EXHIBIT 4(b)
DEFERRED
COMBINATION
VARIABLE AND
FIXED ANNUITY
GROUP MASTER
CONTRACT
Golden American is a stock company domiciled in Delaware
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Offices: 0000 Xxxxxxxx Xxxxx, Xxxx Xxxxxxx, Xxxxxxxxxxxx 00000
CONTRACTHOLDER: GROUP CONTRACT NUMBER:
ISSUED IN: CONTRACT ISSUE DATE:
In this Contract, we, our and us refer to the Golden American
Life Insurance Company.
In consideration of application for this Contract and the
payment of premiums, we agree, subject to the terms and
conditions of this Contract, to provide the benefits described
in this Contract to the persons eligible (herein called
"Annuitant[s]") under the terms of this Contract.
If this Contract is in force, we will make income payments to
the Certificate Owner starting on the Annuity Commencement Date
shown in each Certificate. If the Certificate Owner or the
Annuitant (if the Owner is other than a natural person) dies
prior to the Annuity Commencement Date shown in each
Certificate, we will pay a death benefit to the Beneficiary.
The amounts of such benefits are subject to the terms of this
Contract.
All death proceeds due under this Contract will be paid
according to the Beneficiary designation and the provisions of
this Contract. Payment of such death proceeds by us will
completely discharge our liability with respect to the amounts so paid.
All provisions set forth on the following pages are a part of this Contract.
Signed for Golden American Life Insurance Company on the Contract Issue Date.
President: Secretary:
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DEFERRED COMBINATION VARIABLE AND FIXED ANNUITY GROUP MASTER CONTRACT
- NO DIVIDENDS
Variable Cash Surrender Values while a Certificate Owner is
living and prior to the Annuity Commencement Date. Death
benefit subject to guaranteed minimum. Additional premium
payment option. Partial Withdrawal Option. Non-participating.
Investment results reflected in values.
GA-MA-1074 1
TABLE OF CONTENTS
The contents of this Contract appear in the following order:
SCHEDULE....................................... 4
Premium Payment and Investment Information
Separate Accounts
Contract Facts
Charges
Income Plan Factors
IMPORTANT TERMS................................ 10
INTRODUCTION TO THE CONTRACT................... 12
Eligibility
The Certificate Owner
The Annuitant
The Beneficiary
Change of Certificate Owner or Beneficiary
PREMIUM PAYMENTS AND ALLOCATION CHANGES........ 13
Initial Premium Payment
Additional Premium Payment Option
Reallocation of Accumulation Value
What Happens if a Division is Not Available
HOW WE MEASURE THE ACCUMULATION VALUE.......... 14
The Separate Account
The General Account
Valuation Period
Accumulation Value
Accumulation Value in Each Division and Fixed Allocation
Fixed Account Guarantee Periods
Market Value Adjustments
Measurement of Investment Experience
Charges Deducted From Accumulation Value for Each Processing
Period
THE CERTIFICATE OWNER'S BENEFITS............... 19
Cash Value Benefit
Partial Withdrawal Option
DEATH BENEFIT PROCEEDS......................... 20
Proceeds Payable to the Beneficiary
GA-MA-1074 2
CHOOSING AN INCOME PLAN........................ 21
Annuity Benefits
Annuity Commencement Date Selection
Frequency Selection
The Income Plan
The Annuity Options
Payment When Named Person Dies
GENERAL PROVISIONS............................. 23
Entire Contract
Sending Notice to Us
Reports to Certificate Owner
Assignment
Changing the Contract
Contract Changes - Applicable Tax Law
Misstatement of Age or Sex
Non-Participating
Payments We May Defer
Authority to Make Agreements
Computations
Facility of Payment
Incontestability
Certificates
Conformity With Law
Records
Certificate Owner's Right to Examine the Certificate
GA-MA-1074 3
THE SCHEDULE
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PREMIUM PAYMENT AND INVESTMENT INFORMATION
Investment
Initial Premium Minimum $10,000.
Accumulation Value As shown in each
Certificate.
Additional Premium Payment
Minimum payment: Qualified plan $250
Non-qualified plan $100
Maximum Attained Age of Annuitants and Certificate Owners 85
Allocations
Maximum Divisions at any one time twenty
Allocation changes per Certificate Year without charge Twelve
Excess allocation charge $0
THE VARIABLE SEPARATE ACCOUNT
Divisions Investing in Shares of Mutual Funds
Separate Account B is a unit investment trust separate account,
organized in and governed by the laws of the State of Delaware,
our state of domicile. Separate Account B is divided into
Divisions. Each Division listed below invests in shares of the
mutual fund portfolio designated. Each portfolio is a part of
The GCG Trust managed by Directed Services, Inc.
SERIES SERIES
[Multiple Allocation Real Estate
Fully Managed Hard Assets
Value Equity Emerging Markets
Small Cap Limited Maturity Bond
Capital Appreciation Liquid Assets
Rising Dividend Strategic Equity
Capital Growth Managed Global
Developing World Global Fixed Income
Large Cap Value Total Return
Growth All-Cap
Mid-Cap Growth Investors
Research Equity Income]
NOTE: PLEASE REFER TO THE PROSPECTUSES FOR THIS CONTRACT AND
THE GCG TRUST FOR MORE DETAILS.
GA-MA-1074 4
THE SCHEDULE (continued)
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GENERAL ACCOUNT
Guaranteed Interest Division
A Guaranteed Interest Division provides an annual minimum
interest rate of 3%. At our sole discretion, we may
periodically declare higher interest rates. Such rates will
apply to periods following the date of declaration. Any
declaration will be by class and will be based on our future
expectations.
Limitations on Allocations
We reserve the right to restrict allocations into and out of the
General Account. Such limits may be dollar restrictions on
allocations into the General Account or we may restrict
reallocations into the General Account.
Transfers from a Guaranteed Interest Division
We currently require that an amount allocated to a Guarantee
Period not be transferred until the Maturity Date, except
pursuant to our published rules. We reserve the right not to
allow amounts previously transferred from a Guaranteed Interest
Division to the Variable Separate Account Divisions or to a
Fixed Allocation to be transferred back to a Guaranteed Interest
Division for a period of at least six months from the date of
transfer.
Systematic Withdrawals
Up to the interest earned in the prior month, quarter or year
may be withdrawn without Surrender Charge adjustment, depending
upon whether you have chosen a monthly, quarterly or annual
frequency, respectively.
GA-MA-1074 5
THE SCHEDULE (continued)
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CONTRACT FACTS
Processing Dates As shown in each Certificate.
Specially Designated Division Liquid Asset Division.
Annuity Commencement Date As shown in each Certificate.
Required Date of Annuity Commencement As shown in each Certificate.
Death Benefits As shown in each Certificate.
Minimum Annuity Income Payment As shown in each Certificate.
Optional Benefit Riders None.
Partial Withdrawals
The minimum withdrawal amount which may be taken is shown in
each Certificate.The maximum amount that can be taken as a
Conventional Partial Withdrawal each Certificate Year without
being considered an Excess Partial Withdrawal is shown in each
Xxxxxxxxxxx.Xx no event may a Partial Withdrawal be greater than
90% of the Cash Surrender Value. After a Partial Withdrawal,
the remaining Accumulation Value must be at least $100 to keep a
Certificate in force.
Systematic Partial Withdrawals and Conventional Partial
Withdrawals may not be taken in the same Certificate Year.
Conventional Partial Withdrawals
The minimum withdrawal amount which may be taken is shown in
each Certificate.The maximum amount that can be taken as a
Conventional Partial Withdrawal each Certificate Year without
being considered an Excess Partial Withdrawal is shown in each
Certificate.
Any Conventional Partial Withdrawal is subject to a Market Value
Adjustment unless withdrawn from a Fixed Allocation within 30
days prior to the Maturity Date.
Systematic Partial Withdrawals
Systematic Partial Withdrawals may be elected to commence after
28 days from the Certificate Issue Date. Systematic Partial
Withdrawals may be taken on a monthly, quarterly or annual
basis. The maximum withdrawal amount which may be taken is
shown in each Certificate. Systematic Partial Withdrawals from
Fixed Allocations are not subject to a Market Value Adjustment.
We may collect a Surrender Charge for Excess Partial
Withdrawals.
XXX Partial Withdrawals for Qualified Certificates Only
XXX Partial Withdrawals may be taken on a monthly, quarterly or
annual basis, as long as the minimum of $100 is met.
GA-MA-1074 6
THE SCHEDULE (continued)
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Fixed Account
Minimum Fixed Allocation As shown in each Certificate.
Guaranteed Minimum Interest Rate As shown in each Certificate.
Guarantee Periods: We currently offer Guarantee Periods of 1,
2, 3, 4, 5, 6, 7,8, 9 and 10 years. We reserve the right to
offer Guarantee Periods of durations other than those available
on the Contract Issue Date. We also reserve the right to cease
offering a particular Guarantee Period or Periods.
Index Rate
The Index Rate is the average of the Ask Yields for U.S.
Treasury Strips as reported by a national quoting service for
the applicable maturity. The average is based on the period
from the 22nd day of the calendar month two months prior to the
calendar month of Index Rate determination to the 21st day of
the calendar month immediately prior to the month of
determination. The applicable maturity date for these U.S.
Treasury Strips is on or next following the last day of the
Guarantee Period. If these Ask Yields are no longer available,
the Index Rate will be determined using a suitable replacement
method.
We currently set the Index Rate once each calendar month.
However, we reserve the right to set the Index Rate more
frequently than monthly, but in no event will such Index Rate be
based on a period of less than 28 days.
CHARGES
Charge Deduction Division Liquid Asset Division.
EXPENSE CHARGES
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Deduction from Premium Payments None.
Deductions from Accumulation Value
Initial Administrative Charge None.
Administrative Charge $30 per Certificate Processing
Period. The charge is incurred
at the beginning of the
Certificate Processing Period
and deducted on the Certificate
Processing Date at the end of
each Certificate Processing
Period.
Excess Allocation Charge $25 - Covers the cost of
allocations in excess of the
twelve free allocation changes
allowed per year. This charge
may be imposed at the time each
additional allocation is
processed. The charge, unless
the Certificate Owner specifies
otherwise, will be deducted in
proportion to the amount being
transferred from each Division
and Fixed Allocation.
Surrender Charges As shown in the Certificate.
GA-MA-1074 7
THE SCHEDULE (continued)
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Premium Taxes We deduct from the Accumulation
Value the amount of any premium
or other state and local taxes
levied by any state or
governmental entity when such
taxes are incurred. We reserve
the right to change the amount
of the deduction to conform
with changes in the law or if
the Certificate Owner changes
state of residence. If the
charge for premium taxes is
incurred when premiums are
received, we advance the amount
of the charge to the
Accumulation Value and deduct
it in equal installments on
each Certificate Processing
Date. Currently, we will waive
the deduction of the applicable
installment on each Certificate
Processing Date. However, we
deduct the applicable
unrecovered portion of the
charge for premium taxes (not
including installments which
were waived) when determining
the Cash Surrender Value
payable if the Certificate is
surrendered.
Deductions from the Divisions
Mortality and Expense Risk Charge As shown in each Certificate.
Asset Based Administrative Charge As shown in each Certificate.
INCOME PLAN FACTORS
These factors are shown in each Certificate.
GA-MA-1074 8
IMPORTANT TERMS
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ACCUMULATION VALUE - The amount that a Certificate provides for
investment at any time. Initially, this amount is equal to
the premium paid.
ANNUITANT - The person designated by the Certificate Owner to be
the measuring life in determining Annuity Payments.
ANNUITY COMMENCEMENT DATE - For each Certificate, the date on
which Annuity Payments begin.
ANNUITY OPTIONS - Options the Certificate Owner selects that
determine the form and amount of Annuity Payments.
ANNUITY PAYMENT - The periodic payment a Certificate Owner
receives. It may be either a fixed or a variable amount
based on the Annuity Option chosen.
ATTAINED AGE - The Issue Age of the Annuitant or Certificate
Owner plus the number of full years elapsed since the
Certificate Date.
BENEFICIARY - The person designated to receive benefits in the
case of the death of the Certificate Owner.
BUSINESS DAY - Any day the New York Stock Exchange ("NYSE") is
open for trading exclusive of federal holidays, or any day
on which the Securities and Exchange Commission ("SEC")
requires that mutual funds, unit investment trusts or other
investment portfolios be valued.
CASH SURRENDER VALUE - The amount the Certificate Owner receives
upon surrender of the Certificate.
CERTIFICATE - This is a summary of the benefits and provisions
provided by this Contract.
CERTIFICATE ANNIVERSARY - The anniversary of the Certificate
Date.
CERTIFICATE DATE - The date we received the Initial Premium upon
which we begin determining the Certificate values. It may
or may not be the same as the Certificate Issue Date. This
date is used to determine Certificate months, processing
dates, years, and anniversaries.
CERTIFICATE ISSUE DATE - The date the Certificate is issued at
our Customer Service Center.
CERTIFICATE PROCESSING DATES - The days when we deduct certain
charges from the Accumulation Value. If the Certificate
Processing Date is not a Valuation Date, it will be on the
next succeeding Valuation Date. The Certificate Processing
Date will be on the Certificate Anniversary of each year.
CERTIFICATE PROCESSING PERIOD - The period between successive
Certificate Processing Dates unless it is the first
Certificate Processing Period. In that case, it is the
period from the Certificate Date to the first Certificate
Processing Date.
CERTIFICATE YEAR - The period between Certificate Anniversaries.
CERTIFICATE OWNER - The person who owns a Certificate and is
entitled to exercise all rights of the Certificate. This
person's death also initiates payment of the death benefit.
CHARGE DEDUCTION DIVISION - The Division from which all charges
are deducted if so designated on the enrollment form or
later elected by the Certificate Owner.
CONTINGENT ANNUITANT - The person designated by the Certificate
Owner who, upon the Annuitant's death prior to the Annuity
Commencement Date, becomes the Annuitant.
GA-MA-1074 9
IMPORTANT TERMS (continued)
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CONTRACT ISSUE DATE - The date this Contract is issued at our
Customer Service Center.
CONTRACTHOLDER - The entity to whom this Contract is issued.
EXPERIENCE FACTOR - The factor which reflects the investment
experience of the portfolio in which a Variable Separate
Account Division invests and also reflects the charges
assessed against the Division for a Valuation Period.
FIXED ACCOUNT - This is the Separate Account established to
support Fixed Allocations.
FIXED ALLOCATION - An amount allocated to the Fixed Account that
is credited with a Guaranteed Interest Rate for a specified
Guarantee Period.
GENERAL ACCOUNT - The account which contains all of our assets
other than those held in our separate accounts.
GUARANTEE PERIOD - The period of years a rate of interest is
guaranteed to be credited to a Fixed Allocation or
allocations to a Guaranteed Interest Division.
GUARANTEED INTEREST DIVISION - An investment option available in
the General Account.
GUARANTEED INTEREST RATE - The effective annual interest rate
which we will credit for a specified Guarantee Period.
GUARANTEED MINIMUM INTEREST RATE - The minimum interest rate
which can be declared by us for Fixed Allocations or
allocations to a Guaranteed Interest Division.
INDEX OF INVESTMENT EXPERIENCE - The index that measures the
performance of a Variable Separate Account Division.
INITIAL PREMIUM - The payment amount required to put each
Certificate in effect.
ISSUE AGE - The Annuitant's or Certificate Owner's age on the
last birthday on or before the Certificate Date.
MARKET VALUE ADJUSTMENT - A positive or negative adjustment to
Fixed Allocation. It may apply if all or part of a Fixed
Allocation is withdrawn, transferred, or applied to an
Annuity Option prior to the end of the Guarantee Period.
MATURITY DATE - The date on which a Guarantee Period matures.
RIDERS - Riders add provisions or change the terms of the
Certificate.
SPECIALLY DESIGNATED DIVISION - Distributions from a portfolio
underlying a Division in which reinvestment is not
available will be allocated to this Division unless the
Certificate Owner specifies otherwise.
VALUATION DATE - The day at the end of a Valuation Period when
each Division is valued.
VALUATION PERIOD - Each Business Day together with any non-
Business Days before it.
VARIABLE SEPARATE ACCOUNT DIVISION - An investment option
available in the Variable Separate Account shown in the
Certificate Schedule.
GA-MA-1074 10
INTRODUCTION TO THE CONTRACT
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ELIGIBILITY
Eligible persons as stated in the application for this Contract
and who have enrolled and for whom the Initial Premium has been
paid are eligible to receive the benefits under this Contract.
THE CERTIFICATE OWNER
The Certificate Owner is also the Annuitant unless another
Annuitant has been named and is shown in the Certificate. The
Certificate Owner has the rights and options described in this
Contract.
One or more people may own a Certificate. If there are
multiple Certificate Owners named, the age of the oldest
Certificate Owner will be used to determine the applicable death
benefit. In the case of a sole Certificate Owner who dies prior
to the Annuity Commencement Date, we will pay the Beneficiary
the death benefit then due. If the sole Certificate Owner is
not an individual, we will treat the Annuitant as the
Certificate Owner for purposes of determining when the
Certificate Owner dies under the death benefit provision (if
there is no Contingent Annuitant), and the Annuitant's Issue Age
will determine the applicable death benefit payable to the
Beneficiary. The sole Certificate Owner's estate will be the
Beneficiary if no beneficiary designation is in effect, or if
the sole designated Beneficiary has predeceased the Certificate
Owner. In the case of a joint Certificate Owner dying prior to
the Annuity Commencement Date, the surviving Certificate
Owner(s) will be deemed the Beneficiary(ies).
THE ANNUITANT
The Annuitant is the measuring life of the annuity benefits
provided under a Certificate. The Annuitant may not be changed
during the Annuitant's lifetime. The Certificate Owner may name
a Contingent Annuitant. The Contingent Annuitant becomes the
Annuitant if the Annuitant dies while a Certificate is in effect
prior to the Annuity Commencement Date. The Certificate Owner
will be the Contingent Annuitant unless the Certificate Owner
names someone else. The Annuitant must be a natural person. If
the Annuitant dies and no Contingent Annuitant has been named,
we will allow the Certificate Owner sixty days to designate
someone else as Annuitant. If all Certificate Owners are not
individuals and, through operation of this provision, a
Certificate Owner becomes the Annuitant, we will pay the death
benefit proceeds to the Beneficiary. If there are joint
Certificate Owners, we will treat the youngest of the
Certificate Owners as the Contingent Annuitant designated,
unless elected otherwise.
THE BENEFICIARY
The Beneficiary is the person to whom we pay death proceeds
if the Certificate Owner dies prior to the Annuity Commencement
Date. See Death Benefit Proceeds for more information. We pay
death proceeds to the primary Beneficiary (unless there are
joint Certificate Owners in which case the death benefit
proceeds are payable to the surviving Certificate Owners). If
the primary Beneficiary dies before the Certificate Owner, the
death proceeds are paid to the contingent Beneficiary, if any.
If there is no surviving Beneficiary, we pay the death proceeds
to the Certificate Owner's estate.
One or more persons may be named as primary Beneficiary or
contingent Beneficiary. In the case of more than one
Beneficiary, we will assume any death proceeds are to be paid in
equal shares to the surviving Beneficiaries. Other than equal
shares may be specified by the Certificate Owner.
The Certificate Owner has the right to change Beneficiaries
during the Certificate Owner's lifetime, unless the primary
Beneficiary is designated irrevocable. When an irrevocable
Beneficiary has been designated, the Certificate Owner and the
irrevocable Beneficiary may have to act together to exercise the
rights and options under a Certificate.
CHANGE OF CERTIFICATE OWNER OR BENEFICIARY
During the Certificate Owner's lifetime and while a Certificate
is in effect under this Contract, the Certificate Owner can
transfer ownership of a Certificate or change the Beneficiary.
To make any of these changes, we require written notice of the
change in a form satisfactory to us. The change will take
effect as of the day the notice is signed. The change will not
affect any payment made or action taken by us before recording
the change at our Customer Service Center. A change of
Certificate Owner may affect the amount of death benefit payable
under the Certificate. See Proceeds Payable to Beneficiary.
GA-MA-1074 11
PREMIUM PAYMENTS AND ALLOCATION CHANGES
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INITIAL PREMIUM PAYMENT
The Initial Premium payment is required to put a Certificate in
effect. The amount and allocation of the Initial Premium
payment is shown in each Certificate.
ADDITIONAL PREMIUM PAYMENT OPTION
Additional premium payments may be made after the Right to
Examine period ends. Satisfactory notice to us must be given
for additional premium payments. Restrictions on additional
premium payments, such as the Attained Age of the Annuitant or
Certificate Owner and the timing and amount of each payment, are
shown in each Certificate. We reserve the right to defer
acceptance of or to return any additional premium payments.
As of the date we receive and accept the Certificate Owner's
additional premium payment:
(1) The Accumulation Value will increase by the
amount of the premium payment less any premium
deductions as shown in each Certificate.
(2) The increase in the Accumulation Value will
be allocated among the Divisions and the Fixed
Allocations in accordance with the Certificate
Owner's instructions. If the Certificate Owner
does not provide such instructions, allocation
will be among the Divisions and in proportion
to the amount of Accumulation Value in each
Division as of the date we receive and accept
the additional premium payment. Allocations to
the Fixed Account will be made only upon
specific written request.
Where to Make Payments
Additional premium payments are to be sent to our Customer
Service Center. On request, a receipt signed by one of our
officers will be provided.
REALLOCATION OF ACCUMULATION VALUE
The Accumulation Value may be reallocated among the Divisions,
and the Fixed Allocations prior to the Annuity Commencement
Date. The number of free allocation changes each Certificate
Year that we will allow is shown in each Certificate. To make
an allocation change, we must receive satisfactory notice at our
Customer Service Center. The change will take effect when we
receive the notice. Restrictions for reallocation into and out
of the Divisions are shown in each Certificate. Some Divisions
may have restrictions on allocations. An allocation from the
Fixed Allocation may be subject to a Market Value Adjustment.
See Market Value Adjustment.
WHAT HAPPENS IF A VARIABLE SEPARATE ACCOUNT DIVISION IS NOT AVAILABLE
When a distribution is made from an investment portfolio
supporting a unit investment trust Division of the Separate
Account in which reinvestment is not available, we will allocate
the distribution to the Specially Designated Division shown in
each Certificate unless the Certificate Owner specifies
otherwise.
Such a distribution may occur when an investment portfolio or
Division matures, when distribution from a portfolio or Division
cannot be reinvested in the portfolio or Division due to the
unavailability of securities, or for other reasons. When this
occurs because of maturity, we will send written notice 30 days
in advance of such date. To elect an allocation to other than
the Specially Designated Division shown in each Certificate, we
must receive satisfactory notice at least seven days prior to
the date the investment matures. Such allocations will not be
counted as an allocation change of the Accumulation Value for
purposes of the number of free allocations permitted.
GA-MA-1074 12
PREMIUM PAYMENTS AND ALLOCATION CHANGES
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RESTRICTED FUNDS
Restricted Funds are subject to limits as to amounts which may be
invested or transferred into such divisions. The designation of a
division as a Restricted Fund may be changed upon 30 days notice to
the Owner with regard to future transfers and premium payments into
such division. When a new division is made available it may be
designated as a Restricted Fund. If so designated, the rules
regarding its restrictions will be sent to the Owner. Also listed
below are
he total Contract limits for Restricted Funds. Listed on the
Schedule Page are the total Contract limits for Restricted Funds.
THRESHOLDS
Each Restricted Fund has one or more thresholds at which point no
further amounts may be allocated to that division. Compliance with a
threshold is verified whenever there is a transaction initiated which
is subject to such threshold (premium payments, transfers,
withdrawals). A threshold is applied to the total Accumulation Value
of each Restricted Fund. Thresholds may be changed by the Company for
new premiums, transfers or withdrawals by Restricted Fund upon 30 day
notice.
DOLLAR CAP
The Dollar Cap is the dollar amount at which no further Accumulation
Value may be added to Restricted Funds.
PREMIUM THRESHOLD
The threshold for premium by Restricted Fund limits the amount of any
premium which may be allocated to that division. Should a request
for allocation to a Restricted Fund exceed the limit in effect for
that division or for the Contract, any excess over that amount shall
be allocated prorata to any non-Restricted Fund(s) in which the
Contract is then invested. Should the Contract not be invested in
other non-Restricted Funds, the excess will be invested in the
Specially Designated Division unless we receive written instructions
to do otherwise. Premium allocations must also satisfy the
Allocation Threshold.
ALLOCATION THRESHOLD
Allocations into a Restricted Fund are limited to that amount such
that the Accumulation Value in that Restricted Fund after such
allocation does not exceed the threshold for that division and does
not cause the Contract's total limit on allocation to Restricted
Funds to be exceeded. If the amount of an allocation would cause
either limit to be exceeded, the allocation will only be executed to
the extent the lower limit would allow.
Allocations from a Restricted Fund will be allowed even if the amount
remaining in the Restricted Fund after an allocation exceeds the
Allocation Threshold. If a program of allocations over time is
authorized by us, verification of the threshold will be performed at
the initiation of such program. If such program is modified at a
later date, a testing of thresholds will be done at that time.
GA-MA-1074 13
PREMIUM PAYMENTS AND ALLOCATION CHANGES
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THRESHOLDS - EFFECT ON WITHDRAWALS
If a withdrawal is requested while any Accumulation Value is
allocated to Restricted Funds and the Allocation Threshold
percentage is currently exceeded, the percentage for funds
invested in Restricted Funds for the total Contract, after taking
into account the withdrawal, may not be higher than prior to the
withdrawal. Should the calculated effect of a withdrawal result
in the total Contract threshold being exceeded, the excess portion
of the withdrawal will be processed prorata from all variable
divisions. Systematic withdrawals, while the Contract has
investments in Restricted Funds, if not withdrawn prorata from all
divisions, shall be monitored annually to assure threshold
compliance. Should the effect of such withdrawals cause a
Restricted Fund to exceed its threshold, the divisions from which
the withdrawals are processed may be adjusted to assure that the
percentage of Accumulation Value in the Restricted Funds does not
increase.
THRESHOLD PROCESSING
For the purpose of calculating any thresholds, the values for the
divisions will be determined using the prior day's closing index
of investment experience.
GA-MA-1074 14
HOW WE MEASURE THE ACCUMULATION VALUE
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THE VARIABLE SEPARATE ACCOUNTS
These accounts, which are designated in each Certificate, are
kept separate from our General Account and any other separate
accounts we may have. They are used to support variable annuity
contracts and may be used for other purposes permitted by
applicable laws and regulations. We own the assets in the
Separate Accounts. Assets equal to the reserves and other
liabilities of the accounts will not be charged with liabilities
that arise from any other business we conduct; but, we may
transfer to our General Account assets which exceed the reserves
and other liabilities of the Variable Separate Accounts. Income
and realized and unrealized gains or losses from assets in these
separate accounts are credited to or charged against the account
without regard to other income, gains or losses in our other
investment accounts.
The Variable Separate Account will invest in mutual funds, unit
investment trusts and other investment portfolios which we
determine to be suitable for this Contract's purposes. This
Variable Separate Account is treated as a unit investment trust
under Federal securities laws. It is registered with the SEC
under the Investment Company Act of 1940. This Variable
Separate Account is also governed by state laws as designated in
each Certificate. The trusts may offer unregistered series.
Divisions of the Variable Separate Account
A unit investment trust Variable Separate Account includes
Divisions, each investing in a designated investment portfolio.
The Divisions and the investment portfolios in which they
invest, if applicable, are specified in each Certificate. Some
of the portfolios designated may be managed by a separate
investment adviser. Such adviser will be registered under the
Investment Advisers Act of 1940 if required.
Changes Within the Variable Separate Accounts
We may, from time to time, make additional Variable Separate
Account Divisions available. These Divisions will invest in
investment portfolios we find suitable for this Contract. We
also have the right to eliminate Divisions from a separate
account, to combine two or more Divisions or to substitute a new
portfolio for the portfolio in which a Division invests. A
substitution may become necessary if, in our judgment, a
portfolio or Division no longer suits the purposes of this
Contract. This may happen due to a change in laws or
regulations, or a change in a portfolio's investment objectives
or restrictions, or because the portfolio or Division is no
longer available for investment, or for some other reason. We
may get prior approval from the insurance department of our
state of domicile before making such a substitution. We will
also get any required approval from the SEC and any other
required approvals before making such a substitution.
Subject to any required regulatory approvals, we reserve the
right to transfer assets of the Divisions of the Variable
Separate Account, which we determine to be associated with the
class of Contracts to which this Contract belongs, to another
Variable Separate Account or Division.
When permitted by law, we reserve the right to:
(1)Deregister a Variable Separate Account under
the Investment Company Act of 1940;
(2)Operate a Variable Separate Account as a
management company under the Investment Company
Act of 1940, if it is operating as a unit
investment trust;
(3)Operate a Variable Separate Account as a unit
investment trust under the Investment Company
Act of 1940, if it is operating as a managed
Variable Separate Account;
(4)Restrict or eliminate any voting rights of
Certificate Owners, or other persons who have
voting rights as to a Variable Separate
Account; and,
(5)Combine a Variable Separate Account with
other Variable Separate Accounts.
GA-MA-1074 15
HOW WE MEASURE THE ACCUMULATION VALUE (continued)
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THE GENERAL ACCOUNT
The General Account contains all assets of the Company other
than those in the Separate Accounts we establish. The
Guaranteed Interest Divisions available for investment are shown
in the Schedule. We may, from time to time, offer other
Divisions where assets are held in the General Account.
VALUATION PERIOD
Each Division and Fixed Allocation will be valued at the end of
each Valuation Period on a Valuation Date. A Valuation Period
is each Business Day together with any non-Business Days before
it. A Business Day is any day the NYSE is open for trading, and
the SEC requires mutual funds, unit investment trusts, or other
investment portfolios to value their securities.
ACCUMULATION VALUE
The Accumulation Value of a Certificate is equal to the sum of
the amounts in each Division of the Variable Separate Account
and General Account and allocations to the Fixed Account. The
Certificate Owner selects how the Accumulation Value is
allocated. The maximum number of Divisions and Fixed
Allocations to which the Accumulation Value may be allocated at
any one time is shown in each Certificate.
ACCUMULATION VALUE IN EACH DIVISION AND FIXED ALLOCATION
On the Certificate Date
On the Certificate Date, the Accumulation Value is allocated to
each Division and the Fixed Allocations as shown in each
Certificate. We reserve the right to allocate premium to the
Specially Designated Division during any Right to Examine
period. After such time, allocation will be made
proportionately in accordance with the initial allocation(s) as
elected by the Certificate Owner.
On each Valuation Date
At the end of each subsequent Valuation Period, the amount of
Accumulation Value in each Division and Fixed Allocation will be
calculated as follows:
(1) We take the Accumulation Value in the
Division or Fixed Allocation at the end of the
preceding Valuation Period.
(2) We multiply (1) by the Variable Separate
Account Division's net rate of return for the
current Valuation Period, or we calculate the
interest to be credited to a Fixed Allocation
or Guaranteed Interest Division for the current
Valuation Period.
(3) We add (1) and (2).
(4) We add to (3) any additional premium payments
(less any premium deductions as shown in each
Certificate) allocated to the Division or Fixed
Allocation during the current Valuation Period.
(5) We add or subtract allocations to or from
that Division or Fixed Allocation during the
current Valuation Period.
(6) We subtract from (5) any Partial Withdrawals
which are allocated to the Division or Fixed
Allocation during the current Valuation Period.
(7) We subtract from (6) the amounts allocated to
that Division or Fixed Allocation for:
(a) any charges due for optional
benefit riders as shown in each Certificate;
(b) any deductions from Accumulation
Value as shown in each Certificate.
All amounts in (7) are allocated to each Division or Fixed
Allocation as shown in each Certificate.
GA-MA-1074 16
HOW WE MEASURE THE ACCUMULATION VALUE (continued)
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FIXED ACCOUNT
The Fixed Account is a Separate Account under state law and
is not required to be registered with the Securities and
Exchange Commission under the Investment Company Act of 1940.
The Fixed Account includes various Fixed Allocations which we
credit with fixed rates of interest for the Guarantee Period (or
Periods) the Certificateowners select. We reset the interest
rates for new Fixed Allocations periodically, based on our sole
discretion.
Guarantee Periods
Each Fixed Allocation is guaranteed an interest rate or
rates for a period, a Guarantee Period. The Guaranteed Interest
Rates for a Fixed Allocation are effective for the entire
period. The Maturity Date of a Guarantee Period will be the
last day of a calendar month in which the Guarantee Period ends.
Withdrawals and transfers made during a Guarantee Period may be
subject to a Market Value Adjustment unless made thirty days or
less prior to the Maturity Date.
Upon the expiry of a Guarantee Period, we will transfer the
Accumulation Value of the expiring Fixed Allocation to a Fixed
Allocation with a Guarantee Period equal in length to the
expiring Guarantee Period, unless the Certificate Owner selects
another period prior to a Maturity Date. We will notify the
Certificate Owner at least thirty days prior to a Maturity Date
of options for renewal. If the period remaining from the expiry
of the previous Guarantee Period to the Annuity Commencement
Date is less than the period elected or the period expiring, the
next shortest period then available that will not extend beyond
the Annuity Commencement Date will be offered. If a period is
not available, the Accumulation Value will be transferred to the
Specially Designated Division.
We will declare Guaranteed Interest Rates for the then
available Fixed Allocation Guarantee Periods. These interest
rates are based solely on our expectation as to our future
earnings. Declared Guaranteed Interest Rates are subject to
change at any time prior to application to specific Fixed
Allocations, although in no event will the rates be less than
the Minimum Guaranteed Interest Rate shown in the Certificate.
Market Value Adjustments
A Market Value Adjustment will be applied to a Fixed
Allocation upon withdrawal, transfer or application to an Income
Plan if made more than thirty days prior to such Fixed
Allocation's Maturity Date, except on Systematic Partial
Withdrawals and XXX Partial Withdrawals. The Market Value
Adjustment is applied to each Fixed Allocation separately.
The Market Value Adjustment is determined by multiplying
the amount of Accumulation Value withdrawn, transferred or
applied to an Income Plan by the following factor:
1 + I
--------------- N/365
(1 + J + .0050) - 1
Where I is the Index Rate for a Fixed Allocation on the
first day of the applicable Guarantee Period; J is the Index
Rate for new Fixed Allocations with Guarantee Periods equal to
the number of years (fractional years rounded up to the next
full year) remaining in the Guarantee Period at the time of
calculation; and N is the remaining number of days in the
Guarantee Period at the time of calculation. (The Index Rate is
described in each Certificate.)
Market Value Adjustments will be applied as follows:
(1) The Market Value Adjustment will be applied
to the amount withdrawn before deduction of any
applicable Surrender Charge.
(2) For a partial withdrawal, partial transfer or
in the case where a portion of a Fixed
Allocation is applied to an Income Plan, the
Market Value Adjustment will be calculated on
the total amount that must be withdrawn,
transferred or applied to an Income Plan in
order to provide the amount requested.
(3) If the Market Value Adjustment is negative,
it will be assessed first against any remaining
Accumulation Value in a particular Fixed
Allocation. Any remaining Market Value
Adjustment will be applied against the amount
withdrawn, transferred or applied to an Income
Plan.
GA-MA-1074 17
HOW WE MEASURE THE ACCUMULATION VALUE (continued)
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(4)If the Market Value Adjustment is positive,
it will be credited to the Accumulation Value
of a particular Fixed Allocation. If a cash
surrender, or full transfer, or application to
an Income Plan has been requested, the Market
Value Adjustment is added to the amount being
withdrawn, transferred or applied to an Income
Plan.
MEASUREMENT OF INVESTMENT EXPERIENCE
Index of Investment Experience
The investment experience of a Division is determined on each
Valuation Date. We use an index to measure changes in each
Division's experience during a Valuation Period. We set the
index at $10 when the first investments in a Division are made.
The index for a current Valuation Period equals the index for
the preceding Valuation Period multiplied by the Experience
Factor for the current Valuation Period.
How We Determine the Experience Factor
For Divisions of a unit investment trust separate account the
Experience Factor reflects the investment experience of the
portfolio in which the Division invests as well as the charges
assessed against the Division for a Valuation Period. The
factor is calculated as follows:
(1)We take the net asset value of the portfolio
in which the Division invests at the end of the
current Valuation Period.
(2)We add to (1) the amount of any dividend or
capital gains distribution declared for the
investment portfolio and reinvested in such
portfolio during the current Valuation Period.
We subtract from that amount a charge for our
taxes, if any.
(3)We divide (2) by the net asset value of the
portfolio at the end of the preceding Valuation
Period.
(4)We subtract the daily mortality and expense
risk charge for each Division shown in each
Certificate for each day in the Valuation
Period. This charge is to cover expense and
mortality risks that we are assuming.
(5)We subtract the daily asset based
administrative charge shown in each Certificate
for each day in the Valuation Period.
Calculations for Divisions investing in unit investment trusts
are on a per unit basis.
Net Rate of Return for a Variable Separate Account Division
The net rate of return for a Division during a Valuation Period
is the Experience Factor for that Valuation Period minus one.
Interest Credited to a Guaranteed Interest Division
Accumulation Value allocated to a Guaranteed Interest Division
will be credited with the Guaranteed Interest Rate for the
Guarantee Period in effect on the date the premium or
reallocation is applied. Once applied, such rate will be
guaranteed until the Maturity Date of that Guarantee Period.
Interest will be credited daily at a rate to yield the declared
annual Guaranteed Interest Rate. No Guaranteed Interest Rate
will be less than the Minimum Interest Rate shown in the
Schedule.
GA-MA-1074 18
HOW WE MEASURE THE ACCUMULATION VALUE (continued)
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Interest Credited to a Fixed Allocation
A Fixed Allocation will be credited with the Guaranteed Interest
Rate for the Guarantee Period in effect on the date the premium
or reallocation is applied. Once applied, such rate will be
guaranteed until that Fixed Allocation's Maturity Date.
Interest will be credited daily at a rate to yield the declared
annual Guaranteed Interest Rate.
We periodically declare Guaranteed Interest Rates for then
available Guarantee Periods. No Guaranteed Interest Rate will
be less than the Minimum Guaranteed Interest Rate shown in each
Certificate.
CHARGES DEDUCTED FROM ACCUMULATION VALUE FOR EACH PROCESSING PERIOD
All charges and fees are shown in each Certificate.
Charge Deduction Division Option
We will deduct all charges against the Accumulation Value of a
Certificate from the Charge Deduction Division if the
Certificate Owner elected this option. If this option was not
elected or if the charges are greater than the amount in the
Charge Deduction Division, the charges against the Accumulation
Value will be deducted as follows:
(1)If these charges are less than the
Accumulation Value in the Variable Separate
Account Divisions, they will be deducted
proportionately from all Divisions.
(2)If these charges exceed the Accumulation
Value in the Variable Separate Account
Divisions, any excess over such value will be
deducted proportionately from any Fixed Account
and Guaranteed Interest Divisions.
Any charges deducted from the Fixed Account or the General
Account will be taken from the Fixed Allocations or the
Guaranteed Interest Divisions, starting with the Guarantee
Period nearest its Maturity Date until such charges have been
paid.
The Certificate Owner may at any time while the Certificate is
in effect change the election of this option. To do so, the
Certificate Owner must send a written request to our Customer
Service Center. Any change will take effect within seven days
of the date we receive the request.
GA-MA-1074 19
THE CERTIFICATE OWNER'S BENEFITS
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While a Certificate is in effect, the Certificate Owner has
important rights and benefits available. We discuss these
rights and benefits in this section.
CASH VALUE BENEFIT
Cash Surrender Value
The Cash Surrender Value before the Annuity Commencement Date,
is determined as follows:
(1) We take a Certificate's Accumulation Value;
(2) We adjust for any applicable Market Value
Adjustment;
(3) We deduct any Surrender Charges;
(4) We deduct any charges as shown in each
Certificate that have been incurred but not yet
deducted, including:
(a) any administrative charge that has not
yet been deducted;
(b) the pro rata part of any charges for
optional benefit riders; and
(c) any applicable premium or other tax.
Cancelling to Receive the Cash Surrender Value
The Certificate Owner may, at any time before the Annuity
Commencement Date, surrender a Certificate to us. To do this,
the Certificate Owner must return the Certificate with a signed
request for cancellation to our Customer Service Center.
The Cash Surrender Value will vary daily. We will determine the
Cash Surrender Value as of the date we receive the Certificate
and the signed request in our Customer Service Center. All
benefits under the Certificate will then end.
We will usually pay the Cash Surrender Value within seven days;
but, we may delay payment as described in the Payments We May
Defer provision.
PARTIAL WITHDRAWAL OPTION
After the Certificate Date, the Certificate Owner may make
Partial Withdrawals. Partial Withdrawals may be subject to a
Partial Withdrawal Charge. The minimum amount that may be
withdrawn is shown in each Certificate. The maximum amount that
may be withdrawn is shown in each Certificate. To take a
Partial Withdrawal, satisfactory notice must be sent to our
Customer Service Center.
GA-MA-1074 20
DEATH BENEFIT PROCEEDS
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PROCEEDS PAYABLE TO THE BENEFICIARY
Prior to the Annuity Commencement Date
If the sole Certificate Owner dies prior to the Annuity
Commencement Date, we will pay the Beneficiary the death
benefit. If there are joint Certificate Owners and any
Certificate Owner dies, we will pay the surviving Certificate
Owners the death benefit. We will pay the amount on receipt of
due proof of the Certificate Owner's death at our Customer
Service Center. Such amount may be received in a single lump
sum or applied to any of the Annuity Options (see Choosing an
Income Plan). When the Certificate Owner (or all Certificate
Owners where there are joint Certificate Owners) is not an
individual, the proceeds become payable on the death of the
Annuitant prior to the Annuity Commencement Date (unless a
Contingent Annuitant survived the Annuitant). Only one death
benefit is payable under a Certificate. In all events,
distributions under the Certificate must be made as required by
applicable law.
How to Claim Payments to Beneficiary
We must receive proof of the Certificate Owner's (or
Annuitant's) death before we will make any payments to the
Beneficiary. We will calculate the death benefit as of the date
we receive due proof of death. The Beneficiary should contact
our Customer Service Center for instructions.
GA-MA-1074 21
CHOOSING AN INCOME PLAN
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ANNUITY BENEFITS
If the Annuitant and Certificate Owner are living on the Annuity
Commencement Date, we will begin making payments to the
Certificateowner. We will make these payments under the Annuity
Option (or Options) as chosen initially or as subsequently
selected. An Annuity Option may be chosen or changed by making
a written request at least 30 days prior to the Annuity
Commencement Date. Unless chosen otherwise, Option 2 on a 10-
year period certain basis will become effective. The amount of
the payments will be determined by applying the Accumulation
Value on the Annuity Commencement Date in accordance with the
Annuity Options section below (See Payments We May Defer). See
each Certificate for certain restrictions which may apply.
Before we pay any annuity benefits, we require the return of the
Certificate. If a Certificate has been lost, we require the
applicable lost certificate form.
ANNUITY COMMENCEMENT DATE SELECTION
The Certificate Owner selects the Annuity Commencement Date.
Any date may be elected following the fifth Certificate
Anniversary but before the required date of annuity commencement
as shown in each Certificate. If a date is not selected, the
Annuity Commencement Date will be in the month following the
required date of annuity commencement.
FREQUENCY SELECTION
The Certificate Owner chooses the frequency of the Annuity
Payments. They may be monthly, quarterly, semi-annually, or
annually. If we do not receive written notice, the payments
will be made monthly.
THE INCOME PLAN
While a Certificate is in effect and before the Annuity
Commencement Date, the Certificate Owner may choose one or more
Annuity Options to which death benefit proceeds may be applied.
If, at the time of the Certificate Owner's death, no option has
been chosen for paying death benefit proceeds, the Beneficiary
may choose an option within one year. An Annuity Option on
surrender of the Certificate for its Cash Surrender Value may
also be elected. For each option we will issue a separate
written agreement putting the option into effect.
Our approval is needed for any option where:
(1) The person named to receive payment is other
than the Certificate Owner or Beneficiary; or
(2) The person named is not a natural person,
such as a corporation; or
(3) Any income payment would be less than the
minimum annuity income payment shown in each
Certificate.
THE ANNUITY OPTIONS
There are four options to choose from. They are:
Option 1. Income for a Fixed Period
Payment is made in equal installments for a fixed number of
years. We guarantee each monthly payment will be at least the
Income For Fixed Period amount shown in each Certificate.
Values for annual, semiannual or quarterly payments are
available on request.
Option 2. Income for Life
Payment is made to the person named in equal monthly
installments and guaranteed for at least a period certain. The
period certain can be 10 or 20 years. Other periods certain are
available on request. A refund certain may be chosen instead.
Under this arrangement, income is guaranteed until payments
equal the amount applied. If the person named lives beyond the
guaranteed period, payments continue until his or her death.
GA-MA-1074 22
CHOOSING AN INCOME PLAN (continued)
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We guarantee each payment will be at least the amount shown in
the Income for Life Table in each Certificate. By age we mean
the named person's age on his or her last birthday before the
option's effective date. Amounts for ages not shown are
available on request.
Option 3. Joint Life Income
This option is available if there are two persons named to
receive payments. At least one of the persons named must be
either the Certificateowner or Beneficiary of the Certificate.
Monthly payments are guaranteed and are made as long as at least
one of the named persons is living. The monthly payment amounts
are available upon request. Such amounts are guaranteed and
will be calculated on the same basis as the Table for Income for
Life, however, the amount will be based on two lives.
Option 4. Annuity Plan
An amount can be used to buy any single premium immediate
annuity we offer on the option's effective date.
The minimum rates for Option 1 are based on 3% interest,
compounded annually. The minimum rates for Options 2 and 3 are
based on 3% interest, compounded annually, and the Annuity 200
Mortality Table. We may pay a higher rate at our discretion.
PAYMENT WHEN NAMED PERSON DIES
When the person named to receive payment dies, we will pay any
amounts still due as provided by the option agreement. The
amounts still due are determined as follows:
(1) For Option 1 or for any remaining guaranteed
payments under Option 2, payments will be
continued.
(2) For Option 3, no amounts are payable after
both named persons have died.
(3) For Option 4, the annuity agreement will
state the amount due, if any.
GA-MA-1074 23
GENERAL PROVISIONS
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ENTIRE CONTRACT
This Contract, including any attached Rider, Endorsement,
amendment and the application of the Contractholder, constitute
the entire Contract between the Contractholder and us. All
statements made by the Contractholder, any Certificate Owner or
any Annuitant will be deemed representations and not warranties.
No such statement will be used in any contest unless it is
contained in the application signed by the Contractholder or in
a written instrument signed by the Certificate Owner, a copy of
which has been furnished to the Certificate Owner, the
Beneficiary or to the Contractholder.
SENDING NOTICE TO US
Any written notices or requests should be sent to our Customer
Service Center.
REPORTS TO CERTIFICATE OWNER
We will send the Certificate Owner a report, at least once
during each Certificate Year, showing the Accumulation Value and
the Cash Surrender Value of each Certificate as of the end of
the Certificate Processing Period. The report will also show
the allocation of the Accumulation Value as of such date and the
amounts deducted from or added to the Accumulation Value since
the last report. The report will also include any other
information that may be currently required by the insurance
supervisory official of the jurisdiction in which the
Certificate is delivered.
We will also send copies of any shareholder reports of the
portfolios in which the Divisions of the Variable Separate
Accounts invest, as well as any other reports, notices or
documents required by law to be furnished to Certificate Owners.
ASSIGNMENT
Benefits under a Certificate may be assigned as collateral
security for a loan or other obligation. This does not change
the Certificate ownership. The Certificate Owner's rights and
any Beneficiary's rights are subject to the terms of the
assignment. To make or release an assignment, we must receive
written notice satisfactory to us, at our Customer Service
Center. We are not responsible for the validity of any
assignment.
CHANGING THE CONTRACT
This Contract or any additional benefit riders may be changed to
another annuity plan according to our rules at the time of the
change.
CONTRACT CHANGES - APPLICABLE TAX LAW
We reserve the right to make changes in this Contract or its
riders to the extent we deem it necessary to continue to qualify
this Contract as an annuity. Any such changes will apply
uniformly to all Certificates that are affected. The
Contractholder and the Certificate Owner will be given advance
written notice of such changes.
MISSTATEMENT OF AGE OR SEX
If an age or sex has been misstated, the amounts payable or
benefits provided under the Contract, as described in each
Certificate, will be those that the premium payment made would
have bought at the correct age or sex.
NON-PARTICIPATING
Neither this Contract, nor its Certificates, participates in the
divisible surplus of Golden American Life Insurance Company.
GA-MA-1074 24
GENERAL PROVISIONS (continued)
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PAYMENTS WE MAY DEFER
We may not be able to determine the value of the assets of the
Variable Separate Account Divisions because:
(1) The NYSE is closed for trading;
(2) The SEC determines that a state of emergency
exists; or
(3) An order or pronouncement of the SEC permits
a delay for the protection of
Certificateowners.
(4) The check used to pay the premium has not
cleared through the banking system. This may
take up to 15 days.
During such times, as to amounts allocated to the Variable
Separate Account Divisions, we may delay:
(1) Determination and payment of the Cash
Surrender Value;
(2) Determination and payment of any death
benefit if death occurs before the Annuity
Commencement Date;
(3) Allocation changes of the Accumulation Value;
or,
(4) Application of the Accumulation Value under
an income plan.
As to the amounts allocated to a Guaranteed Interest Division in
the General Account and as to amounts allocated to Fixed
Allocations of the Fixed Account, we may, at any time, defer
payment of the Cash Surrender Value for up to six months after we
receive a request for it. We will allow interest of at least
3.00% a year on any Cash Surrender Value payment derived from a
Fixed Allocation or Guaranteed Interest Division that we defer for
30 days or more.
AUTHORITY TO MAKE AGREEMENTS
All agreements made by us must be signed by one of our officers.
No other person, including an insurance agent or broker, can:
(1) Change any of the Contract's terms; or
(2) Make any agreement binding on us.
COMPUTATIONS
We have filed a detailed statement of our computations with the
insurance supervisory official in appropriate jurisdictions.
The values are not less than those required by the law of that
state or jurisdiction. Any benefit provided by an attached
optional benefit rider will not increase these values unless
otherwise stated in that rider.
FACILITY OF PAYMENT
If no Beneficiary is named, we reserve the right to pay an
amount not to exceed $2,000 to any person we determine to be
entitled to such amount by reason of incurred expenses incident
to the last illness or death of a Certificate Owner.
INCONTESTABILITY
The benefits under this Contract will not be contested, except
for nonpayment of premiums, after it has been in effect during
the Annuitant's lifetime for two years from the Certificate
Date.
CERTIFICATES
Certificates will be furnished by us.
CONFORMITY WITH LAW
If any provision of this Contract is contrary to any law to
which it is subject, such provision is considered amended to
conform to such law.
GA-MA-1074 25
GENERAL PROVISIONS (continued)
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RECORDS
The Contractholder will furnish us information relative to this
Contract as we may require to administer this Contract. Such
records, which in our opinion have a bearing on this Contract,
will be open to us for inspection at all reasonable times.
CERTIFICATE OWNER'S RIGHT TO EXAMINE THE CERTIFICATE
A Certificate Owner may return a Certificate to us or the agent
through whom it was purchased within 10 days of receipt. If so
returned, we will treat the Certificate as though it were never
issued. Upon receipt we will promptly refund the Accumulation
Value plus any charges we have deducted as of the date the
returned Certificate is received by us.
GA-MA-1074 26
SECTION 72 RIDER
Golden American is a stock company domiciled in Wilmington, Delaware
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REQUIRED DISTRIBUTION OF PROCEEDS ON DEATH OF CERTIFICATE OWNER
This Rider is required to qualify the Certificate to which
it is attached as an annuity Certificate under section 72 of the
Internal Revenue Code of 1986, as amended (the "Code"). Where
the terms of this Rider are in conflict with the terms of the
Certificate, the Rider will control. This Rider and the
Certificate should be construed so that they comply with
applicable tax requirements.
DEATH OF CERTIFICATE OWNER ON OR AFTER ANNUITY COMMENCEMENT DATE
IF ANY CERTIFICATE OWNER DIES ON OR AFTER the Annuity
Commencement Date but prior to the time the entire interest in
the Certificate has been distributed, the remaining portion will
be distributed at least as rapidly as under the method of
distribution being used as of the date of the Certificate
Owner's or Annuitant's death.
DEATH OF CERTIFICATE OWNER PRIOR TO ANNUITY COMMENCEMENT DATE
IF ANY CERTIFICATE OWNER DIES PRIOR TO the Annuity
Commencement Date, the entire interest in the Certificate will
be distributed within five years of the Certificate Owner's
death.
However, this distribution requirement will be considered
satisfied as to any portion of the owner's interest in the
Certificate which is payable to or for the benefit of a
"designated beneficiary" and which will be distributed over the
life of such "designated beneficiary" or over a period not
extending beyond the life expectancy of that "designated
beneficiary", provided such distributions begin within one year
of the Certificate Owner's death. If the "designated
beneficiary" is the surviving spouse of the decedent, the
Certificate may be continued in the name of the spouse as
Certificate Owner and these distribution rules are applied by
treating the spouse as the Certificate Owner. However, on the
death of the surviving spouse, this provision regarding spouses
may not be used again.
If any Certificate Owner is not an individual, the death or
change (where permitted) of the Annuitant will be treated as the
death of a Certificate Owner.
The "designated beneficiary" is the person entitled to
ownership rights under the Certificate. Thus, where no death
benefit has become payable, the "designated beneficiary", for
the purposes of applying this Rider, is the Certificate
Owner(s). Where a death benefit has become payable, the
"designated beneficiary", for the purposes of applying this
Rider, is the person(s) entitled to the death benefit, generally
the Beneficiary or surviving Certificateowners, as appropriate.
Upon the death of any Certificate Owner, the "designated
beneficiary" will become the Certificate Owner or, if an
individual, will become the Annuitant.
* * *
A Certificate Owner may notify Golden American as to the
manner of payment under this Rider. If such Certificate Owner
has not so notified Golden American prior to his or her death,
the "designated beneficiary" under the Certificate may so notify
Golden American.
GOLDEN AMERICAN LIFE INSURANCE COMPANY
President Secretary
GA-MA-1074
WAIVER OF SURRENDER CHARGE RIDER
Golden American is a stock company domiciled in Wilmington, Delaware
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Golden American Life Insurance Company ("we" or "us") will
waive any Surrender Charge incurred due to a surrender or Excess
Partial Withdrawal under the Certificate in the event the
Certificate Owner ("you") is subject to Qualified Extended
Medical Care or suffers from a Qualifying Terminal Illness
subject to the terms and conditions stated below:
EXTENDED MEDICAL CARE
To qualify for this waiver, you must first begin receiving
Qualified Extended Medical Care on or after the first
Certificate Anniversary for at least 45 days during any
continuous sixty-day period, and your request for the surrender
or withdrawal, together with proof of such Qualified Extended
Medical Care, must be received at our Customer Service Center
during the term of such care or within ninety days after the
last day upon which you received such care.
Qualified Extended Medical Care" means confinement in a
Qualified Licensed Hospital or Nursing Care Facility prescribed
by a Qualifying Medical Professional.
"Qualifying Licensed Hospital or Nursing Care Facility"
means a skilled or intermediate care nursing facility at which
medical treatment is available on a daily basis; and daily
medical records are kept on each patient. This does not include
a facility whose purpose is to provide accommodations, board or
personal care services to individuals who do not need medical or
nursing care; nor a place mainly for rest.
"Qualifying Medical Professional" means a legally-qualified
practitioner of the healing arts who is acting within the scope
of his or her license; is not a resident of your household or
that of the Annuitant; and is not related to you or the
Annuitant by blood or marriage.
TERMINAL ILLNESS
To qualify for this waiver, you must be first diagnosed by
a Qualifying Medical Professional, on or after the first
Certificate Anniversary, as having a Qualifying Terminal
Illness. Written proof of terminal illness, satisfactory to us,
must be received at our Customer Service Center. We reserve the
right to require an examination by a physician of our choice.
"Qualifying Terminal Illness" means an illness or accident,
the result of which results in a life expectancy of twelve
months or less, as measured from the date of diagnosis.
CLAIMS
Evidence, satisfactory to us, must be submitted to qualify
for waiver of Surrender Charge pursuant to this Rider. This
evidence will be in writing and, where applicable, be attested
to by a Qualified Medical Professional.
This Rider is attached to and becomes part of the
Certificate to which it is attached. The provisions of this
Rider shall supersede the provisions of the Certificate where
applicable.
GOLDEN AMERICAN LIFE INSURANCE COMPANY
President Secretary
GA-RA-1003-12/94
DEFERRED COMBINATION VARIABLE AND FIXED ANNUITY GROUP MASTER
CONTRACT-NO DIVIDENDS
Variable Cash Surrender Values while a Certificate Owner is living and
prior to the Annuity Commencement Date. Death benefit subject to guaranteed
minimum. Additional premium payment option. Partial withdrawal option.
Non-participating. Investment results reflected in values.
GA-MA-1074
