EX-99.(G)(3)(I) 4 a13-3080_1ex99dg3i.txt EX-99.(G)(3)(I) (016) 10285-04-00 AMENDMENT 10 EFFECTIVE MARCH 8, 2005 TO THE AUTOMATIC AND FACULTATIVE YEARLY RENEWABLE TERM REINSURANCE AGREEMENT EFFECTIVE MARCH 1, 2004 BETWEEN HARTFORD LIFE AND ANNUITY INSURANCE COMPANY ("CEDING COMPANY") AND RGA REINSURANCE COMPANY ("REINSURER") ("AGREEMENT") WHEREAS, the Reinsurer agrees to extend coverage for the policy listed below on a facultative basis, acknowledging the fact that said policy was issued on a Plan of Insurance not covered under the Agreement. NOW, THEREFORE, for good and valuable consideration, receipt of which is hereby acknowledged, the Ceding Company and the Reinsurer hereby agree as follows: 1. The above recitals are true and accurate and are incorporated herein. 2. The policy listed below shall be reinsured on a Facultative Reinsurance basis, under the terms of the Agreement.
INSURED POLICY NUMBER DATE OF BIRTH PLAN FACE AMT REINSURED AMT TABLE ---------------------------------------------------------------------------------------------------------
3. The reference above to a specific policy is for purposes of description only; such reference shall not create any relationship between the policyholder, beneficiary or insured of that policy and the Reinsurer, and such references shall not create any rights in any party other than the Ceding Company and the Reinsurer. LS Excess Treaty -- Effective 3/01/2004 Between HLAIC and RGA Amendment # 10 -- Effective 3/8/2005 1 (016) 10285-04-00 4. This Amendment represents an exception to the Agreement. The Reinsurer's acceptance should not be viewed as a precedent in the event future cases should arise as a result of similar circumstances. 5. Except as herein amended, all other terms and conditions of the Agreement shall remain unchanged. In witness of the foregoing, the Ceding Company and the Reinsurer have, by their respective officers, executed this Amendment in duplicate on the dates indicated below, with an effective date of March 8, 2005. RGA REINSURANCE COMPANY By: /s/ Chris Noyes Attest: /s/ Julie A. Decker ---------------------------------------- ---------------------------------------- Name: Chris Noyes Name: Julie A. Decker Title: Vice President, Business Development Title: Vice President and Actuary Date: 6/11/12 Date: 6/11/2012
HARTFORD LIFE AND ANNUITY INSURANCE COMPANY By: /s/ Paul Fischer Attest: /s/ Donna R. Jarvis ---------------------------------------- ---------------------------------------- Name: Paul Fischer Name: Donna R. Jarvis Title: Assistant Vice President and Actuary Title: Vice President and Actuary Date: June 18, 2012 Date: 6/25/2012
LS Excess Treaty -- Effective 3/01/2004 Between HLAIC and RGA Amendment # 10 -- Effective 3/8/2005 2