-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, NwGoiJ/Pp7Y8dJg//nSAWu/w3TooeV0N6+rxlN5v8dCF5+4CE2RYOiUY8aMbrWgy Oem10+JMp9PotyivS3JTig== 0000771726-98-000178.txt : 19990101 0000771726-98-000178.hdr.sgml : 19990101 ACCESSION NUMBER: 0000771726-98-000178 CONFORMED SUBMISSION TYPE: 485BPOS PUBLIC DOCUMENT COUNT: 4 FILED AS OF DATE: 19981231 EFFECTIVENESS DATE: 19981231 FILER: COMPANY DATA: COMPANY CONFORMED NAME: SEPARATE ACCOUNT A OF EQUITABLE LIFE ASSU SOC OF THE US CENTRAL INDEX KEY: 0000089024 STANDARD INDUSTRIAL CLASSIFICATION: [] IRS NUMBER: 135570651 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 485BPOS SEC ACT: SEC FILE NUMBER: 002-30070 FILM NUMBER: 98779439 FILING VALUES: FORM TYPE: 485BPOS SEC ACT: SEC FILE NUMBER: 811-01705 FILM NUMBER: 98779440 BUSINESS ADDRESS: STREET 1: 1290 AVE OF THE AMERICAS CITY: NEW YORK STATE: NY ZIP: 10104 BUSINESS PHONE: 2126416277 MAIL ADDRESS: STREET 1: 1290 AVE OF THE AMERICAS CITY: NEW YORK STATE: NY ZIP: 10104 FORMER COMPANY: FORMER CONFORMED NAME: SEPARATE ACCOUNT A OF THE EQUITABLE LIFE ASSU SOC OF THE US DATE OF NAME CHANGE: 19920703 485BPOS 1 EQUI-VEST POST EFFECTIVE AMENDMENT Registration No. 2-30070 Registration No. 811-1705 - ------------------------------------------------------------------------------- SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 ----------------------------------- FORM N-4 REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933 | | Pre-Effective Amendment No. | | ---- |X| Post-Effective Amendment No. 63 ---- AND/OR REGISTRATION STATEMENT UNDER THE INVESTMENT COMPANY ACT OF 1940 | | |X| Amendment No. 65 ---- (Check appropriate box or boxes) -------------------------------- SEPARATE ACCOUNT A of THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES (Exact Name of Registrant) -------------------------- THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES (Name of Depositor) 1290 Avenue of the Americas, New York, New York 10104 (Address of Depositor's Principal Executive Offices) Depositor's Telephone Number, including Area Code: (212) 554-1234 ---------------------------- MARY P. BREEN VICE PRESIDENT AND ASSOCIATE GENERAL COUNSEL The Equitable Life Assurance Society of the United States 1290 Avenue of the Americas, New York, New York 10104 (Names and Addresses of Agents for Service) -------------------------------- Please send copies of all communications to: PETER E. PANARITES, ESQ. Freedman, Levy, Kroll & Simonds 1050 Connecticut Avenue, N.W., Suite 825 Washington, D.C. 20036 --------------------------------- Approximate Date of Proposed Public Offering: Continuous It is proposed that this filing will become effective (check appropriate box): |X| Immediately upon filing pursuant to paragraph (b) of Rule 485. | | On (date) pursuant to paragraph (b) of Rule 485. | | 60 days after filing pursuant to paragraph (a)(1) of Rule 485. | | On (date) pursuant to paragraph (a)(1) of Rule 485. | | 75 days after filing pursuant to paragraph (a)(2) of Rule 485. | | On (date) pursuant to paragraph (a)(3) of Rule 485. If appropriate, check the following box: | | This post-effective amendment designates a new effective date for previously filed post-effective amendment. --------------------------------- Title of Securities Being Registered: Units of interest in Separate Account under variable annuity contracts. NOTE This Post Effective Amendment No. 63 ("PEA") to the Form N-4 Registration Statement No. 2-30070 ("Registration Statement") of The Equitable Life Assurance Society of the United States ("Equitable Life") and its Separate Account A is being filed solely for the purpose of filing a Supplement to Equitable Life's EQUI-VEST Prospectus dated May 1, 1998, and certain related exhibits. The supplement describes Iowa/Enhanced EDC contracts to be offered only in Iowa to fund certain Internal Revenue Code Section 457 plans. The PEA does not amend or delete the EQUI-VEST Prospectus or Statement of Additional Information, dated May 1, 1998, any other supplement thereto, or any other part of the Registration Statement except as specifically noted herein. THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES SUPPLEMENT DATED JANUARY 30, 1999 TO EQUI-VEST(R) PROSPECTUS DATED MAY 1, 1998 EQUI-VEST(R) EDC CONTRACTS (SERIES 100 AND SERIES 200) OFFERED TO CERTAIN EMPLOYEES OF STATE AND MUNICIPAL GOVERNMENTS WITHIN THE STATE OF IOWA This Supplement adds to and modifies certain information contained in the prospectus dated May 1, 1998 (PROSPECTUS) for EQUI-VEST(R) PERSONAL RETIREMENT PROGRAMS AND EMPLOYER-SPONSORED RETIREMENT PROGRAMS offered by Equitable Life. Equitable Life will offer EQUI-VEST(R) EDC, as described below (IOWA/ENHANCED EDC CONTRACTS), to fund plans that meet the requirements of Internal Revenue Code Section 457 ("Section 457 Plans") sponsored by certain state and municipal governments described in Section 457 of the Code, within the State of Iowa (EMPLOYER). Iowa/Enhanced EDC Contracts will be available only when an Employer (i) makes contributions to a Section 457 Plan, whether in addition to, or instead of, employee salary reduction or elective deferred contributions, as applicable, (ii) has entered into an agreement with Equitable Life that permits Equitable Life to offer Iowa/Enhanced EDC Contracts as a funding vehicle for your Employer's Section 457 Plan; and (iii) has greater than $50 million in plan assets for all Iowa/Enhanced EDC Contracts within the state of Iowa. Capitalized terms not otherwise defined in this Supplement have the same meaning as in the Prospectus. Page references are to pages in the Prospectus. Employees of an Employer may participate under an Iowa/Enhanced EDC Contract on the same basis and under the same terms and conditions described in the Prospectus as applicable to EQUI-VEST(R) EDC Contracts, except for certain material differences described in this Supplement. Participation under Iowa/Enhanced EDC Contracts, will be available to (i) Annuitants, within the state of Iowa, participating under EQUI-VEST EDC Contracts purchased prior to the date of this Supplement and (ii) any Annuitant participating under an Iowa/Enhanced EDC Contract purchased as of or after the date of this Supplement. "PART 1: SUMMARY" OF THE PROSPECTUS HAS BEEN MODIFIED AS FOLLOWS: ANNUAL ADMINISTRATIVE CHARGE. The Annual Administrative Charge is waived and does not apply to Iowa/Enhanced EDC Contracts. FEE TABLES. For Iowa/Enhanced EDC Contracts, the following fee tables replace Table 1: EQUI-VEST Series 100 and Table 2: EQUI-VEST Series 200 fee tables at pages 13, 14, and 15. You should refer to the fee tables in "Part I: SUMMARY" of the Prospectus for all other applicable expenses related to EQUI-VEST Series 100 and Series 200 Contracts. Please also see the discussion of the modifications to "Part 7: DEDUCTIONS AND CHARGES" set forth in this Supplement. FOR USE ONLY IN THE STATE OF IOWA TABLE 1: EQUI-VEST SERIES 100
- ----------------------------------------------------------------------------------------------------------------------------------- ALLIANCE ALLIANCE INTERMEDIATE ALLIANCE ALLIANCE ALLIANCE ALLIANCE MONEY GOVERNMENT QUALITY HIGH GROWTH & EQUITY MARKET SECURITIES BOND YIELD INCOME INDEX -------------------------------------------------------------------------------------- Separate Account Annual Expenses (4) Mortality and Expense Risk Fees .65% .65% .65% .65% .65% .65% Other Expenses .25% .25% .25% .25% .25% .25% - ------------------------------------------------------------------------------------------------------- --------------------------- Total Separate Account Annual Expenses .90% .90% .90% .90% .90% .90% HRT Annual Expenses (4) Investment Advisory Fees .35% .50% .53% .60% .55% .32% Rule 12b-1 Fees (7) .25% .25% .25% .25% .25% .25% Other Expenses. .04% .06% .05% .04% .04% .04% - ----------------------------------------------------------------------------------------------------------------------------------- Total HRT Annual Expenses (5)(6) .64% .81% .83% .89% .84% .61% - ----------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- TABLE 1: EQUI-VEST SERIES 100 - ---------------------------------------------------------------------------------------------------------------------------------- ALLIANCE ALLIANCE ALLIANCE ALLIANCE ALLIANCE CONSER- ALLIANCE COMMON ALLIANCE INTER- AGGRESSIVE SMALL CAP VATIVE ALLIANCE GROWTH STOCK GLOBAL NATIONAL STOCK GROWTH INVESTORS BALANCED INVESTORS ---------------------------------------------------------------------------------------------------- Separate Account Annual Expenses (4) Mortality and Expense Risk Fees .65% .65% .65% .65% .65% .65% .65% .65% Other Expenses .25% .25% .25% .25% .25% .25% .25% .25% - ---------------------------------------------------------------------------------------------------------------------------------- Total Separate Account Annual Expenses .90% .90% .90% .90% .90% .90% .90% .90% HRT Annual Expenses (4) Investment Advisory Fees .37% .65% .90% .54% .90% .48% .42% .52% Rule 12b-1 Fees (7) .25% .25% .25% .25% .25% .25% .25% .25% Other Expenses .03% .08% .18% .03% .05% .07% .05% .05% - ---------------------------------------------------------------------------------------------------------------------------------- Total HRT Annual Expenses (5)(6) .65% .98% 1.33% .82% 1.20% .80% .72% .82% ====================================================================================================================================
FOR USE ONLY IN THE STATE OF IOWA 2 TABLE 1: EQUI-VEST SERIES 100 (CONTINUED)
- ---------------------------------------------------------------------------------------------------------------------------------- T. ROWE T. ROWE PRICE PRICE EQ/PUTNAM INTERNATIONAL EQUITY GROWTH & EQ/PUTNAM MFS STOCK INCOME INCOME VALUE BALANCED RESEARCH PORTFOLIO PORTFOLIO PORTFOLIO PORTFOLIO PORTFOLIO -------------------------------------------------------------------------------------- Separate Account Annual Expenses Mortality and Expense Risk Fees .65% .65% .65% .65% .65% Other Expenses .25% .25% .25% .25% .25% - ----------------------------------------------------------------------------------------------------------------------------------- Total Separate Account Annual Expenses .90% .90% .90% .90% .90% EQAT Annual Expenses Investment Management and Advisory Fees .75% .55% .55% .55% .55% Rule 12b-1 Fees .25% .25% .25% .25% .25% Other Expenses .20% .05% .05% .10% .05% - ----------------------------------------------------------------------------------------------------------------------------------- Total EQAT Annual Expenses 1.20% .85% .85% .90% .85% - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- TABLE 1: EQUI-VEST SERIES 100 - ----------------------------------------------------------------------------------------------------------------------------------- MORGAN MFS STANLEY EMERGING EMERGING WARBURG PINCUS MERRILL LYNCH GROWTH MARKETS SMALL COMPANY MERRILL LYNCH BASIC VALUE COMPANIES EQUITY VALUE WORLD STRATEGY EQUITY PORTFOLIO PORTFOLIO PORTFOLIO PORTFOLIO PORTFOLIO -------------------------------------------------------------------------------------- Separate Account Annual Expenses Mortality and Expense Risk Fees .65% .65% .65% .65% .65% Other Expenses .25% .25% .25% .25% .25% - ------------------------------------------------------------------------------------------------------------------------------------ Total Separate Account Annual Expenses .90% .90% .90% .90% .90% EQAT Annual Expenses Investment Management and Advisory Fees .55% 1.15% .65% .70% .55% Rule 12b-1 Fees (7) .25% .25% .25% .25% .25% Other Expenses .05% .35% .10% .25% .05% - ------------------------------------------------------------------------------------------------------------------------------------ Total EQAT Annual Expenses .85% 1.75% 1.00% 1.20% .85% - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------
FOR USE ONLY IN THE STATE OF IOWA 3 TABLE 2: EQUI-VEST SERIES 200
- ----------------------------------------------------------------------------------------------------------------------------------- ALLIANCE ALLIANCE INTERMEDIATE ALLIANCE ALLIANCE ALLIANCE ALLIANCE MONEY GOVERNMENT QUALITY HIGH GROWTH & EQUITY MARKET SECURITIES BOND YIELD INCOME INDEX -------------------------------------------------------------------------------------- Separate Account Annual Expenses (4) Mortality and Expense Risk Fees .65% .65% .65% .65% .65% .65% Other Expenses .25% .25% .25% .25% .25% .25% - ----------------------------------------------------------------------------------------------------------------------------------- Total Separate Account Annual Expenses .90% .90% .90% .90% .90% .90% HRT Annual Expenses Investment Advisory Fees .35% .50% .53% .60% .55% .32% Rule 12b-1 Fees .25% .25% .25% .25% .25% .25% Other Expenses. .04% .06% .05% .04% .04% .04% - ----------------------------------------------------------------------------------------------------------------------------------- Total HRT Annual Expenses(5)(6) .64% .81% .83% .89% .84% .61% - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- TABLE 2: EQUI-VEST SERIES 200 - ----------------------------------------------------------------------------------------------------------------------------------- ALLIANCE ALLIANCE ALLIANCE ALLIANCE ALLIANCE CONSER- ALLIANCE COMMON ALLIANCE INTER- AGGRESSIVE SMALL CAP VATIVE ALLIANCE GROWTH STOCK GLOBAL NATIONAL STOCK GROWTH INVESTORS BALANCED INVESTORS ---------------------------------------------------------------------------------------------------- Separate Account Annual Expenses Mortality and Expense Risk Fees .65% .65% .65% .65% .65% .65% .65% .65% Other Expenses .25% .25% .25% .25% .25% .25% .25% .25% - ---------------------------------------------------------------------------------------------------------------------------------- Total Separate Account Annual Expenses .90% .90% .90% .90% .90% .90% .90% .90% HRT Annual Expenses (4) Investment Advisory Fees .37% .65% .90% .54% .90% .48% .42% .52% Rule 12b-1 Fees (7) .25% .25% .25% .25% .25% .25% .25% .25% Other Expenses .03% .08% .18% .03% .05% .07% .05% .05% - ---------------------------------------------------------------------------------------------------------------------------------- Total HRT Annual Expenses(5)(6) .65% .98% 1.33% .82% 1.20% .80% .72% .82% - ---------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------
FOR USE ONLY IN THE STATE OF IOWA 4 TABLE 2: EQUI-VEST SERIES 200 (CONTINUED)
- ------------------------------------------------------------------------------------------------------------------------------ T. ROWE T. ROWE PRICE PRICE EQ/PUTNAM INTERNATIONAL EQUITY GROWTH & EQ/PUTNAM MFS STOCK INCOME INCOME VALUE BALANCED RESEARCH PORTFOLIO PORTFOLIO PORTFOLIO PORTFOLIO PORTFOLIO --------------------------------------------------------------------------------- Separate Account Annual Expenses Mortality and Expense Risk Fees .65% .65% .65% .65% .65% Other Expenses .25% .25% .25% .25% .25% - ------------------------------------------------------------------------------------------------------------------------------ Total Separate Account Annual Expenses .90% .90% .90% .90% .90% EQAT Annual Expenses Investment Management and Advisory Fees .75% .55% .55% .55% .55% Rule 12b-1 Fees .25% .25% .25% .25% .25% Other Expenses .20% .05% .05% .10% .05% - ----------------------------------------------------------------------------------------------------------------------------- Total EQAT Annual Expenses 1.20% .85% .85% .90% .85% - ----------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- TABLE 2: EQUI-VEST SERIES 200 - ----------------------------------------------------------------------------------------------------------------------------- MORGAN MFS sSTANLEY EMERGING EMERGING WARBURG PINCUS MERRILL LYNCH GROWTH MARKETS SMALL COMPANY MERRILL LYNCH BASIC VALUE COMPANIES EQUITY VALUE WORLD STRATEGY EQUITY PORTFOLIO PORTFOLIO PORTFOLIO PORTFOLIO PORTFOLIO -------------------------------------------------------------------------------- Separate Account Annual Expenses Mortality and Expense Risk Fees .65% .65% .65% .65% .65% Other Expenses .25% .25% .25% .25% .25% - ----------------------------------------------------------------------------------------------------------------------------- Total Separate Account Annual Expenses .90% .90% .90% .90% .90% EQAT Annual Expenses Investment Management and Advisory Fees .55% 1.15% .65% .70% .55% Rule 12b-1 Fees .25% .25% .25% .25% .25% Other Expenses .05% .35% .10% .25% .05% - ----------------------------------------------------------------------------------------------------------------------------- Total EQAT Annual Expenses .85% 1.75% 1.00% 1.20% .85% - ----------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------
- ------------- At page 16, Note 3 of the Fee Table is not applicable to Iowa/Enhanced EDC Contracts. As to certain limitations on charges, see "Limitations on Charges" under the discussion below of the modifications to "Part 7: DEDUCTIONS AND CHARGES." Also, at page 16, Note 7 is revised as follows: (7) The respective Class IB shares of HRT and EQAT are subject to fees imposed under distribution plans (the "Rule 12b-1 Plans") adopted by HRT and EQAT pursuant to Rule 12b-1 under the Investment Company Act of 1940, as amended. The Rule 12b-1 Plans provide that HRT and EQAT, on behalf of each of their Portfolios may charge annually up to 0.25% of the average daily net assets of a Portfolio attributable to its Class IB shares in respect of activities primarily intended to result in the sale of the Class IB shares. The 12b-1 fees will not be increased for the life of the Iowa/Enhanced EDC Contracts. FOR USE ONLY IN THE STATE OF IOWA 5 "PART 7: DEDUCTIONS AND CHARGES" OF THE PROSPECTUS HAS BEEN MODIFIED AS FOLLOWS: CHARGES TO PORTFOLIOS. The following paragraph is added to "Charges to Portfolios" at page 55, after the HRT Portfolio investment advisory fee table: The Rule 12b-1 Plan adopted with respect to HRT's Class IB shares provides that HRT, on behalf of each Portfolio, may charge annually up to 0.25% of the average daily net assets of a Portfolio attributable to its Class IB shares in respect of activities primarily intended to result in the sale of the Class IB shares. This fee will not be increased for the life of the Iowa/Enhanced EDC Contracts. Fees and expenses are described more fully in the HRT prospectus. LIMITATION ON CHARGES. At page 59, the discussion under "Limitation on Charges" is applicable to Iowa/Enhanced EDC Contracts attributable to EQUI-VEST EDC Contracts issued to fund Section 457 Plans prior to the date of this Supplement. The discussion, however, does not apply to Iowa/Enhanced EDC Conatracts issued on and after the date of this Supplement. CHARGES TO INVESTMENT FUNDS. At page 59, the discussion under "Charges to Investment Funds" through the Series 200 table of specific charges is replaced by the following: We make a daily charge (after any deductions to provide for taxes) against the assets held in each of the Investment Funds under an Iowa/Enhanced EDC Contract. This charge is reflected in the Accumulation Unit Values and made at an annual rate not to exceed 0.90% for each of the Investment Funds. The charge is for financial accounting, death benefits, mortality risk, expenses and expense risk. The specific changes for Series 100 and 200 Iowa/Enhanced EDC Contracts are: expenses and financial accounting - 0.25%; expense risks - 0.30%; and mortality risks and death benefits - 0.35%. ANNUAL ADMINISTRATIVE CHARGE. The Annual Administrative Charge, discussed at page 60, under Iowa/Enhanced EDC Contracts is waived. CONTINGENT WITHDRAWAL CHARGE. At page 61, the following will apply to withdrawals under Iowa/Enhanced EDC Contracts, in addition to the exceptions to the withdrawal charge discussed under the section entitled "No charge will be applied to any amount withdrawn from an IRA, Roth IRA, QP IRA, SEP, SIMPLE IRA, TSA, EDC or Annuitant-Owned HR-10 (except for NQ and Trusteed Contracts) if:" o the Annuitant retires pursuant to terms of the Section 457 plan, or separates from service; o the Annuitant has qualified to receive Social Security disability benefits as certified by the Social Security Administration; o we receive proof satisfactory to us that the Annuitant's life expectancy is six months or less (such proof must include, but is not limited to, certification by a licensed physician); o the Annuitant elects a withdrawal that qualifies as a hardship withdrawal under the Code; o the Annuitant has been confined to a nursing home for more than a 90-day period (or such other period, if required in Iowa as verified by a licensed physician. A nursing home for this purpose means one which is (a) approved by Medicare as a provider of skilled nursing care service, or (b) licensed as a skilled nursing home by the state or territory in which it is located (it must be within the United States, Puerto Rico, U.S. Virgin Islands, or Guam) and meets all of the following: o its main function is to provide skilled, intermediate or custodial nursing care; o it provides continuous room and board to three or more persons; o it is supervised by a registered nurse or practical nurse; o it keeps daily medical records of each patient; o it controls and records all medications dispensed; and o its primary service is other than to provide housing for residents. FOR USE ONLY IN THE STATE OF IOWA 6 PART C OTHER INFORMATION ----------------- This Part C is amended solely for the purpose of filing the exhibits noted below. No amendment or deletion is made of any of the other information set forth under Part C of the Registration Statement. Item 24. Financial Statements and Exhibits ---------------------------------- (b) Exhibits. The following additional exhibits are filed herewith: 4. (j) Forms of Rider Nos. PF10933-IA (for use with Contract No. 11936-P (see Exhibit 4.(a)), 98EDCB-IA and (Form No. Pending) (for use with Contract No. 92EDCB (see Exhibit 4.(d)), in connection with Iowa EDC. 5. (c) Form of EQUI-VEST Application No. 180-1009 for use with Iowa EDC. 10. (c) Consent of PricewaterhouseCoopers LLP. C-1 SIGNATURES As required by the Securities Act of 1933 and the Investment Company Act of 1940, the Registrant certifies that it meets the requirements of Securities Act Rule 485(b) for the effectiveness of this amendment to the Registration Statement and has duly caused this amendment to the Registration Statement to be signed on its behalf, in the City and State of New York, on the 31st day of December, 1998. SEPARATE ACCOUNT A OF THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES (Registrant) By: The Equitable Life Assurance Society of the United States By: /s/ Naomi Weinstein ------------------------- Naomi Weinstein Vice President The Equitable Life Assurance Society of the United States C-2 SIGNATURES As required by the Securities Act of 1933 and the Investment Company Act of 1940, the Depositor has duly caused this Registration Statement or amendment thereto to be signed on its behalf, in the City and State of New York, on the 31st day of December, 1998. THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES (Depositor) By: /s/ Naomi Weinstein ------------------------ Naomi Weintein Vice President The Equitable Life Assurance Society of the United States As required by the Securities Act of 1933, this amendment to the Registration Statement or amendment thereto has been signed by the following persons in the capacities and on the date indicated: PRINCIPAL EXECUTIVE OFFICERS: Edward D. Miller Chairman of the Board, Chief Executive Officer and Director Michael Hegarty President, Chief Operating Officer and Director PRINCIPAL FINANCIAL OFFICER: Stanley B. Tulin Vice Chairman of the Board, Chief Financial Officer and Director PRINCIPAL ACCOUNTING OFFICER: Senior Vice President and Controller /s/ Alvin H. Fenichel - --------------------- Alvin H. Fenichel December 31, 1998 DIRECTORS: Francoise Colloc'h Donald J. Greene George T. Lowy Henri de Castries John T. Hartley Edward D. Miller Joseph L. Dionne John H.F. Haskell, Jr. Didier Pineau-Valencienne Denis Duverne Michael Hegarty George J. Sella, Jr. William T. Esrey Mary R. (Nina) Henderson Stanley B. Tulin Jean-Rene Fourtou W. Edwin Jarmain Dave H. Williams Norman C. Francis G. Donald Johnston, Jr. By: /s/ Naomi Weinstein ------------------------- Naomi Weinstein Attorney-in-Fact December 31, 1998 C-3 EXHIBIT INDEX -------------- EXHIBIT NO. TAG VALUE - ----------- --------- 4(j) Forms of Riders Nos. PF10933-IA, 98EDCB-IA EX-99.4j and (Form No. Pending) 5(c) Form of Application No. 180-1009 EX-99.5c 10(c) Consent of PricewaterhouseCoopers LLP EX-99.10c C-4 EX-99.4J 2 FORMS OF RIDERS STATE OF IOWA RIDER TO CERTIFICATE 11936P: Effective immediately, your Certificate issued under Group Annuity Contract No. 11932CP is amended as follows: With respect to PART I - DEFINITIONS, SECTION 1.18 CASH VALUE, the following text is added after item (v) under the paragraph No Withdrawal Charge: (vi) the Participant retires pursuant to terms of the Plan, or separates from Service; (vii) the Participant has qualified to receive Social Security disability benefits as certified by the Social Security Administration; (viii) we receive proof satisfactory to us that the Participant's life expectancy is six months or less (such proof must include, but is not limited to, certification by a licensed physician). (ix) the Participant elects a withdrawal that qualifies as a hardship withdrawal under the Code. (x) the Participant has been confined to a nursing home for more than a 90 day period (or such other period, if required in your state) as verified by a licensed physician. A nursing home for this purpose means one which is (a) approved by Medicare as a provider of skilled nursing care service, or (b) licensed as a skilled nursing home by the state or territory in which it is located (it must be within the United States, Puerto Rico, U.S. Virgin Islands, or Guam) and meets all of the following: o its main function is to provide skilled, intermediate or custodial nursing care; o it provides continuous room and board to three or more persons; o it is supervised by a registered nurse or practical nurse; o it keeps daily medical records of each patient; o it controls and records all medications dispensed; and o its primary service is other than to provide housing for residents. FORM RIDER PF 17105P IS NO LONGER APPLICABLE. Your Certificate is amended as follows: PART II - PARTICIPANT'S ANNUITY ACCOUNT VALUE, SECTION 2.08 ANNUAL ADMINISTRATIVE CHARGE is replaced with the following: The Annual Administrative Charge is waived in all instances. PF10933-IA ITEM 1 (B) ON FORM RIDER PF 17214P is revised as follows: SECTION 1.15 ENTITLED "THE SEPARATE ACCOUNT" is amended by replacing the paragraph in Item 1(b) with the following: Assets of the Investment Divisions attributable to the Certificate issued under the Contract shall be subject to a daily charge (after any deductions to provide for applicable tax charges) for financial accounting, death benefits, mortality risk, expenses and expense risk which shall not exceed .90% per year for each of the Investment Divisions. The charge shall be made in accordance with Subsection (c) of the Net Investment Factor provision in Section 1.16. In addition to this daily charge, investment advisory fee charges and other charges of the Trust (or any other designated trust or investment company) shall apply to assets of the Investment Divisions. The relative proportion of these charges may be modified. With respect to the Alliance Stock, Alliance Money Market, Alliance Balanced, and Alliance Aggressive Stock Divisions only, such daily charge, plus the investment advisory fee charges and other charges of the Trust (or any other designated trust or investment company), shall not in the aggregate exceed a total annual rate of 1.75% of the value of the assets of such Investment Divisions attributable to the certificate. The 1.75% maximum does not apply to any Investment Division other than the Alliance Stock, Alliance Money Market, Alliance Balanced, and Alliance Aggressive Stock Divisions and will not apply to any Investment Divisions added in the future. Such maximum rate may not be altered without approval by the certificate Owner. /s/ Edward Miller /s/ Pauline Sherman - ----------------------- --------------------------------- Edward Miller Pauline Sherman Chairman and Chief Vice President, Secretary and Executive Officer Associate General Counsel PF10933-IA STATE OF IOWA RIDER TO CONTRACT 92EDCB Effective immediately, your Contract is amended as follows: With respect to PART I - DEFINITIONS, SECTION 1.05 CASH VALUE, the following text is added after item (vii): (viii) the Annuitant retires pursuant to terms of the Plan, or separates from Service; (ix) the Annuitant has qualified to receive Social Security disability benefits as certified by the Social Security Administration; (x) we receive proof satisfactory to us that the Annuitant's life expectancy is six months or less (such proof must include, but is not limited to, certification by a licensed physician); (xi) the Annuitant elects a withdrawal that qualifies as a hardship withdrawal under the Code; the Annuitant has been confined to a nursing home for more than a 90 day period (or such other period, if required in your state) as verified by a licensed physician. A nursing home for this purpose means one which is (a) approved by Medicare as a provider of skilled nursing care service, or (b) licensed as a skilled nursing home by the state or territory in which it is located (it must be within the United States, Puerto Rico, U.S. Virgin Islands, or Guam) and meets all of the following: o its main function is to provide skilled, intermediate or custodial nursing care; o it provides continuous room and board to three or more persons; o it is supervised by a registered nurse or practical nurse; o it keeps daily medical records of each patient; o it controls and records all medications dispensed; and o its primary service is other than to provide housing for residents. With respect to PART II - ANNUITY ACCOUNT VALUE, SECTION 2.10 ANNUAL ADMINISTRATIVE CHARGE is replaced with the following: The Annual Administrative Charge is waived in all instances. 98 EDCB-1A ITEM 1 (B) ON FORM RIDER NO. 93DIVEDC is revised as follows: SECTION 1.23 ENTITLED "THE SEPARATE ACCOUNT" is amended by replacing the paragraph in Item 1(b) with the following: Assets of the Investment Divisions attributable to this Contract shall be subject to a daily charge (after any deductions to provide for applicable tax charges) for financial accounting, death benefits, mortality risk, expenses and expense risk which shall not exceed .90% per year for each of the Investment Divisions. The charge shall be made in accordance with Subsection (c) of the Net Investment Factor provision in Section 1.24. In addition to this daily charge, investment advisory fee charges and other charges of the Trust (or any other designated trust or investment company) shall apply to assets of the Investment Divisions. The relative proportion of these charges may be modified. With respect to the Alliance Stock, Alliance Money Market, Alliance Balanced, and Alliance Aggressive Stock Divisions only, such daily charge, plus the investment advisory fee charges and other charges of the Trust, shall not exceed a total annual rate of 1.75% of the value of the assets of such Investment Divisions attributable to this Contract. The 1.75% maximum does not apply to any Investment Division other than the Alliance Stock, Alliance Money Market, Alliance Balanced, and Alliance Aggressive Stock Divisions and will not apply to any Investment Divisions added in the future. Such maximum rate may not be altered without your approval. /s/ Edward Miller /s/ Pauline Sherman - ----------------------- --------------------------------- Edward Miller Pauline Sherman Chairman and Chief Vice President, Secretary and Executive Officer Associate General Counsel 98EDCB-1A STATE OF IOWA RIDER TO CONTRACT 92EDCB Effective immediately, your Contract is amended as follows: ON THE COVER OF YOUR CONTRACT, the last two sentences of the last paragraph are replaced with the following: THE DAILY RATE OF INVESTMENT RETURN IS BEFORE DEDUCTION OF CHARGES. THESE CHARGES INCLUDE A DAILY CHARGE FOR FINANCIAL ACCOUNTING, DEATH BENEFITS, MORTALITY RISKS, EXPENSES AND EXPENSE RISK, PLUS THE INVESTMENT ADVISORY FEE CHARGES AND OTHER CHARGES OF THE TRUST. With respect to PART I - DEFINITIONS, SECTION 1.05 CASH VALUE, the following text is added after item (vii): (viii) the Annuitant retires pursuant to terms of the Plan, or separates from Service; (ix) the Annuitant has qualified to receive Social Security disability benefits as certified by the Social Security Administration; (x) we receive proof satisfactory to us that the Annuitant's life expectancy is six months or less (such proof must include, but is not limited to, certification by a licensed physician); (xi) the Annuitant elects a withdrawal that qualifies as a hardship withdrawal under the Code; the Annuitant has been confined to a nursing home for more than a 90 day period (or such other period, if required in your state) as verified by a licensed physician. A nursing home for this purpose means one which is (a) approved by Medicare as a provider of skilled nursing care service, or (b) licensed as a skilled nursing home by the state or territory in which it is located (it must be within the United States, Puerto Rico, U.S. Virgin Islands, or Guam) and meets all of the following: o its main function is to provide skilled, intermediate or custodial nursing care; o it provides continuous room and board to three or more persons; o it is supervised by a registered nurse or practical nurse; o it keeps daily medical records of each patient; o it controls and records all medications dispensed; and o its primary service is other than to provide housing for residents. With respect to PART II - ANNUITY ACCOUNT VALUE, SECTION 2.10 ANNUAL ADMINISTRATIVE CHARGE is replaced with the following: The Annual Administrative Charge is waived in all instances. Form No. Pending ITEM 1 (B) ON FORM RIDER NO. 93DIVEDC is revised as follows: SECTION 1.23 ENTITLED "THE SEPARATE ACCOUNT" is amended by replacing the paragraph in Item 1(b) with the following: Assets of the Investment Divisions attributable to this Contract shall be subject to a daily charge (after any deductions to provide for applicable tax charges) for financial accounting, death benefits, mortality risk, expenses and expense risk which shall not exceed .90% per year for each of the Investment Divisions. The charge shall be made in accordance with Subsection (c) of the Net Investment Factor provision in Section 1.24. In additions to this daily charge, investment advisory fee charges and other charges of the Trust (or any other designated trust or investment company) shall apply to assets of the Investment Divisions. The relative proportion of these charges may be modified. /s/ Edward Miller /s/ Pauline Sherman - ----------------------- --------------------------------- Edward Miller Pauline Sherman Chairman and Chief Vice President, Secretary and Executive Officer Associate General Counsel Form No. Pending EX-99.5C 3 FORM OF APPLICATION EQUI-VEST(R) TAX-DEFERRED VARIABLE ANNUITY INDIVIDUAL APPLICATION KIT (REPRESENTATIVE REPORT, APPLICATION INSTRUCTIONS, APPLICATION) PLEASE PRINT IN BLACK INK. - -------------------------------------------------------------------------------- EQUI-VEST REPRESENTATIVE REPORT A. |_| I (WE) CERTIFY THAT A PROSPECTUS FOR THE CONTRACT HAS BEEN GIVEN TO THE PROPOSED OWNER, AND THAT NO WRITTEN SALES MATERIALS OTHER THAN THOSE APPROVED BY EQUITABLE LIFE HAVE BEEN USED. B. WAS OR WILL AN EXISTING ANNUITY OR INSURANCE CERTIFICATE BE REPLACED, ASSUMING THE CONTRACT WILL BE ISSUED? |_| YES |_| NO C. COMPENSATION METHOD: ELECT ONE OF THE FOLLOWING FOR THIS APPLICATION ONLY. (IF THERE ARE MULTIPLE AGENTS ON THE CONTRACT, THIS ELECTION MUST BE THE SAME FOR ALL.) REFER TO AIG 98-15 IF YOU HAVE QUESTIONS. |_| I (WE) ELECT THE TRADITIONAL PREMIUM-BASED COMPENSATION METHOD WHICH PROVIDES FOR AN UP-FRONT PREMIUM-BASED COMPENSATION PAYMENT, PLUS PCs. OR |_| I (WE) ELECT THE VOLUNTARY TRADE-OFF COMPENSATION METHOD WHICH INCLUDES A REDUCED UP-FRONT PREMIUM-BASED COMPENSATION PAYMENT WITH PCs PLUS AN ANNUAL ASSET-BASED PAYMENT BEGINNING AFTER YEAR ONE (1) WITH PCs. (THE VOLUNTARY TRADE-OFF IS AVAILABLE ONLY FOR SERIES 300 AND 400 EQUI-VEST CONTRACTS IN THE IRA, QP IRA, ROTH IRA AND NQ MARKETS AND FOR SERIES 200 CONTRACTS (IN OREGON ONLY) IN THE NQ MARKET.) EQUI-VEST ISSUES MUST ADEQUATELY REFLECT THE COMMISSION INTEREST OF ALL REPRESENTATIVES ON PREVIOUS CONTRACTS.
--------------------------------------------------------------------------------------------------------------------------- PRINT LAST REPRESENTATIVE REPRESENTATIVE AGENCY DISTRICT REPRESENTATIVE REPRESENTATIVE(S) REPRESENTATIVE(S) NAME(S) NAME NUMBER % CODE MGR CODE INS. SIGNATURE(S) (SERVICE REPRESENTATIVE FIRST) INITIAL LICENSE* --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- *WHERE REQUIRED BY STATE REGULATIONS ---------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------- FOR EQUI-VEST ADMINISTRATION OFFICE USE REPRESENTATIVE(S) SHOWN ABOVE IS (ARE) EQUITY QUALIFIED AND LICENSED IN THE STATE IN WHICH THE REQUEST IS SIGNED. APPLICATION NO. _____________________________ EAD REC'D_______________________ - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- PROCESSING ________________ _______________ _________________ ______________ CONTRACT NUMBER BATCH NUMBER INQUIRY NUMBER PROCESSOR - -------------------------------------------------------------------------------- [EQUITABLE LOGO] THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES New York, New York 10019 EQUI-VEST(R) TAX-DEFERRED VARIABLE ANNUITY APPLICATION Application Number:__________________ (Page 1 of 5)
- -------------------------------------------------------------------------------------------------------------------- 1. EQUI-VEST PROGRAM (CHECK ONE) TAX-EXEMPT BUSINESS INDIVIDUAL A. |_| TSA PUBLIC SCHOOL E. |_| KEOGH I. |_| TRADITIONAL IRA B. |_| TSA 501(C)(3) (HR-10 Individual) J. ROTH IRA: |_| ADVANTAGE OR |_| STANDARD C. |_| TSA UNIVERSITY F. |_| SEP |_| Conversion Rollover from Traditional IRA D. |_| EDC G. |_| SARSEP |_| Direct Transfer or Rollover form another ROTH IRA H. |_| SIMPLE IRA |_| Recurring Contributory ROTH IRA K. |_| QP-IRA ((Pension Distributions) L. |_| UNIT-BILLED TRADITIONAL IRA M. |_| UNIT-BILLED ROTH IRA |_| Advantage |_| Standard N. |_| NQ (Non-Qualified Variable Annuity) O. |_| UNIT-BILLED NQ - --------------------------------------------------------------------------------------------------------------------
- -------------------------------------------------------------------------------- 2. EMPLOYER UNIT INFORMATION (COMPLETE FOR ALL PROGRAMS EXCEPT FOR I,J,K, AND N _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ CLIENT/EMPLOYER NAME (Select one) |_| _|_|_|_|_|_|_|_|_|_|_|_|_|__|_ or NEW UNIT |_| Must Com- EXISTING UNIT NUMBER LOCATION plete Plan Enrollment Kit) - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- 3. ANNUITANT INFORMATION (CHECK APPROPRIATE BOXES) |_| Mr. |_| Mrs. |_| Miss |_| Ms. |_|Other __________ |_| Male |_| Female _|_|_|_|_|_|_|_|_ SOCIAL SECURITY NO. (REQUIRED) _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ FIRST NAME MIDDLE INITIAL ONLY LAST NAME BIRTH _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_| DATE: YEAR MONTH DAY AGE AT NEAREST BIRTHDAY (_|_|_|_|_||_|_|_|_|_|_|_|_ |_| Home |_| Work AREA CODE DAYTIME PHONE NUMBER _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ STREET ADDRESS _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ CITY STATE ZIP - -------------------------------------------------------------------------------- 4. ANNUITY COMMENCEMENT DATE (WHEN ANNUITANT ANTICIPATES DISTRIBUTIONS TO BEGIN) ____________________ (Maximum age: 85 except SIMPLE IRA and Roth IRA which is 90) - -------------------------------------------------------------------------------- 5. BENEFICIARY(IES) INFORMATION INCLUDE FULL NAME(S) AND RELATIONSHIP(S) TO OWNER. USE *14 IF YOU NEED MORE SPACE. PRIMARY _____________________________________________________________________ _____________________________________________________________________________ CONTINGENT (IF ANY): ________________________________________________________ - -------------------------------------------------------------------------------- 6. SUCCESSOR ANNUITANT/OWNER INFORMATION (AVAILABLE ONLY FOR TRADITIONAL IRA, ROTH IRA, NQ, SEP, SARSEP AND SIMPLE IRA CONTRACTS, EXCEPT IN OREGON) SUCCESSOR ANNUITANT AND OWNER MUST BE ANNUITANT/OWNER'S SPOUSE AND THE SOLE PRIMARY BENEFICIARY NAMED IN #5. |_| NO, I don't elect a Successor Annuitant/Owner. |_| YES, I do elect a Successor Annuitant/Owner. If YES, complete the following: _|_|_|_|_|_|_|_|_ SPOUSE'S SOCIAL SECURITY NO. Spouse's Birth Date: _|_|_|_|_|_|_|_ YEAR MONTH DAY - -------------------------------------------------------------------------------- Form #180-1009 Cat. #127124 (6/98) Application Number: _____________________ (Page 2 of 5) - -------------------------------------------------------------------------------- 7. OWNER INFORMATION (COMPLETE FOR EDC AND NQ IF THE OWNER WILL BE DIFFERENT FROM THE ANNUITANT NAMED IN #3.) |_| Individual |_| Guardian |_| Custodian (See below) |_| Trustee (For an entity) ** |_| Trustee (For an individual) _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ FIRST NAME MIDDLE INITIAL LAST NAME _______________________________________ RELATIONSHIP TO ANNUITANT _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ STREET ADDRESS _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ CITY STATE ZIP _|_|_|_|_|_|_|_|_|_|_|_ (IF GUARDIAN OR CUSTODIAN TAX ID OR OWNER S.S. NO. USE MINOR'S S.S. NO.) Birth Date: _|_|_|_|_|_|_|_ YEAR MONTH DAY *As Custodian under the _____________ Uniform Gifts to Minors Act (UGMA) or STATE Uniform Transfer to Minors Act (UTMA). Please note if issued under UGMA or UTMA, the beneficiary named in #5 must **Inside build-up is taxable. be the Estate of the Annuitant. - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- 8. NQ SUCCESSOR OWNER INFORMATION (NOT AVAILABLE FOR NQ CONTRACTS IN OREGON) AVAILABLE ONLY FOR NQ CONTRACTS AND ONLY IF ANNUITANT AND OWNER IN #3 AND #7 ARE DIFFERENT PARTIES. |_| NO, I don't elect a Successor/Owner YES, I do elect a Successor/Owner _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ FIRST NAME MIDDLE INITIAL LAST NAME _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ STREET ADDRESS _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ _|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_ CITY STATE ZIP _|_|_|_|_|_|_|_|_|_|_ BIRTH DATE: _|_|_|_|_|_|_|_|_|_ SOCIAL SECURITY NUMBER YEAR MONTH DAY - -------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- 9. CONTRIBUTION INFORMATION (COMPLETE #9A ONLY IF A PAYMENT IS PROVIDED WHEN THE APPLICATION IS SIGNED. IF PAYMENT WILL BE FORWARDED AT A LATER DATE, YOU MUST COMPLETE ONLY #9R) A. AMOUNT PROVIDED WITH THIS APPLICATION: (i) Total amount for investment options listed in #11. (Do not include amounts for the Fixed Maturity Account.) $ _______________ (ii) Total amount for Fixed Maturity Period(s) listed in #12. $ _______________ (iii) If TSA (#1A, 1B or 1C) or SARSEP (#1G) or SIMPLE IRA (#1H) has been checked, provide a monthly breakdown of employee and employer contributions. $ _______________ $ _______________ Employee Employer (iv) Total Amount Remitted. $ _______________ B. EXPECTED FIRST YEAR CONTRIBUTION: Indicate the amount expected to be contributed in the first year of this contract. $ _______________ - -------------------------------------------------------------------------------- Application Number: ____________________ (Page 3 of 5) - -------------------------------------------------------------------------------- 10. REMINDER/CONTRIBUTION STATEMENTS INFORMATION (COMPLETE #10A, 10B OR 10C AS APPLICABLE) A. INDIVIDUAL REMINDER NOTICE: (COMPLETE ONLY IF YOU CHECKED THE TRADITIONAL OR ROTH IRA OR NQ BOX IN #1.) (i) Indicate if a Contribution Reminder Notice is desired. |_| YES |_| NO (ii) If Yes, complete the reminder frequency: |_| Annually |_| Semi-Annually |_| Quarterly (iii) Date of First Reminder ________/_________ (not past the 28th) MONTH DAY (iv) Contribution Reminder Notice Amount $__________________ B. PLAN CONTRIBUTION STATEMENT FREQUENCY (UNIT-BILLED/SALARY DEDUCTION CASES) (i) Complete only if you checked TSA PUblic School, TSA 501(c)(3), TSA University, EDC, Keogh (Non-Trusteed), SEP, SARSEP, SIMPLE IRA, Unit-Billed Traditional or Roth IRA or Unit-Billed NQ. |_| Annually |_| Semi-Annually |_| Quarterly |_| Monthly |_| Semi-Monthly |_| Bi-Weekly (ii) |_| YES |_| NO I want to be included on the Contribution Statement sent to my employer. (Each Contribution Statement will show the amount of the last contribution made.) Initial Contribution Statement Reminder Amount. $___________________. C. FOR TSA UNITS ONLY: Months to be excluded, if any, from Plan Contribution Statement (months must be consecutive and from May to September only). ____________________ ================================================================================ 11. SELECTION OF INVESTMENT OPTIONS AND ALLOCATION PERCENTAGES (CHECK EITHER BOX A OR BOX B BUT NOT BOTH.) ------ A. |_| MAXIMUM TRANSFER FLEXIBILITY. By checking this box, you may only invest in those options listed below which have been shaded. Transfers our of the GIA will not be limited. B. |_| MAXIMUM FUND CHOICE. By checking this box, you may invest in any of the options listed below (shaded or not shaded). Transfers out of the GIA will be limited (see Prospectus for details). CURRENT ALLOCATION. Select the allocation for the amount indicated in #9A(i) or any amounts that you may invest in these options in the future. You can change this allocation for future contributions at any time. You must allocate your contributions below by entering percentages in whole numbers totalling 100% for funds you have chosen. Note: If you are investing in the Fixed Maturity Account (FMA) you must be certain that you have entered an amount in #9A(ii), checked box #11B, and complete #12. There is no need to complete the allocation below if you intend to use only the FMA under your EQUI-VEST contract. Guaranteed Interest Account _______% T. Rowe Price International Stock ________% Alliance Equity Index _______% T. Rowe Price Equity Income ________% Alliance Growth & Income _______% EQ/Putnam Growth & Income Value ________% Alliance Common Stock _______% EQ/Putnam Balanced ________% Alliance Global _______% MFS Research ________% Alliance International _______% MFS Emerging Growth Companies ________% Alliance Aggressive Stock _______% Morgan Stanley Emerging Alliance Growth Investors _______% Markets Equity ________% Alliance Balanced _______% Warburg Pincus Small Company Value ________% Alliance Small Cap Growth _______% Merrill Lynch World Strategy ________% Alliance Conservative Investors _______% Merrill Lynch Basic Value Equity ________% Alliance Money Market _______% TOTAL (FOR BOTH COLUMNS) 100% Alliance Intermediate Gov't. Securities _______% Alliance Quality Bond _______% Alliance High Yield _______%
- -------------------------------------------------------------------------------- Application Number: ____________________ (Page 4 of 5) - -------------------------------------------------------------------------------- 12. FIXED MATURITY ACCOUNT ELECTIONS (AVAILABLE ONLY FOR SERIES 400 IRA, QP IRA, AND NQ CONTRACTS, BUT NOT AVAILABLE IN MARYLAND) For the amount shown in #9A(ii), please allocate by whole percentages to the following Fixed Maturity Period(s). (Do not select a Maturity Date that has already expired.) Percentages of Amount Maturity Dates Shown in 9A(ii) |_| June 15, 1999 ______________________% |_| June 15, 2000 ______________________% _____________ |_| June 15, 2001 ______________________% | | |_| June 14, 2002 ______________________% | USE WHOLE | |_| June 13, 2003 ______________________% | PERCENTAGES | |_| June 15, 2004 ______________________% | ONLY | |_| June 15, 2005 ______________________% |_____________| |_| June 15, 2006 ______________________% |_| June 15, 2007 ______________________% |_| June 13, 2008 ______________________% TOTAL 100 % ---------------------- ================================================================================ 13. INFORMATION TO SATISFY REGULATORY REQUIREMENTS A. THE OWNER RECEIVED THE FOLLOWING EQUI-VEST PROSPECTUS AND ANY APPLICABLE SUPPLEMENT: ------------------ ------------------------------------------ DATE OF PROSPECTUS DATE(S) OF ANY SUPPLEMENT(S) TO PROSPECTUS B. WILL ANY EXISTING INSURANCE OR ANNUITY BE (OR HAS IT BEEN) REPLACED OR CHANGED, ASSUMING THE CONTRACT APPLIED FOR WILL BE ISSUED? |_| Yes |_| No If Yes, complete the following: ------------------ ------------------ ----------------- ---------------- YEAR ISSUED TYPE OF PLAN COMPANY CONTRACT NUMBER --------------------------------------------------------------------------- COMPANY ADDRESS NQ Only: Contribution basis (check one): |_| Before 8/14/82 |_| 8/14/82 or later Net cost: ____________ (attach illustration) C. NATIONAL ASSOCIATION OF SECURITIES DEALERS, INC. (NASD) INFORMATION (AS REQUIRED BY THE NASD). ------------------------------------ _|_|_|_|_|_|_|_|_|_|_|_ EMPLOYER'S NAME OWNER'S OCCUPATION --------------------------------------------------------------------------- EMPLOYER'S STREET ADDRESS --------------------------------------------------------------------------- CITY STATE ZIP ------------------------------ ----------------------------------- ESTIMATED ANNUAL FAMILY INCOME ESTIMATED NET WORTH Investment objective: |_| Income |_| Income & Growth |_| Growth |_| Aggressive Growth |_| Safety of Principal Is Owner or Annuitant associated with or employed by a member of the NASD? |_| Yes |_| No ================================================================================ 14. SPECIAL INSTRUCTIONS (FOR BENEFICIARY, REPLACEMENT, OR TRANSFER INFORMATION) --------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------------------------------------------- - -------------------------------------------------------------------------------- Application Number: ____________________ (Page 5 of 5) - -------------------------------------------------------------------------------- 15. AGREEMENT All information and statements furnished in this application are true and complete to the best of my knowledge and belief. I understand and acknowledge that no Agent has the authority to make or modify any contract on Equitable Life's behalf, or to waive or alter any of Equitable Life's rights and regulations. I understand that amounts withdrawn from the contract may be subject to a withdrawal charge. I UNDERSTAND THAT THE ANNUITY ACCOUNT VALUE ATTRIBUTABLE TO ALLOCATIONS TO THE INVESTMENT FUNDS OF THE SEPARATE ACCOUNT OR VARIABLE ANNUITY BENEFIT PAYMENTS MAY INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. For the Fixed Maturity Account, amounts payable under the contract before the Maturity Date selected in Item 12, are subject to market value adjustments. ------------------------------------------ ------------------------------ PROPOSED ANNUITANT'S SIGNATURE DATE CITY STATE ------------------------------------------ ------------------------------ SIGNATURE OF OWNER DATE CITY STATE (IF OTHER THAN PROPOSED ANNUITANT) (NEW YORK AND OREGON RESIDENTS SIGN ABOVE, ALL OTHER RESIDENTS SIGN BELOW.) - -------------------------------------------------------------------------------- In 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 policyholder 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. In Florida: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. In New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties. In Arkansas, Any person who knowingly and with intent Kentucky and to defraud ay insurance company or other Pennsylvania: 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. All Other States: Laws in your state may make it a crime to fill out an insurance or annuity application with information you know is false or to leave out material facts. - -------------------------------------------------------------------------------- ------------------------------------------ ------------------------------ PROPOSED ANNUITANT'S SIGNATURE DATE CITY STATE ------------------------------------------ ------------------------------ SIGNATURE OF OWNER DATE CITY STATE (IF OTHER THAN PROPOSED ANNUITANT) - -------------------------------------------------------------------------------- Form #180-1009 Cat. #127124 (6/98) [EQUITABLE - MEMBER OF THE GLOBAL AKA GROUP - LOGO] EX-99.10A 4 CONSENT OF PRICEWATERHOUSECOOPERS LLP CONSENT OF INDEPENDENT ACCOUNTANTS We hereby consent to the use in the Statement of Additional Information constituting part of this Post-Effective Amendment No. 63 to the Registration Statement No. 2-30070 on Form N-4 (the "Registration Statement") of (1) our report dated February 10, 1998 relating to the financial statements of Separate Account A of the Equitable Life Assurance Society of the United States for the year ended December 31, 1997, and (2) our report dated February 10, 1998 relating to the consolidated financial statements of The Equitable Life Assurance Society of the United States for the year ended December 31, 1997, which reports appear in such Statement of Additional Information, and to the incorporation by reference of our reports into the Prospectus which constitutes part of this Registration Statement. We also consent to the incorporation by reference of our report on the Consolidated Financial Statement Schedules dated February 10, 1998 which appears on page F-54 of such Annual Report on Form 10-K. We also consent to the references to us under the headings "Independent Accountants" in the Prospectus and "Custodian and Independent Accountants" in the Statement of Additional Information. /s/ PricewaterhouseCoopers LLP - ------------------------------ PricewaterhouseCoopers LLP New York, New York December 30, 1998 -----END PRIVACY-ENHANCED MESSAGE-----