HomeMy WebLinkAboutResolution - 065 - Master Application - Aetna VALI Company - Deferred Compensation Plan - 02/08/1979RESO #65 (2/8/79)
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G f RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
7 directed to execute for and on behalf of the City of Lubbock a Master Application
i to AETNA VARIABLE ANNUITY LIFE INSURANCE COMPANY for''a Group Contract with the
6� CITY OF LUBBOCK for the Deferred Compensation Plan, attached herewith which
shall be spread upon the minutes of the Council and as spread upon the minutes
of this Council shall constitute and be a part of this Resolution as if fully
copied herein in detail.
Passed by the City Council this 8th day of February ,1979.
ST, MAYOR
ATTEST:
Evelyn Gaf ga, City S r -Treasurer
APPROVED AS TO FORM:
hn C. Ross, Jr., City Attorney
APPROVED AS TO CONTENT:
terling Miller, Director of Finance Administration
MASTER APPLICATION
' to AEtna Variable Annuity Life Insurance Company.
For Group Contract
t�
1. Applicant (give exact legal name): QJJ7 of 16bback .
Address: 916 TexasLubbock Texas ZgLl�l
2. Employer:
City of Lubbock (street) (city) (state) (zip code)
Address: Same
(street) (city) (state) (zip code)
Tax Identification Number: - 75-6=59O
3. Exact Name of Pian, it any City of Lubbock Deferred Compensation Plan
4. Section (if any) of internal Revenue Code under which plan Is to qualify
(complete one block only):
4A - Section 401 Type of Contract:
❑ Corporation ❑ Unallocated
❑ Self-employed, HR -10 - 0. Allocated
❑ Allocated with minimum death benefit
Ownership will be vested in applicant, unless stated otherwise in Item 8 or on the Individual Application.
4B — Section 403 (b)
❑ Public -School System
❑ Other:
Ownership will be vested In applicant, but participants will at all times have 100% vested interest in their own
Individual account.
40 — Non -Qualified Type of Contract:
❑ Deferred Compensation Group Variable Fund (Account E)
Ownership must be vested in employer. 17 Group Unit Purchase
5. Percent (in multiples of 10) of employer contributions (if any) to be allocated to:
❑ A. Etna Variable Fund
Mna Variable Encore Fund
General (Fixed) Account
Other.
❑ B. Per individual application or allocation form.
6. Contract to be effective on September 1 1978
7. Is the contract for which -you are applying Intended to replace any existing insurance or annuity contracts or mutual
funds investments? if "yes" give amount, pian, name of company and date of termination:
Ne.
8. Special Requests: None
Corrections and amendments. (Home Office Use Only). (Errors and omissions may be corrected by the Company,
except that no change in plan, classification, amount or extra benefits shalt be made without written agreement of
the undersigned.) -
I understand that annuity payments and termination values (if any), provided by the contract being applied for, when
based on investment experience of a separate account, are variable and are not guaranteed as to fixed dollar amount.
Lubb k Texas 8th February_
Da at ' this day of 19 79
(city and state) C I OF LU 0 JK, ex
EV
Evelyn Gaf ga, CityISe retest West, Mayor
Agent's Note
Do you know or have reason to beli�eve,�at any existing insurance or annuities will be replaced or. modified If this con-
tract Is Issued? ❑ Yes 0
Signature of SolicitingPent ent o
300-GMV-GG PRINTED'IN U.SA. CAT 164874
AGENT'S REPORT
t
Affix Prospectus Receipt Here*
No Text
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