Sec Form N3 - Registration Statement Under The Securities Act Of 1933 And/or Registration Statement Under The Investment Company Act Of 1940 Page 13
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54(ii) the date and form of organization of the Insurance Company and the name of the state or other jurisdiction under whose
laws it is organized; and
(iii) if the Insurance Company is controlled by another person, the name of that person and the general nature of its business (If
the Insurance Company is subject to more than one level of control, simply give the name of the ultimate control person.).
(b) Briefly describe the Registrant, including:
(i) the date and form of organization of the Registrant and the Registrant’s classification pursuant to Section 4 of the 1940 Act
[15 U.S.C. 80a-4] (i.e., a separate account and an open-end investment company);
(ii) the subclassification of the Registrant pursuant to Section 5(b) of the 1940 Act [15 U.S.C. 80a-5(b)];
(iii) a statement indicating:
(A) that income, gains, and losses, whether or not realized, from assets allocated to the Registrant are, in accordance with
the applicable variable annuity contracts, credited to or charged against the Registrant without regard to other income,
gains, or losses of the Insurance Company;
(B) that the assets of the Registrant may not be charged with liabilities arising out of any other business of the Insurance
Company, and
(C) whether the obligations arising under the variable annuity contracts are obligations of the Insurance Company.
(iv) whether there are sub-accounts of the Registrant (i.e., for qualified and non-qualified contracts or for different portfolios of
the Registrant); and
(v) if 10 percent or more of the assets of any sub-account are attributable to one variable annuity contract, the name and
address of the contractowner of, and the percentage of assets attributable to, the variable annuity contract.
Instruction
Sub-accounts that fund obligations of the Registrant under contracts that are not offered by means of this prospectus need not be
described.
(c) Concisely describe the investment objectives and policies of the Registrant, including:
(i) whether those objectives may be changed without the approval of a majority of votes;
(ii) how the Registrant proposes to achieve its objectives including:
(A) the types of securities in which Registrant invests or will invest principally and any special investment practices or
techniques that will be used and
(B) the identity of any particular industry or group of industries in which the Registrant proposes to concentrate.
(Concentration, for purposes of this Item, is deemed to be investment of 25% or more of the value of Registrant’s
total assets in a particular industry or group of industries. The policy on concentration should not be inconsistent with
Registrant’s name.);
(iii) subject to subparagraph (d) of this Item, the identity of other policies of Registrant that may be changed only with the
approval of a majority of votes, including those policies which Registrant deems to be fundamental within the meaning of
Section 8(b) of the 1940 Act; and
(iv) subject to subparagraph (d) of this Item, the significant investment policies or techniques (such as risk arbitrage,
repurchase agreements, forward delivery contracts, investing for control or management) that are not described pursuant to
subparagraphs (ii) or (iii) above that Registrant employs or intends to employ in the foreseeable future.
(d) Discussion of types of investments that will not be Registrant’s principal portfolio emphasis, and of related policies or practices,
should generally receive less emphasis in the prospectus, and under the circumstances set forth below may be omitted or limited to
information necessary to identify the type of investment, policy, or practice. Specifically,
(i) do not disclose a policy which prohibits a particular practice, or one which permits a particular practice but which the
Registrant has not used within the past year and does not intend to use in the foreseeable future, and
(ii) if a policy limits a particular practice so that no more than 5% of Registrant’s net assets are at risk, or if Registrant has not
followed that practice within the last year, and does not intend to follow such practice in the foreseeable future, simply
identify the practice.
(e) Discuss briefly the principal risk factors associated with investment in Registrant, including factors peculiar to the types of
portfolio securities in which it invests or intends to invest, as well as those factors generally associated with investment in a
company with investment policies and objectives similar to Registrant’s.
(f) State that a description of the Registrant’s policies and procedures with respect to the disclosure of the Registrant’s portfolio
securities is available (A) in the Registrant’s Statement of Additional Information; and (B) on the Registrant’s website, if
applicable.
8
SEC 2124 (5/15)
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