New York State seal

April 21, 1976

SUBJECT: INSURANCE

WITHDRAWN

Circular Letter No. 11(1976)

TO: ALL AUTHORIZED LIFE INSURERS WRITING SEPARATE ACCOUNT ANNUITIES

RE: REPORTING REQUIREMENTS CONCERNING INCIDENTAL DEATH BENEFIT RESERVE AND ANNUITANT MORTALITY FLUCTUATION FUND APPLICABLE TO SEPARATE ACCOUNT ANNUITIES.

This letter is a request for certain information to be furnished annually to the Life Insurance and Companies Bureau concerning your Incidental Death Benefit Reserve and Annuitant Mortality Fluctuation Fund applicable to separate account annuity contracts.

Report to be Submitted on or Before March 1 of Each Year Following 1976

A. Incidental Death Benefit Reserve

(1) Total amount of the reserve as of the preceding year end.

(2) Amount of yearly contributions to the reserve during the preceding calendar year.

(3) Amounts of withdrawals from such reserve during the preceding calendar year.

(4) Maximum and minimum targets for the reserve (if changed since the most recent report), and the percentages funded to date.

(5) Details as to the manner in which the accumulation of the reserve and its current value are stated in the annual statement, if such procedure since the most recent report.

B. Annuitant Mortality Fluctuation Fund

(6) through (10) came as items (1) through (5) above, except that the term "fund" is substituted for the term "reserve".

(11) Mortality gains (or losses) should be excluded from items (7) and (8) above and shown separately for the preceding calendar year.

C. Any Additional Funds

(12) In addition to the above reserve funds, please furnish the details with respect to the establishment of any other funds maintained by the company for separate accounts, whether or not such fund(s) are maintained in the separate account.

Special Instructions for Report Due June 1, 1976

Items (1) and (6) should be reported as of December 31, 1975. Items (2), (3), (7), (8) and (11) and any applicable portions of item (12) should be reported separately for each year since inception. Items (4), (5), (9), (10) and (12) should be reported on a current basis.

Please acknowledge receipt of this letter to Alvin H. Alpert. Chief of the Life Insurance and Companies Bureau.

Very truly yours,

(Signed) THOMAS A. HARNETT

Superintendent of Insurance