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iu-ia3090.htm - Generated by SEC Publisher for SEC Filing

 

	ING Life Insurance and Annuity Company 	 
	[Windsor, Connecticut] 	 
	 
	[Customer Service Center 	Important terms and definitions used in this 
	P.O. Box 10450 	Contract appear on page 4. 
	909 Locust Street 	 
	Des Moines, Iowa 50306-0450] 	 
	[1-888-854-5950] 	 

	Product Name 	 	Contract Number 
	[ING Select Multi-Index 7] 	 	[R123456] 
	Annuitant(s) 	Age of Annuitant(s) 	Sex of Annuitant(s) 
	[Thomas J. Doe] 	[55] 	[Male] 
	Owner/Joint Owner 	Age of Owner/Joint Owner 	Residence State 
	[John Q. Doe] 	[35] 	[Connecticut] 
	Contract Date 	Issue State 	 
	[July 1, 2009] 	[Connecticut] 	 
	Initial Premium 	 	 
	[$15,000.00] 	 	 
	Maturity Date 	Annuity Plan 	 
	[July 1, 2039] 	[Payments for Life with 10 Year Period Certain] 

MODIFIED SINGLE PREMIUM DEFERRED ANNUITY CONTRACT

In this Contract "you" or "your" refers to the Owner shown above. "We," "our," or "us" refers to ING Life Insurance and Annuity Company.

READ THIS CONTRACT CAREFULLY. This is a legal contract between you and us.

RIGHT TO EXAMINE AND RETURN THIS CONTRACT

You may return this Contract by mailing or delivering it to our Customer Service Center at the address shown above or to the producer through whom you purchased it within twenty days (or thirty days if this is a replacement contract as defined by applicable state regulation) after the date you receive it. If so returned, we will promptly pay you any portion of the Premium paid and not previously Surrendered as of the date the returned Contract is received by us. If you are unsure whether your Contract is a replacement contract, please contact us at our Customer Service Center at the phone number or address set forth above.

WE WILL PROVIDE YOU WITH ADDITIONAL INFORMATION REGARDING THE BENEFITS AND PROVISIONS OF THIS CONTRACT UPON WRITTEN REQUEST. YOU MAY ALSO CALL OUR CUSTOMER SERVICE CENTER AT [1-888-854-5950] FOR INQUIRIES, INFORMATION OR ASSISTANCE.

     Cash Surrender Values may increase based on the Strategy you have selected. You may allocate your Premium between the Fixed Rate Strategy and the Point-to-Point Cap Index Strategy. Under the Point-to-Point Cap Index Strategy contract values are affected by the performance of an external index, but the Contract does not directly participate in such external index or other equity investments.

The initial interest rate for the Fixed Rate Strategy is guaranteed for one year only.

If you Surrender all or a portion of the Accumulation Value of the Contract, Surrender Charges may apply. Surrender Charges, when applied, will reduce the amount paid to you. Surrender Charges will not apply under certain conditions (see Section 6.3).

This Contract is non-participating which means it will not pay dividends resulting from any of the surplus or earnings of ING Life Insurance and Annuity Company.

IU-IA-3090

				
	 TABLE OF CONTENTS
	  
	  
	  
	  	  	  	 Page 
	  
	 1. 	 CONTRACT SCHEDULE 	 3 
	  
	 2. 	 IMPORTANT TERMS AND DEFINITIONS 	 4 
	  
	 3. 	 INTRODUCTION TO THE CONTRACT 	  
	  	 3.1 	 The Contract 	 7 
	  	 3.2 	 The Owner 	 7 
	  	 3.3 	 The Annuitant 	 7 
	  	 3.4 	 The Beneficiary 	 7 
	  
	 4. 	 PREMIUMS 	  
	  	 4.1 	 Premiums 	 9 
	  	 4.2 	 Allocating Strategies 	 9 
	  
	 5. 	 STRATEGIES 	  
	  	 5.1 	 Strategies 	 10 
	  	 5.2 	 Fixed Rate Strategy 	 10 
	  	 5.3 	 Point-to-Point Cap Index Strategy 	 11 
	  
	 6. 	 CONTRACT VALUES 	  
	  	 6.1 	 The Accumulation Value 	 12 
	  	 6.2 	 The Cash Surrender Value 	 12 
	  	 6.3 	 Charges 	 12 
	  
	 7. 	 CONTRACT BENEFITS 	  
	  	 7.1 	 Contract Surrender 	 13 
	  	 7.2 	 The Death Benefit 	 13 
	  	 7.3 	 Annuity Payments 	 14 
	  
	 8. 	 OTHER IMPORTANT INFORMATION 	  
	  	 8.1 	 Annual Report to Owner 	 17 
	  	 8.2 	 Assignment 	 17 
	  	 8.3 	 Misstatement Made by Owner in Connection with the Purchase of this Contract 	 17 
	  	 8.4 	 Payments We May Defer 	 17 
	  	 8.5 	 Incontestability 	 17 
	  	 8.6 	 Basis of Computation 	 17 
	  	 8.7 	 Rules for Interpreting this Contract 	 17 
	  	 8.8 	 Non-Waiver 	 17 

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	1. CONTRACT SCHEDULE

	A. 	Charges 	 	 	 	 	 	 	 	 
	 	Surrender Charge Schedule: 	 	 	 	 	 	 	 	 
	 	         Contract Year 	1 	2 	3 	4 	5 	6 	7 	8+ 
	 	         Surrender Charge Percentage 	9% 	8% 	7% 	6% 	5% 	4% 	3% 	0% 
	 	         See Section 6.3 for details 	 	 	 	 	 	 	 	 

	B. 	Available Strategies and Indexes 	 
	 
	 	Fixed Rate Strategy 	 
	 	         Initial Premium applied to this Strategy 	[$7,500] 
	 	         Premium Allocation Percentage of Initial Premium 	[50%] 
	 	         Initial Fixed Rate Strategy Interest Rate 	[3.00%] 
	 	         Minimum Guaranteed Interest Rate 	1.0% 

	      Point-to-Point Cap Index Strategy 	 
	 
	         Initial Premium applied to this Strategy 	[$7,500] 
	         Premium Allocation Percentage of Initial Premium 	[50%] 

	 	 	Percentage of 	 
	 	Initial Premium 	Initial Premium 	Initial 
	Index 	Allocated to Each Index 	Allocated to Each Index 	Index Cap* 
	[1S&P 500] 	[$3,750.00] 	[25.0%] 	[6.0%] 
	[2Dow Jones EURO STOXX 50® Index] 	[$3,750.00] 	[25.0%] 	[5.5%] 
	[3Insert Index Name] 	[$0.00] 	[0.0%] 	[0.0%] 
	[4Insert Index Name] 	[$0.00] 	[0.0%] 	[0.0%] 

	*Any Index Cap declared in the future will never be less than 2% and will never exceed 100%

[1“Standard & Poor’s®”, “S&P® “, “S&P 500® “, “Standard & Poor’s 500”, and “500” are trademarks of The McGraw-Hill Companies, Inc. and have been licensed for use by ING Life Insurance and Annuity Company. The product is not sponsored, endorsed, sold or promoted by Standard & Poor's and Standard & Poor's makes no representation regarding the advisability of investing in the product.]

[2STOXX and Dow Jones (“Licensors”) have no relationship to the Company, except the licensing of the Dow Jones EURO STOXX 50® Index, (the “Index”) and related trademarks for use with this fixed annuity Contract (the “Contract”). Licensors do not: sponsor, endorse, sell, promote or recommend the Contract; have any responsibility or liability for, or make any decisions on pricing administration, management or marketing of the Contract; or consider the needs of the Contract or its Owners in determining, composing or calculating the Index or have any obligation to do so.

Licensors will not have any liability in connection with the Contract. Specifically, Licensors do not make any warranty, express or implied and disclaim any and all warranty about: the results to be obtained by the Contract, the Contract Owner or any other person in connection with the use of the Index and the data included in the Index; accuracy or completeness of the Index and its data; merchantability and fitness for a particular purpose or use of the Index and its data; or have any have liability for any errors, omissions or interruptions in the Index or its data; Under no circumstances will Licensors be liable for any lost profits or indirect, punitive, special or consequential damages or losses, even if Licensors knows that they might occur.

The licensing agreement between the Company and Licensors is solely for their benefit and not for the benefit of the Contract Owners or any other third parties.]

[3Insert Index Trademark Language]

[4Insert Index Trademark Language]

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	1. CONTRACT SCHEDULE (cont.)

	C.      	Minimum Guaranteed Contract Value 
	 	The      	Minimum Guaranteed Contract Value equals the greater of: 
	 	(1)      	The sum of the Minimum Guaranteed Strategy Value of each Strategy; or 
	 	(2)      	100% of the Premium, less premium taxes, if applicable, less: 
	 	 	(a)      	Any Surrenders of Accumulation Value; plus 
	 	 	(b)      	Interest credited and compounded daily in a manner to yield the annual rate of 1.00%; less 
	 	 	(c)      	Any Surrender Charges. 
		
	D.      	Minimum Guaranteed Strategy Value 

	 	Fixed Rate Strategy 	Point-to-Point Cap 
	 	 	Index Strategy 
	Initial Minimum Guaranteed Strategy Value Rate: 	[3.00%] 	[2.00%] 

		
	The Minimum Guaranteed Strategy Value of each Strategy equals: 
	(1) 	87.5% of the Premium allocated to the Strategy, less premium taxes, if applicable; plus 
	(2) 	Reallocations into that Strategy; less 
	(3) 	Reallocations and Surrenders taken from Accumulation Value in that Strategy; plus 
	(4) 	Interest credited and compounded daily in a manner to yield the applicable Minimum Guaranteed 
	 	Strategy Value Rate. 

The initial Minimum Guaranteed Strategy Value Rates shown above are set on the Contract Date and will not change for the first seven Contract Years. On the seventh Contract Anniversary and on each Contract Anniversary thereafter, the Minimum Guaranteed Strategy Value Rates for all Strategies will be set equal to the average of the five-year Constant Maturity Treasury Rate for each day that it is reported by the Federal Reserve during the month of October in the calendar year preceding the calendar year of the Contract Anniversary, less 1.25% for the Fixed Rate Strategy and less 2.25% for the Point-to-Point Cap Index Strategy. The Minimum Guaranteed Strategy Value Rate for both the Fixed Rate Strategy and the Point-to-Point Cap Index Strategy will be rounded to the nearest 0.05% and will not be greater than 3.0% or less than 1.0%.

	E. 	Reallocations and Surrender Adjustments 	 
	 	A Reallocation of Accumulation Value will result in a pro-rata Reallocation of the Minimum Guaranteed 
	 	Strategy Value in the same proportion as the Accumulation Value being reallocated bears to the total 
	 	Accumulation Value of the Strategy and applicable Index, if any, attributable to the Allocation Anniversary. 
	 
	 	Surrender of Accumulation Value from any Strategy will result in a dollar for dollar reduction of the 
	 	Minimum Guaranteed Strategy Value of that Strategy equal to the amount of the Accumulation Value 
	 	Surrendered (excluding the amount of any Surrender Charges deducted, if any). 
	 
	F. 	Attached Endorsements 	 
	 
	 	[Form numbers and name of all attached 	[Endorsement price if separate identified cost] 
	 	Endorsements] 	 

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	 2. IMPORTANT TERMS AND DEFINITIONS

 

 Accumulation Value is defined in Section 6.1.

 Additional Premium means any payment, other than the Initial Premium, made by you and accepted by us for this Contract.

 Allocation means apportioning your Premium among available Strategies and Indexes, if applicable.

 Allocation Anniversary means the same date as the applicable Allocation Date each year. If the Allocation Date is February 29th, in non-leap years the Allocation Anniversary shall be March 1st.

 Allocation Date means the date on which the Initial Premium, Reallocation or Additional Premium, as applicable, is allocated to any specific Strategy or Index.

 Allocation Year means the period beginning on an Allocation Anniversary and ending on the day before the following Allocation Anniversary.

 The Annuitant is designated by you as the individual upon whose life Annuity Payments will be based. There may be two Annuitants. The Annuitant(s) on the Contract Date are shown on the first page of this Contract. See Section 3.3 for additional details.

 Annuity Payments are periodic payments made by us to you or, subject to our consent in the event the payee is not a natural person, to a payee designated by you.

 The Annuity Plan is an option elected by you (or, if none is elected, is the option as described in Section 7.3) that determines the frequency, duration and amount of the Annuity Payments.

 Beneficiary means the individual or entity you select to receive the Death Benefit.

 Business Day means any day that the New York Stock Exchange ("NYSE") is open for trading, exclusive of federal holidays, or any day the Securities and Exchange Commission ("SEC") requires that mutual funds, unit investment trusts or other investment portfolios be valued.

 The Cash Surrender Value is the amount you receive upon full Surrender of this Contract. See Section 6.2 for additional details.

 Code means the Internal Revenue Code of 1986, as amended.

 Company Death Benefit Rate means the effective annual interest rate that we will credit to the Death Benefit from the date of death until the Death Benefit is paid. See Section 7.2 for additional details.

 The Contingent Annuitant is the individual who is not an Annuitant and will become the Annuitant if all named Annuitants die prior to the Maturity Date and the Death Benefit is not otherwise payable.

 Contract means this Modified Single Premium Deferred Annuity Contract.

 The Contract Anniversary is the same day and month each year as the Contract Date. If the Contract Date is February 29th, in non-leap years the Contract Anniversary shall be March 1st.

 Contract Date means the date on which this Contract becomes effective. The Contract Date is shown on the first page of this Contract.

 A Contract Year is the period beginning on a Contract Anniversary (or, in the first Contract Year only, beginning on the Contract Date) and ending on the day preceding the next Contract Anniversary.

 The Death Benefit is the amount payable to the Beneficiary upon death of any Owner (or, if the Owner is not a natural person, upon the death of any Annuitant) prior to the Maturity Date.

 Endorsements are attachments to this Contract that add, change or supersede its terms or provisions.

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 Extended Medical Care means confinement in a Hospital or Nursing Home prescribed by a Qualifying Medical Professional.

 Fixed Rate Strategy is the Strategy that applies the declared Fixed Rate Strategy Interest Rate to the applicable Premium or Reallocation of Accumulation Value. See Section 5.2 for additional details.

 Fixed Rate Strategy Interest Rate is the declared annual interest rate applicable to the Fixed Rate Strategy. The Fixed Rate Strategy Interest Rate is declared annually and in advance and is guaranteed for one year unless the Premium or Reallocation of Accumulation Value is reallocated to another strategy. The Fixed Rate Strategy Interest Rate shall be declared in our discretion and it will be at least equal to the Fixed Rate Strategy Minimum Guaranteed Interest Rate shown on the Contract Schedule.

 Hospital or Nursing Home means a hospital or a skilled care or intermediate care nursing facility, operating as such according to applicable law and at which medical treatment is available on a daily basis. This does not include a rest home or other facility whose primary purpose is to provide accommodations, board, or personal care services to individuals who do not need medical or nursing care.

 Index means an index applicable to the Point-to-Point Cap Index Strategy. See Section 5.3 for additional details.

 Index Cap means the maximum Index Credit that may be applied at the end of each Indexing Period. It is declared annually in advance and is guaranteed for one year unless that Premium or Reallocation is reallocated to another Strategy or Index.

 Index Credit means the rate credited to each Premium and Reallocation of Accumulation Value allocated to the Point-to-Point Cap Index Strategy and is based on the performance of the applicable Index as measured over the Indexing Period.

 Index Number means the value of the Index. It excludes any dividends that may be paid by the firms that comprise the Index.

 Indexing Period means the period over which the Index Cap is guaranteed and the Index Credit is calculated.

 The Initial Premium is the payment made by you to us to put this Contract into effect.

 An Irrevocable Beneficiary is a Beneficiary whose rights and interests under this Contract cannot be changed without his, her or its consent.

 A Joint Owner is an individual who, along with another individual Owner, is entitled to exercise the rights incident to ownership. Both Joint Owners must agree to any change or the exercise of any rights under the Contract. The Joint Owner may not be an entity and may not be named if the Owner is an entity. The Joint Owner, if any, on the Contract Date is shown on the first page of this Contract. See Section 3.2 for additional details

 Maturity Date means the date shown on the first page of this Contract. As long as this Contract is still in force on the Maturity Date, the Proceeds are used to determine the amount paid under the Annuity Plan chosen. The Maturity Date shall be the Contract Anniversary following the oldest Annuitant's attainment of age 85.

 Minimum Guaranteed Contract Value is the minimum amount payable upon a full Surrender, at the Maturity Date or which would be payable as a Death Benefit. The Minimum Guaranteed Contract Value is defined in the Contract Schedule.

 Minimum Guaranteed Interest Rate is the minimum interest rate that can be credited under the Fixed Rate Strategy. The Minimum Guaranteed Interest Rate is set forth in the Contract Schedule.

 Minimum Guaranteed Strategy Value is the minimum value of any Strategy and is utilized only in the calculation of the Minimum Guaranteed Contract Value. The Minimum Guaranteed Strategy Value for each Strategy is defined in the Contract Schedule.

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Minimum Guaranteed Strategy Value Rates are the rates which are utilized to determine the Minimum Guaranteed Strategy Value for each Strategy. The initial Minimum Guaranteed Strategy Value Rates are set forth in the Contract Schedule.

Notice to Us means notice made in a form that: (1) is approved by or is acceptable to us; (2) has the information and any documentation we determine in our discretion to be necessary to take the action requested or exercise the right specified; and (3) is received by us at our Customer Service Center at the address specified on the first page of this Contract. Under certain circumstances, we may permit you to provide Notice to Us by telephone or electronically.

The Owner is the individual (or entity) who is entitled to exercise the rights incident to ownership. The terms "you" or "your," when used in this Contract, refer to the Owner. The Owner on the Contract Date is shown on the first page of this Contract. See Section 3.2 for additional details.

Point-to-Point Cap Index Strategy is the Strategy that credits interest to the applicable Premium or Reallocation of Accumulation Value based on the Index Change, as defined in Section 5.3, of the Index over the Indexing Period. See Section 5.3 for additional details.

Premium means collectively the Initial Premium and any Additional Premium.

Premium Allocation Percentage means the percentage of Premium allocated into any specific Strategy.

Proceeds means the greater of the Minimum Guaranteed Contract Value or the Accumulation Value.

Proof of Death means the documentation we deem necessary to establish death including, but not limited to: (1) a certified copy of a death certificate; (2) a certified copy of a statement of death from an attending physician; (3) a finding of a court of competent jurisdiction as to the cause of death; (4) or any other proof that we deem in our discretion to be satisfactory to us.

Qualifying Medical Professional means a legally licensed practitioner of the healing arts who: (1) is acting within the scope of his or her license; (2) is not a resident of your household or that of the Annuitant; and (3) is not related to you or the Annuitant by blood or marriage.

Reallocation means changing the Strategy and/or Index applicable to a portion or all of the Accumulation Value.

The Right to Examine and Return This Contract is the period of time during which you have the right to return the Contract for any reason, or no reason at all, and receive the payment as described in the Right to Examine and Return This Contract provision appearing on the first page of this Contract.

Strategy means any interest crediting strategy available under this Contract, as defined in Section 5.

A Surrender is a transaction in which all or a part of the Accumulation Value is taken from the Contract.

A Surrender Charge is a charge applied to certain full or partial Surrenders during the first seven Contract Years and will reduce the amount paid to you. See Section 6.3 for additional details.

The Surrender Charge Free Amount equals 10% of the Contract's Accumulation Value as determined on the date of the first partial Surrender during the Contract Year. This is the amount you may Surrender without any Surrender Charge.

Terminal Condition means an illness or injury that results in a life expectancy of twelve months or less, as measured from the date of diagnosis by a Qualifying Medical Professional.

"We," "our," or "us," when used in this Contract, refers to ING Life Insurance and Annuity Company, a stock company domiciled in Connecticut.

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	                                        3. INTRODUCTION TO THE CONTRACT

	3.1 The Contract

This Contract and any attached application, amendments, or Endorsements constitute the entire contract

between you and us. It is issued in consideration of the Initial Premium.

Only our President, a Vice President or Secretary is authorized to change or modify any of this Contract's

terms, provisions or requirements. Any such change must be in writing. We may make changes to this

Contract if required by law, including any changes necessary to continue to qualify such Contract as an

annuity contract under applicable law. An Endorsement added to comply with applicable law does not

require your consent but is subject to regulatory approval. Any such changes will apply uniformly to all

contracts that are affected.

The provisions of this Contract shall, in all events, be construed to comply with applicable U.S. federal

income tax requirements including the requirements of Section 72(s) of the Code.

3.2 The Owner

The Owner owns the Contract and is entitled to exercise the rights incident to ownership. You are the

Owner of this Contract. There may be Joint Owners; however, if there is more than one Owner, both

Owners must agree to any change or exercise of the rights under this Contract.

You may change the ownership of this Contract at any time prior to the Maturity Date. Any change,

addition or deletion of an Owner is treated as a change of ownership. To change ownership, you must

provide Notice to Us of such change. Change of ownership will take effect as of the date we receive Notice

to Us.

3.3 The Annuitant

The Annuitant is the individual upon whose life the Annuity Payments are based. The Annuitant must be a

natural person and is designated by you at the time this Contract is issued and cannot be changed. There

may be two Annuitants.

In addition to the Annuitant, you may also name a Contingent Annuitant. The Contingent Annuitant cannot

be changed while he or she is living.

If at the time of any Annuitant's death the Owner is not a natural person, the death of such Annuitant prior

to the Maturity Date will be treated as the death of an Owner as described in Section 7.2.

If the Annuitants are not the Owners and all Annuitants die prior to the Maturity Date (and no Contingent

Annuitant is named) and the Owner is a natural person, we will treat you or, if there are Joint Owners, the

youngest Owner, as the Annuitant if such youngest Owner has not attained age 85 as of the date of the

Annuitant's death. Otherwise you must name an individual as an Annuitant who has not attained age 85.

3.4 The Beneficiary

The Beneficiary is an individual or entity designated by you to receive the Death Benefit. A Beneficiary’s

status may be changed at any time prior to the Maturity Date unless you designate such Beneficiary as an

Irrevocable Beneficiary. An Irrevocable Beneficiary cannot be changed without the consent of the

Irrevocable Beneficiary. You may designate one or more (i) primary Beneficiaries and (ii) contingent

Beneficiaries. These classes set the order under which the Death Benefit is paid. If all the primary

Beneficiaries die before any Owner (or, if the Owner is not a natural person, any Annuitant), the contingent

Beneficiary shall take the place of, and be deemed to be, the primary Beneficiary, and the Death Benefit

will be paid to the contingent Beneficiary. If there are multiple Beneficiaries, the Death Benefit shall be paid

in equal shares to all Beneficiaries in the same class (primary or contingent, as applicable) unless you

provide Notice to Us directing otherwise.

If there are Joint Owners, at the death of the first Owner, any surviving Owner shall take the place of, and

be deemed to be, the primary Beneficiary. This will override any other Beneficiary designation.

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	7

	If there is a single natural Owner and all Beneficiaries die before the Owner, or if no Beneficiary has been

designated at the time of the Owner’s death, the Owner’s estate will be deemed to be the primary

Beneficiary.

If the Owner is not a natural person and all Beneficiaries die before any Annuitant, or if no Beneficiary has

been designated at the time of any Annuitant's death, the Owner will be deemed to be the primary

Beneficiary.

We will deem any Beneficiary to have predeceased the Owner if:

(1) such Beneficiary died at the same time as the Owner;

(2) such Beneficiary died within twenty-four hours after the Owner's death; or

(3) there is not sufficient evidence to determine that the Beneficiary and Owner died other than at the

    same time.

To make a Beneficiary change, you must provide Notice to Us. Unless you specify otherwise, such change

cancels any existing Beneficiary designations in the same class (primary or contingent) and will take effect

as of the date Notice to Us is received.

The rights of any Beneficiary (if a natural person), including an Irrevocable Beneficiary, will end if he or she

dies prior to the Owner and will pass to any other Beneficiary (which, if a natural person, must be then

living) as described in this Section 3.4 unless you provide Notice to Us directing otherwise.

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	                                                                4. PREMIUMS

	4.1 Premiums

The Initial Premium for this Contract is required to put this Contract into effect. The amount of the Initial

Premium is shown on the first page of this Contract.

We retain the right, in our sole discretion, to refuse to accept any Additional Premium. Subject to our right

to refuse and return any Additional Premium, you may pay Additional Premiums prior to the first Contract

Anniversary.

Any Additional Premium must be received at our Customer Service Center at the address shown on the

first page of this Contract and are subject to the following limitations:

(1) Each payment of Additional Premium must be at least $5,000.

(2) The sum of all Premiums paid or the Accumulation Value under all annuity contracts you have with us,

     including this Contract, is less than $1,000,000.

4.2 Allocating Strategies

You select the Strategy and Index, if applicable, to which to allocate your Premiums from among those

offered by us. Your selection of Strategy and Index, if applicable, for any Additional Premium payments will

be at the same Premium Allocation Percentage as your Initial Premium, unless you provide Notice to Us

directing otherwise. You may reallocate all or a portion of the Accumulation Value, attributable to that

Allocation Anniversary in any Strategy and/or Index to any other available Strategy and/or Index by

providing Notice to Us. You may do so only during the 30-day period following an Allocation Anniversary.

No Surrender Charge will apply. The Reallocation from each Strategy and Index is taken on a last in first

out basis. Such Reallocations are effective on the Allocation Anniversary immediately preceding the

Reallocation and interest will be applied as though the Reallocation was in effect on such Allocation

Anniversary. Reallocation requests must be in a form acceptable to us.

We may cease to accept Additional Premium payments to any specific Index at any time at our discretion.

In addition, we may cease to accept Reallocations to any specific Index, or cease to permit Accumulation

Value from continuing to be applied to any specific Index at the applicable Allocation Anniversary under

the following circumstances:

(1) The Index is discontinued or its composition is substantially changed, or our agreement with the

     sponsor of the Index is terminated; or

(2) We determine that conditions in the capital markets do not permit us to effectively establish

     reasonable Index Caps applicable to the Point-to-Point Cap Index Strategy.

We will notify you in advance of the date on which we will cease accepting Additional Premiums or

Reallocations to an Index or cease to permit Accumulation Value from continuing to be applied to any

specific Index at the applicable Allocation Anniversary. If you do not provide Notice to Us regarding the

Reallocation of Accumulation Value from a discontinued Index, the Accumulation Value applicable to the

discontinued Index will be reallocated to the Fixed Rate Strategy at the next Allocation Anniversary

applicable to Accumulation Value allocated to the discontinued Index.

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	9

	5. STRATEGIES

	5.1 Strategies

You select the Strategy and Index, if applicable, for which any portion of Premiums and Reallocations are

allocated, subject to the terms of this Contract. We reserve the right to add Indexes as approved by the

insurance supervisory official in the jurisdiction in which the Contract is issued.

We may cease to offer a specific Index or cease to accept Premiums and/or Reallocations to a specific

Index at any time. Any Additional Premiums and Reallocations accepted or continued application of

amounts to any Strategy and Index are subject to the terms and conditions in existence for any Strategy

and Index available at that time, including the then existing Fixed Rate Strategy Interest Rate and Index

Caps which may differ from those applicable to previous allocations or Reallocations.

Surrenders are taken on a last in first out basis and in the same proportion as the Accumulation Value

associated with the Strategy and any applicable Index relative to the total Accumulation Value.

5.2 Fixed Rate Strategy

Fixed Rate Strategy Interest Rates

In our discretion, we determine and set the Fixed Rate Strategy Interest Rate. The Initial Fixed Rate

Strategy Interest Rate is stated in the Contract Schedule. The Fixed Rate Strategy Interest Rate will be

declared annually and in advance and is guaranteed for one year unless the Premium or Reallocation of

Accumulation Value is reallocated to another strategy. The Fixed Rate Strategy Interest Rate will be at

least equal to the Fixed Rate Strategy Minimum Guaranteed Interest Rate shown on the Contract

Schedule.

Fixed Rate Strategy Accumulation Value

The Accumulation Value for the Fixed Rate Strategy equals the sum of the Accumulation Value associated

with each Premium and Reallocation allocated to this Strategy. Each Premium and Reallocation allocated

to this Strategy will have an associated Accumulation Value which will be calculated as follows:

(1) On each Allocation Date the Accumulation Value for each Premium or Reallocation equals the amount

     of Premium or Reallocation allocated to this Strategy, if any, less any premium tax, if applicable.

(2) On each Allocation Anniversary the Accumulation Value associated with each Premium or

     Reallocation allocated to this Strategy equals:

     (a) The Accumulation Value of the Premium or Reallocation allocated to this Strategy on the last

          Allocation Anniversary; less

     (b) Any Reallocations out of the Accumulation Value of the Premium or Reallocation allocated to this

          Strategy since the last Allocation Anniversary; less

     (c) Adjustments for any partial Surrenders of Accumulation Value of the Premium or Reallocation

          allocated to this Strategy since the last Allocation Anniversary; plus

     (d) Interest credited daily.

     For the purpose of this calculation, during the first Allocation Year, the Allocation Date shall be

     deemed to be “the last Allocation Anniversary.”

     Interest will be compounded daily in a manner to yield the declared annual Fixed Rate Strategy

     Interest Rate.

The portion of any Additional Premium or Reallocations allocated to this Strategy will be credited an

interest rate declared in advance by us. The initial interest rate applicable to the Initial Premium is also

shown in the Contract Schedule.

In case of full or partial Surrender, interest will be credited on the portion of this Strategy’s Accumulation

Value Surrendered up to and including the date the transaction is processed. The Accumulation Value of

this Strategy at any date within an Allocation Year will be determined by us with allowance for the time

elapsed in the Allocation Year. No interest will be credited on any premium tax after we deduct it.

	IU-IA-3090

	10

	5.3 Point-to-Point Cap Index Strategy

The following definitions apply to the Point-to-Point Cap Index Strategy:

Index Change is calculated as (i)/(ii)-1, where:

          (i) is the Index Number as of the end of the Indexing Period; and

          (ii) is the Index Number as of the start of the Indexing Period.

The Index Change is calculated separately for each Index.

Index Credit. We will apply the Index Credit to each Premium and Reallocation allocated to the Point-to-

Point Index Cap Strategy. The Index Credit will equal the lesser of the Index Cap or the Index Change.

The Index Credit will never be less than zero.

Index Number. Each Allocation of Premium and Reallocation will be assigned an Index Number equal to

the value of the Index as of the close of business on the day before the Allocation Date. The Index

Number for the start of each applicable Indexing Period after the first Indexing Period will be the Index

Number as of the end of the Business Day before the Allocation Anniversary. If the Index Number is not

published on any day for which a calculation is made, the first preceding published Index Number will be

used.

Indexing Period. Each Allocation of Premium and Reallocation has its own specific Indexing Period. The

initial Indexing Period for each Premium or Reallocation begins on the Allocation Date for that Premium or

Reallocation and ends on the day before the following Allocation Anniversary. Subsequent Indexing

Periods begin on the Allocation Anniversary and end on the day before the next Allocation Anniversary.

Point-to-Point Cap Index Strategy Accumulation Value

The Accumulation Value for this Strategy equals the sum of the Accumulation Value associated with each

Premium and Reallocation allocated to an Index in the Strategy. Each Premium and Reallocation allocated

to an Index in this Strategy will have an associated Accumulation Value which will be calculated as follows:

(1) On each Allocation Date the Accumulation Value for each Premium or Reallocation equals the amount

     of Premium or Reallocation allocated to an Index in this Strategy, if any, less any premium tax, if

     applicable.

(2) On each Allocation Anniversary the Accumulation Value associated with each Premium or

     Reallocation allocated to an Index in this Strategy equals:

     (a) The Accumulation Value of the Premium or Reallocation allocated to an Index on the last

          Allocation Anniversary; less

     (b) Any Reallocations out of the Accumulation Value of the Premium or Reallocation allocated to an

          Index since the last Allocation Anniversary; less

     (c) Adjustments for any partial Surrenders of Accumulation Value of the Premium or Reallocation

         allocated to an Index since the last Allocation Anniversary; plus

     (d) The result multiplied by (1+ the applicable Index Credit)

     For the purpose of this calculation, on the first Allocation Anniversary the Allocation Date shall be

     deemed to be "the last Allocation Anniversary."

(3) On any other date during the applicable Allocation Year, the Accumulation Value associated with each

     Premium or Reallocation allocated to an Index in this Strategy is calculated as follows:

     (a) The Accumulation Value of the Premium or Reallocation allocated to an Index on the last

          Allocation Anniversary; less

     (b) Any Reallocations out of the Accumulation Value of the Premium or Reallocation allocated to an

          Index since the last Allocation Anniversary; less

     (c) Adjustments for any partial Surrenders of Accumulation Value of the Premium or Reallocation

         allocated to an Index since the last Allocation Anniversary.

For the purpose of this calculation, during the first Allocation Year the Allocation Date shall be deemed

to be "the last Allocation Anniversary."

Surrenders do not participate in any Index Credits for the Allocation Year in which they are taken.

	IU-IA-3090

	11

	                                                      6. CONTRACT VALUES

	6.1 The Accumulation Value

On the Contract Date, the Contract’s Accumulation Value equals the Initial Premium paid less any

premium tax, if applicable. At any time after the Contract Date, the Contract’s Accumulation Value equals

the sum of the Accumulation Value for each Allocation of Premium and Reallocation to a Strategy and

associated Index, where applicable. The Accumulation Value for each Strategy and Index is calculated

separately as set forth in Section 5 of this Contract.

6.2 The Cash Surrender Value

The Cash Surrender Value of this Contract equals the greater of:

(1) The Minimum Guaranteed Contract Value (as defined in the Contract Schedule); or

(2) The Accumulation Value, less any Surrender Charge.

6.3 Charges

Surrender Charge

Except as described below, if the Contract is Surrendered, in full or in part, while the Surrender Charge

schedule shown in the Contract Schedule is in effect a Surrender Charge will be imposed as a percentage

of Accumulation Value Surrendered. The percentage imposed at the time of Surrender depends on the

number of complete years that have elapsed since Contract issue. Surrender Charges are shown in the

Contract Schedule.

No Surrender Charges will be assessed upon:

(1) the commencement of Annuity Payments if Annuity Payments begin after the seventh Contract Year;

(2) any Surrender of Accumulation Value less than or equal to the Surrender Charge Free Amount; or

(3) any Surrender of the Accumulation Value after the seventh Contract Year.

If total Surrenders in any Contract Year exceed the Surrender Charge Free Amount, any applicable

Surrender Charges will apply to the amount Surrendered that is in excess of the Surrender Charge Free

Amount.

Waiver of Surrender Charges due to Extended Medical Care or Terminal Condition

We will waive any Surrender Charges otherwise applicable if you Surrender, in full or in part, because you

are receiving Extended Medical Care or if you are diagnosed with a Terminal Condition.

To qualify for a waiver as a result of Extended Medical Care:

(1) You (or any Annuitant, if the Owner is not a natural person) must first begin receiving Extended

     Medical Care on or after the first Contract Anniversary and receive such Extended Medical Care for at

     least forty-five days during any continuous sixty day period; and

(2) Your request for a Surrender, together with satisfactory proof of such Extended Medical Care, must be

     provided by Notice to Us during the term of such Extended Medical Care or within ninety days after the

     last day that you received such Extended Medical Care. Such proof must be in writing and, where

     applicable, attested to by a Qualifying Medical Professional.

To qualify for a waiver as a result of a Terminal Condition:

(1) You (or any Annuitant, if the Owner is not a natural person) must first be diagnosed by a Qualifying

     Medical Professional as having a Terminal Condition on or after the first Contract Anniversary; and

(2) Your request for a Surrender, together with satisfactory proof of such Terminal Condition, must be

     provided in a Notice to Us. Such proof must be in writing and, where applicable, attested to by a

     Qualifying Medical Professional.

We may, at any time and at our expense, require a secondary medical opinion by a Qualifying Medical

Professional of our choosing in connection with (i) the prescription of Extended Medical Care, or (ii) the

diagnosis of a Terminal Condition.

Premium Tax

We may deduct from the Accumulation Value, as applicable, the amount of any premium tax or other state

and local taxes levied by any state or local government entity when:

(1) such premium tax is incurred by us; or

(2) the Proceeds or Cash Surrender Value, as applicable, is applied to an Annuity Plan as described in

    Section 7.3.

We have the right to change the amount we charge for any premium tax to conform to changes in

applicable law or if you change your state of residence. Any premium taxes will be deducted on a last in

first out basis and on a pro rata basis from the Strategy and Index.

	IU-IA-3090

	12

	                                                           7. CONTRACT BENEFITS

	7.1 Contract Surrender

On or at any time prior to the Maturity Date you may Surrender the Contract in full for its Cash Surrender

Value. To do so you must provide Notice to Us, as defined in Section 2, which we must receive no later

than the Maturity Date. If we receive your Notice to Us before the close of business on any Business Day,

the Cash Surrender Value will be determined at the close of business on such Business Day; otherwise,

the Cash Surrender Value will be determined as of the close of the next Business Day. We may require

that this Contract be returned to us before we pay you the Cash Surrender Value. If you have lost the

Contract, we may require that you complete and return to our Customer Service Center a lost contract

form. Upon payment of the Cash Surrender Value, this Contract shall cease to have any further value.

At any time prior to the Maturity Date, you may also Surrender a portion of the Contract's Accumulation

Value. The minimum amount that may be Surrendered at any one time is the lesser of: (i) $1,000; or (2)

the Surrender Charge Free Amount. A partial Surrender will be deemed to be a full Surrender and the

Cash Surrender Value will be paid if, at the time of the Surrender, the Cash Surrender Value is reduced to

less than $2,500. Partial Surrenders will be taken on a last in first out basis and on a pro rata basis from

the Strategy and Index.

7.2 The Death Benefit

If any Owner (or, if the Owner is not a natural person, any Annuitant) dies before the Maturity Date, the

Death Benefit is payable to the Beneficiary as determined under Section 3.4. Only one Death Benefit is

payable under this Contract. If there are multiple Beneficiaries, the Death Benefit will be paid in equal

shares to all Beneficiaries in the same class (primary or contingent, as applicable) unless you provide

Notice to Us directing otherwise.

The Death Benefit equals the Proceeds as of the date of death of the Owner or Annuitant, whichever is

applicable. From the date of death until the Death Benefit is paid, the Death Benefit will be credited with

interest at the greater of the Company Death Benefit Rate or the applicable state interest rate required to

be paid on annuity death claims, if any. We determine the Company Death Benefit Rate solely in our

discretion and it is subject to change. Your Beneficiaries may contact us to determine the current Company

Death Benefit Rate.

The entire interest in this Contract must be distributed as described below in accordance with the

requirements of Section 72(s) of the Code and all the terms of this Contract shall be interpreted in

accordance with that section. If the Death Benefit is applied to an Annuity Plan, the primary Beneficiary will

be deemed to be the Annuitant. See Section 7.3 for more information on applying the Death Benefit to an

Annuity Plan.

If any Owner (or, if the Owner is not a natural person, any Annuitant) dies before the Maturity Date, the

following applies:

Spousal Beneficiaries

If the sole primary Beneficiary is the deceased Owner's "spouse" (as defined by federal law), upon Notice

to Us from your surviving spouse, in lieu of receiving the Death Benefit, the Contract may be continued

with the surviving spouse as the new Owner, pursuant to Section 72(s) of the Code, and the following will

apply:

(1) If the deceased Owner was an Annuitant, the surviving spouse will also become an Annuitant.

(2) The age of the surviving spouse will be used as the Owner's age under the continued Contract.

(3) Surrender Charges on subsequent Surrenders will be waived.

(4) Additional Premiums will not be accepted.

(5) At the subsequent death of the new Owner (i.e., the surviving spouse), the Death Benefit must be

    distributed as required for non-spousal Beneficiaries as stated below after which the continued

    Contract will terminate.

If the deceased Owner’s spouse does not choose to continue the Contract (or, if continued, upon the

death of the deceased Owner’s spouse), the Death Benefit will be distributed as stated below for non-

spousal Beneficiaries. If the deceased Owner’s spouse has attained age 85 on the date of the Owner’s

death, the deceased Owner’s spouse may not choose to continue the Contract.

	IU-IA-3090

	13

	Non-spousal Beneficiaries

If any primary Beneficiary is someone other than the deceased Owner's spouse, the primary Beneficiary

will become the Annuitant and the following will apply:

(1) No Additional Premiums may be made following the date of the Owner's death; and

(2) The entire Proceeds must be distributed to the Beneficiary:

     (a) in its entirety within five years of the Owner's death; or

     (b) beginning within one year after the Owner's death: (i) over the life of the Beneficiary; or (ii) over a

          period not greater than the Beneficiary's life expectancy.

If the Beneficiary dies before all Death Benefit payments have been distributed, any remaining

distributions will be paid to such Beneficiary’s estate or as otherwise directed by the Beneficiary in a Notice

to Us.

How to Claim the Death Benefit

We shall pay the Death Benefit upon our receipt of Proof of Death and all required claim forms. The

claimant should contact our Customer Service Center at the address or phone number on the first page of

this Contract for further instructions.

7.3 Annuity Payments

If the Proceeds are less than $2,000 on the Maturity Date as shown on the first page of this Contract, we

will pay you or, subject to our consent in the event the payee is not a natural person, a payee designated

by you, the Proceeds in one lump sum payment as directed by you and this Contract will have no further

value. If the Proceeds are equal to or greater than $2,000 on the Maturity Date as shown on the first page

of this Contract and an Annuitant is living on the Maturity Date, we will begin making Annuity Payments as

described below.

We will make Annuity Payments beginning on the Maturity Date, on a monthly basis unless you deliver

Notice to Us directing us to pay at a different frequency. However, requests for periodic payments other

than monthly, quarterly, semi-annually or annually require our consent.

If the day an Annuity Payment is scheduled to be paid is not a Business Day, for instance, a weekend, or

does not exist in any month in which an Annuity Payment is due, for instance, a month that does not

contain twenty-nine, thirty, or thirty-one days, such Annuity Payment will be paid on the next Business

Day.

The amount applied to an Annuity Plan will be the Proceeds, less any applicable premium tax, which will

determine the Annuity Payment under the Annuity Plan you have elected.

Each Annuity Payment must equal at least $20. If Annuity Payments would be less than $20, we have the

right to make such Annuity Payments less frequently as necessary to make the Annuity Payment equal to

at least $20.

We have the right to change the $2,000 and $20 minimums stated in this provision based upon increases

reflected in the Consumer Price Index for All Urban Consumers (CPI-U) since January 1, 2005.

Electing an Annuity Plan

You may elect any of the Annuity Plans described below. In addition, you may elect any other Annuity Plan

we may be offering on the Maturity Date. You may change the Annuity Plan you have elected at any time

before the Maturity Date upon thirty days prior Notice to Us. Upon request, we will send you the proper

forms to elect or change an Annuity Plan. The elected Annuity Plan shall become effective when we

receive satisfactorily completed forms indicating your election.

If you do not elect an Annuity Plan by the Maturity Date, payments, calculated based on the oldest

Annuitant's life, will be made to you or a payee designated by you automatically each month for a

minimum of 120 months and as long thereafter as the oldest Annuitant lives unless otherwise limited by

applicable law.

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	14

	Your election of an Annuity Plan is subject to the following additional terms and conditions:

(1) If you do not direct us otherwise, Annuity Payments will be paid to you.

(2) Our consent is necessary if the payee is not a natural person.

(3) Any change in the payee will take effect as of the date we receive Notice to Us.

If any Owner or payee dies on or after the Maturity Date but before all Annuity Payments have been paid,

we will pay the primary Beneficiary the remaining value of any such Annuity Payments at least as rapidly

as under the Annuity Plan in effect at the time of death.

Subject to the provisions set forth above an Annuity Plan may also be elected for the distribution of the

Cash Surrender Value after the first Contract Year, or the Death Benefit.

The Annuity Plans

(1) Payments for a Period Certain

     Annuity Payments are paid in equal installments for a fixed number of years as shown in Table A

     below. The number of years cannot be less than ten or more than thirty unless otherwise limited by

     applicable law.

(2) Payments for Life with Period Certain

     Annuity Payments are paid for a fixed number of years and as long thereafter as the Annuitant is living

     as shown in Table B below. However, the number of years cannot be less than ten or more than thirty

     unless otherwise required by applicable law.

(3) Life Only Payments

     Annuity Payments are paid for as long as the Annuitant is living as shown in Table B below.

(4) Joint and Last Survivor Life Payments

     Annuity Payments are paid for as long as either of two Annuitants is living as shown in Table C below.

Annuity Plan Tables

The following tables show the minimum monthly payments for each $1,000 of Proceeds or Cash

Surrender Value, as applicable, applied under the Annuity Plan, assuming fixed payments with a net

investment return of 1.0%, using the Annuity 2000 Mortality Tables. We may pay a higher rate at our

discretion.

In Tables B and C, the amount of each payment will depend on the Annuitant's sex and age as determined

by the nearest birthday at the time Annuity Payments commence. Annuity Payments made on a basis

other than monthly and for ages or number of years not shown will be calculated on the same basis as

those shown and may be obtained from us by contacting our Customer Service Center at the address or

phone number set forth on the first page of this Contract.

	Table A:  Monthly Payments for a Period Certain 

	Years 	Monthly 	Years 	Monthly 	Years 	Monthly 
	Payable 	Payment 	Payable 	Payment 	Payable 	Payment 
	10 	$8.75 	17 	$5.33 	24 	$3.90 
	11 	7.99 	18 	5.05 	25 	3.76 
	12 	7.36 	19 	4.81 	26 	3.64 
	13 	6.83 	20 	4.59 	27 	3.52 
	14 	6.37 	21 	4.40 	28 	3.41 
	15 	5.98 	22 	4.22 	29 	3.31 
	16 	5.63 	23 	4.05 	30 	3.21 

	IU-IA-3090

	15

							
	Table B: Monthly Life Payments (Single Annuitant)
	 
	 	 	 	   Life with 10 Year 	Life with 20 Year 
	Age of 	Life Only 	Period Certain 	Period Certain 
	Payee 	Male 	Female 	Male 	Female 	Male 	Female 
	50 	$2.98 	$2.75 	$2.97 	$2.74 	$2.89 	$2.70 
	55 	3.37 	3.08 	3.34 	3.07 	3.20 	2.99 
	60 	3.89 	3.52 	3.82 	3.49 	3.55 	3.34 
	65 	4.58 	4.11 	4.44 	4.04 	3.91 	3.72 
	70 	5.54 	4.93 	5.20 	4.75 	4.22 	4.10 
	75 	6.87 	6.12 	6.09 	5.67 	4.43 	4.38 
	80 	8.72 	7.88 	7.00 	6.71 	4.54 	4.53 
	85 	11.30 	10.50 	7.79 	7.65 	4.58 	4.58 

									
	 	Table C: Monthly Joint and Last Survivor Life Payments (Joint Annuitants) 	 
	 
	 	 	 	 	         Male Age 	 	 	 
	Female 	50 	55 	 60 	 65 	70 	75 	 80 	 85 
	Age 	 	 	 	 	 	 	 	 
	50 	$2.47 	$2.55 	$2.47 	$2.55 	$2.62 	$2.67 	$2.70 	$2.72 
	55 	2.60 	2.73 	2.85 	2.93 	2.99 	3.03 	3.05 	3.06 
	60 	2.71 	2.90 	3.08 	3.22 	3.33 	3.41 	3.46 	3.48 
	65 	2.81 	3.05 	3.30 	3.53 	3.73 	3.87 	3.97 	4.03 
	70 	2.87 	3.16 	3.49 	3.83 	4.15 	4.41 	4.61 	4.75 
	75 	2.92 	3.25 	3.64 	4.09 	4.56 	5.01 	5.39 	5.67 
	80 	2.95 	3.30 	3.74 	4.28 	4.91 	5.58 	6.23 	6.79 
	85 	2.96 	3.34 	3.81 	4.42 	5.17 	6.06 	7.03 	7.98 

	IU-IA-3090

	16

	                                      8. OTHER IMPORTANT INFORMATION

	8.1 Annual Report to Owner

We will provide you a report at least once during each Contract Year. The report will show the current

Accumulation Value and the Cash Surrender Value of this Contract, as well as any amounts deducted

from, or added to, the Accumulation Value since the last report. The report will also include any other

information that is required by law or regulation.

This report will be sent to you at your last known address within sixty days after the report date. Upon

your request, we will provide additional reports, but we reserve the right to assess a reasonable

charge for each such additional report. We will also provide you with copies of any other notices,

reports or documents as required by law or regulation.

8.2 Assignment

You may assign this Contract as security for a loan or other obligation. Such an assignment is not a

change of ownership. However, your rights, and those of any Beneficiary, are subject to the terms of

any assignment. Written consent of any Irrevocable Beneficiary is required before any assignment is

effective. You shall provide Notice to Us in order to make, modify or release any assignment. We are

not responsible for the validity or other effects of any assignment.

8.3 Misstatement Made by Owner in Connection with the Purchase of this Contract

We may require proof of the age and/or sex of any person upon whose life Death Benefits or Annuity

Payments are determined. If you have misstated the age or sex of such person, we will adjust future

benefit payments to reflect those that the Premiums would have purchased at the correct age or sex.

We will include in the next payment any underpayments due to such misstatement with interest

credited at the rate of 1.5% annually. We will deduct any overpayments plus interest at 1.5% annually

from future payments until the overpayment has been repaid in full.

We reserve the right to void this Contract and return the Cash Surrender Value in the event you make

any material misrepresentation in connection with the purchase of this Contract.

8.4 Payments We May Defer

We may, at any time, defer payment of the full Cash Surrender Value or any partial Surrender for up to

six months after we receive a request for it, contingent upon written approval by the insurance

supervisory official in the jurisdiction in which this Contract is issued.

8.5 Incontestability

Except in the case of fraud, this Contract shall be incontestable from the Contract Date.

8.6 Basis of Computation

If required by law, we have filed a detailed statement of our computations with the insurance

supervisory official in the jurisdiction where this Contract is issued. The reserves and guaranteed

values will at no time be less than the minimums required by the laws of such jurisdiction.

8.7 Rules for Interpreting this Contract

In this Contract, headings and captions are intended for convenience in reference only and do not

affect interpretation of the Contract’s provisions. Unless the context clearly indicates otherwise:

(1) All language that implies the singular will also include the plural (and vice versa) and any words

     indicating one gender will also include the other gender, as appropriate; and

(2) Where a word or phrase has been given a defined meaning, any other part of speech or

     grammatical form of that word or phrase will have a corresponding meaning.

8.8 Non-Waiver

We may, in our discretion, elect not to exercise any right, privilege, or option under this Contract. Such

election will not constitute a waiver of the right to exercise such right, privilege, or option at any

subsequent time, nor will it constitute a waiver of any provision in the Contract.

	IU-IA-3090

	17

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	ING Life Insurance and Annuity Company 
	[Windsor, Connecticut] 

	[Customer Service Center 
	P.O. Box 10450 
	909 Locust Street 
	Des Moines, Iowa 50306-0450] 
	[1-888-854-5950] 

 

 

 

 

 

 

MODIFIED SINGLE PREMIUM DEFERRED ANNUITY CONTRACT

     Cash Surrender Values may increase based on the Strategy you have selected. You may allocate your Premium between the Fixed Rate Strategy and the Point-to-Point Cap Index Strategy. Under the Point-to-Point Cap Index Strategy contract values are affected by the performance of an external index, but the Contract does not directly participate in such external index or other equity investments.

The initial interest rate for the Fixed Rate Strategy is guaranteed for one year only.

If you Surrender all or a portion of the Accumulation Value of the Contract, Surrender Charges may apply. Surrender Charges, when applied, will reduce the amount paid to you. Surrender Charges will not apply under certain conditions (see Section 6.3).

This Contract is non-participating which means it will not pay dividends resulting from any of the surplus or earnings of ING Life Insurance and Annuity Company.

IU-IA-3090application-152344_12142009.htm - Generated by SEC Publisher for SEC Filing

 

 ING SELECT MULTI-INDEX 5 APPLICATION

 MODIFIED SINGLE PREMIUM DEFERRED ANNUITY

 ING Life Insurance and Annuity Company

 (the “Company”)

 A member of the ING family of companies

 PO Box 10450, Des Moines, IA 50306-0450

 Overnight Delivery: 909 Locust Street, Des Moines, IA 50309-2899 Phone: 888-845-5950 Fax: 860-580-0919

	 www.ingfinancialsolutions.com      		 	
	 1.      		 CONTRACT INFORMATION	

 If this application is being signed in a state other than the owner’s resident state, please specify the state where the business was solicited and the purpose of the visit.

	
	 Client Account Number (Broker-dealer use only.) 
	 2. OWNER (If a trust is designated as the owner, complete the Certificate of Trust form and submit it with this application.) 
	 Name 

				
	 SSN/TIN 	 Birth Date/Trust Date 	 c Male 	 c Female 
	 Street Address (PO boxes are not permitted.) 	  	  	  
	 City 	                                                                                State 	 ZIP 	  
	 Mailing Address (If different than above.) 	  	  	  
	 City 	                                                                                State 	 ZIP 	  
	 Country of Citizenship 	                                        Country of Incorporation 	  	  
	 Phone 	                                        E-mail Address 	  	  
	 JOINT OWNER (Not available with qualified plans.) 	  	  
	 Name 	  	  	  
	 SSN 	 Birth Date 	 c Male 	 c Female 
	 Street Address (PO boxes are not permitted.) 	  	  	  
	 City 	                                                                                State 	 ZIP 	  
	 Mailing Address (If different than above.) 	  	  	  
	 City 	                                                                                State 	 ZIP 	  
	 Country of Citizenship 	                                        Phone 	  	  
	 Relationship to Owner 	                                        E-mail Address 	  	  
	 152344(10/09) 	 Page 1 of 6 - Incomplete without all pages. 	  	 Order #152344 12/14/2009 
	  	  	  	                                    LifeCad/R 

 3. ANNUITANT(S) (Designate an annuitant below in the event that: 1) the individual owner is not the annuitant; 2) there is joint ownership; or 3) the owner is not a natural person. If an individual owner is named and an annuitant is not named below, the individual owner will be named as the annuitant. The owner is required to have an insurable interest in the life of the annuitant. As defined in more detail in the prospectus, an insurable interest means the owner has a lawful and substantial economic interest in the continued life of the annuitant.)

					
	 Name 	  	                                        Phone 	  	  
	 SSN 	 Birth Date 	  	 c Male 	 c Female 
	 Street Address (PO boxes are not permitted.) 	  	  	  	  
	 City 	  	                                      State 	 ZIP 	  
	 Country of Citizenship 	  	 Relationship to Owner 	  	  
	 ANNUITANT 	  	  	  	  
	 Name 	  	                                        Phone 	  	  
	 SSN 	 Birth Date 	  	 c Male 	 c Female 
	 Street Address (PO boxes are not permitted.) 	  	  	  	  
	 City 	  	                                        State 	 ZIP 	  
	 Country of Citizenship 	  	 Relationship to Owner 	  	  

 c Contingent annuitant (Provide the contingent annuitant’s name, SSN, birth date, gender, and street address in the Special Remarks area of Section 8.)

 4. BENEFICIARY INFORMATION

 If you would like to designate a restricted beneficiary, complete the Restricted Beneficiary form and submit it with this application. Total percentage of primary beneficiary shares must equal 100%. Total percentage of contingent beneficiary shares must also equal 100%. If no percentages are listed, beneficiaries' shares will be distributed equally. Additional beneficiaries should be listed on a separate piece of paper that includes the owner’s signature and the date.

	 Name

 

	 Gender Birth Date/Trust Date

 

	 SSN/TIN

 

	 Relationship to Owner

 

	 % Beneficiary Type

Primary

c Primary

c Contingent

c Primary

c Contingent

c Primary

c Contingent

c Primary

c Contingent

 

 5. PREMIUM AND PLAN TYPE

 Make all checks payable to ING Life Insurance and Annuity Company. Complete either the nonqualified or the qualified section, not both.

				
	 Premium: $ 	 and/or Estimated Amount of Transfer(s)/1035 Exchange(s): $ 
	  
	 NONQUALIFIED - SOURCE OF FUNDS: 	 c New Purchase (money with application) 	  
	  	 c 1035 Exchange c Transfer from money market account, CD or mutual fund 
	 QUALIFIED - SOURCE OF FUNDS: 	 c New Purchase (money with application) 	 c Contribution for tax year 
	  	          c Rollover 	 c 	  
	  	                    Transfer 	  	  
	  
	 Type of IRA Applied For: 	 c Traditional IRA 	 c Roth IRA c SEP-IRA 
	  
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	  	  	  	 LifeCad/R 

 6. STRATEGY REALLOCATION AUTHORIZATION

 By checking the box below and signing this form, you authorize the Company to act upon reallocation instructions, given by electronic means, voice command, or otherwise from the producer(s) named in Section 9 or the individual(s) named below not registered with the Financial Industry Regulatory Authority (FINRA), upon furnishing their Social Security number or alternative identification number.

 Neither the Company nor any person the Company authorizes will be responsible for any claim, loss, liability or expense in connection with instructions received by electronic means, voice command or otherwise from such person if the Company acts in good faith in reliance upon this authorization in connection with instructions received. The Company will continue to act upon this authorization until 1) the producer(s) named in Section 9 are no longer affiliated with the broker-dealer under which your contract was purchased; or 2) you notify the Company by phone or in writing. The Company may discontinue or limit this privilege at any time.c I authorize the Company to act upon reallocation instructions given by my producer(s) or a nonregistered individual named below.

 To provide a nonregistered individual with reallocation authorization, please complete the following. If the individual’s Social Security number is not provided, the individual will not be authorized.

		
	
Name Name

7. IMPORTANT INFORMATION AND STATE REQUIRED NOTICES

	
SSN/TIN SSN/TIN

 To help the government fight the funding for terrorism and money-laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you — when you apply for an annuity, we will ask for your name, address, date of birth, and other information that will allow us to identify you.

 We may also ask to see your driver’s license or other identifying documents. If you wish to have a more detailed explanation of our information practices, please write to: Customer Service Center, ING Annuities, 909 Locust Street, Des Moines, IA 50309-2899.

 Pursuant to federal law (the Defense of Marriage Act of 1996), certain favorable federal tax treatment available to opposite-sex spouses is not available to same-sex spouses. For instance, federal tax law allows a surviving spouse who is designated the beneficiary under an annuity to continue the annuity when the owner dies. This alternative death benefit option is not available to a same-sex spouse beneficiary. If you are a same-sex spouse, we suggest that you consult with a tax advisor prior to purchasing an annuity contract, such as this one, which provides spousal benefits.

 Below are notices that apply only in certain states. Please read the following carefully to see if any apply in your state. Arkansas, Louisiana, Maine, New Mexico, Ohio, Oklahoma, Tennessee, Washington, West Virginia: Any person who knowingly and with intent to injure, defraud or deceive any insurance company, submits an application for insurance containing any materially false, incomplete, or misleading information, or conceals for the purpose of misleading, any material fact, is guilty of insurance fraud, which is a crime and in certain states, a felony. Penalties may include imprisonment, fine, denial of benefits, or civil damages.

 Arizona: On receiving your written request, we will provide you with information regarding the benefits and provisions of the annuity contract for which you have applied. If you are not satisfied, you may cancel your contract by returning it within 20 days, or within 30 days if you are 65 years of age or older on the date of the application for the annuity, after the date you receive it. Any premium paid for the returned contract will be refunded without interest.

 California Reg789.8: The sale or liquidation of any stock, bond, IRA, certificate of deposit, mutual fund, annuity, or other asset to fund the purchase of this product may have tax consequences, early withdrawal penalties, or other costs or penalties as a result of the sale or liquidation. You or your agent may wish to consult independent legal or financial advice before selling or liquidating any assets and prior to the purchase of any life or annuity products being solicited, offered for sale, or sold.

 Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

 District of Columbia: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant.

 Florida: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURANCE COMPANY FILES AN APPLICATION FOR INSURANCE CONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING INFORMATION IS GUILTY OF A FELONY IN THE THIRD DEGREE.

 Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

 Maryland: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

 New Jersey: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.

 Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

 Virginia: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an

			
	 application or files a claim containing a false or deceptive statement may have violated the state law. 	  
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	  	  	 LifeCad/R 

 8. ACKNOWLEDGEMENTS AND SIGNATURES (Please read carefully.)

 SIGNATURE REQUIRED BELOW! THIS ENTIRE SECTION MUST BE COMPLETED FOR YOUR APPLICATION TO BE PROCESSED IN “GOOD ORDER.” REPLACEMENT

 If either question below is answered “Yes,” you must complete any state-required replacement forms, as applicable, and submit them with this application.

				
	 1. Do you currently have any existing individual life insurance policies or annuity contracts? (If “Yes,” complete the 	  	  
	      state-required replacement form(s) and provide details below.) 	 c Yes 	 c No 
	 2. Will this contract replace any existing individual life insurance policies or annuity contracts? (If “Yes,” complete 	  	  
	      the state-required replacement form(s) and provide details below.) 	 c Yes 	 c No 
	  
	 Company 	 Policy/Contract # 	  	  
	  
	 Company 	 Policy/Contract # 	  	  
	  
	 SPECIAL REMARKS 	  	  	  

 By signing below, I acknowledge receipt of the prospectus. My signature also serves as representation that: (a) all statements and answers in this form, which include my strategy allocation instructions indicated in Section 10, are complete and true to the best of my knowledge and may be relied upon in determining whether to issue the applied for annuity; and (b) the owner has an insurable interest, as defined above and in more detail in the prospectus, in the life of the annuitant. Only the owner and the Company have the authority to modify this form. After reviewing my financial information, I believe this contract is suitable and will meet my financial goals and objectives.

 I have been advised that the annuity applied for offers an equity index strategy, and that if elected, contract values may be affected by the performance of an external index. The contract does not directly participate in any stock or equity investments. Any values shown, other than guaranteed minimum values, are not guarantees, promises or warranties.

 I understand that Individual Retirement Accounts (IRAs) already provide tax deferral like that provided by the contract. For an additional cost, this contract provides additional features and benefits, including death benefits and the ability to receive a lifetime income. I understand that I should purchase an annuity contract only if I have taken into account the cost of these features and benefits.

 Additional information about the contract can be found in the prospectus.

 TAXPAYER CERTIFICATION

 Under penalties of perjury, my/our signature(s) certifies/certify that:

	 1.      		 The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me).	
	 2.      		 I am not subject to backup withholding because (a) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (b) the IRS has notified me that I am no longer subject to backup withholding.	
	 3.      		 I am a U.S. citizen or U.S. resident alien.	

 The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

				
	 ¬Owner Signature 	  	  	  
	                Signed at (city, state) 	  	 Date 	  
	  
	 ¬Joint Owner Signature (if applicable) 	  	  
	                Signed at (city, state) 	  	 Date 	  
	 By signing below, I consent to being the individual annuitant. 	  	  
	  
	 ¬Annuitant Signature (if other than named owner(s)) 	 Date 	  
	 ¬Annuitant Signature (if other than named owner(s)) 	 Date 	  
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	  	  	  	 LifeCad/R 

 9. PRODUCER INFORMATION

 CHECK ¬THE BOXES BELOW ONLY IF THEY APPLY:c Check here to confirm that the owner(s) has an insurable interest in the life of the annuitant. As defined in more detail in the prospectus, an insurable interest means the owner has a lawful and substantial ¬ economic interest in the continued life of the annuitant.c Check here if the applicant is on active duty with the U.S. Armed Forces or is a dependent of any active duty service member of the U.S. Armed Forces. Complete the Military Personnel Financial Services Disclosure Regarding Insurance Products and return it with this application.

 If any questions below or in the Replacement section are answered “Yes,” the applicant must complete and submit any state-required replacement forms/sales material, as applicable, with this application.

			
	 Does the applicant have any existing individual life insurance policies or annuity contracts? 	 c Yes 	 c 
	 No 	  	  
	 Do you have reason to believe that the contract applied for will replace any existing annuity or life insurance coverage? 	 c Yes 	 c 
	 No 	  	  

 If your state has adopted replacement regulations, did you remember to do the following?

 Q Provide required replacement notice to the applicant and offer to read it aloud.

 Q Complete required, state-specific paperwork.

 Compensation Alternative (Select one. Please verify with your broker-dealer that the option you select is available.)

	 c Ac B

 

	 c Cc D

 

 Compensation will be split equally if no percentage is indicated. Partial percentages will be rounded up. Percentages must total 100%. The primary producer will be given the highest percentage in the case of unequal percentages and will receive all correspondence regarding the contract.

 By signing below you certify that: 1) replacement questions were answered; 2) any sales material was shown to the applicant and a copy was left with the applicant; 3) you used only insurer-approved sales material; 4) you have not made statements that differ from the sales material; and 5) no promises were made about the future value of any contract elements that are not guaranteed.

 (This includes any expected future index gains that may apply to this contract.)

 SIGNATURE REQUIRED BELOW! THIS ENTIRE SECTION MUST BE COMPLETED FOR YOUR APPLICATION TO BE PROCESSED IN “GOOD

 ORDER.”

					
	 Primary Producer: Split 	 % 	  	  	  
	 Print Name 	  	                                        ¬Signature 	  	  
	 NPN 	 SSN 	                                        Florida License # (if applicable) 	  	  
	 Producer Phone 	  	                                        Broker Code 	  	  
	 Broker-Dealer Branch 	  	  	  	  
	 Producer #2: Split 	 % 	  	  	  
	 Print Name 	  	                                        ¬Signature 	  	  
	 NPN 	 SSN 	                                        Florida License # (if applicable) 	  	  
	 Producer Phone 	  	                                        Broker Code 	  	  
	 Broker-Dealer Branch 	  	  	  	  
	 Producer #3: Split 	 % 	  	  	  
	 Print Name 	  	                                        ¬Signature 	  	  
	 NPN 	 SSN 	                                        Florida License # (if applicable) 	  	  
	 Producer Phone 	  	                                        Broker Code 	  	  
	 Broker-Dealer Branch 	  	  	  	  
	 Broker-Dealer Use Only: Team Name 	  	 Team ID 	  
	 152344(10/09) 	  	 Page 5 of 6 - Incomplete without all pages. 	  	 Order #152344 12/14/2009 
	  	  	  	  	 LifeCad/R 

 10. STRATEGY ALLOCATION (All strategies may not be available in all states.)

 ANY ADDITIONAL PREMIUM WILL BE ALLOCATED AS INDICATED ON THIS APPLICATION, UNLESS OTHERWISE DIRECTED.

 The sum of all strategy allocations must total 100 percent. Please use whole percentages when totaling the sum.

		
	  Fixed Rate Strategy Allocation 	                            Percentage 
	  Fixed Rate Strategy 	                                                          % 
	 Index Strategy Allocation 	  
	  Point-to-Point Cap Index Strategy Allocation 	                            Percentage 
	  S&P 500® Index 	                                                          % 
	  Dow Jones EURO STOXX 50® Index 	                                                          % 
	  Russell 2000® Index 	                                                          % 
	  S&P MidCap 400® Index 	                                                          % 
	  	 GRAND TOTAL = 100% 

			
	 152344(10/09) 	 Page 6 of 6 - Incomplete without all pages. 	 Order #152344 12/14/2009 
	  	  	 LifeCad/R

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