Document:

Exhibit 4(i)

 

PROTECTIVE LIFE AND ANNUITY
INSURANCE COMPANY • P. O. BOX 10648 • BIRMINGHAM, ALABAMA

35202-0648

 

ROTH INDIVIDUAL RETIREMENT ANNUITY (IRA) ENDORSEMENT

FOR ANNUITY CONTRACTS

 

	
  Check if
  this endorsement supersedes a prior Roth IRA endorsement

  	
   

  	
  o

  
	
  Check if
  Roth Conversion IRA

  	
   

  	
  o

  

 

This Roth Individual Retirement
Annuity Endorsement is made a part of the annuity Contract to which it is
attached, and the following provisions apply in lieu of any provisions in the
Contract to the contrary.

 

The Annuitant is establishing a
Roth Individual Retirement Annuity (“Roth IRA”) under section 408A to provide
for his or her retirement and for the support of his or her Beneficiaries after
death.

 

Article I

 

If this Roth IRA is not
designated as a Roth Conversion IRA, then, except in the case of a rollover
contribution described in section 408A(e), the issuer will accept only cash
contributions. The total cash contributions shall not exceed $3,000 for any taxable year beginning in 2002
through 2004, $4,000 for any taxable year beginning in 2005 through 2007, and
$5,000 for any taxable year beginning in 2008 and years thereafter. After 2008,
the limit will be adjusted by the Secretary of the Treasury for cost-of-living
increases under Code Section 219(b)(5)(C). Such adjustments will be in
multiples of $500.

 

If this Roth IRA is designated
as a Roth Conversion IRA, no contributions other than IRA Conversion
Contributions made during the same tax year will be accepted.

 

Article II

 

The contribution limits
described in Article I is gradually reduced to $0 between certain levels of
adjusted gross income (“AGI”). For a single Annuitant, the annual contribution
is currently phased out between AGI of $95,000 and $110,000; for a married
Annuitant who files jointly, between AGI of $150,000 and $160,000; and for a
married Annuitant who files separately, between $0 and $10,000. In the case of
a conversion, the issuer will not accept IRA Conversion Contributions in a tax
year if the Annuitant’s AGI for that tax year exceeds $100,000 or if the
Annuitant is married and files a separate return. Adjusted gross income is
defined in section 408A(c)(3) and does not include IRA Conversion
Contributions.

 

Article III

 

The Annuitant’s interest in the
Contract is non-forfeitable and nontransferable.

 

1

 

Article IV

 

The Contract does not require
fixed contributions.

 

Any dividends (refund of
contributions other than those attributable to excess contributions) arising
under the Contract will be applied before the close of the calendar year
following the year of the dividend as contributions toward the Contract.

 

Article V

 

If the Annuitant dies before
his or her entire interest in the Contract is distributed to him or her and the
Annuitant’s surviving spouse is not the sole Beneficiary, the entire remaining
interest will, at the election of the Annuitant or, if the Annuitant has not so
elected, at the election of the Beneficiary, either:

 

(a)                                  be
distributed by December 31 of the calendar year containing the fifth
anniversary of the Annuitant’s death, or

 

(b)                                 be
distributed over the life, or a period not longer than the life expectancy, of
the designated Beneficiary starting no later than December 31 of the calendar
year following the calendar year of the Annuitant’s death. Life expectancy is
computed using the expected return multiples in Table V of section 1.72-9 of
the Income Tax Regulations.

 

If distributions do not begin
by the date described in (b), distribution method (a) will apply.

 

If the Annuitant’s spouse is
the sole Beneficiary on the Annuitant’s date of death, such spouse will then be
treated as the Annuitant.

 

Article VI

 

The Annuitant agrees to provide
the issuer with information necessary for the issuer to prepare any reports
required under sections 408(i) and 408A(d)(3)(E),  Regulation sections1.408-5 and 1.408-6, and
under guidance published by the Internal Revenue Service.

 

The issuer agrees to submit
reports to the Internal Revenue Service and the Annuitant as prescribed by the
Internal Revenue Service.

 

Article VII

 

Notwithstanding any other
articles which may be added or incorporated, the provisions of Articles I
through IV and this sentence will be controlling. Any additional articles that
are not consistent with section 408A, the related regulations, and other
published guidance will be invalid.

 

2

 

Article VIII

 

This endorsement will be
amended from time to time to comply with the provisions of the Code, related
regulations, and other published guidance. Other amendments may be made with
the consent of the persons whose signatures appear on the Contract.

 

Article IX

 

The Annuitant must be an
individual who is the sole Owner. Neither the Annuitant nor Owner may be
changed while the Annuitant is living. All payments made under the Contract
while the Annuitant is alive must be made to the Annuitant. The Contract is
established for the exclusive benefit of the Owner and his or her beneficiaries.
The Contract is not transferable, and may not be sold, assigned, discounted or
pledged as collateral for a loan or as security for the performance on any
obligation or for any other purpose, to any person.

 

If the Annuitant’s spouse is
the sole Beneficiary on the Annuitant’s date of death, such spouse may elect
not to be treated as the Annuitant and the entire interest in the Contract must
be distributed under the rules set out in Article V, paragraph 1, above.

 

If your ROTH IRA is amended
pursuant to Article VIII, above, we will obtain all necessary approvals
including, where required, that of the Owner and will send you a copy of the
endorsement that modifies your ROTH IRA.

 

The provisions of this ROTH IRA
endorsement apply from the Effective Date.

 

Protective Life and Annuity Insurance
Company

	
  

  	
   

  
	
  Deborah J. Long

  	
   

  
	
  Secretary

  	
   

  

 

The required instructions on
the following page are provided by the Internal Revenue Service in connection
with your Roth IRA. These instructions are not part of your Roth IRA Contract
and do not change or modify the Contract in any way but do provide information
about the way your Contract will be administered.

 

3

 

GENERAL INSTRUCTIONS

(Section references are to the Internal Revenue Code unless otherwise
noted.)

 

Purpose
of Form –– Form AF-2069 is a model annuity endorsement
that meets the requirements of section 408A and has been automatically approved
by the IRS. A Roth individual retirement annuity (Roth IRA) is established
after the contract, which includes this endorsement, is fully executed by both
the individual (annuitant) and the issuer. The contract must be for the
exclusive benefit of the annuitant or his or her beneficiaries.

 

Do not file Form IPV-2028 with
the IRS. Instead, keep it for records purposes.

 

Unlike contributions to
traditional individual retirement arrangements, contributions to a Roth IRA are
not deductible from the annuitant’s gross income; and distributions after 5
years that are made when the annuitant is 591⁄2 years of age or older or on
account of death, disability, or the purchase of a home by a first-time
homebuyer (limited to $10,000), are not includable in gross income. For more
information on Roth IRAs, including the required disclosure the annuitant can
get from the issuer, get Pub. 590, Individual Retirement Arrangements (IRAs).

 

This Roth IRA can be used by an
annuitant to hold: (1) IRA Conversion Contributions, amounts rolled over or
transferred from another Roth IRA, and annual cash contributions of up to
$2,000 from the annuitant; or (2) if designated as a Roth Conversion IRA (by
checking the box on page 1), only IRA Conversion Contributions for the same tax
year.

 

To simplify the identification
of funds distributed from Roth IRAs, annuitants are encouraged to maintain IRA
Conversion Contributions for each tax year in a separate Roth IRA.

 

DEFINITIONS

 

Roth Conversion IRA. Roth Conversion IRA is a
Roth IRA that accepts only IRA Conversion Contributions made during the same
tax year.

 

IRA Conversion Contributions. IRA Conversion
Contributions are amounts rolled over, transferred, or considered transferred
from a non-Roth IRA to a Roth IRA. A non-Roth IRA is an individual retirement
account or annuity described in section 408(a) or 408(b), other than a Roth
IRA.

 

Issuer. The issuer is the insurance company
providing the annuity contract. The insurance company may use other terms
besides “issuer” to refer to itself, such as “company”, “insurer”, or “us”.

 

Annuitant. The annuitant is the person who
establishes the annuity contract. The insurance company may use other terms
besides “annuitant” to refer to the person who establishes the annuity
contract, such as, “owner”, “applicant”, “insured”, or “you”.

 

SPECIFIC INSTRUCTIONS

 

Article
I –– The annuitant may be subject to a 6-percent tax
on excess contributions if (1) contributions to other individual retirement
arrangements of the annuitant have been made for the same tax year, (2) the
annuitant’s adjusted gross income exceeds the applicable limits in Article II
for the tax year, or (3) the annuitant’s and spouse’s compensation does not
exceed the amount contributed for them for the tax year. The annuitant should
see the disclosure statement of Pub. 590 for more information.

 

Article
IX –– Article IX and any that follow it may
incorporate additional provisions that are agreed to by the annuitant and
issuer to complete the contract. They may include, for example, definitions,
investment powers, voting rights, exculpatory provisions, amendment and
termination, removal or the issuer, issuer’s fees, state law requirements,
beginning date of distributions, accepting only cash, treatment of excess
contributions, prohibited transactions with the annuitant, etc. Use additional
pages if necessary and attach them to this form.

 

4Exhibit 4(j)

 

PROTECTIVE
LIFE AND ANNUITY INSURANCE COMPANY • P. O. BOX 10648 • BIRMINGHAM,
ALABAMA

35202-0648

 

TAX SHELTERED ANNUITY (TSA) ENDORSEMENT FOR ANNUITY CONTRACTS

 

The Contract to which this Tax Sheltered Annuity
(TSA) Endorsement is attached is amended to qualify as a tax-sheltered annuity
under section 403(b) of the Internal Revenue Code of 1986, as amended (the “Code”)
which is not subject to the requirements of the Employee Retirement Income
Security Act of 1974, as amended (“ERISA”). Accordingly, all provisions of the
Contract and this Endorsement shall be interpreted in accordance with
qualification as a tax-sheltered annuity under Code section 403(b) and the
regulations thereunder.

 

The Contract is amended as of
the Effective Date as follows:

 

1.             OWNER AND ANNUITANT

 

The Annuitant must be an individual who is the
sole Owner, and all payments made from the Contract while the Annuitant is
alive must be made to the Annuitant. The Owner must be an employee or former
employee of an organization described in Code section 403(b)(1)(A) for whose
benefit the organization has established an annuity program under Code section
403(b) in connection with which this Contract was purchased. Except as
otherwise permitted under the Code and applicable regulations, neither the
Owner nor the Annuitant can be changed.

 

2.             NONTRANSFERABLE AND NONFORFEITABLE

 

The Contract is established for the exclusive
benefit of the Owner and his or her beneficiaries. The Owner’s interest under
the Contract is nontransferable (within the meaning of Code section 401(g)) and
is non-forfeitable. In particular, except as permitted by federal tax law, the
Contract may not be sold, assigned, discounted or pledged as collateral for a
loan or as security for the performance of any obligation or for any other
purpose, to any person other than the Company.

 

3.             PURCHASE PAYMENTS

 

All
Purchase Payments must be made only (a) as rollover contributions (as permitted
by Code sections 402(c), 402(e)(6), 403(a)(4), 403(b)(8), 403(b)(10),
408(d)(3), and 457(e)(16)); or (b) as non-taxable transfers from other
contracts qualifying under Code section 403(b) or custodial accounts qualifying
under Code section 403(b)(7). Purchase Payments must consist only of amounts
that are not subject to the requirements of ERISA. The Company will not accept
a Purchase Payment that includes after-tax contributions.

 

When allowed, Purchase Payments made pursuant to
a salary reduction agreement shall not exceed the limits set forth in Code
section 402(g), except as permitted under Code section 414(v), if applicable. Purchase
Payments also must not exceed the limitations on contributions under Code
sections 403(b) and 415, as applicable. To the extent Purchase Payments are in
excess of the amounts permitted under Code sections 402(g), 403(b), 414(v), or
415, we may distribute amounts equal to such excess as permitted by applicable
federal tax law. Any Contract provision requiring a specific minimum amount for
a subsequent Purchase Payment is deleted.

 

4.             REQUIRED DISTRIBUTIONS GENERALLY

 

The Owner’s entire interest in the Contract
shall be distributed as required under Code sections 401(a)(9) and 403(b)(10)
and applicable federal income tax regulations. The provisions of this
Endorsement reflecting these requirements override any provision of the
Contract that is inconsistent with such requirements.

 

1

 

5.             REQUIRED BEGINNING DATE

 

As
used in this Endorsement, the term “Required Beginning Date” means April 1 of
the calendar year following the calendar year following the later of (1) the
calendar year in which the Owner attains age 701⁄2; or (2) the calendar year in
which the Owner retires, or such later date as provided by law. However, unless
the Owner’s interest in the Contract is on account of the Owner’s participation
in a governmental plan (as defined in Code section 414(d)) or church plan (as
defined in Code section 401(a)(9)(C)), if the Owner is a 5-percent owner (as
defined in IRC section 416) of the organization described in section 1 of this
Endorsement with respect to the plan year ending in the calendar year in which
the Owner attains age 701⁄2, the Required Beginning Date is April 1 of the
calendar year following the calendar year in which the Owner attains age 701⁄2.

 

6.             DISTRIBUTIONS DURING OWNER’S LIFE

 

A.                                   Unless
otherwise permitted under applicable law, the Owner’s entire interest in the
Contract shall be distributed, or commence to be distributed, no later than the
Required Beginning Date over:

 

(i)            the life of the Owner,
or the lives of the Owner and his or her designated beneficiary (within the
meaning of Code section 401(a)(9)), or

 

(ii)           a period certain not
extending beyond the life expectancy of the Owner, or the joint and last
survivor expectancy of the Owner and his or her designated beneficiary.

 

Payments must
be made in periodic intervals of no longer than one year. In addition, payments
must be either non-increasing or they may increase only as provided by
applicable federal tax law.

 

B.                                     If
the Owner’s interest is to be distributed over a period greater than one year,
the amount to be distributed by December 31 of each year (including the year in
which the Required Beginning Date occurs) will be made in accordance with the
requirements of Code section 401(a)(9) and the regulations thereunder,
including the incidental death benefit requirements of Code section
401(a)(9)(G) and the regulations thereunder, including the minimum distribution
incidental benefit requirement under such regulations.

 

7.             DISTRIBUTIONS AFTER DEATH OF THE
OWNER

 

A.                                   Unless
otherwise permitted under applicable federal tax law, if the Owner dies before
distribution of his or her interest in the Contract has begun, distribution of
the Owner’s entire interest will be distributed in accordance with one of the
following three provisions:

 

(i)                                     The entire interest will be distributed
by December 31 of the calendar year containing the fifth anniversary of the
Owner’s death.

 

(ii)                                  If
the interest is payable to an individual who is the Owner’s designated beneficiary,
except as provided in paragraph (iii) below, the entire interest will be
distributed beginning on or before December 31 of the calendar year immediately
following the calendar year in which the Owner died and will be made over the
life of the designated beneficiary or over a period not extending

 

2

 

beyond the
life expectancy of the designated beneficiary. The irrevocable election of this
method of distribution must be made by the designated beneficiary no later than
December 31 of the calendar year immediately following the calendar year in
which the Owner died.

 

(iii)          If the designated
beneficiary is the Owner’s surviving spouse, the spouse may irrevocably elect
to receive payments over the life of the surviving spouse or over a period not
extending beyond the life expectancy of the surviving spouse, commencing at any
date prior to the later of: (a) December 31 of the calendar year immediately
following the calendar year in which the Owner died; and (b) December 31 of the
calendar year in which the Owner would have attained age 701⁄2. Such election by
the surviving spouse must be made no later than the earlier of December 31 of
the calendar year containing the fifth anniversary of the Owner’s death or the
date distributions are required to begin pursuant to the preceding sentence.

 

If the
surviving spouse dies before distributions begin, the limitations of this
section 7.A (without regard to this paragraph iii) shall be applied as if the
surviving spouse were the Owner.

 

B.                                     Unless
otherwise permitted under applicable federal tax law, if the Owner dies after
distribution of his or her interest in the Contract has begun, the remaining
portion of such interest, if any, will continue to be distributed at least as
rapidly as under the method of distribution being used at the time of the Owner’s
death.

 

C.                                     Distributions
under this section are considered to have begun if distributions are made on
account of the Owner reaching his or her Required Beginning Date or if prior to
the Required Beginning Date the distributions (except for acceleration) irrevocably
commence to the Owner over a period permitted and in an annuity form acceptable
under the applicable federal tax law.

 

8.             LIFE EXPECTANCY CALCULATIONS

 

Unless otherwise provided by
applicable federal tax law, life expectancy is computed using the expected
return multiples in Tables V and VI of Section 1.72-9 of the Federal income tax
regulations in accordance with Code sections 401(a)(9) and the regulations thereunder.
Life expectancy will not be recalculated with respect to payments under an
annuity option under the Contract. In other situations, life expectancy will
not be recalculated unless otherwise permitted under Code section 401(a)(9) and
the regulations thereunder.

 

9.             ANNUITY OPTIONS

 

All annuity options under the
Contract must meet the requirements of Code sections 401(a)(9) and 403(b)(10). The
provisions of this Endorsement reflecting the requirements of these Code
sections override any annuity option that is inconsistent with such
requirements.

 

If guaranteed payments are to
be made under an annuity option, the period over which the guaranteed payments
are to be made must not exceed the period permitted under Q&A-3 of Section
1.401(a)(9)-6 of the Income Tax Regulations (except as otherwise provided by
applicable federal tax law).

 

3

 

10.          WITHDRAWAL OF SALARY REDUCTION
CONTRIBUTIONS

 

Notwithstanding any other
provision of the Contract, withdrawals and other distributions attributable to
contributions after December 31, 1988, made pursuant to a salary reduction
agreement, and the earnings on such contributions and on amounts held as of
December 31, 1988, shall not be paid unless the Owner has reached age 591⁄2, had
a severance from employment, died, become disabled (within the meaning of Code
section 72(m)(7)), or incurred a hardship (in accordance with Code section
403(b)(11) and as provided by the Company); provided that amounts permitted to
be distributed in the event of hardship shall be limited to actual salary
deferral contributions (excluding earnings thereon); and provided further that
amounts may be distributed pursuant to a qualified domestic relations order to
the extent permitted by Code section 414(p).

 

11.          WITHDRAWAL OF CUSTODIAL ACCOUNT
CONTRIBUTIONS

 

Notwithstanding any other
provision of the Contract, Purchase Payments made by a nontaxable transfer from
a custodial account qualifying under Code section 403(b)(7) (or amounts
attributable to such amounts), and earnings of such amounts, shall not be paid
or made available before the Owner has attained age 591⁄2, had a severance from
employment, died, become disabled (within the meaning of Code section
72(m)(7)), or in the case of such amounts attributable to contributions made
under the custodial account pursuant to a salary reduction agreement,
encounters financial hardship (in accordance with Code section 403(b)(7)(A)(ii)
and as provided by the Company); provided that such amounts permitted to be
paid or made available in the event of financial hardship shall be limited to
amounts attributable to actual salary deferral contributions made under the
custodial account (excluding earnings thereon); and provided further that
amounts may be distributed pursuant to a qualified domestic relations order to
the extent permitted by Code section 414(p).

 

Section 10 of this Endorsement
shall not apply to payments or earnings subject to this section 11 which shall
instead govern.

 

12.          TAX-FREE DIRECT TRANSFERS

 

Direct transfers to another
contract qualifying under Code section 403(b) or to a custodial account
qualifying under Code section 403(b)(7) may be made only as permitted by the
Contract or under applicable law. To the extent provided by federal tax law,
amounts subject to distribution restrictions under the Code may only be
transferred to such a contract or account with the same or more stringent
restrictions. Direct trustee-to-trustee transfers may be made to a defined
benefit governmental plan (as defined in Code section 414(d)) as provided in
Code section 403(b)(13).

 

13.          DIRECT ROLLOVERS

 

A distributee may elect, at the
time and in the manner prescribed by us, to have any portion of an eligible
rollover distribution paid directly to an eligible retirement plan specified by
the distributee in a direct rollover.

 

A.                                   A
distributee includes an Owner. In addition, the Owner’s surviving spouse and
the Owner’s spouse or former spouse who is the alternative payee under a
qualified domestic relations order, as defined in Code section 414(p), are
distributees with regard to the interest of the spouse or former spouse.

 

B.                                     An
eligible rollover distribution is any distribution of all or any portion of the
balance to the credit of the distributee, except that an eligible rollover
distribution does not

 

4

 

include (i)
any distribution that is one of a series of substantially equal periodic
payments (not less frequently than annually) made for the life (or life
expectancy) of the distributee or the joint lives (or joint and last survivor
expectancies) of the distributee and the distributee’s designated beneficiary,
or for a specified period of ten years or more; (ii) any distribution to the
extent such distribution is required under Code section 401(a)(9); (iii) the
portion of any distribution that is not includible in gross income (determined
without regard to the exclusion for net unrealized appreciation with respect to
employer securities); (iv) any hardship distribution described in Code section
403(b)(11) or 403(b)(7)(A)(ii) made to your after 1998; and (v) any other
amounts designated in published federal income tax guidance.

 

C.                                     An
eligible retirement plan is an annuity described in Code section 403(b), an
individual retirement account described in Code section 408(a), or an
individual retirement annuity described in Code section 408(b) that accepts the
distributee’s eligible rollover distribution. However, in the case of an
eligible rollover distribution to the surviving spouse, an eligible retirement
plan is an individual retirement account or individual retirement annuity.

 

D.                                    A
direct rollover is a payment by us to the eligible retirement plan specified by
the distributee. All eligible rollover distributions shall be made in accordance
with the requirements of Code sections 403(b)(8), 403(b)(10), and 401(a)(31)
applicable to tax sheltered annuity contracts.

 

E.                                      Except
as otherwise provided under applicable federal tax law, the following
provisions shall apply to distributions after December 31, 2001, for purposes
of this section 13.

 

(i)            An eligible retirement
plan also shall mean an annuity plan described in Code section 403(a), a
qualified plan described in Code section 401(a), and an eligible plan under
Code section 457(b) which is maintained by a state, political subdivision of a
state, or any agency or instrumentality of a state or political subdivision of
a state and which agrees to separately account for amounts transferred into
such plan from this Contract. The definition of eligible retirement plan also
shall apply in the case of a distribution to a surviving spouse, or to a spouse
or former spouse who is the alternate payee under a qualified domestic
relations order.

 

(ii)           Any amount that is
distributed on account of hardship shall not be an eligible rollover
distribution, and the distributee may not elect to have any portion of such a
distribution paid directly to an eligible retirement plan.

 

(iii)          To the extent permitted
by federal tax law, a portion of a distribution shall not fail to be an
eligible rollover distribution merely because the portion consists of after-tax
employee contributions that are not includible in gross income. However, such
after-tax portion may be transferred only to an eligible retirement plan that
is permitted by law to accept such contributions. If required by law, the
receiving plan must agree to separately account for amounts so transferred,
including separately accounting for the portion of the distribution which is
includible in gross income and the portion of the distribution which is not so
includible.

 

5

 

14.          CODE SECTION 72(s)

 

All references in the Contract
to Code section 72(s) are deleted.

 

15.          AMENDMENT OF THIS ENDORSEMENT

 

The
Company reserves the right, and the Owner agrees the Company shall have such
right, to make any amendments to this Endorsement from time to time as may be
necessary to comply with the Code, as amended, and the regulations thereunder. We
will obtain all necessary approvals including, where required, that of the
Owner and will send you a copy of the endorsement that modifies your Contract. We
will not be responsible for any adverse tax consequences resulting from the
rejection of such an amendment.

 

16.          GROUP CONTRACT

 

If this Endorsement is used
with a certificate issued under a group contract, the term “Owner” refers to
the Participant/Annuitant and the term “Contract” refers to your Certificate.

 

Signed for the Company as of
the Effective Date.

 

Protective Life and Annuity Insurance
Company

	
  

  	
   

  
	
  Deborah J. Long

  	
   

  
	
  Secretary

  	
   

  

 

6

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00134-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00134-of-00352.parquet"}]]