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ING Life
Insurance and Annuity Company
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[Windsor,
Connecticut]
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[Customer
Service Center
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Important terms
and definitions used in this
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P.O. Box
10450
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Contract appear
on page 4.
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909 Locust
Street
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Des Moines,
Iowa 50306-0450]
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[1-888-854-5950]
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Product
Name
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Contract
Number
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[ING Secure
Guarantee]
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[R123456]
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Annuitant(s)
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Age of
Annuitant(s)
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Sex of
Annuitant(s)
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[Thomas J.
Doe]
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[55]
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[Male]
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Owner/Joint
Owner
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Age of
Owner/Joint Owner
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Residence
State
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[John Q.
Doe]
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[35]
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[Connecticut]
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Contract
Date
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Issue
State
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[July 1,
2009]
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[Connecticut]
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Single
Premium
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[$10,000.00]
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Initial
Guarantee Period
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Initial
Guarantee Period Interest Rate
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[10
years]
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[4.0%]
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Annuity
Commencement Date
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Annuity
Plan
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[July 1,
2039]
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[Payments for
Life with 10 Year Period Certain]
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Separate
Account
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[GAA Separate
Account]
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SINGLE PREMIUM
DEFERRED MODIFIED GUARANTEED 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.
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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 ten 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 the Accumulation Value, adjusted for any
Market Value Adjustment,
which may be
more or less than the Single Premium paid. 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.
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