treasurer
- ------------------------------------------------------------------
George R. Jay Controller
- ------------------------------------------------------------------
</TABLE>
ADDITIONAL INFORMATION ABOUT CHARGES
- --------------------------------------------------------------------------------
SALES LOAD -- The front-end sales load is a charge deducted from each premium
payment. The current and maximum sales load in policy year 1 is 8%. The current
and maximum sales load after policy year 1 is 4%.
The front-end load under the policies may be used to cover expenses related to
the sale and distribution of the policies.
REDUCED CHARGES FOR ELIGIBLE GROUPS -- Certain of the charges and deductions
described above may be reduced for policies issued in connection with a specific
plan, in accordance with our rules in effect as of the date the application for
a policy is approved. To qualify for such a reduction, a plan must satisfy
certain criteria, e.g., as to size of the plan, expected number of participants
and anticipated premium payment from the plan. Generally, the sales contacts and
effort, administrative costs and mortality cost per policy vary, based on such
factors as the size of the plan, the purposes for which policies are purchased
and certain characteristics of the plan's members. The amount of reduction and
the criteria for qualification will be reflected in the reduced sales effort and
administrative costs resulting from, and the different mortality experience
expected as a result of, sales to qualifying plans. We may modify, from time to
time on a uniform basis, both the amounts of reductions and the criteria for
qualification. Reductions in these charges will not be unfairly discriminatory
against any person, including the affected policy owners invested in Separate
Account VL I.
UNDERWRITING PROCEDURES -- To purchase a policy you must submit an application
to us. Within limits, you may choose the initial Face Amount. Policies generally
will be issued only on the lives of insureds the ages of 0 and 85 who supply
evidence of insurability satisfactory to us. Acceptance is subject to our
underwriting rules and we reserve the right to reject an application for any
reason.
Cost of insurance rates will be determined on each policy anniversary based on
our future expectations of such factors as mortality, expenses, interest,
persistency and taxes. For preferred and standard risks, the cost of insurance
rate will not exceed those based on the 1980 Commissioners' Standard Ordinary
Mortality Table (ALB), Male or Female, Nonsmoker or Smoker Table, age last
birthday (unisex rates may be required in some states). A table of guaranteed
cost of insurance rates per $1,000 will be included in your policy, however, we
reserve the right to use rates less than those shown in the table. Special risk
classes are used when mortality experience in excess of the standard risk
classes is expected. These substandard risks will be charged a higher cost of
insurance rate that will not exceed rates based on a multiple of 1980
Commissioners' Standard Ordinary Mortality Table (ALB), Male or Female,
Nonsmoker or Smoker Table, age last birthday (unisex rates may be required in
some states) plus any flat extra amount assessed. The multiple will be based on
the insured's substandard rating.
No change in the terms or conditions of a policy will be made without your
consent.
UNSCHEDULED INCREASES IN FACE AMOUNT -- At any time after the first policy
year, you may request in writing to change the Face Amount. The minimum amount
by which the Face Amount can be increased is based on our rules then in effect.
We reserve the right to limit the number of increases or decreases made under a
policy to no more than one in any 12 month period.
All requests to increase the Face Amount must be applied for on a new
application and accompanied by your policy. All requests will be subject to
evidence of insurability satisfactory to us. Any increase approved by us will be
effective on the Monthly Activity Date shown on the new policy specifications
page, provided that the Monthly Deduction Amount for the first month after the
effective date of the increase is made. Each unscheduled increase in Face Amount
is subject to an increase fee. We deduct the fee each month for twelve months
after the increase. The Face Increase Fee rate is per $1,000 amount and varies
by the attained age of the insured.
<PAGE>
STATEMENT OF ADDITIONAL INFORMATION 7
- --------------------------------------------------------------------------------
ILLUSTRATION OF DEATH BENEFITS, ACCOUNT VALUES
AND CASH SURRENDER VALUES
The following tables illustrate the way in which the Policy operates. They show
how the Death Benefit, Account Values and Cash Surrender Values could vary over
an extended period of time, assuming hypothetical gross rates of return equal to
constant after tax annual rates of 0%, 6% and 12%. The illustrations assume a
male, preferred, non-nicotine, age 35, with $250,000 of Face Amount and a
premium of $1,875 paid in all years.
The Death Benefit, Account Value and Cash Surrender Value for a Policy would be
different from those shown if the rates of return averaged 0%, 6% and 12% over a
period of years, but also fluctuated above or below those averages for
individual Policy Years. They would also differ if any Policy loan was made
during the period of time illustrated.
The tables reflect the deductions of current Policy charges and guaranteed
Policy charges for a single gross interest rate. The Death Benefits, Account
Values and Cash Surrender Values would change if current Cost of Insurance
charges change.
The amounts shown for the Death Benefit, Account Value and Cash Surrender Value
as of the end of each Policy Year take into account an average daily charge
equal to an annual charge of 0.71% of the average daily net assets of the Funds
for investment advisory and administrative services fees. The gross annual
investment return rates of 0%, 6% and 12% on the Fund's assets are equal to net
annual investment return rates (net of the 0.71% average daily charge) of
- -0.71%, 5.29% and 11.29%, respectively.
In addition, the Death Benefit, Account Value and Cash Surrender Value as of the
end of each Policy Year take into account the front-end sales load, tax charge,
Cost of Insurance charge, monthly administrative fee, and mortality and expense
risk charge. For purpose of the illustrations in this Statement of Additional
Information, the tax charge is assumed to be an average of 1.75%.
The hypothetical returns shown in the illustrations are without any tax charges
that may be allocable to the Separate Account in the future. In order to produce
after-tax returns of 0%, 6%, and 12%, the Separate Account would have to earn a
sufficient amount in excess of 0% or 6% or 12%, respectively, to cover any tax
charges.
The "Premiums Accumulated at 5% Interest Per Year" column of each illustration
table shows the amount which would accumulate if the initial premium was
invested to earn interest, after taxes, of 5% per year, compounded annually.
Hartford will furnish, upon request, a comparable illustration reflecting the
proposed Insured's age and risk classification, a Policy's proposed Face Amount
or the initial premium requested, and reflecting guaranteed Cost of Insurance
rates. Hartford will also furnish an additional similar illustration reflecting
current Cost of Insurance rates, which may be less than, but never greater than,
the guaranteed Cost of Insurance rates.
<PAGE>
8 HARTFORD LIFE INSURANCE COMPANY
- --------------------------------------------------------------------------------
[ILLUSTRATIONS TO BE FILED BY AMENDMENT.]
<PAGE>
STATEMENT OF ADDITIONAL INFORMATION 9
- --------------------------------------------------------------------------------
[FINANCIAL STATEMENTS TO BE FILED BY AMENDMENT.]
<PAGE>
PART C
<PAGE>
OTHER INFORMATION
Item 27. Exhibits
(a) Resolution of the Board of Directors of Hartford Life Insurance
Company ("Hartford") authorizing the establishment of the
Separate Account.(1)
(b) Not Applicable.
(c) Principal Underwriting Agreement.(2)
(d) Form of Flexible Premium Variable Life Insurance Policy.
(e) Form of Application for Flexible Premium Variable Life Insurance
Policies, to be filed by amendment.
(f) Certificate of Incorporation of Hartford(2) and Bylaws of
Hartford.(1)
(g) Contracts of Reinsurance.(3)
(h) Form of Participation Agreement.(3)
(i) Not Applicable.
(j) Not Applicable.
(k) Opinion and consent of Lynda Godkin, Senior Vice President, General
Counsel and Corporate Secretary.
(l) Opinion and Consent of Kenneth A. McCullum, FSA., MAAA, to be filed
by amendment.
(m) Not Applicable.
(n) Consent of Arthur Andersen LLP, Independent Public Accountants, to
be filed by amendment.
(o) No financial statement will be omitted.
(p) Not Applicable.
(q) Memorandum describing transfer and redemption procedures.(1)
(r) Power of Attorney.(3)
(s) Organizational Chart(3)
___________________________
(1) Incorporated by reference to Post-Effective Amendment No. 3 to the
Registration Statement on Form S-6, File No. 33-53692, of Hartford Life
Insurance Company filed with the Securities and Exchange Commission
on May 1, 1995.
(2) Incorporated by reference to Post-Effective Amendment No. 4 to the
Registration Statement on Form S-6, File No. 33-53692, of Hartford Life
Insurance Company filed with the Securities and Exchange Commission
on May 1, 1996.
(3) Incorporated by reference to Post-Effective Amendment No. 9 to the
Registration Statement on Form S-6, File No. 333-53692 of Hartford Life
Insurance Company filed with the Securities and Exchange Commission on
April 12, 1999.
<PAGE>
Item 28. Officers and Directors.
- --------------------------------------------------------------------------
NAME POSITION WITH HARTFORD
- --------------------------------------------------------------------------
Wendell J. Bossen Vice President
- --------------------------------------------------------------------------
Gregory A. Boyko Senior Vice President, Director*
- --------------------------------------------------------------------------
Peter W. Cummins Senior Vice President
- --------------------------------------------------------------------------
Timothy M. Fitch Vice President & Actuary
- --------------------------------------------------------------------------
Mary Jane B. Fortin Vice President & Chief Accounting Officer
- --------------------------------------------------------------------------
David T. Foy Senior Vice President & Treasurer
- --------------------------------------------------------------------------
Lynda Godkin Senior Vice President, General Counsel, and
Corporate Secretary, Director*
- --------------------------------------------------------------------------
Lois W. Grady Senior Vice President
- --------------------------------------------------------------------------
Stephen T. Joyce Vice President
- --------------------------------------------------------------------------
Michael D. Keeler Vice President
- --------------------------------------------------------------------------
Robert A. Kerzner Senior Vice President
- --------------------------------------------------------------------------
Thomas M. Marra Executive Vice President, Director*
- --------------------------------------------------------------------------
Steven L. Matthiesen Vice President
- --------------------------------------------------------------------------
Joseph J. Noto Vice President
- --------------------------------------------------------------------------
Craig R. Raymond Senior Vice President and Chief Actuary
- --------------------------------------------------------------------------
Lowndes A. Smith President and Chief Executive Officer, Director*
- --------------------------------------------------------------------------
David M. Znamierowski Senior Vice President, Director*
- --------------------------------------------------------------------------
Unless otherwise indicated, the principal business address of each of the above
individuals is P.O. Box 2999, Hartford, CT 06104-2999.
_______________________________________________
* Denotes Board of Directors of Hartford.
Item 29. Persons Controlled By or Under Common Control with the Depositor or
Registrant
Filed herewith as Exhibit (s).
Item 30: Indemnification
Under Section 33-772 of the Connecticut General Statutes, unless
limited by its certificate of incorporation, the Registrant must
indemnify a director who was wholly successful, on the merits or
otherwise, in the defense of any proceeding to which he was a party
because he is or was a director of the corporation against
reasonable expenses incurred by him in connection with the
proceeding.
<PAGE>
The Registrant may indemnify an individual made a party to a
proceeding because he is or was a director against liability
incurred in the proceeding if he acted in good faith and in a
manner he reasonably believed to be in or not opposed to the best
interests of the Registrant, and, with respect to any criminal
proceeding, had no reason to believe his conduct was unlawful.
Conn. Gen. Stat. Section 33-771(a). Additionally, pursuant to Conn.
Gen. Stat. Section 33-776, the Registrant may indemnify officers
and employees or agents for liability incurred and for any expenses
to which they becomes subject by reason of being or having been an
employees or officers of the Registrant. Connecticut law does not
prescribe standards for the indemnification of officers, employees
and agents and expressly states that their indemnification may be
broader than the right of indemnification granted to directors.
The foregoing statements are specifically made subject to the
detailed provisions of Section 33-770 et seq.
Notwithstanding the fact that Connecticut law obligates the
Registrant to indemnify only a director that was successful on the
merits in a suit, under Article VIII, Section 2 of the Registrant's
bylaws, the Registrant must indemnify both directors and officers
of the Registrant who are parties or threatened to be parties to a
legal proceeding by reason of his being or having been a director
or officer of the Registrant for any expenses if he acted in good
faith and in a manner he reasonably believed to be in or not
opposed to the best interests of the company, and with respect to
criminal proceedings, had no reason to believe his conduct was
unlawful. Unless otherwise mandated by a court, no indemnification
shall be made if such officer or director is adjudged to be liable
for negligence or misconduct in the performance of his duty to the
Registrant.
Additionally, the directors and officers of Hartford and Hartford
Equity Sales Company, Inc. ("HESCO") are covered under a directors
and officers liability insurance policy issued to The Hartford
Financial Services Group, Inc. and its subsidiaries. Such policy
will reimburse the Registrant for any payments that it shall make
to directors and officers pursuant to law and will, subject to
certain exclusions contained in the policy, further pay any other
costs, charges and expenses and settlements and judgments arising
from any proceeding involving any director or officer of the
Registrant in his past or present capacity as such, and for which
he may be liable, except as to any liabilities arising from acts
that are deemed to be uninsurable.
Insofar as indemnification for liabilities arising under the
Securities Act of 1933 (the "Act") may be permitted to directors,
officers and controlling persons of the Registrant pursuant to the
foregoing provisions, the Registrant has been
<PAGE>
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 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 31. Principal Underwriters
(a) HESCO acts as principal underwriter for the following investment
companies:
Hartford Life Insurance Company - Separate Account VL I
Hartford Life Insurance Company - Separate Account VL II
Hartford Life Insurance Company - ICMG Secular Trust Separate
Account
Hartford Life Insurance Company -- ICMG Registered Variable Life
Separate Account A
Hartford Life and Annuity Insurance Company -- Separate
Account VL I
Hartford Life and Annuity Insurance Company -- Separate
Account VL II
Hartford Life and Annuity Insurance Company -- ICMG Registered
Variable Life Separate Account One
(b) Directors and Officers of HESCO
Name and Principal Positions and Offices
Business Address With Underwriter
------------------ ---------------------
Lowndes A. Smith President and Chief Executive
Officer, Director
Thomas M. Marra Executive Vice President,
Director
Peter W. Cummins Senior Vice President
Lynda Godkin Senior Vice President, General
Counsel and Corporate Secretary
Richard J. Garrett Vice President
Donald A. Salama Vice President
Donald E. Waggaman, Jr. Treasurer
George R. Jay Controller
Unless otherwise indicated, the principal business address of each the above
individuals is P.O. Box 2999, Hartford, CT 06104-2999.
<PAGE>
Item 32. Location of Accounts and Records
All of the accounts, books, records or other documents required to
be kept by Section 31(a) of the Investment Company Act of 1940 and
rules thereunder, are maintained by Hartford at 200 Hopmeadow
Street, Simsbury, Connecticut 06089.
Item 33. Management Services
All management contracts are discussed in Part A and Part B of this
Registration Statement.
Item 34. Representation of Reasonableness of Fees
Hartford hereby represents that the aggregate fees and charges under the
Policy are reasonable in relation to the services rendered, the expenses
expected to be incurred, and the risks assumed by Hartford.
<PAGE>
SIGNATURES
Pursuant to the requirements of the Securities Act and the Investment Company
Act, the Registrant certifies that it duly caused this registration statement
to be signed on its behalf by the undersigned, duly authorized, in the Town
of Simsbury, and State of Connecticut on the 12th day of January, 2000.
HARTFORD LIFE INSURANCE
COMPANY SEPARATE ACCOUNT VL I
(Registrant)
*By: David T. Foy *By: /s/ Marianne O'Doherty
----------------------------------- ----------------
David T. Foy, Senior Vice President Marianne O'Doherty
and Treasurer Attorney-In-Fact
HARTFORD LIFE INSURANCE
COMPANY
(Depositor)
*By: David T. Foy
-------------------------------------------------
David T. Foy, Senior Vice President and Treasurer
Pursuant to the requirements of the Securities Act of 1933, this Registration
Statement has been signed by the following persons and in the capacities and on
the dates indicated.
Gregory A. Boyko, Senior Vice President
and Director*
Lynda Godkin, Senior Vice President, General *By: /s/ Marianne O'Doherty
Counsel, & Corporate Secretary, Director* ---------------------
Thomas M. Marra, Executive Vice Marianne O'Doherty
President, Director* Attorney-In-Fact
Lowndes A. Smith, President,
Chief Executive Officer, Director*
David M. Znamierowski, Senior Vice President, Dated: January 12, 2000
Director*
<PAGE>
EXHIBIT INDEX
1.1 Form of Flexible Premium Variable Universal LIfe Insurance Policy.
1.2 Opinion and Consent of Lynda Godkin, Senior Vice President, General
Counsel and Corporate Secretary.
<PAGE>
EX-1.1
Form of Flexible
Premium Variable Universal Life Insurance
Policy
<PAGE>
HARTFORD LIFE INSURANCE COMPANY
HOME OFFICE ADDRESS:
P.O. BOX 2999:
HARTFORD, CONNECTICUT 06104-2999
(A stock insurance company)
ADMINISTRATIVE OFFICE ADDRESS:
NATIONAL SERVICE CENTER
P.O. BOX 59179
MINNEAPOLIS, MINNESOTA 55459
Agrees with the Policyowner to provide benefits as provided herein.
The Policy is a Group Flexible Premium Variable Life Insurance Policy.
The Policy Specifications on Page 3 and the conditions and provisions on this
and the following pages are part of the policy
Signed for the Company
/s/ Lynda Godkin /s/ Lowndes A. Smith
Lynda Godkin, SECRETARY Lowndes A. Smith, PRESIDENT
GROUP FLEXIBLE PREMIUM
VARIABLE LIFE INSURANCE POLICY
[LOGO]
HL-15470(99)(NY) Printed in U.S.A.
<PAGE>
TABLE OF CONTENTS
PAGE
Policy Specifications 3
Definitions 5
Certificate's Death Benefit 7
Increases and Decreases in Certificate's Face Amount 8
Certificate Premiums 9
Certificate Valuation Provisions 10
Certificate Account Value, Cash Value
and Cash Surrender Value 11
Transfers Within the Certificate 12
Certificate Monthly Deduction Amount 13
Certificate Lapse and Certificate Grace Period 15
Certificate Reinstatement 16
Certificate Loans 16
Withdrawals 18
Surrenders 18
Payments By Us 18
Taxation of The Separate Account 18
The Contract 18
Ownership and Beneficiary 21
Termination and Maturity Date 22
Income Settlement Options 22
Any Riders follow page 23
Page 2
HL-15470(99)(NY) Printed in U.S.A.
<PAGE>
POLICY SPECIFICATIONS
- -------------------------------------------------------------------------------
BASE POLICY INFORMATION
- -------------------------------------------------------------------------------
POLICY: GROUP FLEXIBLE PREMIUM VARIABLE LIFE
GROUP CONTRACT NUMBER: [1234]
GROUP CONTRACT OWNER: [TRUSTEE OF HARTFORD BROKER DEALER TRUST]
POLICY DATE: JANUARY 1, 1999
DATE OF ISSUE: JANUARY 1, 1999
CERTIFICATE CHARGES AND FEES ARE UNIQUE TO AND DESCRIBED IN THE CERTIFICATE.
CHARGES CONSIST OF SALES CHARGES, TAX CHARGES, ADMINISTRATIVE CHARGES, MORTALITY
AND EXPENSE CHARGES, AND CHARGES FOR INCREASES AND TRANSFERS.
EACH CERTIFICATE IS SUBJECT TO A SURRENDER CHARGE FOR THE FIRST NINE CERTIFICATE
YEARS.
Page 3
15470(3)(NY) PRINTED IN U.S.A.
<PAGE>
DEFINITIONS The definitions in this section apply to the following words
and phrases whenever and wherever they appear in the
Certificate.
ACCOUNT VALUE: for each Certificate, the total of all amounts
in the Certificate's Fixed Account, Loan Account and
Sub-Accounts.
ACCUMULATION UNIT: an accounting unit used to calculate the
value of a Sub-Account.
CERTIFICATE ATTAINED AGE: the Issue Age plus the number of
completed Certificate Years.
CASH SURRENDER VALUE: for each Certificate, the Certificate's
Cash Value less all Indebtedness.
CASH VALUE: for each Certificate, the Certificate's Account
Value less any applicable Surrender Charges.
CERTIFICATE: the individual Certificate issued by Us to the
Owner of the Certificate which demonstrates that a premium
payment has been made by or on behalf of the Certificate Owner,
and which summarizes the provisions of the Policy.
CERTIFICATE ANNIVERSARY: an anniversary of the Certificate
Date.
CERTIFICATE DATE: the date shown on Page 3 of the Certificate.
It is the date from which Certificate Anniversaries and
Certificate Years are determined.
CERTIFICATE GRACE PERIOD: the 61 day period between the day the
Certificate goes into default and the day on which the
certificate terminates.
CERTIFICATE INDEBTEDNESS: for each Certificate, all loans taken
on the Certificate, plus any interest due or accrued minus any
loan repayments.
CERTIFICATE LOAN ACCOUNT: for each Certificate, an account
established for any amounts transferred from the Certificate's
Fixed Account and Sub-Accounts as a result of loans. The
amounts in each Certificate's Loan Account are credited with
interest and are not subject to the investment experience of
any Sub-Accounts.
CERTIFICATE OWNER: the owner of the Certificate as shown on
Page 3 of the Certificate.
CERTIFICATE YEARS: years as measured from the Certificate Date.
COMPANY, WE, US, OUR: the Company referred to on the first page
of the Certificate.
CUMULATIVE NO LAPSE GUARANTEE PREMIUM: for each Certificate,
the premium required to maintain the No Lapse Guarantee. On the
Certificate Date, the Cumulative No Lapse Guarantee Premium is
the Monthly No Lapse Guarantee Premium shown on Page 3. On each
Monthly Activity Date thereafter, the Cumulative No Lapse
Premium is: (a) the Cumulative No Lapse Guarantee Premium on
the previous Monthly Activity Date; plus (b) the current
Monthly No Lapse Guarantee Premium.
DATE OF ISSUE: for this Policy, the date shown on Page 3. For
each Certificate, the date shown on Page 3 of the Certificate
from which the Suicide and Incontestability provisions are
measured. The date may be different from the Certificate Date.
Page 5
15470(5/6)(NY) PRINTED IN U.S.A.
<PAGE>
DEFINITIONS DEATH BENEFIT: for each Certificate, the amount used to
(CONTINUED) calculate the Death Proceeds. The Death Benefit on
the Certificate Date is determined by the Death Benefit Option
selected on the application. Thereafter, it may change in
accordance with the terms of the Death Benefit Option
provision, the Minimum Death Benefit provision and the No Lapse
Guarantee provision.
DEATH BENEFIT OPTION: for each Certificate, the Death Benefit
Option in effect determines how the Death Benefit is
calculated. The three Death Benefit Options provided are
described in the Death Benefit section.
DEATH PROCEEDS: for each Certificate, the amount which We will
pay on the death of the Insured.
DOLLAR COST AVERAGING: systematic transfers from one account to
any other available account.
FACE AMOUNT: for each Certificate, an amount We use to
determine the Certificate's Death Benefit. On the Certificate
Date, the Face Amount equals the Initial Face Amount shown on
Page 3. Thereafter, it may change in accordance with the terms
of the Increases and Decreases in Face Amount provision, the
Death Benefit Option Changes provision and the Withdrawals
provision.
FIXED ACCOUNT: part of the Company's General Account to which
all or a portion of the Account Value may be allocated.
FUNDS: the registered open-end management companies in which
assets of the Separate Account may be invested.
GENERAL ACCOUNT: all Company assets other than those allocated
to separate accounts.
INSURED: the person whose life is insured as shown on Page 3 of
the Certificate.
IN WRITING: in a written form satisfactory to Us.
INTERNAL REVENUE CODE: Internal Revenue Code of 1986, as
amended.
ISSUE AGE: as of the Certificate Date, an Insured's age on
his/her last birthday.
MONTHLY ACTIVITY DATE: for each Certificate, the Certificate
Date and the same date in each succeeding month as the
Certificate Date. However, whenever the Monthly Activity Date
falls on a date other than a Valuation Day, the Monthly
Activity Date will be deemed to be the next Valuation Day.
NET AMOUNT AT RISK: the Net Amount at Risk is determined by
subtracting the Account Value from the policy's current Face
Amount. If the Face Amount has been increased from the initial
Face Amount, the Account Value is first subtracted from the
initial Face Amount and then, sequentially, any remaining
Account Value is subtracted from each subsequent increase.
NET PREMIUM: for each Certificate, the amount of premium
credited to the Account Value. It is the premium paid minus the
deductions from premium shown on Page 3A.
Page 6
15470(5/6)(NY) PRINTED IN U.S.A.
<PAGE>
DEFINITIONS We can use sales loads that are lower than the sales loads
(CONTINUED) shown on Page 3A. Sales loads will be determined on each
Certificate Anniversary based on future expectations for such
factors as mortality, expenses, interest, persistency and
taxes. Sales loads will be reviewed no more often than once a
year, nor less than every 5 years. Any change We make will be
on a uniform basis for Insureds of the same Issue Age, sex and
insurance class and whose coverage has been in force for the
same length of time. No change in sales loads will occur on
account of deterioration of the Insured's health.
Any change in sales loads will be determined in accordance with
the procedures and standards on file with the Insurance
Department where the Certificate is delivered.
PLANNED PREMIUM: for each Certificate, the amount that the
Certificate Owner intends to pay. The Initial Planned Premium
is shown on Page 3 of the Certificate.
PRO RATA BASIS: an allocation method based on the proportion of
the Account Value in the Fixed Account and each Sub-Account.
SCHEDULED MATURITY DATE: the date, shown on Page 3 of the
Certificate. It is the date on which the Certificate will
mature.
SEPARATE ACCOUNT: an account, as specified on Page 3 of the
Certificate, which has been established by Us to separate the
assets funding the variable benefits for the class of contracts
to which the Certificate belongs from the other assets of the
Company.
SUB-ACCOUNTS: the subdivisions of the Separate Account.
SURRENDER CHARGE: for each Certificate, a charge that may be
assessed if the Certificate Owner surrenders the Certificate or
requests a policy change that results in a Certificate Face
Amount decrease.
VALUATION DAY: the date on which a Sub-Account is valued. This
occurs everyday We are open and the New York Stock Exchange is
open for trading.
VALUATION PERIOD: the period of time between the close of
business on successive Valuation Days.
CERTIFICATE'S GENERAL
DEATH BENEFIT Upon receipt of due proof of the Insured's death, We
will pay the Death Proceeds to the Beneficiary.
DEATH PROCEEDS
Death Proceeds equal the Death Benefit described below less
Certificate Indebtedness and less any due and unpaid Monthly
Deduction Amounts occurring during a Certificate Grace Period.
However, if the Insured dies after We receive a request In
Writing from the Certificate Owner to surrender the
Certificate, the Certificate's Cash Surrender Value will be
paid in lieu of the Death Proceeds.
The Death Benefit is the greater of:
(a) the Death Benefit provided by the Death Benefit Option
chosen by the Certificate Owner; and
(b) the Minimum Death Benefit described below.
Page 7
15470(7/8)(NY) PRINTED IN U.S.A.
<PAGE>
CERTIFICATE'S DEATH BENEFIT OPTIONS
DEATH BENEFIT The Certificate Owner has three Death Benefit Options.
(CONTINUED) 1. Under Option A (Level Option), the Death Benefit is the
current Face Amount.
2. Under Option B (Return of Account Value Option), the Death
Benefit is the current Face Amount, plus the Account Value
on the date We receive due proof of the Insured's death.
3. Under Option C (Return of Premium Option), the Death Benefit
is the lesser of: (a) the current Face Amount, plus the sum
of the premiums paid; or (b) the Death Benefit Option C
Limit shown on Page 3 of the Certificate.
DEATH BENEFIT OPTION CHANGES
The Certificate Owner may change the Death Benefit
Option, subject to the conditions described here.
The Certificate Owner must notify Us In Writing
of the change. Such change will be effective on the Monthly
Activity Date following the date We receive the request.
The Certificate Owner may change Option C (Return of Premium
Option) or Option B (Return of Account Value Option) to Option
A (Level Option). On the date the change becomes effective, the
Certificate's Face Amount will become that amount available as
a Death Benefit immediately prior to the option change.
The Certificate Owner may change Option A (Level Option) to
Option B (Return of Account Value Option). On the date the
change becomes effective, the Certificate's Face Amount will
become that amount available as a Death Benefit immediately
prior to the option change, reduced by the then current Account
Value. Any resulting decrease in the Face Amount may be subject
to a partial Surrender Charge as described in the Decreases in
Face Amount provision.
MINIMUM DEATH BENEFIT
We will automatically increase the Certificate's Death Benefit
so that it will never be less than the Certificate's Account
Value multiplied by the Minimum Death Benefit Percentage for
the then current Certificate Year. The Table of Minimum Death
Benefit Percentages is shown on Page 3E of the Certificate.
This is to ensure that:
(a) the Certificate continues to qualify as life insurance
under the Internal Revenue Code; or
(b) the Certificate maintains the relationship between the
Certificate's Account Value and the Death Benefit the
Certificate Owner selected on his/her application, if
greater.
INCREASES AND GENERAL
DECREASES IN THE At any time after the first Certificate Year, The Certificate
CERTIFICATE'S Owner may make a request In Writing to change
FACE AMOUNT the Certificate's Face Amount. The minimum amount by which a
Certificate's Face Amount can be increased or
decreased is shown on Page 3 of the Certificate. We reserve the
right to limit the Certificate Owner to one increase or
decrease in any 12 month period.
SCHEDULED INCREASES IN A CERTIFICATE'S FACE AMOUNT
We will increase the Certificates Face Amount automatically by
the amounts shown on Page 3D of the Certificate. These
scheduled increases will continue until the Certificate Owner
requests to discontinue the increases or until the Certificate
Owner requests to decrease the Certificate's Face Amount.
Decreases in the Face Amount as a result of a withdrawal will
not affect the Certificate Owner's scheduled increases.
Scheduled increases in the Certificate's Face Amount are not
subject to the Face Amount Increase Fee.
Page 8
15470(7/8)(NY) PRINTED IN U.S.A.
<PAGE>
INCREASES AND UNSCHEDULED INCREASES IN A CERTIFICATE'S FACE AMOUNT
DECREASES IN THE All requests to increase the Certificate's Face Amount must be
CERTIFICATE'S applied for on a new application and accompanied by the
FACE AMOUNT Certificate. All requests will be subject to evidence of
(CONTINUED) insurability satisfactory to Us. Any increase approved by Us
will be effective on the Monthly Activity Date shown on the new
certificate specifications page, provided that the Monthly
Deduction Amount for the first month after the effective date
of the increase is made. A Face Amount Increase Fee is assessed
on the first twelve Monthly activity dates beginning on the
effective date of each increase. The Face Amount Increase Fee
will not exceed those shown on Page 3C of the Certificate.
DECREASES IN A CERTIFICATE'S FACE AMOUNT A decrease in the
Certificate's Face Amount will be effective on the Monthly
Activity Date following the date We receive the Certificate
Owner's request. The remaining Certificate Face Amount must not
be less than the minimum Face Amount shown on Page 3 of the
Certificate. If during the Surrender Charge Period, The
Certificate Owner decreases the Certificate's Face Amount to an
amount lower than it has ever been, a partial Surrender Charge
will be assessed.
The Surrender Charge assessed will be:
(a) the Surrender Charge applicable to the then current
Certificate Year, if any; multiplied by
(b) the percentage described below.
The percentage will be determined by:
(i) subtracting the new Face Amount from the lowest previous
Face Amount; and
(ii) dividing that difference by the lowest previous Face
Amount.
The Surrender Charge assessed will be deducted from the
Certificate Owner's Account Value on the Monthly Activity Date
on which the decrease becomes effective. We will also reduce
the Surrender Charges applicable to future Certificate Years
and provide the Certificate Owner a revised schedule of Maximum
Surrender Charges.
CERTIFICATE GENERAL
PREMIUMS No insurance is effective until We receive premiums sufficient
to cover the Monthly Deduction Amount on the Certificate Date,
subject to the terms of the application's conditional receipt.
After the first premium has been paid, subsequent premiums can
be paid at any time.
Checks must be made payable to the Company shown on the first
page of the Certificate.
Checks may be sent to either:
(a) Us at the address shown on the premium notice; or
(b) Our authorized agent in exchange for a receipt signed by
Our President or Secretary and countersigned by such agent.
We will apply any amount received under the Certificate as a
premium unless it is clearly marked otherwise. The premium will
be applied on the date We receive it at the address shown on
the premium notice.
PLANNED PREMIUM PAYMENTS
We will send the Certificate Owner a premium notice for the
Planned Premium payment. The notices may be sent at 12, 6, or 3
month intervals. The Initial Planned Premium payment and
payment frequency the Certificate Owner selected are shown on
Page 3 of the Certificate. The Certificate Owner may change the
Planned Premium payment shown on the premium notices subject to
Our premium limitations.
Page 9
15470(9/10)(NY) PRINTED IN U.S.A.
<PAGE>
CERTIFICATE FLEXIBLE PREMIUMS
PREMIUMS After the first premium has been paid, the Certificate Owner's
(CONTINUED) subsequent premium payments are flexible. The actual amount
and frequency of payment will affect the Account Value and
could affect the amount and duration of insurance provided by
the Certificate. The Certificate Owner may pay additional
premiums at any time prior to the Scheduled Maturity Date
subject to Our Premium Limitations.
PREMIUM LIMITATIONS
The Certificate Owner may pay premiums at any time prior to the
Scheduled Maturity Date subject to the following limitations:
(a) the minimum premium that We will accept is $50 or the
amount required to keep the Certificate in force.
(b) if premiums are received which would cause the Certificate
to fail to meet the definition of a life insurance contract
in accordance with the Internal Revenue Code, We reserve
the right to refund the excess premium payments. Such
refunds and interest thereon will be made within 60 days
after the end of a Certificate Year.
(c) We reserve the right to require evidence of insurability
for any premium payment that results in an
increase in the Certificate Death Benefit greater than the
amount of the premium.
(d) any premium received in excess of $1,000,000 is subject to
Our approval.
INITIAL PREMIUM ALLOCATION
The initial Net Premium and any additional Net Premiums
received by Us prior to the end of the free look period as
described in the Right to Examine Certificate Provision, will
be allocated as shown on Page 3 of the Certificate on the later
of:
(a) the Certificate Date; and
(b) the date We receive the premium.
The accumulated values of these amounts will then be allocated
to the Fixed Account and Sub-Accounts according to the premium
allocation the Certificate Owner specified in the application
on the later of:
(a) 10 days after the Certificate Owner receives the
Certificate; or
(b) the date We receive the final requirement to put the
Certificate in force.
SUBSEQUENT PREMIUM ALLOCATIONS
The Certificate Owner may change how the premiums are allocated
by notifying Us In Writing. Subsequent Net Premiums will be
allocated to the Fixed Account and Sub-Accounts according to
The Certificate Owner's most recent instructions as long as:
(a) the total number of active Sub-Accounts does not exceed 9;
and
(b) the percentage the Certificate Owner allocates to each
Sub-Account is in whole percentages.
If We receive a premium with a premium allocation instruction
that does not comply with the above rules, We will allocate the
Net Premium on a Pro Rata Basis.
CERTIFICATE SUB-ACCOUNT ACCUMULATION UNITS
VALUATION Amounts allocated to each Sub-Account increase the number of
PROVISIONS Accumulation Units in each Sub-Account. The number of
Accumulation Units added to each Sub-Account is determined by
dividing the amount allocated to the Sub-Account by the dollar
value of one Accumulation Unit for such Sub-Account.
Amounts taken from each Sub-Account decrease the number of
Accumulation Units in each Sub-Account. The number of
Accumulation Units subtracted from each Sub- Account is
determined by dividing the amount taken from the Sub-Account by
the dollar value of one Accumulation Unit for such Sub-Account.
Page 10
15470(9/10)(NY) PRINTED IN U.S.A.
<PAGE>
CERTIFICATE The number of Accumulation Units will not be affected by any
VALUATION subsequent change in the value of the units. The Accumulation
PROVISIONS Unit Values in each Sub-Account may increase or decrease daily
(CONTINUED) as described below.
SUB-ACCOUNT ACCUMULATION UNIT VALUE
The Accumulation Unit Value for each Sub-Account will vary to
reflect the investment experience of the applicable Fund and
will be determined on each Valuation Day by multiplying the
Accumulation Unit Value of the particular Sub-Account on the
preceding Valuation Day by a Net Investment Factor for that
Sub-Account for the Valuation Period then ended. The Net
Investment Factor for each of the Sub-Accounts is equal to the
net asset value per share of the corresponding Fund at the end
of the Valuation Period (plus the per share amount of any
dividend or capital gain distributions paid by that Fund in the
Valuation Period then ended) divided by the net asset value per
share of the corresponding Fund at the beginning of the
Valuation Period.
EMERGENCY PROCEDURE
If the New York Stock Exchange is closed (except for holidays
or weekends) or trading is restricted due to an existing
emergency as defined by the Securities and Exchange Commission
so that We cannot value the Sub-Accounts, We may postpone all
transactions which require valuation of the Sub-Accounts until
valuation is possible. Any provision of the Certificate which
specifies a Valuation Day will be superseded by the emergency
procedure.
FIXED ACCOUNT
We will credit interest to amounts in the Fixed Account on a
monthly basis at rates We determine. The Annual Fixed Account
Minimum Credited Rate is shown on Page 3. We may credit
interest rates greater than the Annual Fixed Account Minimum
Credited Rate to the Fixed Account. Such additional amounts of
interest will be nonforfeitable from the effective date of
their crediting. The interest credited will reflect the timing
of amounts added to or withdrawn from the Fixed Account. Rates
will be determined from time to time based on Our expectations
as to interest, mortality, expenses, persistency and taxes.
CERTIFICATE CERTIFICATE ACCOUNT VALUE
ACCOUNT VALUE, The Certificate Owner's Account Value on the Certificate Date
CASH VALUE equals the initial Net Premium less the Monthly Deduction
AND CASH Amount for the first certificate month.
SURRENDER VALUE
On each subsequent Monthly Activity Date, The Certificate
Owner's Account Value equals:
(a) the sum of the Certificate's Accumulated Values in the
Fixed Account and Sub-Accounts; plus
(b) the value of the Certificate's Loan Account, if any; minus,
(c) the appropriate Monthly Deduction Amount.
On each Valuation Day (other than a Monthly Activity Date), the
Certificate's Account Value equals:
(a) the sum of the Certificate's Accumulated Values in the
Fixed Account and Sub-Accounts; plus
(b) the value of the Certificate Loan Account, if any.
Page 11
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<PAGE>
CERTIFICATE CERTIFICATE ACCUMULATED VALUE - FIXED ACCOUNT
ACCOUNT VALUE, A Certificate's Accumulated Value in the Fixed Account equals:
CASH VALUE (a) the Net Premiums allocated to it; plus
AND CASH (b) amounts transferred to it from the Sub-Accounts or the
SURRENDER VALUE Certificate Loan Account; plus
(CONTINUED) (c) interest credited to it; minus
(d) amounts transferred out of it to the Sub-Accounts or the
Certificate Loan Account; minus
(e) any transfer charges or Surrender Charges that have been
taken from it; minus
(f) any Monthly Deduction Amounts taken from it; minus
(g) any withdrawals taken from it.
CERTIFICATE ACCUMULATED VALUE - SUB-ACCOUNTS
A Certificate Accumulated Value in any Sub-Account equals:
(a) the number of Accumulation Units in that Sub-Account on the
Valuation Day; multiplied by
(b) that Sub-Account's Accumulation Unit Value on the Valuation
Day.
The number of Accumulation Units in any Sub-Account is
increased when:
(a) Net Premiums are allocated to it; or
(b) amounts are transferred to it from other Sub-Accounts, the
Fixed Account or the Certificate Loan Account.
The number of Accumulation Units in any Sub-Account is
decreased when:
(a) amounts are transferred out of it to other Sub-Accounts,
the Fixed Account or the Certificate Loan Account; or
(b) any transfer charges or Surrender Charges have been taken
from it; or (c) any Monthly Deduction Amounts are taken
from it; or (d) any withdrawals are taken from it.
CERTIFICATE CASH VALUE
A Certificate's Cash Value is equal to the Certificate's
Account Value less any applicable Surrender Charges. The
Maximum Surrender Charges and the Certificate Years during
which they will be applied are shown on Page 3B of the
Certificate.
CERTIFICATE CASH SURRENDER VALUE
The Certificate's Cash Surrender Value is equal to
Certificate's Cash Value minus the Indebtedness, if any.
TRANSFERS AMOUNT AND FREQUENCY OF TRANSFERS
WITHIN THE Upon request and as long as the Certificate is in effect,
CERTIFICATE the Certificate Owner may transfer amounts among the Fixed
Account and Sub-Accounts.
We reserve the right to limit the size of transfers and
remaining balances, and to limit the number and frequency of
transfers. However, in no event will there be fewer than 12
free transfers.
DOLLAR COST AVERAGING
From time to time, We may offer and the Certificate Owner may
enroll in a Dollar Cost Averaging program. Prior to enrollment,
the Certificate Owner may obtain information on the available
programs from Us.
The Certificate Owner may terminate participation in the
program at any time by calling or writing Us. In such an event,
any non-transferred balances will be allocated to the other
accounts according to the Certificate Owner's instructions.
Page 12
15470(11/12)(NY) PRINTED IN U.S.A.
<PAGE>
TRANSFERS RESTRICTIONS ON TRANSFERS
WITHIN THE Transfers from the Fixed Account (other than those allowed
CERTIFICATE under a Dollar Cost Averaging program) are subject
(CONTINUED) to the following:
(a) the transfer must occur during the 30 day period following
each Certificate Anniversary; and
(b) the maximum amount transferred in any Certificate Year will
be the greater of $1,000 or 25% of the Accumulated Value in
the Fixed Account on the date of transfer.
TRANSFERS TO THE FIXED ACCOUNT
The Certificate Owner may transfer all amounts in the
Sub-Accounts to the Fixed Account and apply the Cash Surrender
Value to purchase a non-variable Paid-Up Life Insurance
Certificate, as long as the Certificate is in effect. The
amount of the non-variable Paid-Up Life Insurance is the amount
that can be purchased by the net single premium at the then
attained age of the Insured based on the Annual Fixed Account
Minimum Credited Rate and guaranteed assumptions. Subsequent
Cash Values of the non-variable Paid-Up Life Insurance are
based on the 1980 Commissioners Standard Ordinary Male/Female
Smoker or Non-Smoker Mortality Table, age last birthday using
the Monthly Maximum Cost of Insurance and the Annual Fixed
Account Minimum Credited Rate. The Paid-Up Life Insurance
Certificate is not subject to the Monthly Administrative
Charge.
While the Certificate is in force, The Certificate Owner may
elect to transfer Accumulated Values in the Sub-Accounts to the
Fixed Account anytime during the first 18 months.
TRANSFER CHARGE
After a transfer has occurred, the Transfer Charge, as
specified on Page 3B of the Certificate, if any, will be
deducted on a Pro Rata Basis.
CERTIFICATE GENERAL
MONTHLY On each Monthly Activity Date, We will deduct an amount from
DEDUCTION the Certificate's Account Value to pay for the benefits
AMOUNT provided by the Certificate. This amount is called the
Certificate's Monthly Deduction Amount and equals:
(a) the Cost of Insurance; plus
(b) the Monthly Administrative Charge; plus
(c) the Mortality and Expense Risk Charge; plus
(d) the Face Amount Increase Fee, if any; plus
(e) the charges for additional benefits provided by rider, if
any.
The Certificate's Monthly Deduction Amount will be taken on a
Pro Rata Basis from the Fixed Account and Sub-Accounts on each
Monthly Activity Date.
COST OF INSURANCE
The Cost of Insurance for any Monthly Activity Date is equal
to:
(a) the Cost of Insurance Rate per $1,000; multiplied by
(b) the Net Amount at Risk; divided by
(c) $1,000.
On any Monthly Activity Date, the Net Amount at Risk equals the
Certificate's Death Benefit less the Certificate's Account
Value on that date prior to assessing the Monthly Deduction
Amount.
Page 13
15470(13/14)(NY) PRINTED IN U.S.A.
<PAGE>
CERTIFICATE COST OF INSURANCE RATE
MONTHLY The Cost of Insurance Rate is based on the then current
DEDUCTION Certificate Year as well as the Initial Face Amount, sex, Issue
AMOUNT Age, and insurance class of the Insured shown on Page 3
(CONTINUED) of the Certificate.
The Cost of Insurance Rates will not exceed those in the Table
of Monthly Maximum Cost of Insurance Rates shown on Page 3E of
the Certificate. Part of the Cost of Insurance charges is used
to recover acquisition expenses arising from the issuance of
the Policy. The expense recovery component is higher in early
Policy Years.
We can use Cost of Insurance Rates that are lower than the
Monthly Maximum Cost of Insurance Rates shown on Page 3E of the
Certificate. Rates will be determined on each Certificate
Anniversary based on Our future expectations of such factors as
mortality, expenses, interest, persistency and taxes. Rates on
in-force policies will be reviewed no more than once a year,
nor less than once every five years. Any change We make will be
on a uniform basis for Insureds of the same Issue Age, sex,
insurance class, Initial Face Amount, and whose coverage has
been in force for the same length of time. Upon providing
satisfactory evidence to Us, the Certificate Owner may change
the insurance class to a more favorable class. Future Cost of
Insurance charges will be based on the more favorable class and
all other contract terms and provisions will remain as
established at issue. No change in insurance class or cost will
occur on account of deterioration of the Insured's health.
Any change in certificate cost factors will be determined in
accordance with the procedures and standards on file with the
Superintendent of Insurance.
MONTHLY ADMINISTRATIVE CHARGE
The Monthly Administrative Charge will not exceed the amounts
shown on Page 3A of the Certificate.
The Monthly Administrative Charge will be determined on each
Certificate Anniversary based upon changes in future
expectations as to mortality, expenses, interest, persistency
and taxes. Charges on in-force policies will be reviewed no
more often than once a year, nor less than every five years.
Any change We make will be on a uniform basis for Insureds of
the same Issue Age, sex, and insurance class and whose coverage
has been in-force for the same length of time.
Any change in the Monthly Administrative Charge will be
determined in accordance with the procedures and standards on
file with the Insurance Department.
MORTALITY AND EXPENSE RISK CHARGE
The Mortality and Expense Risk Charge for any Monthly Activity
Date is equal to the sum of (a) and (b) where
(a) equals:
(i) the monthly Accumulated Value Mortality and Expense
Risk Rate; multiplied by
(ii) the sum of The Certificate Ownerr Accumulated Values
in the Sub-Accounts on the Monthly Activity Date,
prior to assessing the Monthly Deduction Amount. and
(b) equals:
(i) the monthly Mortality and Expense Risk Rate per
$1,000; multiplied by
(ii) the lower of the Initial
Face Amount or the current Face Amount; divided by
(iii) $1,000.
Each month the Mortality and Expense Risk Rates will not exceed
those shown on Page 3A of the Certificate.
Page 14
15470(13/14)(NY) PRINTED IN U.S.A.
<PAGE>
CERTIFICATE Mortality and Expense Risk Charges will be determined on each
MONTHLY Certificate Anniversary based upon changes in future
DEDUCTION expectations as to mortality, expenses, interest,
AMOUNT persistency and taxes. Mortality and Risk Charges on in-force
(CONTINUED) policies will be reviewed no more than once a year, nor less
than once every five years. Any change We make will be on a
uniform basis for Insureds of the same Issue Age, sex, and
insurance class and whose coverage has been in-force for the
same length of time.
Any change in the Mortality and Expense Risk Charges will be
determined in accordance with the procedures and standards on
file with the Insurance Department where this certificate is
delivered.
FACE AMOUNT INCREASE FEE
The Face Amount Increase Fee will not exceed the amount shown
on Page 3C of the Certificate.
CERTIFICATE CERTIFICATE GRACE PERIOD
LAPSE AND During the first three Certificate Years, the Certificate will
CERTIFICATE go into default on any Monthly Activity Date on which the
GRACE PERIOD Account Value less Indebtedness is not sufficient to cover the
Monthly Deduction Amount.
During the fourth Certificate Year and thereafter, the
Certificate will go into default on any Monthly Activity Date
if the Cash Surrender Value is not sufficient to cover the
Monthly Deduction Amount.
If the Certificate goes into default, We will send the
Certificate Owner a lapse notice warning the Certificate Owner
that the Certificate is in danger of terminating. That lapse
notice will tell the Certificate Owner the minimum premium
required to keep the Certificate from terminating. This minimum
premium equals the amount to pay three Monthly Deduction
Amounts as of the day the Certificate Grace Period began. That
notice will be mailed both to The Certificate Owner at the
Certificate Owner's last known address and to any assignee of
record at lease 30 days, but no more than 45 days before the
end of the Certificate Grace Period.
We will keep the Certificate inforce for the 61 day period
following the date the Certificate goes into default. We call
that period the Certificate Grace Period. However, if We have
not received the required premiums (specified in the lapse
notice) by the end of the Certificate Grace Period, the
Certificate will terminate unless the No Lapse Guarantee is in
effect (see the No Lapse Guarantee provision which follows).
The Certificate will be in default if total Indebtedness equals
or exceeds the Cash Value on any Monthly Activity Date. We will
advise the Certificate Owner of the amount required to repay or
reinstate such indebtedness. If such payment is not made by the
end of the Certificate Grace Period, the Certificate will
terminate without value.
If the Insured dies during the Certificate Grace Period, We
will pay the Death Proceeds.
NO LAPSE GUARANTEE
The Certificate will remain in force at the end of the
Certificate Grace Period as long as the No Lapse Guarantee is
available, as described below.
This certificate provides a No Lapse Guarantee subject to the
conditions described below to Insureds with an Issue Age of 79
or below as long as:
(a) the Certificate is in the No Lapse Guarantee Period; and
(b) on each Monthly Activity Date during that period, the
cumulative premiums paid into the Certificate, less
Indebtedness and less withdrawals from the Certificate,
equal or exceed the Cumulative No Lapse Guarantee Premium.
Page 15
15470(15/16)(NY) PRINTED IN U.S.A.
<PAGE>
CERTIFICATE The No Lapse Guarantee Period is shown on Page 3 of the
LAPSE AND Certificate.
CERTIFICATE
GRACE PERIOD If the No Lapse Guarantee is available and the Certificate
(CONTINUED) Owner fails to pay the required premium as defined in the
Certificate Owner's lapse notice by the end of the Certificate
Grace Period, the No Lapse Guarantee will then go into effect.
The Certificate will remain in force, however:
(a) the Death Benefit Option becomes Level;
(b) all riders will terminate.
(c) any future scheduled increases in the Face Amount will be
canceled.
The No Lapse Guarantee will remain in effect on each subsequent
Monthly Activity Date provided:
(a) the Certificate remains in default; and
(b) the No Lapse Guarantee is available.
While the No Lapse Guarantee is in effect, We guarantee that
the Certificate's Account Value will never be less than zero.
If during the No Lapse Guarantee Period, there is any increase
or decrease in the Face Amount, or any change in rider coverage
or a change in insurance class, a new monthly No Lapse
Guarantee Premium will be calculated. We will send the
Certificate Owner a notice of the new Monthly No Lapse
Guarantee Premium, which will be used in calculating the
Cumulative No Lapse Guarantee Premium in subsequent months.
NO LAPSE GUARANTEE GRACE PERIOD
If, on each Monthly Activity Date during the No Lapse Guarantee
Period, the cumulative premiums paid into the Certificate, less
Indebtedness and less withdrawals from the Certificate, do not
equal or exceed the Cumulative No Lapse Guarantee Premium on
that date, a No Lapse Guarantee Grace Period of 61 days will
begin. We will mail the Certificate Owner and any assignee a
notice. That notice will warn the Certificate Owner that he/she
is in danger of losing the No Lapse Guarantee and will tell the
Certificate Owner the amount of premium he/she needs to pay to
continue the No Lapse Guarantee. The No Lapse Guarantee will be
removed from the Certificate if the required premium is not
paid by the end of the No Lapse Guarantee Grace Period. The
Certificate Owner will receive a written notification of the
change and the No Lapse Guarantee will never again be available
or in effect on the Certificate.
CERTIFICATE Unless the Certificate has been surrendered for its Cash
REINSTATEMENT Surrender Value, the Certificate may be reinstated prior to the
Scheduled Maturity Date provided:
(a) The Certificate Owner makes a request In Writing within
five years from the Termination Date;
(b) satisfactory evidence of insurability is submitted;
(c) any Indebtedness at the time of termination must be repaid
or carried over to the reinstated certificate; and
(d) The Certificate Owner pays sufficient premium to:
(i) cover all Monthly Deduction Amounts that are due and
unpaid during the Certificate Grace Period; and
(ii) keep the Certificate in force for 3 months after the
date of reinstatement.
The Account Value on the reinstatement date will equal:
(a) the Cash Value at the time of termination; plus
(b) Net Premiums attributable to premiums paid at the time of
reinstatement; minus
(c) the Monthly Deduction Amounts that were due and unpaid
during the Certificate Grace Period; plus
(d) the Surrender Charge at the time of reinstatement.
The Surrender Charge will be based on the duration from the
original Certificate Date as though the Certificate had never
lapsed.
Page 16
15470(15/16)(NY) PRINTED IN U.S.A.
<PAGE>
CERTIFICATE GENERAL
LOANS At any time while the Certificate is in force, The Certificate
Owner may borrow against the Certificate by assigning it as
sole security to Us. We may defer granting a loan, except to
pay premiums to Us, for the period permitted by law but not
more than six months. Any loan amount secured by transfers from
the Sub-Accounts are subject to the Separate Account deferral
provisions. We recommend consultation with a Tax Advisor prior
to taking a loan.
CERTIFICATE LOAN AMOUNTS
Any new loan taken together with any existing Indebtedness may
not exceed 90% of the Cash Value on the date We grant a loan.
The minimum loan amount that We will allow is $500.
Unless the Certificate Owner specifies otherwise, all loan
amounts will be transferred from the Fixed Account and the
Sub-Accounts to the Loan Account on a Pro Rata Basis.
If total Indebtedness equals or exceeds the Cash Value on any
Monthly Activity Date, the Certificate will then go into
default. See the Lapse and Certificate Grace Period provision
for details.
CREDITED INTEREST
Any amounts in the Certificate Loan Account will be credited
with interest at a rate equal to the Annual Fixed Account
Minimum Credited Rate shown on Page 3 of the Certificate.
PREFERRED INDEBTEDNESS
If, any time after the 10th Certificate Anniversary, the
Account Value exceeds the total of all premiums paid since
issue, a portion of the Certificate Indebtedness may qualify as
preferred. Preferred Indebtedness is charged a lower interest
rate than the non-preferred Indebtedness, if any. (Refer to the
Interest Charged on Indebtedness provision for details.) The
maximum amount of Preferred Indebtedness is the amount by which
the Account Value exceeds the total premiums paid and is
determined on each Monthly Activity Date.
CERTIFICATE LOAN REPAYMENTS
All or part of a loan may be repaid at any time that:
(a) the Certificate is in force; and
(b) the Insured is alive.
However, each repayment must be at least the lesser of $50 or
the Indebtedness and clearly identified In Writing as a loan
repayment. Otherwise, it will be considered a premium payment.
The amount of a loan repayment will be deducted from the
Certificate's Loan Account and will be allocated among the
Fixed Account and Sub-Accounts in the same percentage as
premiums are allocated.
INTEREST CHARGED ON CERTIFICATE INDEBTEDNESS
The table below shows the interest rates We will charge on a
Certificate's Indebtedness.
<TABLE>
<CAPTION>
--------------------------------- ------------------------------ -------------------------------
DURING CERTIFICATE PORTION OF INTEREST RATE CHARGED
YEARS CERTIFICATE INDEBTEDNESS EQUALS THE FIXED
ACCOUNT MINIMUM
CREDITED RATE PLUS:
--------------------------------- ------------------------------ -------------------------------
<S> <C> <C>
1-10 All 2%
--------------------------------- ------------------------------ -------------------------------
11 and later Preferred 0%
Non-Preferred 1%
--------------------------------- ------------------------------ -------------------------------
</TABLE>
Page 17
15470(17/18)(NY) PRINTED IN U.S.A.
<PAGE>
CERTIFICATE Because the interest charged on a Certificate's Indebtedness
LOANS may exceed the rate credited to the Certificate Loan Account,
(CONTINUED) the Indebtedness may grow faster than the Certificate Loan
Account. If this happens, any difference between the value of
the Certificate Loan Account and the Certificate Indebtedness
will be transferred on each Monthly Activity Date from the
Fixed Account and Sub-Accounts to the Certificate Loan Account
on a Pro Rata Basis.
WITHDRAWALS GENERAL
The Certificate Owner may request a withdrawal In Writing. The
minimum withdrawal allowed is $500. The maximum withdrawal is
the Certificate's Cash Surrender Value less $1,000. A charge of
up to $10 may be assessed for each withdrawal. One withdrawal
per calendar month is allowed. Unless specified otherwise the
withdrawal will be deducted on a Pro Rata Basis.
If the Death Benefit Option then in effect is Option A (Level
Option) or Option C (Return of Premium Option), the
Certificate's Face Amount will be reduced by the amount equal
to the reduction in the Account Value resulting from the
withdrawal. If the Death Benefit Option then in effect is
Option B (Return of Account Value), the Certificate's Face
Amount will not be reduced.
Any withdrawal that causes the Certificate's Face Amount to
fall below the lowest previous Certificate's Face Amount will
be subject to a partial Surrender Charge. Refer to the
Decreases in Certificate's Face Amount provision for an
explanation of the applicable partial Surrender Charge.
SURRENDERS GENERAL
While the Certificate is in force, the Certificate Owner may
surrender the Certificate to Us. The Certificate, and
additional benefits provided by rider, are then canceled as of
the day We receive the request In Writing or the date the
Certificate Owner requests the surrender, whichever is later.
We will then pay the Certificate Owner the Certificate's Cash
Surrender Value as of that date.
PAYMENTS GENERAL
BY US We will pay Certificate's Death Proceeds, Cash Surrender
Values, withdrawals and loan amounts attributable to the
Sub-Accounts within 7 days after We receive all the information
needed to process the payment unless:
(a) the New York Stock Exchange is closed on other than
customary weekend and holiday closings or trading on the
New York Stock Exchange is restricted as determined by the
Securities and Exchange Commission (SEC); or
(b) an emergency exists, as determined by the SEC, as a result
of which disposal of securities is not reasonably
practicable to determine the value of the Sub-Accounts.
DEFERRAL OF PAYMENTS FROM THE FIXED ACCOUNT
We may defer payment of any Certificate's Cash Surrender
Values, withdrawals and loan amounts which are not attributable
to the Sub-Accounts for up to six months from the date of the
request, except to pay premiums to Us. If We defer payment for
more than 10 days, We will pay interest at the rate We declare
under Settlement Option 1 - Interest Income.
TAXATION OF THE GENERAL
SEPARATE ACCOUNT We do not expect to incur any federal, state or local
income tax on the earnings or realized capital gains
attributable to the Separate Account. Based upon these
expectations, no charge is being made to the Separate Account
for federal, state or local income taxes. If We incur income
taxes attributable to the Separate Account or determine that
such taxes will be incurred, We may assess a charge for taxes
against the Certificate in the future, subject to approval by
the Superintendent of Insurance in the state where this
Certificate is issued for delivery.
Page 18
15470(17/18)(NY) PRINTED IN U.S.A.
<PAGE>
THE CONTRACT ENTIRE CONTRACT
The contract consists of the Policy, and the application, a
copy which is attached.
INTERPRETATION OF POLICY TERMS AND CONDITIONS
We have full discretion and authority to determine eligibility
for benefits and to construe and interpret all terms and
provisions of the Policy.
CONTRACT MODIFICATION
The only way this contract may be modified is by a written
agreement signed by Our President, or one of Our Vice
Presidents, Secretaries or Assistant Secretaries.
FUND MODIFICATION
We reserve the right, subject to any applicable law, to make
certain changes, including the right to add, eliminate or
substitute any investment options offered under the
Certificate.
NON-PARTICIPATION
The Contract is non-participating. It does not share in Our
surplus earnings, so the Certificate Owner will receive no
Certificate dividends under it.
MISSTATEMENT OF AGE AND/OR SEX If on the date of death:
(a) the Issue Age of the Insured is understated; or
(b) the sex of the Insured is incorrectly stated such that it
resulted in lower Costs of Insurance,
the Certificate's Death Benefit will be reduced to the
Certificate's Death Benefit that would have been provided by
the last Cost of Insurance charge at the correct Issue Age
and/or sex.
If on the date of death:
(a) the Issue Age of the Insured is overstated; or
(b) the sex of the Insured is incorrectly stated such that it
resulted in higher Costs of Insurance,
the Certificate's Death Benefit will be adjusted by the return
of all excess Costs of Insurance prior to the date of the
Insured's death.
SUICIDE
If, within 2 years from the Date of Issue of a Certificate, the
Insured covered by that Certificate dies by suicide, Our
liability will be limited to the premiums paid less Certificate
Indebtedness and less any withdrawals.
If, within 2 years from the effective date of any increase in
the Certificate's Face Amount for which evidence of
insurability was obtained, the Insured dies by suicide, Our
liability with respect to such increase, will be limited to the
Cost of Insurance for the increase.
INCONTESTABILITY
We cannot contest the Certificate after it has been in force,
during the Insured's lifetime, for 2 years from its Date of
Issue, except for non-payment of premium.
Any increase in the Certificate's Face Amount for which
evidence of insurability was obtained, will be incontestable
only after the increase has been in force, during the Insured's
lifetime, for 2 years from the effective date of the increase.
Page 19
15470(19/20)(NY) PRINTED IN U.S.A.
<PAGE>
THE CONTRACT The Certificate may not be contested for more than 2
(CONTINUED) years after the reinstatement date. Any contest We make after
the Certificate is reinstated will be limited to the material
misrepresentations in the evidence of insurability provided to
Us in the request for reinstatement. However, the provision
will not affect Our right to contest any statement in the
original application or a different reinstatement request which
was made during the Insured's lifetime for 2 years from the
Date of Issue of the Certificate or a subsequent reinstatement
date.
APPEALING DENIAL OF CLAIM
On any denied claim, the Certificate Owner or the Certificate
Owner's representative may appeal to the Company for a full and
fair review. The Certificate Owner may:
(a) request a review upon written application within 60 days of
receipt of a claim denial;
(b) review pertinent documents; and (c) submit issues and
comments In Writing.
SEPARATE ACCOUNTS
We will have exclusive and absolute ownership and control of
the assets of Our Separate Accounts. The assets of a Fund will
be available to cover the liabilities of Our General Account
only to the extent that those assets exceed the liabilities of
that Separate Account. Such assets will not be chargeable with
liabilities arising out of any other business that We may
conduct. The assets of a Fund will be valued on each Valuation
Day. Realized and unrealized gains and losses from the assets
of each Fund are credited or charged to against such Fund
without regard to Our other income, gains and losses. Our
determination of the value of an Accumulation Unit by the
method described in the Certificate will be conclusive.
If there are material changes in the investment certificate of
a Sub-Account, and the Certificate Owner objects to such
changes, the Certificate Owner may transfer the Accumulated
Value in that Sub-Account to another Sub-Account or the Fixed
Account. No Transfer Charge will be assessed.
CHANGE IN THE OPERATION OF THE SEPARATE ACCOUNT
At Our election and subject to any necessary vote by persons
having the right to give instructions on the voting of Fund
shares held by the Sub-Accounts, the Separate Account may be
operated as a management company under the Investment Company
Act of 1940 or any form permitted by law, may be deregistered
under the Investment Company Act of 1940 in the event
registration is no longer required, or may be combined with one
or more Separate Accounts.
VOTING RIGHTS
We will notify the Certificate Owner of any Fund shareholder's
meetings at which the shares held for the Certificate's
Sub-Account may be voted. We will also send proxy materials and
instructions for the Certificate Owner to vote the shares held
for the Certificate Owner's Sub-Account. We will arrange for
the handling and tallying of proxies received from the Owners.
We will vote the Fund shares held by Us in accordance with the
instructions received from the Owners. The Certificate Owner
may attend any meeting, where shares held for the Certificate
Owner's benefit may be voted.
In the event that the Certificate Owner gives no instructions
or leaves the manner of voting discretionary, We will vote such
shares of the appropriate Fund in the same proportion as shares
of that Fund for which instructions have been received. Also,
We will vote the Fund shares in this proportionate manner which
are held by Us for Our own account.
Page 20
15470(19/20)(NY) PRINTED IN U.S.A.
<PAGE>
THE CONTRACT ANNUAL REPORT
(CONTINUED) We will send the Certificate Owner a report at least once each
Certificate Year showing:
(a) the Certificate's current Account Value, Cash Surrender
Value and Face Amount;
(b) the premiums paid, Monthly Deduction Amounts and loans
since the last report;
(c) the amount of any Certificate Indebtedness; and
(d) any other information required by the Insurance Department
of the state where the Certificate was delivered.
OWNERSHIP AND CHANGE OF CERTIFICATE OWNER OR BENEFICIARY
BENEFICIARY The Certificate Owner and Beneficiary will be those named in
the application until the Certificate Owner changes them. To
change the Certificate Owner or Beneficiary, the Certificate
Owner must notify Us In Writing while the Insured is alive.
After We receive Certificate Owner written notice, the change
will be effective as of the date the Certificate Owner signed
such notice, whether or not of the Insured is living when We
receive it. However, the change will be subject to any payment
We made or actions We may have taken before We received the
request.
ASSIGNMENT
The Certificate Owner may assign the Certificate. Until the
Certificate Owner notifies Us In Writing, no assignment will be
effective against Us. We are not responsible for the validity
of any assignment.
CERTIFICATE OWNER'S RIGHTS
While the Insured is alive and no Beneficiary is irrevocably
named, the Certificate Owner may:
(a) exercise all the rights and options that the Certificate
provides or that We permit;
(b) assign the Certificate; and
(c) agree with Us to any change to the Certificate.
NO NAMED BENEFICIARY
If no named Beneficiary survives the Insured, then, unless the
Certificate provides otherwise:
(a) The Certificate Owner will be the Beneficiary; or
(c) if the Certificate Owner is the Insured, the Certificate
Owner's estate will be the Beneficiary.
TERMINATION AND TERMINATION
MATURITY DATE The Certificate will terminate upon the earliest of the
following events:
(a) the Scheduled Maturity Date of the Certificate; or
(b) the surrender of the Certificate; or
(c) the end of the Certificate Grace Period during which
premiums sufficient for the required deductions are not
paid, provided the No Lapse Guarantee is not available; or
(d) the end of the No Lapse Guarantee Period, provided the No
Lapse Guarantee is available and in effect; or
(e) the end of the No Lapse Guarantee Grace Period during which
premiums sufficient to maintain the No Lapse Guarantee are
not paid; provided the No Lapse Guarantee is available and
in effect; or
(f) the date We receive notification In Writing of the death of
the Insured. In this event, the Certificate Owner's Death
Benefit will not be affected by any Monthly Deduction
Amounts taken after the date of the Insured's death and
before We receive due proof of death.
SCHEDULED MATURITY DATE
The Scheduled Maturity Date is the last date on which the
Certificate Owner may elect to pay premium. The Certificate
will terminate on that date and any Cash Surrender Value will
be paid to the Certificate Owner.
Page 21
15470(21/22)(NY) PRINTED IN U.S.A.
<PAGE>
INCOME AVAILABILITY
SETTLEMENT All or parts of the proceeds of the Certificate may, instead of
OPTIONS being paid in one sum, be left with Us under any one or
a combination of the following options, subject to Our minimum
amount requirements on the date of election.
We will pay interest of at least 3% per year (or higher, if
required by state law) on the Certificate's Death Proceeds from
the date of the Insured's death to the date payment is made or
an Income Settlement Option is elected. The rate will always be
at least the rate of interest payable under Option 1 - Interest
Income. These proceeds are then no longer subject to the
investment experience of a Separate Account.
If any payee is a corporation, partnership, association,
assignee, or fiduciary, an option may be chosen only with Our
consent. Option 4 is not available to any payee whose age
exceeds 90.
DESCRIPTION OF TABLES
The options shown below and on the next page are based on
interest at a guaranteed rate of 3% per year. Payments under
Option 4 are based on mortality according to the 1983a
Individual Annuity Mortality Table, with ages set back one
year.
We may pay or credit excess interest of such amount and in such
manner as We determine.
DEATH OF PAYEE
If the payee dies while receiving payments under one of the
options below, We will pay the following:
(a) Any principal and accrued interest remaining unpaid under
Option 1 or 2.
(b) The value of remaining unpaid guaranteed payments, if any,
under Option 3 or 4, commuted using interest of 3% per
year.
Any such amount will be paid in one sum to the payee's estate.
OTHER OPTIONS
To convert the monthly payments shown in the tables for Options
3 and 4 to quarterly, semi-annual or annual payments, multiply
by the following factors:
PAYMENT INTERVAL FACTOR
Quarterly 2.99
Semi-annual 5.96
Annual 11.84
Other options may be arranged with Our consent.
OPTION 1 - INTEREST INCOME
Payments of interest at the rate We declare, but not less than
3% per year, on the amount left under this option.
OPTION 2 - INCOME OF FIXED AMOUNT
Equal payments of the amount chosen until the amount left under
this option, with interest of not less than 3% per year, is
exhausted. The final payment will be for the balance only.
Page 22
15470(21/22)(NY) PRINTED IN U.S.A.
<PAGE>
INCOME OPTION 3 - INCOME FOR FIXED PERIOD
SETTLEMENT Payments, determined from the table below, are guaranteed for
OPTIONS the number of years chosen. The first payment will be due
(CONTINUED) on the date proceeds are applied under this option.
<TABLE>
<CAPTION>
MONTHLY PAYMENTS MONTHLY PAYMENTS
NUMBER PER $1,000 OF NUMBER PER $1,000 OF
OF YEARS PROCEEDS OF YEARS PROCEEDS
<S> <C> <C> <C>
1 $84.47 10 $9.61
2 42.86 15 6.87
3 28.99 20 5.51
4 22.06 25 4.71
5 17.91 30 4.18
</TABLE>
OPTION 4 - LIFE INCOME
Payments, determined from the table shown below for the option
elected, are based on the payee's sex and age nearest birthday
on the day the first payment becomes due. The first payment
will be due on the date proceeds are applied under this option.
The Life Income available are:
(a) Payments only while the payee is alive.
(b) Payment guaranteed for 10 years; then continuing while the
payee is alive.
MONTHLY PAYMENTS PER $1,000 OF PROCEEDS
<TABLE>
<CAPTION>
OPTION 4A OPTION 4B OPTION 4A OPTION 4B
PAYEE'S LIFE ONLY 10 YRS. CERTAIN PAYEE'S LIFE ONLY 10 YRS. CERTAIN
AGE MALE FEMALE MALE FEMALE AGE MALE FEMALE MALE FEMALE
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
20 $3.02 $2.92 $3.01 $2.92 68 $6.51 $5.68 $6.12 $5.50
25 3.12 3.00 3.12 3.00 69 6.74 5.85 6.28 5.65
30 3.25 3.10 3.24 3.10 70 6.98 6.04 6.44 5.80
35 3.41 3.23 3.40 3.23 71 7.24 6.25 6.61 5.97
40 3.61 3.39 3.60 3.38 72 7.51 6.47 6.79 6.14
45 3.87 3.59 3.85 3.58 73 7.81 6.72 6.96 6.32
50 4.19 3.85 4.15 3.83 74 8.12 6.98 7.14 6.50
51 4.27 3.91 4.22 3.89 75 8.46 7.26 7.32 6.69
52 4.35 3.97 4.30 3.95 76 8.83 7.57 7.50 6.89
53 4.43 4.03 4.37 4.01 77 9.22 7.90 7.68 7.09
54 4.51 4.10 4.45 4.08 78 9.64 8.27 7.85 7.29
55 4.61 4.18 4.54 4.15 79 10.09 8.66 8.02 7.50
56 4.70 4.25 4.63 4.22 80 10.57 9.08 8.18 7.70
57 4.80 4.34 4.72 4.30 81 11.08 9.54 8.33 7.89
58 4.91 4.42 4.82 4.38 82 11.63 10.04 8.48 8.08
59 5.03 4.52 4.92 4.47 83 12.22 10.59 8.62 8.27
60 5.15 4.62 5.03 4.56 84 12.84 11.18 8.75 8.44
61 5.28 4.72 5.15 4.66 85 13.50 11.81 8.86 8.60
62 5.43 4.83 5.27 4.76 86 14.19 12.50 8.97 8.74
63 5.58 4.95 5.39 4.87 87 14.93 13.24 9.07 8.87
64 5.74 5.08 5.53 4.98 88 15.71 14.04 9.16 8.99
65 5.91 5.21 5.67 5.10 89 16.53 14.89 9.24 9.09
66 6.10 5.36 5.81 5.23 90 17.40 15.79 9.31 9.18
67 6.30 5.51 5.96 5.36
</TABLE>
Page 23
15470(23)(NY) PRINTED IN U.S.A.
<PAGE>
[LOGO]
HARTFORD LIFE
APPLICATION
FOR
LIFE INSURANCE
NOTE: IF THE APPLICATION QUALIFIES FOR SIMPLIFIED ISSUE AND AN AGREEMENT FOR
SIMPLIFIED ISSUE HAS BEEN OBTAINED FROM THE UNDERWRITING DEPARTMENT, ONLY THE
FOLLOWING QUESTIONS SHOULD BE ANSWERED:
PART A - QUESTIONS #1-4 AND 5 (as applicable)
PART B - ALL QUESTIONS EXCEPT 6B, 6C, AND 10
IN ADDITION, THE AGREEMENT AND AUTHORIZATION SECTIONS AND AGENT'S REPORT SHOULD
BE COMPLETED.
FORM IIL-14622(NY) Printed in U.S.A.
<PAGE>
AGENT: THIS NOTICE MUST BE REMOVED AND LEFT WITH THE PROPOSED INSURED(S)
HARTFORD LIFE INSURANCE COMPANY
NATIONAL SERVICE CENTER ADDRESS:
P.O. BOX 59179
MINNEAPOLIS, MN 55459
INVESTIGATIVE CONSUMER REPORT PRE-NOTIFICATION
Federal and state laws require notification that, in connection with your
application, we may request an investigative consumer report. In addition,
such a report may be requested subsequently to update our records if you
apply for additional coverage. You may request to be interviewed in
connection with the preparation of the investigative consumer report. Within
5 business days of receiving your written request, we will inform you whether
or not an investigative consumer report was requested and, if such a report
was requested, the address and telephone number of the investigative agency
to which the request was made. By contacting the local office and providing
proper identification, you may inspect or, for the appropriate fee, receive a
copy of such report. The investigative agency may retain information they
gather and disclose it at a later date to other persons.
Typically the report will contain information as to character, general
reputation, personal characteristics and mode of living, which information is
obtained through an interview with you or an adult member of your family,
employers or business associates, financial sources, friends, neighbors or
others with whom you are acquainted. The information will consist, when
applicable, of a confirmation of your identity, age, residence, marital
status, and past and present employment including occupational duties,
financial information, driving record, sports and recreational activities,
health history, use of alcohol or drugs, if any, living conditions and type
of community.
MEDICAL INFORMATION BUREAU (MIB) PRE-NOTIFICATION
Information regarding your insurability will be treated as confidential. The
Hartford Life Insurance Company or its reinsurer(s) may, however, make a
brief report thereon to the Medical Information Bureau, a non-profit
membership organization of life insurance companies, which operates an
information exchange on behalf of its members. If you apply to another Bureau
member company for life or health insurance coverage, or a claim for benefits
is submitted to such a company, the Bureau, upon request, will supply such a
company, with the information in its file.
Upon receipt of a request from you, the Bureau will arrange disclosure of any
information it may have in your file. If you question the accuracy of
information in the bureau's file, you may contact the Bureau and seek a
correction in accordance with the procedures set forth in the Federal Fair
Credit Reporting Act. The address of the Bureau's information office is Post
Office Box 105, Essex Station, Boston, Massachusetts 02112, telephone number
(617)426-3660.
The Hartford Life Insurance Company or its reinsurer(s) may also release
information in their files to other life insurance companies to whom you may
apply for life or health insurance, or to whom a claim for benefits may be
submitted.
PERSONAL HISTORY INTERVIEW
To provide you, our client, with the best possible service, we may follow-up
your application for insurance with what we call a personal history
interview. This is a phone call placed from our underwriting office. Its
purpose is to make sure that our application information is accurate and
complete.
We strive to make you the best possible offer for your premium dollar. The
personal history interview gives us the opportunity to gather the information
necessary for fair and prompt processing of your application.
Our interviewers are trained to conduct their calls in a friendly, professional
manner. The nature of the information discussed is always treated as personal
and confidential.
FORM IIL-14622(NY) Printed in U.S.A.
<PAGE>
HARTFORD LIFE INSURANCE COMPANY
HARTFORD, CONNECTICUT 06104-2999
<TABLE>
<S> <C>
[LOGO]
PART A HARTFORD LIFE
- -----------------------------------------------------------------------------------------------------------------------------------
1. PROPOSED INSURED INFORMATION - COMPLETE FOR ALL APPLICATIONS.
- -----------------------------------------------------------------------------------------------------------------------------------
a. Name of Proposed Insured b. Age c. Sex f. Date of Birth h. Social Sec. No.
-------------------------------------------------------
d. Height e. Weight g. Place of Birth
- -----------------------------------------------------------------------------------------------------------------------------------
i. Residence Address j. How Long? k. Former Residence l. How Long?
- -----------------------------------------------------------------------------------------------------------------------------------
m. City, State Zip n. City, State Zip
- -----------------------------------------------------------------------------------------------------------------------------------
o. Occupation/Duties p. How Long? q. Employer's Name and Address
- -----------------------------------------------------------------------------------------------------------------------------------
2. PROPOSED JOINT INSURED/OTHER COVERED INSURED INFORMATION - COMPLETE IF APPLICABLE.
- -----------------------------------------------------------------------------------------------------------------------------------
a. Name of Proposed Joint Insured b. Age c. Sex f. Date of Birth h. Social Sec. No.
-------------------------------------------------------
d. Height e. Weight g. Place of Birth
- -----------------------------------------------------------------------------------------------------------------------------------
i. Residence Address j. How Long? k. Former Residence l. How Long?
(if different from above)
- -----------------------------------------------------------------------------------------------------------------------------------
m. City, State Zip n. City, State Zip
- -----------------------------------------------------------------------------------------------------------------------------------
o. Occupation/Duties p. How Long? q. Employer's Name and Address
- -----------------------------------------------------------------------------------------------------------------------------------
3. OWNER/BENEFICIARY INFORMATION - COMPLETE FOR ALL APPLICATIONS.
- -----------------------------------------------------------------------------------------------------------------------------------
a. Policy Owner Name and Address. b. Soc. Sec. No. or Tax ID c. Relationship to Proposed Insured(s)
- -----------------------------------------------------------------------------------------------------------------------------------
d. Owner is:
/ / Individual / / Partnership / / Corporation / / Trustee
- -----------------------------------------------------------------------------------------------------------------------------------
c. Primary Beneficiary(s). Name(s)/Address/Soc. Sec. # f. Relationship to Proposed Insured(s) g. % of Death Benefit
- -----------------------------------------------------------------------------------------------------------------------------------
h. Contingent Beneficiary. Name(s)/Address/Soc. Sec. # i. Relationship to Proposed Insured(s)
- -----------------------------------------------------------------------------------------------------------------------------------
4. LIFE INSURANCE PLAN INFORMATION - COMPLETE FOR ALL APPLICATIONS.
- -----------------------------------------------------------------------------------------------------------------------------------
a. Name of Basic Policy b. Face Amount of Policy (Indicate amount of j. Premiums to be Paid:
Basic Face Amount and Supplemental Face / / Annually / / Semi-annually / / Quarterly / / COM
Amount, if applicable)
- -----------------------------------------------------------------------------------------------------------------------------------
c. Death Benefit Options (Choose One, if applicable) k. Send Billing/Correspondence to Proposed Insured's
/ / Option A (Level) / / Option C (Return of Premium) / / Residence / / Business
/ / Option B (Return of Account Value) / / Policy Owner / / Other:
- -----------------------------------------------------------------------------------------------------------------------------------
d. Premiums: l. Additional Benefits:
i) Flexible Premium UL Plans / / Waiver of Premium / / Accidental Death Benefit
Planned Premiums / / ____% Increase in Face Amount for ____ Year(s)
$___________ First Year $______________ Subsequent Years (Last Survivor Interest Sensitive Life Plans Only)
ii) Interest Sensitive Life and All Other Plans / / Increase in Coverage Option Rider
Annual Scheduled Premiums (Individual Variable Life Plans Only)
$___________ First Year $______________ Subsequent Years / / Additional Insurance Benefit
(COMPLIANCE ILLUSTRATION MUST ACCOMPANY CASH APPLICATION) $_______________ Premium for ____ Year(s).
- ----------------------------------------------------------------------
e. Premium Options (Choose one)(Interest Sensitive Life Plans Only) / / Other: ___________ / / See Attached Sheet
/ / Option 1 - Premiums Based on Guaranteed Assumptions
/ / Option 2 - Premiums Based on Current Assumptions
- -----------------------------------------------------------------------------------------------------------------------------------
f. Premium Option 2 only; (Interest Sensitive Life Plans Only) m. Issue Policy if offered on a Requested Policy
Premium Payment Period ______ Years Special Class Basis? / / Yes / / No Date:___________
- -----------------------------------------------------------------------------------------------------------------------------------
g. Automatic Premium Loan / / Yes / / No n. Special Requests (Attach Additional sheet if necessary.)
- ----------------------------------------------------------------------
h. Is this Insurance Part of a If "YES", do you work on a full
Qualified Retirement Plan? time basis? / / Yes / / No
/ / Yes / / No
- ----------------------------------------------------------------------
i. Is this Insurance Part of If "YES", If you are an employee, have
a Corporate Owned Life you been actively at work at least 30
Insurance Plan? hours per week for the past 90 days
/ / Yes / / No doing your usual duties at your normal
place of work? / / Yes / / No
- -----------------------------------------------------------------------------------------------------------------------------------
FORM IIL-14622(NY) APPLICATION CONTINUED Printed in U.S.A.
</TABLE>
<PAGE>
<TABLE>
<S> <C>
- ---------------------------------------------------------------------------------------------------------------------------------
- ------- Proposed Joint/
PART B Proposed Other Covered
- ------- ANSWER THE FOLLOWING QUESTIONS AND GIVE DETAILS Insured Insured
- ----- OF "YES" ANSWERS UNDER #8. BELOW ------------------------------------
5. YES NO YES NO
- ---------------------------------------------------------------------------------------------------------------------------------
a. DURING THE PAST 5 YEARS HAVE YOU CONSULTED A PHYSICIAN OR
VISITED A CLINIC OR HOSPITAL AS A PATIENT? / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
b. HAVE YOU had insurance rejected or offered with an extra premium? / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
c. DO YOU plan to travel or reside outside the United States? (If yes, state when, where,
how long.) / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
d. HAVE YOU smoked cigarettes in the past 12 months? / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
e. HAVE YOU used any other form of tobacco or nicotine replacement therapy in the past 12
months (for example - cigars, pipes, chewing tobacco, nicorette gum, nicotine patch or
nasal spray)? (If "yes", specify substance(s).) / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
f. HAVE YOU ever been arrested for drug possession, or had or been advised to have
treatment for alcohol or drug abuse? / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
g. WILL YOU replace or change life insurance or annuities in any company if this policy
is issued? IF "YES", GIVE DETAILS. / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
6. HAVE YOU EVER HAD OR BEEN TREATED FOR:
- ---
a. Diabetes, heart attack, angina, chest pain, stroke, heart murmur, high blood pressure, or
other heart, blood or circulatory disorder? / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
b. Emotional or nervous disorder, epilepsy, convulsions, brain or spinal cord disorder,
cancer or tumor? / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
c. Any disease of the kidney, liver, lung, lymph glands, muscles, bones, stomach or
intestines? / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
7. Have you been diagnosed by a member of the medical profession as having AIDS, AIDS
- --- Related Complex or other immune deficiency disorder? / / / / / / / /
- ---------------------------------------------------------------------------------------------------------------------------------
-----
Question NAME OF 8. GIVE COMPLETE DETAILS INCLUDING NAMES AND ADDRESSES OF DOCTORS AND HOSPITALS.
Number PERSON ----- (ATTACH AN ADDITIONAL SHEET OF PAPER, IF NECESSARY)
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
9. DO YOU HAVE LIFE INSURANCE IN FORCE OR APPLIED FOR? GIVE COMPANY, AMOUNT, PLAN, ISSUE YEARS, OWNERSHIP AND IF WAIVER OF
- --- PREMIUM OR ACCIDENTAL DEATH BENEFITS ARE INCLUDED. (ATTACH AN ADDITIONAL SHEET OF PAPER, IF NECESSARY)
- ---------------------------------------------------------------------------------------------------------------------------------
Proposed Insured YES / / NO / / Proposed Joint Insured YES / / NO / / * Applicant YES / / NO / /
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------------
10. VARIABLE LIFE PLAN INFORMATION - COMPLETE IF APPLICABLE.
- ---------------------------------------------------------------------------------------------------------------------------------
a. Dollar Cost Averaging Option / / YES / / NO h. Net Premium Allocation. Select up to 9 Subaccounts.
(Available on an Annual Mode Only) (0 or minimum of 10%. Must total 100%)
- ----------------------------------------------------------------- If using supplement, disregard this section.
b. Guarantee Period
- -----------------------------------------------------------------
SUITABILITY YES NO FUND NAME % ALLOCATED
- ----------------------------------------------------------------- ------------------------------------- --------------------%
c. Do you believe that this policy will meet your ------------------------------------- --------------------%
insurance need and financial objectives? ------------------------------------- --------------------%
- ----------------------------------------------------------------- ------------------------------------- --------------------%
d. Do you understand that the amount and duration ------------------------------------- --------------------%
of the death benefit may vary, depending on the ------------------------------------- --------------------%
investment performance of the variable accounts ------------------------------------- --------------------%
in the separate account? ------------------------------------- --------------------%
- ----------------------------------------------------------------- ------------------------------------- --------------------%
e. Do you understand that the policy values may ------------------------------------- --------------------%
increase or decrease, depending on the investment ------------------------------------- --------------------%
performance of the variable accounts in the ------------------------------------- --------------------%
separate account? ------------------------------------- --------------------%
- ----------------------------------------------------------------- ------------------------------------- --------------------%
f. Did you receive the separate account prospectus
for the policy applied for? FIXED ACCOUNT
- ----------------------------------------------------------------- ------------------------------------- --------------------%
g. Date of Separate Account Prospectus: ______________________
- ---------------------------------------------------------------------------------------------------------------------------------
ILLUSTRATION OF BENEFITS, INCLUDING DEATH BENEFITS, ACCOUNT VALUES, CASH VALUES AND ANY OTHER INFORMATION REQUIRED BY THE
SUPERINTENDENT OF INSURANCE, ARE AVAILABLE UPON REQUEST.
- ---------------------------------------------------------------------------------------------------------------------------------
* Complete only if Proposed Insured is under 15 years of age
Form IIL-14622(NY) APPLICATION CONTINUED Printed in U.S.A.
</TABLE>
<PAGE>
<TABLE>
<S> <C>
- ------------------------------------------------------------------------------------------------------------------------------------
PART C Proposed
- ------ Proposed Joint/Other
HAZARDOUS ACTIVITIES OF PROPOSED INSURED(S)- COMPLETE FOR ALL APPLLICATIONS. Insured Covered
PLEASE ANSWER ALL QUESTIONS "YES" OR "NO." EXPLAIN "YES" ANSWERS IN THE SPACE PROVIDED. Insured
------------------------
11. YES NO YES NO
- ------------------------------------------------------------------------------------------------------------------------------------
a. Within the past 3 years, have you been convicted or, pleaded guilty or no contest to:
(I). three or more moving violations and/or accidents? / / / / / / / /
(II). driving under the influence of alcohol and/or drugs? / / / / / / / /
IF "YES", EXPLAIN:
- ------------------------------------------------------------------------------------------------------------------------------------
b. Have you ever been convicted of a felony or misdemeanor other than a minor traffic violation? / / / / / / / /
IF "YES", EXPLAIN:
- ------------------------------------------------------------------------------------------------------------------------------------
c. Are you a member, or do you intend to become a member, of the armed forces, including the
Reserves? / / / / / / / /
IF "YES", EXPLAIN:
- ------------------------------------------------------------------------------------------------------------------------------------
d. Except for vacation trips, do you intend to travel outside the U. S. or Canada within the
next two years? / / / / / / / /
IF "YES", EXPLAIN:
- ------------------------------------------------------------------------------------------------------------------------------------
e. Do you participate in aeronautics (hand-gliding, soaring, sky-diving, ballooning, etc.)? / / / / / / / /
IF "YES", EXPLAIN:
- ---------------------------------------------------------------------------------------------------------
Jumps/Flights Total # of jumps/Flights Name of Club Date of Last Jump/Flight
per year
- ------------------------------------------------------------------------------------------------------------------------------------
f. Do you race, test or stunt drive automobiles, motorcycles, motor boats, or jet powered vehicles,
or do you use or race snow mobiles, dirt bikes, dune buggies, etc.? IF "YES", COMPLETE BELOW: / / / / / / / /
- ---------------------------------------------------------------------------------------------------------
Type of vehicle Type of terrain/race/course # of Races or Uses/year Date of Last Race or Use
- ------------------------------------------------------------------------------------------------------------------------------------
g. Do you participate in skin or scuba diving? / / / / / / / /
IF "YES", COMPLETE BELOW:
- ---------------------------------------------------------------------------------------------------------
Depth of Dives # of Times per Year Name of Club Date of Last Dive
- ------------------------------------------------------------------------------------------------------------------------------------
h. Do you participate in any other hazardous sports or activities (mountain climbing, competitive
skiing, rodeos, etc.? IF "YES", EXPLAIN: / / / / / / / /
- ------------------------------------------------------------------------------------------------------------------------------------
i. Have you ever engaged in or do you plan to engage in any aviation activity other than as a fare-paying
passenger? IF "YES", COMPLETE THE REMAINDER OF THIS SECTION. / / / / / / / /
- ------------------------------------------------------------------------------------------------------------------------------------
j. What types and kinds of planes do you fly or intend to fly?
- ------------------------------------------------------------------------------------------------------------------------------------
PERSON FLIGHT STATUS PILOT-MILITARY OR RESERVE PILOT CIVILIAN CREW MEMBER
- ------------------------------------------------------------------------------------------------------------------------------------
HOURS FLOWN
PAST 12 MOS.
- ------------------------------------------------------------------------------------------------------------------------------------
HOURS FLOWN
1-2 YRS. AGO
- ------------------------------------------------------------------------------------------------------------------------------------
HOURS NEXT
12 MONTHS
- ------------------------------------------------------------------------------------------------------------------------------------
Total Solo Hours Total Hours Flown as a Pilot Date of Last Flight
- ------------------------------------------------------------------------------------------------------------------------------------
k. Type of Pilot's Certificate(s) or Rating(s)? (check as appropriate)
/ / Student / / Private / / Commercial / / ATR / / IFR
Year Issued:
- ------------------------------------------------------------------------------------------------------------------------------------
l. If aviation avocation does not qualify for aviation coverage without additional premium, issue policy as follows:
/ / Aviation Coverage with Extra Premium / / Aviation Exclusion Rider
- ------------------------------------------------------------------------------------------------------------------------------------
REMARKS - IDENTIFY QUESTION, PROPOSED INSURED, AND ADDITIONAL DETAILS
- ------------------------------------------------------------------------------------------------------------------------------------
Form IIL-14622(NY) APPLICATION CONTINUED Printed in the U. S. A.
</TABLE>
<PAGE>
<TABLE>
<S> <C>
- -----------------------------------------------------------------------------------------------------------------------------------
Part D
- -------
12. AGREEMENT AND ACKNOWLEDGEMENT - COMPLETE FOR ALL APPLICATIONS.
- -----------------------------------------------------------------------------------------------------------------------------------
Each of the undersigned declares that: the statements and answers contained in this application are complete and true to the best
of each person's knowledge and belief, and, unless otherwise provided by the terms of the Conditional Receipt, each agrees that
coverage can take effect only if the Proposed Insured(s) is/are alive and all answers material to the risk are still true and
complete when the policy is delivered and paid for. I/We agree that the statements and answers contained in this application
shall form the basis of any contract for life insurance that may be issued; and, a copy of this application shall be attached to
and made part of the policy. I/We have received a copy of the Company Compliance Illustration for the life insurance applied for
herein. I/We agree that only an Officer of the Company may alter the terms of the application, the Conditional Receipt or the
policy, or waive any of the Company's rights or requirements.
Signed at this day of 19 .
-------------------------- ------------------ ----------------------- -------------
X
- --------------------------------------------- ---------------------------------------------------------------
Signature of Proposed Insured SIGNATURE OF PROPOSED JOINT INSURED/OTHER COVERED INSURED
(Parent or Guardian if under 15 years of Age) (PARENT OR GUARDIAN IF UNDER 15 YEARS OF AGE)
$ X
--------------------------------------- ---------------------------------------------------------------
Amount Received with Application Signature of Applicant/Owner if other than Proposed Insured(s)
---------------------------------------------------------------
Signature of Licensed Agent
- -----------------------------------------------------------------------------------------------------------------------------------
13. AUTHORIZATION TO OBTAIN, RELEASE AND DISCLOSE INFORMATION - COMPLETE FOR ALL APPLICATIONS.
- -----------------------------------------------------------------------------------------------------------------------------------
I authorize Hartford Life Insurance Company (Hartford) to complete a Personal History Interview and to obtain an Investigative
Consumer Report on me or on my children. I authorize the release of any medical or non-medical information that relates to: (1)
past or current health conditions including illnesses; sicknesses; diseases, disabilities; disorders; accidents; or injuries: (2)
confinements in any hospital; medical facility; or medical clinic; (3) outpatient treatment in any hospital; hospital emergency
room; medical facility; or clinic; (4) treatment for alcohol abuse; drug abuse; or mental health protected by Federal Law.
This information may be released by any person or organization that has records or knowledge of my health or of the health of my
children, if they are applying for insurance. This includes any doctor; medical professional; health practitioner; therapist;
counselor; hospital; clinic; insurer; reinsurer, consumer reporting firm; employer or the Medical Information Bureau (MIB). This
information may be released for the purpose of determining eligibility for insurance under a new or an existing policy.
This information may be released to Hartford or to their legal representative. I understand that the MIB will release records of
information only to Hartford.
Hartford may release the information in their file(s) to: their reinsurers; the MIB; any other insurance company to whom I or my
children apply for life or health insurance; or other persons and/or organizations performing business or legal services in
connection with this application or a claim. Except as specified, this information will not be given, sold or transferred to any
person without first obtaining my consent. This consent must be written and state the use and the need for such information.
I understand that if I request details about any of the medical information gathered about me or my children which relates to this
application; (a) the medical information; and, (b) the identity of the medical care institution or the medical person who provided
the information; shall be released to me or to a licensed medical person of my choice.
Upon written request, I will receive details of the method I must use to exercise my right to access, correct and amend any
information gathered about me or my children which relates to this application. I may revoke, upon written request, the right to
use this consent form except to the extent that action has already been taken. A photocopy of this consent form is as valid as
the original. When requested in writing, I will receive a copy of this form. This consent form will expire: two years from the
date of the contract; or, one year from date below, if no contract has yet been issued.
Dated Signed X
---------------------------------------- ---------------------------------------------------------------
Proposed Insured (Parent or Guardian if under 15 years of Age)
Dated Signed
---------------------------------------- ---------------------------------------------------------------
PROPOSED JOINT INSURED/ OTHER COVERED INSURED
(PARENT OR GUARDIAN IF UNDER 15 YEARS OF AGE)
- -----------------------------------------------------------------------------------------------------------------------------------
Form IIL-14622(NY) APPLICATION CONTINUED Printed in U.S.A.
</TABLE>
<PAGE>
<TABLE>
<S> <C>
PART E AGENT INFORMATION - COMPLETE FOR ALL APPLICATIONS.
- -----------------------------------------------------------------------------------------------------------------------------------
1. How well do you know the Proposed Insured(s)?
- -----------------------------------------------------------------------------------------------------------------------------------
2. Do you have knowledge or reason to believe that replacement of existing life insurance or annuities is involved in this
transaction?
- -----------------------------------------------------------------------------------------------------------------------------------
3. Personal History Interview
Most convenient time to call / / Morning / / Afternoon
Place to call / / Home / / Business / / Phone Number _______________________________
May we interview the Spouse of an adult member of the family: / / Yes / / No
Show any unusual name pronunciation phonetically. ________________________________________
- -----------------------------------------------------------------------------------------------------------------------------------
4. Estimated annual income, net worth and marital status of Proposed Insured(s)?
- -----------------------------------------------------------------------------------------------------------------------------------
5. Give the purpose of this insurance and the nature of the Owner/Applicant's insurance interest.
- -----------------------------------------------------------------------------------------------------------------------------------
6. This Application is submitted on the following basis: / / Medically / / Non-medically
/ / Other
Has a medical examination been arranged? / / Yes / / No
- -----------------------------------------------------------------------------------------------------------------------------------
REMARKS - IDENTIFY QUESTION AND GIVE DETAILS
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IF THE APPLICATION PACKAGE IS NOT BEING SUBMITTED THROUGH YOUR BROKER/DEALER, CONTACT THAT BROKER/DEALER FOR THEIR
SUITABILITY REQUIREMENTS. WE SUGGEST YOU SEND YOUR BROKER/DEALER A COPY OF PART A (PAGE 1), SECTION 9, (PAGE 2)
(SUITABILITY AND FUND SELECTION) AND PART E (AGENT INFORMATION) OF THE APPLICATION, ALONG WITH A COPY OF THE ILLUSTRATION
USED IN THE FINAL SALE.
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PRODUCER CERTIFICATION - COMPLETE FOR ALL APPLICATIONS.
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1. I CERTIFY that I asked each question separately; the answers were recorded as given; and, they are complete and accurate
to the best of my knowledge and belief.
2. I CERTIFY that I am duly licensed in the state in which this application was signed.
3. I have given the Proposed Insured(s) the appropriate Disclosure documents.
4. For Variable Life Business, I CERTIFY that I am a NASD Registered Representative.
5. I have complied with state and federal laws on disclosure, cost comparison and replacement.
6. I have reviewed the purchase of this insurance policy as to suitability.
X _____________________________________________________________________________________________________________________
Signature(s) of Writing Agent(s). Writing Agent's Code Number
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PAY COMMISSIONS AS INDICATED BELOW (COMMISSION SPLITS ARE AT WRITING AGENT LEVEL) SPLIT
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AGENT NAME AGENT CODE SOCIAL SEC./ TAX I.D. 1ST YR. RENEWAL
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Sales Office Use Only: F.O.# _______ Staff Code _______ Advanced Und. Code _______ Marketing Code _______
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WHEN CONDITIONAL RECEIPT CAN BE USED
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An advance payment may be accepted and the Conditional Receipt may be given ONLY under the following conditions:
1. The advance premium is at least equal to the amount of the full first premium for the mode selected.
2. The answers in Part B, questions 5f, 6 and 7 are "No".
3. The Proposed Insured(s) appear to be standard risks in all respects.
4. The Conditional receipt is given and the advance premium is collected only at the time the application is taken and signed.
5. The application does not contain a request for postdating.
6. The agent does not make an advance payment for the Proposed Insured or Applicant. If this is done, loss of the agent's
license could result.
7. The proposed Insured(s) is/are 75 years old or less, age last birthday.
8. The amount of insurance applied for does not exceed $500,000.
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AGENT'S REPORT
</TABLE>
<PAGE>
CONDITIONAL RECEIPT
VALID FOR USE WITH LIFE INSURANCE ON PROPOSED INSURED(S) AGE 75 OR LESS WITH THE
AMOUNTS OF INSURANCE APPLIED FOR NOT IN EXCESS OF $500,000.
If any person proposed for coverage has answered "Yes" to question 5f, 6 or 7,
or is over age 75, age last birthday, no payment may be accepted with the
application.
1. NO COVERAGE WILL BECOME EFFECTIVE PRIOR TO DELIVERY OF THE POLICY APPLIED
FOR UNLESS AND UNTIL ALL THE CONDITIONS OF THIS RECEIPT HAVE BEEN FULFILLED
EXACTLY:
(a) The amount of payment taken with the application must be at least
equal to the amount of the full first premium for the mode of payment
selected in the application and for the amount of insurance which may
become effective prior to delivery of the policy.
(b) The first medical examination (or the second medical examination, if
necessary due to the insured's age or the amount of insurance applied
for) tests, x-rays and electrocardiograms required by the Company's
published underwriting rules, must be completed and received at its
National Service Center in Minneapolis, Minnesota within 60 days from
the date of completion of Part 1 of this application.
(c) As of the effective date, as defined below, each person proposed for
insurance in this application must be a risk insurable in accordance
with the Company's rules, limits, and standards for the plan and the
amount applied for without any modification either as to plan, amount,
riders and/or the rate of premium paid.
(d) As of the effective date, the state of health and all factors
affecting the insurability of each and every person proposed
for insurance must be as stated in the application.
(e) If one of the persons proposed for insurance coverage under a last
survivor policy dies prior to the effective date as determined in item
2 and both insureds were considered to be insurable in accordance with
the Company's published underwriting rules as of that date, then a
last survivor policy will be issued to the last surviving insured.
However, no insurance will take effect if one of the persons proposed
for last survivor insurance coverage died prior to the effective date
and was found to be uninsurable in accordance with the Company's
published underwriting rules as of that date. The applicable premium
payment will be refunded and no policy would be issued.
2. Subject to the conditions of paragraph 1, insurance, as provided by the
terms and conditions of the policy applied for and in use on the effective
date, but for an amount not exceeding that specified in paragraph 3, will
become effective as of the effective date. "Effective date", as used
herein, is the later of: (a) the date of completion of Part 1 of the
application, or (b) the date of completion of the first medical examination
(or the second medical examination, if necessary due to the insured's age
or the amount of insurance applied for) tests, x-rays and
electrocardiograms required by the Company's published underwriting rules.
The effective date is determined separately for each person proposed for
coverage.
3. The total amount of insurance which may become effective on any person
proposed for insurance shall not exceed $500,000 of life insurance,
including any accidental death insurance benefits.
4. If one or more of the conditions of this receipt have not been fulfilled
exactly, there shall be no liability on the part of the Company except to
return the applicable payment in exchange for this Receipt.
5. NO AGENT OR ANY OTHER PERSON IS AUTHORIZED BY THE COMPANY TO WAIVE OR
MODIFY IN ANY WAY ANY OF THE PROVISIONS OF THIS CONDITIONAL RECEIPT.
If all the conditions are not fulfilled exactly, and the premium has been
refunded, the insurance will take effect when the policy is delivered to the
owner stated in the application; but only if at the time of such delivery there
has been no change in insurability as represented in the application.
All premium checks must be made payable to the Insurance Company. Do not make
checks payable to the agent or leave the payee blank.
Received a check totaling $____________ from ___________________________in
connection with the application for life insurance totaling $__________________,
bearing the same date as this Conditional Receipt.
Dated at this day of , 19
----------------------- ---------------- ------------ -----.
-----------------------------------
Signature of Agent
I acknowledge possession of this receipt and I certify that I have read it and
the agreement in the application. The terms and conditions of this receipt, to
which I agree, and the agreement in this application have been explained to me
fully by the agent and I understand them.
-----------------------------------
Signature of Applicant
THIS RECEIPT IS TO BE DETACHED AND GIVEN TO THE APPLICANT AT THE TIME OF
APPLICATION IF ANY MONEY IS TAKEN
HO COPY
<PAGE>
CONDITIONAL RECEIPT
VALID FOR USE WITH LIFE INSURANCE ON PROPOSED INSURED(S) AGE 75 OR LESS WITH THE
AMOUNTS OF INSURANCE APPLIED FOR NOT IN EXCESS OF $500,000.
If any person proposed for coverage has answered "Yes" to question 5f, 6 or 7,
or is over age 75, age last birthday, no payment may be accepted with the
application.
1. NO COVERAGE WILL BECOME EFFECTIVE PRIOR TO DELIVERY OF THE POLICY APPLIED
FOR UNLESS AND UNTIL ALL THE CONDITIONS OF THIS RECEIPT HAVE BEEN FULFILLED
EXACTLY:
(a) The amount of payment taken with the application must be at least
equal to the amount of the full first premium for the mode of payment
selected in the application and for the amount of insurance which may
become effective prior to delivery of the policy.
(b) The first medical examination (or the second medical examination, if
necessary due to the insured's age or the amount of insurance applied
for) tests, x-rays and electrocardiograms required by the Company's
published underwriting rules, must be completed and received at its
National Service Center in Minneapolis, Minnesota within 60 days from
the date of completion of Part 1 of this application.
(c) As of the effective date, as defined below, each person proposed for
insurance in this application must be a risk insurable in accordance
with the Company's rules, limits, and standards for the plan and the
amount applied for without any modification either as to plan, amount,
riders and/or the rate of premium paid.
(d) As of the effective date, the state of health and all factors
affecting the insurability of each and every person proposed for
insurance must be as stated in the application.
(e) If one of the persons proposed for insurance coverage under a last
survivor policy dies prior to the effective date as determined in item
2 and both insureds were considered to be insurable in accordance with
the Company's published underwriting rules as of that date, then a
last survivor policy will be issued to the last surviving insured.
However, no insurance will take effect if one of the persons proposed
for last survivor insurance coverage died prior to the effective date
and was found to be uninsurable in accordance with the Company's
published underwriting rules as of that date. The applicable premium
payment will be refunded and no policy would be issued.
2. Subject to the conditions of paragraph 1, insurance, as provided by the
terms and conditions of the policy applied for and in use on the effective
date, but for an amount not exceeding that specified in paragraph 3, will
become effective as of the effective date. "Effective date", as used
herein, is the later of: (a) the date of completion of Part 1 of the
application, or (b) the date of completion of the first medical examination
(or the second medical examination, if necessary due to the insured's age
or the amount of insurance applied for) tests, x-rays and
electrocardiograms required by the Company's published underwriting rules.
The effective date is determined separately for each person proposed for
coverage.
3. The total amount of insurance which may become effective on any person
proposed for insurance shall not exceed $500,000 of life insurance,
including any accidental death insurance benefits.
4. If one or more of the conditions of this receipt have not been fulfilled
exactly, there shall be no liability on the part of the Company except to
return the applicable payment in exchange for this Receipt.
5. NO AGENT OR ANY OTHER PERSON IS AUTHORIZED BY THE COMPANY TO WAIVE OR
MODIFY IN ANY WAY ANY OF THE PROVISIONS OF THIS CONDITIONAL RECEIPT.
If all the conditions are not fulfilled exactly, and the premium has been
refunded, the insurance will take effect when the policy is delivered to the
owner stated in the application; but only if at the time of such delivery there
has been no change in insurability as represented in the application.
All premium checks must be made payable to the Insurance Company. Do not make
checks payable to the agent or leave the payee blank.
Received a check totaling $____________ from ___________________________in
connection with the application for life insurance totaling $__________________,
bearing the same date as this Conditional Receipt.
Dated at this day of , 19
----------------------- ---------------- ------------ -----.
-----------------------------------
Signature of Agent
I acknowledge possession of this receipt and I certify that I have read it and
the agreement in the application. The terms and conditions of this receipt, to
which I agree, and the agreement in this application have been explained to me
fully by the agent and I understand them.
-----------------------------------
Signature of Applicant
THIS RECEIPT IS TO BE DETACHED AND GIVEN TO THE APPLICANT AT THE TIME OF
APPLICATION IF ANY MONEY IS TAKEN
PROPOSED INSURED'S/APPLICANT'S COPY