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AS FILED WITH THE SECURITIES AND EXCHANGE COMMISSION DECEMBER 1, 1995
FILE NO. 811-8970
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SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
AMENDMENT NO. 1
TO
FORM N-8B-2
REGISTRATION STATEMENT OF UNIT INVESTMENT
TRUSTS WHICH ARE CURRENTLY
ISSUING SECURITIES
PURSUANT TO SECTION 8(B) OF THE
INVESTMENT COMPANY ACT OF 1940
CG VARIABLE LIFE INSURANCE SEPARATE ACCOUNT II
OF
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
ISSUER OF PERIODIC PAYMENT PLAN CERTIFICATES
ONLY FOR PURPOSES OF INFORMATION PROVIDED HEREIN
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ORGANIZATION AND GENERAL INFORMATION
1. (a) Furnish name of the trust and the Internal Revenue Service Employer
Identification Number.
CG Variable Life Insurance Separate Account II of Connecticut General
Life Insurance Company ("Account"). The Account has no Internal Revenue
Service Employer Identification number.
(b) Furnish title of each class or series of securities issued by the trust.
Flexible Premium Variable Life Insurance Policies ("Policies"). Policy
provisions may vary in some states to comply with applicable law.
Policies may be issued either on an individual or a group basis. The
terms "Policy" and "Policies" herein encompass individual certificates,
and the rights of certificate holders, under group contracts.
"Policyowners" includes certificate holders under group contracts.
2. Furnish name and principal business address and ZIP Code and the Internal
Revenue Service Employer Identification Number of each depositor of the
trust.
Connecticut General Life Insurance Company ("Company")
900 Cottage Grove Road
Hartford, CT 06152
Internal Revenue Service Employer
Identification Number: 06-0303370
3. Furnish name and principal business address and ZIP Code and the Internal
Revenue Service Employer Identification Number of each custodian or trustee
of the trust indicating for which class or series of securities each
custodian or trustee is acting.
Not applicable.
4. Furnish name and principal business address and ZIP Code and the Internal
Revenue Service Employer Identification Number of each principal underwriter
currently distributing securities of the trust.
CIGNA Financial Advisors, Inc. ("CFA")
900 Cottage Grove Road
Hartford, CT 06152
Internal Revenue Service Employer
Identification Number: 06-0841987
5. Furnish name of state or other sovereign power, the laws which govern with
respect to the organization of the trust.
Connecticut.
6. (a) Furnish the dates of execution and termination of any indenture or
agreement currently in effect under the terms of which the trust was
organized and issued or proposes to issue securities.
The Account was established under Connecticut law pursuant to a
resolution of the Board of Directors of the Company dated July 6, 1994.
The Account will continue in existence until the Company's Board of
Directors directs that it be terminated.
(b) Furnish the dates of execution and termination of any indenture or
agreement currently in effect pursuant to which the proceeds of payments
on securities issued or to be issued by the trust are held by the
custodian or trustee.
Not applicable.
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7. Furnish in chronological order the following information with respect to
each change of name of the trust since January 1, 1930.
Not applicable.
8. State the date on which the fiscal year of the trust ends.
December 31.
MATERIAL LITIGATION
9. Furnish a description of any pending legal proceedings, material with
respect to the security holders of the trust by reason of the nature of the
claim or the amount thereof, to which the trust, the depositor, or the
principal underwriter is a party or of which the assets of the trust are the
subject, including the substance of the claims involved in such proceeding
and the title of the proceeding. Furnish a similar statement with respect to
any pending administrative proceeding commenced by a governmental authority
or any such proceeding or legal proceeding known to be contemplated by a
governmental authority. Include any proceeding which, although immaterial
itself, is representative of, or one of, a group which in the aggregate is
material.
No such legal or administrative proceedings are pending. No legal or
administrative proceedings are known to be contemplated by a governmental
authority.
II.
GENERAL DESCRIPTION OF THE TRUST
AND SECURITIES OF THE TRUST
GENERAL INFORMATION CONCERNING THE SECURITIES
OF THE TRUST AND THE RIGHTS OF HOLDERS
10. Furnish a brief statement with respect to the following matters for each
class or series of securities issued by the trust:
(a) Whether the securities are of the registered or bearer type.
The Policies which are to be issued are of the registered type, insofar
as the Policies are personal to the owners of the Policies
("policyowners"), and the records concerning the policyowners are
maintained by or on behalf of the Company.
(b) Whether the securities are of the cumulative or distributive type.
The Policies are of the cumulative type, providing for no distribution
of income, dividends, or capital gains. Such amounts are not separately
identifiable but are reflected in the accumulation value and may be
reflected in death benefit under a Policy at any time.
(c) The rights of security holders with respect to withdrawal or redemption.
A Policy may be cancelled within the right-to-examine period in
accordance with applicable state law. In most states, the Policy must be
returned within the later of (i) 10 days after receipt by a policyowner
of the Policy and the Company's notice to the policyowner of this right
or (ii) 45 days after the application for insurance is signed by the
applicant and mailed or delivered to the Company or its representative.
If the Policy is cancelled in a timely fashion, the Company will refund
the premiums paid, without interest, unless state law requires otherwise.
The initial premium is held in the Company's general account and not
allocated to the Account even if the policyowner so directed until three
business days following expiration of the right-to-examine period.
Refunds will usually occur within seven days of notice of cancellation
although a refund of premiums paid by check may be delayed until the
check clears a policyowner's bank.
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At any time before the death of the insured, a policyowner may totally
or partially surrender a Policy by sending a written request to the
Company at its Variable Products Service Center (the "Center"). The
amount of a partial surrender may be no less than the minimum amount set
forth in the Policy, currently $500, and not more than 90% of the
Surrender Value at the end of the valuation period in which the election
becomes or would become effective. The amount available for surrender is
the Accumulation Value, less any outstanding loan balance, less
applicable surrender charges, at the end of the valuation period during
which the surrender or request is received at the Center. Accumulation
Value in the Account available for surrender on any given valuation day
reflects total net premiums (premiums paid less a premium load of 5.0% to
cover applicable state and federal taxes and a portion of the sales
expenses of the company) allocated to the Account, investment performance
through the date of the request, other charges incurred in connection
with a Policy, and any previous partial surrenders. No partial surrender
will be permitted which would result in a specified amount lower than the
then current minimum for which a Policy would be issued. The Accumulation
Value will vary daily. The method for calculating Accumulation Value is
described in Item 10(i)(3).
If a Policy is being fully surrendered, it must be returned to the
Company along with the request. Any unpaid charges and indebtedness,
together with applicable surrender charges, will be deducted from the
Accumulation Value.
Payment of a Policy's Accumulation Value, less applicable transaction
and surrender charges, in connection with a partial or full surrender,
respectively, will normally occur within seven (7) days after receipt of
a written request. Payment may be postponed whenever: (i) the New York
Stock Exchange is closed, other than customary week-end and holiday
closings, or trading on the New York Stock Exchange is restricted as
determined by the Securities and Exchange Commission ("Commission"); (ii)
the Commission by order permits postponement for the protection of
policyowners; (iii) an emergency exists, as determined by the Commission,
as a result of which disposal of securities is not reasonably practicable
or it is not reasonable practicable to determine the value of the
Account's assets.
A policyowner may elect to have the surrender amount paid in a lump sum
or under one of the settlement options referred to in Item 10(i)(7). Upon
the death of the insured, the designated beneficiary is entitled to
receive the death benefit under a Policy. The death benefit is described
in Item 10(i)(2).
See Item 13 for a discussion of applicable surrender charges.
(d) The rights of security holders with respect to conversion, transfer,
partial redemption, and similar matters.
At any time within 24 months of the issuance of a Policy, the
policyowner may convert a Policy to a permanent life insurance policy
providing benefits which do not depend on the investment experience of a
separate account. The new policy will have, at the policyowner's
election, the same specified amount or the same net amount at risk (death
benefit less Accumulation Value) as the Policy as well as the same issue
age, policy date and rate class as the Policy. No evidence of
insurability is required for such an exchange unless the election of the
policyowner results in an increase in the net amount at risk.
A policyowner may obtain policy loans, as described in Item 21.
A policyowner may make surrenders, as described in Item 10(c), subject
to a $25 transaction charge on a partial surrender or applicable
surrender charges on a total surrender, as described in Item 13.
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A policyowner may allocate net premiums (premiums paid less the 5.0%
premium load) among (a) the sub-accounts of the Account (the
"Sub-Accounts") and (b) the Fixed Account, as described in Item 15.
Transfers among the Sub-Accounts are permitted subject to certain
conditions. Up to 20% of Policy values in the Fixed Account may be
transferred in a policy year to one or more of the Sub-Accounts. However,
such transfers from the Fixed Account are only allowed within the 30-day
period following a policy anniversary. The first 12 transfers in a policy
year are free of any transfer charge. A $25 transfer charge will be
imposed for the thirteenth and each subsequent transfer in a policy year.
Transfers resulting from policy loans, dollar cost averaging and the
exercise of conversion rights will not be subject to any charge and will
not count against the number of free transfers. The Company will
implement all transfers and determine all values at the end of the
valuation period during which the transfer request is received and
recorded. The Company may, at any time, revoke or modify the transfer
privilege.
(e) If the trust is the issuer of periodic plan certificates, the substance
of the provisions of any indenture or agreement with respect to lapses or
defaults by security holders in making principal payments, and with
respect to reinstatement.
The duration of a Policy depends upon the surrender value. Except as
noted below, a Policy will lapse only when the surrender value is
insufficient to cover the monthly deduction on the monthly anniversary
day.
If the surrender value is insufficient to cover the monthly deduction,
the Company will notify a policyowner of the minimum payment needed to
keep the Policy in force. A policyowner will have a grace period of 61
days for the Company to receive sufficient payments. The notice will be
sent at least 31 days before the end of the grace period. If the Company
does not receive a sufficient payment within the grace period, lapse of
the Policy will result. If a sufficient payment is received during the
grace period, any resulting net premium will be allocated among the
Sub-Accounts and the Fixed Account based on the most recent previous
premium payment, unless the Company is instructed otherwise, and any
monthly deductions due will be charged to the Sub-Accounts and the Fixed
Account.
During the first five policy years, the Policy will not lapse and no
grace period will begin provided the premium(s) paid have been at least
equal to the guaranteed initial death benefit premiums shown in the
Policy, assuming there have been no loans or partial surrenders. After
the first five policy years, or if there have been loans or partial
surrenders, the Policy may lapse if there is insufficient surrender value
to cover the monthly deduction.
The Company (or "we") will allow reinstatement at any time within the
Insured's lifetime; reinstatement will require evidence of insurability,
and the payment of an amount which will keep the Policy in force for at
least two months.
(f) The substance of the provisions of any indenture or agreement with
respect to voting rights, together with the names of any persons other
than security holders given the right to exercise voting rights
pertaining to the trust's securities or the underlying securities and the
relationship of such persons to the trust.
To the extent required by law, the Company will vote the shares of the
various mutual funds held in the Account (the "Funds") at regular and
special shareholder meetings of the Funds in accordance with instructions
received from persons having voting interest in the corresponding
Sub-Accounts. If, however, the Investment Company Act of 1940
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("1940 Act") or any regulation thereunder would be amended or if the
present interpretation thereof should change, and as a result the Company
determines that it is permitted to vote the Fund(s) shares in its own
right, it may elect to do so.
The number of votes which a policyowner has the right to instruct will
be calculated separately for each Sub-Account. This number will be
determined by dividing the Policy's Accumulation Value in a Sub-Account
by the net asset value per share of the corresponding Fund. In
determining the number of votes, fractional shares will be recognized.
The number of votes that a policyowner has the right to instruct will be
determined as of the date coincident with the date established by the
Appropriate Trust for determining shareholders eligible to vote at the
meeting of the Fund, but not more than 60 days before the meeting of the
Fund. Voting instructions will be solicited by written communication at
least 14 days prior to such meeting in accordance with procedures
established by the Fund. Each person having a voting interest in the Fund
will receive appropriate proxy materials and reports.
The Company will vote the Fund shares as to which no timely instructions
are received in proportion to the voting instructions from others with an
interest in the particular Sub-Account. Voting instructions to abstain on
any item to be voted upon will be applied to reduce the votes eligible to
be cast by the Company.
We may, if required by State insurance regulatory authorities, disregard
voting instructions if the instructions require that the shares be voted
so as to cause a change in the sub-classification or investment
objectives of the Fund or to approve or disapprove an investment advisory
contract for a Fund. A change would be disapproved only if the proposed
change is contrary to state law or prohibited by state regulatory
authorities or we determine that the change would have an adverse effect
on the Sub-Account in that the proposed investment policy for a Fund may
result in overly speculative or unsound investments. In the event we do
disregard voting instructions, a summary of that action and the reasons
for such action will be included in the next annual report to
policyowners.
(g) Whether security holders must be given notice of any change in:
(1) the composition of the assets of the trust.
The Company reserves the right, subject to compliance with
applicable law:
(i) to make additions to, deletions from, or substitutions for the
Fund shares that are held or purchased by the Account;
(ii) to eliminate the shares of any Fund and to substitute shares of
another open-end, registered investment company, if the shares
of that Fund are no longer available for investment, or if in
its judgment further investment in that Fund should become
inappropriate in view of the purposes of the Account;
(iii) to eliminate one or more Sub-Accounts, if, in its sole
discretion, marketing, tax or investment conditions warrant;
(iv) to operate the Account as a management company under the 1940
Act;
(v) to deregister the Account under the 1940 Act in the event such
registration is no longer required; and
(vi) to combine the Account with one or more of the Company's other
separate accounts as may be established.
In no event will any of the changes described above be made without
notice to policyowners in accordance with the 1940 Act and without
obtaining, as necessary, prior approval of the Commission.
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(2) the terms and conditions of the securities issued by the trust.
No changes in the terms and conditions of a Policy that affect a
policyowner's rights will be made without notice to the policyowner.
(3) the provisions of any indenture or agreement of the trust.
Not applicable.
(4) the identity of the depositor, trustee or custodian.
The Account has no trustee or custodian. There is no provision
requiring notice to, or consent of, security holders, with respect
to a change in the identity of the depositor.
(h) Whether the consent of security holders is required in order for action
to be taken concerning any change in:
(1) the composition of the assets of the trust.
Consent of policyowners is not required when changing the underlying
securities of the Account. However, to change such securities,
approval of the Commission is required by Section 26(b) of the 1940
Act. Except as required by Federal or State law or regulation, no
action will be taken by the Company which will adversely affect the
rights of policyowners without their consent.
(2) the terms and conditions of the securities issued by the trust.
No changes in the terms and conditions of a Policy that affect a
policyowner's rights will be made without notice to the policyowner.
The Company reserves the right to amend the Policy without
policyowner consent as may be necessary to comply with applicable
law.
(3) the provisions of any indenture or agreement of the trust.
Not applicable.
(4) the identity of the depositor, trustee or custodian.
See Item 10(g)(4).
(i) Any other principal feature of the securities issued by the trust or any
other principal right, privilege or obligation not covered by
subdivisions (a) to (g) or by any other item in this form.
(1) PREMIUM PAYMENTS. The policyowner may make premium payments in any
amount and at any frequency, subject to the basic premium
requirements and certain restrictions stated in the Policy.
A policyowner may also determine a planned periodic premium payment
schedule that provides for the payment of a level premium at a fixed
interval for a specified period of time. A policyowner need not make
premium payments in accordance with such planned periodic premium
schedule and the failure to make a planned payment will not itself
cause a Policy to lapse. A policyowner may make unscheduled premium
payments subject to restrictions listed in the Policy.
A load of 5.0% for state and federal taxes and certain sales
expenses will be deducted from each premium payment. See Item 13.
Additional net premium payments (premium payments net of that load)
made by a policyowner while there is indebtedness will be treated
first as loan repayments.
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In the application for a Policy, a policyowner can allocate net
premiums (total premium less premium load) among the Sub-Accounts
and the Fixed Account. The net premium will be allocated on the
first valuation day on or following three business days following
the expiration of the right-to-examine period (see Item 10(c)) in
accordance with the directions in the application. Net premiums paid
after the issue date will be allocated in accordance with the
policyowner's instructions in the application. Percentages must be
in whole numbers, with at least 10% allocated to a particular
Sub-Account or the Fixed Account. The allocation for future net
premiums may be changed at any time once the Company receives
written notification from the policyowner at the Center.
(2) GENERAL DESCRIPTION OF BASIC POLICY BENEFITS. As long as the Policy
remains in force, the Company will, upon receipt of proof of the
insured's death, pay the death benefit proceeds of the Policy,
reduced by any outstanding indebtedness and due and unpaid charges,
to the named beneficiary in accordance with the designated death
benefit option. Death benefits will be determined at the end of the
valuation period during which the insured dies. The proceeds may be
paid in a lump sum or under one or more of the settlement options
set forth in the Policy.
The Policies provide two death benefit options: Death Benefit Option
1 ("Option 1") and Death Benefit Option 2 ("Option 2"). Generally, a
policyowner designates the death benefit option in the application.
Absent such a designation, Option 1 is in effect. The death benefit
under Option 1 is the greater of the specified amount of the Policy
("specified amount") or a specified percentage (the "corridor
percentage") times the Accumulation Value (in the latter case, the
Policy would be "in the Corridor"). The death benefit under Option 2
is equal to the greater of the specified amount plus the
Accumulation Value of the Policy or the corridor percentage times
the Accumulation Value.
A policyowner may, at any time, increase or decrease the specified
amount. For any increase, we will require satisfactory evidence of
insurability. The effective date of the increase will be the monthly
anniversary day on or following approval of the increase by the
Company.
Any increase will increase the Surrender Charge. Decreases will not
decrease the Surrender Charge. No decrease may reduce the specified
amount to less than the then current minimum for this type of Policy
(currently $100,000). Any decrease will be applied first to the most
recent increase in coverage under the Policy, if any, then to the
next most recent, and so forth.
Generally, the death benefit option in effect may be changed by
sending a written request for change to the Center. The death
benefit may not be changed if it would result in a specified amount
less than the minimum specified amount then allowed by the Company
(currently $100,000). The effective date of any change will be the
monthly anniversary day on or following receipt of the request.
The specified amount will be changed when a change in death benefit
option is made. If the change is from Option 1 to Option 2, the new
specified amount will equal the Net Amount at Risk. If the change is
from Option 2 to Option 1, the new specified amount will equal the
death benefit as of the date of the change.
There will be no change in Surrender Charge (either increase or
decrease) at the time of a change in death benefit option.
(3) CALCULATION OF EACH SUB-ACCOUNT'S VALUE. When the initial premium
has been paid, the Policy's value in a Sub-Account will equal the
portion of the net premium allocated to the Sub-Account reduced by
the portion of the first monthly deduction allocated to that
Sub-Account.
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Thereafter, on each valuation day, the Policy's account value in
each Sub-Account will equal:
(a) The Policy's Accumulation Value in the Sub-Account on the
preceding valuation day, multiplied by the net investment factor
for the current valuation period; plus
(b) Any net premium payments received during the current valuation
period which are allocated to the Sub-Account; plus
(c) All account values transferred to the Sub-Account from the Fixed
Account or Loan Account or from another Sub-Account during the
current valuation period; minus
(d) All account values transferred from the Sub-Account to the Fixed
Account or Loan Account or to another Sub-Account during the
current valuation period; minus
(e) All partial surrenders from the Sub-Account during the current
valuation period; minus
(f) The portion of the monthly deduction allocated to the
Sub-Account during the current valuation period.
A Policy's Accumulation Value equals the sum of a Policy's value in
each Sub-Account plus the Policy's Fixed Account Value, plus the
Loan Account Value. Because Accumulation Value is dependent upon a
number of variables, including the investment experience of the
chosen Fund(s), the frequency and amount of premium payments,
transfers and surrenders, and charges assessed in connection with
the Policy, the Policy's Accumulation Value cannot be predetermined.
(4) INVESTMENT PERFORMANCE. The net investment factor measures
investment performance during a valuation period. Each Sub-Account
has its own distinct net investment factor. In calculating the
Sub-Account's net investment factor for a valuation period, the net
asset value for each share of the Fund in that Sub-Account at the
end of the current valuation period is increased by the amount of
the Sub-Account's share of any dividend or capital gain distribution
declared during the current valuation period and decreased by a
charge for taxes. The total is then divided by the net asset value
at the end of the preceding valuation period. A charge equivalent to
an annual rate of as much as .90% (but initially .80% during the
first twelve policy years and .55% thereafter) of the net daily
assets for each day in the valuation period is subtracted to
compensate the Company for certain mortality and expense risks.
(5) LOAN PROVISIONS. See Item 21.
(6) PAYMENT OF BENEFITS. Death benefits will be determined at the end
of the valuation period during which the insured dies and will
ordinarily be paid within seven days after the Company receives due
proof of death. Payment of the benefits under the Policy may be
postponed whenever: (i) the New York Stock Exchange is closed other
than customary week-end and holiday closings, or trading on the New
York Stock Exchange is restricted as determined by the Commission;
(ii) the Commission by order permits postponement for the protection
of policyowners; or (iii) an emergency exists, as determined by the
Commission, as a result of which disposal of securities held by the
sub-account is not reasonably practicable or it is not reasonably
practicable to determine the value of the Account's net assets.
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(7) SETTLEMENT OPTIONS. Policyowners and beneficiaries, subject to a
prior election of the policyowner, may decide the form in which the
benefits will be paid. The benefits under a Policy may be paid in a
lump sum or under one or more of the settlement options. These
choices are also available if a Policy is surrendered. If no
election is made, the Company will pay the benefits in a lump sum.
The settlement options include: payments for a fixed period; life
income; and life income with a guaranteed fixed period.
(8) OPTIONAL INSURANCE BENEFIT. Subject to certain requirements, an
optional insurance benefit, Waiver of Monthly Deductions, may be
added to a Policy by rider. The cost of this optional insurance
benefit will be deducted as part of the monthly deduction.
INFORMATION CONCERNING THE SECURITIES UNDERLYING THE TRUST'S SECURITIES
11. Describe briefly the kind or type of securities comprising the unit of
specified securities in which security holders have an interest. (If the
unit consists of a single security issued by an investment company, name
such investment company and furnish a description of the type of securities
comprising the portfolio of such investment company.)
The Account invests, at the policyowner's option, in securities of one or
more of the Funds (see Item 10(f)), each of which is a mutual fund
registered with the Commission as an open-end diversified management
company. Each Sub-Account invests solely in shares of one of the sixteen
Funds. Each Fund is a series or portfolio of a Delaware or Massachusetts
business trust registered under the 1940 Act, except that AIM Variable
Insurance Funds, Inc. is a Maryland corporation. See Item 12(a). The sixteen
Funds and their investment objectives are as follows:
AIM V.I. CAPITAL APPRECIATION FUND: Seeks to provide capital appreciation
through investments in common stocks, with emphasis on medium-sized and
smaller emerging growth companies.
AIM V.I. GROWTH FUND: Seeks to provide growth of capital through investments
primarily in common stocks of leading U.S. companies considered by
management to have strong earnings momentum.
AIM V.I. VALUE FUND: Seeks to achieve long-term growth of capital by
investing primarily in equity securities judged by management to be
undervalued relative to the current or projected earnings of the companies
issuing the securities, or relative to current market values of assets owned
by the companies issuing the securities or relative to the equity markets
generally. Income is a secondary objective.
FIDELITY ASSET MANAGER PORTFOLIO: Seeks high total return with reduced risk
over the long-term by allocating its assets among domestic and foreign
stocks, bonds and short-term fixed-income instruments.
FIDELITY BOND PORTFOLIO: Seeks as high a level of current income as is
consistent with the preservation of capital by investing in a broad range of
investment-grade fixed-income securities, with a dollar-weighted average
portfolio maturity of ten years or less.
FIDELITY EQUITY-INCOME PORTFOLIO: Seeks reasonable income by investing
primarily in income-producing equity securities, with some potential for
capital appreciation, seeking to exceed the composite yield on the
securities comprising the Standard and Poor's 500 Composite Stock Price
Index.
MFS TOTAL RETURN SERIES: Seeks primarily to obtain above-average income,
(compared to a portfolio entirely invested in equity securities) consistent
with the prudent employment of capital, and secondarily to provide a
reasonable opportunity for growth of capital and income.
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MFS UTILITIES SERIES: Seeks capital growth and current income (income above
that obtainable from a portfolio invested entirely in equity securities).
MFS WORLD GOVERNMENTS SERIES: Seeks not only preservation, but also growth,
of capital together with moderate current income.
TEMPLETON ASSET ALLOCATION FUND: Seeks a high level of total return through
a flexible policy of investing in stocks and debt obligations of companies
and governments of any nation. Templeton Management allocates assets among
different investments depending upon its assessment of market and economic
conditions.
TEMPLETON INTERNATIONAL FUND: Seeks long term growth through a flexible
policy of investing in stocks and debt obligations of companies and
governments outside the United States.
TEMPLETON STOCK FUND: Seeks capital growth through a policy of investing
primarily in common stocks issued by companies, large and small, in various
nations throughout the world.
QUEST GLOBAL EQUITY PORTFOLIO: Seeks long-term capital appreciation through
a global investment strategy primarily involving equity securities.
QUEST MANAGED PORTFOLIO: Seeks growth of capital over time through
investment in a portfolio of common stocks, bonds and cash equivalents, the
percentage of which will vary based on management's assessments of relative
investment values.
QUEST SMALL CAP PORTFOLIO: Seeks capital appreciation through investments in
a diversified portfolio of equity securities of companies with market
capitalizations of under $1 billion.
12. If the trust is the issuer of periodic payment plan certificates and if any
underlying securities were issued by another investment company, furnish the
following information for each such company:
(a) Name of Company.
AIM Variable Insurance Funds, Inc. ("AIM V.I. Fund"), managed by AIM
Advisors, Inc., and distributed by AIM Distributors Inc., 11 Greenway
Plaza, Suite 1919, Houston, TX 77046-1173;
Variable Insurance Products Fund I ("Fidelity Trust I"), managed by
Fidelity Management & Research Company, 82 Devonshire Street, Boston, MA
02103;
Variable Insurance Products Fund II ("Fidelity Trust II"), managed by
Fidelity Management & Research Company, 82 Devonshire Street, Boston, MA
02103;
MFS Variable Insurance Trust ("MFS Trust"), managed by Massachusetts
Financial Services Company, 500 Boylston Street, Boston, MA 02116;
Templeton Variable Products Fund, ("Templeton Fund") managed by
Templeton Investment Counsel, Inc. and distributed by Franklin/Templeton
Distribution Inc., 700 Central Avenue, St. Petersburgh, FL 33701;
Quest for Value Accumulation Trust ("Quest for Value Trust"), managed by
Quest for Value Advisors, One World Financial Center, New York, NY 10281.
(b) Name and principal business address of depositor.
Not applicable.
(c) Name and principal business address of trustee or custodian.
AIM V.I. Fund: State Street Bank and Trust Company, 225 Franklin Street,
Boston MA 02110.
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Fidelity Asset Manager and Equity-Income Funds: The Chase Manhattan Bank,
N.A., 1211 Avenue of the Americas, New York, NY 10036.
Fidelity Bond Fund: The Bank of New York, 110 Washington Street, New
York, NY.
MFS Trust: Investors Bank & Trust Company, 89 South Street, Boston, MA
02110.
Templeton Fund: Chase Manhattan Bank, N.A. Metrotech Center, Brooklyn,
New York, NY 11245.
Quest for Value Trust: State Street Bank and Trust Company, P.O. Box
8505, Boston, MA 02266-8505.
(d) Name and principal business address of principal underwriter.
AIM V.I. Fund: AIM Distributors Inc., 11 Greenway Plaza, Suite 1919,
Houston, TX 97046-1173
Fidelity Trusts I and II: Fidelity Distribution Corporation, 82
Devonshire Street, Boston, MA 02109.
MFS Trust: MFS Investor Services, Inc., 500 Boylston Street, Boston, MA
02116.
Templeton Fund: Franklin/Templeton Distribution Inc., 700 Central Avenue,
St. Petersburgh, FL 33701.
Quest for Value Trust: Quest for Value Distributors, One World Financial
Center, New York, NY 10281.
(e) The period during which the securities of such company have been the
underlying securities.
Not applicable.
INFORMATION CONCERNING LOAD, FEES, CHARGES AND EXPENSES
13. (a) Furnish the following information with respect to each load, fee,
expense or charge to which (1) principal payments, (2) underlying
securities, (3) distributions, (4) cumulated or reinvested distributions
or income, and (5) redeemed or liquidated assets of the trust's
securities are subject:
(A) the nature of such load, fee, expense or charge;
(B) the amount thereof;
(C) the name of the person to whom such amounts are paid and his
relationship to the trust;
(D) the nature of the services performed by such person in
consideration for such load, fee, expense or charge.
(1) PRINCIPAL PAYMENTS
A deduction of 5.0% of the premium will be made from each premium
payment. The deduction represents an amount the Company deems
sufficient to pay state taxes and federal income tax liabilities and
a proportionate amount of the sales expenses incurred by the
Company.
(2) UNDERLYING SECURITIES
No load, fee expense or charge is assessed in connection with the
purchase of the underlying securities for the Account.
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<PAGE>
(3) DISTRIBUTIONS
No load, fee, expense or charge is assessed in connection with
distributions, except for a $25 transaction fee with respect to
partial surrenders.
(4) CUMULATED OR REINVESTED DISTRIBUTIONS OR INCOME
All income and other distributions earned by each Fund are
reinvested, without charge, at net asset value in shares of the
Fund.
(5) REDEEMED OR LIQUIDATED ASSETS
For charges associated with total surrenders, see Item 13(c).
(b) For each installment payment type of periodic payment plan certificate
of the trust, furnish the following information with respect to sales
load and other deductions from principal payments.
Not applicable.
(c) State the amount of sales load as a percentage of the net amount
invested. State the amount of total deductions as a percentage of the net
amount invested for each type of security issued by the trust.
The amount of sales load will vary, depending upon the frequency and
amount of premium payments and the specified amount of the Policy.
Expressed as a percentage of premiums, the total deferred sales charge
imposed under the Policy in the event of a total surrender will not
exceed 28.5% of the sum of premiums paid up to one Guideline Annual
Premium, plus 8.5% of premium payments between one and two times one
Guideline Annual Premium, plus 7.5% of premium payments in excess of two
times one Guideline Annual Premium, during the first two policy years.
During policy years three through five, it will remain unchanged in
dollar amount. During policy years six through ten, it will decline by
one-sixtieth each month to zero. Under certain circumstances involving
the payment of very large premiums during the first two policy years, a
lesser portion of the deferred sales charge will be applied to reimburse
the Company for sales and promotional expenses, to the extent required by
Federal or State laws.
(d) Explain fully the reasons for any differences in the price at which
securities are offered generally to the public, and the price at which
securities are offered for any class of transactions to any class or
group of individuals, including officers, directors or employees of the
depositor, trustee, custodian or principal underwriter.
Not applicable.
(e) Furnish a brief description of any loads, fees, expenses or charges not
covered in Item 13(a) which may be paid by security holders in connection
with the trust or its securities.
(1) MORTALITY AND EXPENSE RISK CHARGE. The Company charges the
Sub-Accounts for the mortality and expense risks the Company
assumes. The charge is made daily at an effective annual rate not to
exceed .90% (initially, .80% during the first twelve policy years
and .55% thereafter) of the value of each Sub-Account's assets. The
Company estimates that .35% of this charge would be for mortality
risks and .55% for expense risks. The mortality risk assumed is that
insureds may live for a shorter period of time than estimated and,
therefore, a greater amount of death benefits will be payable. The
expense risk assumed is that expenses incurred in issuing and
administering the Policies will be greater than estimated.
13
<PAGE>
(2) ACCUMULATION VALUE TRANSFER CHARGE. After the twelfth transfer
during any one policy year, a charge of $25 will be imposed for each
transfer and deducted from the Sub-Account or Fixed Account from
which the transfer is being made.
(3) TAXES. Currently no charge is made to the Account for Federal
income taxes that may be attributable to the Account. The Company
may, however, make such a charge in the future. Charges for other
taxes, if any, attributable to the Account may also be made.
(4) MONTHLY DEDUCTION. Charges will be deducted monthly from the
Accumulation Value of each Policy to compensate the Company for
certain administrative costs, and for the cost of insurance and
optional benefits added by rider. The monthly deduction will be
deducted on each monthly anniversary day and allocated among the
funding vehicles used (Sub-Accounts and the Fixed Account) based on
the proportionate values in each funding vehicle. The monthly
charges consist of the following:
(A) MONTHLY ADMINISTRATIVE CHARGE. The Company has responsibility
for the administration of the Policy and the Account. Annual
administrative expenses include premium billing and collection,
recordkeeping, processing death benefit claims, cash surrenders
and Policy changes, reporting and overhead costs. As
reimbursement for administrative expenses related to the
maintenance of each Policy and the Account, the Company assesses
a monthly administrative fee of $15 during the first policy
year, and, currently, $5 during subsequent policy years (but
never more than $10), which will not exceed the Company's costs.
(B) COST OF INSURANCE CHARGE. Because the cost of insurance depends
upon a number of variables, this charge can vary from month to
month. The Company will determine the monthly cost of insurance
charge by multiplying the applicable cost of insurance rate by
the Net Amount at Risk for each policy month. The Net Amount at
Risk for a policy month is (a) the death benefit at the
beginning of the policy month, divided by 1.0032737 (which
reduces the Net Amount at Risk, solely for purposes of computing
the cost of insurance, by taking into account assumed monthly
interest earnings at an annual rate of 4%), less (b) the
Accumulation Value at the beginning of the policy month. The Net
Amount at Risk may be affected by changes in the Accumulation
Value or the specified amount of a Policy.
The cost of insurance rate is based on gender classification,
attained age and rate class. The actual monthly cost of
insurance rates will be based on the Company's expectations as
to future experience. They will not, however, be greater than
the guaranteed cost of insurance rates set forth in the Policy.
These guaranteed rates are based on the applicable 1980
Commissioners Standard Ordinary Mortality Table and the
insured's attained age at the nearest birthday. Any change in
the cost of insurance rates will apply to all persons of the
same age, gender classification and rate class whose Policies
have been in force for the same length of time.
(C) OPTIONAL INSURANCE BENEFITS CHARGE. The monthly deduction will
include deductions for any optional insurance benefits added to
a Policy by rider.
(5) SURRENDER CHARGE. There is a charge potentially imposed at the time
of surrender of a Policy (but not a partial surrender) which occurs
prior to the end of ten years from the date of the issuance of the
Policy or the effective date of any increase in specified amount
under the Policy. The portion of the surrender charge applied to
14
<PAGE>
reimburse the Company for sales and promotional expense is based on
net premium payments during the first two policy years and is
described in Item 13(c). The portion of the surrender charge which
reimburses the Company for certain first year administrative costs
is $6.00 per $1,000 of initial specified amount. The dollar amount
of the surrender charge will not change during the third, fourth and
fifth years following the issue date; thereafter, it will decline
monthly to zero after ten years following the issue date, assuming
no increases in specified amount.
If a policyowner increases the specified amount, a new surrender
charge will be applicable in addition to the then existing surrender
charge. The surrender charge applicable to the increase will be
equal to the surrender charge on a new Policy whose specified amount
equals the amount of the increase.
No surrender charge will be imposed on a partial surrender; however,
a $25 transaction charge will be made against the Accumulation
Value.
(e) State whether the depositor, principal underwriter, custodian or
trustee, or any affiliated person of the foregoing may receive profits or
other benefits not included in answer to Item 13(a) or 13(d) through the
sale or purchase of the trust's securities or underlying securities or
interests in underlying securities, and describe fully the nature and
extent of such profits or benefits.
Neither the Company nor any affiliated person of the Company may receive
any profit or any other benefit from premium payments under the Policies
or the investments held in the Account not included in answer to Item
13(a) or (d) through the sale or purchase of the Policies or shares of
the Funds, except that (1) the Company may receive a profit to the extent
that the cost of insurance built into a Policy exceeds the actual cost of
insurance needed to pay benefits, (2) favorable mortality or expense
experience may cause the insurance provided under a Policy to be
profitable to the Company, (3) on Policy loans, the Company may derive a
profit on the difference between interest charged and interest credited;
(4) the Company will compensate certain other persons, including Company
agents, for services rendered in connection with the distribution of a
Policy, as described in Item 38, but such payments will be made from the
Company's General Account and (5) the Company will receive fees from the
Funds or their advisers for making the Funds available under the
Policies.
(f) State the percentage that the aggregate annual charges and deductions
for maintenance and other expenses of the trust bear to the dividend and
interest income from the trust property during the period covered by the
financial statements filed herewith.
Not applicable.
INFORMATION CONCERNING THE OPERATIONS OF THE TRUST
14. Describe the procedure with respect to applications (if any) and the
issuance and authentication of the trust's securities, and state the
substance of the provisions of any indenture or agreement pertaining
thereto.
Individuals wishing to purchase a Policy must complete an application. A
Policy may only be issued upon receipt of evidence of insurability
satisfactory to the Company. Acceptance is subject to the Company's
underwriting rules and the Company reserves the right to reject any
application. The Company generally will issue a Policy only to insureds
below the age of 80. Policies will be issued in accordance with the
applicable state insurance laws.
Interests in the Sub-Accounts of the Account may also be acquired by
transfers, as described in Item 10(d).
15
<PAGE>
15. Describe the procedure with respect to the receipt of payments from
purchasers of the trust's securities and the handling of the proceeds
thereof, and state the substance of the provisions of any indenture or
agreement pertaining thereto.
When a person applies for the Policy, that person will be asked to select
one or more of the applicable funding vehicles to which net premium payments
are to be allocated, and the applicable percentage (a whole number, at least
10%) to be allocated to each such funding vehicle. That allocation can be
changed at any time with respect to future premium payments upon receipt of
written notice at the Center at no charge. Premiums will be allocated as the
policyowner has directed. All premiums paid, after the first premium
payment, must be sent directly to the Center and will be deemed received
when actually received at the Center.
16. Describe the procedure with respect to the acquisition of underlying
securities and the disposition thereof, and state the substance of the
provisions of any indenture or agreement pertaining thereto.
On each valuation day of each Fund, the Account purchases or redeems shares
in each Fund based on a netting of all transactions for that day, including
the amount of net premiums invested in the applicable Sub-Account,
transfers, policy loans and loan repayments, surrender payments, charges,
and payment of benefits to be effected on that day.
17. (a) Describe the procedure with respect to withdrawal or redemption by
security holders.
The procedures with respect to surrenders or redemption by security
holders are described in response to Items 10 (c), (d), (e) and (i).
(b) Furnish the names of any persons who may redeem or repurchase, or are
required to redeem or repurchase, the trust's securities or underlying
securities from security holders, and the substance of the provisions of
any indenture or agreement pertaining thereto.
The Company is required to process all surrender requests as described
in Item 10(c). Each Fund will redeem its shares upon the Company's
request in accordance with the 1940 Act. Redeemed shares are retired
although they may later be reissued if a Fund's governing documents
permit.
(c) Indicate whether repurchased or redeemed securities will be canceled or
may be resold.
A Policy, once fully surrendered, may not be resold.
18. (a) Describe the procedure with respect to the receipt, custody and
disposition of the income and other distributable funds of the trust and
state the substance of the provisions of any indenture or agreement
pertaining thereto.
All dividend and capital gains distributions (if any) of the Funds will
be automatically reinvested in additional Funds shares at their net
asset value. Pursuant to the Policy, the Company will make distributions
from the Account in connection with death benefits, policy loans, and
Accumulation Value surrenders. Applicable procedures for such
distributions are described in the answers to Items 10(c), 10(i)(6), and
21.
(b) Describe the procedure, if any, with respect to the reinvestment of
distributions to security holders and state the substance of the
provisions of any indenture or agreement pertaining thereto.
Not applicable.
16
<PAGE>
(c) If any reserves or special funds are created out of income or principal,
state with respect to each such reserve or fund the purpose and ultimate
disposition thereof, and describe the manner of handling of same.
Net premium payments placed in the Account constitute reserves for
benefits under the Policies.
(d) Submit a schedule showing the periodic and special distributions which
have been made to security holders during the three years covered by the
financial statements filed herewith. State for each such distribution the
aggregate amount and amount per share. If distributions from sources
other than current income have been made, identify each such other source
and indicate whether such distribution represents the return of principal
payments to security holders. If payments other than cash were made,
describe the nature thereof, the account charged and the basis of
determining the amount of such charge.
No distributions have been made.
19. Describe the procedure with respect to the keeping of records and accounts
of the trust, the making of reports and the furnishing of information to
security holders, and the substance of the provisions of any indenture or
agreement pertaining thereto.
The Company will have primary responsibility for all administration of the
Policies and the Account. The administrative services provided include
preparation of the Policies, maintenance of policyowners' records and all
accounting, valuation, regulatory and reporting services required by the
Company.
The Company will send such reports of the Account as are presently required
by the 1940 Act and regulations promulgated thereunder. The Company will
also mail to policyowners, at the last known address of record at the
Center, any reports required by state law. Each person having a voting
interest will receive proxy material, reports, and other materials relating
to the Funds.
20. State the substance of the provisions of any indenture or agreement
concerning the trust with respect to the following:
(a) Amendments to such indenture or agreement.
Not applicable.
(b) The extension or termination of such indenture or agreement.
Not applicable.
(c) The removal or resignation of the trustee or custodian, or the failure
of the trustee or custodian to perform its duties, obligations and
functions.
Not applicable.
(d) The appointment of a successor trustee and the procedure if a successor
trustee is not appointed.
Not applicable.
(e) The removal or resignation of the depositor, or the failure of the
depositor to perform its duties, obligations and functions.
The Company acts as depositor. There are no provisions relating to the
removal or resignation of the depositor or the failure of the depositor
to perform its duties, obligations and functions.
17
<PAGE>
(f) The appointment of a successor depositor and the procedure if a
successor depositor is not appointed.
There are no provisions relating to the appointment of a successor
depositor and the procedure if a successor depositor is not appointed.
21. (a) State the substance of the provisions of any indenture or agreement with
respect to loans to security holders.
So long as the Policy remains in force, a policyowner may borrow money
from the Company using the Policy as the only security for the loan. The
maximum amount that may be borrowed is 100% of the surrender value at
the time of the loan, but the Company reserves the right to limit total
indebtedness to an amount which is 90% of the Accumulation Value, less
the surrender charge applicable at the time of the loan. The loan may be
repaid in whole or in part at any time while the Policy is in force. The
minimum loan repayment is $100 or, if less, the amount of indebtedness.
An amount equal to the loan plus interest will be withdrawn from the
funding vehicles being used in proportion to the value of each funding
vehicle, and transferred to the Loan Account until the loan is repaid.
The interest rate charged on policy loans will be at the rate of 8% per
year in arrears. If unpaid when due, interest will be added to the
amount of the loan and will become part of the loan and bear interest at
the same rate.
The Loan Account will be credited with interest of at least 6% per year
(at least 7% after the first ten policy years).
Indebtedness equals the total of all policy loans and accrued interest
on the loans. If at any time indebtedness exceeds the Accumulation Value
less the surrender charge, a grace period will begin, and the Company
will notify a policyowner and any assignee of record at least 31 days
before the end of the grace period. If a sufficient payment to eliminate
such excess indebtedness is not received by the Company within 61 days
after the grace period begins, the Policy will lapse and terminate
without value. The Policy, however, may later be reinstated subject to
certain conditions.
Indebtedness may be repaid any time while the Policy is in force.
Additional net premium payments made by the policyowner while there is
indebtedness will be applied first to reduce indebtedness. If not
repaid, the Company may deduct indebtedness from any amount payable
under the Policy. As indebtedness is repaid, the value in the Loan
Account securing the indebtedness will be transferred from the Loan
Account to the Sub-Accounts and, if applicable, the Fixed Account in the
same proportion in which net premium payments are then being allocated,
at the end of the valuation period during which the repayment is
received.
(b) Furnish a brief description of any procedure or arrangement by which
loans are made available to security holders by the depositor, principal
underwriter, trustee or custodian, or any affiliated person of the
foregoing.
The portion of a Policy loan attributable to the Sub-Accounts will
normally be paid within seven days after receipt of written request. The
Company may postpone payment of any such policy loan whenever: (i) the
New York Stock Exchange is closed other than customary weekend and
holiday closings, or trading on the New York Stock Exchange is restricted
as determined by the Commission; (ii) the Commission by order permits
postponement for the protection of policyowners; (iii) an emergency
exists, as determined by the Commission, as a result of which disposal of
securities is not reasonably practicable or it is not reasonably
practicable to determine the value of any Sub-
18
<PAGE>
Account's net assets. In addition, the Company may delay the payment of
policy loans secured by Accumulation Value that the policyowner paid by
check until such time as the check has cleared a policyowner's bank.
See also paragraph (a) of this Item.
(c) If such loans are made, furnish the aggregate amount of loans
outstanding at the end of the last fiscal year, the amount of interest
collected during the last fiscal year allocated to the depositor,
principal underwriter, trustee or custodian or affiliated person of the
foregoing and the aggregate amount of loans in default at the end of the
last fiscal year covered by financial statements filed herewith.
Not applicable.
22. State the substance of the provisions of any indenture or agreement with
respect to limitations on the liabilities of the depositor, trustee or
custodian, or any party to such indenture or agreement.
There are no such provisions.
23. Describe any bonding arrangement for officers, directors, partners or
employees of the depositor or principal underwriter of the trust, including
the amount of coverage and the type of bond.
A blanket bond for $10 million covers all of the officers and employees of
the Company.
24. State the substance of any other material provisions of any indenture or
agreement concerning the trust or its securities and a description of any
other material functions or duties of the depositor, trustee or custodian
not stated in Item 10 or Items 14 to 23 inclusive.
INCONTESTABILITY. The Company cannot contest the Policy as to the initial
specified amount after it has been in force during the lifetime of the
insured for two years from the issue date. A new two year contestability
period will apply to each increase in specified amount beginning on the
effective date of each such increase and will apply to material
misrepresentations made in the application for the increase. If the Policy
is reinstated, a new two year contestability period (apart from any
remaining contestability period) will apply from the date of the application
for reinstatement and will apply only to statements made in the application
for reinstatement.
SUICIDE. If the Insured commits suicide, while sane or insane, within two
years from the issue date, the only benefit paid will be the sum of: a)
premiums paid, minus the amount of any partial surrenders, minus any
outstanding loan balance. In the event of lapse of a Policy, the suicide
period will be measured from the effective date of reinstatement. If the
insured, while sane or insane, commits suicide within two years after the
effective date of any increase in insurance or any reinstatement, the
Company's total liability with respect to such increase or reinstatement
will be a refund of the monthly charges for its cost of insurance.
MISSTATEMENT OF AGE OR SEX. If the age or sex of the insured is misstated,
the death benefit will be adjusted based on what the cost of insurance
charge for the most recent monthly deduction would have purchased based on
the correct age and sex.
19
<PAGE>
III.
ORGANIZATION, PERSONNEL AND AFFILIATED PERSONS
OF DEPOSITOR
ORGANIZATION AND OPERATIONS OF DEPOSITOR
25. State the form or organization of the depositor of the trust, the name of
the state or other sovereign power under the laws of which the depositor was
organized and the date of organization.
The Company was incorporated under the laws of Connecticut in 1865.
26. (a) Furnish the following information with respect to all fees received by
the depositor of the trust in connection with the exercise of any
functions or duties concerning securities of the trust during the period
covered by the financial statements filed herewith.
Not applicable.
(b) Furnish the following information with respect to any fee or any
participation in fees received by the depositor from any underlying
investment company or any affiliated person or investment adviser of such
company.
In connection with Fund Participation Agreements with the Trusts and
their investment advisers or distributors, the depositor or the principal
underwriter may in some instances receive fees of as much as .20% per
year from the advisers or their affiliated persons for making Trust
shares available and/or providing certain services such as individual
contract recordkeeping.
27. Describe the general character of the business engaged in by the depositor
including a statement as to any business other than that of depositor of the
trust. If the depositor acts or has acted in any capacity with respect to
any investment company or companies other than the trust, state the name or
names of such company or companies, their relationship, if any, to the
trust, and the nature of the depositor's activities therewith. If the
depositor has ceased to act in such named capacity, state the date of and
circumstance surrounding such cessation.
The Company is principally engaged in offering group and individual life and
health insurance policies and annuity contracts. It is licensed to do
business in 50 states, the District of Columbia and Puerto Rico. The Company
is also the depositor of three other of its separate accounts registered
with the Commission as unit investment trusts which fund or will fund
variable annuity contracts or variable life insurance policies of the
Company. They are called CG Variable Annuity Separate Account, CG Variable
Annuity Separate Account II and CG Variable Life Insurance Separate Account
I.
OFFICIALS AND AFFILIATED PERSONS OF DEPOSITOR
28. (a) Furnish as at latest practicable date the following information with
respect to the depositor of the trust, with respect to each officer,
director, or partner of the depositor, and with respect to each natural
person directly or indirectly owning, controlling or holding with power
to vote 5% or more of the outstanding voting securities of the
depositor.
(i) name and principal business address;
(ii) nature of relationship or affiliation with depositor or the trust;
(iii) ownership of all securities of the depositor;
(iv) ownership of all securities of the trust;
(v) other companies of which each person named above is presently
officer, director or partner.
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<PAGE>
See the table below. See also Item 29.
(b) Furnish a brief statement of the business experience during the last
five years of each officer, director or partner of the depositor.
See the table below. Each of these persons has been employed by the
Company for more than five years in his or her present position or in an
earlier position of lesser responsibility, except that prior to December
1994, Mr. Alexander was Director, Human Development, E.I. Dupont De
Nemours, Inc. and prior to May 1993, Dr. Schaffer was Vice President,
Professional Affairs, Aetna Health Plans, Aetna Life & Casualty. The
address of each of them is 900 Cottage Grove Road, Hartford, CT 06152.
DIRECTORS AND OFFICERS OF THE COMPANY
<TABLE>
<CAPTION>
POSITIONS AND OFFICES
NAME AND ADDRESS WITH THE COMPANY
- ------------------------------ ----------------------------------
<S> <C> <C>
Thomas C. Jones President
(Principal Executive Officer)
James T. Kohan Vice President and Actuary
(Principal Financial Officer)
Robert Moose Vice President
(Principal Accounting Officer)
David C. Kopp Corporate Secretary
Secretary
Stephen C. Stachelek Vice President and Treasurer
Harold W. Albert Director
S. Tyrone Alexander Director and Senior Vice President
Martin A. Brennan Director and Senior Vice President
Robert W. Burgess Director
John G. Day Director and Chief Counsel
Lawrence P. English Director and Chairman of the Board
Joseph M. Fitzgerald Director and Senior Vice President
Faerie C. Kizzire Director and Senior Vice President
Arthur C. Reeds, III Director and Senior Vice President
W. Allen Schaffer, M.D. Director and Senior Vice President
John Wilkinson Director, Senior Vice President
and Chief Financial Officer
</TABLE>
21
<PAGE>
COMPANIES OWNING SECURITIES OF DEPOSITOR
29. Furnish as at latest practicable date the following information with respect
to each company which directly or indirectly owns, controls or holds power
to vote 5% or more of the outstanding voting securities of the depositor:
(a) name and principal business address; (b) nature of business; (c)
ownership of all securities of the depositor.
The Company is a wholly-owned subsidiary of Connecticut General Corporation
("CGC"), Bloomfield, Connecticut. CGC is a wholly-owned subsidiary of CIGNA
Holdings Inc., Philadelphia, Pennsylvania, which is in turn wholly-owned by
CIGNA Corporation, Philadelphia, Pennsylvania. CGC is the holding company of
various insurance companies, one of which is the Company.
CIGNA Corporation has no information that any person or concern beneficially
owns more than five percent of the outstanding Common Stock, except as
reported on three Schedules 13G received in February 1995. The Windsor Fund
Series -- Windsor Funds, Inc. ("Windsor"), Vanguard Financial Center, Valley
Forge, Pennsylvania 19482, reported sole voting power and shared dispositive
power as to 6,268,500 shares of Common Stock, or 8.68% of the outstanding
Common Stock as of December 31, 1994. Also, Wellington Management Company
("Wellington"), 75 State Street, Boston, Massachusetts 02109, in its
capacity as investment advisor to Windsor and other investment advisory
clients, reported shared dispositive power as to 7,136,400 shares (which
includes the shares reported by Windsor), or 9.88% of the outstanding Common
Stock as of December 31, 1994, and shared voting power as to 301,200 of
these shares. Finally, Sanford C. Bernstein & Co., Inc. ("Bernstein"), One
State Street Plaza, New York, New York 10004, reported sole dispositive
power as to 5,788,890 of such shares, or 8.02% of the outstanding Common
Stock as of December 31, 1994 and sole voting power as to 2,952,350 of these
shares of Common Stock as of December 31, 1994.
CONTROLLING PERSONS
30. Furnish as at latest practicable date the following information with respect
to any person, other than those covered by Items 28, 29, and 42 who directly
or indirectly controls the depositor.
None.
COMPENSATION OF OFFICERS AND DIRECTORS OF DEPOSITOR
COMPENSATION OF OFFICERS
31. Furnish the following information with respect to the remuneration for
services paid by the depositor during the last fiscal year covered by
financial statements filed herewith:
(a) directly to each of the officers or partners of the depositor directly
receiving the three highest amounts of remuneration;
(b) directly to all officers or partners of the depositor as a group
exclusive of persons whose remuneration is included under Item 31(a),
stating separately the aggregate amount paid by the depositor itself and
the aggregate amount paid by all the subsidiaries;
(c) indirectly or through subsidiaries to each of the officers or partners
of the depositor.
Not applicable with respect to the Account. As of this date, the Account
had not yet commenced operations.
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<PAGE>
COMPENSATION OF DIRECTORS
32. Furnish the following information with respect to the remuneration for
services, exclusive of remuneration reported under Item 31, paid by the
depositor during the last fiscal year covered by financial statements filed
herewith:
(a) the aggregate direct remuneration to directors;
(b) indirectly or through subsidiaries to directors.
Not applicable with respect to the Account. See Item 31.
COMPENSATION TO EMPLOYEES
33. (a) Furnish the following information with respect to the aggregate amount
of remuneration for services of all employees of the depositor
(exclusive of persons whose remuneration is reported in Items 31 and 32)
who received remuneration in excess of $10,000 during the last fiscal
year covered by financial statements filed herewith from the depositor
and any of its subsidiaries.
Not applicable with respect to the Account. See Item 31.
(b) Furnish the following information with respect to the remuneration for
services paid directly during the last fiscal year covered by financial
statements filed herewith to the following classes of persons (exclusive
of those persons covered by Item 33(a)): (1) Sales managers, branch
managers, district managers and other persons supervising the sale of
registrant's securities; (2) Salesmen, sales agents, canvassers and other
persons making solicitations but not in supervisory capacity; (3)
Administrative and clerical employees; and (4) Others (specify). If a
person is employed in more than one capacity, classify according to
predominant type of work.
Not applicable with respect to the Account. See Item 31.
COMPENSATION TO OTHER PERSONS
34. Furnish the following information with respect to the aggregate amount of
compensation for services paid any person (exclusive of persons whose
remuneration is reported in Items 31, 32 and 33), whose aggregate
compensation in connection with services rendered with respect to the trust
in all capacities exceeded $10,000 during the last fiscal year covered by
financial statements filed herewith from the depositor and any of its
subsidiaries.
Not applicable with respect to the Account. See Item 31.
IV.
DISTRIBUTION AND REDEMPTION OF SECURITIES
DISTRIBUTION OF SECURITIES
35. Furnish the names of the states in which sales of the trust's securities (A)
are currently being made, (B) are presently proposed to be made, and (C)
have been discontinued, indicating by appropriate letter the status with
respect to each state.
No sales are currently being made. It is proposed that Policies will
initially be offered in all jurisdictions where the Company has the
authority to sell the Policies. The sale of the Policies has not been
discontinued in any states.
36. If sales of the trust's securities have at any time since January 1, 1936
been suspended for more than a month describe briefly the reasons for such
suspension.
Not applicable.
37. (a) Furnish the following information with respect to each instance where
subsequent to January 1, 1937, any federal or state governmental
officer, agency, or regulatory body
23
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denied authority to distribute securities of the trust, excluding a
denial which was merely a procedural step prior to any determination by
such officer, etc., and which denial was subsequently rescinded.
(1) Name of officer, agency or body.
(2) Date of denial.
(3) Brief statement of reason given for revocation.
Not applicable.
(b) Furnish the following information with regard to each instance where,
subsequent to January 1, 1937, the authority to distribute securities of
the trust has been revoked by any federal or state governmental officer,
agency or regulatory body.
Not applicable.
38. (a) Furnish a general description of the method of distribution of
securities of the trust.
The Company plans to distribute the Policies through the Account's
principal underwriter, CIGNA Financial Advisors, Inc. ("CFA"), which is
a broker-dealer registered with the Commission, and is a member of the
National Association of Securities Dealers, Inc. ("NASD"). The Company
and CFA expect to enter into selling agreements with other
broker-dealers and insurance agencies to distribute the Policies.
(b) State the substance of any current selling agreement between each
principal underwriter and the trust or the depositor, including a
statement as to the inception and termination dates of the agreement, any
renewal and termination provisions, and any assignment provisions.
Not applicable.
(c) State the substance of any current agreements or arrangements of each
principal underwriter with dealers, agents, salesmen, etc., with respect
to commissions and overriding commissions, territories, franchises,
qualifications and revocations. If the trust is the issuer of periodic
payment plan certificates, furnish schedules of commissions and the bases
thereof. In lieu of a statement concerning schedules of commissions, such
schedules of commissions may be filed as Exhibit A(3)(c).
Not applicable.
INFORMATION CONCERNING PRINCIPAL UNDERWRITER
39. (a) State the form of organization of each principal underwriter of
securities of the trust, the name of the state of other sovereign power
under the laws of which each underwriter was organized and the date of
organization.
CFA is a Connecticut corporation incorporated in 1967.
(b) State whether any principal underwriter currently distributing
securities of the trust is a member of the National Association of
Securities Dealers, Inc.
Not applicable.
40. (a) Furnish the following information with respect to all fees received by
each principal underwriter of the trust from the sale of securities of
the trust and any other functions in connection therewith exercised by
such underwriter in such capacity or otherwise during the period covered
by the financial statements filed herewith.
Not applicable.
24
<PAGE>
(b) Furnish the following information with respect to any fee or any
participation in fees received by each principal underwriter from any
underlying investment company or any affiliated person or investment
adviser of such company:
(1) The nature of such fee or participation.
(2) The name of the person making payment.
(3) The nature of the services rendered in consideration for such fee or
participation.
(4) The aggregate amount received during the last fiscal year covered by
the financial statements filed herewith.
Not applicable.
41. (a) Describe the general character of the business engaged in by each
principal underwriter, including a statement as to any business other
than the distribution of securities of the trust. If a principal
underwriter acts or has acted in any capacity with respect to any
investment company or companies other than the trust, state the name or
names of such company or companies, their relationship, if any, to the
trust and the nature of such activities. If a principal underwriter has
ceased to act in such named capacity, state the date of and the
circumstances surrounding such cessation.
CFA, a registered broker-dealer and a registered investment adviser,
engages both in the distribution of securities, principally investment
company securities, and in the provision of investment advice to a
variety of clients. It is the principal underwriter for three other
registered separate accounts of the Company, CG Variable Annuity
Separate Account, CG Variable Annuity Separate Account II, and CG
Variable Life Separate Account I.
(b) Furnish as at latest practicable date the address of each branch office
of each principal underwriter currently selling securities of the trust
and furnish the name and residence address of the person in charge of
such office.
Not applicable.
(c) Furnish the number of individual salesmen of each principal underwriter
through whom any of the securities of the trust were distributed for the
last fiscal year of the trust covered by the financial statements filed
herewith and furnish the aggregate amount of compensation received by
such salesmen in such year.
Not applicable.
42. Furnish as at latest practicable date the following information with respect
to each principal underwriter currently distributing securities of the trust
and with respect to each of the officers, directors or partners of such
underwriter: (a) name and principal business address; (b) position with
principal underwriter; (c) ownership of securities of the trust.
Not applicable.
43. Furnish, for the last fiscal year covered by the financial statements filed
herewith, the amount of brokerage commissions received by any principal
underwriter who is a member of a national securities exchange and who is
currently distributing the securities of the trust or effecting transactions
for the trust in the portfolio securities of the trust.
Not applicable.
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OFFERING PRICE OR ACQUISITION VALUATION OF
SECURITIES OF THE TRUST
44. (a) Furnish the following information with respect to the method of
valuation used by the trust for purpose of determining the offering
price to the public of securities issued by the trust or the valuation
of shares or interests in the underlying securities acquired by the
holder of a periodic payment plan certificate:
(1) The source of quotations used to determine the value of portfolio
securities.
Each Fund's shares are valued at net asset value as supplied to the
Company by the Fund or its agent.
(2) Whether opening, closing, bid, asked or any other price is used.
See Items 44(a)(1) and 16.
(3) Whether price is as of the day of sale or as of any other time.
See Item 16.
(4) A brief description of the methods used by registrant for
determining other assets and liabilities including accrual for
expenses and taxes (including taxes on unrealized appreciation).
The Account's assets and liabilities (such as charges against the
Account) are valued in accordance with generally-accepted accounting
principles on an accrual basis. The Company does not currently
intend to create a reserve for its Federal income taxes.
(5) Other items which registrant adds to the net asset value in
computing offering price of its securities.
Not applicable.
(6) Whether adjustments are made for fractions:
(i) before adding distributor's compensation (load); and
(ii) after adding distributor's compensation (load).
Not applicable because the Account does not compute per-unit values
and sales loads in the manner presupposed by this Item and Item
44(b). Appropriate adjustments will be made for fractions in all
computations.
(b) Furnish a specimen schedule showing the components of the offering price
of the trust's securities as the latest practicable date.
No Policies have yet been offered for sale to the public.
(c) If there is any variation in the offering price of the trust's
securities to any person or classes of persons other than underwriters,
state the nature and amount of such variation and indicate the person or
classes of persons to whom such offering is made.
The Company does not require a premium payment of a fixed amount at
fixed intervals for a specified time period. A policyowner may, subject
to the limitations set forth in Item 10(i), pay premiums at any frequency
in any amount. Nonetheless, policyowners will need to pay sufficient
premiums to maintain adequate surrender value to pay monthly charges,
including the cost of insurance. The cost of insurance will vary,
depending upon the insured's age, gender classification and risk
classification. In addition, there will be additional charges if optional
insurance benefits are elected.
45. Furnish the following information with respect to any suspension of the
redemption rights of the securities issued by the trust during the three
fiscal years covered by the financial statements filed herewith.
Not applicable.
26
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REDEMPTION VALUATION OF SECURITIES OF THE TRUST
46. (a) Furnish the following information with respect to the method of
determining the redemption or withdrawal valuation of securities issued
by the trust:
(1) The source of quotations used to determine the value of portfolio
securities.
See Item 44(a)(1).
(2) Whether opening, closing, bid, asked or any other price is used.
See Item 44(a)(2).
(3) Whether price is as of the day of sale or as of any other time.
As of the day a request for surrender is received at the Center.
(4) A brief description of the methods used by registrant for
determining other assets and liabilities including accrual for
expenses and taxes (including taxes on unrealized appreciation).
See Items 44(a)(4) and 18(c).
(5) Other items which registrant deducts from the net asset value in
computing redemption value of its securities:
See Item 10(c).
(6) Whether adjustments are made for fractions.
Not applicable.
(b) Furnish a specimen schedule showing the components of the redemption
price to the holders of the trust's securities as at latest practicable
date.
No Policies have yet been offered for sale to the public.
PURCHASE AND SALE OF INTERESTS IN UNDERLYING SECURITIES
FROM AND TO SECURITY HOLDERS.
47. Furnish a statement as to the procedure with respect to the maintenance of a
position in the underlying securities or interests in the underlying
securities, the extent and nature thereof and the person who maintains such
a position. Include a description of the procedure with respect to the
purchase of underlying securities or interests in underlying securities from
security holders who exercise redemption or withdrawal rights and the sale
of such underlying securities and interests in the underlying securities to
other security holders. State whether the method of valuation of such
underlying securities or interests in underlying securities differs from
that set forth in Items 44 and 46. If any item of expenditure included in
the determination of the valuation is not or may not actually be incurred or
expended, explain the nature of such item and who may benefit from the
transaction.
The Company will invest net premiums, through the Account, in shares of the
underlying Funds at net asset value and allocate them to the Sub-Accounts
designated by a policyowner. Shares of the Funds are currently sold only to
the Company and to other life insurance companies to support their
obligations under variable annuity and variable life insurance contracts and
are not sold directly to the general public. The Company may redeem
sufficient shares of the appropriate Fund to pay death benefits, benefits at
maturity, or surrender proceeds, or for other purposes contemplated by the
Policies. In addition, if a policyowner elects to transfer Accumulation
Value among the Sub-Accounts, the Company may redeem shares held in any
Sub-Account from which a transfer is made and purchase shares for any
Sub-Account into which Accumulation Value is transferred. See Item 10(c).
27
<PAGE>
V.
INFORMATION CONCERNING THE TRUSTEE
OR CUSTODIAN
48. Furnish the following information as to each trustee or custodian of the
trust:
(a) Name and principal business address.
(b) Form or organization.
(c) State or other sovereign power under the laws of which the trustee or
custodian was organized.
(d) Name of governmental supervising or examining authority.
Not applicable.
49. State the basis for payment of fees or expenses of the trustee or custodian
for services rendered with respect to the trust and its securities, and the
aggregate amount thereof for the last fiscal year. Indicate the person
paying such fees or expenses. If any fees or expenses are prepaid, state the
unearned amount.
Not applicable.
50. State whether the trustee or custodian or any other person has or may create
a lien on the assets of the trust and, if so, give full particulars,
outlining the substance of the provisions of any indenture or agreement with
respect thereto.
The assets of the Account are not chargeable with liabilities arising out of
any other business that the Company may conduct except to the extent such
assets exceed liabilities arising under the variable portion of the Policy.
The income, capital gains, and capital losses of each Sub-Account are
credited to or charged against the assets held in that Sub-Account in
accordance with the terms of each Policy, without regard to the income,
capital gains and capital losses of any other Sub-Account.
VI.
INFORMATION CONCERNING INSURANCE OF
HOLDERS OF SECURITIES
51. Furnish the following information with respect to insurance of holders of
securities:
(a) The name and address of the insurance company.
The name and address of the Company are set forth in the answer to Item
2.
(b) The types of Policies and whether individual or group Policies.
The Policy is an individual flexible premium variable life insurance
policy.
Under circumstances described in Item 10(d), a Policy may be converted
to a permanent life insurance policy with death benefits that do not vary
based on the performance of a separate account. The Policies are issued
on an individual basis.
(c) The types of risks insured and excluded.
Death benefits, in an amount chosen by the insured. The Company assumes
the risk that the deductions made for mortality risks will prove
inadequate to cover actual mortality costs. The Company also assumes the
risk that deductions for expenses may be inadequate.
(d) The coverage of the Policies.
28
<PAGE>
See Paragraph (c) of this Item. The minimum specified amount is $50,000.
Death benefit proceeds will be reduced by any outstanding indebtedness
and any due and unpaid charges and increased by any unearned loan
interest.
(e) The Beneficiaries of such Policies and the uses to which the proceeds of
Policies must be put.
The recipient of the benefits of the insurance undertakings described in
Item 51(c) is either the owner or the beneficiary under a Policy. There
are no restrictions on the use of the proceeds other than those
established by a policyowner.
(f) The terms and manners of cancellation and of reinstatement.
The insurance undertakings described in Item 51(c) are an integral part
of a Policy and may not be terminated while a Policy remains in effect.
(g) The method of determining the amount of premiums to be paid by holders
of securities.
See Items 13(a) and 13(d) for the amount of charges imposed. See Items
10(c), 10(i) and 44(c) for the manner in which the premium is determined.
(h) The amount of aggregate premiums paid to the insurance company during
the last fiscal year.
Not applicable.
(i) Whether any person other than the insurance company receives any part of
such premiums, the name of each such person and the amounts involved, and
the nature of the services rendered therefor.
No person other than the Company receives any part of the amounts
deducted for assumption of mortality and expense risks.
(j) The substance of any other material provisions of any indenture or
agreement of the trust relating to insurance.
None.
VII.
POLICY OF REGISTRANT
52. (a) Furnish the substance of the provisions of any indenture or agreement
with respect to the conditions upon which and the method of selection by
which particular portfolio securities must or may be eliminated from
assets of the trust or must or may be replaced by other portfolio
securities. If an investment adviser or other person is to be employed
in connection with such selection, elimination of substitution, state
the name of such person, the nature of any affiliation to the depositor,
trustee or custodian, and any principal underwriter, and the amount of
remuneration to be received for such services. If any particular person
is not designated in the indenture or agreement, describe briefly the
method of selection of such person.
See Items 10(g) and 10(h) as regards the Company's right to substitute
any other investment for shares of any Fund.
(b) Furnish the following information with respect to each transaction
involving the elimination of any underlying security during the period
covered by the financial statements filed herewith.
Not applicable.
29
<PAGE>
(c) Describe the policy of the trust with respect to the substitution and
elimination of the underlying securities of the trust with respect to:
(1) the grounds for elimination and substitution;
(2) the type of securities which may be substituted;
(3) whether the acquisition of such substituted security or securities
would constitute the concentration of investment in a particular
industry or group of industries or would conform to a policy of
concentration of investment in a particular industry or group of
industries;
(4) whether such substituted securities may be the securities of another
investment company; and
(5) the substance of the provisions of any indenture or agreement which
authorize or restrict the policy of the registrant in this regard.
See Items 10(g) and 10(h).
(d) Furnish a description of any policy (exclusive of policies covered by
paragraphs (a) and (b) herein) of the trust which is deemed a matter of
fundamental policy and which is elected to be treated as such.
None.
53. (a) State the taxable status of the trust.
The Company does not initially expect to incur any income tax upon the
earnings or the realized gains attributable to the Account. Accordingly,
the Company does not intend to create a reserve for its Federal income
taxes attributable to the Account. If, however, the Company determines
that it may incur such taxes, it may assess a charge for those taxes
from the Account.
Under current laws the Company may incur state and local taxes (in
addition to premium taxes) in several states, and will incur certain
federal tax liabilities in connection with the Policies. The premium
load of 5.0% is intended to defray such obligations.
(b) State whether the trust qualified for the last taxable year as a
regulated investment company as defined in Section 851 of the Internal
Revenue Code of 1954, and state its present intention with respect to
such qualification during the current taxable year.
Not applicable. See Item 53(a).
VIII.
FINANCIAL AND STATISTICAL INFORMATION
54. If the trust is not the issuer of periodic payment plan certificates,
furnish the following information with respect to each class or series of
its securities.
Not applicable.
55. If the trust is the issuer of periodic payment plan certificates, a
transcript of a hypothetical account shall be filed in approximately the
following form on the basis of the certificate calling for the smallest
amount of payments. The schedule shall cover a certificate of the type
currently being sold assuming that such certificate had been sold at a date
approximately ten years prior to the date of registration or at the
approximate date of organization of the trust.
Not applicable.
30
<PAGE>
56. If the trust is the issuer of periodic payment plan certificates, furnish by
years for the period covered by the financial statements filed herewith in
respect of certificates sold during each period, the following information
for each fully paid type and each installment payment type of periodic
payment plan certificate currently being issued by the trust.
Not applicable.
57. If the trust is the issuer of periodic payment plan certificates, furnish by
years for the period covered by the financial statements filed herewith the
following information for each installment payment type of periodic payment
plan certificate currently being issued by the trust.
Not applicable.
58. If the trust is the issuer of periodic payment plan certificates, furnish
the following information for each installment payment type of periodic
payment plan certificate outstanding as at the latest practicable date.
Not applicable.
59. Financial statements:
(a) FINANCIAL STATEMENTS OF THE TRUST
Not applicable. The Trust is newly organized.
(c) FINANCIAL STATEMENTS OF THE DEPOSITOR
Consolidated balance sheets of the Depositor and its subsidiaries as of
December 31, 1994 and 1993, together with related consolidated statements
of income and retained earnings and cash flows for the years ended
December 31, 1994, 1993 and 1992, are incorporated by reference to
Pre-Effective Amendment No. 2 to registrant's Registration Statement on
Form S-6 under the Securities Act of 1933 (File No. 33-89238), filed
December 1, 1995.
31
<PAGE>
CONSENT OF INDEPENDENT ACCOUNTANTS
We hereby consent to the incorporation by reference in this Amendment No. 1
to the registration statement of CG Variable Life Insurance Separate Account
II on Form N-8B-2 of our report dated February 13, 1995 relating to the
consolidated financial statements of Connecticut General Life Insurance
Company.
/s/ Price Waterhouse LLP
PRICE WATERHOUSE LLP
Hartford, Connecticut
December 1, 1995
<PAGE>
IX.
EXHIBITS
A. (1) July 6, 1994 Resolution of the Board of Directors of the Company
authorizing establishment of the Account.
(2) Not applicable.
(3) (a) See Exhibit 3(b).
(b) Form of selling agreement among depositor, principal underwriter
and selling dealers.*
(c) Schedule of sales commissions.
(4) Not applicable.
(5) (a)Proposed form of individual Policy (Form LN 605), together with
riders LR434, LR435, LR436 and LR437 and with unisex provisions
LN605AA.**
(b)Proposed form of group Policy (LN616), together with group
Certificate (LN617), and riders LR462, LR463, LR464, LR465, LR466 and
LR467.
(6) (a) Certificate of Incorporation of the Company.*
(b) By-laws of the Company.*
(7) Not applicable.
(8) Fund participation agreements between the depositor and certain of the
underlying investment companies and affiliated persons.
(a) To be filed by Amendment.
(9) Not applicable.
(10) Variable Life Application Forms B10244***, B10295 and B10296.
B. (1) Not applicable.
(2) Not applicable.
C. Not applicable.
* Incorporated by reference to Exhibits of Post-Effective Amendment No. 1 to
Registration Statement on Form N-4 (File No. 33-83020) filed June 22, 1995
by CG Variable Annuity Separate Account II as registrant and the Company as
depositor.
** Incorporated by reference to Exhibit A(5) of Registration Statement on Form
N-8B2 (File No. 811-8970) filed March 13, 1995 by CG Variable Life Insurance
Separate Account II as registrant.
*** Incorporated by reference to Exhibit A(10) of Registration Statement on Form
N-8B2 (File No. 811-8970) filed March 13, 1995 CG Variable Life Insurance
Separate Account II as registrant.
32
<PAGE>
SIGNATURE
Pursuant to the requirements of the Investment Company Act of 1940, the
depositor of the registrant has caused this Amendment No. 1 to this registration
statement on Form N-8B-2 (File No. 811-8970) to be duly signed on behalf of the
registrant in Bloomfield, Connecticut on the 27th day of November, 1995.
CG VARIABLE LIFE INSURANCE SEPARATE ACCOUNT II
(Name of Registrant)
By: __________________THOMAS C. JONES_________________
Thomas C. Jones
President
Connecticut General Life Insurance Company
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
(Name of Depositor)
By: _______________THOMAS C. JONES______________(Seal)
Thomas C. Jones
President
Attest:
______________/S/ EDWIN L. KERR______
Edwin L. Kerr
Counsel
33
<PAGE>
SECRETARY'S CERTIFICATE
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
The following is certified to be a true and correct copy of certain resolutions
adopted by the Board of Directors of Connecticut General Life Insurance Company
at a meeting held on July 6, 1994, a quorum being present; and such resolutions
remain in full force and effect as of the date of certification, not having been
amended, modified or rescinded since the date of its adoption.
ESTABLISHMENT OF CG VARIABLE LIFE INSURANCE SEPARATE ACCOUNT II
WHEREAS, Section 38a-433 of the Connecticut Insurance Laws permits a
domestic life insurance company to establish one or more separate accounts;
and
WHEREAS, it is desired that the Company create such a separate account to
house certain of its variable life insurance products;
NOW, THEREFORE, BE IT RESOLVED: That a separate account referred to herein
as "CG Variable Life Insurance Separate Account II" is hereby established.
FURTHER RESOLVED: That the assets of CG Variable Life Insurance Separate
Account II shall be derived solely from (a) sale of variable life insurance
products, (b) funds corresponding to dividend accumulation with respect to
investment of such assets, and (c) advances made by the Company in
connection with operation of CG Variable Life Insurance Separate Account
II.
FURTHER RESOLVED: That this Company shall maintain in CG Variable Life
Insurance Separate Account II assets with a fair market value at least
equal to the statutory valuation reserves for the variable life insurance
policies.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized in his or her discretion, as the Company may deem
appropriate from time to time, in accordance with applicable laws and
regulations (a) to divide CG Variable Life Insurance Separate Account II
into divisions and subdivisions, with each division or subdivision
investing in shares of designated classes of designated investment
companies or other appropriate securities, (b) to modify or eliminate any
such divisions or subdivisions, (c) to designate
<PAGE>
further any division or subdivision thereof and (d) to change the
designation of CG Variable Life Insurance Separate Account II to another
designation.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to invest cash from the Company's general account in
CG Variable Life Insurance Separate Account II or in any division or
subdivision thereof as may be deemed necessary or appropriate to facilitate
the commencement of the operations of CG Variable Life Insurance Separate
Account II or to meet any minimum capital requirements under the Investment
Company Act of 1940 and to transfer cash or securities from time to time
between the Company's general account and CG Variable Life Insurance
Separate Account II as deemed necessary or appropriate so long as such
transfers are not prohibited by law and are consistent with the terms of
the variable life insurance policies issued by the Company providing for
allocations to CG Variable Life Insurance Separate Account II.
FURTHER RESOLVED: That the income, gains, and losses (whether or not
realized) from assets allocated to CG Variable Life Insurance Separate
Account II shall, in accordance with any variable life insurance policies
issued by the Company providing for allocations to CG Variable Life
Insurance Separate Account II, be credited to or charged against CG
Variable Life Insurance Separate Account II without regard to the other
income, gains, or losses of the Company.
FURTHER RESOLVED: That authority is hereby delegated to the President of
the Company to adopt procedures regarding, among other things, criteria by
which the Company shall afford a pass-through of voting rights to the
owners of variable life insurance policies providing for allocation to CG
Variable Life Insurance Separate Account II with respect to the shares of
any investment companies which are held in CG Variable Life Insurance
Separate Account II.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized and directed to prepare and execute any necessary
agreements to enable CG Variable Life Insurance Separate Account II to
invest or reinvest the assets of CG Variable Life Insurance Separate
Account II in securities issued by investment companies registered under
the Investment Company Act of 1940 or other appropriate securities as the
officers of the Company may designate pursuant to the provisions of the
variable life insurance policies providing for allocations to CG Variable
Life Insurance Separate Account II.
<PAGE>
FURTHER RESOLVED: That the Company may register under the Securities Act
of 1933 variable life insurance policies, or units of interest thereunder,
under which amounts will be allocated by the Company to CG Variable Life
Insurance Separate Account II to support reserves for such policies and, in
connection therewith, the officers of the Company be, and each of them
hereby is, authorized, to prepare, execute and file with the Securities and
Exchange Commission, in the name and on behalf of the Company, registration
statements under the Securities Act of 1933, including prospectuses,
supplements, exhibits and other documents relating thereto, and amendments
to the foregoing, in such form as the officer executing the same may deem
necessary or appropriate.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to take all actions necessary to register CG Variable
Life Insurance Separate Account II as a unit investment trust under the
Investment Company Act of 1940 and to take such related actions as they
deem necessary and appropriate to carry out the foregoing.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to prepare, execute and file with the Securities and
Exchange Commission, applications and amendments thereto for such
exemptions from or orders under the Investment Company Act of 1940 and the
Securities Act of 1933, and to request from the Securities and Exchange
Commission no action and interpretative letters as they may from time to
time deem necessary or desirable.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to prepare, execute and file all periodic reports
required under the Investment Company Act of 1940 and the Securities
Exchange Act of 1934.
FURTHER RESOLVED: That the Chief Counsel of the Company, or the person as
is designated by him from time to time, is hereby appointed as agent for
service under any such registration statement and is duly authorized to
receive communications and notices from the Securities and Exchange
Commission with respect thereto, and to exercise powers given to such agent
by the Securities Act of 1933 and the Rules thereunder and any other
necessary Acts.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to effect in the name and on behalf of the Company,
all such registrations, filings and qualifications under blue sky or other
applicable securities laws and regulations and
<PAGE>
under insurance securities laws and insurance laws and regulations of such
states and other jurisdictions as they may deem necessary or appropriate,
with respect to the Company, and with respect to any variable life
insurance policies under which amounts will be allocated by the Company to
CG Variable Life Insurance Separate Account II to support reserves for such
policies; such authorization shall include registration, filing and
qualification of the Company and of said policies, as well as registration,
filing and qualification of officers, employees and agents of the Company
as brokers, dealers, agents, salespersons, or otherwise; and such
authorization shall also include, in connection therewith, authority to
prepare, execute, acknowledge and file all such applications, applications
for exemptions, certificates, affidavits, covenants, consents to service of
process and other instruments, and to take all such action as the officer
executing the same or taking such action may deem necessary or desirable.
FURTHER RESOLVED: That the officers of the Company be, and each of them
hereby is, authorized to execute and deliver all such documents and papers
and to do or cause to be done all such acts and things as they may deem
necessary or desirable to carry out the foregoing resolutions and the
intent and purpose thereof.
Dated: July 6, 1994 /s/ David C. Kopp
------------------------- ----------------------------
David C. Kopp
Corporate Secretary
(SEAL)
<PAGE>
EXHIBIT A(3)(c)
SCHEDULE OF SALES COMMISSIONS
Base Expense Total Sales
Commissions Allowance Commissions
----------- --------- -----------
Year 1* . . . . . . . . . . . . . . . 50.00% 125.00% 112.50%
Year 2 - Year 10. . . . . . . . . . . 2.50% 125.00% 5.63%
Year 11+. . . . . . . . . . . . . . . 2.50% 125.00% 5.63%
* In Year 1, the base commission is payable up to the breakpoint premium.
The amount of commission paid on the premium received in excess of the
breakpoint premium is 3%.
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
A Stock Company Home Office Location: 900 Cottage Grove Road
Bloomfield, Connecticut
MAILING ADDRESS: CIGNA INDIVIDUAL INSURANCE
VARIABLE PRODUCTS SERVICE CENTER - ROUTING S249
HARTFORD, CT 06152-2249
The Company agrees with the Policyowner to provide the benefits in this policy.
RIGHT TO EXAMINE THIS GROUP POLICY. The policy may be returned to the insurance
agent through whom it was purchased or to the Company within 45 days of the date
the application is signed by the Policyowner or within 10 days after receipt of
the policy, (20 days after its receipt where required by law for group policies
issued in replacement of other insurance), whichever is later. During this
period, the premium paid will be placed in the Fixed Account, and if the policy
is so returned, it will be deemed void from the Policy Date of Issue and the
Company will refund all premium paid.
ALL BENEFITS AND VALUES PROVIDED BY THIS GROUP POLICY WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT.
The policy is governed by the laws of the jurisdiction of issue and is issued
and accepted subject to the terms set forth on this page and on the following
pages, which are made a part of the policy. In consideration of the application
for it, this policy is executed by Connecticut General Life Insurance Company as
of its Policy Date of Issue.
/s/ Thomas C. Jones
PRESIDENT
Registrar
FLEXIBLE PREMIUM GROUP VARIABLE LIFE INSURANCE POLICY - NON-PARTICIPATING
LN616
<PAGE>
TABLE OF CONTENTS
Page
Policy Specifications........................................................3
List of Variable Account Sub-Accounts........................................5
Schedule 1: Surrender Charges...............................................7
Schedule 2: Expense Charges and Fees........................................8
Schedule 3: Table of Guaranteed Maximum Cost of Insurance Rates.............9
Schedule 4: Corridor Percentages Table.....................................10
Definitions.................................................................11
Premium and Reinstatement Provisions........................................12
Ownership, Assignment and Beneficiary Provisions............................13
Variable Accounts Provisions................................................14
Certificate Values Provisions...............................................15
Transfer Privilege Provision................................................18
Nonforfeiture and Surrender Value Provisions................................19
Loan Provisions.............................................................19
Insurance Coverage Provisions...............................................20
General Provisions..........................................................22
Followed by Optional Methods of Settlement and Any Riders
Note: Pages 4 and 6 are intentionally "blank".
LN616 2
<PAGE>
POLICY SPECIFICATIONS
<TABLE>
<S> <C> <C> <C>
Insured Per Each Certificate Group Policy Number SPECIMEN
Initial Specified Amount Per Each Certificate Policy Date of Issue 12/01/95
Minimum Specified Amount Per Each Certificate Issue Age Per Each Certificate
Monthly Anniversary Day Per Each Certificate Premium Class Per Each Certificate
</TABLE>
LN616 FLEXIBLE PREMIUM GROUP VARIABLE LIFE INSURANCE
DEATH BENEFIT: The Death Benefit Option is that elected under each certificate.
PREMIUM PAYMENTS: Per Each Certificate
PAYMENT MODE: Per Each Certificate
GUARANTEED INITIAL DEATH BENEFIT PREMIUM: Per Each Certificate
NOTE: Each certificate may terminate prior to its Coverage Date if
actual premiums paid, interest credited and market performance
are insufficient to maintain a positive surrender value to
continue coverage to that date. The Coverage Date under each
certificate is the certificate anniversary nearest to the
Insured's age 100.
GUIDELINE ANNUAL PREMIUM AMOUNT: Per Each Certificate
NOTE: A separate Guideline Annual Premium Amount will apply to
increases if any, in Specified Amount.
LIMITS ON ALLOCATION OF NET PREMIUM PAYMENTS: Under each certificate, the
minimum allocation percentage to the Fixed Account or a Variable Account
Sub-Account is 10%. All allocations must be made in whole percentages and in
aggregate must total 100%. Premium payments will be allocated net of the
Premium Load specified in Schedule 2.
LIMITS ON TRANSFERS: Transfer(s) from the Fixed Account under each certificate
may only be made during the 30-day period following each Certificate Anniversary
and is (are) subject to a maximum aggregate annual limit of 20% of the Fixed
Account Value as of that Certificate Anniversary. Additionally, the Company has
the right to limit the dollar amount of such transfers.
GUARANTEED MINIMUM INTEREST RATES: Under each certificate, the interest rate
used to credit interest on the Fixed Account Value may vary but will never be
less than .010746% compounded daily (4% compounded yearly).
The interest rate used to credit interest on the Loan Account Value may vary but
will never be less than the loan interest rate less 2% per year during
Certificate Years 1 through 10 and less 1% per year thereafter. (As of the
Policy Date of Issue, the difference between the loan interest rate charged and
the interest rate credited on the Loan Account Value is 1% per year for
Certificate Years 1 through 10 and .50% per year thereafter.)
POLICYOWNER: CIGNA VARIABLE PRODUCTS TRUST (DATED 06/07/95)
JURISDICTION OF ISSUE OF GROUP POLICY: RHODE ISLAND
CERTIFICATE OWNER: PER EACH CERTIFICATE
BENEFICIARY: PER EACH CERTIFICATE
LN616 3
<PAGE>
LIST OF VARIABLE ACCOUNT SUB-ACCOUNTS
<TABLE>
FUND GROUPS FUNDS (SUB-ACCOUNTS)
<S> <C>
AIM
AIM Variable Insurance Funds, Inc. AIM V.I. Capital Appreciation Fund
AIM V.I. Diversified Income Fund
AIM V.I. Growth Fund
AIM V.I. Value Fund
FIDELITY INVESTMENTS
Variable Insurance Products Fund Equity-Income Portfolio
Variable Insurance Products Fund II Asset Manager Portfolio
Investment Grade Bond Portfolio
MASSACHUSETTS FINANCIAL SERVICES
MFS Variable Insurance Trust MFS Total Return Series
MFS Utilities Series
MFS World Governments Series
QUEST FOR VALUE
Quest for Value Accumulation Trust Quest Global Equity Portfolio
Quest Managed Portfolio
Quest Small Cap Portfolio
TEMPLETON
Templeton Variable Product Funds Templeton Asset Allocation Fund
Templeton International Fund
Templeton Stock Fund
</TABLE>
NOTE: NET PREMIUM PAYMENTS UNDER EACH CERTIFICATE MAY ALSO BE ALLOCATED TO
THE FIXED ACCOUNT.
VARIABLE ACCOUNT SEPARATE ACCOUNT: CG Variable Life Insurance Separate Account
II: A Connecticut General Life Insurance Company separate Investment Account
which was established on July 6, 1994.
LN616 5
<PAGE>
SCHEDULE 1: SURRENDER CHARGES
Surrender charges are used in the determination of the surrender value under
each certificate and are assessed upon surrender of a certificate. Such charges
are applicable within 10 years of the Certificate Date and within 10 years
following the date of any increase in Specified Amount under each certificate.
The surrender charge is calculated as (a) times (b), where (a) is the sum of (i)
a Deferred Sales Charge and (ii) a Deferred Administrative Charge and (b) is the
applicable Surrender Charge Grading Factor from the table below, but in no event
will the surrender charge ever exceed the maximum surrender charge allowed by
law.
(a) (i) The Deferred Sales Charge is based on the actual premium paid and the
applicable Guideline Annual Premium Amount, and is calculated as
follows:
DURING CERTIFICATE YEAR*:
1 and 2 28.5% of the sum of premiums paid up to an amount equal to the
Guideline Annual Premium Amount, plus 8.5% of the sum of
premiums paid between one and two times the Guideline Annual
Premium Amount, plus 7.5% of the sum of premiums paid in excess
of two times the Guideline Annual Premium Amount.
3 through 10 Same dollar amount as end of Certificate Year* 2.
(ii) The Deferred Administrative Charge is $6.00 per $1,000 of Specified
Amount.
(b) SURRENDER CHARGE GRADING FACTORS
Certificate Years* 1-5 100%
Certificate Year 6 80%
Certificate Year 7 60%
Certificate Year 8 40%
Certificate Year 9 20%
Certificate Year 10 0%
If a surrender becomes effective at other than the end of a Certificate
Year, any applicable surrender charge grading factor will be applied on a
pro rata basis as of such effective date.
*NUMBER OF CERTIFICATE YEARS ELAPSED SINCE THE CERTIFICATE DATE OR
FROM THE EFFECTIVE DATE(S) OF ANY INCREASE(S) IN SPECIFIED AMOUNT
UNDER THE CERTIFICATE.
No surrender charge is applied upon either a partial surrender or a decrease in
Specified Amount under a certificate, however, a transaction fee of $25 is
assessed for each partial surrender and will be processed as set forth in the
"Partial Surrender" provision, and for any decrease in Specified Amount effected
while surrender charges apply under the certificate, there will be no change in
the surrender charge from that which was applicable before the decrease took
effect.
LN616 7
<PAGE>
SCHEDULE 2: EXPENSE CHARGES AND FEES
PREMIUM LOAD. A charge equal to 5.0% of each premium payment will be deducted
under each certificate to cover applicable state taxes, federal income tax
liabilities, and a portion of sales expenses.
MONTHLY ADMINISTRATIVE FEE. A monthly deduction is made under each certificate
on each Monthly Anniversary Day. (See "Monthly Deduction" provision.) It
includes an administrative fee charge, cost of insurance charges and any charges
for supplemental riders or optional benefits.
The monthly administrative fee as of each Certificate Date is $15.00 per month
during the first Certificate Year and $5.00 per month during subsequent
Certificate Years. This fee may be changed by the Company after the first
Certificate Year based on its expectations of future expenses, but the amount of
such fee is guaranteed not to exceed $10.00 per month.
CHARGES AND FEES ASSOCIATED WITH THE VARIABLE ACCOUNT SUB-ACCOUNTS. For
mortality and expense risk, an asset charge is deducted from each Variable
Account Sub-Account under each certificate at the end of each Valuation Period.
This charge may be changed by the Company from time to time, but it is
guaranteed not to exceed a daily rate which is equivalent to .90% annually of a
Sub-Account's Value. As of the Policy Date of Issue, this charge was equal to a
daily rate which is equivalent to .80% annually during Certificate Years 1
through 12 and a daily rate which is equivalent to .55% annually during the 13th
and later Certificate Years.
In addition, Daily Fund Operating Expenses will be applied by each Fund as set
forth in the prospectus for the applicable Fund(s).
TRANSFER FEE. A transaction fee of $25 applies to each transfer in excess of 12
made during any Certificate Year.
LN616 8
<PAGE>
SCHEDULE 3: TABLE OF GUARANTEED MAXIMUM COST OF INSURANCE RATES
(ATTAINED AGE MONTHLY RATES PER $1,000 OF NET AMOUNT AT RISK)
SPECIAL NOTE: The actual monthly cost of insurance rates charged under each
certificate will vary based on the sex, attained age (nearest
birthday) and Premium Class of the person insured; however, they
will not exceed the rates shown in the table below. In
determining the monthly cost of insurance, the Company will add
the amount of the Flat Extra Monthly Insurance Cost, if any,
shown in the Certificate Specifications. If the person insured is
in a rated premium class, the Guaranteed Maximum Life Insurance
Rates will be those in the table multiplied by the Risk Factor,
if any, shown in the Certificate Specifications. The rates below
are based on the 1980 CSO Tables (Male or Female as appropriate).
<TABLE>
<CAPTION>
ATTAINED ATTAINED ATTAINED
AGE MALE FEMALE AGE MALE FEMALE AGE MALE FEMALE
(NEAREST MONTHLY MONTHLY (NEAREST MONTHLY MONTHLY (NEAREST MONTHLY MONTHLY
BIRTHDAY) RATE RATE BIRTHDAY) RATE RATE BIRTHDAY) RATE RATE
- ------------------------------- ----------------------------- -------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
0 0.34845 0.24089 35 0.17586 0.13752 70 3.30338 1.84590
1 0.08917 0.07251 36 0.18670 0.14669 71 3.62140 2.02325
2 0.08251 0.06750 37 0.20004 0.15752 72 3.98666 2.24419
3 0.08167 0.06584 38 0.21505 0.17003 73 4.40599 2.51548
4 0.07917 0.06417 39 0.23255 0.18503 74 4.87280 2.83552
- ------------------------------- ------------------------------ -------------------------------------
5 0.07501 0.06334 40 0.25173 0.20171 75 5.37793 3.19685
6 0.07167 0.06084 41 0.27424 0.22005 76 5.91225 3.59370
7 0.06667 0.06000 42 0.29675 0.23922 77 6.46824 4.01942
8 0.06334 0.05834 43 0.32260 0.25757 78 7.04089 4.47410
9 0.06167 0.05750 44 0.34929 0.27674 79 7.64551 4.97042
- ------------------------------- ------------------------------ -------------------------------------
10 0.06084 0.05667 45 0.37931 0.29675 80 8.30507 5.52957
11 0.06417 0.05750 46 0.41017 0.31677 81 9.03761 6.17118
12 0.07084 0.06000 47 0.44353 0.33761 82 9.86724 6.91414
13 0.08251 0.06250 48 0.47856 0.36096 83 10.80381 7.77075
14 0.09584 0.06667 49 0.51777 0.38598 84 11.82571 8.72632
- ------------------------------- ------------------------------ -------------------------------------
15 0.11085 0.07084 50 0.55948 0.41350 85 12.91039 9.76952
16 0.12585 0.07501 51 0.60870 0.44270 86 14.03509 10.89151
17 0.13919 0.07917 52 0.66377 0.47523 87 15.18978 12.08770
18 0.14836 0.08167 53 0.72636 0.51276 88 16.36948 13.35774
19 0.15502 0.08501 54 0.79730 0.55114 89 17.57781 14.70820
- ------------------------------- ------------------------------ -------------------------------------
20 0.15836 0.08751 55 0.87326 0.59118 90 18.82881 16.15259
21 0.15919 0.08917 56 0.95591 0.63123 91 20.14619 17.71416
22 0.15752 0.09084 57 1.04192 0.66961 92 21.57655 19.43814
23 0.15502 0.09251 58 1.13378 0.70633 93 23.20196 21.40786
24 0.15169 0.09501 59 1.23235 0.74556 94 25.28174 23.83051
- ------------------------------- ------------------------------ -------------------------------------
25 0.14752 0.09668 60 1.34180 0.78979 95 28.27411 27.16158
26 0.14419 0.09918 61 1.46381 0.84488 96 33.10677 32.32378
27 0.14252 0.10168 62 1.60173 0.91417 97 41.68475 41.21204
28 0.14169 0.10501 63 1.75809 1.00267 98 58.01259 57.81394
29 0.14252 0.10835 64 1.93206 1.10539 99 83.33333 83.33333
- ------------------------------- ------------------------------ -------------------------------------
30 0.14419 0.11251 65 2.12283 1.21731
31 0.14836 0.11668 66 2.32623 1.33511
32 0.15252 0.12085 67 2.54312 1.45461
33 0.15919 0.12502 68 2.77350 1.57247
34 0.16669 0.13168 69 3.02328 1.69955
- ------------------------------- -----------------------------
</TABLE>
LN616 9
<PAGE>
SCHEDULE 4: CORRIDOR PERCENTAGES TABLE
As of the Policy Date of Issue the formula in effect to determine the amount
under item (b) of both Death Benefit Option 1 and Death Benefit Option 2 is
based on a percent of the Accumulation Value as determined from the following
table:
<TABLE>
<CAPTION>
INSURED'S CORRIDOR INSURED'S CORRIDOR
ATTAINED AGE PERCENTAGE ATTAINED AGE PERCENTAGE
------------ ---------- ------------ ----------
<S> <C> <C> <C>
0-40 250% 70 115%
41 243 71 113
42 236 72 111
43 229 73 109
44 222 74 107
------------ ---------- ------------ ----------
45 215 75 105
46 209 76 105
47 203 77 105
48 197 78 105
49 191 79 105
------------ ---------- ------------ ----------
50 185 80 105
51 178 81 105
52 171 82 105
53 164 83 105
54 157 84 105
------------ ---------- ------------ ----------
55 150 85 105
56 146 86 105
57 142 87 105
58 138 88 105
59 134 89 105
------------ ---------- ------------ ----------
60 130 90 105
61 128 91 104
62 126 92 103
63 124 93 102
64 122 94 101
------------ ---------- ------------ ----------
65 120 95 100
66 119 96 100
67 118 97 100
68 117 98 100
69 116 99 100
------------ ---------- ------------ ----------
</TABLE>
LN616 10
<PAGE>
DEFINITIONS
ACCUMULATION VALUE. The sum of (i) the then current value of the Fixed Account,
(ii) all of the then current values of the Variable Account Sub-Accounts (i.e.
the Variable Account Value), and (iii) the Loan Account Value under the
certificate.
CERTIFICATE ANNIVERSARIES AND CERTIFICATE YEARS. Twelve-month periods measured
from each Certificate Date.
CERTIFICATE DATE (OR "DATE OF ISSUE"). The date on which a certificate becomes
effective. The Certificate Date is shown in each Certificate Specifications.
The term "Date of Issue", by itself, shall mean Certificate Date.
CERTIFICATE OWNER (OR "OWNER"). The Certificate Owner is defined under
"Ownership, Assignment and Beneficiary Provisions". The term "Owner", by
itself, shall mean Certificate Owner.
COMPANY. Connecticut General Life Insurance Company.
DUE PROOF OF DEATH. An original certified copy of an official death
certificate, an original certified copy of a decree of a court of competent
jurisdiction as to the finding of death, or any other proof of death
satisfactory to the Company.
FIXED ACCOUNT. The account which provides for a guaranteed minimum interest
rate. The Company may, at its discretion, credit a higher current rate of
interest. Fixed Account assets are general assets of the Company and are
distinguishable from those allocated to a separate account of the Company.
FUND(S). The Portfolio(s) of Fund Groups whose shares are acquired for the
Variable Account Sub-Accounts in which Net Premium Payments or transfers may be
invested.
FUND GROUPS. The open-end management investment companies (mutual funds)
registered under the Investment Company Act of 1940, as amended, (hereinafter
referred as the "1940 Act"), one or more of whose Portfolio(s)' shares are made
available as investment vehicles for the policies through the Variable Account
Sub-Accounts.
HOME OFFICE. The term "Home Office" means the home office of Connecticut
General Life Insurance Company, the mailing address of which for a certificate
issued under this group policy is CIGNA Individual Insurance, Variable Products
Service Center - Routing S249, Hartford, Connecticut 06152-2249.
IN WRITING. The term "in writing" means in a written form satisfactory to the
Company and received by the Company at its Home Office.
LOAN ACCOUNT. The account in which a certificate's indebtedness (outstanding
loans and interest) accrues once it is transferred out of the Fixed Account and
Variable Account Sub-Accounts. The Loan Account is part of the Company's
general account.
LOAN ACCOUNT VALUE. The value of the Loan Account, the amount of which equals
the indebtedness under the certificate.
MONTHLY ANNIVERSARY DAY. The day of the month, as shown in the Certificate
Specifications, under each certificate, when the Company deducts certain
charges. If that day does not occur on a Valuation Day or is nonexistent for
that month, then such charges will be deducted on the next Valuation Day.
NET ACCUMULATION VALUE. An amount equal to the Accumulation Value less the
amount of indebtedness, if any, in the Loan Account.
NET PREMIUM PAYMENT. The amount of a premium payment, under each certificate,
less the premium load shown in Schedule 2. A Net Premium Payment is the amount
available for allocation to the Fixed Account and the Variable Account
Sub-Accounts.
POLICY DATE OF ISSUE: The date on which this group policy becomes effective.
POLICYOWNER. The person or entity designated in the Policy Specifications.
LN616 11
<PAGE>
DEFINITIONS (CONTINUED)
SEC. The Securities and Exchange Commission.
SUB-ACCOUNT. That portion of the Variable Account which invests in shares of a
specific Fund.
VALUATION DAY. Every day on which the New York Stock Exchange ("NYSE") is open
for business, except any day on which trading on the NYSE is restricted, or on
which an emergency exists, as determined by the SEC, so that valuation or
disposal of securities is not practicable.
VALUATION PERIOD. The period of time for which a Fund determines its net asset
value; a Valuation Period begins on the day following a Valuation Day and ends
on the next Valuation Day. A Valuation Period may be more than one day in
length.
VARIABLE ACCOUNT. The account consisting of all Sub-Account(s) invested in
shares of the Fund(s). Variable Account assets are separate account assets of
the Company, the investment performance of which is kept separate from that of
the general assets of the Company and are not chargeable with the general
liability of the Company.
VARIABLE ACCUMULATION UNIT. A unit of measure used in the calculation of the
value of each Variable Account Sub-Account.
PREMIUM AND REINSTATEMENT PROVISIONS
PAYMENT OF PREMIUMS. Under each certificate all premiums are payable at the
Home Office or to an authorized representative of the Company. The first
premium is due on the Certificate Date and is payable in advance. Additional
premiums may be paid under each certificate before the Coverage Date subject to
the consent of the Company and the requirements specified under the "Minimum
Premiums" and "Additional Premiums" provisions. Receipts signed by the
President or Secretary and duly countersigned will be furnished upon request.
MINIMUM PREMIUMS. The minimum premium under each certificate is the amount
necessary to maintain a positive surrender value as set forth under the "Grace
Period" provision. The Guaranteed Initial Death Benefit Premium, as shown in
the Certificate Specifications under each certificate, is not mandatory but is
the premium amount necessary to guarantee that the death benefit will not be
less than the Initial Specified Amount during the first 5 Certificate Years
regardless of market performance, assuming that there are no loans or partial
surrenders under the certificate. If premiums paid less any partial surrenders
and certificate loans exceed the minimum premium, the certificate will not lapse
during the first 5 certificate years
PLANNED PREMIUMS. The Company will send premium reminder notices for the
amounts and frequency of payments established by each Certificate Owner.
Changes in the amounts or frequency of such planned periodic payments by each
Certificate Owner will be subject to the consent of the Company.
COVERAGE DATE. Payment of (a) the Guaranteed Initial Death Benefit Premium
shown in each Certificate Specifications, or (b) Planned Premiums payable in
accordance with the payment mode specified, may not continue the certifiate in
force until the Coverage Date even if the amount is paid as scheduled. The
Coverage Date is not guaranteed based upon the level of Planned Premiums. The
period for which a certificate will continue will depend on:
1. The amount, timing, and frequency of premium payment;
2. Changes in the Specified Amount and Death Benefit options;
3. Interest credits and insurance costs;
4. Changes in deductions for riders, if any; and
5. Partial withdrawals and loans.
ADDITIONAL PREMIUMS. In addition to planned premiums, if any, additional
premium payments of at least $100.00 each may be made before the Coverage Date
during the continuance of a certificate. The Company reserves the right to
limit the amount or number of any such additional premium payments if such is
necessary to qualify the certificate as life insurance under the Internal
Revenue Code.
Unless otherwise specified by the Certificate Owner, if there is any certificate
indebtedness, any additional premiums paid will be used first as a loan
repayment with any excess applied as an additional premium.
ALLOCATION OF NET PREMIUM PAYMENTS. Net Premium Payments may be allocated to
the Fixed Account and/or to Variable Account Sub-Accounts under a certificate
subject to the "Limits on Allocation of Net Premium Payments" shown in the
Certificate Specifications. The Net Premium Payment associated with the initial
premium payment will be allocated within 3 business days of the expiration of
each certificate's "Right To Examine The Certificate" period in accordance with
the allocation percentages specified in the application. Subsequent Net Premium
Payments will be allocated under each certificate on the same basis as the most
recent previous Net Premium Payment unless the Company is otherwise instructed
in writing to change the allocation percentages.
LN616 12
<PAGE>
PREMIUM AND REINSTATEMENT PROVISIONS (CONTINUED)
GUIDELINE ANNUAL PREMIUM AMOUNT. The level annual amount as shown in the
Certificate Specifications as of the Certificate Date is an amount calculated in
accordance with SEC Rule 6e-3(T) under the 1940 Act as in effect on such date.
The Guideline Annual Premium Amount under each certificate is used in
determining the amount of the surrender charges if the certificate is
surrendered during a period for which surrender charges are applicable.
GRACE PERIOD. If the surrender value on any Monthly Anniversary Day under a
certificate is less than the required monthly deduction, a grace period of 61
days will be granted to pay a premium sufficient to cover the required monthly
deduction. If, however, the Guaranteed Initial Death Benefit Premium
requirement as set forth in the Certificate Specifications is met, the
certificate will not lapse during the first 5 Certificate Years and a minimum
death benefit amount at least equal to the Initial Specified Amount will be
guaranteed during that period, regardless of market performance (assuming that
there are no loans or partial surrenders under the certificate). If premiums
paid less any partial surrenders and certificate loans exceed the minimum
premium, the certificate will not lapse during the first 5 certificate years.
At least 31 days before the end of the grace period the Company will send a
notice that there is insufficient value under the certificate. The notice will
show the amount of premium required to cover the monthly deduction to prevent
the certificate from lapsing and will be mailed to the last known addresses of
the Certificate Owner and the assignee of record with the Company, if any. If
such premium, as billed by the Company, is not paid within the grace period, all
coverage under the certificate will terminate without value at the end of the
grace period. If the Insured dies during the grace period, the Company will
deduct any overdue monthly deductions from the benefits.
REINSTATEMENT. After a certificate has lapsed due to the expiration of a grace
period, it may be reinstated any time during the Insured's lifetime prior to the
Coverage Date provided: (a) it has not been surrendered for cash, (b) a written
application for reinstatement is submitted to the Company, (c) evidence of
insurability satisfactory to the Company is furnished, (d) enough premium is
paid to keep the certificate in force for at least 2 months, and (e) any
indebtedness against the certificate increased by any loan interest is paid or
reinstated.
The effective date of the reinstated certificate will be the Monthly Anniversary
Day next following the date the application for reinstatement is approved by the
Company. The surrender charges set forth in Schedule 1 will be reinstated as of
the Certificate Year in which the certificate lapsed.
OWNERSHIP, ASSIGNMENT AND BENEFICIARY PROVISIONS
CERTIFICATE OWNER. Under each certificate, the certificate Owner on the
Certificate Date will be the person designated in the Certificate
Specifications. If no person is designated as Certificate Owner, the Insured
will be the Certificate Owner.
RIGHTS OF CERTIFICATE OWNER. While the Insured is alive, a Certificate Owner
may exercise all rights and privileges under the certificate including the right
to: (a) release or surrender the certificate to the Company, (b) agree with
the Company to any change in or amendment to the certificate, (c) transfer all
rights and privileges to another person, (d) change the Beneficiary, and (e)
assign the certificate.
All rights and privileges of a Certificate Owner may be exercised without the
consent of any designated transferee, or any Beneficiary if the Certificate
Owner has reserved the right to change the Beneficiary. All such rights and
privileges, however, may be exercised only with the consent of any assignee
recorded with the Company.
Unless provided otherwise, if a Certificate Owner is a person other than the
Insured and dies before the Insured, all the rights and privileges of the
Certificate Owner will vest in the Certificate Owner's executors, administrators
or assigns.
TRANSFER OF CERTIFICATE OWNERSHIP. A Certificate Owner may transfer all rights
and privileges of the Certificate Owner. On the effective date of transfer, the
transferee will become the Certificate Owner and will have all the rights and
privileges of the Certificate Owner. A Certificate Owner may revoke any
transfer prior to its effective date.
Unless provided otherwise, a transfer will not affect the interest of any
Beneficiary designated prior to the effective date of transfer.
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OWNERSHIP, ASSIGNMENT AND BENEFICIARY PROVISIONS (CONTINUED)
A transfer of Certificate Ownership, or a revocation of transfer, must be in
writing on a form satisfactory to the Company and filed at the Home Office. A
transfer, or a revocation, will not take effect until recorded in writing by the
Company. When a transfer or revocation has been so recorded, it will take
effect as of the effective date specified by the Certificate Owner. Any payment
made or any action taken or allowed by the Company before the transfer, or the
revocation, is recorded will be without prejudice to the Company.
ASSIGNMENT. The Company will not be affected by any assignment of a certificate
until the original assignment or a certified copy of the assignment is filed at
the Home Office.
The Company does not assume responsibility for the validity or sufficiency of
any assignment. An assignment of a certificate will operate so long as the
assignment remains in force.
To the extent provided under the terms of the assignment, an assignment will
transfer the interest of any designated transferee or of any Beneficiary if the
Certificate Owner has reserved the right to change the Beneficiary.
BENEFICIARY. The Beneficiary on the Certificate Date will be the person
designated in the Certificate Specifications under each certificate.
Unless provided otherwise, the interest of any Beneficiary who dies before the
Insured will vest in the Certificate Owner or the Certificate Owner's executors,
administrators or assigns.
CHANGE OF BENEFICIARY. A new Beneficiary may be designated from time to time. A
request for change of Beneficiary must be in writing on a form satisfactory to
the Company and filed at the Home Office. The request must be signed by the
Certificate Owner. The request must also be signed by the Beneficiary if the
right to change the Beneficiary has not been reserved to the Certificate Owner.
A change of Beneficiary will not take effect until recorded in writing by the
Company. When a change of Beneficiary has been so recorded, whether or not the
Insured is then alive, it will take effect as of the date the request was
signed. Any payment made or any action taken or allowed by the Company before
the change of Beneficiary is recorded will be without prejudice to the Company.
Unless provided otherwise, the right to change any Beneficiary is reserved to
the Certificate Owner.
VARIABLE ACCOUNT PROVISIONS
VARIABLE ACCOUNT AND SUB-ACCOUNTS. Assets accumulated on a variable basis are
held in the Variable Account Separate Account designated in this policy on page
5 which was established by a resolution of the Company's Board of Directors as a
"separate account" under governing law of Connecticut, the Company's state of
domicile, is registered as a unit investment trust under the 1940 Act and is
subject to the law of the state in which this certificate is delivered. Under
Connecticut law, the Variable Account assets (except assets in excess of its
reserves and other contract liabilities) cannot be charged with the general
liabilities of the Company. The Variable Account assets are owned and
controlled exclusively by the Company, and the Company is not a trustee with
respect to those assets.
The Variable Account is divided into Sub-Accounts. Each Sub-Account's assets
are invested in shares of a particular Fund of one of the Fund Groups made
available as funding vehicles under each certificate. For each Sub-Account, the
Company maintains Variable Accumulation Units whose values reflect the
investment performance of the Fund whose shares are held in that Sub-Account.
Subject to any vote by persons having the right under the 1940 Act to vote
thereon, the Company may elect to operate the Variable Account as a management
company rather than a unit investment trust under the 1940 Act, or, if
registration is no longer required, to deregister the Variable Account. In such
event, the Company may endorse this policy and the certificates issued under it
to reflect such change and any necessary or appropriate action taken to effect
the change. Any changes in Variable Account investment policy shall have been
approved by the Connecticut Insurance Commissioner and approved or filed, as
required, in the state or other jurisdiction where this certificate was issued.
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VARIABLE ACCOUNT PROVISIONS (CONTINUED)
INVESTMENT RISK. Each Sub-Account's assets are always fully invested in the
shares of the particular Fund purchased for that Sub-Account. Each
Sub-Account's investment performance reflects the investment performance of that
Fund. Fund share values fluctuate, reflecting the risks of changing economic
conditions and the ability of a Fund Group's investment adviser or sub-adviser
to manage that Fund and anticipate changes in economic conditions. As to the
Variable Account assets, the Certificate Owner bears the entire investment risk
of gain or loss.
INVESTMENTS OF THE VARIABLE ACCOUNT SUB-ACCOUNTS. All amounts allocated to a
Variable Account Sub-Account will be used to purchase shares of the specific
Fund of a Fund Group used by that Sub-Account. Each Fund Group is registered
under the 1940 Act as an open-end management investment company, and each Fund
of that Fund Group is regulated as an open-end management investment company.
All Funds available as funding vehicles under this policy as of the Policy Date
of Issue are listed on page 5. The Company may add additional Fund Groups and
additional Funds at any time or may change Funds or Fund Groups in accordance
with the "Substituted Securities" provision.
Any and all distributions made by a Fund will be reinvested in additional shares
of that Fund at net asset value. Deductions by the Company from a Sub-Account
will be made by redeeming a number of Fund shares at net asset value equal in
total value to the amount to be deducted.
SUBSTITUTED SECURITIES. Shares corresponding to a particular Fund may not
always be available for purchase or the Company may decide that further
investment in such Fund is no longer appropriate in view of the purposes of the
Variable Account or in view of legal, regulatory or federal income tax
restrictions. In such event, shares of another registered open-end investment
company or unit investment trust may be substituted both for Fund shares already
purchased and/or as the securities to be purchased in the future, provided that
these substitutions meet applicable Internal Revenue Service diversification
guidelines and any necessary regulatory or other approvals of such substitutions
have been obtained. In the event of any substitution pursuant to this
provision, the Company may make appropriate endorsement(s) to this policy and
the certificate issued under it to reflect the substitution.
CERTIFICATE VALUES PROVISIONS
ACCUMULATION VALUE. Under each certificate the Accumulation Value equals the
sum of (i) the then current value of the Fixed Account (ii) all of the then
current values of the Variable Account Sub-Accounts (i.e. the Variable Account
Value), and (iii) the Loan Account Value. At any point in time, therefore, the
Accumulation Value reflects (a) Net Premium Payments made, (b) interest credited
under the Fixed Account, (c) the amount of any partial surrenders, (d) interest
charged and credited under the Loan Account, (e) any transfer fees, (f) all
monthly and other deductions as specified below, (g) the daily mortality and
expense deduction specified under Schedule 2, and (h) any increases or decreases
as a result of market performance in the Variable Account Sub-Accounts.
CALCULATION OF ACCUMULATION VALUE. On each Valuation Day after the Certificate
Date, the Accumulation Value under a certificate will be equal to (1), plus (2),
plus (3), minus (4), plus or minus (5) as the case may be, minus (6), minus (7),
minus (8), and if the Valuation Day is the same as a Monthly Anniversary Day,
minus (9), where;
(1) is the Accumulation Value on the preceding Valuation Day;
(2) is all premiums received since the preceding Valuation Day less the premium
load charges from Schedule 2;
(3) the interest credited under the Fixed Account and the Loan Account since
the preceding Valuation Day;
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CERTIFICATE VALUES PROVISIONS (CONTINUED)
(4) the interest charged against the Loan Account since the preceding Valuation
Day;
(5) is the gain or loss in the Variable Account Value based on market
performance since the last Valuation Day;
(6) the charges and fees associated with the Variable Account Sub-Accounts from
Schedule 2;
(7) the amount of any partial surrenders since the preceding Valuation Day;
(8) any transaction fees assessed since the preceding Valuation Day;
(9) is the monthly deduction for the month following the Monthly Anniversary
Day.
FIXED ACCOUNT VALUE. The Fixed Account Value, if any, with respect to a
certificate, at any point in time, is equal to the sum of the Net Premium
Payments allocated or other amounts (net of any charges) transferred to the
Fixed Account plus interest credited to such account less the monthly deductions
applied to such account and less any partial surrenders or amounts transferred
from the Fixed Account.
INTEREST CREDITED UNDER FIXED ACCOUNT. The Company will credit interest to the
Fixed Account under a certificate daily. The interest rate applied to the Fixed
Account will be the greater of: (a) .010746% compounded daily, (4% compounded
yearly), or (b) a rate determined by the Company from time to time. Such rate
will be established on a prospective basis and may vary by the issue year and
duration for each certificate.
VARIABLE ACCOUNT VALUE. The Variable Account Value, if any, for any Valuation
Period under a certificate is equal to the sum of the then current values of all
Variable Account Sub-Accounts under the certificate. The value of each Variable
Account Sub-Account is determined by multiplying the number of Variable
Accumulation Units, if any, credited or debited to such Variable Account
Sub-Account with respect to the certificate by the Variable Accumulation Unit
Value of the particular Variable Account Sub-Account for such Valuation Period.
CREDITING AND CANCELLING VARIABLE ACCUMULATION UNITS. Upon receipt of a premium
payment or a request for transfer of funds from the Fixed Account under a
certificate, all or that portion, if any, of the Net Premium Payment to be
allocated to the Variable Account Sub-Accounts and/or the net amount transferred
will be credited to the Variable Account in the form of Variable Accumulation
Units. The number of Variable Accumulation Units to be credited is determined
by dividing the dollar amount allocated to the particular Variable Account
Sub-Account by the Variable Accumulation Unit Value for the particular Variable
Account Sub-Account for the Valuation Period during which the premium payment
and/or the request for transfer is received by the Company. The amount of
monthly deduction allocated to each Variable Account Sub-Account will result in
the cancellation of Variable Accumulation Units which have an aggregate value on
the date of such deduction equal to the total amount by which the Variable
Account Sub-Account is reduced.
VARIABLE ACCUMULATION UNIT VALUE. The Variable Accumulation Unit Value for each
Variable Account Sub-Account was established at $10.00 for the first Valuation
Period of the particular Variable Account Sub-Account. The Variable
Accumulation Unit Value for the particular Variable Account Sub-Account for any
subsequent Valuation Period is determined by methodology which is the
mathematical equivalent of multiplying the Variable Accumulation Unit Value for
the particular Variable Account Sub-Account for the immediately preceding
Valuation Period by the Net Investment Factor for the particular Variable
Account Sub-Account for such subsequent Valuation Period. The Variable
Accumulation Unit Value for each Variable Account Sub-Account for any Valuation
Period is the value determined as of the end of the particular Valuation Period
and may increase, decrease or remain constant from Valuation Period to Valuation
Period.
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CERTIFICATE VALUES PROVISIONS (CONTINUED)
NET INVESTMENT FACTOR. The Net Investment Factor is an index applied to measure
the investment performance of a Variable Account Sub-Account from one Valuation
Period to the next. The Net Investment Factor may be greater or less than or
equal to 1.0; therefore, the value of a Variable Accumulation Unit may increase,
decrease or remain the same.
The Net Investment Factor for any Variable Account Sub-Account for any Valuation
Period is determined by dividing (a) by (b) and then subtracting (c) from the
result where:
(a) is the net result of:
(1) is the net asset value (as described in the prospectus for the
Fund) of a Fund share held in the Variable Account Sub-Account
determined as of the end of the Valuation Period, plus
(2) the per share amount of any dividend or other distribution
declared by the Fund on the shares held in the Variable Account
Sub-Account if the "ex-dividend" date occurs during the Valuation
Period, plus or minus
(3) a per share credit or charge with respect to any taxes paid or
reserved for by the Company during the Valuation Period which are
determined by the Company to be attributable to the operation of the
Variable Account Sub-Account;
(b) is the net asset value of a Fund share held in the Variable Account
Sub-Account determined as of the end of the preceding Valuation Period; and
(c) is the asset charge factor determined by the Company for the Valuation
Period to reflect the charges for assuming the mortality and expense risks.
The asset charge factor for any Valuation Period is equal to the daily asset
charge factor multiplied by the number of 24-hour periods in the Valuation
Period. The daily asset charge factor will be determined annually by the
Company, but in no event may it exceed that specified in Schedule 2.
COST OF INSURANCE RATES. Monthly cost of insurance rates will be determined
from time to time by the Company based on its expectations of future mortality.
Any change in cost of insurance rates will apply to all individuals of the same
class. Under no circumstance will the cost of insurance rates under a
certificate ever be greater than those described in Schedule 3.
COST OF INSURANCE. The cost of insurance for the Insured under a certificate
is determined on a monthly basis. Such cost is calculated as (1), multiplied by
the result of (2) minus (3), where:
1. is the cost of insurance rate as described in the "Cost of Insurance Rates"
provision,
2. is the death benefit at the beginning of the certificate month, divided by
1.0032737, and
3. is the Accumulation Value at the beginning of the certificate month prior to
the deduction for the monthly
cost of insurance.
MONTHLY DEDUCTION. The monthly deduction for a certificate month will be
calculated as Charge (1) plus Charge (2) where:
Charge (1) is the cost of insurance (as described in the "Cost of Insurance"
provision) and the cost of any supplemental riders or optional benefits, and
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CERTIFICATE VALUES PROVISIONS (CONTINUED)
Charge (2) is the Monthly Administrative Fee as described under Schedule 2.
The amount of monthly deduction will be deducted under a certificate from the
Fixed Account and each Variable Account Sub-Account in the same proportion that
the value of each account bears to the Net Accumulation Value as of the date on
which the deduction is made.
BASIS OF COMPUTATIONS. The minimum Fixed Account Value is guaranteed to be no
less than that calculated based on the applicable Commissioners 1980 Standard
Ordinary Mortality Table (age nearest birthday) from Schedule 3 with interest at
4% per year, compounded yearly.
All certificate values are at least equal to that required by the jurisdiction
in which the certificate is delivered. A detailed statement of the method of
computing values has been filed with the insurance supervisory official of that
jurisdiction.
TRANSFER PRIVILEGE PROVISION
TRANSFER PRIVILEGE. At any time while a certificate is in effect, other than
during the "Right to Examine This Certificate" period, the Certificate Owner may
transfer all or part of the Variable Account Value to the Fixed Account and/or
to one or more of the Variable Account Sub-Accounts then available under the
certificate, and/or transfer part of the Fixed Account Value to one or more
Variable Account Sub-Accounts, subject to the provisions set forth below.
Transfers may be made in writing. Transfer requests must be received at the
Company's Home Office prior to the time of day set forth in the prospectus and
provided the NYSE is open for business, in order to be processed as of the close
of business on the date the request is received; otherwise, the transfer will be
processed on the next business day the NYSE is open for business.
Transfers involving Variable Account Sub-Accounts will reflect the purchase or
cancellation of Variable Accumulation Units having an aggregate value equal to
the dollar amount being transferred to or from a particular Variable Account
Sub-Account. The purchase or cancellation of such units shall be made using
Variable Accumulation Unit Values of the applicable Variable Account Sub-Account
for the Valuation Period during which the transfer is effective. Transfers to
the Fixed Account will earn interest as specified under the "Interest Credited
Under Fixed Account" provision.
Unless otherwise changed by the Company to be less restrictive, transfers shall
be subject to the following conditions: (a) Up to 12 transfers may be made
during any Certificate Year without charge, however, for each transfer in excess
of 12, a transfer fee as set forth in Schedule 2 will be deducted on a pro-rata
basis from the Fixed Account and/or Variable Account Sub-Accounts from which the
transfer is being made; (b) No partial surrender transaction fee will be imposed
on transferred amounts; (c) The amount being transferred may not be less than
$500 unless the entire value of the Fixed Account or a Variable Account
Sub-Account is being transferred; (d) The amount being transferred may not
exceed the Company's maximum amount limit then in effect; (e) Transfers among
the Variable Account Sub-Accounts or from a Variable Account Sub-Account to the
Fixed Account can be made at any time; (f) Transfers from the Fixed Account are
subject to the "Limits on Transfers" as set forth in the Certificate
Specifications; (g) Any value remaining in the Fixed Account or a Variable
Account Sub-Account following a transfer may not be less than $500; (h)
Transfers involving Variable Account Sub-Account(s) shall be subject to such
additional terms and conditions as may be imposed by the Funds.
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NONFORFEITURE AND SURRENDER VALUE PROVISIONS
SURRENDER AND SURRENDER VALUE. A certificate may be surrendered on any day
during the lifetime of the Insured and before the Coverage Date, for its
surrender value by returning it to the Company with a signed request for
surrender in a form satisfactory to the Company. The surrender will take effect
on the business day the certificate and the request are received in the Home
Office. The amount payable on surrender of the certificate (i.e., the
"surrender value") will be the Net Accumulation Value less any surrender charges
as determined from Schedule 1.
The surrender value will be paid in cash or under an elected optional mode of
settlement. Any deferment of payments will be subject to the "Deferment of
Payments" provision (See "General Provisions").
Any surrender from a Variable Account Sub-Account will result in the
cancellation of Variable Accumulation Units which have an aggregate value on the
effective date of the surrender equal to the total amount by which the Variable
Account Sub-Account is reduced. The cancellation of such units will be based on
the Variable Accumulation Unit Value of the Variable Account Sub-Account
determined at the close of the Valuation Period during which the surrender is
effective.
INSUFFICIENT VALUE. If the surrender value, on the day preceding a Monthly
Anniversary Day is insufficient under a certificate to cover the monthly
deduction for the month following such Monthly Anniversary Day, the certificate
will terminate as provided in the "Grace Period" provision.
PARTIAL SURRENDER. A partial surrender of a certificate may be elected on any
Valuation Day during the lifetime of the Insured and prior to the Coverage Date
by submitting a written request to the Company. Such request may also be made
by telephone if telephone transfers have been previously authorized in writing.
The amount of each partial surrender (a) must be at least $500.00 but (b) may
not exceed 90% of the surrender value at the end of the Valuation Period during
which the election becomes or would become effective.
When a partial surrender is made under a certificate, the Accumulation Value is
reduced by (a) the amount of the partial surrender and (b) the transaction fee
as specified in Schedule 1. Also, the death benefit will be reduced by the
amount of the partial surrender. The Specified Amount remaining in force after
any partial surrender may not be less than the Minimum Specified Amount shown in
the Certificate Specifications.
When the partial surrender is processed, the amount of the partial surrender and
the transaction fee will be deducted from the applicable Fixed Account and/or
Variable Account Sub-Accounts in proportion to the then current account values
provided there are sufficient account values for making the deduction(s);
otherwise, the amount payable upon a partial surrender will be net of any
remaining transaction fee, unless the Certificate Owner and the Company agree
otherwise.
LOAN PROVISIONS
CERTIFICATE LOANS. After a surrender value is available, the Company will grant
a loan against a certificate provided: (a) a proper loan agreement is executed
and (b) a satisfactory assignment of the certificate to the Company is made.
The loan may be for any amount up to 100% of the then current surrender value;
however, the Company reserves the right to limit the amount of such loan so that
total indebtedness will not exceed 90% of an amount equal to the then current
Accumulation Value less surrender charge.
The amount borrowed will be paid within seven days of the Company's receipt of
such request, except as the Company may be permitted to defer the payment of
amounts as specified under the "Deferment of Payments" provision. (See "General
Provisions.")
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LOAN PROVISIONS (CONTINUED)
The minimum loan amount under a certificate is $500. The Company reserves the
right to modify this amount in the future. The Company will effect such loan
from the Fixed Account and each Variable Account Sub-Account in proportion to
the then current account values, unless the Certificate Owner instructs the
Company otherwise.
LOAN ACCOUNT AND LOAN ACCOUNT VALUE. The amount of any loan will be transferred
out of the Fixed Account and Variable Accounts Sub-Accounts as described above.
Such amount will become part of the Loan Account Value. The outstanding loan
balance at any time includes accrued interest on the loan.
The outstanding loan balance (i.e. Indebtedness) may be repaid under a
certificate at any time during the lifetime of the Insured, however, the minimum
loan repayment is $100.00 or the amount of the outstanding indebtedness, if
less. The Loan Account Value will be reduced by the amount of any loan
repayment. Loan repayments will be allocated under the certificate to the Fixed
Account and each Variable Account Sub-Account in the proportion in which current
Net Premium Payment(s) are being allocated, unless otherwise agreed to in
writing by the Certificate Owner and the Company.
Net loan interest, which equals the difference between interest charged and
interest credited on the Loan Account Value, is payable annually on each
certificate anniversary or as otherwise agreed in writing by the Certificate
Owner and the Company. Such loan interest amount, if not paid when due, will be
transferred out of the Fixed Account and each Variable Account Sub-Account in
proportion to the then current account value, unless both the Certificate Owner
and the Company agree otherwise.
INTEREST RATE CHARGED ON LOAN ACCOUNT VALUE. Interest charged under a
certificate on the Loan Account Value will be at a rate equivalent to 8% per
year, payable in arrears.
INTEREST RATE CREDITED ON LOAN ACCOUNT VALUE. The interest rate used to credit
interest on the Loan Account Value may vary, but will not be less than the loan
interest rate less 2% per year during Certificate Years 1 through 10 and less 1%
per year thereafter. (The Certificate Specifications page will exhibit the rate
in effect as of the Certificate Date).
INDEBTEDNESS. The term "indebtedness" means money which is owed on a certificate
due to an outstanding loan and interest accrued thereon. A loan, whether or not
repaid, will have a permanent effect on the Net Accumulation Value and on the
death benefits. Any indebtedness at time of settlement will reduce the proceeds
payable under the certificate. A certificate loan reduces the then current Net
Accumulation Value under the certificate while repayment of a loan will cause an
increase in the then current Net Accumulation Value.
If at any time the total indebtedness against a certificate, including interest
accrued but not due, equals or exceeds the then current Accumulation Value less
surrender charge, the certificate will thereupon terminate without value subject
to the conditions in the "Grace Period" provision and a notice will be sent at
least 31 days before the end of the grace period to the Certificate Owner and to
assignees, if any, that the certificate will terminate unless the indebtedness
is repaid.
INSURANCE COVERAGE PROVISIONS
EFFECTIVE DATE OF COVERAGE. The effective date of a certificate will be the
Certificate Date provided the initial premium has been paid (1) while the
Insured is alive and (2) prior to any change in the health and insurability of
the Insured as represented in the application.
For any insurance that has been reinstated, the effective date will be the
Monthly Anniversary Day that coincides with or next follows the day the
application for reinstatement is approved by the Company, provided the Insured
is alive on such day.
TERMINATION OF COVERAGE. All coverage under a certificate will automatically
terminate upon whichever of the following occurs first:
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INSURANCE COVERAGE PROVISIONS (CONTINUED)
1. The Certificate Owner surrenders the certificate.
2. The Insured dies.
3. The certificate matures at its Coverage Date.
4. The grace period ends and the necessary premium payment has not been made
prior to such time.
Any monthly deduction made after termination of coverage will not, by itself, be
considered a reinstatement of the certificate nor a waiver by the Company of the
termination. Any such deduction will be refunded.
DEATH BENEFIT. If the Insured dies while the certificate is in force, the
Company will pay a death benefit based upon the Death Benefit Option in effect
under the certificate on the date of death, less (a) any indebtedness against
the certificate and (b) the amount of any partial surrenders.
The Death Benefit Options available under each certificate are as follows:
DEATH Insured's Specified Amount includes the Accumulation Value. The
Insured's death benefit
BENEFIT (before deduction of any indebtedness against the certificate and the
amount of any partial
OPTION 1 surrenders) will equal the greater of:
(a) the Specified Amount on the date of death, or
(b) an amount determined by the Company equal to that required by the
Internal Revenue Code to maintain the certificate as life
insurance (See Schedule 4). Any amount so determined will be set
forth in the annual report which the Company will send to the
Certificate Owner.
DEATH The Insured's Specified Amount is in addition to the Accumulation
Value. The Insured's death benefit (before deduction of any
BENEFIT indebtedness against the certificate and the amount of any
partial surrenders) will equal the greater of:
OPTION 2
(a) the Specified Amount on the date of death plus the Accumulation
Value on the date of death, or
(b) an amount determined by the Company equal to that required by the
Internal Revenue Code to maintain the certificate as life
insurance (See Schedule 4). Any amount so determined will be set
forth in the annual report which the Company will send to the
Certificate Owner.
Unless the application for the certificate indicates otherwise, or a change in
the death benefit option is effected as provided below, the Company will
consider Death Benefit Option 1 to be the option in effect.
CHANGES IN SPECIFIED AMOUNT. Unless provided otherwise, a change in Specified
Amount may be effected any time while a certificate is in force, subject to (a)
the consent of the Company and (b) the following conditions:
1. All such changes must be requested in writing on a form satisfactory to the
Company and filed at the Home Office.
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INSURANCE COVERAGE PROVISIONS (CONTINUED)
2. If a decrease in the Insured's Specified Amount is requested, the decrease
under the certificate will become effective on the Monthly Anniversary Day
that coincides with or next follows receipt of the request provided any
requirements as determined by the Company are met.
In such event, the Company will reduce the existing Specified Amount
against the most recent increase first, then against the next most recent
increases successively, and finally, against insurance provided under the
original application; however, the Company reserves the right to limit the
amount of any decrease so that the Specified Amount will not be less than
the Minimum Specified Amount shown in the Certificate Specifications.
3. If an increase in the Insured's Specified Amount under a certificate is
requested:
(a) a supplemental application must be submitted and evidence of
insurability satisfactory to the Company must be furnished; and
(b) any other requirements as determined by the Company must be met.
If the Company approves the request, the increase will become effective
upon (i) the Monthly Anniversary Day that coincides with or next follows
the date the request is approved by the Company and (ii) the deduction from
the Accumulation Value (in proportion to the then current account values of
the Fixed Account and/or Variable Account Sub-Accounts) of the first
month's cost of insurance for the increase, provided the Insured is alive
on such day.
4. If a request is made to change the death benefit under a certificate from
Death Benefit Option 1 to Death Benefit Option 2:
(a) the Specified Amount will be reduced to equal the death benefit, less
the Accumulation Value, as of the effective date of change; and
(b) the effective date will be the Monthly Anniversary Day that coincides
with or next follows the date of receipt of the request for change.
5. If a request is made to change the death benefit under a certificate from
Death Benefit Option 2 to Death Benefit Option 1:
(a) the Specified Amount will be increased to equal the death benefit as
of the effective date of change; and
(b) the effective date will be the Monthly Anniversary Day that coincides
with or next follows the date of receipt of the request for change.
The Company will not allow a decrease in the amount of insurance below the
minimum amount required to maintain the certificate as life insurance under the
Internal Revenue Code.
RIGHT TO CONVERT. The Certificate Owner may convert a certificate to a
substantially comparable flexible premium adjustable life insurance policy
without evidence of insurability for an amount of insurance not exceeding the
death benefit of the variable life insurance certificate on the date of
conversion.
GENERAL PROVISIONS
THE POLICY. The policy and the application for the policy constitute the entire
contract between the parties. All statements made in the application will be
deemed representations and not warranties.
Only the President, a Vice President, a Secretary, a Director or an Assistant
Director of the Company may execute or modify this policy.
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GENERAL PROVISIONS (CONTINUED)
The policy is executed at the Home Office of the Company, the mailing address of
which for this policy is CIGNA Individual Insurance, Variable Products Service
Center - Routing S249, Hartford, Connecticut 06152.
INDIVIDUAL CERTIFICATES. Individual certificates will be delivered to each
Certificate Owner under this policy. Each certificate will include the
essential features of the coverage under this policy. The rights described in
the certificate are controlled by the provisions of this policy and are subject
to any changes in this policy.
MODIFICATION OF POLICY OR CERTIFICATE. The Company reserves the right to modify
this policy or any certificate issued under it to meet the requirements of
applicable state and federal laws or regulations. The Company will notify the
Policyowner and/or the Certificate Owners in writing of any changes that bear
upon the policy or their certificates.
NON-PARTICIPATION. The policy and the certificates issued under it are not
entitled to share in surplus distribution.
PAYMENT OF PROCEEDS. Proceeds, as used in this policy, means the amount payable
under a certificate (a) on the Coverage Date, (b) upon the surrender of a
certificate before the Coverage Date, or (c) upon the death of the Insured under
a certificate.
The proceeds payable to the Beneficiary under a certificate upon receipt of due
proof of the Insured's death will be the Death Benefit as of the date of death
which takes into account (a) any indebtedness against the certificate and (b)
the amount of any partial surrenders (See "Death Benefit" provision). If the
Insured dies during the grace period under a certificate, the Company will pay
the death benefit proceeds in effect immediately prior to the grace period
reduced by any overdue monthly deductions.
If a certificate is surrendered before the Coverage Date, the proceeds will be
the surrender value described in the "Nonforfeiture and Surrender Value
Provisions" section. On the Coverage Date, the proceeds will be the Surrender
Value.
The proceeds under a certificate are subject to the adjustments described in the
following provisions:
1. Misstatement of Age or Sex;
2. Incontestability;
3. Suicide;
4. Grace Period;
5. Indebtedness; and
6. Partial Surrender
When settlement is made, the Company may require return of the certificate.
DEFERMENT OF PAYMENTS. Any amounts payable as a result of loans, surrender, or
partial surrenders under a certificate will be paid within 7 days of the
Company's receipt of such request. However, payment of amounts from the
Variable Account Sub-Accounts may be postponed when the NYSE is closed or when
the SEC declares an emergency. Additionally, the Company reserves the right to
defer the payment of such amounts from the Fixed Account for a period not to
exceed 6 months from the date written request is received by the Company; during
any such deferred period, the amount payable will bear interest as required by
law.
MISSTATEMENT OF AGE OR SEX. If the age or sex of the Insured is misstated, the
Company will adjust all benefits under the applicable certificate to the amounts
that would have been purchased for the correct age and sex.
LN616 23
<PAGE>
GENERAL PROVISIONS (CONTINUED)
SUICIDE. If the Insured commits suicide within 2 years from a Certificate Date,
the death benefit under the certificate will be limited to a refund of premiums
paid, less (a) any indebtedness against the certificate and (b) the amount of
any partial surrenders. If the Insured commits suicide within 2 years from the
effective date of any increase in the Specified Amount under a certificate, the
death benefit payment with respect to such increase will be limited to a refund
of the monthly charges for the cost of such additional insurance.
INCONTESTABILITY. Except for nonpayment of monthly deductions, a certificate
will be incontestable after it has been in force during the Insured's lifetime
for 2 years from its Certificate Date. This means that the Company will not use
any misstatement in the certificate application to challenge a claim or avoid
liability after that time. Any increase in the Specified Amount under a
certificate, effective after the Certificate Date will be incontestable only
after such increase has been in force for 2 years during the Insured's lifetime.
The basis for contesting an increase in Specified Amount under a certificate
will be limited to material misrepresentations made in the supplemental
application for the increase. The basis for contesting after reinstatement will
be (a) limited for a period of 2 years from the date of reinstatement and (b)
limited to material misrepresentations made in the reinstatement application.
ANNUAL REPORT. The Company will send a report to each Certificate Owner at least
once a year without charge. The report will show the Accumulation Value under
the certificate as of the reporting date and the amounts deducted from or added
to the Accumulation Value since the last report. The report will also show (a)
the current death benefit, (b) the current certificate values, (c) premiums paid
and all deductions made since the last report, (d) outstanding certificate
loans, and (e) any other information required by the Superintendent of
Insurance.
PROJECTION OF BENEFITS AND VALUES. The Company will provide a projection of
illustrative future death benefits and values to a Certificate Owner at any time
upon written request and payment of a reasonable service fee.
CHANGE OF PLAN. Within the first 2 Certificate Years the Certificate Owner may
exchange a certificate without any evidence of insurability for any one of the
permanent insurance policies then being issued by the Company to the same class
to which the certificate belongs. The request for the exchange must be received
by the Company within 24 months from the Certificate Date. Unless otherwise
agreed to between the Certificate Owner and the Company, the new policy shall
have the same amount of insurance and surrender value as the certificate as of
the date of exchange, its date of issue shall be the date of exchange, and the
Insured's issue age under the new policy shall be the Insured's then attained
age (as of the date of exchange).
CERTIFICATE CHANGES - APPLICABLE LAW. Certificates issued with this policy must
qualify initially and continue to qualify as life insurance under the Internal
Revenue Code in order for the Certificate Owner to receive the tax treatment
accorded to life insurance under Federal law. Therefore, to maintain this
qualification to the maximum extent permitted by law, the Company reserves the
right to return any premium payments that would cause a certificate to fail to
qualify as life insurance under applicable tax law as interpreted by the
Company. Further, the Company reserves the right to make changes in the
certificate or to make distributions from the certificate to the extent it deems
necessary, in its sole discretion, to continue to qualify the certificate as
life insurance. Any such changes will apply uniformly to all certificates that
are affected. The Certificate Owner will be given advance written notice of
such changes.
LN616 24
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
FLEXIBLE PREMIUM GROUP VARIABLE LIFE INSURANCE POLICY - NON-PARTICIPATING
LN616 NY
<PAGE>
OPTIONAL METHODS OF SETTLEMENT
This rider is made part of the group policy to which it is attached as of the
Policy Date of Issue. Upon written request, the Company will agree to pay in
accordance with any one of the options shown below all or part of the net
proceeds that may be payable under the certificates issued under the group
policy.
If any income optional settlement provides for instalment payments for a given
age of payee for an amount which would be the same for different periods
certain, the Company will deem that an election has been made for the longest
period certain for such age and amount.
While the Insured under the certificate is alive, the request, including the
designation of the payee, may be made by the Certificate Owner. At the time a
Death Benefit becomes payable under the certificate, the request, including the
designation of the payee, may then be made by the Beneficiary. Once Income
Payments have begun, the certificate cannot be surrendered and the payee cannot
be changed, nor can the settlement option be changed.
PAYMENT DATES. The first Income Payment under the settlement option selected
will become payable on the date proceeds are settled under the option.
Subsequent payments will be made on the first day of each month in accordance
with the manner of payment selected.
MINIMUM PAYMENT AMOUNT. The settlement option elected must result in an Income
Payment at least equal to the minimum payment amount in accordance with the
Company's rules then in effect. If at any time payments are less than the
minimum payment amount, the Company has the right to change the frequency to an
interval that will provide the minimum payment amount. If any amount due is
less than the minimum per year, the Company may make other arrangements that are
equitable.
INCOME PAYMENTS. Income Payments will remain constant pursuant to the terms of
the settlement option(s) selected. The amount of each Income Payment shall be
determined in accordance with the terms of the settlement option and the
table(s) set forth in this rider, as applicable. The mortality table used is
the 1983 Individual Annuitant Mortality (IAM) Table "a" and 3% interest. In
determining the settlement amount, the settlement age of the payee will be
reduced by one year when the first installment is payable during the 1990's,
reduced by two years when the first installment is payable during the decade
2000-2009, and so on.
FIRST OPTION: LIFE ANNUITY. An annuity payable monthly to the payee during the
lifetime of the payee, ceasing with the last payment due prior to the death of
the payee.
OPTION: LIFE ANNUITY WITH CERTAIN PERIOD. An annuity providing monthly income
to the payee for a fixed period of 60, 120, 180, or 240 months (as selected),
and for as long thereafter as the payee shall live.
THIRD OPTION: ANNUITY CERTAIN. An amount payable monthly for the number of
years selected which may be from 5 to 30 years.
FOURTH OPTION: AS A DEPOSIT AT INTEREST. The Company will retain the proceeds
while the payee is alive and will pay interest annually thereon at a rate of not
less than 3% per year. Upon the payee's death, the amount on deposit will be
paid.
EXCESS INTEREST. At the sole discretion of the Company, excess interest may be
paid or credited from time to time in addition to the payments guaranteed under
any Optional Method of Settlement.
ADDITIONAL OPTIONS. Any proceeds payable under a certificate may also be
settled under any other method of settlement offered by the Company at the time
of the request.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
/s/ Thomas C. Jones
PRESIDENT
LR466 LR466 (Page 1)
<PAGE>
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD TABLE
FOR EACH $1,000 APPLIED - MALE
<TABLE>
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
10 $2.87 $2.87 $2.87 $2.87 $2.87
11 2.89 2.89 2.89 2.88 2.88
12 2.90 2.90 2.90 2.90 2.90
13 2.92 2.92 2.91 2.91 2.91
14 2.93 2.93 2.93 2.93 2.92
15 2.95 2.95 2.95 2.94 2.94
16 2.96 2.96 2.96 2.96 2.96
17 2.98 2.98 2.98 2.98 2.97
18 3.00 3.00 3.00 2.99 2.99
19 3.02 3.02 3.01 3.01 3.01
20 3.04 3.04 3.03 3.03 3.03
21 3.06 3.05 3.05 3.05 3.05
22 3.08 3.08 3.07 3.07 3.07
23 3.10 3.10 3.09 3.09 3.09
24 3.12 3.12 3.12 3.11 3.11
25 3.14 3.14 3.14 3.14 3.13
26 3.17 3.17 3.16 3.16 3.15
27 3.19 3.19 3.19 3.19 3.18
28 3.22 3.22 3.22 3.21 3.20
29 3.25 3.25 3.24 3.24 3.23
30 3.28 3.28 3.27 3.27 3.26
31 3.31 3.31 3.30 3.30 3.29
32 3.34 3.34 3.33 3.33 3.32
33 3.37 3.37 3.37 3.36 3.35
34 3.41 3.41 3.40 3.39 3.38
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
35 $3.44 $3.44 $3.44 $3.43 $3.41
36 3.48 3.48 3.48 3.46 3.45
37 3.52 3.52 3.52 3.50 3.48
38 3.57 3.56 3.56 3.54 3.52
39 3.61 3.61 3.60 3.58 3.56
40 3.66 3.65 3.65 3.63 3.60
41 3.71 3.70 3.69 3.67 3.64
42 3.76 3.75 3.74 3.72 3.68
43 3.81 3.81 3.79 3.77 3.73
44 3.87 3.86 3.85 3.82 3.77
45 3.93 3.92 3.90 3.87 3.82
46 3.99 3.98 3.96 3.92 3.87
47 4.05 4.05 4.02 3.98 3.92
48 4.12 4.11 4.09 4.04 3.97
49 4.19 4.18 4.15 4.10 4.03
50 4.27 4.26 4.22 4.17 4.08
51 4.34 4.33 4.30 4.23 4.14
52 4.43 4.41 4.37 4.30 4.20
53 4.51 4.50 4.45 4.37 4.26
54 4.60 4.59 4.54 4.45 4.32
55 4.70 4.68 4.62 4.53 4.39
56 4.80 4.78 4.72 4.61 4.45
57 4.91 4.89 4.82 4.69 4.51
58 5.03 5.00 4.92 4.78 4.58
59 5.15 5.12 5.03 4.87 4.65
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
60 $5.28 $5.25 $5.14 $4.96 $4.71
61 5.43 5.39 5.27 5.06 4.78
62 5.58 5.53 5.39 5.16 4.84
63 5.74 5.69 5.53 5.26 4.90
64 5.91 5.85 5.66 5.36 4.96
65 6.10 6.03 5.81 5.46 5.02
66 6.30 6.21 5.96 5.56 5.08
67 6.51 6.41 6.12 5.66 5.13
68 6.73 6.62 6.28 5.77 5.18
69 6.97 6.84 6.44 5.86 5.23
70 7.23 7.07 6.61 5.96 5.27
71 7.51 7.32 6.79 6.05 5.31
72 7.80 7.58 6.96 6.14 5.34
73 8.12 7.85 7.14 6.23 5.37
74 8.46 8.14 7.32 6.31 5.40
75 8.82 8.45 7.50 6.38 5.42
76 9.21 8.76 7.67 6.45 5.44
77 9.63 9.10 7.84 6.51 5.45
78 10.08 9.44 8.01 6.57 5.47
79 10.56 9.80 8.17 6.62 5.48
80 11.07 10.17 8.33 6.66 5.49
81 11.62 10.55 8.48 6.70 5.49
82 12.20 10.94 8.61 6.73 5.50
83 12.82 11.33 8.74 6.76 5.50
84 13.47 11.73 8.86 6.79 5.51
85 14.17 12.12 8.97 6.81 5.51
</TABLE>
LR466 LR466 (Page 3)
<PAGE>
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD TABLE
FOR EACH $1,000 APPLIED - FEMALE
<TABLE>
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
10 $2.80 $2.80 $2.80 $2.80 $2.80
11 2.81 2.81 2.81 2.81 2.81
12 2.82 2.82 2.82 2.82 2.82
13 2.83 2.83 2.83 2.83 2.83
14 2.85 2.85 2.85 2.84 2.84
15 2.86 2.86 2.86 2.86 2.86
16 2.87 2.87 2.87 2.87 2.87
17 2.89 2.89 2.89 2.88 2.88
18 2.90 2.90 2.90 2.90 2.90
19 2.92 2.92 2.92 2.91 2.91
20 2.93 2.93 2.93 2.93 2.93
21 2.95 2.95 2.95 2.95 2.94
22 2.96 2.96 2.96 2.96 2.96
23 2.98 2.98 2.98 2.98 2.98
24 3.00 3.00 3.00 3.00 2.99
25 3.02 3.02 3.02 3.02 3.01
26 3.04 3.04 3.04 3.03 3.03
27 3.06 3.06 3.06 3.06 3.05
28 3.08 3.08 3.08 3.08 3.07
29 3.10 3.10 3.10 3.10 3.09
30 3.13 3.13 3.12 3.12 3.12
31 3.15 3.15 3.15 3.14 3.14
32 3.18 3.18 3.17 3.17 3.16
33 3.20 3.20 3.20 3.20 3.19
34 3.23 3.23 3.23 3.22 3.22
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
35 $3.26 $3.26 $3.26 $3.25 $3.24
36 3.29 3.29 3.29 3.28 3.27
37 3.32 3.32 3.32 3.31 3.30
38 3.35 3.35 3.35 3.34 3.33
39 3.39 3.39 3.38 3.38 3.37
40 3.42 3.42 3.42 3.41 3.40
41 3.46 3.46 3.46 3.45 3.43
42 3.50 3.50 3.50 3.49 3.47
43 3.54 3.54 3.54 3.53 3.51
44 3.59 3.59 3.58 3.57 3.55
45 3.64 3.63 3.63 3.61 3.59
46 3.68 3.68 3.67 3.66 3.63
47 3.73 3.73 3.72 3.71 3.68
48 3.79 3.79 3.77 3.76 3.72
49 3.84 3.84 3.83 3.81 3.77
50 3.90 3.90 3.89 3.86 3.82
51 3.97 3.96 3.95 3.92 3.88
52 4.03 4.03 4.01 3.98 3.93
53 4.10 4.10 4.08 4.04 3.99
54 4.18 4.17 4.15 4.11 4.04
55 4.25 4.25 4.22 4.18 4.11
56 4.34 4.33 4.30 4.25 4.17
57 4.42 4.41 4.38 4.32 4.23
58 4.52 4.51 4.47 4.40 4.30
59 4.61 4.60 4.56 4.48 4.37
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
60 $4.72 $4.70 $4.66 $4.57 $4.44
61 4.83 4.81 4.76 4.66 4.51
62 4.95 4.93 4.87 4.75 4.58
63 5.08 5.05 4.98 4.85 4.65
64 5.21 5.18 5.10 4.95 4.72
65 5.36 5.32 5.22 5.05 4.79
66 5.51 5.47 5.36 5.16 4.86
67 5.67 5.63 5.50 5.26 4.93
68 5.85 5.80 5.65 5.37 5.00
69 6.04 5.98 5.80 5.49 5.06
70 6.25 6.18 5.97 5.60 5.12
71 6.47 6.39 6.14 5.71 5.18
72 6.71 6.62 6.32 5.83 5.23
73 6.98 6.86 6.50 5.94 5.28
74 7.26 7.12 6.69 6.04 5.32
75 7.57 7.40 6.89 6.14 5.35
76 7.90 7.69 7.09 6.24 5.39
77 8.26 8.01 7.29 6.33 5.41
78 8.65 8.34 7.49 6.41 5.43
79 9.08 8.70 7.69 6.49 5.45
80 9.54 9.07 7.89 6.55 5.47
81 10.03 9.47 8.08 6.61 5.48
82 10.58 9.88 8.26 6.66 5.49
83 11.16 10.31 8.43 6.70 5.49
84 11.80 10.75 8.59 6.74 5.50
85 12.48 11.20 8.74 6.77 5.50
</TABLE>
ANNUITY CERTAIN TABLE FOR EACH $1,000 APPLIED
<TABLE>
<CAPTION>
- -----------------------------------------------------
Number of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- -----------------------------------------------------
<S> <C> <C>
5 $211.99 $17.91
6 179.22 15.14
7 155.83 13.16
8 138.31 11.68
9 124.69 10.53
10 113.82 9.61
11 104.93 8.86
<CAPTION>
- -----------------------------------------------------
Numbers of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- -----------------------------------------------------
<S> <C> <C>
12 $97.54 $8.24
13 91.29 7.71
14 85.95 7.26
15 81.33 6.87
16 77.29 6.53
17 73.74 6.23
18 70.59 5.96
<CAPTION>
- -----------------------------------------------------
Numbers of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- -----------------------------------------------------
<S> <C> <C>
19 $67.78 $5.73
20 65.26 5.51
25 55.76 4.71
30 49.53 4.18
</TABLE>
LR466 LR466 (Page 4)
<PAGE>
OPTIONAL METHODS OF SETTLEMENT
This rider is made part of the group policy to which it is attached as of the
Policy Date of Issue. Upon written request, the Company will agree to pay in
accordance with any one of the options shown below all or part of the net
proceeds that may be payable under the certificates issued under the group
policy.
If any income optional settlement provides for instalment payments for a given
age of payee for an amount which would be the same for different periods
certain, the Company will deem that an election has been made for the longest
period certain for such age and amount.
While the Insured under the certificate is alive, the request, including the
designation of the payee, may be made by the Certificate Owner. At the time a
Death Benefit becomes payable under the certificate, the request, including the
designation of the payee, may then be made by the Beneficiary. Once Income
Payments have begun, the certificate cannot be surrendered and the payee cannot
be changed, nor can the settlement option be changed.
PAYMENT DATES. The first Income Payment under the settlement option selected
will become payable on the date proceeds are settled under the option.
Subsequent payments will be made on the first day of each month in accordance
with the manner of payment selected.
MINIMUM PAYMENT AMOUNT. The settlement option elected must result in an Income
Payment at least equal to the minimum payment amount in accordance with the
Company's rules then in effect. If at any time payments are less than the
minimum payment amount, the Company has the right to change the frequency to an
interval that will provide the minimum payment amount. If any amount due is
less than the minimum per year, the Company may make other arrangements that are
equitable.
INCOME PAYMENTS. Income Payments will remain constant pursuant to the terms of
the settlement option(s) selected. The amount of each Income Payment shall be
determined in accordance with the terms of the settlement option and the
table(s) set forth in this rider, as applicable. The mortality table used is
the 1983 Individual Annuitant Mortality (IAM) Table "a" and 3% interest. In
determining the settlement amount, the settlement age of the payee will be
reduced by one year when the first installment is payable during the 1990's,
reduced by two years when the first installment is payable during the decade
2000-2009, and so on.
FIRST OPTION: LIFE ANNUITY. An annuity payable monthly to the payee during the
lifetime of the payee, ceasing with the last payment due prior to the death of
the payee.
SECOND OPTION: LIFE ANNUITY WITH CERTAIN PERIOD. An annuity providing monthly
income to the payee for a fixed period of 60, 120, 180, or 240 months (as
selected), and for as long thereafter as the payee shall live.
THIRD OPTION: ANNUITY CERTAIN. An amount payable monthly for the number of
years selected which may be from 5 to 30 years.
FOURTH OPTION: AS A DEPOSIT AT INTEREST. The Company will retain the proceeds
while the payee is alive and will pay interest annually thereon at a rate of not
less than 3% per year. Upon the payee's death, the amount on deposit will be
paid.
EXCESS INTEREST. At the sole discretion of the Company, excess interest may be
paid or credited from time to time in addition to the payments guaranteed under
any Optional Method of Settlement.
ADDITIONAL OPTIONS. Any proceeds payable under a certificate may also be
settled under any other method of settlement offered by the Company at the time
of the request.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
/s/ Thomas C. Jones
PRESIDENT
LR467 LR467 (Page 1)
<PAGE>
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD
TABLE FOR EACH $1,000 APPLIED - UNISEX
<TABLE>
<CAPTION>
- ---------------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
10 2.84 2.84 2.84 2.84 2.83
11 2.85 2.85 2.85 2.85 2.85
12 2.86 2.86 2.86 2.86 2.86
13 2.88 2.88 2.88 2.87 2.87
14 2.89 2.89 2.89 2.89 2.89
15 2.91 2.90 2.90 2.90 2.90
16 2.92 2.92 2.92 2.92 2.91
17 2.94 2.94 2.93 2.93 2.93
18 2.95 2.95 2.95 2.95 2.95
19 2.97 2.97 2.97 2.96 2.96
20 2.99 2.99 2.98 2.98 2.98
21 3.00 3.00 3.00 3.00 3.00
22 3.02 3.02 3.02 3.02 3.01
23 3.04 3.04 3.04 3.04 3.03
24 3.06 3.06 3.06 3.06 3.05
25 3.08 3.08 3.08 3.08 3.07
26 3.11 3.11 3.10 3.10 3.10
27 3.13 3.13 3.13 3.12 3.12
28 3.15 3.15 3.15 3.15 3.14
29 3.18 3.18 3.17 3.17 3.16
30 3.20 3.20 3.20 3.20 3.19
31 3.23 3.23 3.23 3.22 3.22
32 3.26 3.26 3.26 3.25 3.24
33 3.29 3.29 3.29 3.28 3.27
34 3.32 3.32 3.32 3.31 3.30
<CAPTION>
- ---------------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
35 3.35 3.35 3.35 3.34 3.33
36 3.39 3.39 3.38 3.38 3.36
37 3.42 3.42 3.42 3.41 3.40
38 3.46 3.46 3.46 3.45 3.43
39 3.50 3.50 3.49 3.48 3.47
40 3.54 3.54 3.54 3.52 3.50
41 3.59 3.59 3.58 3.56 3.54
42 3.63 3.63 3.62 3.61 3.58
43 3.68 3.68 3.67 3.65 3.62
44 3.73 3.73 3.72 3.70 3.67
45 3.78 3.78 3.77 3.74 3.71
46 3.84 3.84 3.82 3.79 3.76
47 3.90 3.89 3.88 3.85 3.80
48 3.96 3.95 3.93 3.90 3.85
49 4.02 4.02 3.99 3.96 3.91
50 4.09 4.08 4.06 4.02 3.96
51 4.16 4.15 4.13 4.08 4.01
52 4.23 4.22 4.20 4.15 4.07
53 4.31 4.30 4.27 4.21 4.13
54 4.39 4.38 4.35 4.28 4.19
55 4.48 4.47 4.43 4.36 4.25
56 4.57 4.56 4.51 4.43 4.32
57 4.67 4.65 4.60 4.51 4.38
58 4.78 4.76 4.70 4.60 4.45
59 4.89 4.87 4.80 4.68 4.51
<CAPTION>
- ---------------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
60 5.00 4.98 4.91 4.77 4.58
61 5.13 5.10 5.02 4.87 4.65
62 5.27 5.23 5.13 4.96 4.72
63 5.41 5.37 5.26 5.06 4.79
64 5.56 5.52 5.39 5.16 4.85
65 5.73 5.68 5.52 5.27 4.92
66 5.90 5.84 5.67 5.37 4.98
67 6.09 6.02 5.82 5.48 5.04
68 6.29 6.21 5.97 5.58 5.10
69 6.51 6.41 6.13 5.69 5.15
70 6.74 6.63 6.30 5.79 5.20
71 6.99 6.86 6.47 5.90 5.25
72 7.25 7.10 6.65 6.00 5.29
73 7.54 7.36 6.83 6.09 5.33
74 7.85 7.63 7.02 6.19 5.36
75 8.19 7.92 7.21 6.27 5.39
76 8.55 8.23 7.39 6.36 5.42
77 8.93 8.56 7.58 6.43 5.44
78 9.35 8.90 7.77 6.50 5.45
79 9.80 9.26 7.95 6.56 5.47
80 10.29 9.63 8.12 6.61 5.48
81 10.81 10.02 8.29 6.66 5.49
82 11.37 10.42 8.45 6.70 5.49
83 11.98 10.83 8.60 6.74 5.50
84 12.62 11.25 8.74 6.76 5.50
85 13.31 11.67 8.86 6.79 5.51
</TABLE>
ANNUITY CERTAIN TABLE FOR EACH $1,000 APPLIED
<TABLE>
<CAPTION>
- --------------------------------------------------
Numbers of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- --------------------------------------------------
<S> <C> <C>
5 $211.99 $17.91
6 179.22 15.14
7 155.83 13.16
8 138.31 11.68
9 124.69 10.53
10 113.82 9.61
11 104.93 8.86
<CAPTION>
- --------------------------------------------------
Number of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- --------------------------------------------------
<S> <C> <C>
12 $97.54 $8.24
13 91.29 7.71
14 85.95 7.26
15 81.33 6.87
16 77.29 6.53
17 73.74 6.23
18 70.59 5.96
<CAPTION>
- --------------------------------------------------
Number of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- --------------------------------------------------
<S> <C> <C>
19 $67.78 $5.73
20 65.26 5.51
25 55.76 4.71
30 49.53 4.18
</TABLE>
LR467 LR467 (Page 3)
<PAGE>
LN617
CERTIFICATE
<PAGE>
Insured JOHN DOE Certificate Number SPECIMEN
Initial Specified Amount $100,000 Certificate Date December 1, 1995
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
A Stock Company Home Office Location: 900 Cottage Grove Road
Bloomfield, Connecticut
MAILING ADDRESS: CIGNA INDIVIDUAL INSURANCE
VARIABLE PRODUCTS SERVICE CENTER - ROUTING S249
HARTFORD, CT 06152-2249
The Company has issued a Flexible Premium Group Variable Life Insurance Policy
to the Policyowner named in the Certificate Specifications. This certificate
describes the terms and conditions of the group policy. Nothing in the group
policy invalidates or impairs any rights granted to the Certificate Owner by the
insurance law or this certificate.
The Company agrees to pay the death benefit to the Beneficiary upon receipt of
due proof of the Insured's death during the continuance of the certificate. The
Company further agrees to pay the surrender value to the Certificate Owner on
the Coverage Date provided the Insured is then alive.
RIGHT TO EXAMINE THIS CERTIFICATE. The certificate may be returned to the
insurance agent through whom it was purchased or to the Company within 45 days
of the date the application is signed by the Certificate Owner or within 10 days
after receipt of the certificate, (20 days after its receipt where required by
law for a certificate issued in replacement of other insurance), whichever is
later. During this period, the premium paid will be placed in the Fixed
Account, and if the certificate is so returned, it will be deemed void from the
Certificate Date and the Company will refund all premium paid. If the
certificate is not returned during the right-to-examine period, the premium
payment will be processed as set forth in the "Allocation of Premium Payments"
provision.
ALL BENEFITS AND VALUES PROVIDED BY THIS CERTIFICATE WHEN BASED ON THE
INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT ARE VARIABLE AND ARE NOT
GUARANTEED AS TO DOLLAR AMOUNT.
THE DEATH BENEFIT AMOUNT ON THE CERTIFICATE DATE EQUALS THE INITIAL SPECIFIED
AMOUNT OF THE CERTIFICATE. THEREAFTER, THE DEATH BENEFIT MAY VARY UNDER THE
CONDITIONS DESCRIBED UNDER THE "INSURANCE COVERAGE PROVISIONS". THE DURATION OF
COVERAGE IS VARIABLE AND MAY INCREASE OR DECREASE WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE VARIABLE ACCOUNT.
The certificate is issued and accepted subject to the terms set forth on the
following pages, which are made a part of the certificate. In consideration of
the application and the payment of premiums as provided, this certificate is
executed by Connecticut General Life Insurance Company as of its Certificate
Date.
/s/ Thomas G. Jones
PRESIDENT
Registrar
FLEXIBLE PREMIUM GROUP VARIABLE LIFE INSURANCE CERTIFICATE
Variable life insurance payable in the event of death before the Coverage Date.
Surrender Value payable on the Coverage Date
Flexible premiums payable to Coverage Date or prior death of the Insured.
Non-participating. Investment results reflected in certificate benefits.
LN617
<PAGE>
TABLE OF CONTENTS
PAGE
CERTIFICATE SPECIFICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . 3
LIST OF VARIABLE ACCOUNT SUB-ACCOUNTS. . . . . . . . . . . . . . . . . . . . . 5
SCHEDULE 1: SURRENDER CHARGES . . . . . . . . . . . . . . . . . . . . . . . . 7
SCHEDULE 2: EXPENSE CHARGES AND FEES. . . . . . . . . . . . . . . . . . . . . 8
SCHEDULE 3: TABLE OF GUARANTEED MAXIMUM COST OF INSURANCE RATES . . . . . . . 9
SCHEDULE 4: CORRIDOR PERCENTAGES TABLE. . . . . . . . . . . . . . . . . . . .10
DEFINITIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
PREMIUM AND REINSTATEMENT PROVISIONS . . . . . . . . . . . . . . . . . . . . .12
OWNERSHIP, ASSIGNMENT AND BENEFICIARY PROVISIONS . . . . . . . . . . . . . . .13
VARIABLE ACCOUNT PROVISIONS. . . . . . . . . . . . . . . . . . . . . . . . . .14
CERTIFICATE VALUES PROVISIONS. . . . . . . . . . . . . . . . . . . . . . . . .15
TRANSFER PRIVILEGE PROVISION . . . . . . . . . . . . . . . . . . . . . . . . .18
NONFORFEITURE AND SURRENDER VALUE PROVISIONS . . . . . . . . . . . . . . . . .19
LOAN PROVISIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
INSURANCE COVERAGE PROVISIONS. . . . . . . . . . . . . . . . . . . . . . . . .20
GENERAL PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
FOLLOWED BY OPTIONAL METHODS OF SETTLEMENT AND ANY RIDERS
NOTE: PAGES 4 AND 6 ARE INTENTIONALLY "BLANK".
LN617 2
<PAGE>
CERTIFICATE SPECIFICATIONS
Insured John Doe Certificate Number SPECIMEN
Initial Specified Amount $100,000 Certificate Date December 1, 1995
Minimum Specified Amount $100,000 Issue Age 35
Monthly Anniversary Day 15 Premium Class Nonsmoker
Group Policy Number SPECIMEN
LN617 FLEXIBLE PREMIUM GROUP VARIABLE LIFE INSURANCE
DEATH BENEFIT: The Death Benefit Option initially elected under this
certificate is Death Benefit Option 1. (See "Insurance Coverage Provisions").
PREMIUM PAYMENTS: Initial premium paid with application $580.00
Planned Premium $100.00
Additional premium payments may vary by frequency or amount.
PAYMENT MODE: Annually
GUARANTEED INITIAL DEATH BENEFIT PREMIUM: $2,249.70, or cumulative premium
payments as of any Monthly
Anniversary Day during the first 5
Certificate Years must be at least
equal to 1/60th of this amount
times the sum of 1 plus the number
of full months that have elapsed
between the Certificate Date and
the applicable Monthly Anniversary
Day. (Such payment(s) will
guarantee a minimum death benefit
equal to the Initial Specified
Amount during the first 5
Certificate Years, assuming there
have been no loans or surrenders.
See "Minimum Premiums" provision).
If premiums paid less any partial
surrenders and the certificate
loans exceed the minimum premium,
the certificate will not lapse
during the first 5 certificate
years.
NOTE: This certificate may terminate prior to the Coverage Date if actual
premiums paid, interest credited and market performance are
insufficient to maintain a positive surrender value to continue
coverage to that date. The Coverage Date is the Certificate
Anniversary nearest the Insured's age 100.
GUIDELINE ANNUAL PREMIUM AMOUNT: $1,177.05
NOTE: A separate Guideline Annual Premium Amount will apply to increases if
any, in Specified Amount.
LIMITS ON ALLOCATION OF NET PREMIUM PAYMENTS: The minimum allocation percentage
to the Fixed Account or a Variable Account Sub-Account is 10%. All allocations
must be made in whole percentages and in aggregate must total 100%. Premium
payments will be allocated net of the Premium Load specified in Schedule 2.
LIMITS ON TRANSFERS: Transfer(s) from the Fixed Account may only be made during
the 30-day period following each Certificate Anniversary and is (are) subject to
a maximum aggregate annual limit of 20% of the Fixed Account Value as of that
Certificate Anniversary. Additionally, the Company has the right to limit the
dollar amount of such transfers.
GUARANTEED MINIMUM INTEREST RATES: The interest rate used to credit interest on
the Fixed Account Value may vary but will never be less than .010746% compounded
daily (4% compounded yearly).
The interest rate used to credit interest on the Loan Account Value may vary but
will never be less than the loan interest rate less 2% per year during
Certificate Years 1 through 10 and less 1% per year thereafter. (As of the
Certificate Date, the difference between the loan interest rate charged and the
interest rate credited on the Loan Account Value is 1% per year for Certificate
Years 1 through 10 and .50% per year thereafter.)
POLICYOWNER: CIGNA VARIABLE PRODUCTS TRUST (DATED 06/07/95)
JURISDICTION OF ISSUE OF GROUP POLICY: RHODE ISLAND
CERTIFICATE OWNER: THE INSURED
BENEFICIARY: MARY DOE, WIFE
LN617 3
<PAGE>
LIST OF VARIABLE ACCOUNT SUB-ACCOUNTS
FUND GROUPS FUNDS (SUB-ACCOUNTS)
AIM
AIM Variable Insurance Funds, Inc. AIM V.I. Capital Appreciation Fund
AIM V.I. Diversified Income Fund
AIM V.I. Growth Fund
AIM V.I. Value Fund
FIDELITY INVESTMENTS
Variable Insurance Products Fund Equity-Income Portfolio
Variable Insurance Products Fund II Asset Manager Portfolio
Investment Grade Bond Portfolio
MASSACHUSETTS FINANCIAL SERVICES
MFS Variable Insurance Trust MFS Total Return Series
MFS Utilities Series
MFS World Governments Series
QUEST FOR VALUE
Quest for Value Accumulation Trust Quest Global Equity Portfolio
Quest Managed Portfolio
Quest Small Cap Portfolio
TEMPLETON
Templeton Variable Product Funds Templeton Asset Allocation Fund
Templeton International Fund
Templeton Stock Fund
NOTE: NET PREMIUM PAYMENTS MAY ALSO BE ALLOCATED TO THE FIXED
ACCOUNT.
VARIABLE ACCOUNT SEPARATE ACCOUNT: CG Variable Life Insurance Separate Account
II: A Connecticut General Life Insurance Company separate Investment Account
which was established on July 6, 1994.
LN617 5
<PAGE>
SCHEDULE 1: SURRENDER CHARGES
Surrender charges are used in the determination of the surrender value of the
certificate and are assessed upon surrender of the certificate. Such charges
are applicable within 10 years of the Certificate Date and within 10 years
following the date of any increase in Specified Amount. The surrender charge is
calculated as (a) times (b), where (a) is the sum of (i) a Deferred Sales Charge
and (ii) a Deferred Administrative Charge and (b) is the applicable Surrender
Charge Grading Factor from the table below, but in no event will the surrender
charge ever exceed the maximum surrender charge allowed by law.
(a) (i) The Deferred Sales Charge is based on the actual premium paid and the
applicable Guideline Annual Premium Amount, and is calculated as
follows:
DURING CERTIFICATE YEAR*:
1 and 2 28.5% of the sum of premiums paid up to an amount equal to
the Guideline Annual Premium Amount, plus 8.5% of the sum of
premiums paid between one and two times the Guideline Annual
Premium Amount, plus 7.5% of the sum of premiums paid in
excess of two times the Guideline Annual Premium Amount.
3 through 10 Same dollar amount as end of Certificate Year* 2.
(ii) The Deferred Administrative Charge is $6.00 per $1,000 of Specified
Amount.
(b) SURRENDER CHARGE GRADING FACTORS
Certificate Years* 1-5 100%
Certificate Year 6 80%
Certificate Year 7 60%
Certificate Year 8 40%
Certificate Year 9 20%
Certificate Year 10 0%
If a surrender becomes effective at other than the end of a Certificate
Year, any applicable surrender charge grading factor will be applied on a
pro rata basis as of such effective date.
*NUMBER OF CERTIFICATE YEARS ELAPSED SINCE THE CERTIFICATE DATE OR
FROM THE EFFECTIVE DATE(S) OF ANY INCREASE(S) IN SPECIFIED AMOUNT.
No surrender charge is applied upon either a partial surrender or a decrease in
Specified Amount, however, a transaction fee of $25 is assessed for each partial
surrender and will be processed as set forth in the "Partial Surrender"
provision, and for any decrease in Specified Amount effected while surrender
charges apply under the certificate, there will be no change in the surrender
charge from that which was applicable before the decrease took effect.
LN617 7
<PAGE>
SCHEDULE 2: EXPENSE CHARGES AND FEES
PREMIUM LOAD. A charge equal to 5.0% of each premium payment will be deducted
to cover applicable state taxes, federal income tax liabilities, and a portion
of sales expenses.
MONTHLY ADMINISTRATIVE FEE. A monthly deduction is made on each Monthly
Anniversary Day. (See "Monthly Deduction" provision.) It includes an
administrative fee charge, cost of insurance charges and any charges for
supplemental riders or optional benefits.
The monthly administrative fee as of the Certificate Date is $15.00 per month
during the first Certificate Year and $5.00 per month during subsequent
Certificate Years. This fee may be changed by the Company after the first
Certificate Year based on its expectations of future expenses, but the amount of
such fee is guaranteed not to exceed $10.00 per month.
CHARGES AND FEES ASSOCIATED WITH THE VARIABLE ACCOUNT SUB-ACCOUNTS. For
mortality and expense risk, an asset charge is deducted from each Variable
Account Sub-Account at the end of each Valuation Period. This charge may be
changed by the Company from time to time, but it is guaranteed not to exceed a
daily rate which is equivalent to .90% annually of a Sub-Account's Value. As of
the Certificate Date, this charge was equal to a daily rate which is equivalent
to .80% annually during Certificate Years 1 through 12 and a daily rate which is
equivalent to .55% annually during the 13th and later Certificate Years.
In addition, Daily Fund Operating Expenses will be applied by each Fund as set
forth in the prospectus for the applicable Fund(s).
TRANSFER FEE. A transaction fee of $25 applies to each transfer in excess of 12
made during any Certificate Year.
LN617 8
<PAGE>
SCHEDULE 3: TABLE OF GUARANTEED MAXIMUM COST OF INSURANCE RATES
(ATTAINED AGE MONTHLY RATES PER $1,000 OF NET AMOUNT AT RISK)
SPECIAL NOTE: The actual monthly cost of insurance rates charged under this
certificate will vary based on the sex, attained age (nearest
birthday) and Premium Class of the person insured; however, they
will not exceed the rates shown in the table below. In
determining the monthly cost of insurance, the Company will add
the amount of the Flat Extra Monthly Insurance Cost, if any,
shown in the Certificate Specifications. If the person insured
is in a rated premium class, the Guaranteed Maximum Life
Insurance Rates will be those in the table multiplied by the Risk
Factor, if any, shown in the Certificate Specifications. The
rates below are based on the 1980 CSO Tables (Male or Female as
appropriate).
<TABLE>
<CAPTION>
ATTAINED ATTAINED ATTAINED
AGE MALE FEMALE AGE MALE FEMALE AGE MALE FEMALE
(NEAREST MONTHLY MONTHLY (NEAREST MONTHLY MONTHLY (NEAREST MONTHLY MONTHLY
BIRTHDAY) RATE RATE BIRTHDAY) RATE RATE BIRTHDAY) RATE RATE
- ----------------------------- ------------------------------ -----------------------------
<S> <C> <C> <C> <C> <C> <C> <C> <C>
0 0.34845 0.24089 35 0.17586 0.13752 70 3.30338 1.84590
1 0.08917 0.07251 36 0.18670 0.14669 71 3.62140 2.02325
2 0.08251 0.06750 37 0.20004 0.15752 72 3.98666 2.24419
3 0.08167 0.06584 38 0.21505 0.17003 73 4.40599 2.51548
4 0.07917 0.06417 39 0.23255 0.18503 74 4.87280 2.83552
- ----------------------------- -------------------------- -------------------------
5 0.07501 0.06334 40 0.25173 0.20171 75 5.37793 3.19685
6 0.07167 0.06084 41 0.27424 0.22005 76 5.91225 3.59370
7 0.06667 0.06000 42 0.29675 0.23922 77 6.46824 4.01942
8 0.06334 0.05834 43 0.32260 0.25757 78 7.04089 4.47410
9 0.06167 0.05750 44 0.34929 0.27674 79 7.64551 4.97042
- ----------------------------- -------------------------- -------------------------
10 0.06084 0.05667 45 0.37931 0.29675 80 8.30507 5.52957
11 0.06417 0.05750 46 0.41017 0.31677 81 9.03761 6.17118
12 0.07084 0.06000 47 0.44353 0.33761 82 9.86724 6.91414
13 0.08251 0.06250 48 0.47856 0.36096 83 10.80381 7.77075
14 0.09584 0.06667 49 0.51777 0.38598 84 11.82571 8.72632
- ----------------------------- -------------------------- -------------------------
15 0.11085 0.07084 50 0.55948 0.41350 85 12.91039 9.76952
16 0.12585 0.07501 51 0.60870 0.44270 86 14.03509 10.89151
17 0.13919 0.07917 52 0.66377 0.47523 87 15.18978 12.08770
18 0.14836 0.08167 53 0.72636 0.51276 88 16.36948 13.35774
19 0.15502 0.08501 54 0.79730 0.55114 89 17.57781 14.70820
- ----------------------------- -------------------------- -------------------------
20 0.15836 0.08751 55 0.87326 0.59118 90 18.82881 16.15259
21 0.15919 0.08917 56 0.95591 0.63123 91 20.14619 17.71416
22 0.15752 0.09084 57 1.04192 0.66961 92 21.57655 19.43814
23 0.15502 0.09251 58 1.13378 0.70633 93 23.20196 21.40786
24 0.15169 0.09501 59 1.23235 0.74556 94 25.28174 23.83051
- ----------------------------- -------------------------- -------------------------
25 0.14752 0.09668 60 1.34180 0.78979 95 28.27411 27.16158
26 0.14419 0.09918 61 1.46381 0.84488 96 33.10677 32.32378
27 0.14252 0.10168 62 1.60173 0.91417 97 41.68475 41.21204
28 0.14169 0.10501 63 1.75809 1.00267 98 58.01259 57.81394
29 0.14252 0.10835 64 1.93206 1.10539 99 83.33333 83.33333
- ----------------------------- -------------------------- -------------------------
30 0.14419 0.11251 65 2.12283 1.21731
31 0.14836 0.11668 66 2.32623 1.33511
32 0.15252 0.12085 67 2.54312 1.45461
33 0.15919 0.12502 68 2.77350 1.57247
34 0.16669 0.13168 69 3.02328 1.69955
- ----------------------------- --------------------------
</TABLE>
LN617 9
<PAGE>
SCHEDULE 4: CORRIDOR PERCENTAGES TABLE
As of the Certificate Date the formula in effect to determine the amount under
item (b) of both Death Benefit Option 1 and Death Benefit Option 2 is based on a
percent of the Accumulation Value as determined from the following table:
<TABLE>
<CAPTION>
INSURED'S CORRIDOR INSURED'S CORRIDOR
ATTAINED AGE PERCENTAGE ATTAINED AGE PERCENTAGE
------------ ---------- ------------ ----------
<S> <C> <C> <C>
0-40 250% 70 115%
41 243 71 113
42 236 72 111
43 229 73 109
44 222 74 107
---------- ---------- ------------ ----------
45 215 75 105
46 209 76 105
47 203 77 105
48 197 78 105
49 191 79 105
---------- ---------- ------------ ----------
50 185 80 105
51 178 81 105
52 171 82 105
53 164 83 105
54 157 84 105
---------- ---------- ------------ ----------
55 150 85 105
56 146 86 105
57 142 87 105
58 138 88 105
59 134 89 105
---------- ---------- ------------ ----------
60 130 90 105
61 128 91 104
62 126 92 103
63 124 93 102
64 122 94 101
---------- ---------- ------------ ----------
65 120 95 100
66 119 96 100
67 118 97 100
68 117 98 100
69 116 99 100
---------- ---------- ------------ ----------
</TABLE>
LN617 10
<PAGE>
DEFINITIONS
ACCUMULATION VALUE. The sum of (i) the then current value of the Fixed Account,
(ii) all of the then current values of the Variable Account Sub-Accounts (i.e.
the Variable Account Value), and (iii) the Loan Account Value.
CERTIFICATE ANNIVERSARIES AND CERTIFICATE YEARS. Twelve-month periods measured
from the Certificate Date.
CERTIFICATE DATE (OR "DATE OF ISSUE"). The date on which the certificate
becomes effective. The Certificate Date is shown in the Certificate
Specifications. The term "Date of Issue", by itself, shall mean Certificate
Date.
CERTIFICATE OWNER (OR "OWNER"). The Certificate Owner is defined under
"Ownership, Assignment and Beneficiary Provisions". The term "Owner", by
itself, shall mean Certificate Owner.
COMPANY. Connecticut General Life Insurance Company.
DUE PROOF OF DEATH. An original certified copy of an official death
certificate, an original certified copy of a decree of a court of competent
jurisdiction as to the finding of death, or any other proof of death
satisfactory to the Company.
FIXED ACCOUNT. The account which provides for a guaranteed minimum interest
rate. The Company may, at its discretion, credit a higher current rate of
interest. Fixed Account assets are general assets of the Company and are
distinguishable from those allocated to a separate account of the Company.
FUND(S). The Portfolio(s) of Fund Groups whose shares are acquired for the
Variable Account Sub-Accounts in which Net Premium Payments or transfers may be
invested.
FUND GROUPS. The open-end management investment companies (mutual funds)
registered under the Investment Company Act of 1940, as amended, (hereinafter
referred as the "1940 Act"), one or more of whose Portfolio(s)' shares are made
available as investment vehicles for the policies through the Variable Account
Sub-Accounts.
HOME OFFICE. The term "Home Office" means the home office of Connecticut
General Life Insurance Company, the mailing address of which for this
certificate is CIGNA Individual Insurance, Variable Products Service Center -
Routing S249, Hartford, Connecticut 06152-2249.
IN WRITING. The term "in writing" means in a written form satisfactory to the
Company and received by the Company at its Home Office.
LOAN ACCOUNT. The account in which certificate indebtedness (outstanding loans
and interest) accrues once it is transferred out of the Fixed Account and
Variable Account Sub-Accounts. The Loan Account is part of the Company's
general account.
LOAN ACCOUNT VALUE. The value of the Loan Account, the amount of which equals
the indebtedness under the certificate.
MONTHLY ANNIVERSARY DAY. The day of the month, as shown in the Certificate
Specifications, when the Company deducts certain charges. If that day does not
occur on a Valuation Day or is nonexistent for that month, then such charges
will be deducted on the next Valuation Day.
NET ACCUMULATION VALUE. An amount equal to the Accumulation Value less the
amount of indebtedness, if any, in the Loan Account.
NET PREMIUM PAYMENT. The amount of a premium payment, less the premium load
shown in Schedule 2. A Net Premium Payment is the amount available for
allocation to the Fixed Account and the Variable Account Sub-Accounts.
POLICYOWNER. The person or entity designated in the Certificate Specifications.
SEC. The Securities and Exchange Commission.
SUB-ACCOUNT. That portion of the Variable Account which invests in shares of a
specific Fund.
LN617 11
<PAGE>
DEFINITIONS (CONTINUED)
VALUATION DAY. Every day on which the New York Stock Exchange ("NYSE") is open
for business, except any day on which trading on the NYSE is restricted, or on
which an emergency exists, as determined by the SEC, so that valuation or
disposal of securities is not practicable.
VALUATION PERIOD. The period of time for which a Fund determines its net asset
value; a Valuation Period begins on the day following a Valuation Day and ends
on the next Valuation Day. A Valuation Period may be more than one day in
length.
VARIABLE ACCOUNT. The account consisting of all Sub-Account(s) invested in
shares of the Fund(s). Variable Account assets are separate account assets of
the Company, the investment performance of which is kept separate from that of
the general assets of the Company and are not chargeable with the general
liability of the Company.
VARIABLE ACCUMULATION UNIT. A unit of measure used in the calculation of the
value of each Variable Account Sub-Account.
PREMIUM AND REINSTATEMENT PROVISIONS
PAYMENT OF PREMIUMS. All premiums are payable at the Home Office or to an
authorized representative of the Company. The first premium is due on the
Certificate Date and is payable in advance. Additional premiums may be paid
under the certificate before the Coverage Date subject to the consent of the
Company and the requirements specified under the "Minimum Premiums" and
"Additional Premiums" provisions. Receipts signed by the President or Secretary
and duly countersigned will be furnished upon request.
MINIMUM PREMIUMS. The minimum premium for the certificate is the amount
necessary to maintain a positive surrender value as set forth under the "Grace
Period" provision. The Guaranteed Initial Death Benefit Premium, as shown in
the Certificate Specifications, is not mandatory but is the premium amount
necessary to guarantee that the death benefit will not be less than the Initial
Specified Amount during the first 5 Certificate Years regardless of market
performance, assuming that there are no loans or partial surrenders under the
certificate. If premiums paid less any partial surrenders and certificate loans
exceed the minimum premium, the certificate will not lapse during the first 5
certificate years
PLANNED PREMIUMS. The Company will send premium reminder notices for the
amounts and frequency of payments established by the Certificate Owner. Changes
in the amounts or frequency of such planned periodic payments by the Certificate
Owner will be subject to the consent of the Company.
COVERAGE DATE. Payment of (a) the Guaranteed Initial Death Benefit Premium
shown in the Certificate Specifications, or (b) Planned Premiums payable in
accordance with the payment mode specified, may not continue the certificate in
force until the Coverage Date even if the amount is paid as scheduled. The
Coverage Date is not guaranteed based upon the level of Planned Premiums. The
period for which the certificate will continue will depend on:
1. The amount, timing, and frequency of premium payment;
2. Changes in the Specified Amount and Death Benefit options;
3. Interest credits and insurance costs;
4. Changes in deductions for riders, if any; and
5. Partial withdrawals and loans.
ADDITIONAL PREMIUMS. In addition to planned premiums, if any, additional
premium payments of at least $100.00 each may be made before the Coverage Date
during the continuance of the certificate. The Company reserves the right to
limit the amount or number of any such additional premium payments if such is
necessary to qualify the certificate as life insurance under the Internal
Revenue Code.
Unless otherwise specified by the Certificate Owner, if there is any certificate
indebtedness, any additional premiums paid will be used first as a loan
repayment with any excess applied as an additional premium.
ALLOCATION OF NET PREMIUM PAYMENTS. Net Premium Payments may be allocated to
the Fixed Account and/or to Variable Account Sub-Accounts under the certificate
subject to the "Limits on Allocation of Net Premium Payments" shown in the
Certificate Specifications. The Net Premium Payment associated with the initial
premium payment will be allocated within 3 business days of the expiration of
the "Right to Examine This Certificate" period in accordance with the allocation
percentages specified in the application. Subsequent Net Premium Payments will
be allocated on the same basis as the most recent previous Net Premium Payment
unless the Company is otherwise instructed in writing to change the allocation
percentages.
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PREMIUM AND REINSTATEMENT PROVISIONS (CONTINUED)
GUIDELINE ANNUAL PREMIUM AMOUNT. The level annual amount as shown in the
Certificate Specifications as of the Certificate Date is an amount calculated in
accordance with SEC Rule 6e-3(T) under the 1940 Act as in effect on such date.
The Guideline Annual Premium Amount under this certificate is used in
determining the amount of the surrender charges if the certificate is
surrendered during a period for which surrender charges are applicable.
GRACE PERIOD. If the surrender value on any Monthly Anniversary Day is less
than the required monthly deduction, a grace period of 61 days will be granted
to pay a premium sufficient to cover the required monthly deduction. If,
however, the Guaranteed Initial Death Benefit Premium requirement as set forth
in the Certificate Specifications is met, the certificate will not lapse during
the first 5 Certificate Years and a minimum death benefit amount at least equal
to the Initial Specified Amount will be guaranteed during that period,
regardless of market performance (assuming that there are no loans or partial
surrenders under the certificate). If premiums paid less any partial surrenders
and certificate loans exceed the minimum premium, the certificate will not lapse
during the first 5 certificate years.
At least 31 days before the end of the grace period the Company will send a
notice that there is insufficient value under the certificate. The notice will
show the amount of premium required to cover the monthly deduction to prevent
the certificate from lapsing and will be mailed to the last known addresses of
the Certificate Owner and the assignee of record with the Company, if any. If
such premium, as billed by the Company, is not paid within the grace period, all
coverage under the certificate will terminate without value at the end of the
grace period. If the Insured dies during the grace period, the Company will
deduct any overdue monthly deductions from the benefits.
REINSTATEMENT. After the certificate has lapsed due to the expiration of a grace
period, it may be reinstated any time during the Insured's lifetime prior to the
Coverage Date provided: (a) it has not been surrendered for cash, (b) a written
application for reinstatement is submitted to the Company, (c) evidence of
insurability satisfactory to the Company is furnished, (d) enough premium is
paid to keep the certificate in force for at least 2 months, and (e) any
indebtedness against the certificate increased by any loan interest is paid or
reinstated.
The effective date of the reinstated certificate will be the Monthly Anniversary
Day next following the date the application for reinstatement is approved by the
Company. The surrender charges set forth in Schedule 1 will be reinstated as of
the Certificate Year in which the certificate lapsed.
OWNERSHIP, ASSIGNMENT AND BENEFICIARY PROVISIONS
CERTIFICATE OWNER. The Certificate Owner on the Certificate Date will be the
person designated in the Certificate Specifications. If no person is designated
as Certificate Owner, the Insured will be the Certificate Owner.
RIGHTS OF CERTIFICATE OWNER. While the Insured is alive, the Certificate Owner
may exercise all rights and privileges under the certificate including the right
to: (a) release or surrender the certificate to the Company, (b) agree with
the Company to any change in or amendment to the certificate, (c) transfer all
rights and privileges to another person, (d) change the Beneficiary, and (e)
assign the certificate.
All rights and privileges of the Certificate Owner may be exercised without the
consent of any designated transferee, or any Beneficiary if the Certificate
Owner has reserved the right to change the Beneficiary. All such rights and
privileges, however, may be exercised only with the consent of any assignee
recorded with the Company.
Unless provided otherwise, if the Certificate Owner is a person other than the
Insured and dies before the Insured, all the rights and privileges of the
Certificate Owner will vest in the Certificate Owner's executors, administrators
or assigns.
TRANSFER OF CERTIFICATE OWNERSHIP. The Certificate Owner may transfer all
rights and privileges of the Certificate Owner. On the effective date of
transfer, the transferee will become the Certificate Owner and will have all the
rights and privileges of the Certificate Owner. The Certificate Owner may
revoke any transfer prior to its effective date.
Unless provided otherwise, a transfer will not affect the interest of any
Beneficiary designated prior to the effective date of transfer.
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OWNERSHIP, ASSIGNMENT AND BENEFICIARY PROVISIONS (CONTINUED)
A transfer of Certificate Ownership, or a revocation of transfer, must be in
writing on a form satisfactory to the Company and filed at the Home Office. A
transfer, or a revocation, will not take effect until recorded in writing by the
Company. When a transfer or revocation has been so recorded, it will take
effect as of the effective date specified by the Certificate Owner. Any payment
made or any action taken or allowed by the Company before the transfer, or the
revocation, is recorded will be without prejudice to the Company.
ASSIGNMENT. The Company will not be affected by any assignment of the
certificate until the original assignment or a certified copy of the assignment
is filed at the Home Office.
The Company does not assume responsibility for the validity or sufficiency of
any assignment. An assignment of the certificate will operate so long as the
assignment remains in force.
To the extent provided under the terms of the assignment, an assignment will
transfer the interest of any designated transferee or of any Beneficiary if the
Certificate Owner has reserved the right to change the Beneficiary.
BENEFICIARY. The Beneficiary on the Certificate Date will be the person
designated in the Certificate Specifications.
Unless provided otherwise, the interest of any Beneficiary who dies before the
Insured will vest in the Certificate Owner or the Certificate Owner's executors,
administrators or assigns.
CHANGE OF BENEFICIARY. A new Beneficiary may be designated from time to time. A
request for change of Beneficiary must be in writing on a form satisfactory to
the Company and filed at the Home Office. The request must be signed by the
Certificate Owner. The request must also be signed by the Beneficiary if the
right to change the Beneficiary has not been reserved to the Certificate Owner.
A change of Beneficiary will not take effect until recorded in writing by the
Company. When a change of Beneficiary has been so recorded, whether or not the
Insured is then alive, it will take effect as of the date the request was
signed. Any payment made or any action taken or allowed by the Company before
the change of Beneficiary is recorded will be without prejudice to the Company.
Unless provided otherwise, the right to change any Beneficiary is reserved to
the Certificate Owner.
VARIABLE ACCOUNT PROVISIONS
VARIABLE ACCOUNT AND SUB-ACCOUNTS. Assets accumulated on a variable basis are
held in the Variable Account Separate Account designated in this certificate on
page 5 which was established by a resolution of the Company's Board of Directors
as a "separate account" under governing law of Connecticut, the Company's state
of domicile, is registered as a unit investment trust under the 1940 Act and is
subject to the law of the state in which this certificate is delivered. Under
Connecticut law, the Variable Account assets (except assets in excess of its
reserves and other contract liabilities) cannot be charged with the general
liabilities of the Company. The Variable Account assets are owned and
controlled exclusively by the Company, and the Company is not a trustee with
respect to those assets.
The Variable Account is divided into Sub-Accounts. Each Sub-Account's assets
are invested in shares of a particular Fund of one of the Fund Groups made
available as funding vehicles under this certificate. For each Sub-Account, the
Company maintains Variable Accumulation Units whose values reflect the
investment performance of the Fund whose shares are held in that Sub-Account.
Subject to any vote by persons having the right under the 1940 Act to vote
thereon, the Company may elect to operate the Variable Account as a management
company rather than a unit investment trust under the 1940 Act, or, if
registration is no longer required, to deregister the Variable Account. In such
event, the Company may endorse this certificate to reflect such change and any
necessary or appropriate action taken to effect the change. Any changes in
Variable Account investment policy shall have been approved by the Connecticut
Insurance Commissioner and approved or filed, as required, in the state or other
jurisdiction where this certificate was issued.
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VARIABLE ACCOUNT PROVISIONS (CONTINUED)
INVESTMENT RISK. Each Sub-Account's assets are always fully invested in the
shares of the particular Fund purchased for that Sub-Account. Each
Sub-Account's investment performance reflects the investment performance of that
Fund. Fund share values fluctuate, reflecting the risks of changing economic
conditions and the ability of a Fund Group's investment adviser or sub-adviser
to manage that Fund and anticipate changes in economic conditions. As to the
Variable Account assets, the Certificate Owner bears the entire investment risk
of gain or loss.
INVESTMENTS OF THE VARIABLE ACCOUNT SUB-ACCOUNTS. All amounts allocated to a
Variable Account Sub-Account will be used to purchase shares of the specific
Fund of a Fund Group used by that Sub-Account. Each Fund Group is registered
under the 1940 Act as an open-end management investment company, and each Fund
of that Fund Group is regulated as an open-end management investment company.
All Funds available as funding vehicles under this certificate as of the
Certificate Date are listed in the application for the certificate and on page 5
of the certificate. The Company may add additional Fund Groups and additional
Funds at any time or may change Funds or Fund Groups in accordance with the
"Substituted Securities" provision.
Any and all distributions made by a Fund will be reinvested in additional shares
of that Fund at net asset value. Deductions by the Company from a Sub-Account
will be made by redeeming a number of Fund shares at net asset value equal in
total value to the amount to be deducted.
SUBSTITUTED SECURITIES. Shares corresponding to a particular Fund may not
always be available for purchase or the Company may decide that further
investment in such Fund is no longer appropriate in view of the purposes of the
Variable Account or in view of legal, regulatory or federal income tax
restrictions. In such event, shares of another registered open-end investment
company or unit investment trust may be substituted both for Fund shares already
purchased and/or as the securities to be purchased in the future, provided that
these substitutions meet applicable Internal Revenue Service diversification
guidelines and any necessary regulatory or other approvals of such substitutions
have been obtained. In the event of any substitution pursuant to this
provision, the Company may make appropriate endorsement(s) to this certificate
to reflect the substitution.
CERTIFICATE VALUES PROVISIONS
ACCUMULATION VALUE. The Accumulation Value equals the sum of (i) the then
current value of the Fixed Account (ii) all of the then current values of the
Variable Account Sub-Accounts (i.e. the Variable Account Value), and (iii) the
Loan Account Value. At any point in time, therefore, the Accumulation Value
reflects (a) Net Premium Payments made, (b) interest credited under the Fixed
Account, (c) the amount of any partial surrenders, (d) interest charged and
credited under the Loan Account, (e) any transfer fees, (f) all monthly and
other deductions as specified below, (g) the daily mortality and expense
deduction specified under Schedule 2, and (h) any increases or decreases as a
result of market performance in the Variable Account Sub-Accounts.
CALCULATION OF ACCUMULATION VALUE. On each Valuation Day after the Certificate
Date, the Accumulation Value will be equal to (1), plus (2), plus (3), minus
(4), plus or minus (5) as the case may be, minus (6), minus (7), minus (8), and
if the Valuation Day is the same as a Monthly Anniversary Day, minus (9), where;
(1) is the Accumulation Value on the preceding Valuation Day;
(2) is all premiums received since the preceding Valuation Day less the premium
load charges from Schedule 2;
(3) the interest credited under the Fixed Account and the Loan Account since
the preceding Valuation Day;
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CERTIFICATE VALUES PROVISIONS (CONTINUED)
(4) the interest charged against the Loan Account since the preceding Valuation
Day;
(5) is the gain or loss in the Variable Account Value based on market
performance since the last Valuation Day;
(6) the charges and fees associated with the Variable Account Sub-Accounts from
Schedule 2;
(7) the amount of any partial surrenders since the preceding Valuation Day;
(8) any transaction fees assessed since the preceding Valuation Day;
(9) is the monthly deduction for the month following the Monthly Anniversary
Day.
FIXED ACCOUNT VALUE. The Fixed Account Value, if any, with respect to this
certificate, at any point in time, is equal to the sum of the Net Premium
Payments allocated or other amounts (net of any charges) transferred to the
Fixed Account plus interest credited to such account less the monthly deductions
applied to such account and less any partial surrenders or amounts transferred
from the Fixed Account.
INTEREST CREDITED UNDER FIXED ACCOUNT. The Company will credit interest to the
Fixed Account daily. The interest rate applied to the Fixed Account will be the
greater of: (a) .010746% compounded daily, (4% compounded yearly), or (b) a
rate determined by the Company from time to time. Such rate will be established
on a prospective basis and may vary by the certificate issue year and duration.
VARIABLE ACCOUNT VALUE. The Variable Account Value, if any, for any Valuation
Period is equal to the sum of the then current values of all Variable Account
Sub-Accounts under the certificate. The value of each Variable Account
Sub-Account is determined by multiplying the number of Variable Accumulation
Units, if any, credited or debited to such Variable Account Sub-Account with
respect to this certificate by the Variable Accumulation Unit Value of the
particular Variable Account Sub-Account for such Valuation Period.
CREDITING AND CANCELLING VARIABLE ACCUMULATION UNITS. Upon receipt of a premium
payment or a request for transfer of funds from the Fixed Account, all or that
portion, if any, of the Net Premium Payment to be allocated to the Variable
Account Sub-Accounts and/or the net amount transferred will be credited to the
Variable Account in the form of Variable Accumulation Units. The number of
Variable Accumulation Units to be credited is determined by dividing the dollar
amount allocated to the particular Variable Account Sub-Account by the Variable
Accumulation Unit Value for the particular Variable Account Sub-Account for the
Valuation Period during which the premium payment and/or the request for
transfer is received by the Company. The amount of monthly deduction allocated
to each Variable Account Sub-Account will result in the cancellation of Variable
Accumulation Units which have an aggregate value on the date of such deduction
equal to the total amount by which the Variable Account Sub-Account is reduced.
VARIABLE ACCUMULATION UNIT VALUE. The Variable Accumulation Unit Value for each
Variable Account Sub-Account was established at $10.00 for the first Valuation
Period of the particular Variable Account Sub-Account. The Variable
Accumulation Unit Value for the particular Variable Account Sub-Account for any
subsequent Valuation Period is determined by methodology which is the
mathematical equivalent of multiplying the Variable Accumulation Unit Value for
the particular Variable Account Sub-Account for the immediately preceding
Valuation Period by the Net Investment Factor for the particular Variable
Account Sub-Account for such subsequent Valuation Period. The Variable
Accumulation Unit Value for each Variable Account Sub-Account for any Valuation
Period is the value determined as of the end of the particular Valuation Period
and may increase, decrease or remain constant from Valuation Period to Valuation
Period.
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CERTIFICATE VALUES PROVISIONS (CONTINUED)
NET INVESTMENT FACTOR. The Net Investment Factor is an index applied to measure
the investment performance of a Variable Account Sub-Account from one Valuation
Period to the next. The Net Investment Factor may be greater or less than or
equal to 1.0; therefore, the value of a Variable Accumulation Unit may increase,
decrease or remain the same.
The Net Investment Factor for any Variable Account Sub-Account for any Valuation
Period is determined by dividing (a) by (b) and then subtracting (c) from the
result where:
(a) is the net result of:
(1) is the net asset value (as described in the prospectus for
the Fund) of a Fund share held in the Variable Account
Sub-Account determined as of the end of the Valuation Period,
plus
(2) the per share amount of any dividend or other distribution
declared by the Fund on the shares held in the Variable Account
Sub-Account if the "ex-dividend" date occurs during the Valuation
Period, plus or minus
(3) a per share credit or charge with respect to any taxes paid
or reserved for by the Company during the Valuation Period which
are determined by the Company to be attributable to the operation
of the Variable Account Sub-Account;
(b) is the net asset value of a Fund share held in the Variable Account
Sub-Account determined as of the end of the preceding Valuation Period; and
(c) is the asset charge factor determined by the Company for the Valuation
Period to reflect the charges for assuming the mortality and expense risks.
The asset charge factor for any Valuation Period is equal to the daily asset
charge factor multiplied by the number of 24-hour periods in the Valuation
Period. The daily asset charge factor will be determined annually by the
Company, but in no event may it exceed that specified in Schedule 2.
COST OF INSURANCE RATES. Monthly cost of insurance rates will be determined
from time to time by the Company based on its expectations of future mortality.
Any change in cost of insurance rates will apply to all individuals of the same
class as the Insured. Under no circumstance will the cost of insurance rates
ever be greater than those described in Schedule 3.
COST OF INSURANCE. The cost of insurance for the Insured is determined on a
monthly basis. Such cost is calculated as (1), multiplied by the result of (2)
minus (3), where:
1. is the cost of insurance rate as described in the "Cost of Insurance Rates"
provision,
2. is the death benefit at the beginning of the certificate month, divided by
1.0032737, and
3. is the Accumulation Value at the beginning of the certificate month prior
to the deduction for the monthly cost of insurance.
MONTHLY DEDUCTION. The monthly deduction for a certificate month will be
calculated as Charge (1) plus Charge (2) where:
Charge (1) is the cost of insurance (as described in the "Cost of Insurance"
provision) and the cost of any supplemental riders or optional benefits, and
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CERTIFICATE VALUES PROVISIONS (CONTINUED)
Charge (2) is the Monthly Administrative Fee as described under Schedule 2.
The amount of monthly deduction will be deducted from the Fixed Account and each
Variable Account Sub-Account in the same proportion that the value of each
account bears to the Net Accumulation Value as of the date on which the
deduction is made.
BASIS OF COMPUTATIONS. The minimum Fixed Account Value is guaranteed to be no
less than that calculated based on the applicable Commissioners 1980 Standard
Ordinary Mortality Table (age nearest birthday) from Schedule 3 with interest at
4% per year, compounded yearly.
All certificate values are at least equal to that required by the jurisdiction
in which this certificate is delivered. A detailed statement of the method of
computing values has been filed with the insurance supervisory official of that
jurisdiction.
TRANSFER PRIVILEGE PROVISION
TRANSFER PRIVILEGE. At any time while this certificate is in effect, other than
during the "Right to Examine This Certificate" period, the Certificate Owner may
transfer all or part of the Variable Account Value to the Fixed Account and/or
to one or more of the Variable Account Sub-Accounts then available under the
certificate, and/or transfer part of the Fixed Account Value to one or more
Variable Account Sub-Accounts, subject to the provisions set forth below.
Transfers may be made in writing. Transfer requests must be received at the
Company's Home Office prior to the time of day set forth in the prospectus and
provided the NYSE is open for business, in order to be processed as of the close
of business on the date the request is received; otherwise, the transfer will be
processed on the next business day the NYSE is open for business.
Transfers involving Variable Account Sub-Accounts will reflect the purchase or
cancellation of Variable Accumulation Units having an aggregate value equal to
the dollar amount being transferred to or from a particular Variable Account
Sub-Account. The purchase or cancellation of such units shall be made using
Variable Accumulation Unit Values of the applicable Variable Account Sub-Account
for the Valuation Period during which the transfer is effective. Transfers to
the Fixed Account will earn interest as specified under the "Interest Credited
Under Fixed Account" provision.
Unless otherwise changed by the Company to be less restrictive, transfers shall
be subject to the following conditions: (a) Up to 12 transfers may be made
during any Certificate Year without charge, however, for each transfer in excess
of 12, a transfer fee as set forth in Schedule 2 will be deducted on a pro-rata
basis from the Fixed Account and/or Variable Account Sub-Accounts from which the
transfer is being made; (b) No partial surrender transaction fee will be imposed
on transferred amounts; (c) The amount being transferred may not be less than
$500 unless the entire value of the Fixed Account or a Variable Account
Sub-Account is being transferred; (d) The amount being transferred may not
exceed the Company's maximum amount limit then in effect; (e) Transfers among
the Variable Account Sub-Accounts or from a Variable Account Sub-Account to the
Fixed Account can be made at any time; (f) Transfers from the Fixed Account are
subject to the "Limits on Transfers" as set forth in the Certificate
Specifications; (g) Any value remaining in the Fixed Account or a Variable
Account Sub-Account following a transfer may not be less than $500; (h)
Transfers involving Variable Account Sub-Account(s) shall be subject to such
additional terms and conditions as may be imposed by the Funds.
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NONFORFEITURE AND SURRENDER VALUE PROVISIONS
SURRENDER AND SURRENDER VALUE. This certificate may be surrendered on any day
during the lifetime of the Insured and before the Coverage Date, for its
surrender value by returning it to the Company with a signed request for
surrender in a form satisfactory to the Company. The surrender will take effect
on the business day the certificate and the request are received in the Home
Office. The amount payable on surrender of the certificate (i.e., the
"surrender value") will be the Net Accumulation Value less any surrender charges
as determined from Schedule 1.
The surrender value will be paid in cash or under an elected optional mode of
settlement. Any deferment of payments will be subject to the "Deferment of
Payments" provision (See "General Provisions").
Any surrender from a Variable Account Sub-Account will result in the
cancellation of Variable Accumulation Units which have an aggregate value on the
effective date of the surrender equal to the total amount by which the Variable
Account Sub-Account is reduced. The cancellation of such units will be based on
the Variable Accumulation Unit Value of the Variable Account Sub-Account
determined at the close of the Valuation Period during which the surrender is
effective.
INSUFFICIENT VALUE. If the surrender value, on the day preceding a Monthly
Anniversary Day is insufficient to cover the monthly deduction for the month
following such Monthly Anniversary Day, the certificate will terminate as
provided in the "Grace Period" provision.
PARTIAL SURRENDER. A partial surrender of this certificate may be elected on
any Valuation Day during the lifetime of the Insured and prior to the Coverage
Date by submitting a written request to the Company. Such request may also be
made by telephone if telephone transfers have been previously authorized in
writing. The amount of each partial surrender (a) must be at least $500.00 but
(b) may not exceed 90% of the surrender value at the end of the Valuation Period
during which the election becomes or would become effective.
When a partial surrender is made, the Accumulation Value is reduced by (a) the
amount of the partial surrender and (b) the transaction fee as specified in
Schedule 1. Also, the death benefit will be reduced by the amount of the
partial surrender. The Specified Amount remaining in force after any partial
surrender may not be less than the Minimum Specified Amount shown in the
Certificate Specifications.
When the partial surrender is processed, the amount of the partial surrender and
the transaction fee will be deducted from the applicable Fixed Account and/or
Variable Account Sub-Accounts in proportion to the then current account values
provided there are sufficient account values for making the deduction(s);
otherwise, the amount payable upon a partial surrender will be net of any
remaining transaction fee, unless the Certificate Owner and the Company agree
otherwise.
LOAN PROVISIONS
CERTIFICATE LOANS. After a surrender value is available, the Company will grant
a loan against the certificate provided: (a) a proper loan agreement is executed
and (b) a satisfactory assignment of the certificate to the Company is made.
The loan may be for any amount up to 100% of the then current surrender value;
however, the Company reserves the right to limit the amount of such loan so that
total indebtedness will not exceed 90% of an amount equal to the then current
Accumulation Value less surrender charge.
The amount borrowed will be paid within seven days of the Company's receipt of
such request, except as the Company may be permitted to defer the payment of
amounts as specified under the "Deferment of Payments" provision. (See "General
Provisions.")
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LOAN PROVISIONS (CONTINUED)
The minimum loan amount is $500. The Company reserves the right to modify this
amount in the future. The Company will effect such loan from the Fixed Account
and each Variable Account Sub-Account in proportion to the then current account
values, unless the Certificate Owner instructs the Company otherwise.
LOAN ACCOUNT AND LOAN ACCOUNT VALUE. The amount of any loan will be transferred
out of the Fixed Account and Variable Accounts Sub-Accounts as described above.
Such amount will become part of the Loan Account Value. The outstanding loan
balance at any time includes accrued interest on the loan.
The outstanding loan balance (i.e. Indebtedness) may be repaid at any time
during the lifetime of the Insured, however, the minimum loan repayment is
$100.00 or the amount of the outstanding indebtedness, if less. The Loan
Account Value will be reduced by the amount of any loan repayment. Loan
repayments will be allocated to the Fixed Account and each Variable Account
Sub-Account in the proportion in which current Net Premium Payment(s) are being
allocated, unless otherwise agreed to in writing by the Certificate Owner and
the Company.
Net loan interest, which equals the difference between interest charged and
interest credited on the Loan Account Value, is payable annually on each
certificate anniversary or as otherwise agreed in writing by the Certificate
Owner and the Company. Such loan interest amount, if not paid when due, will be
transferred out of the Fixed Account and each Variable Account Sub-Account in
proportion to the then current account value, unless both the Certificate Owner
and the Company agree otherwise.
INTEREST RATE CHARGED ON LOAN ACCOUNT VALUE. Interest charged on the Loan
Account Value will be at a rate equivalent to 8% per year, payable in arrears.
INTEREST RATE CREDITED ON LOAN ACCOUNT VALUE. The interest rate used to credit
interest on the Loan Account Value may vary, but will not be less than the loan
interest rate less 2% per year during Certificate Years 1 through 10 and less 1%
per year thereafter. (See Certificate Specifications page for the rate in
effect as of the Certificate Date).
INDEBTEDNESS. The term "indebtedness" means money which is owed on this
certificate due to an outstanding loan and interest accrued thereon. A loan,
whether or not repaid, will have a permanent effect on the Net Accumulation
Value and on the death benefits. Any indebtedness at time of settlement will
reduce the proceeds payable under the certificate. A certificate loan reduces
the then current Net Accumulation Value under the certificate while repayment of
a loan will cause an increase in the then current Net Accumulation Value.
If at any time the total indebtedness against the certificate, including
interest accrued but not due, equals or exceeds the then current Accumulation
Value less surrender charge, the certificate will thereupon terminate without
value subject to the conditions in the "Grace Period" provision and a notice
will be sent at least 31 days before the end of the grace period to the
Certificate Owner and to assignees, if any, that this certificate will terminate
unless the indebtedness is repaid.
INSURANCE COVERAGE PROVISIONS
EFFECTIVE DATE OF COVERAGE. The effective date of this certificate will be the
Certificate Date provided the initial premium has been paid (1) while the
Insured is alive and (2) prior to any change in the health and insurability of
the Insured as represented in the application.
For any insurance that has been reinstated, the effective date will be the
Monthly Anniversary Day that coincides with or next follows the day the
application for reinstatement is approved by the Company, provided the Insured
is alive on such day.
TERMINATION OF COVERAGE. All coverage under this certificate will automatically
terminate upon whichever of the following occurs first:
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INSURANCE COVERAGE PROVISIONS (CONTINUED)
1. The Certificate Owner surrenders the certificate.
2. The Insured dies.
3. The certificate matures at its Coverage Date.
4. The grace period ends and the necessary premium payment has not been made
prior to such time.
Any monthly deduction made after termination of coverage will not, by itself, be
considered a reinstatement of the certificate nor a waiver by the Company of the
termination. Any such deduction will be refunded.
DEATH BENEFIT. If the Insured dies while the certificate is in force, the
Company will pay a death benefit based upon the Death Benefit Option in effect
on the date of death, less (a) any indebtedness against the certificate and (b)
the amount of any partial surrenders.
The Death Benefit Options available under this certificate are as follows:
DEATH Insured's Specified Amount includes the Accumulation Value. The
BENEFIT Insured's death benefit (before deduction of any indebtedness against
OPTION 1 the certificate and the amount of any partial surrenders) will equal
the greater of:
(a) the Specified Amount on the date of death, or
(b) an amount determined by the Company equal to that required by the
Internal Revenue Code to maintain this certificate as life
insurance (See Schedule 4). Any amount so determined will be set
forth in the annual report which the Company will send to the
Certificate Owner.
DEATH The Insured's Specified Amount is in addition to the Accumulation
BENEFIT Value. The Insured's death benefit (before deduction of any
OPTION 2 indebtedness against the certificate and the amount of any partial
surrenders) will equal the greater of:
(a) the Specified Amount on the date of death plus the Accumulation
Value on the date of death, or
(b) an amount determined by the Company equal to that required by the
Internal Revenue Code to maintain this certificate as life
insurance (See Schedule 4). Any amount so determined will be set
forth in the annual report which the Company will send to the
Certificate Owner.
Unless the application for the certificate indicates otherwise, or a change in
the death benefit option is effected as provided below, the Company will
consider Death Benefit Option 1 to be the option in effect.
CHANGES IN SPECIFIED AMOUNT. Unless provided otherwise, a change in Specified
Amount may be effected any time while this certificate is in force, subject to
(a) the consent of the Company and (b) the following conditions:
1. All such changes must be requested in writing on a form satisfactory to the
Company and filed at the Home Office.
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<PAGE>
INSURANCE COVERAGE PROVISIONS (CONTINUED)
2. If a decrease in the Insured's Specified Amount is requested, the decrease
will become effective on the Monthly Anniversary Day that coincides with or
next follows receipt of the request provided any requirements as determined
by the Company are met.
In such event, the Company will reduce the existing Specified Amount
against the most recent increase first, then against the next most recent
increases successively, and finally, against insurance provided under the
original application; however, the Company reserves the right to limit the
amount of any decrease so that the Specified Amount will not be less than
the Minimum Specified Amount shown in the Certificate Specifications.
3. If an increase in the Insured's Specified Amount is requested:
(a) a supplemental application must be submitted and evidence of
insurability satisfactory to the Company must be furnished; and
(b) any other requirements as determined by the Company must be met.
If the Company approves the request, the increase will become effective
upon (i) the Monthly Anniversary Day that coincides with or next follows
the date the request is approved by the Company and (ii) the deduction from
the Accumulation Value (in proportion to the then current account values of
the Fixed Account and/or Variable Account Sub-Accounts) of the first
month's cost of insurance for the increase, provided the Insured is alive
on such day.
4. If a request is made to change the death benefit from Death Benefit Option
1 to Death Benefit Option 2:
(a) the Specified Amount will be reduced to equal the death benefit, less
the Accumulation Value, as of the effective date of change; and
(b) the effective date will be the Monthly Anniversary Day that coincides
with or next follows the date of receipt of the request for change.
5. If a request is made to change the death benefit from Death Benefit Option
2 to Death Benefit Option 1:
(a) the Specified Amount will be increased to equal the death benefit as
of the effective date of change; and
(b) the effective date will be the Monthly Anniversary Day that coincides
with or next follows the date of receipt of the request for change.
The Company will not allow a decrease in the amount of insurance below the
minimum amount required to maintain this certificate as life insurance under the
Internal Revenue Code.
RIGHT TO CONVERT. The Certificate Owner may convert this certificate to a
substantially comparable flexible premium adjustable life insurance policy
without evidence of insurability for an amount of insurance not exceeding the
death benefit of the variable life insurance certificate on the date of
conversion.
GENERAL PROVISIONS
THE GROUP POLICY AND THE CERTIFICATE. The group policy is an agreement between
the Policyowner and the Company and this certificate is based on the group
policy. The certificate (including any amendments, endorsements or rider
attached thereto), and the application for the certificate (a copy of which is
attached to the certificate when issued), constitute the entire certificate.
All statements made in the application will be deemed representations and not
warranties. No statement will be used in defense of a claim under the
certificate unless it is contained in the application, and a copy of the
application is attached to the certificate when issued.
LN617 22
<PAGE>
GENERAL PROVISIONS (CONTINUED)
Only the President, a Vice President, a Secretary, a Director or an Assistant
Director of the Company may execute or modify this group policy or any
certificate issued under it.
Both the group policy and this certificate are executed at the Company's Home
Office, the mailing address of which for this certificate is CIGNA Individual
Insurance, Variable Products Service Center, Routing S249, Hartford,
Connecticut 06152-2249.
MODIFICATION OF CERTIFICATE. The Company reserves the right to modify this
certificate to meet the requirements of applicable state and federal laws or
regulations. The Company will notify the Certificate Owner in writing of any
changes that bear upon the certificate.
NON-PARTICIPATION. This certificate is not entitled to share in surplus
distribution.
PAYMENT OF PROCEEDS. Proceeds, as used in this certificate, means the amount
payable (a) on the Coverage Date, (b) upon the surrender of this certificate
before the Coverage Date, or (c) upon the death of the Insured.
The proceeds payable to the Beneficiary upon receipt of due proof of the
Insured's death will be the Death Benefit as of the date of death which takes
into account (a) any indebtedness against the certificate and (b) the amount of
any partial surrenders (See "Death Benefit" provision). If the Insured dies
during the grace period, the Company will pay the death benefit proceeds in
effect immediately prior to the grace period reduced by any overdue monthly
deductions.
If the certificate is surrendered before the Coverage Date, the proceeds will be
the surrender value described in the "Nonforfeiture and Surrender Value
Provisions" section. On the Coverage Date, the proceeds will be the Surrender
Value.
The proceeds are subject to the adjustments described in the following
provisions:
1. Misstatement of Age or Sex;
2. Incontestability;
3. Suicide;
4. Grace Period;
5. Indebtedness; and
6. Partial Surrender
When settlement is made, the Company may require return of the certificate.
DEFERMENT OF PAYMENTS. Any amounts payable as a result of loans, surrender, or
partial surrenders will be paid within 7 days of the Company's receipt of such
request. However, payment of amounts from the Variable Account Sub-Accounts may
be postponed when the NYSE is closed or when the SEC declares an emergency.
Additionally, the Company reserves the right to defer the payment of such
amounts from the Fixed Account for a period not to exceed 6 months from the date
written request is received by the Company; during any such deferred period, the
amount payable will bear interest as required by law.
MISSTATEMENT OF AGE OR SEX. If the age or sex of the Insured is misstated, the
Company will adjust all benefits to the amounts that would have been purchased
for the correct age and sex.
LN617 23
<PAGE>
GENERAL PROVISIONS (CONTINUED)
SUICIDE. If the Insured commits suicide within 2 years from the Certificate
Date, the death benefit will be limited to a refund of premiums paid, less (a)
any indebtedness against the certificate and (b) the amount of any partial
surrenders. If the Insured commits suicide within 2 years from the effective
date of any increase in the Specified Amount, the death benefit payment with
respect to such increase will be limited to a refund of the monthly charges for
the cost of such additional insurance.
INCONTESTABILITY. Except for nonpayment of monthly deductions, this certificate
will be incontestable after it has been in force during the Insured's lifetime
for 2 years from its Certificate Date. This means that the Company will not use
any misstatement in the application to challenge a claim or avoid liability
after that time. Any increase in the Specified Amount effective after the
Certificate Date will be incontestable only after such increase has been in
force for 2 years during the Insured's lifetime.
The basis for contesting an increase in Specified Amount will be limited to
material misrepresentations made in the supplemental application for the
increase. The basis for contesting after reinstatement will be (a) limited for a
period of 2 years from the date of reinstatement and (b) limited to material
misrepresentations made in the reinstatement application.
ANNUAL REPORT. The Company will send a report to the Certificate Owner at least
once a year without charge. The report will show the Accumulation Value as of
the reporting date and the amounts deducted from or added to the Accumulation
Value since the last report. The report will also show (a) the current death
benefit, (b) the current certificate values, (c) premiums paid and all
deductions made since the last report, (d) outstanding certificate loans, and
(e) any other information required by the Superintendent of Insurance.
PROJECTION OF BENEFITS AND VALUES. The Company will provide a projection of
illustrative future death benefits and values to the Certificate Owner at any
time upon written request and payment of a reasonable service fee.
CHANGE OF PLAN. Within the first 2 Certificate Years the Certificate Owner may
exchange this certificate without any evidence of insurability for any one of
the permanent insurance policies then being issued by the Company to the same
class to which this certificate belongs. The request for the exchange must be
received by the Company within 24 months from the Certificate Date. Unless
otherwise agreed to between the Certificate Owner and the Company, the new
policy shall have the same amount of insurance and surrender value as this
certificate as of the date of exchange, its date of issue shall be the date of
exchange, and the Insured's issue age under the new policy shall be the
Insured's then attained age (as of the date of exchange).
CERTIFICATE CHANGES - APPLICABLE LAW. This certificate must qualify initially
and continue to qualify as life insurance under the Internal Revenue Code in
order for the Certificate Owner to receive the tax treatment accorded to life
insurance under Federal law. Therefore, to maintain this qualification to the
maximum extent permitted by law, the Company reserves the right to return any
premium payments that would cause this certificate to fail to qualify as life
insurance under applicable tax law as interpreted by the Company. Further, the
Company reserves the right to make changes in this certificate or to make
distributions from the certificate to the extent it deems necessary, in its sole
discretion, to continue to qualify this certificate as life insurance. Any such
changes will apply uniformly to all policies that are affected. The Certificate
Owner will be given advance written notice of such changes.
LN617 24
<PAGE>
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
FLEXIBLE PREMIUM GROUP VARIABLE LIFE INSURANCE CERTIFICATE
Variable life insurance payable in the event of death before the Coverage Date.
Surrender Value payable on the Coverage Date
Flexible premiums payable to Coveratge Date or prior death of the Insured.
Non-participating. Investment results reflected in certificate benefits.
LN617
<PAGE>
OPTIONAL METHODS OF SETTLEMENT
This rider is made part of the certificate to which it is attached as of the
Certificate Date. Upon written request, the Company will agree to pay in
accordance with any one of the options shown below all or part of the net
proceeds that may be payable under the certificate.
If any income optional settlement provides for instalment payments for a given
age of payee for an amount which would be the same for different periods
certain, the Company will deem that an election has been made for the longest
period certain for such age and amount.
While the Insured is alive, the request, including the designation of the payee,
may be made by the Certificate Owner. At the time a Death Benefit becomes
payable under the certificate, the request, including the designation of the
payee, may then be made by the Beneficiary. Once Income Payments have begun,
the certificate cannot be surrendered and the payee cannot be changed, nor can
the settlement option be changed.
PAYMENT DATES. The first Income Payment under the settlement option selected
will become payable on the date proceeds are settled under the option.
Subsequent payments will be made on the first day of each month in accordance
with the manner of payment selected.
MINIMUM PAYMENT AMOUNT. The settlement option elected must result in an Income
Payment at least equal to the minimum payment amount in accordance with the
Company's rules then in effect. If at any time payments are less than the
minimum payment amount, the Company has the right to change the frequency to an
interval that will provide the minimum payment amount. If any amount due is
less than the minimum per year, the Company may make other arrangements that are
equitable.
INCOME PAYMENTS. Income Payments will remain constant pursuant to the terms of
the settlement option(s) selected. The amount of each Income Payment shall be
determined in accordance with the terms of the settlement option and the
table(s) set forth in this rider, as applicable. The mortality table used is
the 1983 Individual Annuitant Mortality (IAM) Table "a" and 3% interest. In
determining the settlement amount, the settlement age of the payee will be
reduced by one year when the first installment is payable during the 1990's,
reduced by two years when the first installment is payable during the decade
2000-2009, and so on.
FIRST OPTION: LIFE ANNUITY. An annuity payable monthly to the payee during the
lifetime of the payee, ceasing with the last payment due prior to the death of
the payee.
SECOND OPTION: LIFE ANNUITY WITH CERTAIN PERIOD. An annuity providing monthly
income to the payee for a fixed period of 60, 120, 180, or 240 months (as
selected), and for as long thereafter as the payee shall live.
THIRD OPTION: ANNUITY CERTAIN. An amount payable monthly for the number of
years selected which may be from 5 to 30 years.
FOURTH OPTION: AS A DEPOSIT AT INTEREST. The Company will retain the proceeds
while the payee is alive and will pay interest annually thereon at a rate of not
less than 3% per year. Upon the payee's death, the amount on deposit will be
paid.
EXCESS INTEREST. At the sole discretion of the Company, excess interest may be
paid or credited from time to time in addition to the payments guaranteed under
any Optional Method of Settlement.
ADDITIONAL OPTIONS. Any proceeds payable under the certificate may also be
settled under any other method of settlement offered by the Company at the time
of the request.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
/s/ Thomas G. Jones
PRESIDENT
LR462 LR462 (Page 1)
<PAGE>
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD TABLE
FOR EACH $1,000 APPLIED - MALE
<TABLE>
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
10 $2.87 $2.87 $2.87 $2.87 $2.87
11 2.89 2.89 2.89 2.88 2.88
12 2.90 2.90 2.90 2.90 2.90
13 2.92 2.92 2.91 2.91 2.91
14 2.93 2.93 2.93 2.93 2.92
15 2.95 2.95 2.95 2.94 2.94
16 2.96 2.96 2.96 2.96 2.96
17 2.98 2.98 2.98 2.98 2.97
18 3.00 3.00 3.00 2.99 2.99
19 3.02 3.02 3.01 3.01 3.01
20 3.04 3.04 3.03 3.03 3.03
21 3.06 3.05 3.05 3.05 3.05
22 3.08 3.08 3.07 3.07 3.07
23 3.10 3.10 3.09 3.09 3.09
24 3.12 3.12 3.12 3.11 3.11
25 3.14 3.14 3.14 3.14 3.13
26 3.17 3.17 3.16 3.16 3.15
27 3.19 3.19 3.19 3.19 3.18
28 3.22 3.22 3.22 3.21 3.20
29 3.25 3.25 3.24 3.24 3.23
30 3.28 3.28 3.27 3.27 3.26
31 3.31 3.31 3.30 3.30 3.29
32 3.34 3.34 3.33 3.33 3.32
33 3.37 3.37 3.37 3.36 3.35
34 3.41 3.41 3.40 3.39 3.38
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
35 $3.44 $3.44 $3.44 $3.43 $3.41
36 3.48 3.48 3.48 3.46 3.45
37 3.52 3.52 3.52 3.50 3.48
38 3.57 3.56 3.56 3.54 3.52
39 3.61 3.61 3.60 3.58 3.56
40 3.66 3.65 3.65 3.63 3.60
41 3.71 3.70 3.69 3.67 3.64
42 3.76 3.75 3.74 3.72 3.68
43 3.81 3.81 3.79 3.77 3.73
44 3.87 3.86 3.85 3.82 3.77
45 3.93 3.92 3.90 3.87 3.82
46 3.99 3.98 3.96 3.92 3.87
47 4.05 4.05 4.02 3.98 3.92
48 4.12 4.11 4.09 4.04 3.97
49 4.19 4.18 4.15 4.10 4.03
50 4.27 4.26 4.22 4.17 4.08
51 4.34 4.33 4.30 4.23 4.14
52 4.43 4.41 4.37 4.30 4.20
53 4.51 4.50 4.45 4.37 4.26
54 4.60 4.59 4.54 4.45 4.32
55 4.70 4.68 4.62 4.53 4.39
56 4.80 4.78 4.72 4.61 4.45
57 4.91 4.89 4.82 4.69 4.51
58 5.03 5.00 4.92 4.78 4.58
59 5.15 5.12 5.03 4.87 4.65
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
60 $5.28 $5.25 $5.14 $4.96 $4.71
61 5.43 5.39 5.27 5.06 4.78
62 5.58 5.53 5.39 5.16 4.84
63 5.74 5.69 5.53 5.26 4.90
64 5.91 5.85 5.66 5.36 4.96
65 6.10 6.03 5.81 5.46 5.02
66 6.30 6.21 5.96 5.56 5.08
67 6.51 6.41 6.12 5.66 5.13
68 6.73 6.62 6.28 5.77 5.18
69 6.97 6.84 6.44 5.86 5.23
70 7.23 7.07 6.61 5.96 5.27
71 7.51 7.32 6.79 6.05 5.31
72 7.80 7.58 6.96 6.14 5.34
73 8.12 7.85 7.14 6.23 5.37
74 8.46 8.14 7.32 6.31 5.40
75 8.82 8.45 7.50 6.38 5.42
76 9.21 8.76 7.67 6.45 5.44
77 9.63 9.10 7.84 6.51 5.45
78 10.08 9.44 8.01 6.57 5.47
79 10.56 9.80 8.17 6.62 5.48
80 11.07 10.17 8.33 6.66 5.49
81 11.62 10.55 8.48 6.70 5.49
82 12.20 10.94 8.61 6.73 5.50
83 12.82 11.33 8.74 6.76 5.50
84 13.47 11.73 8.86 6.79 5.51
85 14.17 12.12 8.97 6.81 5.51
</TABLE>
LR462 LR462 (Page 3)
<PAGE>
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD TABLE
FOR EACH $1,000 APPLIED - FEMALE
<TABLE>
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
10 $2.80 $2.80 $2.80 $2.80 $2.80
11 2.81 2.81 2.81 2.81 2.81
12 2.82 2.82 2.82 2.82 2.82
13 2.83 2.83 2.83 2.83 2.83
14 2.85 2.85 2.85 2.84 2.84
15 2.86 2.86 2.86 2.86 2.86
16 2.87 2.87 2.87 2.87 2.87
17 2.89 2.89 2.89 2.88 2.88
18 2.90 2.90 2.90 2.90 2.90
19 2.92 2.92 2.92 2.91 2.91
20 2.93 2.93 2.93 2.93 2.93
21 2.95 2.95 2.95 2.95 2.94
22 2.96 2.96 2.96 2.96 2.96
23 2.98 2.98 2.98 2.98 2.98
24 3.00 3.00 3.00 3.00 2.99
25 3.02 3.02 3.02 3.02 3.01
26 3.04 3.04 3.04 3.03 3.03
27 3.06 3.06 3.06 3.06 3.05
28 3.08 3.08 3.08 3.08 3.07
29 3.10 3.10 3.10 3.10 3.09
30 3.13 3.13 3.12 3.12 3.12
31 3.15 3.15 3.15 3.14 3.14
32 3.18 3.18 3.17 3.17 3.16
33 3.20 3.20 3.20 3.20 3.19
34 3.23 3.23 3.23 3.22 3.22
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
35 $3.26 $3.26 $3.26 $3.25 $3.24
36 3.29 3.29 3.29 3.28 3.27
37 3.32 3.32 3.32 3.31 3.30
38 3.35 3.35 3.35 3.34 3.33
39 3.39 3.39 3.38 3.38 3.37
40 3.42 3.42 3.42 3.41 3.40
41 3.46 3.46 3.46 3.45 3.43
42 3.50 3.50 3.50 3.49 3.47
43 3.54 3.54 3.54 3.53 3.51
44 3.59 3.59 3.58 3.57 3.55
45 3.64 3.63 3.63 3.61 3.59
46 3.68 3.68 3.67 3.66 3.63
47 3.73 3.73 3.72 3.71 3.68
48 3.79 3.79 3.77 3.76 3.72
49 3.84 3.84 3.83 3.81 3.77
50 3.90 3.90 3.89 3.86 3.82
51 3.97 3.96 3.95 3.92 3.88
52 4.03 4.03 4.01 3.98 3.93
53 4.10 4.10 4.08 4.04 3.99
54 4.18 4.17 4.15 4.11 4.04
55 4.25 4.25 4.22 4.18 4.11
56 4.34 4.33 4.30 4.25 4.17
57 4.42 4.41 4.38 4.32 4.23
58 4.52 4.51 4.47 4.40 4.30
59 4.61 4.60 4.56 4.48 4.37
<CAPTION>
- ---------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
60 $4.72 $4.70 $4.66 $4.57 $4.44
61 4.83 4.81 4.76 4.66 4.51
62 4.95 4.93 4.87 4.75 4.58
63 5.08 5.05 4.98 4.85 4.65
64 5.21 5.18 5.10 4.95 4.72
65 5.36 5.32 5.22 5.05 4.79
66 5.51 5.47 5.36 5.16 4.86
67 5.67 5.63 5.50 5.26 4.93
68 5.85 5.80 5.65 5.37 5.00
69 6.04 5.98 5.80 5.49 5.06
70 6.25 6.18 5.97 5.60 5.12
71 6.47 6.39 6.14 5.71 5.18
72 6.71 6.62 6.32 5.83 5.23
73 6.98 6.86 6.50 5.94 5.28
74 7.26 7.12 6.69 6.04 5.32
75 7.57 7.40 6.89 6.14 5.35
76 7.90 7.69 7.09 6.24 5.39
77 8.26 8.01 7.29 6.33 5.41
78 8.65 8.34 7.49 6.41 5.43
79 9.08 8.70 7.69 6.49 5.45
80 9.54 9.07 7.89 6.55 5.47
81 10.03 9.47 8.08 6.61 5.48
82 10.58 9.88 8.26 6.66 5.49
83 11.16 10.31 8.43 6.70 5.49
84 11.80 10.75 8.59 6.74 5.50
85 12.48 11.20 8.74 6.77 5.50
</TABLE>
ANNUITY CERTAIN TABLE FOR EACH $1,000 APPLIED
<TABLE>
<CAPTION>
- -----------------------------------------------------
Number of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- -----------------------------------------------------
<S> <C> <C>
5 $211.99 $17.91
6 179.22 15.14
7 155.83 13.16
8 138.31 11.68
9 124.69 10.53
10 113.82 9.61
11 104.93 8.86
<CAPTION>
- -----------------------------------------------------
Numbers of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- -----------------------------------------------------
<S> <C> <C>
12 $97.54 $8.24
13 91.29 7.71
14 85.95 7.26
15 81.33 6.87
16 77.29 6.53
17 73.74 6.23
18 70.59 5.96
<CAPTION>
- -----------------------------------------------------
Numbers of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- -----------------------------------------------------
<S> <C> <C>
19 $67.78 $5.73
20 65.26 5.51
25 55.76 4.71
30 49.53 4.18
</TABLE>
LR462 LR462 (Page 4)
<PAGE>
OPTIONAL METHODS OF SETTLEMENT
This rider is made part of the certificate to which it is attached as of the
Certificate Date. Upon written request, the Company will agree to pay in
accordance with any one of the options shown below all or part of the net
proceeds that may be payable under the certificate.
If any income optional settlement provides for instalment payments for a given
age of payee for an amount which would be the same for different periods
certain, the Company will deem that an election has been made for the longest
period certain for such age and amount.
While the Insured is alive, the request, including the designation of the payee,
may be made by the Certificate Owner. At the time a Death Benefit becomes
payable under the certificate, the request, including the designation of the
payee, may then be made by the Beneficiary. Once Income Payments have begun,
the certificate cannot be surrendered and the payee cannot be changed, nor can
the settlement option be changed.
PAYMENT DATES. The first Income Payment under the settlement option selected
will become payable on the date proceeds are settled under the option.
Subsequent payments will be made on the first day of each month in accordance
with the manner of payment selected.
MINIMUM PAYMENT AMOUNT. The settlement option elected must result in an Income
Payment at least equal to the minimum payment amount in accordance with the
Company's rules then in effect. If at any time payments are less than the
minimum payment amount, the Company has the right to change the frequency to an
interval that will provide the minimum payment amount. If any amount due is
less than the minimum per year, the Company may make other arrangements that are
equitable.
INCOME PAYMENTS. Income Payments will remain constant pursuant to the terms of
the settlement option(s) selected. The amount of each Income Payment shall be
determined in accordance with the terms of the settlement option and the
table(s) set forth in this rider, as applicable. The mortality table used is
the 1983 Individual Annuitant Mortality (IAM) Table "a" and 3% interest. In
determining the settlement amount, the settlement age of the payee will be
reduced by one year when the first installment is payable during the 1990's,
reduced by two years when the first installment is payable during the decade
2000-2009, and so on.
FIRST OPTION: LIFE ANNUITY. An annuity payable monthly to the payee during the
lifetime of the payee, ceasing with the last payment due prior to the death of
the payee.
SECOND OPTION: LIFE ANNUITY WITH CERTAIN PERIOD. An annuity providing monthly
income to the payee for a fixed period of 60, 120, 180, or 240 months (as
selected), and for as long thereafter as the payee shall live.
THIRD OPTION: ANNUITY CERTAIN. An amount payable monthly for the number of
years selected which may be from 5 to 30 years.
FOURTH OPTION: AS A DEPOSIT AT INTEREST. The Company will retain the proceeds
while the payee is alive and will pay interest annually thereon at a rate of not
less than 3% per year. Upon the payee's death, the amount on deposit will be
paid.
EXCESS INTEREST. At the sole discretion of the Company, excess interest may be
paid or credited from time to time in addition to the payments guaranteed under
any Optional Method of Settlement.
ADDITIONAL OPTIONS. Any proceeds payable under the certificate may also be
settled under any other method of settlement offered by the Company at the time
of the request.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
/s/ Thomas G. Jones
PRESIDENT
LR463 LR463 (Page 1)
<PAGE>
OPTIONAL METHODS OF SETTLEMENT (CONTINUED)
LIFE ANNUITY AND LIFE ANNUITY WITH CERTAIN PERIOD
TABLE FOR EACH $1,000 APPLIED - UNISEX
<TABLE>
<CAPTION>
- ---------------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
10 2.84 2.84 2.84 2.84 2.83
11 2.85 2.85 2.85 2.85 2.85
12 2.86 2.86 2.86 2.86 2.86
13 2.88 2.88 2.88 2.87 2.87
14 2.89 2.89 2.89 2.89 2.89
15 2.91 2.90 2.90 2.90 2.90
16 2.92 2.92 2.92 2.92 2.91
17 2.94 2.94 2.93 2.93 2.93
18 2.95 2.95 2.95 2.95 2.95
19 2.97 2.97 2.97 2.96 2.96
20 2.99 2.99 2.98 2.98 2.98
21 3.00 3.00 3.00 3.00 3.00
22 3.02 3.02 3.02 3.02 3.01
23 3.04 3.04 3.04 3.04 3.03
24 3.06 3.06 3.06 3.06 3.05
25 3.08 3.08 3.08 3.08 3.07
26 3.11 3.11 3.10 3.10 3.10
27 3.13 3.13 3.13 3.12 3.12
28 3.15 3.15 3.15 3.15 3.14
29 3.18 3.18 3.17 3.17 3.16
30 3.20 3.20 3.20 3.20 3.19
31 3.23 3.23 3.23 3.22 3.22
32 3.26 3.26 3.26 3.25 3.24
33 3.29 3.29 3.29 3.28 3.27
34 3.32 3.32 3.32 3.31 3.30
<CAPTION>
- ---------------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
35 3.35 3.35 3.35 3.34 3.33
36 3.39 3.39 3.38 3.38 3.36
37 3.42 3.42 3.42 3.41 3.40
38 3.46 3.46 3.46 3.45 3.43
39 3.50 3.50 3.49 3.48 3.47
40 3.54 3.54 3.54 3.52 3.50
41 3.59 3.59 3.58 3.56 3.54
42 3.63 3.63 3.62 3.61 3.58
43 3.68 3.68 3.67 3.65 3.62
44 3.73 3.73 3.72 3.70 3.67
45 3.78 3.78 3.77 3.74 3.71
46 3.84 3.84 3.82 3.79 3.76
47 3.90 3.89 3.88 3.85 3.80
48 3.96 3.95 3.93 3.90 3.85
49 4.02 4.02 3.99 3.96 3.91
50 4.09 4.08 4.06 4.02 3.96
51 4.16 4.15 4.13 4.08 4.01
52 4.23 4.22 4.20 4.15 4.07
53 4.31 4.30 4.27 4.21 4.13
54 4.39 4.38 4.35 4.28 4.19
55 4.48 4.47 4.43 4.36 4.25
56 4.57 4.56 4.51 4.43 4.32
57 4.67 4.65 4.60 4.51 4.38
58 4.78 4.76 4.70 4.60 4.45
59 4.89 4.87 4.80 4.68 4.51
<CAPTION>
- ---------------------------------------------------------
Settlement age of Number of instalments certain
payee nearest
birthday 60 120 180 240
- ---------------------------------------------------------
Age Life Annuity
<S> <C> <C> <C> <C> <C>
60 5.00 4.98 4.91 4.77 4.58
61 5.13 5.10 5.02 4.87 4.65
62 5.27 5.23 5.13 4.96 4.72
63 5.41 5.37 5.26 5.06 4.79
64 5.56 5.52 5.39 5.16 4.85
65 5.73 5.68 5.52 5.27 4.92
66 5.90 5.84 5.67 5.37 4.98
67 6.09 6.02 5.82 5.48 5.04
68 6.29 6.21 5.97 5.58 5.10
69 6.51 6.41 6.13 5.69 5.15
70 6.74 6.63 6.30 5.79 5.20
71 6.99 6.86 6.47 5.90 5.25
72 7.25 7.10 6.65 6.00 5.29
73 7.54 7.36 6.83 6.09 5.33
74 7.85 7.63 7.02 6.19 5.36
75 8.19 7.92 7.21 6.27 5.39
76 8.55 8.23 7.39 6.36 5.42
77 8.93 8.56 7.58 6.43 5.44
78 9.35 8.90 7.77 6.50 5.45
79 9.80 9.26 7.95 6.56 5.47
80 10.29 9.63 8.12 6.61 5.48
81 10.81 10.02 8.29 6.66 5.49
82 11.37 10.42 8.45 6.70 5.49
83 11.98 10.83 8.60 6.74 5.50
84 12.62 11.25 8.74 6.76 5.50
85 13.31 11.67 8.86 6.79 5.51
</TABLE>
ANNUITY CERTAIN TABLE FOR EACH $1,000 APPLIED
<TABLE>
<CAPTION>
- --------------------------------------------------
Numbers of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- --------------------------------------------------
<S> <C> <C>
5 $211.99 $17.91
6 179.22 15.14
7 155.83 13.16
8 138.31 11.68
9 124.69 10.53
10 113.82 9.61
11 104.93 8.86
<CAPTION>
- --------------------------------------------------
Number of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- --------------------------------------------------
<S> <C> <C>
12 $97.54 $8.24
13 91.29 7.71
14 85.95 7.26
15 81.33 6.87
16 77.29 6.53
17 73.74 6.23
18 70.59 5.96
<CAPTION>
- --------------------------------------------------
Number of years Amount of each instalment
during which
instalments will be
paid Annual Monthly
- --------------------------------------------------
<S> <C> <C>
19 $67.78 $5.73
20 65.26 5.51
25 55.76 4.71
30 49.53 4.18
</TABLE>
LR463 LR463 (Page 3)
<PAGE>
WAIVER OF MONTHLY DEDUCTION BENEFIT RIDER
This rider is made part of the certificate to which it is attached if "Form
LR464, Waiver of Monthly Deduction Benefit" is shown in the Certificate
Specifications. As used in this rider the Date of Expiry is the certificate
anniversary nearest to the Insured's 65th birthday.
BENEFITS. The Company will waive the monthly deductions falling due under the
certificate, during the continuance of Total Disability (as defined below)
provided: (a) Total Disability commences prior to the certificate anniversary
nearest to the Insured's 60th birthday, (b) the Home Office is furnished due
proof that the Insured has become so disabled, and (c) the Insured has remained
continuously so disabled for at least 6 consecutive months.
If Total Disability commences on or after the certificate anniversary nearest to
the Insured's 60th birthday but prior to the Date of Expiry, such monthly
deductions falling due will be waived subject to the above due proof and
continuous disability requirements.
If Total Disability commences prior to the certificate anniversary nearest to
the Insured's 60th birthday and the Insured remains continuously so disabled to
the certificate anniversary nearest to the Insured's 65th birthday, Total
Disability will be deemed to be permanent. In such event, all such monthly
deductions falling due subsequent to the certificate anniversary nearest the
Insured's 65th birthday will be waived automatically as long as the Insured
shall live.
All monthly deductions made which subsequently qualify for waiver will be added
to the Accumulation Value in the same manner in which monthly deductions are
made under the certificate.
DEFINITION OF TOTAL DISABILITY. The term "Total Disability" as used in this
rider means the complete incapacity of the Insured which (a) results from bodily
injury or disease beginning while the certificate and this rider are in force,
and (b) during the first 24 months of disability prevents the Insured from
performing the duties of the Insured's occupation for remuneration or profit and
thereafter prevents the Insured from engaging in any occupation for remuneration
or profit for which the Insured is qualified or may reasonably become qualified
by education, training or experience.
The term "Total Disability" also means the total and irrecoverable loss of the
sight of both eyes, or of the use of both hands, or both feet, or of one hand
and one foot whether or not such loss prevents the Insured from engaging in any
occupation or business provided, however, the cause of such loss occurs after
the effective date of this rider.
RISKS NOT COVERED. The insurance under this rider does not cover disability
resulting from (a) intentionally self-inflicted injury or (b) military or naval
service with any country at war. "Military or naval service" includes service in
any air force or branch of any country or international organization or
combination of countries. "War" includes undeclared war and armed conflict
involving the military, naval or air forces of any country, international
organization or combination of countries.
CHANGE IN DEATH BENEFIT. The Company will not allow an increase in the Specified
Amount under the certificate during the continuance of Total Disability.
Unless provided otherwise, if Death Benefit Option 1 is in effect when waiver of
monthly deductions commence, the Company will automatically change it to Death
Benefit Option 2. In such event, the Company will reduce the Specified Amount to
equal the death benefit less the Accumulation Value of the certificate as of the
date Total Disability commenced.
COST OF INSURANCE. The cost for the insurance provided by this rider will be
part of the monthly deduction made under the certificate. The amount so deducted
each month will be determined by multiplying the applicable Rate Factor from the
table below by the sum of all the other covered monthly charges for the
certificate and all riders.
LR464 LR464 (Page 1)
<PAGE>
If the Insured is in a rated premium class, the rate factor used in determining
the cost for the insurance will be the Rate Factor from the table multiplied by
the Risk Factor, if any, shown in the Certificate Specifications.
------------------------------------------------------------
------------------------------------------------------------
ATTAINED
AGE MALE RATE FEMALE RATE
(NEAREST BIRTHDAY) FACTOR FACTOR
------------------------------------------------------------
5-24 .0270 .0315
25-39 .0300 .0350
40-44 .0300 .0425
45-49 .0350 .0500
50-54 .0500 .0600
55 .0650 .0800
56 .0750 .0900
57 .0850 .1000
58 .0950 .1100
59 .1050 .1200
60 .0750 .0900
61 .0700 .0850
62 .0650 .0800
63 .0500 .0600
64 .0200 .0300
------------------------------------------------------------
------------------------------------------------------------
WRITTEN NOTICE AND PROOF OF CLAIM. Written notice of claim and due proof of
Total Disability must be given to the Company at the Home Office (a) while the
Insured is alive and during the continuance of Total Disability.
Failure to give such timely notice and proof will not, however, invalidate or
diminish any claim if it is shown that such notice and proof were given as soon
as was reasonably possible.
PROOF OF CONTINUATION OF TOTAL DISABILITY. While the Insured is disabled, the
Company may require proof of the continuance of Total Disability and may require
the Insured to be examined at reasonable intervals by a physician other than the
Insured. The Company may not, however, require such proof more often than once
a year if at least 2 years have elapsed since the approval of the claim. If
such proof is not furnished or if the Insured fails to submit to such
examination no further monthly deductions will be waived.
RECOVERY FROM DISABILITY. If and when the Insured has recovered from Total
Disability, no further monthly deductions will be waived. Monthly deductions
becoming due after such recovery will be made in accordance with the terms of
the certificate.
TERMINATION. This rider and all insurance provided under it will terminate
automatically upon whichever of the following occurs first: (a) the Date of
Expiry, except with respect to benefits accruing during the continuance of any
then existing Total Disability for which the Company has received due proof as
required, (b) nonpayment of a premium within the grace period as specified in
the certificate, (c) the date the certificate matures or is continued in force
under a settlement option, or (d) surrender or other termination of the
certificate. If, however, the certificate is reinstated prior to the Date of
Expiry, this rider will likewise be reinstated.
Upon written request and the return of the certificate for endorsement, this
rider may be terminated as of any Monthly Anniversary Day. In such event,
subsequent monthly deductions will be reduced accordingly.
Any termination of the coverage provided by this rider would be without
prejudice to any claim beginning while this rider was in effect.
LR464 LR464 (Page 2)
<PAGE>
INCONTESTABILITY. Except for nonpayment of monthly deductions, this rider will
be incontestable after it has been in force during the Insured's lifetime and
without the occurrence of Total Disability (a) for 2 years from its date of
issue, or (b) with respect to any requested increase in Specified Amount under
the certificate, for 2 years from the date of such increase.
CONSIDERATION. The consideration for the Waiver of Monthly Deductions Benefit is
the application for this benefit, a copy of which is attached to and made a part
of the certificate, and the payment of the additional cost for this benefit.
EFFECTIVE DATE. This rider becomes effective as of its date of issue which is
the Certificate Date unless a later date is shown in the Certificate
Specifications.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
/s/ Thomas G. Jones
PRESIDENT
LR464 LR464 (Page 3)
<PAGE>
WAIVER OF MONTHLY DEDUCTION BENEFIT RIDER
This rider is made part of the certificate to which it is attached if "Form
LR465, Waiver of Monthly Deduction Benefit" is shown in the Certificate
Specifications. As used in this rider the Date of Expiry is the certificate
anniversary nearest to the Insured's 65th birthday.
BENEFITS. The Company will waive the monthly deductions falling due under the
certificate, during the continuance of Total Disability (as defined below)
provided: (a) Total Disability commences prior to the certificate anniversary
nearest to the Insured's 60th birthday, (b) the Home Office is furnished due
proof that the Insured has become so disabled, and (c) the Insured has remained
continuously so disabled for at least 6 consecutive months.
If Total Disability commences on or after the certificate anniversary nearest to
the Insured's 60th birthday but prior to the Date of Expiry, such monthly
deductions falling due will be waived subject to the above due proof and
continuous disability requirements.
If Total Disability commences prior to the certificate anniversary nearest to
the Insured's 60th birthday and the Insured remains continuously so disabled to
the certificate anniversary nearest to the Insured's 65th birthday, Total
Disability will be deemed to be permanent. In such event, all such monthly
deductions falling due subsequent to the certificate anniversary nearest the
Insured's 65th birthday will be waived automatically as long as the Insured
shall live.
All monthly deductions made which subsequently qualify for waiver will be added
to the Accumulation Value in the same manner in which monthly deductions are
made under the certificate.
DEFINITION OF TOTAL DISABILITY. The term "Total Disability" as used in this
rider means the complete incapacity of the Insured which (a) results from bodily
injury or disease beginning while the certificate and this rider are in force,
and (b) during the first 24 months of disability prevents the Insured from
performing the duties of the Insured's occupation for remuneration or profit and
thereafter prevents the Insured from engaging in any occupation for remuneration
or profit for which the Insured is qualified or may reasonably become qualified
by education, training or experience.
The term "Total Disability" also means the total and irrecoverable loss of the
sight of both eyes, or of the use of both hands, or both feet, or of one hand
and one foot whether or not such loss prevents the Insured from engaging in any
occupation or business provided, however, the cause of such loss occurs after
the effective date of this rider.
RISKS NOT COVERED. The insurance under this rider does not cover disability
resulting from (a) intentionally self-inflicted injury or (b) military or naval
service with any country at war. "Military or naval service" includes service in
any air force or branch of any country or international organization or
combination of countries. "War" includes undeclared war and armed conflict
involving the military, naval or air forces of any country, international
organization or combination of countries.
CHANGE IN DEATH BENEFIT. The Company will not allow an increase in the Specified
Amount under the certificate during the continuance of Total Disability.
Unless provided otherwise, if Death Benefit Option 1 is in effect when waiver of
monthly deductions commence, the Company will automatically change it to Death
Benefit Option 2. In such event, the Company will reduce the Specified Amount to
equal the death benefit less the Accumulation Value of the certificate as of the
date Total Disability commenced.
COST OF INSURANCE. The cost for the insurance provided by this rider will be
part of the monthly deduction made under the certificate. The amount so deducted
each month will be determined by multiplying the applicable Rate Factor from the
table below by the sum of all the other covered monthly charges for the
certificate and all riders.
LR465 LR465 (Page 1)
<PAGE>
If the Insured is in a rated premium class, the rate factor used in determining
the cost for the insurance will be the Rate Factor from the table multiplied by
the Risk Factor, if any, shown in the Certificate Specifications.
--------------------------------
--------------------------------
ATTAINED
AGE RATE
(NEAREST FACTOR
BIRTHDAY)
--------------------------------
5-24 .0270
25-39 .0300
40-44 .0300
45-49 .0350
50-54 .0500
55 .0650
56 .0750
57 .0850
58 .0950
59 .1050
60 .0750
61 .0700
62 .0650
63 .0500
64 .0200
--------------------------------
--------------------------------
WRITTEN NOTICE AND PROOF OF CLAIM. Written notice of claim and due proof of
Total Disability must be given to the Company at the Home Office (a) while the
Insured is alive and during the continuance of Total Disability.
Failure to give such timely notice and proof will not, however, invalidate or
diminish any claim if it is shown that such notice and proof were given as soon
as was reasonably possible.
PROOF OF CONTINUATION OF TOTAL DISABILITY. While the Insured is disabled, the
Company may require proof of the continuance of Total Disability and may require
the Insured to be examined at reasonable intervals by a physician other than the
Insured. The Company may not, however, require such proof more often than once
a year if at least 2 years have elapsed since the approval of the claim. If
such proof is not furnished or if the Insured fails to submit to such
examination no further monthly deductions will be waived.
RECOVERY FROM DISABILITY. If and when the Insured has recovered from Total
Disability, no further monthly deductions will be waived. Monthly deductions
becoming due after such recovery will be made in accordance with the terms of
the certificate.
TERMINATION. This rider and all insurance provided under it will terminate
automatically upon whichever of the following occurs first: (a) the Date of
Expiry, except with respect to benefits accruing during the continuance of any
then existing Total Disability for which the Company has received due proof as
required, (b) nonpayment of a premium within the grace period as specified in
the certificate, (c) the date the certificate matures or is continued in force
under a settlement option, or (d) surrender or other termination of the
certificate. If, however, the certificate is reinstated prior to the Date of
Expiry, this rider will likewise be reinstated.
Upon written request and the return of the certificate for endorsement, this
rider may be terminated as of any Monthly Anniversary Day. In such event,
subsequent monthly deductions will be reduced accordingly.
Any termination of the coverage provided by this rider would be without
prejudice to any claim beginning while this rider was in effect.
LR465 LR465 (Page 2)
<PAGE>
INCONTESTABILITY. Except for nonpayment of monthly deductions, this rider will
be incontestable after it has been in force during the Insured's lifetime and
without the occurrence of Total Disability (a) for 2 years from its date of
issue, or (b) with respect to any requested increase in Specified Amount under
the certificate, for 2 years from the date of such increase.
CONSIDERATION. The consideration for the Waiver of Monthly Deductions Benefit is
the application for this benefit, a copy of which is attached to and made a part
of the certificate, and the payment of the additional cost for this benefit.
EFFECTIVE DATE. This rider becomes effective as of its date of issue which is
the Certificate Date unless a later date is shown in the Certificate
Specifications.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
/s/ Thomas G. Jones
PRESIDENT
LR465 LR465 (Page 3)
<PAGE>
CERTIFICATE OWNER CIGNA INDIVIDUAL INSURANCE [LOGO]
VARIABLE LIFE INSURANCE APPLICATION Connecticut General Life Insurance Company
PART 1 Hartford, CT 06152-2249
MAILING ADDRESS: CIGNA INDIVIDUAL INSURANCE
VARIABLE PRODUCTS SERVICE
CENTER, S249
HARTFORD, CT 06152-2249
<TABLE>
<S> <C>
1. CERTIFICATE
OWNER Name
-----------------------------------------------------------------------------------------
First Middle Last
(FOR JOINT OR
MULTIPLE OWNER- Address
SHIP, ENTER "1," --------------------------------------------------------------------------------------
"2," ETC. ALONG- Number Street City State Zip Code
SIDE OWNERS'
NAMES AND ALONG- Date of / / SS#
SIDE CORRESPOND- Birth -------------- ---------------- Sex / / M Telephone ( )
ING RESPONSES TO Mo. Day Yr. (or Tax Iden. #) / / F --------------------------(HOME)
EACH ITEM) ( )
--------------------------(WORK)
Full Name of Trust (If applicable) --------------------------------------- ----------------
(Also complete Address, Tax Iden. # and Telephone items above) (Date of Trust)
Name(s) of Trustee(s) (If applicable)
-------------------------------------------------------
2. PROPOSED (If Proposed Insured is same as Certificate Owner, skip to Age Nearest Birthday, Place of Birth, and
INSURED Occupation/Employment items)
(MAY NOT BE A Name
CORPORATION OR A -----------------------------------------------------------------------------------------
TRUST; MUST BE A First Middle Last
NATURAL PERSON) Address
---------------------------------------------------------------------------------------
Number Street City State Zip Code
Date of / / SS# Sex / / M Telephone ( )
Birth ------------- --------------- / / F ---------------------(HOME)
( )
---------------------(WORK)
Age Nearest Birthday __________________ Place of Birth ___________________________________
CITY, STATE
Regular Occupation: How long so employed?
-------------------- -------------------
Name of employer and nature of business:
-----------------------------------------------------
-----------------------------------------------------------------------------------------------
3.BENEFICIARY ALL PRIMARY BENEFICIARIES SHALL SHARE EQUALLY UNLESS OTHERWISE INDICATED. IF NO PRIMARY BENEFICIARY IS ALIVE
AT THE TIME DEATH BENEFITS ARE PAYABLE, BENEFITS WILL BE PAID IN EQUAL SHARES TO THE CONTINGENT BENEFICIARIES,
IF SURVIVING THE INSURED, UNLESS OTHERWISE SPECIFIED.
Primary Beneficiary(s) and relationship to Contingent Beneficiary(s) and relationship to
Proposed Insured Proposed Insured
___________________________________ ____________________________________
___________________________________ ____________________________________
___________________________________ ____________________________________
If Beneficiary or Certificate Owner is other than an individual, indicate whether:
Beneficiary is a / / Corporation Certificate Owner is a / / Corporation
/ / Partnership / / Partnership
<PAGE>
4. PLAN Initial Specified Amount (Face Amount) $ ______________
INFORMATION
Death Benefit Option Waiver of Monthly Deduction Benefit
/ / Option 1: Specified Amount / / Yes
/ / Option 2: Specified Amount Plus / / No
Accumulation Value
5. PREMIUM
PAYMENT(S) Initial Premium Payment $ ____________ (MAKE CHECK PAYABLE TO "CGLIC")
IF CERTICATE Planned Periodic Payments $ ____________ Payable / / Annually / / Quarterly
IS FOR USE
WITH A (FILL-INS OPTIONAL) / / Semi-Annually / / PAC
QUALIFIED / / Other ______________________
PLAN, CHECK
HERE: To whom shall premium notices be sent? (MAY NOT CHECK MORE THAN 2)
/ / QUALIFIED / / Certificate Owner / / Insured / / Other _______________________
6. INITIAL FIXED ACCOUNT ________%
PREMIUM
PAYMENT
ALLOCATION
(Allocation to any VARIABLE ACCOUNT - SUB-ACCOUNTS (FUNDS)
one % line must be
10% or more. Use AIM QUEST FOR VALUE
whole percentages ___% AIM V.I. Capital Appreciation Fund ___% Quest Global Equity Portfolio
only. Grand Total ___% AIM V.I. Diversified Income Fund ___% Quest Managed Portfolio
of all allocations ___% AIM V.I. Growth Fund ___% Quest Small Cap Portfolio
made in this section ___% AIM V.I. Value Fund
of the application
must equal 100%)
FIDELITY INVESTMENTS TEMPLETON
If DOLLAR
COST AVERAG- ___% Asset Manager Portfolio ___% Templeton Asset Allocation Fund
ING is employed, ___% Equity-Income Portfolio ___% Templeton International Fund
an allocation must ___% Investment Grade Bonds Portfolio ___% Templeton Stock Fund
be made to the
Fixed Account and
the % allocation
must result in at MASSACHUSETTS FINANCIAL SERVICES OTHER (IF AVAILABLE FOR THESE PRODUCTS)
least $12,000 to
such account. ___% MFS Total Return Series ___% ___________________________________
Please complete ___% MFS Utilities Series ___% ___________________________________
Section 9. ___% MFS World Governments Series
NOTE: ALL PAYMENTS AND VALUES PROVIDED BY THE LIFE INSURANCE CERTIFICATE WHEN BASED ON THE INVESTMENT
EXPERIENCE OF THE VARIABLE ACCOUNT ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. THE DURATION
OF COVERAGE IS VARIABLE AND MAY INCREASE OR DECREASE WHEN BASED UPON THE INVESTMENT EXPERIENCE OF THE
VARIABLE ACCOUNT.
7. REPLACEMENT Will you discontinue, stop paying premiums or initiate a reduction in face amount/cash value on any Life
Insurance if this insurance is issued? / / Yes / / No
IF "YES," GIVE FULL DETAILS BELOW. FORWARD PROPER REPLACEMENT FORMS, IF REQUIRED.
Company Policy Number Amount
________________________ _________________________ _____________________
________________________ _________________________ _____________________
<PAGE>
8. DOLLAR COST
AVERAGING
(FOLLOW INSTRUCTIONS SELECT ONE TRANSFER OPTION ($1,000 MINIMUM PER TRANSFER):
IN SECTION 6 BEFORE / / $_____________ monthly / / $_____________ quarterly
COMPLETING THIS
SECTION) Each amount transferred is to be applied to the following Fund(s) in these percentages (USE WHOLE
PERCENTAGES ONLY. TOTAL MUST EQUAL 100%).
AIM QUEST FOR VALUE
___% AIM V.I. Capital Appreciation Fund ___% Quest Global Equity Portfolio
___% AIM V.I. Diversified Income Fund ___% Quest Managed Portfolio
___% AIM V.I. Growth Fund ___% Quest Small Cap Portfolio
___% AIM V.I. Value Fund
FIDELITY INVESTMENTS TEMPLETON
___% Asset Manager Portfolio ___% Templeton Asset Allocation Fund
___% Equity-Income Portfolio ___% Templeton International Fund
___% Investment Grade Bonds Portfolio ___% Templeton Stock Fund
MASSACHUSETTS FINANCIAL SERVICES OTHER (IF AVAILABLE FOR THESE PRODUCTS)
___% MFS Total Return Series ___% ________________________________
___% MFS Utilities Series ___% ________________________________
___% MFS World Governments Series
I(We) understand that these transfers will be made on the 20th day of the month (or the next business day)
and will continue for the period specified or until the value of the Fund noted above with respect to the
certificate is exhausted or I(we) terminate the program, whichever occurs earlier. I(We) also understand
that I(we) may add to such Fund at any time to continue this program or may change the periodic amounts.
9.UNDERWRITING
INFORMATION
(IN THIS SECTION, a. Do you contemplate flying, or have you flown during the past 2 years as a pilot, student pilot or crew
"YOU" REFERS TO THE member? / / Yes / / No
PROPOSED INSURED IF YES, AN AVIATION SUPPLEMENT IS REQUIRED.
AND RESPONSES ARE TO
BE PROVIDED BY THE b. Do you plan to participate or have you participated within the past 2 years in motor vehicle or boat
PROPOSED INSURED) racing, hang gliding or sky, skin, or scuba diving or similar sports? / / Yes / / No
IF YES, COMPLETE AVOCATION QUESTIONNAIRE.
c. Do you contemplate residence or travel outside of the United States or Canada for more than 30 days
within the next year? / / Yes / / No
IF YES, COMPLETE FOREIGN TRAVEL OR RESIDENCE QUESTIONNAIRE.
d. Have you ever been convicted of a felony? / / Yes / / No
Have you within the last 3 years had convictions for motor vehicle violations, or had your license
suspended, revoked or restricted? / / Yes / / No
IF YES, PROVIDE DETAILS BELOW.
e. Have you within the last 12 months used tobacco in any form? / / Yes / / No
IF YES, DESCRIBE BELOW, THE FREQUENCY, QUANTITY AND KIND OF TOBACCO USED.
f. Have you ever applied for any Life or Health Insurance which resulted in your being turned down,
asked to pay extra premium or issued a reduced face amount? / / Yes / / No
IF YES, PROVIDE DETAILS BELOW.
g. Are you negotiating or have you within the past 6 months negotiated for Life
Insurance? / / Yes / / No
IF YES, INDICATE BELOW, THE COMPANY, AMOUNT, PLAN AND PURPOSE.
h. What is the total amount of Life Insurance (Personal and Business) presently in force on your life
EXCLUDING ANY POLICIES BEING REPLACED? The amount shown for each policy should also include coverage
under any term riders, but Group or Health Insurance policies should not be included. List each
policy separately. IF NONE, SO STATE.
Company When Issued Amount AI Amount
__________________ ___________________ ________________ __________________
__________________ ___________________ ________________ __________________
<PAGE>
10. ADDITIONAL
INFORMATION/
INSTRUCTIONS
11. HOME OFFICE Changes or corrections made by the Company are ratified by the Certificate Owner upon acceptance of a life
CHANGES OR insurance certificate containing this Application with the changes or corrections noted below. In those
CORRECTIONS where written consent is required by statute or State Insurance Department regulation, amendments as to plan,
amount, age at issue, classification, or benefits will be made only with Certificate Owner's written consent.
12. CERTIFICATIONS I (We) have read the above questions and answers and declare that they are complete and true to the best of my
(our) knowledge and belief. I (We) agree, a) that this Application Part I (and Part II, or Part IIA, if
required) shall form a part of any certificate issued, and b) that no Agent/Representative of the Company
shall have the authority to waive a complete answer to any question in this Application, transfer
insurability, make or alter any certificate, or waive any of the Company's other rights or requirements. I
(We) further agree that no insurance shall take effect unless and until the certificate has been delivered to
and accepted by me (us) and the initial premium paid during the lifetime of the Proposed Insured, and while
the Proposed Insured is in the state of health and insurability represented in this Application.
I (We) acknowledge receipt of a current prospectus. Please check here / / if you wish to receive a copy of
the Statement of Additional Information which supplements the information in the prospectus. Under penalties
of perjury, I (the Certificate Owner) certify that the above Social Security and Taxpayer Identification
numbers are correct and that I am of legal age to enter into this agreement.
Illustrations of benefits, including death benefits, certificate values and cash surrender values are
available upon request.
13. SIGNATURES Signed at ________________________________________________________ On _____/_____/_____
CITY / STATE MO. DAY YEAR
___________________________________________________________________________________
SIGNATURE OF PROPOSED INSURED
___________________________________________________________________________________
SIGNATURE(S) OF CERTIFICATE OWNER(S) IF OTHER THAN PROPOSED INSURED
___________________________________________________________________________________
SIGNATURE OF WITNESS
14. CERTIFICATION/ The Registered Representative hereby certifies that the certificate / / IS / / IS NOT intended to replace
REPORT BY or change any existing annuity or life insurance.
REGISTERED
REPRESENTA- Print Name ______________________________ Signature ________________________________
TIVE/ SS# ______________________________ Telephone ________________________________
WITNESS Rep.Code Percentage ___________/___________% Field Office Code _____________________________
Print Name ________________________________ Signature ________________________________
SS# ________________________________ Telephone ________________________________
Rep.Code Percentage ___________/___________% Field Office Code __________________________
15. BROKER/ Print Name ________________________________ Telephone _______________________________
DEALER Address ________________________________ Broker Code _______________________________
INFORMATION ________________________________ Field Office Code __________________________
</TABLE>
B10295 (PAGE 4)
<PAGE>
POLICYOWNER VARIABLE LIFE INSURANCE APPLICATION
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
A CIGNA Company
No. 000001
- --------------------------------------------------------------------------------
1a. Name of Policyowner b. Policyowner Tax Iden. #
___ ___ - ___ ___ - ___ ___ ___ ___ ___
- --------------------------------------------------------------------------------
c. Address (No., Street, City, State & Zip Code) of Policyowner
- --------------------------------------------------------------------------------
ADDITIONAL INSTRUCTIONS HOME OFFICE CHANGES OR CORRECTIONS
- --------------------------------------------------------------------------------
The Policyowner hereby applies to Connecticut General Life Insurance company for
a Flexible Premium Group Variable Life Insurance Policy. Under penalties of
perjury, I (as an officer of the Policyowner) hereby certify that the above
Taxpayer Identification number is correct.
- --------------------------------------------------------------------------------
Dated at (City & State)
On ___ / ___ / ___
Mo. Day Year
- --------------------------------------------------------------------------------
<TABLE>
<S> <C>
Registered Representative/Witness Signature and Title of Officer of Policyowner
a. Print Name: a. Print Name:
----------------------------- -----------------------------
b. Signature: b. Signature:
----------------------------- -----------------------------
c. SS#: c. Title:
------------------------------ -----------------------------
d. Telephone:
------------------------------
e. Rep Code:
------------------------------
f. Field Office Code:
---------------------
</TABLE>
B10296
