OMB APPROVAL 

OMB Number: 3235-0503 

Expires: October 31, 2024 

Estimated average burden 

hours per response ............82.4 

UNITED STATES 

SECURITIES AND EXCHANGE COMMISSION 

Washington, DC 20549 

FORM N-6 

This is a reference copy of Form N-6. You may not send a completed printout of this form to the SEC to satisfy a filing obligation. 

You can only satisfy an SEC filing obligation by submitting the information required by this form to the SEC in electronic format 

online at https://www.edgarfiling.sec.gov. 
 

 

 

 

 

__________________________________________________________________________ 

__________________________________________________________________________ 

__________________________________________________________________________ 

__________________________________________________________________________ 

__________________________________________________________________________ 

UNITED STATES 

SECURITIES AND EXCHANGE 

COMMISSION 

Washington, DC 20549 

FORM N-6 

REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933 

Pre-Effective Amendment No. 

Post-Effective Amendment 

No. 

and/or 

REGISTRATION STATEMENT UNDER THE INVESTMENT COMPANY ACT OF 1940 

Amendment No. 

(Check appropriate box or boxes.) 

(Exact Name of Registrant) 

(Name of Depositor) 

(Address of Depositor’s Principal Executive Offices) (Zip Code) 

(Depositor’s Telephone Number, including Area Code) 

(Name and Address of Agent for Service) 

Approximate Date of Proposed Public Offering: __________________________________________ 

It is proposed that this filing will become effective (check appropriate box): 

immediately upon filing pursuant to paragraph (b) 

on (date) pursuant to paragraph (b) 

60 days after filing pursuant to paragraph (a)(1) 

on (date) pursuant to paragraph (a)(1) of rule 485 under the Securities Act. 

If appropriate, check the following box: 

this post-effective amendment designates a new effective date for a previously filed post-effective 

amendment. 

Persons who respond to the collection of information contained in this form are not required to 

respond unless the form displays a currently valid OMB control number. 

SEC 2567 (1/22) 
Omit from the facing sheet reference to the other Act if the registration statement or amendment is 

filed under only one of the Acts. Include the “Approximate Date of Proposed Public Offering” only where 

securities are being registered under the Securities Act of 1933. 

Form N-6 is to be used by separate accounts that are unit investment trusts that offer variable life 

insurance contracts to register under the Investment Company Act of 1940 and to offer their securities 

under the Securities Act of 1933. The Commission has designed Form N-6 to provide investors with 

information that will assist them in making a decision about investing in a variable life insurance 

contract. The Commission also may use the information provided on Form N-6 in its regulatory, 

disclosure review, inspection, and policy-making roles. 

A Registrant is required to disclose the information specified by Form N-6, and the Commission will 

make this information public. A Registrant is not required to respond to the collection of information 

contained in Form N-6 unless the Form displays a currently valid Office of Management and Budget 

(“OMB”) control number. Please direct comments concerning the accuracy of the information collection 

burden estimate and any suggestions for reducing the burden to Secretary, Securities and Exchange 

Commission, 100 F Street, N.E., Washington, DC 20549. The OMB has reviewed this collection of 

information under the clearance requirements of 44 U.S.C. § 3507 

Persons who respond to the collection of information contained in this form are not required to 

respond unless the form displays a currently valid OMB control number. 

SEC 2567 (1/22) 
 

CONTENTS OF FORM N-6 

GENERAL INSTRUCTIONS.........................................................................................................................................................................v 

A. Definitions.........................................................................................................................................................................................v 

B. Filing and Use of Form N-6 .............................................................................................................................................................vi 

C. Preparation of the Registration Statement...................................................................................................................................vii 

D. Incorporation by Reference .............................................................................................................................................................x 

PART A - INFORMATION REQUIRED IN A PROSPECTUS ..........................................................................................................................1 

Item 1. Front and Back Cover Pages ......................................................................................................................................................1 

Item 2. Key Information...........................................................................................................................................................................2 

Item 3. Overview of the Contract.............................................................................................................................................................6 

Item 4. Fee Table .....................................................................................................................................................................................6 

Item 5. Principal Risks of Investing in the Contract .............................................................................................................................10 

Item 6. General Description of Registrant, Depositor, and Portfolio Companies...............................................................................10 

Item 7. Charges......................................................................................................................................................................................11 

Item 8. General Description of Contracts .............................................................................................................................................12 

Item 9. Premiums ..................................................................................................................................................................................14 

Item 10. Standard Death Benefits........................................................................................................................................................16 

Item 11. Other Benefits Available Under the Contract ........................................................................................................................17 

Item 12. Surrenders and Withdrawals..................................................................................................................................................18 

Item 13. Loans.......................................................................................................................................................................................19 

Item 14. Lapse and Reinstatement ......................................................................................................................................................19 

Item 15. Taxes .......................................................................................................................................................................................19 

Item 16. Legal Proceedings...................................................................................................................................................................20 

Item 17. Financial Statements..............................................................................................................................................................20 

Item 18. Portfolio Companies Available Under the Contract...............................................................................................................20 

PART B - INFORMATION REQUIRED IN A STATEMENT OF ADDITIONAL INFORMATION.......................................................................23 

Item 19. Cover Page and Table of Contents.........................................................................................................................................23 

Item 20. General Information and History............................................................................................................................................23 

Item 21. Non-Principal Risks of Investing in the Contract...................................................................................................................24 

Item 22. Services ...................................................................................................................................................................................24 

Item 23. Premiums ................................................................................................................................................................................25 

Item 24. Additional Information About Operation of Contracts and Registrant .................................................................................25 

Item 25. Underwriters............................................................................................................................................................................26 

Item 26. Additional Information About Charges...................................................................................................................................27 

Item 27. Lapse and Reinstatement ......................................................................................................................................................27 

Item 28. Financial Statements..............................................................................................................................................................28 

Item 29. Illustrations .............................................................................................................................................................................29 

PART C - OTHER INFORMATION..............................................................................................................................................................31 

Item 30. Exhibits ....................................................................................................................................................................................31 

Item 31. Directors and Officers of the Depositor.................................................................................................................................33 

Item 32. Persons Controlled by or Under Common Control with the Depositor or the Registrant....................................................33 

Item 33. Indemnification .......................................................................................................................................................................34 

Item 34. Principal Underwriters ............................................................................................................................................................34 

Item 35. Location of Accounts and Records ........................................................................................................................................35 

Item 36. Management Services............................................................................................................................................................35 

Item 37. Fee Representation ................................................................................................................................................................35 

SIGNATURES ...........................................................................................................................................................................................36 

iv 
 

 

 

 

 

 

 

GENERAL INSTRUCTIONS 

A. Definitions 

References to sections and rules in this Form N-6 are to the Investment Company Act of 1940 [15 

U.S.C. 80a-1 et seq.] (the “Investment Company Act”), unless otherwise indicated. Terms used in this 

Form N-6 have the same meaning as in the Investment Company Act or the related rules, unless otherwise 

indicated. As used in this Form N-6, the terms set out below have the following meanings: 

“Class” means a version of a Variable Life Insurance Contract that varies principally with respect to 

distribution-related fees and expenses. 

“Depositor” means the person primarily responsible for the organization of the Registrant and the 

person, other than the trustee or custodian, who has continuing functions or responsibilities for the 

administration of the affairs of the Registrant. “Depositor” includes the sponsoring insurance company 

that establishes and maintains the Registrant. If there is more than one Depositor, the information called 

for in this Form about the Depositor shall be provided for each Depositor. 

“Investor Account” means any account of a contract owner, participant, or beneficiary to which (net) 

premiums under a variable life contract are added and from which contract or transaction expenses may 

be subtracted. 

“Platform Charge” means any fee charged by the Registrant to make a Portfolio Company available as 

an investment option under the Contract, and that varies solely on the basis of the Portfolio Company 

selected. 

“Portfolio Company” means any company in which the Registrant invests and which may be selected as 

an option by the investor. 

“Registrant” means the separate account (as defined in section 2(a)(37) of the Investment Company 

Act [15 U.S.C. 80a-2(a)(37)]) that offers the Variable Life Insurance Contracts. 

“SAI” means the Statement of Additional Information required by Part B of this Form. 

“Securities Act” means the Securities Act of 1933 [15 U.S.C. 77a et seq.]. 

“Securities Exchange Act” means the Securities Exchange Act of 1934 [15 U.S.C. 78a et seq.]. 

“Statutory Prospectus” means a prospectus that satisfies the requirements of section 10(a) of the 

Securities Act [15 U.S.C. 77j(a)]. 

“Summary Prospectus” has the meaning provided by paragraph (a)(11) of rule 498A under the 

Securities Act [17 CFR 230.498A(a)(11)]. 

“Variable Life Insurance Contract” or “Contract” means a life insurance contract that provides for death 

benefits and cash values that may vary with the investment experience of any separate account. Unless 

the context otherwise requires, “Variable Life Insurance Contract” or “Contract” refers to the Variable Life 

Insurance Contracts being offered pursuant to the registration statement prepared on this Form. 

v 
 

 

 

 

 

 

B. Filing and Use of Form N-6 

1. What is Form N-6 used for? 

Form N-6 is used by all separate accounts organized as unit investment trusts and offering Variable 

Life Insurance Contracts to file: 

(a) An initial registration statement under the Investment Company Act and any amendments to the 

registration statement; 

(b) An initial registration statement required under the Securities Act and any amendments to the 

registration statement, including amendments required by section 10(a)(3) of the Securities Act 

[15 U.S.C. 77j(a)(3)]; or 

(c) Any combination of the filings in paragraph (a) or (b). 

2. What is included in the registration statement? 

(a) For registration statements or amendments filed under both the Investment Company Act and 

the Securities Act or only under the Securities Act, include the facing sheet of the Form, Parts 

A, B, and C, and the required signatures. 

(b) For registration statements or amendments filed only under the Investment Company Act, 

include the facing sheet of the Form, responses to all Items of Parts A (except Items 1, 4, 5, 

10, and 17), B, and C (except Items 29(c), (k), (l), (n), and (o)), and the required signatures. 

3. What are the fees for Form N-6? 

No registration fees are required for a filing on Form N-6 to register as an investment company 

under the Investment Company Act or to register securities under the Securities Act. If a filing on 

Form N-6 is made to register securities under the Securities Act and securities are sold to the 

public, registration fees must be paid on an ongoing basis after the end of the Registrant’s fiscal 

year. See section 24(f) [15 U.S.C. 80a-24(f)] and related rule 24f-2 [17 CFR 270.24f-2]. 

4. What rules apply to the filing of a registration statement on Form N-6? 

(a) For registration statements and amendments filed under both the Investment Company Act and 

the Securities Act or under only the Securities Act, the general rules under the Securities Act, 

particularly the rules regarding the filing of registration statements in Regulation C [17 CFR 

230.400 - 230.498A] apply to the filing of registration statements on Form N-6. Specific 

requirements concerning investment companies appear in rules 480 - 488 and 495 - 498A of 

Regulation C. 

(b) For registration statements and amendments filed only under the Investment Company Act, the 

general rules under the Investment Company Act, particularly the provisions in rules 8b-1 – 8b31 [17 CFR 270.8b-1 to 8b-31] apply to the filing of registration statements on Form N-6. 

(c) The plain English requirements of rule 421(d) under the Securities Act [17 CFR 230.421(d)] 

apply to prospectus disclosure in Part A of Form N-6. 

(d) Regulation S-T [17 CFR 232.10 - 232.501] applies to all filings on the Commission’s Electronic 

Data Gathering, Analysis, and Retrieval system (“EDGAR”). 

vi 
 

 

 

 

C. Preparation of the Registration Statement 

1. Administration of the Form N-6 Requirements 

(a) The requirements of Form N-6 are intended to promote effective communication between the 

Registrant and prospective investors. A Registrant’s prospectus should clearly disclose the 

fundamental features and risks of the Variable Life Insurance Contracts, using concise, 

straightforward, and easy to understand language. A Registrant should use document design 

techniques that promote effective communication. 

(b) The prospectus disclosure requirements in Form N-6 are intended to elicit information for an 

average or typical investor who may not be sophisticated in legal or financial matters. The 

prospectus should help investors to evaluate the risks of an investment and to decide whether 

to invest in a Variable Life Insurance Contract by providing a balanced disclosure of positive and 

negative factors. Disclosure in the prospectus should be designed to assist an investor in 

comparing and contrasting a Variable Life Insurance Contract with other Contracts. 

(c) Responses to the Items in Form N-6 should be as simple and direct as reasonably possible and 

should include only as much information as is necessary to enable an average or typical 

investor to understand the particular characteristics of the Variable Life Insurance Contracts. 

The prospectus should avoid including lengthy legal and technical discussions and simply 

restating legal or regulatory requirements to which Contracts generally are subject. Brevity is 

especially important in describing the practices or aspects of the Registrant’s operations that do 

not differ materially from those of other separate accounts. Avoid excessive detail, technical or 

legal terminology, and complex language, including the use of formulas as the primary means of 

communicating certain terms or features of the Contract. Also avoid lengthy sentences and 

paragraphs that may make the prospectus difficult for investors to understand and detract from 

its usefulness. 

(d) The requirements for prospectuses included in registration statements on Form N-6 will be 

administered by the Commission in a way that will allow variances in disclosure or presentation 

if appropriate for the circumstances involved while remaining consistent with the objectives of 

Form N-6. 

2. Form N-6 is divided into three parts: 

(a) Part A. Part A includes the information required in a Registrant’s prospectus under section 

10(a) of the Securities Act. The purpose of the prospectus is to provide essential information 

about the Registrant and the Contracts in a way that will help investors to make informed 

decisions about whether to purchase the securities described in the prospectus. In responding 

to the Items in Part A, avoid cross-references to the SAI. Cross-references within the prospectus 

are most useful when their use assists investors in understanding the information presented 

and does not add complexity to the prospectus. 

(b) Part B. Part B includes the information required in a Registrant’s SAI. The purpose of the SAI is 

to provide additional information about the Registrant and the Contracts that the Commission 

has concluded is not necessary or appropriate in the public interest or for the protection of 

investors to be in the prospectus, but that some investors may find useful. Part B affords the 

Registrant an opportunity to expand discussions of the matters described in the prospectus by 

including additional information that the Registrant believes may be of interest to some 

investors. The Registrant should not duplicate in the SAI information that is provided in the 

vii 
 

 

 

prospectus, unless necessary to make the SAI comprehensible as a document independent of 

the prospectus. 

(c) Part C. Part C includes other information required in a Registrant’s registration statement. 

3. Additional Matters 

(a) Organization of Information. Organize the information in the prospectus and SAI to make it easy 

for investors to understand. Notwithstanding rule 421(a) under the Securities Act [17 CFR 

230.421(a)] regarding the order of information required in a prospectus, disclose the 

information required by Item 2 (Key Information), Item 3 (Overview of the Contract), and Item 4 

(Fee Table) in numerical order at the front of the prospectus. Do not precede Items 2, 3, and 4 

with any other Item except the Cover Page (Item 1), a glossary, if any (General Instruction 

C.3.(d)), or a table of contents meeting the requirements of rule 481(c) under the Securities Act 

[17 CFR 230.481(c)]. If the discussion of the information required by Items 2 or 3 also 

responds to disclosure requirements in other items of the prospectus, a Registrant need not 

include additional disclosure in the prospectus that repeats the information disclosed in 

response to Items 2 and 3. 

(b) Other Information. A Registrant may include, except in response to Items 2 and 3, information 

in the prospectus or the SAI that is not otherwise required so long as the information is not 

incomplete, inaccurate, or misleading and does not, because of its nature, quantity, or manner 

of presentation, obscure or impede understanding of the information that is required to be 

included. For example, Registrants are free to include in the prospectus financial statements 

required to be in the SAI, and may include in the SAI financial statements that may be placed in 

Part C. However, information regarding non-principal risks that is not otherwise required to be 

in the prospectus must be disclosed in the SAI and not the prospectus, in accordance with 

Items 5 and 21. 

(c) Presentation of Information. To aid investor comprehension, Registrants are encouraged to 

use, as appropriate, question-and-answer formats, tables, side-by-side comparisons, captions, 

bullet points, numeric examples, illustrations or similar presentation methods. For example, 

such presentation methods would be appropriate when presenting disclosure for similar 

Contract features, prospectuses describing multiple Variable Life Insurance Contracts, or the 

operation of optional benefits. 

(d) Use of Terms. 

(i) Definitions. Define the special terms used in the prospectus (e.g., accumulation unit, 

participant, sub-account, etc.) in any presentation that clearly conveys meaning to investors. 

If the Registrant elects to include a glossary or list of definitions, only special terms used 

throughout the prospectus must be defined or listed. If a special term is used in only one 

section of the prospectus, it may be defined there (and need not be included in any glossary 

or list of definitions that the Registrant includes). 

(ii) Alternate Terminology. A Registrant may use alternate terminology other than that used in 

the form so long as the terminology used by the Registrant clearly conveys the meaning of, 

or provides comparable information as, the terminology included in the form. 

viii 
 

 

 

 

 

 

 

 

 

(e) Use of Form N-6 to Register Multiple Contracts. 

(i) A single prospectus may describe multiple Contracts that are essentially identical. Whether 

the prospectus describes Contracts that are “essentially identical” will depend on the facts 

and circumstances. For example, a Contract that does not offer optional benefits would not 

be essentially identical to one that does for a charge. Similarly, group and individual 

Contracts would not be essentially identical. However, Contracts that vary only due to state 

regulatory requirements would be essentially identical. 

(A) Paragraph (a) of General Instruction C.3 requires Registrants to disclose the 

information required by Items 2, 3, and 4 in numerical order at the front of the 

prospectus and generally not to precede the Items with other information. As a 

general matter, Registrants providing disclosure in a single prospectus for more 

than one Contract, may depart from the requirement of paragraph (a) as necessary 

to present the required information clearly and effectively (although the order of 

information required by each Item must remain the same). For example, the 

prospectus may present all of the Item 2 information for several Contracts (e.g., by 

providing several Key Information Tables sequentially or by providing a single Key 

Information Table containing separate disclosures for each Contract to the extent 

that such disclosures would vary by Contract), followed by all of the Item 3 

information for the Contracts, and followed by all of the Item 4 information for the 

Contracts. Alternatively, the prospectus may present Items 2, 3, and 4 for each of 

several Contracts sequentially. Other presentations also would be acceptable if 

they are consistent with the Form’s intent to disclose the information required by 

Items 2, 3, and 4 in a standard order at the beginning of the prospectus. 

Registrants that present Items 2, 3, and 4 for each of several Contracts 

sequentially or that utilize another presentation should consider whether investors 

might benefit from a brief explanation about how the information in the prospectus 

is presented, such as headings for each contract in the prospectus’ table of 

contents and/or a brief narrative at the beginning of the prospectus explaining the 

presentation. Registrants are encouraged to present information in a manner that 

limits repetition. 

(B) The Registrant should generally include appropriate titles, headings, or any other 

information to promote clarity and facilitate understanding regarding which 

disclosures apply to which Contract, if such disclosures would vary based on the 

Contract. 

(ii) Multiple prospectuses may be combined in a single registration statement on Form N-6 

when the prospectuses describe Contracts that are substantially similar. For example, a 

Registrant could determine it is appropriate to include multiple prospectuses in a 

registration statement in the following situations: (i) the prospectuses describe the same 

Contract that is sold through different distribution channels; (ii) the prospectuses describe 

Contracts that differ only with respect to Portfolio Companies offered; or (iii) the 

prospectuses describe both the original and a modified version of the same Contract (where 

the “modified” version differs in the features or options that the Registrant offers under that 

Contract). 

ix 
 

 

 

 

 

 

 

 

 

 

 

(f) Dates. Rule 423 under the Securities Act [17 CFR 230.423] applies to the dates of the 

prospectus and the SAI. The SAI should be made available at the same time that the 

prospectus becomes available for purposes of rules 430 and 460 under the Securities Act [17 

CFR 230.430 and 230.460]. 

(g) Sales Literature. A Registrant may include sales literature in the prospectus so long as the 

amount of this information does not add substantial length to the prospectus and its placement 

does not obscure essential disclosure. 

(h) Interactive Data File 

(i) An Interactive Data File (see rule 232.11 of Regulation S-T [17 CFR 232.11]) is required to 

be submitted to the Commission in the manner provided by rule 405 of Regulation S-T [17 

CFR 232.405] for any registration statement or post-effective amendment thereto on Form 

N-6 that includes or amends information provided in response to Items 2, 4, 5, 10, 11, or 18 

with regards to Contracts that are being sold to new investors. 

(A) Except as required by paragraph (h)(i)(B), the Interactive Data File must be submitted as 

an amendment to the registration statement to which the Interactive Data File relates. 

The amendment must be submitted on or before the date the registration statement or 

post-effective amendment that contains the related information becomes effective. 

(B) In the case of a post-effective amendment to a registration statement filed pursuant to 

paragraphs (b)(1)(i), (ii), (v), (vi), or (vii) of rule 485 under the Securities Act [17 CFR 

230.485(b)], the Interactive Data File must be submitted either with the filing, or as an 

amendment to the registration statement to which the Interactive Data Filing relates that 

is submitted on or before the date the post-effective amendment that contains the 

related information becomes effective. 

(ii) An Interactive Data File is required to be submitted to the Commission in the manner 

provided by rule 405 of Regulation S-T for any form of prospectus filed pursuant to 

paragraphs (c) or (e) of rule 497 under the Securities Act [17 CFR 230.497(c) or (e)] that 

includes information provided in response to Items 2, 4, 5, 10, 11, or 18 that varies from 

the registration statement with regards to Contracts that are being sold to new investors. 

The Interactive Data File must be submitted with the filing made pursuant to rule 497. 

(iii) The Interactive Data File must be submitted in accordance with the specifications in the 

EDGAR Filer Manual, and in such a manner that will permit the information for each 

Contract, and, for any information that does not relate to all of the Classes in a filing, each 

Class of the Contract to be separately identified. 

(i) Website Addresses. Any website address included in an electronic version of the Statutory 

Prospectus must include an active hyperlink or other means of facilitating access that leads 

directly to the relevant website address. This requirement does not apply to an electronic 

Statutory Prospectus filed on the EDGAR system. 

D. Incorporation by Reference 

1. General Requirements 

All incorporation by reference must comply with the requirements of this Form and the following 

rules on incorporation by reference: rule 411 under the Securities Act [17 CFR 230.411] (general 

x 
 

 

 

 

 

rules on incorporation by reference in a prospectus); rule 303 of Regulation S-T [17 CFR 232.303] 

(specific requirements for electronically filed documents); and rule 0-4 under the Investment 

Company Act [17 CFR 270.0-4] (additional rule on incorporation by reference for investment 

companies). In general, a Registrant may incorporate by reference, in the answer to any item of 

Form N-4 not required to be in the prospectus, any information elsewhere in the registration 

statement or in other statements, applications, or reports filed with the Commission. 

2. Specific Rules for Incorporation by Reference in Form N-6 

(a) A Registrant may not incorporate by reference into a prospectus information that Part A of this 

Form requires to be included in a prospectus, except as specifically permitted by Part A of the 

Form. 

(b) A Registrant may incorporate by reference any or all of the SAI into the prospectus (but not to 

provide any information required by Part A to be included in the prospectus) without delivering 

the SAI with the prospectus. 

(c) A Registrant may incorporate by reference into the SAI or its response to Part C information that 

Parts B and C require to be included in the Registrant’s registration statement. 

xi 
 

 

 

 

 

PART A - INFORMATION REQUIRED IN A PROSPECTUS 

Item 1. Front and Back Cover Pages 

(a) Front Cover Page. Include the following information on the outside front cover page of the 

prospectus: 

(1) The Registrant’s name. 

(2) The Depositor’s name. 

(3) The types of Variable Life Insurance Contracts offered by the prospectus (e.g., group, individual, 

scheduled premium, flexible premium). 

(4) The name of the Contract and the Class or Classes, if any, to which the Contract relates. 

(5) The date of the prospectus. 

(6) The statement required by rule 481(b)(1) under the Securities Act [17 CFR 230.481(b)(1)]. 

(7) The statement that additional information about certain investment products, including variable 

life insurance, has been prepared by the Securities and Exchange Commission’s staff and is 

available at Investor.gov. 

(8) If applicable, the legend: “If you are a new investor in the Contract, you may cancel your 

Contract within 10 days of receiving it without paying fees or penalties. In some states, this 

cancellation period may be longer. Upon cancellation, you will receive either a full refund of the 

amount you paid with your application or your total Contract value. You should review this 

prospectus, or consult with your investment professional, for additional information about the 

specific cancellation terms that apply.” 

Instruction. A Registrant may include on the front cover page any additional information, subject to the 

requirements of General Instruction C.3.(b) and (c). 

(b) Back Cover Page. Include the following information on the outside back cover page of the 

prospectus: 

(1) A statement that the SAI includes additional information about the Registrant. Explain that the 

SAI is available, without charge, upon request, and explain how investors may make inquiries 

about their Contracts. Provide a toll-free (or collect) telephone number for investors to call to 

request the SAI, to request other information about the Contracts, and to make investor 

inquiries. 

Instructions. 

1. A Registrant may indicate, if applicable, that the SAI and other information are available on its 

website and/or by email request. 

1 
 

2. A Registrant may indicate, if applicable, that the SAI and other information are available from 

an insurance agent or financial intermediary (such as a broker-dealer or bank) through which 

the Contracts may be purchased or sold. 

3. When a Registrant (or an insurance agent or financial intermediary through which Contracts 

may be purchased or sold) receives a request for the SAI, the Registrant (or insurance agent 

or financial intermediary) must send the SAI within 3 business days of receipt of the request, 

by first-class mail or other means designed to ensure equally prompt delivery. 

(2) A statement whether and from where information is incorporated by reference into the 

prospectus as permitted by General Instruction D. Unless the information is delivered with the 

prospectus, explain that the Registrant will provide the information without charge, upon 

request (referring to the telephone number provided in response to paragraph (b)(i)). 

Instruction. The Registrant may combine the information about incorporation by reference with the 

statements required under paragraph (b)(i). 

(3) A statement that reports and other information about the Registrant are available on the 

Commission’s website at http://www.sec.gov, and that copies of this information may be 

obtained, upon payment of a duplicating fee, by electronic request at the following email 

address: publicinfo@sec.gov. 

(4) The EDGAR contract identifier for the Contract on the bottom of the back cover page in type size 

smaller than that generally used in the prospectus (e.g., 8-point modern type). 

Item 2. Key Information 

Include the following information: 

Important Information You Should Consider About the [Contract] 

FEES AND EXPENSES 

Charges for Early 

Withdrawals 

Transaction 

Charges 

Ongoing Fees and 

Expenses (annual 

charges) 

RISKS 

Risk of Loss 

Not a Short-Term 

Investment 

2 
 

 

Risks Associated 

with Investment 

Options 

Insurance Company 

Risks 

Contract Lapse 

RESTRICTIONS 

Investments 

Optional Benefits 

TAXES 

Tax Implications 

CONFLICTS OF INTEREST 

Investment 

Professional 

Compensation 

Exchanges 

Instructions. 

1. General. 

(a) Disclose the required information in the tabular presentation(s) reflected herein, in the order 

specified. A Registrant may exclude any disclosures that are not applicable, or modify any of 

the statements required to be included, so long as the modified statement contains 

comparable information. Notwithstanding this instruction and General Instruction C.3.(d)(ii), 

the title, headings, and sub-headings for this tabular presentation may not be modified or 

substituted with alternate terminology unless otherwise provided. 

(b) Provide cross-references to the location in the Statutory Prospectus where the subject matter 

is described in greater detail. Cross-references in electronic versions of the Summary 

Prospectus and/or Statutory Prospectus should link directly to the location in the Statutory 

Prospectus where the subject matter is discussed in greater detail, or should provide a means 

of facilitating access to that information through equivalent methods or technologies. The 

cross-reference should be adjacent to the relevant disclosure, either within the table row, or 

presented in an additional table column. 

(c) All disclosures provided in response to this Item should be short and succinct, consistent with 

the limitations of a tabular presentation. 

3 
 

 

 

 

 

 

 

 

 

 

2. Fees and Expenses. 

(a) Charges for Early Withdrawals. Include a statement that if the investor withdraws money from 

the Contract within [x] years following his or her last premium payment, he or she will be 

assessed a surrender charge. Include in this statement the maximum surrender charge (as a 

percentage of [contribution/premium or amount surrendered]), and the maximum number of 

years that a surrender charge may be assessed since the last premium payment under the 

Contract. Provide an example of the maximum surrender charge an investor could pay (in 

dollars) under the Contract assuming a $100,000 investment (e.g., “[i]f you make an early 

withdrawal, you could pay a surrender charge of up to $9,000 on a $100,000 investment.”). 

(b) Transaction Charges. State that in addition to surrender charges (if applicable), the investor 

may also be charged for other transactions, and provide a brief narrative description of the 

types of such charges (e.g., front-end loads, charges for transferring cash value between 

investment options, charges for wire transfers, etc.). 

(c) Ongoing Fees and Expenses (annual charges). 

(i) Briefly state that in addition to surrender charges and transaction charges, an investment 

in the Contract is subject to certain ongoing fees and expenses, including fees and 

expenses covering the cost of insurance under the Contract and the cost of optional 

benefits available under the Contract, and that such fees and expenses are set based on 

characteristics of the insured (e.g., age, sex, and rating classification). State that investors 

should view the policy specifications page of their Contract for rates applicable to their 

Contract. 

(ii) Briefly state that investors will also bear expenses associated with the Portfolio Companies 

under the Contract, as shown in the following table: 

Annual Fee Minimum Maximum 

Investment options 

(Portfolio Company fees and expenses) 

[ ]% [ ]% 

(A) If a Registrant offers multiple Portfolio Companies under the Contract, it should 

disclose the minimum and maximum “Total Annual Portfolio Company Operating 

Expenses” calculated in accordance with Item 3 of Form N-1A [17 CFR §§ 239.15A 

and 274.11A] (before expense reimbursements or fee waiver arrangements). If the 

Registrant charges a Platform Charge to make any of the Portfolio Companies available 

as investment options under the Contract, the Registrant should include the maximum 

Platform Charge associated with each Portfolio Company when calculating minimum 

and maximum Annual Portfolio Company Expenses. 

(B) The Minimum Annual Fee means the lowest Portfolio Company Total Annual Operating 

Expenses. The Maximum Annual Fee means the highest Portfolio Company Total 

Operating Expenses. 

3. Risks. 

(a) Risk of Loss. State that an investor can lose money by investing in the Contract. 

4 
 

 

 

 

 

 

 

 

 

 

 

(b) Not a Short-Term Investment. State that a Contract is not a short-term investment and is not 

appropriate for an investor who needs ready access to cash, accompanied by a brief 

explanation. 

(c) Risks Associated with Investment Options. State that an investment in the Contract is subject 

to the risk of poor investment performance and can vary depending on the performance of the 

investment options available under the Contract (e.g., Portfolio Companies), that each 

investment option (including any fixed account investment option) will have its own unique risks, 

and that the investor should review these investment options before making an investment 

decision. 

(d) Insurance Company Risks. State that an investment in the Contract is subject to the risks 

related to the Depositor, including that any obligations (including under any fixed account 

investment options), guarantees, or benefits are subject to the claims-paying ability of the 

Depositor. Further state that more information about the Depositor, including if applicable its 

financial strength ratings, is available upon request, and indicate how such requests can be 

made (e.g., via toll-free telephone number). 

Instruction. A Registrant may include the Depositor’s financial strength rating(s) and omit the 

portion of the disclosures regarding the availability of the Depositor’s financial strength ratings 

specified by the last sentence of Instruction 3.(d). 

(e) Contract Lapse. Briefly state (1) the circumstances under which the Contract may lapse (e.g., 

insufficient premium payments, poor investment performance, withdrawals, unpaid loans or 

loan interest), (2) whether there is a cost associated with reinstating a lapsed Contract, and (3) 

that death benefits will not be paid if the Contract has lapsed. 

4. Restrictions. 

(a) Investments. State whether there are any restrictions that may limit the investments that an 

investor may choose, as well as any limitations on the transfer of Contract value among Portfolio 

Companies. If applicable, state that the insurer reserves the right to remove or substitute 

Portfolio Companies as investment options. 

(b) Optional Benefits. State whether there are any restrictions or limitations relating to optional 

benefits, and/or whether an optional benefit may be modified or terminated by the Registrant. 

If applicable, state that withdrawals that exceed limits specified by the terms of an optional 

benefit may affect the availability of the benefit by reducing the benefit by an amount greater 

than the value withdrawn, and/or could terminate the benefit. 

5. Taxes—Tax Implications. State that an investor should consult with a tax professional to 

determine the tax implications of an investment in and payments received under the Contract, 

and that there is no additional tax benefit to the investor if the Contract is purchased through a 

tax-qualified plan or individual retirement account (IRA). Explain that withdrawals will be subject 

to ordinary income tax, and may be subject to tax penalties. 

6. Conflicts of Interest. 

(a) Investment Professional Compensation. State that some investment professionals may 

receive compensation for selling the Contract to investors, and briefly describe the basis upon 

which such compensation is typically paid (e.g., commissions, revenue sharing, compensation 

5 
 

 

 

 

 

 

 

 

 

 

from affiliates and third parties). State that these investment professionals may have a 

financial incentive to offer or recommend the Contract over another investment. 

(b) Exchanges. State that some investment professionals may have a financial incentive to offer 

an investor a new contract in place of the one he or she already owns, and that an investor 

should only exchange his or her Contract if he or she determines, after comparing the 

features, fees, and risks of both contracts, that it is preferable for him or her to purchase the 

new contract rather than continue to own the existing Contract. 

Instruction. A Registrant may omit these line-items if neither the Registrant nor any of its related 

companies pay financial intermediaries for the sale of the Contract or related services. 

Item 3. Overview of the Contract 

Provide a concise description of the Contract, including the following information: 

(a) Purpose. Briefly describe the purpose(s) of the Contract (e.g., to help the investor accumulate assets 

through an investment portfolio, to provide or supplement the investor’s retirement income, to 

provide death and/or other benefits). State for whom the Contract may be appropriate (e.g., by 

discussing a representative investor’s time horizon, liquidity needs, and financial goals). 

(b) Premiums. Briefly describe the payment of premiums under the Contract. 

(1) State whether premiums may vary in timing and amount (e.g., flexible premiums). 

(2) State whether restrictions may be imposed on premiums (e.g., by age of insured, or by amount). 

(3) Describe how premiums may be allocated. This discussion should include a brief overview of 

the investment options available under the Contract, as well as any “fixed account” (general 

account) investment options. 

Instructions. 

1. Prominently disclose that additional information about each Portfolio Company is provided in 

an appendix to the prospectus, and provide a cross-reference to the appendix. 

2. A detailed explanation of the separate account, sub-accounts, Portfolio Companies, and any 

“fixed account” (general account) investment options is not necessary and should be avoided. 

(4) State that payment of insufficient premiums may result in a lapse of the Contract. 

(c) Contract Features. Summarize the Contract’s primary features, including death benefits, withdrawal 

options, loan provisions, and any available optional benefits. If applicable, state that the investor will 

incur an additional fee for selecting a particular benefit. 

Item 4. Fee Table 

Include the following information: 

6 
 

 

 

 

The following tables describe the fees and expenses that you will pay when buying, owning, and 

surrendering or making withdrawals from the Contract. Please refer to your Contract specifications page 

for information about the specific fees you will pay each year based on the options you have elected. 

The first table describes the fees and expenses that you will pay at the time that you buy the Contract, 

surrender or make withdrawals from the Contract, or transfer cash value between investment options. 

Transaction Fees 

Charge When Charge is Deducted Amount Deducted 

Maximum Sales Charge 

Imposed on Premiums (Load) 

Premium Taxes 

Maximum Deferred 

Sales Charge (Load) 

Other Surrender Fees 

Transfer Fees 

The next table describes the fees and expenses that you will pay periodically during the time that you own 

the Policy, not including Portfolio Company fees and expenses. 

Periodic Charges Other Than Annual Portfolio Company Expenses 

Charge When Charge is Deducted Amount Deducted 

Base Contract Charge: 

Cost of Insurance*: 

Minimum and 

Maximum Charge 

Charge for a 

Representative 

Investor 

Annual Maintenance Fee 

Mortality and Expense Risk Fees 

Administrative Expenses 

Optional Benefit Charges: 

* [Footnote: Include disclosure required by Instruction 3(b).] 

7 
 

 

 

 

The next item shows the minimum and maximum total operating expenses charged by the Portfolio 

Companies that you may pay periodically during the time that you own the Contract. [These amounts 

also include applicable Platform Charges if you choose to invest in certain Portfolio Companies.] A 

complete list of Portfolio Companies available under the Contract, including their annual expenses, may 

be found at the back of this document. 

Annual Portfolio Company Expenses Minimum Maximum 

(expenses that are deducted from Portfolio Company 

assets, including management fees, distribution [and/or 

service] (12b-1) fees, and other expenses) 

________% ________% 

Instructions. 

1. General. 

(a) Round all percentages to the nearest hundredth of one percent. 

(b) Include the narrative explanations in the order indicated. A Registrant may modify a narrative 

explanation if the explanation contains comparable information to that shown. 

(c) A Registrant may omit captions if the Registrant does not charge or reserve the right to charge 

the fees or expenses covered by the captions. 

(d) If a Registrant uses one prospectus to offer a Contract in both the group and individual 

variable life markets, the Registrant may include narrative disclosure in a footnote or following 

the tables identifying markets where certain fees are either inapplicable or waived or lower 

fees are charged. In the alternative, a Registrant may present the information for group and 

individual contracts in another format consistent with General Instruction C.3.(c). 

(e) The “When Charge is Deducted” column must be used to show when a charge is deducted, 

e.g., upon purchase, surrender or withdrawal, policy anniversary, monthly, or daily. 

(f) Under the “Amount Deducted” column, the Registrant must disclose the maximum 

guaranteed charge unless a specific instruction directs otherwise. The Registrant should 

include the basis on which the charge is imposed (e.g., 0.95% of average daily net assets, $5 

per exchange, $5 per thousand dollars of face amount). The Registrant may disclose the 

current charge, in addition to the maximum charge, if the disclosure of the current charge is 

no more prominent than, and does not obscure or impede understanding of, the disclosure of 

the maximum charge. In addition, the Registrant may include in a footnote to the table a 

tabular, narrative, or other presentation providing further detail regarding variations in the 

charge. For example, if deferred sales charges decline over time, the Registrant may include 

in a footnote a presentation regarding the scheduled reductions in the deferred sales charges. 

Charges assessed on the basis of the face amount should be disclosed as the charge per 

$1000 of face amount. 

(g) Provide a separate fee table (or separate column within the table) for each Contract form 

offered by the prospectus that has different fees. 

(h) For a Contract with more than one Class, provide a separate response for each Class. 

8 
 

 

 

 

 

 

 

2. Transaction Fees. 

(a) “Other Surrender Fees” include any fees charged for surrender or withdrawal, other than sales 

charges imposed upon surrender or withdrawal. 

(b) “Transfer Fees” include any fees charged for any transfer or exchange of cash value from the 

Registrant to another investment company, from one sub-account of the Registrant to another 

sub-account or the Depositor’s general account, or from the Depositor’s general account to 

the Registrant. 

(c) If the Registrant (or any other party pursuant to an agreement with the Registrant) charges 

any other transaction fee, add another caption describing it and complete the other columns 

of the table for that fee. 

3. Periodic Charges Other Than Annual Portfolio Company Expenses. 

(a) The Registrant may substitute the term used in the prospectus to refer to the Portfolio 

Companies for the bracketed portion of the caption provided. 

(b) For “Cost of Insurance” and any other charges that depend on investor characteristics, such 

as age or rating classification, the Registrant should disclose the minimum and maximum 

charges that may be imposed for a Contract, and the charges that may be paid by a 

representative investor, using appropriate sub-captions. In a footnote to the table, disclose (i) 

that the cost of insurance or other charge varies based on individual characteristics; (ii) that 

the cost of insurance charge or other charge shown in the table may not be representative of 

the charge that a particular investor will pay; and (iii) how the investor may obtain more 

information about the particular cost of insurance or other charges that would apply to him or 

her. 

(i) In disclosing cost of insurance or other charges that depend on investor characteristics for 

a representative investor, the Registrant should assume characteristics (e.g., sex, age, and 

rating classification) that are fairly representative of actual or expected Contract sales, and 

describe these characteristics in the sub-caption for the charge (e.g., “charge for a 40-

year-old non-smoking female”). The rating classification used for the representative 

investor should be the classification with the greatest number of outstanding Contracts (or 

expected Contracts in the case of a new Contract), unless this rating classification is not 

fairly representative of actual or expected Contract sales. In this case, the Registrant 

should use a commonly used rating classification that is fairly representative of actual or 

expected Contract sales. 

(ii) The Registrant may supplement this disclosure of the minimum charges, maximum 

charges, and charges for a representative investor with additional disclosure immediately 

following the fee table. For example, the additional disclosure may include an explanation 

of the factors that affect the cost of insurance or other charge or tables showing the cost 

of insurance or other charge for a spectrum of representative investors. 

(c) “[Annual] Maintenance Fee” includes any Contract, account, or similar fee imposed on a 

percentage basis and charged to all Investor Accounts on any recurring basis. Any nonrecurring Contract, account, or similar fee should be included in the “Transaction Fees” table. 

(d) “Mortality and Expense Risk Fees” may be listed separately on two lines in the table. 

9 
 

 

 

 

 

 

 

 

(e) Administrative Expenses include any Contract, account, or similar fee imposed on all Investor 

Accounts on a dollar basis (e.g., $50 per year) and charged on any recurring basis. 

(f) Optional Benefits expenses include any optional features (e.g., terminal illness or term 

insurance riders) offered under the Contract for an additional charge. 

(g) A Registrant may consolidate any charges that are assessed on a similar basis (e.g., 

Administrative Expenses and Mortality and Expense Risk Fees). 

(h) If the Registrant (or any other party pursuant to an agreement with the Registrant) imposes 

any other recurring charge other than Annual Portfolio Company Expenses, add another 

caption describing it and complete the other columns of the table for that charge. 

4. Annual Portfolio Company Expenses. 

(a) If a Registrant offers multiple Portfolio Companies, it should disclose the minimum and 

maximum “Annual Portfolio Company Expenses” for any Portfolio Company calculated in 

accordance with Item 3 of Form N-1A [17 CFR §§ 239.15A and 274.11A] (before expense 

reimbursements or fee waiver arrangements). If the Registrant charges a Platform Charge to 

make any of the Portfolio Companies available as investment options under the Contract, the 

Registrant should include the maximum Platform Charge associated with each Portfolio 

Company when calculating minimum and maximum Annual Portfolio Company Expenses. 

(b) A Registrant may also reflect, in an additional line-item to the range of Annual Portfolio 

Company Expenses, minimum and maximum Annual Portfolio Company Expenses calculated 

in accordance with Item 3 of Form N-1A that include expense reimbursements or fee waiver 

arrangements that are in place and reflected in the Portfolio Company’s registration 

statement pursuant to Item 3 of Form N-1A. If the Registrant provides this disclosure, also 

disclose the period for which the expense reimbursements or fee waiver arrangement is 

expected to continue, and, if applicable, that it can be terminated at any time at the option of 

a Portfolio Company. If the Registrant charges a Platform Charge to make any of the Portfolio 

Companies available as investment options under the Contract, the Registrant should include 

the current Platform Charge associated with each Portfolio Company when calculating 

minimum and maximum Annual Portfolio Company Expenses that include expense 

reimbursements or fee waiver arrangements. 

Item 5. Principal Risks of Investing in the Contract 

Summarize the principal risks of purchasing a Contract, including the risks of poor investment 

performance, that Contracts are unsuitable as short-term savings vehicles, the risks of Contract lapse, 

limitations on access to cash value through withdrawals, and the possibility of adverse tax 

consequences. 

Item 6. General Description of Registrant, Depositor, and Portfolio Companies 

Concisely discuss the organization and operation or proposed operation of the Registrant. Include the 

information specified below. 

(a) Depositor. Provide the name and address of the Depositor. 

10 
 

 

 

 

 

 

 

 

 

(b) Registrant. Briefly describe the Registrant. Include a statement indicating that: 

(1) income, gains, and losses credited to, or charged against, the Registrant reflect the Registrant’s 

own investment experience and not the investment experience of the Depositor’s other assets; 

(2) the assets of the Registrant may not be used to pay any liabilities of the Depositor other than 

those arising from the Contracts; and 

(3) the Depositor is obligated to pay all amounts promised to investors under the Contracts. 

(c) Portfolio Companies. State that information regarding each Portfolio Company, including (i) its 

name; (ii) its type (e.g., money market fund, bond fund, balanced fund, etc.) or a brief statement 

concerning its investment objectives; (iii) its investment adviser and any sub-investment adviser; (iv) 

current expenses; and (v) performance is available in the appendix to the prospectus, and provide 

cross-references. State that each Portfolio Company has issued a prospectus that contains more 

detailed information about the Portfolio Company, and provide instructions regarding how investors 

may obtain paper or electronic copies. 

(d) Voting. Concisely discuss the rights of investors to instruct the Depositor on the voting of shares of 

the Portfolio Companies, including the manner in which votes will be allocated. 

Item 7. Charges 

(a) Description. Briefly describe all current charges deducted from premiums, Investor Accounts, assets 

of the Registrant, or any other source (e.g., sales loads, premium taxes and other taxes, 

administrative and transaction charges, risk charges, Contract loan charges, cost of insurance, and 

optional benefit charges). Indicate whether each charge will be deducted from premium payments, 

Investor Accounts, the Registrant’s assets, the proceeds of withdrawals or surrenders, or some other 

source. When possible, specify the amount of any charge as a percentage or dollar figure (e.g., 

0.95% of average daily net assets, $5 per exchange, $5 per thousand dollars of face amount). For 

recurring charges, specify the frequency of the deduction (e.g., daily, monthly, annually). Identify the 

person who receives the amount deducted, briefly explain what is provided in consideration for the 

charges, and explain the extent to which any charge can be modified. Where it is possible to identify 

what is provided in consideration for a particular charge (e.g., use of sales load to pay distribution 

costs, use of cost of insurance charge to pay for insurance coverage), explain what is provided in 

consideration for that charge separately. 

Instructions. 

1. Describe the sales loads applicable to the Contract and how sales loads are charged and 

calculated, including the factors affecting the computation of the amount of the sales load. If the 

Contract has a front-end sales load, describe the sales load as a percentage of the applicable 

measure of premium payments (e.g., actual premiums paid, target or guideline premiums). For 

Contracts with a deferred sales load, describe the sales load as a percentage of the applicable 

measure of premiums paid (or other basis) that the deferred sales load may represent. 

Percentages should be shown in a table. Identify any events on which a deferred sales load is 

deducted (e.g., surrender or withdrawal, increase or decrease in face amount). The description of 

any deferred sales load should include how the deduction will be allocated among sub-accounts 

of the Registrant and when, if ever, the sales load will be waived (e.g., if the Contract provides a 

free withdrawal amount). 

11 
 

 

 

 

 

2. Identify the factors that determine the applicable cost of insurance rate. Specify whether the 

mortality charges guaranteed in the contracts differ from the current charges. Identify the factors 

that affect the amount at risk, including investment performance, payment of premiums, and 

charges. Disclose how the cost of insurance charge is calculated based on the cost of insurance 

rate, amount at risk, and any other applicable factors. If the Depositor intends to use simplified 

underwriting or other underwriting methods that would cause healthy individuals to pay higher 

cost of insurance rates than they would pay under a substantially similar policy that is offered by 

the Depositor using different underwriting methods, state that the cost of insurance rates are 

higher for healthy individuals when this method of underwriting is used than under the 

substantially similar policy. 

3. If the Contract’s charge for premium or other taxes varies according to jurisdiction, identification 

of the range of current premium or other taxes is sufficient. 

4. Identify charges that may be different in amount or method of computation when imposed in 

connection with, or subsequent to, increases in face amount of a Contract and briefly describe 

the differences. 

(b) Commissions Paid to Dealers. State the commissions paid to dealers as a percentage of premiums. 

(c) Portfolio Company Charges. State that charges are deducted from and expenses paid out of the 

assets of the Portfolio Companies that are described in the prospectuses for those companies. 

(d) Incidental Insurance Charges. If incidental insurance benefits (as defined in rules 6e-2 and 6e-3 [17 

CFR 270.6e-2, 17 CFR 270.6e-3]) are offered along with the Contract, state that charges also will be 

incurred for those benefits. 

(e) Operating Expenses. Describe any type of operating expenses for which the Registrant is 

responsible. If organizational expenses of the Registrant are to be paid out of its assets, explain how 

the expenses will be amortized and the period over which the amortization will occur. 

Item 8. General Description of Contracts 

(a) Contract Rights. Identify the person or persons (e.g., the investor, insured, or beneficiary) who have 

material rights under the Contracts, and the nature of those rights. 

Instruction. Disclose all material state variations and intermediary specific variations (e.g., variations 

resulting from different brokerage channels) to the offering. 

(b) Contract Limitations. Briefly describe any provisions for and limitations on: 

(1) allocation of premiums among sub-accounts of the Registrant; 

(2) transfer of Contract value between sub-accounts of the Registrant, including transfer programs 

(e.g., dollar cost averaging, portfolio rebalancing, asset allocation programs, and automatic 

transfer programs); and 

12 
 

 

 

 

 

 

 

(3) conversion or exchange of Contracts for another contract, including a fixed or variable annuity or 

life insurance contract. 

Instruction. In discussing conversion or exchange of Contracts, the Registrant should include any 

time limits on conversion or exchange, the name of the company issuing the other contract and 

whether that company is affiliated with the issuer of the Contract, and how the cash value of the 

Contract will be affected by the conversion or exchange. 

(c) General Account. Describe the obligations under the contract that are funded by the Depositor’s 

general account (e.g., death benefits, living benefits, or other benefits available under the Contract), 

and state that these amounts are subject to the Depositor’s claims-paying ability and financial 

strength. 

(d) Contract or Registrant Changes. Briefly describe the changes that can be made in the Contracts or 

the operations of the Registrant by the Registrant or the Depositor, including: 

(1) why a change may be made (e.g., changes in applicable law or interpretations of law); 

(2) who, if anyone, must approve any change (e.g., the investor or the Commission); and 

(3) who, if anyone, must be notified of any change. 

Instruction. Describe only those changes that would be material to a purchaser of the Contracts, such as 

a reservation of the right to deregister the Registrant under the Investment Company Act or to substitute 

one Portfolio Company for another. Do not describe possible non-material changes, such as changing 

the time of day at which contract values are determined. 

(e) Class of Purchasers. Disclose any limitations on the class or classes of purchasers to whom the 

Contracts are being offered. 

(f) Frequent Transfers among Sub-accounts of the Registrant. 

(1) Describe the risks, if any, that frequent transfers of Contract value among sub-accounts of the 

Registrant may present for other investors and other persons (e.g., the insured or beneficiaries) 

who have material rights under the Contract. 

(2) State whether or not the Registrant or Depositor has adopted policies and procedures with 

respect to frequent transfers of Contract value among sub-accounts of the Registrant. 

(3) If neither the Registrant nor the Depositor has adopted any such policies and procedures, 

provide a statement of the specific basis for the view of the Depositor that it is appropriate for 

the Registrant and Depositor not to have such policies and procedures. 

(4) If the Registrant or Depositor has any such policies and procedures, describe those policies and 

procedures, including: 

(i) whether or not the Registrant or Depositor discourages frequent transfers of Contract value 

among sub-accounts of the Registrant; 

(ii) whether or not the Registrant or Depositor accommodates frequent transfers of Contract 

value among sub-accounts of the Registrant; and 

13 
 

 

 

(iii) any policies and procedures of the Registrant or Depositor for deterring frequent transfers of 

Contract value among sub-accounts of the Registrant, including any restrictions imposed by 

the Registrant or Depositor to prevent or minimize frequent transfers. Describe each of these 

policies, procedures, and restrictions with specificity. Indicate whether each of these 

restrictions applies uniformly in all cases or whether the restriction will not be imposed under 

certain circumstances, including whether each of these restrictions applies to trades that 

occur through omnibus accounts at intermediaries, such as investment advisers, brokerdealers, transfer agents, and third party administrators. Describe with specificity the 

circumstances under which any restriction will not be imposed. Include a description of the 

following restrictions, if applicable: 

(A) any restrictions on the volume or number of transfers that may be made within a given 

time period; 

(B) any transfer fee; 

(C) any costs or administrative or other fees or charges that are imposed on persons deemed 

to be engaged in frequent transfers of Contract value among sub-accounts of the 

Registrant, together with a description of the circumstances under which such costs, fees, 

or charges will be imposed; 

(D) any minimum holding period that is imposed before a transfer may be made from a subaccount into another sub- account of the Registrant; 

(E) any restrictions imposed on transfer requests submitted by overnight delivery, 

electronically, or via facsimile or telephone; and 

(F) any right of the Registrant or Depositor to reject, limit, delay, or impose other conditions on 

transfers or to terminate or otherwise limit Contracts based on a history of frequent 

transfers among sub-accounts, including the circumstances under which such right will be 

exercised. 

(5) If applicable, include a statement, adjacent to the disclosure required by paragraphs (f)(1) 

through (f)(4) of this Item, that the Statement of Additional Information includes a description of 

all arrangements with any person to permit frequent transfers of Contract value among subaccounts of the Registrant. 

Item 9. Premiums 

(a) Purchase Procedures. Describe the provisions of the Contract that relate to premiums and the 

procedures for purchasing a Contract, including: 

(1) the minimum initial and subsequent premiums required and any limitations on the amount and 

the frequency of premiums that will be accepted. If there are separate limits for each subaccount, state these limits; 

(2) whether required premiums, if any, are payable for the life of the Contract or some other term; 

(3) if applicable, under what circumstances premiums may be required in order to avoid lapse and 

how the amount of the additional premiums will be determined; and 

14 
 

 

 

 

(4) if applicable, under what circumstances premiums in addition to the required premiums will be 

permitted. 

(b) Premium Amount. Briefly describe the factors that determine the amount of any required premiums 

(e.g., face amount, death benefit option, and charges and expenses). 

(c) Premium Due Dates. Briefly explain the provisions of the Contract that relate to premium due dates 

and the operation of any grace period, including the effect of the insured’s death during the grace 

period. 

(d) Premium Payment Plans. Identify the premium payment plans available. Include the available 

payment frequencies, payment facilities such as employee payroll deduction plans and preauthorized 

checking arrangements, and any special billing arrangements. Indicate whether the premium 

payment plan or schedule may be changed. 

(e) Additional Purchase Procedures. Describe the provisions of the Contract that relate to premiums and 

the procedures for purchasing a Contract, including: 

(1) whether payment of certain levels of premiums will guarantee that the Contract will not lapse 

regardless of the Contract’s cash value; 

(2) if applicable, under what circumstances nonpayment of a required premium will not cause the 

Contract to lapse; 

(3) if applicable, whether the level of the Contract’s required premiums may change and, if so, how 

the amount of the change will be determined; and 

(4) how premiums are allocated to the investment options, including how such allocation would 

take place in the absence of instructions from the investor. 

(f) Premium Payment Plans. Identify the premium payment plans available. Include the available 

payment frequencies, payment facilities such as employee payroll deduction plans and preauthorized 

checking arrangements, and any special billing arrangements. Indicate whether the premium 

payment plan or schedule may be changed. 

(g) Automatic Premium Loans. If applicable, briefly describe the circumstances under which required 

premiums may be paid by means of an automatic premium loan. 

(h) Sub-Account Valuation. Describe the procedures for valuing sub-account assets, including: 

(1) an explanation of when the required premiums and additional premiums are credited to the 

Contract’s cash value in the sub-accounts, and the basis (e.g., accumulation unit value) on 

which premiums are credited; 

(2) an explanation, to the extent applicable, that premiums are credited to the Contract’s cash 

value on the basis of the sub- account valuation next determined after receipt of a premium; 

Instruction. If, in any case, a delay occurs between the receipt of premiums and the crediting of 

premiums to the sub-accounts (e.g., a delay during the “free-look” period), describe where the 

premiums are held in the interim. 

15 
 

 

 

 

(3) an explanation of when valuations of the assets of the sub-accounts are made; and 

(4) a statement identifying in a general manner any national holidays when sub-account assets 

will not be valued and specifying any additional local or regional holidays when sub-account 

assets will not be valued. 

Instruction. In responding to this paragraph, a Registrant may use a list of specific days or any other 

means that effectively communicates the information (e.g., explaining that sub-account assets will 

not be valued on the days on which the New York Stock Exchange is closed for trading). 

Item 10. Standard Death Benefits 

(a) Standard Death Benefits. Describe the standard death benefits available under the Contract (i.e., 

excluding optional, supplemental death benefits available for a separate charge). 

Instruction. Include, for each standard death benefit: 

(i) when insurance coverage is effective; 

(ii) when the death benefit is calculated and payable; 

(iii) how the death benefit is calculated; 

(iv) who has the right to choose the form of benefit and the procedure for choosing the form of 

benefit, including when the choice is made and whether the choice is revocable; 

(v) the forms the benefit may take and the form of benefit that will be provided if a particular form 

has not been elected; 

(vi) whether there is a minimum death benefit guarantee associated with the Contract; and 

(vii)if an investor may increase or decrease the face amount of the death benefit. 

(b) Additional Information About Standard Death Benefits. If applicable, describe how an investor may 

change the face amount of the standard death benefit, including the minimum and the maximum 

amounts, any requirement of additional evidence of insurability, and whether charges, including sales 

load, are affected. 

(c) Charges and Contract Values. Explain how the investment performance of the Portfolio Companies, 

expenses, and deduction of charges affect contract values and standard death benefits. 

16 
 

 

 

 

 

 

 

Item 11. Other Benefits Available Under the Contract 

(a) Include the following information: 

In addition to the standard death benefit(s) associated with your contract, other standard and/or 

optional benefits may also be available to you. The following table(s) summarize information about 

those benefits. Information about the fees associated with each benefit included in the table(s) may be 

found in the Fee Table. 

Name of Benefit Purpose Is Benefit Standard Brief Description of 

or Optional Restrictions/ Limitations 

Instructions. 

1. General. 

(a) The table required by paragraph (a) of this Item is meant to provide a tabular summary 

overview of the benefits described in paragraph (b) of this Item (e.g., standard or optional 

living benefits, etc.). 

(b) If the Contract offers multiple benefits of the same type (e.g., accumulation benefit, 

withdrawal benefit, long-term care benefit), the Registrant may include multiple tables in 

response to paragraph (a) of this Item, if doing so might better permit comparisons of different 

benefits of the same type. Registrants that choose to use a single table should consider 

whether grouping together multiple benefits of the same type, with appropriate headings, 

might similarly permit better comparisons of those benefits. 

(c) The Registrant should include appropriate titles, headings, or any other information to 

promote clarity and facilitate understanding of the table(s) presented in response to 

paragraph (a) of this Item. For example, if certain optional benefits are only available to 

certain investors (e.g., investors who invested during specific time periods), the table could 

include footnotes or headings to identify which optional benefits are affected and to whom 

those optional benefits are available. 

2. Name of Benefit. State the name of each benefit included in the table(s). 

3. Purpose. Briefly describe the purpose of each benefit included in the table(s). 

4. Is Benefit Standard or Optional. State whether the benefit is standard or optional. If the 

Registrant includes titles or headings for the table(s) specifying whether the benefit is standard or 

optional, the Registrant does not need to include the “Is Benefit Standard or Optional” column in 

the table(s). 

5. Brief Description of Restrictions/Limitations. Briefly describe the restriction(s) or limitation(s) 

associated with each benefit. Registrants are encouraged to use short phrases (e.g., “benefit 

limits investment options available,” “withdrawals could terminate benefit”) to describe the 

restriction(s) or limitation(s). 

17 
 

 

 

 

 

 

 

 

 

 

 

(b) Briefly describe any other benefits (other than standard death benefits, e.g., living benefits, optional 

supplemental death benefits available for a separate charge, etc.) offered under a Contract, 

including: 

(1) Whether the benefit is standard or optional; 

(2) The operation of the benefit, including the amount of the benefit and how the benefit amount 

may vary, the circumstances under which the value of the benefit may increase or be reduced 

(including the effect of withdrawals), and how the benefit may be terminated; and 

(3) How the benefit amount is calculated and payable and the effect of choosing a specific method 

of payment on calculation of the benefit. 

(c) Briefly describe any limitations, restrictions and risks associated with any benefit (other than 

standard death benefits) offered under the Contract (e.g., restrictions on which Portfolio Companies 

may be selected; risk of reduction or termination of benefit resulting from excess withdrawals). 

Instruction. In responding to paragraphs (b) and (c) of this Item, provide one or more examples 

illustrating the operation of each benefit in a clear, concise, and understandable manner. 

Item 12. Surrenders and Withdrawals 

(a) Surrender and Withdrawal. Briefly describe how surrenders and withdrawals can be made from a 

Contract, including any limits on the ability to surrender, how the proceeds are calculated, and when 

they are payable. Briefly describe the potential effect of such surrenders and withdrawals. 

(b) Additional Information Regarding Surrender and Withdrawal. Indicate generally whether and under 

what circumstances surrenders and withdrawals are available under a Contract, including the 

minimum and maximum amounts that may be surrendered or withdrawn, any limits on their 

availability, how the proceeds are calculated, and when the proceeds are payable. 

(c) Effect of Surrender and Withdrawal. Indicate generally whether and under what circumstances 

surrenders or withdrawals will affect a Contract’s cash value or death benefit and whether any 

charge(s) will apply. 

(d) Sub-Account Allocation. Describe how surrenders and withdrawals will be allocated to the 

investment options, including how such allocation would take place in the absence of instructions 

from the investor. 

Instruction. The Registrant should generally describe the terms and conditions that apply to surrender and 

withdrawal transactions. Technical information regarding the determination of amounts available to be 

surrendered or withdrawn should be included in the SAI. 

(e) Revocation Rights. Briefly describe any revocation rights (e.g., “free-look” provisions), including a 

description of how the amount refunded is determined, the method for crediting earnings to 

premiums during the free-look period, and whether investment options are limited during the freelook period. 

18 
 

 

 

 

 

 

 

 

Item 13. Loans 

Briefly describe the loan provisions of the Contract, including any of the following that are applicable. 

(a) Availability of Loans. State that a portion of the Contract’s cash surrender value may be borrowed. 

State how the amount available for a loan is calculated. 

(b) Limitations. Describe any limits on availability of loans (e.g., a prohibition on loans during the first 

Contract year). 

(c) Interest. Describe how interest accrues on the loan, when it is payable, and how interest is treated if 

not paid. Explain how interest on the amount in the collateral account is credited to the Contract and 

allocated among the investment options. 

(d) Effect on Cash Value and Death Benefit. Describe how loans and loan repayments affect cash 

value and how they are allocated among the investment options, including, if applicable, how such 

allocation would take place in the absence of instructions from the investor. Include (i) a brief 

explanation that amounts borrowed under a Contract do not participate in a Registrant’s investment 

experience and that loans, therefore, can affect the Contract’s value and death benefit whether or 

not the loan is repaid, and (ii) a brief explanation that the cash surrender value and the death 

proceeds payable will be reduced by the amount of any outstanding Contract loan plus accrued 

interest. 

(e) Other Effects. Describe any other effect that a loan could have on the Contract (e.g., the effect of a 

Contract loan in excess of Contract value). 

(f) Procedures. Describe the loan procedures, including how and when amounts borrowed are 

transferred out of the Registrant and how and when amounts repaid are credited to the Registrant. 

Item 14. Lapse and Reinstatement 

(a) Lapse. State when and under what circumstances a Contract will lapse. 

(b) Effect of Lapse. Describe briefly the factors that will determine the amount of insurance coverage 

provided under the available lapse options. Describe concisely how the cash value, surrender value, 

and death benefit will be determined. If these values and benefits will be determined in the same 

manner as prior to lapse, a statement to that effect is sufficient. 

(c) Reinstatement. State under what circumstances a Contract may be reinstated. Explain any 

requirements for reinstatement, including charges to be paid by the investor, outstanding loan 

repayments, and evidence of insurability. 

(d) Lapse Options. Describe briefly any lapse options available. Indicate those that will not apply unless 

they are elected and those that will apply in the absence of an election. Indicate whether the 

availability of any of the lapse options is limited. 

Item 15. Taxes 

(a) Tax Consequences. Describe the material tax consequences to the investor and beneficiary of 

buying, holding, exchanging, or exercising rights under the Contract. 

19 
 

 

 

 

 

 

 

 

 

 

 

Instruction. Discuss the taxation of death benefit proceeds, periodic and non-periodic withdrawals, 

loans, and any other distribution that may be received under the Contract, as well as the tax benefits 

accorded the Contract and other material tax consequences. Describe, if applicable, whether the tax 

consequences vary with different uses of the Contract. 

(b) Effect. Describe the effect, if any, of taxation on the determination of cash values or sub-account 

values. 

Item 16. Legal Proceedings 

Describe any material pending legal proceedings, other than ordinary routine litigation incidental to the 

business, to which the Registrant, the Registrant’s principal underwriter, or the Depositor is a party. 

Include the name of the court where the case is pending, the date instituted, the principal parties 

involved, a description of the factual basis alleged to underlie the proceeding, and the relief sought. 

Include similar information as to any proceedings instituted, or known to be contemplated, by a 

governmental authority. 

Instruction. For purposes of this requirement, legal proceedings are material only to the extent that they 

are likely to have a material adverse effect on the Registrant, the ability of the principal underwriter to 

perform its contract with the Registrant, or the ability of the Depositor to meet its obligations under the 

Contracts. 

Item 17. Financial Statements 

If all of the required financial statements of the Registrant and the Depositor (see Item 28 and General 

Instruction C.3.(b)) are not in the prospectus, state, under a separate caption, where the financial 

statements may be found. Briefly explain how investors may obtain any financial statements not in the 

Statement of Additional Information. 

Item 18. Portfolio Companies Available Under the Contract 

Include as an Appendix under the heading “Appendix: Portfolio Companies Available Under the Contract” 

the following legend, in the format specified below: 

The following is a list of Portfolio Companies available under the Contract. More information about the 

Portfolio Companies is available in the prospectuses for the Portfolio Companies, which may be 

amended from time to time and can be found online at [___]. You can also request this information at 

no cost by calling [____] or by sending an email request to [___]. 

The current expenses and performance information below reflects fees and expenses of the Portfolio 

Companies, but do not reflect the other fees and expenses that your Contract may charge [such as 

Platform Charges]. Expenses would be higher and performance would be lower if these other charges 

were included. Each Portfolio Company’s past performance is not necessarily an indication of future 

performance. 

20 
 

 

 

 

 

 

 

Type/ 

Investment 

Objective 

Portfolio 

Company and 

Adviser/ 

Subadviser 

Current Expenses Average Annual Total Returns 

(as of 12/31/_) 

1 year 5 year 10 year 

[Insert] [Names of 

Portfolio 

Company and 

adviser / 

subadviser] 

[_]% [_]% [_]% [_]% 

Instructions. 

1. General. 

(a) Only include Portfolio Companies that are investment options under the Contract. Indicate if 

investments in any of the Portfolio Companies are restricted (e.g., because of a “hard” or 

“soft” close). 

(b) The introductory legend to the table must provide a website address, other than the address 

of the Commission’s electronic filing system; toll free telephone number; and email address 

that investors can use to obtain the prospectuses of the Portfolio Companies and to request 

other information about the Portfolio Companies. The website address must be specific 

enough to lead investors directly to the prospectuses of the Portfolio Companies, rather than 

to the home page or other section of the website on which the materials are posted. The 

website could be a central site with prominent links to each document. 

(c) The legend may indicate, if applicable, that the prospectuses and other information are 

available from a financial intermediary (such as an insurance sales agent or broker-dealer) 

through which the Contract may be purchased or sold. 

(d) Registrants not relying upon rule 498A(j) under the Securities Act [17 CFR 230.498A(j)] with 

respect to the Portfolio Companies that are investment options under the Contract may, but 

are not required to, provide the next-to-last sentence of the first paragraph of the introductory 

legend to the table regarding online availability of the prospectuses. 

(e) If applicable, include a statement explaining that updated performance information is 

available and providing a website address and/or toll-free (or collect) telephone number 

where the updated information may be obtained. 

(f) If the availability of one or more Portfolio Companies as investment options under the 

Contract varies by benefit offered under the Contract: 

(1) The following sentence should be added to the first paragraph of the legend preceding the 

table: “Depending on the optional benefits you choose, you may not be able to invest in 

certain Portfolio Companies.”; and 

(2) Indicate which Portfolio Companies are available (or are restricted) under the benefits 

offered under the Contract. The Appendix could incorporate a separate table that is 

structured pursuant to the following example, or could use any other presentation that might 

promote clarity and facilitate understanding: 

21 
 

 

 

 

 

 

 

[Portfolio Company] [Benefit #1] [Benefit #2] [Benefit #3] [Benefit #4] 

Portfolio Company A    

Portfolio Company B   

Portfolio Company C  

Portfolio Company D 

2. Type/Investment Objective. Briefly describe each Portfolio Company’s type (e.g., money market 

fund, bond fund, balanced fund, etc.), or include a brief statement describing the Portfolio 

Company’s investment objectives. 

3. Portfolio Company and Adviser/Subadviser. State the name of each Portfolio Company and its 

adviser/subadviser, as applicable. The adviser’s/sub-adviser’s name may be omitted if it is 

incorporated into the name of the Portfolio Company. A Registrant also need not identify a subadviser whose sole responsibility for the Portfolio Company is limited to day-to-day management 

of the Portfolio Company’s holdings of cash and cash equivalent instruments, unless the Portfolio 

Company is a money market fund or other Portfolio Company with a principal investment strategy 

of regularly holding cash and cash equivalent instruments. If the Portfolio Company has three or 

more sub-advisers, each of which manages a portion of the Portfolio Company’s portfolio, the 

Registrant need not identify each such sub-adviser, except that the Registrant must identify any 

sub-adviser that is (or is reasonably expected to be) responsible for the management of a 

significant portion of the Portfolio Company’s net assets. For purposes of this paragraph, a 

significant portion of a Portfolio Company’s net assets generally will be deemed to be 30% or 

more of the Portfolio Company’s net assets. 

4. Current Expenses. Report “Total Annual Fund Operating Expenses” as calculated pursuant to 

Item 3 of Form N-1A [17 CFR §§ 239.15A and 274.11A], reflecting any expense reimbursements 

or fee waiver arrangements that are in place and reported in the Portfolio Company’s registration 

statement on Form N-1A. If applicable, identify each Portfolio Company subject to an expense 

reimbursement or fee waiver arrangement and provide a footnote stating that their annual 

expenses reflect temporary fee reductions. 

5. Platform Charge. If the Registrant charges a Platform Charge to make any of the Portfolio 

Companies available as investment options under the Contract, add a column titled “Platform 

Charge” disclosing the current Platform Charge for each Portfolio Company. If applicable, the 

Registrant must also provide a footnote indicating the highest level to which any relevant Platform 

Charge may be increased. 

6. Current Expenses + Platform Charge. If the Registrant charges a Platform Charge to make any of 

the Portfolio Companies available as investment options under the Contract, add a column titled 

“Current Expenses + Platform Charge.” The column contemplated by this Instruction must be 

presented in a manner reasonably calculated to draw investor attention to that column. 

7. Average Annual Total Returns. For purposes of this Item, “average annual total returns” means 

the “average annual total return” (before taxes) as calculated pursuant to Item 4(b)(2)(iii) of Form 

N-1A. 

22 
 

 

 

 

PART B - INFORMATION REQUIRED IN A STATEMENT OF ADDITIONAL INFORMATION 

Item 19. Cover Page and Table of Contents 

(a) Front Cover Page. Include the following information on the outside front cover page of the SAI: 

(1) The Registrant’s name. 

(2) The Depositor’s name. 

(3) The name of the Contract and the Class or Classes, if any, to which the Contract relates. 

(4) A statement or statements: 

(i) That the SAI is not a prospectus; 

(ii) How the prospectus may be obtained; and 

(iii) Whether and from where information is incorporated by reference into the SAI, as permitted 

by General Instruction D. 

Instruction. Any information incorporated by reference into the SAI must be delivered with the SAI. 

(5) The date of the SAI and the prospectus to which the SAI relates. 

(b) Table of Contents. Include under appropriate captions (and subcaptions) a list of the contents of the 

SAI and, when useful, provide cross-references to related disclosure in the prospectus. 

Item 20. General Information and History 

(a) Depositor. Provide the date and form of organization of the Depositor, the name of the state or other 

jurisdiction in which the Depositor is organized, and a description of the general nature of the 

Depositor’s business. 

Instruction. The description of the Depositor’s business should be short and need not list all of the 

businesses in which the Depositor engages or identify the jurisdictions in which it does business if a 

general description (e.g., “life insurance” or “reinsurance”) is provided. 

(b) Registrant. Provide the date and form of organization of the Registrant and the Registrant’s 

classification pursuant to section 4 of the Investment Company Act [15 U.S.C. 80a-4] (i.e., a separate 

account and a unit investment trust). 

(c) History of Depositor and Registrant. If the Depositor’s name was changed during the past five years, 

state its former name and the approximate date on which it was changed. If, at the request of any 

state, sales of contracts offered by the Registrant have been suspended at any time, or if sales of 

contracts offered by the Depositor have been suspended during the past five years, briefly describe 

the reasons for and results of the suspension. Briefly describe the nature and results of any 

bankruptcy, receivership, or similar proceeding, or any other material reorganization, readjustment, 

or succession of the Depositor during the past five years. 

23 
 

 

 

 

 

 

 

(d) Ownership of Sub-Account Assets. If 10 percent or more of the assets of any sub-account are not 

attributable to Contracts or to accumulated deductions or reserves (e.g., initial capital contributed by 

the Depositor), state what percentage those assets are of the total assets of the Registrant. If the 

Depositor, or any other person controlling the assets, has any present intention of removing the 

assets from the sub-account, so state. 

(e) Control of Depositor. State the name of each person who controls the Depositor and the nature of its 

business. 

Instruction. If the Depositor is controlled by another person that, in turn, is controlled by another person, 

give the name of each control person and the nature of its business. 

Item 21. Non-Principal Risks of Investing in the Contract 

Summarize the non-principal risks of purchasing a Contract to the extent not disclosed in the prospectus. 

Item 22. Services 

(a) Expenses Paid by Third Parties. Describe all fees, expenses, and costs of the Registrant that are to 

be paid by persons other than the Depositor or the Registrant, and identify those persons. 

(b) Service Agreements. Summarize the substantive provisions of any management-related service 

contract that may be of interest to a purchaser of the Registrant’s securities, under which services 

are provided to the Registrant, unless the contract is described in response to some other item of the 

form. Indicate the parties to the contract, and the total dollars paid and by whom for each of the past 

three years. 

Instructions. 

1. The term “management-related service contract” includes any contract with the Registrant to 

keep, prepare, or file accounts, books, records, or other documents required under federal or 

state law, or to provide any similar services with respect to the daily administration of the 

Registrant, but does not include the following: 

(a) Any agreement with the Registrant to act as custodian or agent to administer purchases and 

redemptions under the Contracts; and 

(b) Any contract with the Registrant for outside legal or auditing services, or contract for personal 

employment entered into with the Registrant in the ordinary course of business. 

2. In summarizing the substantive provisions of any management-related service contract, include 

the following: 

(a) The name of the person providing the service; 

(b) The direct or indirect relationships, if any, of the person with the Registrant, its Depositor, or 

its principal underwriter; and 

(c) The nature of the services provided, and the basis of the compensation paid for the services 

for the Registrant’s last three fiscal years. 

24 
 

 

 

 

 

 

(c) Other Service Providers. 

(1) Unless disclosed in response to paragraph (b) or another item of this form, identify and state 

the principal business address of any person who provides significant administrative or 

business affairs management services for the Registrant (e.g., an “Administrator,” “SubAdministrator,” “Servicing Agent”), describe the services provided, and the compensation paid 

for the services. 

(2) State the name and principal business address of the Registrant’s custodian and independent 

public accountant and describe generally the services performed by each. 

(3) If the Registrant’s assets are held by a person other than the Depositor, a commercial bank, 

trust company, or depository registered with the Commission as custodian, state the nature of 

the business of each such person. 

(4) If an affiliated person of the Registrant or the Depositor, or an affiliated person of such an 

affiliated person, acts as administrative or servicing agent for the Registrant, describe the 

services the person performs and the basis for remuneration. State, for the past three years, 

the total dollars paid for the services, and by whom. 

Instruction. No disclosure need be given in response to paragraph (c)(4) of this Item for an 

administrative or servicing agent who is also the Depositor. 

(5) If the Depositor is the principal underwriter of the Contracts, so state. 

Item 23. Premiums 

(a) Administrative Procedures. Discuss generally the Registrant’s administrative rules applicable to 

premium payments, to the extent that they are not discussed in the prospectus. 

Instruction. Examples include information regarding any condition applicable to changes in premium 

payment schedules, any limitations on prepayments of premiums, any relevant rules for classifying 

payments made other than in response to a bill or in an amount other than the amount billed for, etc. 

(b) Automatic Premium Loans. If the contract provides an automatic premium loan option, describe the 

option, including the circumstances under which it will be used to pay a required premium and 

whether, and how, interest will be charged on the loan. Describe any effect not described in the 

prospectus that an automatic premium loan could have on the Contract (e.g., how automatic 

premium loans affect cash value). 

Item 24. Additional Information About Operation of Contracts and Registrant 

(a) Incidental Benefits. To the extent not described in the prospectus, explain the manner in which the 

purchase or operation of other incidental benefits affects the exercise of rights and the determination 

of benefits under the Contract such as whether the Contract or any rider provides for a change of 

insured or for all or a portion of the death benefit to be paid while the insured is still alive. 

(b) Surrender and Withdrawal. To the extent not described in the prospectus, explain the Contract’s 

surrender and withdrawal provisions. 

25 
 

 

 

(c) Material Contracts Relating to the Registrant. Disclose any material contract relating to the 

operation or administration of the Registrant. 

(d) Describe any arrangements with any person to permit frequent transfers of Contract value among 

sub-accounts of the Registrant, including the identity of the persons permitted to engage in frequent 

transfers pursuant to such arrangements, and any compensation or other consideration received by 

the Registrant, the Depositor, or any other party pursuant to such arrangements. 

Instructions. 

1. The consideration required to be disclosed by paragraph (d) of this Item includes any agreement 

to maintain assets in the Registrant or in other investment companies or accounts managed or 

sponsored by the Depositor, any investment adviser of a Portfolio Company, or any affiliated 

person of the Depositor or of any such investment adviser. 

2. If the Registrant has an arrangement to permit frequent transfers of Contract value among subaccounts of the Registrant by a group of individuals, such as the participants in a defined 

contribution plan that meets the requirements for qualification under section 401(k) of the 

Internal Revenue Code (26 U.S.C. 401(k)), the Registrant may identify the group rather than 

identifying each individual group member. 

Item 25. Underwriters 

(a) Identification. Identify each principal underwriter (other than the Depositor) of the Contracts, and 

state its principal business address. If the principal underwriter is affiliated with the Registrant, the 

Depositor, or any affiliated person of the Registrant or the Depositor, identify how they are affiliated 

(e.g., the principal underwriter is controlled by the Depositor). 

(b) Offering and Commissions. For each principal underwriter distributing Contracts of the Registrant, 

state: 

(1) whether the offering is continuous; and 

(2) the aggregate dollar amount of underwriting commissions paid to, and the amount retained by, 

the principal underwriter for each of the Registrant’s last three fiscal years. 

(c) Other Payments. With respect to any payments made by the Registrant to an underwriter of or dealer 

in the Contracts during the Registrant’s last fiscal year, disclose the name and address of the 

underwriter or dealer, the amount paid and basis for determining that amount, the circumstances 

surrounding the payments, and the consideration received by the Registrant. Do not include 

information about: 

(1) Payments made through deduction from premiums paid at the time of sale of the Contracts; or 

(2) Payments made from cash values upon surrender of or withdrawal from the Contracts or from 

an increase or decrease in the face amount of the Contracts. 

Instructions. 

1. Information need not be given about the service of mailing proxies or periodic reports of the 

Registrant. 

26 
 

 

 

 

 

 

2. Exclude information about bona fide contracts with the Registrant or its Depositor for outside 

legal or auditing services, or bona fide contracts for personal employment entered into with 

the Registrant or its Depositor in the ordinary course of business. 

3. Information need not be given about any service for which total payments of less than 

$15,000 were made during each of the Registrant’s last three fiscal years. 

4. Information need not be given about payments made under any contract to act as 

administrative or servicing agent. 

5. If the payments were made under an arrangement or policy applicable to dealers generally, 

describe only the arrangement or policy. 

Item 26. Additional Information About Charges 

(a) Sales Load. Describe the method that will be used to determine the sales load on the Contracts 

offered by the Registrant. 

(b) Special Purchase Plans. Describe any special purchase plans (e.g., group life insurance plans) or 

methods that reflect scheduled variations in, or elimination of, any applicable charges (e.g., group 

discounts, waiver of deferred sales loads for a specified percentage of cash value, investment of 

proceeds from another Contract, exchange privileges, employee benefit plans, or the terms of a 

merger, acquisition, or exchange offer made pursuant to a plan of reorganization). Identify each 

class of individuals or transactions to which the plans or methods apply, including officers, directors, 

members of the board of managers, or employees of the Depositor, underwriter, Portfolio Companies, 

or investment adviser to Portfolio Companies, and the amount of the reductions, and state from 

whom additional information may be obtained. For special purchase plans or methods that reflect 

variations in, or elimination of, charges other than according to a fixed schedule, describe the basis 

for the variation or elimination (e.g., the size of the purchaser, a prior existing relationship with the 

purchaser, the purchaser’s assumption of certain administrative functions, or other characteristics 

that result in differences in costs or services). 

(c) Underwriting Procedures. Briefly identify underwriting procedures used in connection with the 

Contract and any effect of different types of underwriting on the charges in the Contract. Specify the 

basis of the mortality charges guaranteed in the Contracts. 

(d) Increases in Face Amount. Describe in more detail the charges assessed on increases in face 

amount, including the procedures used following an increase in face amount to allocate cash values 

and premiums between the original Contract and incremental Contracts. 

Item 27. Lapse and Reinstatement 

To the extent that the prospectus does not do so, describe the lapse and reinstatement provisions of the 

Contract. Include a discussion of any time limits that apply, how the charge to reinstate is determined, 

and any other conditions that apply to reinstatement. Describe the features of any lapse options not 

described in the prospectus, including any factors that will determine the amount or duration of the 

insurance coverage, and the limitations and conditions on availability of each lapse option. Identify 

which Contract transactions (e.g., loans, withdrawals and surrenders, transfers) are available while the 

Contract is continued under a lapse option. Indicate when limits on contract transactions are different 

from those that apply prior to lapse. 

27 
 

 

 

 

Item 28. Financial Statements 

(a) Registrant. Provide financial statements of the Registrant. 

Instruction. Include, in a separate section, the financial statements and schedules required by 

Regulation S-X [17 CFR 210]. Financial statements of the Registrant may be limited to: 

(i) An audited balance sheet or statement of assets and liabilities as of the end of the most recent 

fiscal year; 

(ii) An audited statement of operations of the most recent fiscal year conforming to the requirements 

of rule 6-07 of Regulation S-X [17 CFR 210.6-07]; 

(iii) An audited statement of cash flows for the most recent fiscal year if necessary to comply with 

generally accepted accounting principles; and 

(iv) Audited statements of changes in net assets conforming to the requirements of rule 6-09 of 

Regulation S-X [17 CFR 210.6- 09] for the two most recent fiscal years. 

(b) Depositor. Provide financial statements of the Depositor. 

Instructions. 

1. Include, in a separate section, the financial statements and schedules of the Depositor required 

by Regulation S-X. If the Depositor would not have to prepare financial statements in accordance 

with generally accepted accounting principles except for use in this registration statement or 

other registration statements filed on Forms N-3, N-4, or N-6, its financial statements may be 

prepared in accordance with statutory requirements. The Depositor’s financial statements must 

be prepared in accordance with generally accepted accounting principles if the Depositor 

prepares financial information in accordance with generally accepted accounting principles for 

use by the Depositor’s parent, as defined in rule 1-02(p) of Regulation S-X [17 CFR 210.1-02(p)], 

in any report under sections 13(a) and 15(d) of the Securities Exchange Act [15 U.S.C. 78m(a) 

and 78o(d)] or any registration statement filed under the Securities Act. 

2. All statements and schedules of the Depositor required by Regulation S-X, except for the 

consolidated balance sheets described in rule 3-01 of Regulation S-X [17 CFR 210.3-01], and any 

notes to these statements or schedules, may be omitted from Part B and instead included in Part 

C of the registration statement. If any of this information is omitted from Part B and included in 

Part C, the consolidated balance sheets included in Part B should be accompanied by a 

statement that additional financial information about the Depositor is available, without charge, 

upon request. When a request for the additional financial information is received, the Registrant 

should send the information within 3 business days of receipt of the request, by first-class mail or 

other means designed to ensure equally prompt delivery. 

3. Notwithstanding rule 3-12 of Regulation S-X [17 CFR 210.3-12], the financial statements of the 

Depositor need not be more current than as of the end of the most recent fiscal year of the 

Depositor. In addition, when the anticipated effective date of a registration statement falls within 

90 days subsequent to the end of the fiscal year of the Depositor, the registration statement need 

not include financial statements of the Depositor more current than as of the end of the third 

fiscal quarter of the most recently completed fiscal year of the Depositor unless the audited 

28 
 

 

 

 

financial statements for such fiscal year are available. The exceptions to rule 3-12 of Regulation 

S-X contained in this Instruction 3 do not apply when: 

(a) The Depositor’s financial statements have never been included in an effective registration 

statement under the Securities Act of a separate account that offers variable annuity 

contracts or variable life insurance contracts; or 

(b) The balance sheet of the Depositor at the end of either of the two most recent fiscal years 

included in response to this Item shows a combined capital and surplus, if a stock company, 

or an unassigned surplus, if a mutual company, of less than $2,500,000; or 

(c) The balance sheet of the Depositor at the end of a fiscal quarter within 135 days of the 

expected date of effectiveness under the Securities Act (or a fiscal quarter within 90 days of 

filing if the registration statement is filed solely under the Investment Company Act) would 

show a combined capital surplus, if a stock company, or an unassigned surplus, if a mutual 

company, of less than $2,500,000. If two fiscal quarters end within the 135 day period, the 

Depositor may choose either for purposes of this test. 

Any interim financial statements required by this Item need not be comparative with financial statements 

for the same interim period of an earlier year. 

Item 29. Illustrations 

The Registrant may, but is not required to, include a table of hypothetical illustrations of death benefits, 

cash surrender values, and cash values in either the prospectus or the SAI. The following standards 

should be used to prepare any table of hypothetical illustrations that is included in the prospectus or the 

SAI: 

(a) Narrative Information. The illustrations should be preceded by a clear and concise explanation, 

including (i) a description of the expenses reflected in the illustrations; (ii) that the illustrations are 

based on assumptions about investment returns and investor characteristics; (iii) the circumstances 

under which actual results for a particular purchaser of the Contract would differ from the 

illustrations; and (iv) whether personalized illustrations are available and, if available, how they may 

be obtained. 

(b) Headings. The headings should contain the following information: sex, age, rating classification (e.g., 

nonsmoker, smoker, preferred, or standard), premium amount and payment schedule, face amount, 

and death benefit option. 

(c) Premiums, Ages. Premium amounts used in the illustrations should be representative of the actual 

or expected typical premium amount. The typical premium amount may be based on the average or 

median premium amount or some other reasonable basis that results in a typical premium amount 

that is fairly representative of actual or expected Contract sales. Ages used in the illustrations should 

be representative of actual or expected Contract sales. 

(d) Rating Classifications. Illustrations should be shown for the rating classification with the greatest 

number of outstanding Contracts (or expected Contracts in the case of a new Contract), unless this 

rating classification is not fairly representative of actual or expected Contract sales. In this case, 

illustrations should be shown for a commonly used rating classification that is fairly representative of 

actual or expected Contract sales. 

29 
 

 

(e) Years. Illustrated values should be provided for Contract years one through ten, for every five years 

beyond the tenth Contract year, and for the year of Contract maturity. 

(f) Illustrated Values. Death benefits and cash surrender values should be illustrated at three rates of 

return and two levels of charges (described in paragraphs (g) and (i)). The Registrant may also 

illustrate cash values, but cash values must be accompanied by corresponding cash surrender 

values. All illustrated values should be determined as of the end of the Contract year. 

(g) Rates of Return. The Registrant should use gross rates of return of 0%, 6%, and one other rate not 

greater than 12%. Additional gross rates of return no greater than 12% may be used. Explain that the 

gross rates of return used in the illustrations do not reflect the deductions of the charges and 

expenses of the Portfolio Companies. 

(h) Portfolio Company Charges. Portfolio Company management fees and other Portfolio Company 

charges and expenses should be reflected using the arithmetic average of those charges and 

expenses incurred during the most recent fiscal year for all of the available Portfolio Companies or 

any materially greater amount expected to be incurred during the current fiscal year. In determining 

charges and expenses incurred during the most recent fiscal year or expected to be incurred during 

the current fiscal year, include amounts that would have been incurred absent expense 

reimbursements or fee waiver arrangements. 

(i) Other Charges. Values should be illustrated using both current and guaranteed maximum charges at 

the 0% rate of return, the 6% rate of return, and one other rate of return no greater than 12%. 

Illustrated values should accurately reflect all charges deducted under the Contract (e.g., mortality 

and expense risk, administrative, and cost of insurance) as well as the actual timing of the deduction 

of those charges (e.g., daily, monthly, or annually). For example, for a Contract with a mortality and 

expense risk charge that is deducted from sub-account assets at a given annual rate, the illustrated 

values will be lower if the charge is deducted from assets on a daily basis rather than on a monthly or 

annual basis. 

(j) Additional Information. Subject to the requirement set out in General Instruction C.3.(b), additional 

information may be shown as part of the illustrations, provided that it is consistent with the standards 

of this Item. 

30 
 

 

PART C - OTHER INFORMATION 

Item 30. Exhibits 

Subject to General Instruction D regarding incorporation by reference and rule 483 under the Securities 

Act [17 CFR 230.483], file the exhibits listed below as part of the registration statement. Letter or 

number the exhibits in the sequence indicated and file copies rather than originals, unless otherwise 

required by rule 483. Reflect any exhibit incorporated by reference in the list below and identify the 

previously filed document containing the incorporated material. 

(a) Board of Directors Resolution. The resolution of the board of directors of the Depositor authorizing 

the establishment of the Registrant. 

(b) Custodian Agreements. All agreements for custody of securities and similar investments of the 

Registrant, including the schedule of remuneration. 

(c) Underwriting Contracts. Underwriting or distribution contracts between the Registrant or Depositor 

and a principal underwriter and agreements between principal underwriters or the Depositor and 

dealers. 

(d) Contracts. The form of each Contract, including any riders or endorsements. 

(e) Applications. The form of application used with any Contract provided in response to (d) above. 

(f) Depositor’s Certificate of Incorporation and By-Laws. The Depositor’s current certificate of 

incorporation or other instrument of organization and by-laws and any related amendment. 

(g) Reinsurance Contracts. Any contract of reinsurance related to a Contract. 

(h) Participation Agreements. Any participation agreement or other contract relating to the investment 

by the Registrant in a Portfolio Company. 

(i) Administrative Contracts. Any contract relating to the performance of administrative services in 

connection with administering a Contract. 

(j) Other Material Contracts. Other material contracts not made in the ordinary course of business to be 

performed in whole or in part on or after the filing date of the registration statement. 

(k) Legal Opinion. An opinion and consent of counsel regarding the legality of the securities being 

registered, stating whether the securities will, when sold, be legally issued and represent binding 

obligations of the Depositor. 

(l) Actuarial Opinion. If illustrations are included in the registration statement as permitted by Item 29, 

an opinion of an actuarial officer of the Depositor as to those illustrations indicating that: 

(1) the illustrations of cash surrender values, cash values, death benefits, and/or any other values 

illustrated are consistent with the provisions of the Contract and the Depositor’s administrative 

procedures; 

(2) the rate structure of the Contract has not been designed, and the assumptions for the 

illustrations (including sex, age, rating classification, and premium amount and payment 

31 
 

 

 

 

 

schedule) have not been selected, so as to make the relationship between premiums and 

benefits, as shown in the illustrations, appear to be materially more favorable than for any other 

prospective purchaser with different assumptions; and 

(3) the illustrations are based on a commonly used rating classification and premium amounts and 

ages appropriate for the markets in which the Contract is sold. 

(m)Calculation. If illustrations are included in the registration statement as permitted by Item 29, one 

sample calculation for each item illustrated (e.g., cash surrender value, cash value, and death 

benefits), showing how the illustrated values for the fifth Contract year have been calculated. 

Demonstrate how the annual investment returns of the sub-accounts were derived from the 

hypothetical gross rates of return, how charges against sub-account assets were deducted from the 

annual investment returns of the sub-accounts, and how the periodic deductions for cost of 

insurance and other Contract charges were made to arrive at the illustrated values. Describe how 

the calculation would differ for other years. 

(n) Other Opinions. Copies of any other opinions, appraisals, or rulings, and consents of their use relied 

on in preparing the registration statement and required by section 7 of the Securities Act [15 U.S.C. 

77g]. 

(o) Omitted Financial Statements. Financial statements omitted from Item 28. 

(p) Initial Capital Agreements. Any agreements or understandings made in consideration for providing 

the initial capital between or among the Registrant, Depositor, underwriter, or initial investors and 

written assurances from the Depositor or initial investors that purchases were made for investment 

purposes and not with the intention of redeeming or reselling. 

(q) Redeemability Exemption. Disclosure (if not provided elsewhere in the registration statement) of 

insurance procedures for which the Registrant and Depositor claim any exemption pursuant to rule 

6e-2(b)(12)(ii) or rule 6e-3(b)(12)(iii) under the Investment Company Act. 

(r) Form of Initial Summary Prospectuses. The form of any Initial Summary Prospectus that the 

Registrant intends to use on or after the effective date of the registration statement, pursuant to rule 

498A under the Securities Act [17 CFR 230.498A]. 

Instructions. 

1. Schedules (or similar attachments) to the exhibits required by this Item are not required to be 

filed provided that they do not contain information material to an investment or voting decision 

and that information is not otherwise disclosed in the exhibit or the disclosure document. Each 

exhibit filed must contain a list briefly identifying the contents of all omitted schedules. 

Registrants need not prepare a separate list of omitted information if such information is 

already included within the exhibit in a manner that conveys the subject matter of the omitted 

schedules and attachments. In addition, the Registrant must provide a copy of any omitted 

schedule to the Commission or its staff upon request. 

2. The Registrant may redact information from exhibits required to be filed by this Item if 

disclosure of such information would constitute a clearly unwarranted invasion of personal 

privacy (e.g., disclosure of bank account numbers, social security numbers, home addresses 

and similar information). 

32 
 

 

 

 

 

 

 

3. The Registrant may redact specific provisions or terms of exhibits required to be filed by 

paragraphs (g) and (j) of this Item if the Registrant customarily and actually treats that 

information as private. If it does so, the Registrant should mark the exhibit index to indicate 

that portions of the exhibit have been omitted and include a prominent statement on the first 

page of the redacted exhibit that certain identified information has been excluded from the 

exhibit because it is both not material and the type that the Registrant treats as private or 

confidential. The Registrant also must include brackets indicating where the information is 

omitted from the filed version of the exhibit. If requested by the Commission or its staff, the 

Registrant must promptly provide on a supplemental basis an unredacted copy of the exhibit 

and its materiality and privacy or confidentiality analyses. Upon evaluation of the Registrant’s 

supplemental materials, the Commission or its staff may require the Registrant to amend its 

filing to include in the exhibit any previously redacted information that is not adequately 

supported by the Registrant’s analyses. The Registrant may request confidential treatment of 

the supplemental material submitted under this Instruction 3 pursuant to rule 83 of the 

Commission’s Organizational Rules [17 CFR 200.83] while it is in the possession of the 

Commission or its staff. After completing its review of the supplemental information, the 

Commission or its staff will return or destroy it, if the Registrant complies with the procedures 

outlined in rule 418 under the Securities Act [17 CFR 230.418]. 

4. Each exhibit identified in the exhibit index (other than an exhibit filed in eXtensible Business 

Reporting Language) must include an active link to an exhibit that is filed with the registration 

statement or, if the exhibit is incorporated by reference, an active hyperlink to the exhibit 

separately filed on EDGAR. If the registration statement is amended, each amendment must 

include active hyperlinks to the exhibits required with the amendment. 

5. Registrants are required to provide the Initial Summary Prospectus exhibits, as required by 

paragraph (r) of this Item, only in connection with the filing of an initial registration statement, 

or in connection with a pre-effective amendment or a post-effective amendment filed in 

accordance with paragraph (a) of rule 485 under the Securities Act [17 CFR 230.485(a)]. 

Registrants should add a legend clearly identifying the document as a form of Summary 

Prospectus the registrant intends to use on or after the effective date of the registration 

statement. 

Item 31. Directors and Officers of the Depositor 

Provide the following information about each director or officer of the Depositor: 

(1) 

Name and Principal 

Business Address 

(2) 

Positions and Offices 

with Depositor 

Instruction. Registrants are required to provide the above information only for officers or directors who 

are engaged directly or indirectly in activities relating to the Registrant or the Contracts, and for executive 

officers including the Depositor’s president, secretary, treasurer, and vice presidents who have authority 

to act as president in his or her absence. 

Item 32. Persons Controlled by or Under Common Control with the Depositor or the Registrant 

Provide a list or diagram of all persons directly or indirectly controlled by or under common control with 

the Depositor or the Registrant. For any person controlled by another person, disclose the percentage of 

voting securities owned by the immediately controlling person or other basis of that person’s control. For 

33 
 

 

 

 

each company, also provide the state or other sovereign power under the laws of which the company is 

organized. 

Instructions. 

1. Include the Registrant and the Depositor in the list or diagram and show the relationship of each 

company to the Registrant and Depositor and to the other companies named, using crossreferences if a company is controlled through direct ownership of its securities by two or more 

persons. 

2. Indicate with appropriate symbols subsidiaries that file separate financial statements, 

subsidiaries included in consolidated financial statements, or unconsolidated subsidiaries 

included in group financial statements. Indicate for other subsidiaries why financial statements 

are not filed. 

Item 33. Indemnification 

State the general effect of any contract, arrangements, or statute under which any underwriter or affiliated 

person of the Registrant is insured or indemnified against any liability incurred in his or her official capacity, 

other than insurance provided by any underwriter or affiliated person for his or her own protection. 

Item 34. Principal Underwriters 

(a) Other Activity. State the name of each investment company (other than the Registrant) for which 

each principal underwriter currently distributing the Registrant’s securities also acts as a principal 

underwriter, depositor, sponsor, or investment adviser. 

(b) Management. Provide the information required by the following table for each director, officer, or 

partner of each principal underwriter named in the response to Item 25: 

(1) (2) 

Name and Principal Positions and Offices 

Business Address With Underwriter 

Instruction. If a principal underwriter is the Depositor or an affiliate of the Depositor, and is also an 

insurance company, the above information for officers or directors need only be provided for officers or 

directors who are engaged directly or indirectly in activities relating to the Registrant or the Contracts, 

and for executive officers including the Depositor’s or its affiliate’s president, secretary, treasurer, and 

vice presidents who have authority to act as president in his or her absence. 

(c) Compensation From the Registrant. Provide the information required by the following table for all 

commissions and other compensation received, directly or indirectly, from the Registrant during the 

Registrant’s last fiscal year by each principal underwriter: 

(1) 

Name of 

Principal 

Underwriter 

(2) 

Net Underwriting 

Discounts and 

Commissions 

(3) 

Compensation on 

Redemption 

(4) 

Brokerage 

Commission 

(5) 

Other 

Compensation 

34 
 

 

 

 

Instructions. 

1. Disclose the type of services rendered in consideration for the compensation listed under column 

(5). 

2. Information need not be given about the service of mailing proxies or periodic reports of the 

Registrant. 

3. Exclude information about bona fide contracts with the Registrant or its Depositor for outside 

legal or auditing services, or bona fide contracts for personal employment entered into with the 

Registrant or its Depositor in the ordinary course of business. 

4. Exclude information about any service for which total payments of less than $15,000 were made 

during each of the Registrant’s last three fiscal years. 

5. Exclude information about payments made under any agreement whereby another person 

contracts with the Registrant or its Depositor to perform as custodian or administrative or 

servicing agent. 

Item 35. Location of Accounts and Records 

State the name and address of each person maintaining physical possession of each account, book, or 

other document required to be maintained by section 31(a) of the Investment Company Act [15 U.S.C. 

80a-30(a)] and the rules under that section. 

Instruction. The Registrant may omit this information to the extent it is provided in its most recent report 

on Form N-CEN [17 CFR 274.101]. 

Item 36. Management Services 

Provide a summary of the substantive provisions of any management-related service contract not 

discussed in Part A or B, disclosing the parties to the contract and the total amount paid and by whom 

for the Registrant’s last three fiscal years. 

Instructions. 

1. The instructions to Item 22(b) also apply to this Item. 

2. Exclude information about any service provided for payments totaling less than $15,000 during 

each of the Registrant’s 

last three fiscal years. 

Item 37. Fee Representation 

Provide a representation of the Depositor that the fees and charges deducted under the Contracts, in the 

aggregate, are reasonable in relation to the services rendered, the expenses expected to be incurred, 

and the risks assumed by the Depositor. 

35 
 

 

 

 

________________________________________________ 

________________________________________________ 

________________________________________________ 

________________________________________________ 

SIGNATURES 

Pursuant to the requirements of the Securities Act of 1933 and the Investment Company Act of 1940, the 

Registrant (certifies that it meets all of the requirements for effectiveness of this registration statement 

under rule 485(b) under the Securities Act and) has duly caused this registration statement to be signed 

on its behalf by the undersigned, duly authorized, in the City of , and State of , 

on this day of , . 

(Registrant) 

By _____________________________________________ 

(Signature) 

(Title) 

(Depositor) 

By _____________________________________________ 

(Name of Officer of Depositor) 

(Title) 

Instruction: 

If the registration statement is being filed only under the Securities Act or under both the Securities Act 

and the Investment Company Act, it should be signed by both the Registrant and the Depositor. If the 

registration statement is being filed only under the Investment Company Act, it should be signed only by 

the Registrant. 

Pursuant to the requirements of the Securities Act of 1933, this registration statement has been signed 

by the following persons in the capacities and on the dates indicated. 

Signature Title Date 

36