FORM SR
Published on
Exhibit 99
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| FORM SR | | OBM Number: 3235-0124 |
| | | Expires November 30, 1993 |
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| hours per response. . . 5.50 |
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| SEC USE ONLY |
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
REPORT OF SALES OF SECURITIES AND USE OF PROCEEDS THEREFROM
MO DAY YEAR
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For period ending | 0 | 9 | | 3 | 0 | | 9 | 7 |.
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Indicate whether the report is an initial report [ ], an amendment [X], or a
final report [ ].
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If the report is an amendment, indicate the number of such amendment [ | ].
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GENERAL INSTRUCTIONS:
A. The report shall be filed in accordance with the provision of Rule 463
(17 CFR 230.463). The provisions of Rule 405 (17 CFR 230.405) regarding
definitions of terms and Rule 409 (17 CFR 230.409) regarding information unknown
or not reasonably available are applicable to the report.
B. Answer each item in the box(es) or space provided. If additional space
is required for any response, continue the response on the attached sheet. Where
the number of boxes provided exceeds the number required for the response, enter
zero(es) in any unnecessary box(es) to the left of the response. For example, if
the date August 1, 1981 is to be entered in the boxes provided, the entry should
appear as MO DAY YEAR
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| 0 | 8 | | 0 | 1 | | 8 | 1 |
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C. If the report is being filed by a sucessor issuer, answer each item with
respect to the successor issuer.
D. If the issuer is required to file any report(s) on this form subsequent
to its initial filing thereon, each subsequent filinq shall be deemed to be an
amendment to the initial filing. Do not report in any amendment on this form any
response to Items 3-12 unless the response reported on the most recent prior
filing has changed.
E. No fee is required to be paid in connection with the filing of the
report.
F. File four copies of the report at the office of the Commission where the
registration statement was filed. At least one copy shall be manually signed;
the other three copies may bear typed or printed signatures.
1. (a) State the name of the issuer or successor issuer filing the report.
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| PRUCO LIFE INSURANCE COMPANY OF NEW JERSEY |
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(b) If a successor issuer is filing the report with respect to the
registration statement of its predecessor, state the name of such
predecessor issuer.
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SEC 1809 (2/91)
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| FORM SR | | Page 2 |
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2. (a) Indicate the effective date of the registration statement for which this
form is filed. MO DAY YEAR
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| 0 | 2 | | 0 | 7 | | 9 | 7 |
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Regional
(b) Provide the SEC file number assigned to the Office
registration statement. Code
If any
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| 3 | 3 | 3 | - | 1 | 8 | 0 | 5 | 3 | - | | |
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(c) If the issuer has been assigned a CUSIP number, specify the first (6)
digits.
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3. (a) Has the offering commenced? YES NO
[X] [ ]
(b) If yes, indicate the date the offering commenced.
MO DAY YEAR
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| 0 | 2 | | 2 | 4 | | 9 | 7 |
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If no, explain briefly______________________________________________
______________________________________________
______________________________________________
4. Did the offering terminate before any securities were sold?
YES NO
[ ] [X]
If yes, explain briefly______________________________________________
______________________________________________
______________________________________________
Note: If the offering terminated before anv securities were sold, see Rule
477 under Regulation C (17 CFR 230.477) regarding withdrawal of the
registration statement.
Instruction: If the answer to Item 4 is "Yes," do not answer Items 5-12.
5. Did the offering terminate prior to the sale of all securities registered?
YES NO
[ ] [X]
If yes, explain briefly______________________________________________
______________________________________________
______________________________________________
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| FORM SR | | Page 3 |
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6. Furnish the name(s) of the managing underwriter(s), if any.
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| (01) |
| PRUCO SECURITIES CORPORATION (DISTRIBUTOR) |
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| (02) |
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| (03) |
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| (04) |
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7. (a) Indicate the title and code of each class of securities registered and,
where a class of convertible securities is being registered, indicate
the title and code of any class of securities into which such securities
may be converted.
Title of security Code
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| (01) | |
| DISCOVERY SELECT VARIABLE ANNUITY | OT |
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| (02) | |
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| (03) | |
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| (04) | |
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Instruction: Select the appropriate code for each class of securities
registered. Debt--DE; Convertible Debt--CD; Equity--EQ; Limited
Partnership Interest--LP; Other (e.g., investment contracts, warrants,
rights, and options)--OT.
(b) Describe briefly any class of securities categorized as "other."
MARKET VALUE ADJUSTED FIXED-DOLLAR ANNUITY CONTRACT.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
8. Indicate on the following table the amount and aggregate offering price of
securities registered and sold to date for the account of the issuer and for
the account(s) of any selling security holder(s).
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| FORM SR | | Page 4 |
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Instructions: 1. List each class of securities registered except any
class of securities into which a class of
convertible securities registered may be converted
without additional payment to the issuer. Match any
class listed with the line on which it was listed in
Item 7(a) (e.g., the class listed on line (01) of
the table should be the same class as listed on line
(01) of Item 7(a)).
2. Compute all amounts from the effective date of the
registration statement to the ending date of the
reporting period for this report.
3. Round all amounts to the nearest dollar.
# These securities are not issued or sold in predetermined units.
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| FORM SR | | Page 5 |
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9. State, if known, or furnish a reasonable estimate of, the amount of
expenses incurred for the issuer's account in connection with the
issuance and distribution of the securities registered for each category
listed below. Place an "X" in the box to the left of any amount given
that is an estimate.
Direct or indirect payments to Direct or indirect
directors, officers, general payments to others
partners of the issuer or their
associates; to persons owning
ten percent or more of any class
of equity securities of the
issuer; and to affiliates of the
issuer
(A) (B)
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| (01) Underwriting | | |
| discounts and |---- |---- |
| commissions | X | $2,577,096* | | $ |
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| (02) | | |
| Finders' Fees |---- |---- |
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| (03) Expenses paid | | |
| to or for |---- |---- |
| underwiters | | | | |
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| (04) | | |
| Other expenes |---- |---- |
| | X | 1,387,715** | | |
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| (05) | | |
| Total expenes |---- |---- |
| | X | $3,964,811 | | $ |
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Instructions: 1. Compute all amounts from the effective date of the
registration statement to the ending date of the
reporting period for this report.
2. Round all amounts to the nearest dollar.
10. Indicate the net offering proceeds to the issuer after the total
expenses in Item 9 above.
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| $71,376,642 |
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11. State, if known, or furnish a reasonable estimate of, the amount of
net offering proceeds to the issuer used for each of the purposes
listed below. Do not include any amount in "working capital" to
which a more specific category is applicable. Place an "X" in the
box to the left of any amount given that is an estimate.
*Amount represents sales commissions paid to affiliated parties.
**Amount represents general administrative expenses paid to the parent under
service and lease agreement.
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| FORM SR | | Page 6 |
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Direct or indirect payments to Direct or indirect
directors, officers, general payments to others
partners of the issuer or their
associates; to persons owning
ten percent or more of any class
of equity securities of the
issuer; and to affiliates of the
issuer
(A) (B)
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| (01) Construction of | | |
| plant, building |---- |---- |
| and facilities | | $ | | $ |
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| (02) Purchase and installation | | |
| of machinery and equipment |---- |---- |
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| (03) Purchase of real estate | | |
| |---- |---- |
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| (04) Acquistion of other | | |
| business(es) |---- |---- |
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| (05) Payment of indebtedness | | |
| |---- |---- |
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| (06) Working capital | | |
| |---- |---- |
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Temporary investment (specify)
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| (07) | | |
| |---- |---- |
| | | $ | | $ |
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| (08) | | |
| |---- |---- |
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| (09) | | |
| |---- |---- |
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| (10) | | |
| |---- |---- |
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Other purposes (specify)
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| (11) | | |
| |---- |---- |
| | | $ | | $ |
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| (12) | | |
| |---- |---- |
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| (13) | | |
| |---- |---- |
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| (14) | | |
| |---- |---- |
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| (15) | | |
| |---- |---- |
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| (16) | | |
| |---- |---- |
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Instructions: 1. Specify under "other purposes" any purpose for which at
least 5 percent of the issuer's total offering proceeds or
$50,000, whichever is less, has been used.
2. Compute all amounts from the effective date of the
registration statement to the ending date of the reporting
period for this report.
3. Round all amounts to the nearest dollar.
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| FORM SR | | Page 7 |
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12. Do the use(s) of proceeds in Item 11 represent a material change in the
use(s) of proceeds described in the prospectus?
YES NO
[ ] [ ]
If yes, explain briefly ___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
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SIGNATURE
Pursuant to the requirements of Rule 463 under the Securities Act of 1933,
Pruco Life Insurance Company of New Jersey has caused this report to be signed
on its behalf by the undersigned thereunto duly authorized.
PRUCO LIFE INSURANCE COMPANY OF NEW JERSEY
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ISSUER
11/14/97 By /s/ LINDA S. DOUGHERY
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DATE Linda S. Dougherty
Vice President and Comptroller
Instruction: The report shall be signed by an executive officer, general partner
or counsel of the issuer or by any other duly authorized person.
The name and any title of the person who signs the report shall be
typed or printed beneath his/her signature.
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| ATTENTION: Intentional misstatements or omissions of facts constitute |
| Federal criminal violations (See 18 U.S.C. 1001). |
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| FORM SR Continuation Sheet | | Page 8 |
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REPORT OF SALES OF SECURITIES
AND USE OF PROCEEDS THEREFROM
Item of Form
(identity) Answer
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