<PAGE>

                               EXHIBIT (4)(c)(5)

                    FORM OF POLICY FOR SEPARATE ACCOUNT VA C

<PAGE>

              [LETTERHEAD OF TRANSAMERICA LIFE INSURANCE COMPANY]

                               ANNUITANT: [John Doe]

                                OWNER(S): [John Doe]

                           POLICY NUMBER: [07 - 12345]

                             POLICY DATE: [November 14, 2001]

                                    WE AGREE

..    To provide annuity payments as set forth in Section 10 of this policy,

..    Or to pay Withdrawal benefits in accordance with Section 5 of this policy,

..    Or to pay death proceeds in accordance with Section 9 of this policy.

Withdrawals may be subject to an Excess Interest Adjustment reflecting changes
in interest rates in accordance with Section 5 of the policy. Transfers and
amounts applied to a Payment Option may also be subject to an Excess Interest
Adjustment in accordance with Sections 5, 8 and 10, respectively, of this
policy.

These agreements are subject to the provisions of this policy. This policy is
issued in consideration of the payment of the initial premium.

This policy may be applied for and issued to qualify as a tax-qualified annuity
under the applicable sections of the Internal Revenue Code.

                             20 DAY RIGHT TO CANCEL

You may cancel this policy by delivering or mailing a written notice or sending
a telegram to us. You must return the policy before midnight of the twentieth
day after the day You receive it. Notice given by mail and return of the policy
by mail are effective on being postmarked, properly addressed and postage
prepaid.

We will pay You an amount equal to the sum of:

..    the premiums paid; and

..    the accumulated gains or losses, if any, in the Separate Account on the
     date of cancellation;

unless otherwise required by law.

                        Signed for us at our home office.

       /s/ Craig D. Vermie                              /s/ Larry N Norman

            SECRETARY                                        PRESIDENT

    This policy is a legal contract between the policyowner and the Company.
                           READ YOUR POLICY CAREFULLY

                   Flexible Premium Deferred Variable Annuity
                   Income Payable At Annuity Commencement Date
          Benefits Based On The Performance Of The Separate Account Are
  Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C)
                                Non-Participating

AV710 101 147 102

<PAGE>

                             SECTION 1 - DEFINITIONS

ADJUSTED POLICY VALUE - The Policy Value increased or decreased by any Excess
Interest Adjustment.

ANNUITANT - The person whose life annuity payments will be based on.

ANNUITY COMMENCEMENT DATE - The Date the Annuitant will begin receiving payments
from this policy, which may not be later than the last day of the policy month
starting after the Annuitant attains age 85, except as expressly allowed by us
(within state restrictions), but in no event later than the last day of the
month in which the Annuitant attains age 95.

CASH VALUE - Amount, defined in Section 5 that is available for partial or full
Surrenders.

CUMULATIVE EARNINGS - An amount equal to the Policy Value at the time a lump sum
payout or systematic payout option payout is made, minus the sum of all premium
payments reduced by all prior Partial Withdrawals deemed to have been from
premium, if any.

CUSTODIAL CARE - Care designed essentially to help a person with the activities
of daily living which does not require the continuous attention of trained
medical or paramedical personnel.

DISTRIBUTION - A Withdrawal or disbursement of funds from the Policy Value or
Cash Value. Policy Value and Cash Value will be reduced by any Distribution.

GAINS - Cumulative Earnings, if any, in the Policy Value.

HOSPITAL - An institution which 1) is operated pursuant to the laws of the
jurisdiction in which it is located, 2) operates primarily for the care and
treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour
nursing service by or under the supervision of registered graduate professional
nurses, 4) is supervised by a staff of one or more licensed Physicians, and 5)
has medical, surgical and diagnostic facilities or access to such facilities.

INVESTMENT OPTIONS - Any of the Guaranteed Period Options of the Fixed Account,
the Dollar Cost Averaging Fixed Account Option, and any of the Subaccounts of
the Separate Account.

MONTHIVERSARY - The same date each month as the Policy Date. If there is no day
in the calendar month, which coincides with the Policy Date, the Monthiversary
will be the first day of the next calendar month.

NURSING CARE - Care prescribed by a Physician and performed or supervised by a
registered graduate nurse. Such care includes nursing and rehabilitation
services available 24 hours.

NURSING FACILITY - A facility which 1) is operated pursuant to the laws of the
jurisdiction in which it is located, 2) provides Nursing Care or Custodial Care,
3) primarily provides Nursing Care under the direction of a licensed Physician,
registered graduate professional nurse, or licensed vocational nurse, except
when receiving Custodial Care, and 4) is not other than incidentally a Hospital,
a home for the aged, a retirement home, a rest home, a community living center
or a place mainly for the treatment of alcoholism, mental illness or drug abuse.

PAYEE - The person to whom annuity payments will be made.

PAYMENT OPTIONS - Options through which the distribution of the Adjusted Policy
Value can be directed.

PHYSICIAN - Doctor of Medicine or Doctor of Osteopathy who is licensed as such
and operating within the scope of the license.

POLICY ANNIVERSARY - The anniversary of the Policy Date for each year the policy
remains in force.

POLICY DATE - The date shown on the Policy Data page of this policy and the date
on which this policy becomes effective.

POLICY VALUE - Amount defined in Section 4, that can be used to fund one of the
Payment Options.

POLICY YEAR - The 12-month period following the Policy Date shown on the Policy
Data page. The first Policy Year starts on the Policy Date. Each subsequent year
starts on the anniversary of the Policy Date.

SEPARATE ACCOUNT - The separate investment account(s) established by us, as
described in Section 6.

SUBACCOUNT - A division of the Separate Account, as described in Section 6.

SURRENDER - A partial or full withdrawal of funds from the Policy Value or Cash
Value.

TERMINAL CONDITION - A condition resulting from an accident or illness which, as
determined by a Physician, has reduced life expectancy to not more than 12
months, despite appropriate medical care.

WITHDRAWAL - A distribution of funds from the Policy Value or Cash Value.

YOU, YOUR - The owner of this policy. Unless otherwise specified on the Policy
Data page, the Annuitant and the owner shall be one and the same person.

AV6710

                                     Page 2

<PAGE>

                             SECTION 2 - POLICY DATA

POLICY NUMBER:        [07 - 12345]                  ANNUITANT:      [John Doe]

INITIAL PREMIUM

PAYMENT:              [$5,000.00]               ISSUE AGE/SEX:      [35/MALE]

POLICY DATE:          [December 4, 2001]             OWNER(S):      [John Doe]

ANNUITY

COMMENCEMENT                                        GUARANTEED
DATE:                 [March 8, 2050]                  MINIMUM
                                                 DEATH BENEFIT
                                                       OPTION:      [P]
BENEFICIARY:          [Jane Doe]

Premium Enhancement Percentage on Initial Premium Payment:                [5%]

Fixed Account Guaranteed Minimum Effective Annual Interest Rate:          [3%]


Before the Annuity Commencement Date:

    Death Benefit Option P - Return of Premium Mortality and Expense Risk Fee
         and Administrative Charge:

                           Policy Years 1-9                  1.75%
                           Policy Years 10 or more           1.30%

   Death Benefit Option N - 6% / Monthly Double Enhanced Mortality and Expense
         Risk Fee and Administrative Charge:

                           Policy Years 1-9                  2.00%
                           Policy Years 10 or more           1.55%


After the Annuity Commencement Date:

         Mortality and Expense Risk Fee and Administrative Charge:    1.25%

AV710 101 147 102SP
                                     Page 3

<PAGE>

                          SECTION 3 - PREMIUM PAYMENTS

PAYMENT OF PREMIUMS
Premium payments may be made any time while this policy is in force before the
Annuity Commencement Date. You may start or stop, increase or decrease, or skip
any premium payments.

PREMIUM ENHANCEMENT
When a premium payment is paid, a Premium Enhancement Percentage will be applied
to that premium payment and the resulting amount will be added to the Policy
Value. The amount of the Premium Enhancement is not considered a premium
payment. The Premium Enhancement is considered part of Earnings. The Premium
Enhancement Percentage may vary from premium to premium on subsequent premium
payments and may vary based on Your attained age at the time a premium payment
is made. The amount of Premium Enhancement will never be less than 0.25% nor
more than 7%. The Premium Enhancement Percentage applicable to the initial
premium payment is set forth on the Policy Data Page. We will advise You of the
amount of the Premium Enhancement applicable to each subsequent premium payment
in a confirmation that We will send to You. Premium Enhancements will be applied
using the same allocation as on the corresponding premium payment. No Premium
Enhancement will apply if the Policy is cancelled pursuant to the Right to
Cancel provision.

The full dollar amount of any Premium Enhancement applied less than one year
prior to the occurrence of any of the following events will be forfeited:

1)       Exercise of Nursing Care and Terminal Condition Withdrawal Option;
2)       Exercise of Unemployment Waiver;
3)       A death benefit is payable; or
4)       Upon annuitization.

MAXIMUM AND MINIMUM PREMIUM PAYMENT
The premium payments may not be more than the amount permitted by law if this is
a tax-qualified annuity. The minimum initial premium payment is $5,000. If this
policy is being used as a tax-qualified annuity, the minimum initial premium is
$1,000, except that no minimum initial premium payment will be required for
403(b) annuities. The minimum subsequent premium payment we will accept is $50.
The maximum total premium payments which we will accept without prior Company
approval is $1,000,000.

PREMIUM PAYMENT DATE
The premium payment date is the date on which the premium payment is credited to
the policy. The initial premium payment less any applicable premium taxes will
be credited to the policy within two business days of receipt of the premium
payment and the information needed. Subsequent additional premium payments will
be credited to the policy as of the business day the premium payment and
required information are received. A business day is any day that the New York
Stock Exchange is open for trading.

ALLOCATION OF PREMIUM PAYMENTS
Premium payments may be applied to various Investment Options, which we make
available. For each premium payment, You must indicate what percentage to
allocate to various Investment Options. Each percent may be either zero or any
whole number; however, the allocation among all accounts must total 100%.

CHANGE OF ALLOCATION
You may change the allocation of premium payments to various Investment Options,
by providing us notice containing the facts that we need. Premium payments
received after the date on which we receive Your notice will be applied on the
basis of the new allocation.

PREMIUM TAXES
Your state may impose a premium tax. It may be imposed either when a premium
payment is made, on the Annuity Commencement Date, on the date of death or on
the date of full Surrender. When permitted by state law, we will not deduct the
premium tax until the Annuity Commencement Date, date of death, or date of full
Surrender.

M1266

                                     Page 4

<PAGE>

                            SECTION 4 - POLICY VALUE

POLICY VALUE
On or before the Annuity Commencement Date, the Policy Value is equal to Your:

(a) premium payments plus corresponding Premium Enhancements; minus
(b) Gross Partial Withdrawals (as defined in Section 5); plus
(c) interest credited to the Fixed Account (see Section 7); plus
(d) accumulated gains in the Separate Account (see Section 6); minus
(e) accumulated losses in the Separate Account (see Section 6); minus
(f) service charges, premium taxes, rider fees and transfer fees, if any.

ADJUSTED POLICY VALUE
The Adjusted Policy Value is the Policy Value increased or decreased by any
Excess Interest Adjustment. You may use the Adjusted Policy Value on the Annuity
Commencement Date to provide lifetime income or income for a period of no less
than 60 months under the Payment Options in Section 10.

SERVICE CHARGE
On each Policy Anniversary and at the time of full Surrender during any Policy
Year before the Annuity Commencement Date, we reserve the right to assess a
service charge up to $40 for policy administration expenses. The Service Charge
will be deducted from each Investment Option in proportion to the portion of
Policy Value (prior to such charge) in each Investment Option. In no event will
the Service Charge exceed 2% of the Policy Value on the Policy Anniversary or at
the time of full Surrender.

The Service Charge will not be deducted on a Policy Anniversary or at the time
of full Surrender if, at either of these times, (1) the sum of all premium
payments less the sum of all Withdrawals taken equals or exceeds $50,000; or (2)
the Policy Value equals or exceeds $50,000.

                 SECTION 5 - CASH VALUE AND PARTIAL WITHDRAWALS

CASH VALUE
On or before the Annuity Commencement Date, the Cash Value is equal to the
Adjusted Policy Value less any surrender charges. Information on the current
amount of Your policy's Cash Value is available upon request. The Cash Value may
be partially withdrawn or will be paid in the event of a full Surrender of the
policy. We must receive Your written partial Withdrawal or Surrender request
before the Annuity Commencement Date.

There is no Cash Value once an Annuity Payment Option has been selected.

EXCESS INTEREST ADJUSTMENT
Full Surrenders, partial Withdrawals, transfers, and amounts applied to a
Payment Option (prior to the end of any Guaranteed Payment Option) from
Guaranteed Period Options of the Fixed Account described in Section 7 will be
subject to an Excess Interest Adjustment except as provided for in the partial
Withdrawals provision below.

An Excess Interest Adjustment applies in the following situations:

1) When You withdraw all or any portion of Your Cash Value,
2) When You exercise Annuity Payment Options,
3) When death proceeds are calculated. However, death proceeds will not be
   reduced if the Excess Interest Adjustment is negative.

The Excess Interest Adjustment is only applied to transactions affecting the
Guaranteed Period Options of the Fixed Account (see Section 7) and is based on
any change in interest rates from the time the affected Guaranteed Period(s)
started until the time the Excess Interest Adjustment occurs. The Excess
Interest Adjustment is applied as follows:

1) The Excess Interest Adjustment is only applied when the transactions occur
   prior to the end of any Guaranteed Period Option;
2) Transfers to the Guaranteed Period Options of the Fixed Account are
   considered Premium Payments for purposes of determining the Excess Interest
   Adjustment;
3) The Excess Interest Adjustment is distinct from, and is applied prior to, the
   surrender charge;
4) The Excess Interest Adjustment may affect the death proceeds defined in
   Section 9;
5) If interest rates have decreased from the time the affected Guaranteed
   Period(s) started until the time the transaction occurs, the Excess Interest
   Adjustment will result in additional funds available to You;
6) If interest rates have increased from the time the affected Guaranteed
   Period(s) started until the time the transaction occurs, the Excess Interest
   Adjustment will result in a decrease in the funds available to You;
7) Certain amounts are not subject to the Excess Interest Adjustment as provided
   in Sections 5, 7 and 8.

U1266                                Page 5

<PAGE>

                              SECTION 5 - CONTINUED

The formula for determining the amount of the Excess Interest Adjustment is as
follows:

Excess Interest Adjustment = S x (G-C) x (M/12) where:
        S  is the amount (before surrender charges and premium taxes, if any)
           being Surrendered, partially withdrawn, transferred, or applied to a
           Payment Option that is subject to the Excess Interest Adjustment.
        G  is the guaranteed interest rate for the Guaranteed Period applicable
           to "S".
        C  is the current guaranteed interest rate then being offered on new
           Premium Payments for the next longer Guaranteed Period than "M." If
           this policy form or such a Guaranteed Period Option is no longer
           offered, "C" will be the U.S. Treasury rate for the next longer
           maturity (in whole years) than "M" on the 25th day of the previous
           calendar month, plus up to 2%.
        M  is the number of months remaining in the Guaranteed Period for "S",
           rounded up to the next higher whole number of months.

Upon full Surrender, the Excess Interest Adjustment (EIA) for each Guaranteed
Period Option will not reduce the Adjusted Policy Value for that Guaranteed
Period Option below the amount paid into, less any prior Withdrawals and
transfers from that Guaranteed Period Option, plus interest at the Fixed Account
Guaranteed Minimum Effective Annual Interest Rate shown on Page 3.

PARTIAL WITHDRAWALS
We will pay You a portion of the Cash Value as a Partial Withdrawal provided we
receive Your written request while the policy is in effect and before the
Annuity Commencement Date. When You request a Partial Withdrawal You must tell
us how it is to be allocated from among the Investment Options. If Your request
for a Partial Withdrawal from any Investment Option is less than or equal to the
Cash Value in that option, we will pay the amount of Your request. However, if
Your request for a Partial Withdrawal from any Investment Option is greater than
the Cash Value in that option, we will pay You the Cash Value of that Investment
Option.

The Gross Partial Withdrawal is the total amount which will be deducted from
Your Policy Value as a result of each Partial Withdrawal. The Gross Partial
Withdrawal may be more or less than Your requested Partial Withdrawal amount,
depending on whether surrender charges and/or Excess Interest Adjustments apply
at the time You request the Partial Withdrawal.

The Excess Partial Withdrawal amount is the portion of the requested Partial
Withdrawal that is subject to surrender charge (that is, the portion which is in
excess of the surrender charge-free portion). For example, if the requested
Withdrawal amount is $1,000, and the surrender charge-free amount is $200, then
the Excess Partial Withdrawal would be $800. Excess Partial Withdrawals will
reduce the Policy Value by an amount equal to (X-Y+Z) where:

X = Excess Partial Withdrawal
A = Amount of Partial Withdrawal subject to Excess Interest Adjustment
Y = Excess Interest Adjustment = (A) x (G-C) x (M/12) where G, C and M are
    defined in the Excess Interest Adjustment provision above, with "A"
    substituted for "S" in the definitions of G and M.
Z = surrender charge on X minus Y.

The formula for determining the Gross Partial Withdrawal is as follows:

Gross Partial Withdrawal = R - E + SC, where:

R   is the requested Partial Withdrawal;
E   is the Excess Interest Adjustment; and
SC  is the surrender charge on (EPW - E); where
EPW is the Excess Partial Withdrawal Amount (the portion of the requested
    Partial Withdrawal that is subject to surrender charge).

If any Partial Withdrawal reduces the Cash Value below $500, we reserve the
right to pay the full Cash Value and terminate the policy.

We may delay payment of the Cash Value from the Fixed Account for up to 6 months
after we receive the request. If the owner dies after we receive the request,
but before the request is processed, the request will be processed before the
death proceeds are determined.

Each Partial Withdrawal consists of a portion that is subject to a surrender
charge (that is, the Excess Partial Withdrawal) and a remaining portion that is
free from surrender charge (that is, the surrender charge-free amount). Either
portion may be zero (0) depending on the Partial Withdrawal requested and prior
amounts withdrawn.

Partial Withdrawals in the amount of the cumulative interest in the Guaranteed
Period Option(s) of the Fixed Account at the time of Withdrawal may be withdrawn
from the GPO(s) of the Fixed Account free of any Excess Interest Adjustment.

Amounts withdrawn under one of the options below may reduce the amount available
free of surrender charges under another option. Surrender charges and/or EIA may
be waived as described below:

P1252                                Page 6

<PAGE>

                              SECTION 5 - CONTINUED

LUMP SUM
Beginning in the second Policy Year, You may withdraw, free from surrender
charges, a lump sum amount equal to the maximum of A and B where:

A   is the Cumulative Earnings, if any, in the Policy Value and

B   is an amount equal to 10% of the premium payments immediately prior to the
    partial Withdrawal reduced by all prior partial Withdrawals deemed to have
    been from premium, if any.

The minimum partial Withdrawal under this option is $500. This partial
Withdrawal option is available once per Policy Year.

SYSTEMATIC PAYOUT OPTION
Beginning in the first Policy Year, a Systematic Payout Option (SPO) is
available on a monthly, quarterly, semi-annual or annual basis. At the time a
SPO payout is made, such payout must be at least $50 and may not exceed the
maximum of A and B, divided by the number of payouts made per year (e.g. 12 for
monthly).

A   is the Cumulative Earnings, if any, in the Policy Value and

B   is an amount equal to 10% of the premium payments immediately prior to the
    partial Withdrawal reduced by all prior partial Withdrawals deemed to have
    been from premium, if any.

No surrender charges or Excess Interest Adjustment will apply to the SPO payout.
Monthly and quarterly payouts must be sent through electronic funds transfer
directly to a checking or savings account. You may start or stop SPO payouts at
any time; however, 30 days' written notice is required to stop SPO payouts.

Once You have elected a SPO, You must wait a minimum time before the first SPO
payment: 1 month for monthly, 3 months for quarterly, 6 months for semi-annual,
or 12 months for annual.

MINIMUM REQUIRED DISTRIBUTION
For tax-qualified plans, partial Withdrawals taken to satisfy minimum
distribution requirements under Section 401(a)(9) of the Internal Revenue Code
(IRC) are available with no surrender charges and no Excess Interest
Adjustments. The amount available from this policy with respect to the minimum
distribution requirement is based solely on this policy.

The owner must be at least 70 1/2 years old in the calendar year of
distribution, must submit a written request to us and must take the distribution
before year-end. If the owner attains age 70 1/2 in the calendar year of
distribution, a written request, which is postmarked no later than the end of
the current calendar year, must be submitted to us.

Systematic minimum distributions must be at least $50 or a lump sum distribution
is available if minimum required distributions are less than $50.

Any amount requested in excess of the IRC minimum required distribution will
have the appropriate surrender charges and Excess Interest Adjustments applied,
unless the excess Distribution qualifies as surrender charge-free or Excess
Interest Adjustment-free under any additional options provided.

NURSING CARE AND TERMINAL CONDITION WITHDRAWAL OPTION
Beginning in the first Policy Year, if the owner or owner's spouse (Annuitant or
Annuitant's spouse if the owner is not a natural person) has been 1) confined in
a Hospital or Nursing Facility for 30 consecutive days or 2) diagnosed as having
a Terminal Condition, You may elect to withdraw all or a portion of the Policy
Value without surrender charges and without an Excess Interest Adjustment. The
minimum Withdrawal under this option is $1000. This option is available even
during the policy years other partial Withdrawal options were exercised prior to
Nursing Care.

For Nursing Care, we must receive each Withdrawal request and proof of
eligibility with each request no later than 90 days following the date that
confinement has ceased, unless it can be shown that it was not reasonably
possible to provide the notice and proof within the above time period and that
the notice and proof were given as soon as reasonably possible. However, in no
event, except the absence of legal capacity, shall the notice and proof be
provided later than one year following the date that confinement has ceased.
Proof of confinement may be a Physician's statement or a statement from a
Hospital or Nursing Facility administrator. For a Terminal Condition, we must
receive each Withdrawal request and the applicable proof of eligibility no later
than one year following diagnosis of the Terminal Condition. Proof of a Terminal
Condition is required only with the initial Withdrawal request and must be
furnished by the owner's, owner's spouse's, Annuitant's, or Annuitant's spouse's
Physician.

UNEMPLOYMENT WAIVER
Beginning in the first Policy Year, You may withdraw all or a portion of the
Policy Value free of any surrender charges and free of any Excess Interest
Adjustment if the owner or owner's spouse (Annuitant or Annuitant's spouse, if
the owner is not a natural person) becomes unemployed. In order to qualify, You
1) must have been employed full-time for at least two years prior to Your
becoming unemployed, 2) must have been employed full-time on Your Policy Date,
3) must have been unemployed for at least 60 consecutive days at the time of
Withdrawal and 4) must have a minimum Cash Value at the time of Withdrawal of
$5000. Proof of unemployment will consist of providing us with a determination
letter from the applicable State's Department of Labor, which verifies that You
qualify for and are receiving unemployment benefits at the time of Withdrawal.
The determination letter must be received by us no later than 15 days following
the date of the Withdrawal request.

PB1252                               Page 7

<PAGE>

                              SECTION 5 - CONTINUED

SURRENDER CHARGES
Amounts withdrawn in excess of the surrender charge-free amount specified in the
Withdrawal provisions above are subject to a surrender charge. The amount of
this charge, if any, will be a percentage, as shown in the table below, of the
amount of premium withdrawn:

Number of Years                   Percentage of
  Since Premium                 Premium Withdrawn
  Payment Date

      0-1                              9%
      1-2                              8%
      2-3                              7%
      3-4                              6%
      4-5                              5%
      5-6                              4%
      6-7                              3%
      7-8                              2%
      8-9                              1%
      9 or more                        0%

For surrender charge purposes, all earnings (including Premium Enhancement) are
considered to be withdrawn first. After all earnings are withdrawn then the
oldest premium payment is the first premium payment considered to be withdrawn.
If the amount withdrawn exceeds this, the next oldest premium payment is
considered to be withdrawn, and so on until the most recent premium payments are
deemed to be withdrawn (the procedure being applied to Withdrawals of premium is
a "First-In, First-Out" or FIFO procedure).

GUARANTEED RETURN OF FIXED ACCOUNT PREMIUM PAYMENTS
Upon full Surrender of the policy, You will always receive at least the premium
payments made to, less prior Withdrawals and transfers from, the Fixed Account.

MINIMUM VALUES
Benefits available under this policy, including any paid up annuity or death
benefits that may be available, are not less than those required by any statute
of the state in which the policy is delivered.

                          SECTION 6 - SEPARATE ACCOUNT

SEPARATE ACCOUNT
We have established and will maintain one or more Separate Account(s), under the
laws of the state of Iowa. Any realized or unrealized income, net gains and
losses from the assets of the Separate Account are credited to or charged
against it without regard to our other income, gains or losses. Assets are put
in the Separate Account for this policy, as well as for other variable annuity
policies. Any Separate Account may invest assets in shares of one or more mutual
fund portfolio, or in the case of a managed Separate Account, direct investments
in stocks or other securities as permitted by law. Fund shares refer to shares
of underlying mutual funds or prorata ownership of the assets held in a
Subaccount of a managed Separate Account. Fund shares are purchased, redeemed
and valued on behalf of the Separate Account.

The Separate Account is divided into Subaccounts. Each Subaccount invests
exclusively in shares of one of the portfolios of an underlying fund. We reserve
the right to add or remove any Subaccount of the Separate Account.

The assets of the Separate Account are our property. These assets will equal or
exceed the reserves and other contract liabilities of the Separate Account.
These assets will not be chargeable with liabilities arising out of any other
business we conduct. We reserve the right, subject to regulations governing the
Separate Account, to transfer assets of a Subaccount, in excess of the reserves
and other contract liabilities with respect to that Subaccount, to another
Subaccount or to our General Account.

We will determine the fair market value of the assets of the Separate Account in
accordance with a method of valuation, which we establish in good faith.
Valuation Period means the period of time from one determination of the value of
each Subaccount to the next. Such determinations are made when the value of the
assets and liabilities of each Subaccount is calculated. This is generally the
close of business on each day on which the New York Stock Exchange is open.

We also reserve the right to transfer assets of the Separate Account, which we
determine to be associated with the class of policies to which this policy
belongs, to another Separate Account. If this type of transfer is made, the term
"Separate Account", as used in the policy, shall then mean the Separate Account
to which the assets were transferred.

We also reserve the right, when permitted by law to:

(a) deregister the Separate Account under the Investment Company Act of 1940;
(b) manage the Separate Account under the direction of a committee at any time;
(c) restrict or eliminate any voting rights of policy owners or other persons
    who have voting rights as to the Separate Account;
(d) combine the Separate Account with one or more other Separate Accounts;
(e) create new Separate Accounts;
(f) add new Subaccounts to or remove existing Subaccounts from the Separate
    Account, or combine Subaccounts; and
(g) add new underlying mutual funds, remove existing mutual funds, or substitute
    a new fund for an existing fund.

V1271                                Page 8

<PAGE>

                              SECTION 6 - CONTINUED

The Net Asset Value of a fund share is the per-share value calculated by the
mutual fund or, in the case of a managed Separate Account, by the Company. The
Net Asset Value is computed by adding the value of the Subaccount's investments,
cash and other assets, subtracting its liabilities, and then dividing by the
number of shares outstanding. Net Asset Values of fund shares reflect investment
advisory fees and other expenses incurred in managing a mutual fund or a managed
Separate Account.

CHANGE IN INVESTMENT OBJECTIVE OR POLICY OF A MUTUAL FUND
If required by law or regulation, an investment policy of the Separate Account
will only be changed if approved by the appropriate insurance official of the
state of Iowa or deemed approved in accordance with such law or regulation. If
so required, the process for obtaining such approval is filed with the insurance
official of the state or district in which this policy is delivered.

CHARGES AND DEDUCTIONS
The Mortality and Expense Risk Fee and the Administrative Charge are each
deducted both before and after the Annuity Commencement Date to compensate for
changes in mortality and expenses not anticipated by the mortality and
administration charges guaranteed in the policy.

The Service Charge is deducted prior to the Annuity Commencement Date only.

If the Mortality and Expense Risk Fee is more than sufficient, the Company will
retain the balance as profit or may reduce this fee in the future.

ACCUMULATION UNITS
The Policy Value in the Separate Account before the Annuity Commencement Date is
represented by accumulation units. The dollar value of accumulation units for
each Subaccount will change from business day to business day reflecting the
investment experience of the Subaccount.

Premium Payments allocated to and any amounts transferred to the Subaccounts
will be applied to provide accumulation units in those Subaccounts. The number
of accumulation units purchased in a Subaccount will be determined by dividing
the amount allocated to or transferred to that Subaccount, by the value of an
accumulation unit for that Subaccount on the premium payment or transfer date.

The number of accumulation units withdrawn or transferred from the Subaccounts
will be determined by dividing the amount withdrawn or transferred by the value
of an accumulation unit for that Subaccount on the Withdrawal or transfer date.

The value of an accumulation unit on any business day is determined by
multiplying the value of that unit at the end of the immediately preceding
valuation period by the net investment factor for the valuation period.

The net investment factor used to calculate the value of an accumulation unit in
each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:

(a)  is the result of:
     (1) the net asset value of a fund share held in that Subaccount determined
         as of the end of the current valuation period; plus
     (2) the per share amount of any dividend or capital gain Distributions made
         by the fund for shares held in that Subaccount if the ex-dividend date
         occurs during the valuation period; plus or minus
     (3) a per share credit or charge for any taxes reserved for, which we
         determine to have resulted from the investment operations of that
         Subaccount.
(b)  is the net asset value of a fund share held in that Subaccount determined
     as of the end of the immediately preceding valuation period.
(c)  is a factor representing the Mortality and Expense Risk Fee and
     Administrative Charge before the Annuity Commencement Date. This factor is
     less than or equal to, on an annual basis, the percentage shown on the
     Policy Data Page of the daily net asset value of a fund share held in that
     Subaccount.

Since the net investment factor may be greater or less than one, the
accumulation unit value may increase or decrease.

VB1271                               Page 9

<PAGE>

                            SECTION 7 - FIXED ACCOUNT

FIXED ACCOUNT
Premium payments applied to and any amounts transferred to the Fixed Account
will reflect a fixed interest rate. The interest rates we set will be credited
for increments of at least one year measured from each premium payment or
transfer date. These rates will never be less than the Fixed Account Guaranteed
Minimum Effective Annual Interest Rate shown on Page 3.

Upon full Surrender of the Policy, the minimum Cash Value provided by the Fixed
Account portion of the Policy Value will be at least 90% of the premium payments
made to the Fixed Account, less prior Withdrawals and transfers from the Fixed
Account, plus interest credited using an Effective Annual Interest Rate of 3%.

GUARANTEED PERIODS
We may offer optional Guaranteed Period Options, into which premium payments may
be paid or amounts transferred. The current interest rate we set for funds
entering each Guaranteed Period Option (GPO) is guaranteed until the end of that
option's Guaranteed Period. At that time, the premium payment made or amount
transferred into the GPO, less any Withdrawals or transfers from that GPO, plus
accrued interest, will be rolled into a new GPO or may be transferred to any
Subaccount(s) within the Separate Account(s).

You may choose the Investment Option(s) You want the funds rolled into by giving
us a written notice within 30 days before the end of the expiring option's
Guaranteed Period. However, any Guaranteed Period elected may not extend beyond
the maximum Annuity Commencement Date defined in Section 11. In the absence of
such election, the funds will be rolled into a new GPO which is the same as the
expiring GPO unless that GPO is no longer offered, in which case, the next
shorter GPO offered will be used. You will be mailed a notice of completion of
the rollover with the new interest rate applicable. The new GPO will be deemed
as accepted if we do not receive a written rejection within 30 days from the
postmark date of the completion notice. We reserve the right for new premium
payments, transfers, or rollovers to offer or not to offer any GPO, except that
we will always offer at least a one-year GPO.

When funds are withdrawn or transferred from a GPO, the Policy Value associated
with the oldest premium payment or rollover is considered to be
withdrawn/transferred first. If the amount withdrawn/transferred exceeds the
Policy Value associated with the oldest premium, the Policy Value associated
with the next oldest premium payment or rollover is considered to be
withdrawn/transferred next, and so on until the Policy Value associated with the
most recent premium payment or rollover is considered to be
withdrawn/transferred (this is a "First-In, First-Out" or FIFO basis).

Partial Withdrawals, Surrenders, transfers, and amounts applied to a Payment
Option from the Guaranteed Period Option(s) are subject to an Excess Interest
Adjustment as described in Section 5.

DOLLAR COST AVERAGING FIXED ACCOUNT OPTION
We may offer a Dollar Cost Averaging (DCA) Fixed Account Option separate from
the Guaranteed Period Options. This option will have a one-year interest rate
guarantee. The current interest rate we set for the DCA Fixed Account may differ
from the rates credited on the one-year GPO in the Fixed Account. In addition,
the current interest rate we credit may vary on different portions of the DCA
Fixed Account. The credited interest rate will never be less than the Fixed
Account Guaranteed Minimum Effective Annual Interest Rate shown on Page 3. The
DCA Fixed Account Option will only be available under a Dollar Cost Averaging
program as described in Section 8.

                              SECTION 8 - TRANSFERS

A.  TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE
Prior to the Annuity Commencement Date, You may transfer the value of the
accumulation units from one Investment Option to another by providing us notice
containing the facts that we need.

Transfers of Policy Value from the Guaranteed Period Options (GPO) of the Fixed
Account prior to the end of that GPO are subject to an Excess Interest
Adjustment. If the Excess Interest Adjustment at the time of such Policy Value
transfer is a negative adjustment, then the maximum Policy Value transfer is 25%
of that GPO's Policy Value, less Policy Values previously transferred out of
that GPO during the current Policy Year.

If the Excess Interest Adjustment at the time of such Policy Value transfer is a
positive adjustment, no maximum will apply to such Policy Values transferred
from the GPO. No Excess Interest Adjustment will apply to Policy Value transfers
at the end of a Guaranteed Period.

Transfers of interest credited in the GPOs to other Investment Options are
allowed on a "First-In, First-Out" basis. Such transfers may be made monthly,
quarterly, semi-annually, or annually. Each such transfer must be at least $50
and will not be subject to an Excess Interest Adjustment.

Transfers of Policy Value from the Separate Account are subject to a minimum of
$500 or the entire Subaccount Policy Value, if less. However, if the remaining
Subaccount Policy Value is less than $500, we reserve the right to include that
amount as part of the transfer.

L998                                 Page 10

<PAGE>

                              SECTION 8 - CONTINUED

You may choose which GPO to transfer to or from, however, any GPO elected may
not extend beyond the maximum Annuity Commencement Date defined in Section 11.

We reserve the right to limit transfers to no more than 12 in any one Policy
Year. Any transfers in excess of 12 per Policy Year may be charged a $10 per
transfer fee. Transfers among multiple Investment Options will be treated as one
transfer in determining the number of transfers that have occurred. We also
reserve the right to prohibit transfers to the Fixed Account if we are crediting
an interest rate equal to the Fixed Account Guaranteed Minimum Effective Annual
Interest Rate shown on Page 3.

The policy was not designed for professional market timing organizations or
other persons that use programmed, large, or frequent transfers. The use of such
transfers may be disruptive to an underlying portfolio. We reserve the right to
reject any transfer request from any person in the interest of overall fund
management or, if, in our judgment, an underlying fund would be unable to invest
effectively in accordance with its investment objectives and policies or would
otherwise be potentially adversely affected or if an underlying fund would
reject our purchase order. We also reserve the right to revoke Your telephone,
fax, and electronic transfer privileges at any time without revoking all owner's
telephone, fax and electronic transfer privileges.

DOLLAR COST AVERAGING OPTION
Prior to the Annuity Commencement Date, You may instruct us to automatically
transfer a specified amount from the Money Market Subaccount or out of the
Dollar Cost Averaging (DCA) Fixed Account Option to any other Subaccount(s) of
the Separate Account. The automatic transfers can occur monthly or quarterly.

Transfers will continue until the elected Subaccount or DCA Fixed Account value
is depleted. The amount transferred each time must be at least $500. All
transfers from the DCA account will be the same amount as the initial transfer.
Changes to the Subaccounts to which these transfers are allocated are not
restricted. Transfers must be scheduled for at least 6, but not more than 24
months or for at least 4, but not more than 8 quarters each time the Dollar Cost
Averaging program is started or restarted following termination of the program
for any reason.

Dollar Cost Averaging results in the purchase of more accumulation units when
the value of the accumulation unit is low, and fewer accumulation units when the
value of the accumulation unit is high. However, there is no guarantee that the
Dollar Cost Averaging program will result in higher Policy Values or will
otherwise be successful.

Dollar Cost Averaging may be discontinued after satisfying the minimum number of
required transfers by sending written notice to us. While Dollar Cost Averaging
is in effect, Asset Rebalancing is not available.

ASSET REBALANCING
Prior to the Annuity Commencement Date, You may instruct us to automatically
transfer amounts among the Subaccounts of the Separate Account on a regular
basis to maintain a desired allocation of the Policy Value among the various
Subaccounts offered. Rebalancing will occur on a monthly, quarterly, semi-annual
or annual basis, beginning on a date selected by You. You must select the
percentage of the Policy Value desired in each of the various Subaccounts
offered (totaling 100%). Any amounts in the Fixed Account are ignored for the
purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at
any time. Asset Rebalancing is not available while Dollar Cost Averaging is in
effect. Rebalancing will cease as soon as we receive a request for any other
transfer.

B.  TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE
After the Annuity Commencement Date, You may transfer the value of the variable
annuity units from one Subaccount to another within the Separate Account or to
the Fixed Account. If You want to transfer the value of the variable annuity
units, You must provide a signed notice, containing the facts that we need. We
reserve the right to limit transfers between the Subaccounts or to the Fixed
Accounts to once per Policy Year.

The minimum amount which may be transferred is the lesser of $10 monthly income
or the entire monthly income of the variable annuity units in the Subaccount
from which the transfer is being made. If the monthly income of the remaining
units in a Subaccount is less than $10, we have the right to include the value
of those variable annuity units as part of the transfer.

After the Annuity Commencement Date, no transfers may be made from the Fixed
Account to any other Investment Options.

LB998                                Page 11

<PAGE>

                           SECTION 9 - DEATH PROCEEDS

A.   DEATH PROCEEDS PRIOR TO ANNUITY COMMENCEMENT DATE
The amount of death proceeds will be the greatest of (a), (b) or (c) where:

(a) is the Policy Value on the date we receive due proof of death and an
    election of a method of settlement;
(b) is the Cash Value on the date we receive due proof of death and an election
    of a method of settlement, and;
(c) is the Guaranteed Minimum Death Benefit (GMDB), if any, plus any additional
    premium payments received, less any Gross Partial Withdrawals from the date
    of death to the date of payment of death proceeds.

If You have not selected a payment option by the date of death, the beneficiary
may make such election within one year of the date we receive due proof of the
owner's or Annuitant's death as described in C below. The beneficiary may elect
to receive the death proceeds as a lump sum payment or may use the death
proceeds to provide any of the annuity Payment Options described in Section 10.
Interest on death proceeds will be paid as required by law.

B.  GUARANTEED MINIMUM DEATH BENEFIT
The amount of the Guaranteed Minimum Death Benefit (GMDB) is based on the death
benefit option shown on the Policy Data Page. You may not change the GMDB option
after the policy is issued.

Option N:    6%/ Monthly Double Enhanced Death Benefit

    This GMDB is equal to the greater of (1) and (2) where:

    (1)  is a 6% Annually Compounding through age 80 Death Benefit, equal to:

         a)  the total premium payments; minus Adjusted Partial Withdrawals, (as
             described below); plus
         b)  Interest accumulated at 6% per annum from the payment or Withdrawal
             date to the earlier of the date of death or the first of any
             Annuitant's 81st birthday.

    (2)  is a Monthly Step-Up through age 80 Death Benefit, equal to:

         a)  the largest Policy Value on the Policy Date or on the policy
             Monthiversary prior to the earlier of the date of death or the
             first of any Annuitant's 81st birthday; plus
         b)  any Premium Payments subsequent to the date of the policy
             Monthiversary with the largest Policy Value; minus
         c)  any Adjusted Partial Withdrawals (as described below), subsequent
             to the date of the policy Monthiversary with the largest Policy
             Value.

Option P:    Return of Premium Death Benefit

    This GMDB is equal to the total premiums paid for this policy, less any
    Adjusted Partial Withdrawals (as described below), as of the date of death.

A partial Withdrawal taken as provided in Section 5 will reduce the Guaranteed
Minimum Death Benefit by an amount referred to as the "Adjusted Partial
Withdrawal". The Adjusted Partial Withdrawal may be a different amount than the
Gross Partial Withdrawal described in Section 5. If at the time of the partial
Withdrawal, the Policy Value is greater than the death proceeds, OR the Gross
Partial Withdrawal is less than a maximum annual amount, the Adjusted Partial
Withdrawal will equal the Gross Partial Withdrawal.

D430                                 Page 12

<PAGE>

                              SECTION 9 - CONTINUED

If the Gross Partial Withdrawal is greater than the maximum annual amount, the
excess amount will be adjusted based on the percentage of Policy Value
withdrawn. The Adjusted Partial Withdrawal may be greater than the Gross Partial
Withdrawal. The Adjusted Partial Withdrawal is equal to the sum of (1) and (2)
where:

    (1) is the amount of the Gross Partial Withdrawal that is less than or
        equal to the maximum annual amount;
    (2) is the adjusted excess Withdrawal amount that is equal to (a) divided
        by (b) multiplied by (c) where:
           (a) is the amount of the excess Withdrawal (that is, the portion of
               the Gross Partial Withdrawal which exceeds the maximum annual
               amount);
           (b) is the Policy Value after the current maximum annual amount has
               been withdrawn, but immediately prior to the Withdrawal of the
               excess portion; and
           (c) is the death proceeds after the maximum annual amount has been
               withdrawn, but prior to Withdrawal of the excess portion.

In any Policy Year, the maximum annual amount will vary based on the death
benefit option chosen. If death benefit Option P is chosen, the maximum annual
amount is equal to zero (all Withdrawal amounts will be adjusted). If death
benefit Option N is chosen, the maximum annual amount is equal to the 6%
Annually Compounding through age 80 portion of the death benefit (Part 1 of
Option N) at the beginning of the Policy Year multiplied by 6%. The maximum
annual amount will be reduced by the sum of all prior Gross Partial Withdrawals
taken during the current Policy Year.

C.    DEATH PRIOR TO ANNUITY COMMENCEMENT DATE
Death proceeds are payable contingent upon the relationships between the owner,
Annuitant, and beneficiary as outlined below. The policy must be Surrendered
upon settlement or on proof of death.

If there is a surviving owner(s), the surviving owner(s) automatically takes the
place of any beneficiary designation.

I.  Annuitant Death

    When we have due proof that the Annuitant died before the Annuity
    Commencement Date, we will provide the death proceeds to the beneficiary. If
    no beneficiary is designated, the owner or owner's estate will become the
    beneficiary.

    a)  Beneficiary is the deceased Annuitant's surviving spouse. The
        beneficiary may elect to continue this policy as owner and Annuitant
        rather than receiving the death proceeds. If the policy is continued, an
        amount equal to the excess, if any, of the Guaranteed Minimum Death
        Benefit over the Policy Value will then be added to the Policy Value.
        This is a one-time only Policy Value adjustment applied at the time the
        policy is continued, and the Guaranteed Minimum Death Benefit will
        continue on as applicable. If the policy is continued, all current
        surrender charges will be waived.

        If this beneficiary elects to have the death proceeds paid, the death
        proceeds must be distributed:

    (1) by the end of 5 years after the date of the deceased Annuitant's death,
        or
    (2) payments must begin no later than one year after the deceased
        Annuitant's death and must be made for a period certain or for this
        beneficiary's lifetime, so long as any period certain does not exceed
        this beneficiary's life expectancy.

    In 1035 exchanges where there are joint Annuitants, the death proceeds will
    only be payable upon the death of the surviving Annuitant.

II. Owner or Joint Owner dies.

    If an owner or joint owner who is also an Annuitant dies, death proceeds
    will be payable according to section I above.

    If an owner or joint owner who is not an Annuitant dies prior to the Annuity
    Commencement Date and before the entire interest in the policy is
    distributed, the successor owner as defined below will become the new owner.
    The person or entity first listed below who is alive or in existence on the
    date of that death will become the successor owner:

    a)        owner or joint owners;
    b)        primary beneficiary;
    c)        contingent beneficiary; or
    d)        owner's estate.

DB430                                Page 13

<PAGE>

                              SECTION 9 - CONTINUED

   If the sole successor owner is the deceased owner's surviving spouse, the
   successor owner may elect to continue this policy rather than receiving the
   Adjusted Policy Value. If the policy is continued, all current surrender
   charges will be waived.

   If the successor owner is a natural person but is not the sole surviving
   spouse, OR if the successor owner is the sole surviving spouse but elects to
   have the Adjusted Policy Value paid, the Adjusted Policy Value must be
   distributed by either a) or b) below:

       a)   by the end of 5 years after the date of the deceased owner's death,
            or

       b)   payments must begin no later than one year after the deceased
            owner's death and must be made for a period certain or for the
            successor owner's lifetime, so long as any period certain does not
            exceed the successor owner's life expectancy.

D. DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE
The death proceeds on or after the Annuity Commencement Date depend on the
payment option selected. If any owner dies on or after the Annuity Commencement
Date, but before the entire interest in the policy is distributed, the remaining
portion of such interest in the policy will be distributed to the owner's
beneficiary at least as rapidly as under the method of distribution being used
as of the date of that owner's death.

E. AN OWNER IS NOT AN INDIVIDUAL
In the case of a non tax-qualified annuity, if any owner or beneficial owner is
not an individual, then for purposes of the federal income tax mandatory
distribution provisions in subsection C or D above, (1) the primary Annuitant
will be treated as the owner of the policy, and (2) if there is any change in
the primary Annuitant, such a change will be treated as the death of the owner.

                          SECTION 10 - ANNUITY PAYMENTS

A. GENERAL PAYMENT PROVISIONS
Payment
If this policy is in force on the Annuity Commencement Date, we will use the
Fixed Account portion and/or the Separate Account portion of the Adjusted Policy
Value to make annuity payments to the Payee under Option 3 and/or 3-V,
respectively, with 10 years certain, or if elected, under one or more of the
other options described in this section. However, the option(s) elected must
provide for lifetime income or income for a period of at least 60 months. You
will become the Annuitant at the Annuity Commencement Date. Payments will be
made at 1, 3, 6 or 12-month intervals. We reserve the right to change the
frequency of payments to avoid making payments of less than $50.00.

Before the Annuity Commencement Date, if the death proceeds become payable or if
You Surrender this policy, we will pay any proceeds in one sum, or if elected,
all or part of these proceeds may be placed under one or more of the options
described in this section. If we agree, the proceeds may be placed under some
other method of payment instead.

Adjusted Age
Payments under Options 3 and 5 and the first payment under Options 3-V and 5-V
are determined based on the adjusted age of the Annuitant. The adjusted age is
the Annuitant's actual age on the Annuitant's nearest birthday, at the Annuity
Commencement Date, adjusted as follows:

     Annuity
Commencement Date              Adjusted Age
-----------------              ------------
   Before 2010               Actual Age
   2010 - 2019               Actual Age minus      1
   2020 - 2026               Actual Age minus      2
   2027 - 2033               Actual Age minus      3
   2034 - 2040               Actual Age minus      4
   After 2040                Determined by us

S1094                                Page 14

<PAGE>

                             SECTION 10 - CONTINUED

Election of Optional Method of Payment
Before the Annuity Commencement Date You can elect or change a Payment Option.
You may elect, in a notice You sign which gives us the facts that we need,
annuity payments that may be either variable, fixed, or a combination of both.
If You elect a combination, You must also tell us what part of the policy
proceeds on the Annuity Commencement Date are to be applied to provide each type
of payment. (You must also specify which Subaccounts.) The amount of a combined
payment will be the sum of the variable and fixed payments. Payments under a
variable Payment Option will reflect the investment performance of the selected
Subaccount of the Separate Account.

Payee
Unless You specify otherwise, the Payee shall be the Annuitant, or the
beneficiary as defined in the Beneficiary provision in Section 11.

Proof of Age
We may require proof of the age of any person who has an annuity purchased under
Options 3, 3-V, 5 and 5-V of this section before we make the first payment.

Minimum Proceeds
If the proceeds are less than $2,000, we reserve the right to pay them out as a
lump sum instead of applying them to a payment option.

Premium Tax
We may be required by law to pay premium tax on the amount applied to a payment
option. If so, we will deduct the premium tax before applying the proceeds.

Supplementary Contract
Once proceeds become payable and a payment option has been selected, we will
issue a supplementary contract to reflect the terms of the selected option. The
contract will name the Payee(s) and will describe the payment schedule.

B.  FIXED ACCOUNT PAYMENTS
Guaranteed Payment Options
The fixed account payment is determined by multiplying each $1,000 of policy
proceeds allocated to a fixed payment option by the amounts shown on page 18 for
the option You select. Options 1, 2 and 4 are based on a guaranteed interest
rate of 3%. Options 3 and 5 are based on a guaranteed interest rate of 3% and
the "Annuity 2000" (male, female, and unisex if required by law) mortality table
projected for improvement using projection scale G. The "Annuity 2000" mortality
rates are adjusted based on improvements in mortality since 2000 to more
appropriately reflect increased longevity. This is accomplished using a set of
improvement factors referred to as projection scale G.

Option 1 - Interest Payments
We will pay the interest on the amount we use to provide annuity payments in
equal payments or this amount may be left to accumulate for a period of time we
and You agree to. We and You will agree on Withdrawal rights when You elect this
option. The interest rate we declare for this option may be different than the
interest rate(s) credited prior to the Annuity Commencement Date.

Option 2 - Income for a Specified Period
We will make level payments only for the fixed period You choose. In the event
of the death of the person receiving payments prior to the end of the fixed
period elected, payments will be continued to that person's beneficiary or their
present value may be paid in a single sum. No funds will remain at the end.

Option 3 - Life Income - You may choose between:
1. No Period Certain - We will make level payments only during the Annuitant's
   lifetime.
2. 10 Years Certain - We will make level payments for the longer of the
   Annuitant's lifetime or ten years.
3. Guaranteed  Return of Policy  Proceeds - We will make level payments for the
   longer of the  Annuitant's  lifetime or until the total dollar amount of
   payments we made to You equals the amount applied to this option.
4. Life with Emergency Cash - We will make level payments during the Annuitant's
   lifetime, but the annuity may be Surrendered (in full or part). The cash
   value is equal to a multiple of the payment where that multiple reduces over
   time to zero at age 101. A surrender charge will be applied. Should the
   Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the
   contract is qualified), the same cash value would be payable, but without the
   surrender charge.

Option 4 - Income of a Specified Amount
Payments are made for any specified amount until the amount applied to this
option, with interest, is exhausted. This will be a series of level payments
followed by a smaller final payment. In the event of the death of the person
receiving payments prior to the time proceeds with interest are exhausted,
payments will be continued to that person's beneficiary or their present value
may be paid in a single sum.

SB1094                               Page 15



<PAGE>

                             SECTION 10 - CONTINUED

Option 5 - Joint and Survivor Annuity - You may choose between:

1.  No Period Certain - Payments are made during the joint lifetime of the
    Payee and a joint Payee of Your selection. Payments will be made as long as
    either person is living.

2.  Life with Emergency Cash - Level payments will be made during the joint
    lifetime of the Payee and a joint Payee of Your selection. Payments will be
    made as long as either person is living, but the annuity may be Surrendered
    (in full or part). The cash value is equal to a multiple of the payment,
    where that multiple reduces over time to zero at age 101 of the younger
    Annuitant. A surrender charge will be applied. Should the last surviving
    Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the
    contract is qualified), the same cash value would be payable, but without
    the surrender charge.

Current Payment Options

The amounts shown in the tables on page 18 are the guaranteed amounts. Current
amounts offered to individuals of the same class may be obtained from us.

C. VARIABLE ACCOUNT PAYMENT OPTIONS
Variable Annuity Units
The policy proceeds You tell us to apply to a variable payment option will be
used to purchase variable annuity units in Your chosen Subaccounts. The dollar
value of variable annuity units in Your chosen Subaccounts will increase or
decrease reflecting the investment experience of Your chosen Subaccounts. The
value of a variable annuity unit in a particular Subaccount on any business day
is equal to (a) multiplied by (b) multiplied by (c), where:

(a) is the variable annuity unit value for that Subaccount on the immediately
    preceding business day;
(b) is the net investment factor for that Subaccount for the Valuation Period;
    and
(c) is the Assumed Investment Return adjustment factor for the Valuation Period.

The Assumed Investment Return adjustment factor for the valuation period is the
product of discount factors of .99986634 per day to recognize the 5.0% effective
annual Assumed Investment Return.

The net investment factor used to calculate the value of a variable annuity unit
in each Subaccount for the Valuation Period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:

(a) is the net result of:
    (1) the net asset value of a fund share held in that Subaccount determined
        as of the end of the current valuation period; plus
    (2) the per share amount of any dividend or capital gain Distributions made
        by the fund for shares held in that Subaccount if the ex-dividend date
        occurs during the Valuation Period; plus or minus
    (3) a per share credit or charge for any taxes reserved for, which we
        determine to have resulted from the investment operations of the
        Subaccount.
(b) is the net asset value of a fund share held in that Subaccount
    determined as of the end of the immediately preceding Valuation Period.
(c) is a factor representing the Mortality and Expense Risk Fee and
    Administrative Charge applicable after the Annuity Commencement Date. This
    factor is less than or equal to, on an annual basis, the percentage shown on
    the Policy Data Page of the daily net asset value of a fund share held in
    the Separate Account for that Subaccount.

Determination of the First Variable Payment
The amount of the first variable payment is determined by multiplying each
$1,000 of policy proceeds allocated to a variable payment option by the amounts
shown on page 20 for the variable option You select. The tables are based on a
5% effective annual Assumed Investment Return and the "Annuity 2000" (male,
female, and unisex if required by law) mortality table projected for improvement
using projection scale G. The "Annuity 2000" mortality rates are adjusted based
on improvements in mortality since 2000 to more appropriately reflect increased
longevity. This is accomplished using a set of improvement factors referred to
as projection scale G.

C852                                 Page 16

<PAGE>

                             SECTION 10 - CONTINUED

Option 3-V - Life Income - You may choose between:

1.  No Period Certain - Payments will be made during the lifetime of the
    Annuitant.
2.  10 Years Certain - Payments will be made for the longer of the Annuitant's
    lifetime or ten years. In the event of the death of the person receiving
    payments prior to the end of the guarantee period for which the election
    was made, payments will be continued to that person's beneficiary or their
    present value may be paid in a single sum.
3.  Life with Emergency Cash - We will make payments during the Annuitant's
    lifetime, but the annuity may be Surrendered (in full or part). The cash
    value is equal to a multiple of the Supportable Payment (see definition
    below), where that multiple reduces over time to zero at age 101. A
    surrender charge will be applied. Should the Annuitant die before age 101
    (or IRS Age Limitation Date if earlier and the contract is qualified), the
    same cash value would be payable, but without the surrender charge.

Option 5-V - Joint and Survivor Annuity - You may choose between:

1.  No Period Certain - Payments are made as long as either the Annuitant or the
    joint Annuitant is living.

2.  Life with Emergency Cash - Payments will be made during the joint lifetime
    of the Payee and a joint Payee of Your selection. Payments will be made as
    long as either person is living, but the annuity may be Surrendered (in full
    or part). The cash value is equal to a multiple of the Supportable Payment
    (see definition below), where that multiple reduces over time to zero at age
    101 of the younger Annuitant. A surrender charge will be applied. Should the
    last surviving Annuitant die before age 101 (or IRS Age Limitation Date if
    earlier and the contract is qualified), the same cash value would be
    payable, but without the surrender charge.

Optional Initial Payment Guarantee
Upon annuitization, You may elect an option that guarantees Your variable
annuity payments will never be less than a percentage of the initial variable
annuity payment. You cannot terminate the payment guarantee after You have
selected the option. The percentage applicable to the initial payment and the
fee for the option will be those currently applicable at the time of
annuitization.

Supportable Payment
The Supportable Payment is the sum of each selected subaccount's variable
annuity unit value times the number of variable annuity units. The variable
annuity units are adjusted to reflect the year-to-date difference between the
stabilized payment and the payment had they not been stabilized. Supportable
Payments are used to determine surrender values, death benefits and transfers.

Determination of Subsequent Variable Payments
The amount of each variable annuity payment after the first will increase or
decrease according to the value of the variable annuity units which reflect the
investment experience of the selected Subaccounts. Each variable annuity payment
after the first will be equal to the number of variable annuity units in the
selected Subaccounts multiplied by the variable annuity unit value on the date
the payment is made. The number of variable annuity units in each selected
Subaccount is determined by dividing the first variable annuity payment
allocated to the Subaccount by the variable annuity unit value of that
Subaccount on the Annuity Commencement Date. If "Life with Emergency Cash" is
chosen (Option 3-V(3) or 5-V(2)), or if the Optional Initial Payment Guarantee
is chosen, payments would be "stabilized" (would change only once per year) but
"value adjustments" would be made to ensure full value would be received.

CB852                                Page 17

<PAGE>

                    GUARANTEED FIXED ACCOUNT PAYMENT OPTIONS

The amounts shown in these tables are the guaranteed amounts for each 1,000 of
      the proceeds. Higher current amounts may be available at the time of
                                  settlement.

<TABLE>
<CAPTION>
------------------------------------------------------------------------------------------------------------------------------------
     Option 2, Table I           Option 3, Table II        Option 3, Table III        Option 3, Table IV       Option 3, Table V
--------- ------------ ----- --------------------------- ------------------------ -------------------------- -----------------------
Number of  Amount of
  Years     Monthly             Monthly Installment For   Monthly Installment For   Monthly Installment For  Monthly Installment for
 Payable  Installment            Life No Period Certain            Life            Life Guaranteed Return Of           Life
                                                            10 Years Certain               Proceeds            With Emergency Cash
--------- ------------ ----- -------- --------- -------- ------- -------- ------- ------- --------- -------- -------- --------------
                        Age    Male     Female   Unisex   Male   Female   Unisex   Male    Female    Unisex   Male    Female Unisex
                        *
--------- ------------ ----- -------- --------- -------- ------- -------- ------- ------- --------- -------- -------- --------------
<S>       <C>          <C>   <C>      <C>       <C>      <C>     <C>      <C>     <C>     <C>       <C>      <C>      <C>     <C>
                        50     $3.82     $3.70   $3.74    $3.80   $3.69    $3.72   $3.70   $3.62     $3.65   $3.57    $3.52   $3.54
                        51      3.89      3.76    3.80     3.86    3.74     3.78    3.75    3.67      3.70    3.62     3.56    3.58
                        52      3.95      3.81    3.86     3.92    3.80     3.84    3.81    3.72      3.75    3.67     3.61    3.63

                        53      4.02      3.88    3.92     3.99    3.86     3.90    3.87    3.78      3.80    3.72     3.65    3.67
    5        17.91      54      4.10      3.94    3.99     4.06    3.92     3.96    3.93    3.83      3.86    3.77     3.70    3.73
    6        15.14      55      4.18      4.01    4.06     4.13    3.99     4.03    3.99    3.89      3.92    3.83     3.76    3.78
    7        13.16      56      4.26      4.08    4.14     4.21    4.06     4.10    4.06    3.95      3.98    3.89     3.81    3.83
    8        11.68      57      4.35      4.16    4.22     4.29    4.13     4.18    4.13    4.02      4.05    3.95     3.87    3.89
    9        10.53      58      4.44      4.24    4.30     4.38    4.21     4.26    4.20    4.08      4.12    4.01     3.93    3.96
    10        9.61      59      4.54      4.33    4.39     4.47    4.29     4.35    4.27    4.16      4.19    4.08     4.00    4.02
    11        8.86      60      4.64      4.42    4.49     4.57    4.38     4.44    4.36    4.23      4.27    4.15     4.06    4.09
    12        8.24      61      4.76      4.52    4.59     4.67    4.47     4.53    4.44    4.31      4.35    4.23     4.14    4.16
    13        7.71      62      4.88      4.63    4.70     4.78    4.57     4.63    4.53    4.39      4.43    4.31     4.21    4.24
    14        7.26      63      5.01      4.74    4.82     4.89    4.67     4.74    4.62    4.48      4.52    4.39     4.29    4.32
    15        6.87      64      5.15      4.86    4.94     5.01    4.78     4.85    4.72    4.57      4.62    4.48     4.38    4.41
    16        6.53      65      5.30      4.98    5.08     5.14    4.89     4.97    4.83    4.67      4.72    4.57     4.47    4.50
    17        6.23      66      5.46      5.12    5.22     5.27    5.02     5.09    4.94    4.78      4.82    4.67     4.56    4.59
    18        5.96      67      5.63      5.27    5.37     5.41    5.14     5.22    5.05    4.89      4.94    4.77     4.66    4.69
    19        5.73      68      5.81      5.42    5.54     5.55    5.28     5.36    5.17    5.00      5.05    4.88     4.77    4.80
    20        5.51      69      6.00      5.59    5.71     5.70    5.42     5.51    5.30    5.13      5.18    4.99     4.88    4.91
                        70      6.21      5.78    5.90     5.86    5.58     5.66    5.43    5.26      5.31    5.12     5.00    5.03
                        71      6.43      5.97    6.11     6.02    5.74     5.82    5.58    5.39      5.45    5.24     5.13    5.16
                        72      6.66      6.19    6.33     6.18    5.90     5.99    5.72    5.54      5.59    5.37     5.26    5.29
                        73      6.91      6.42    6.56     6.35    6.08     6.16    5.88    5.70      5.75    5.51     5.40    5.43
                        74      7.18      6.67    6.82     6.53    6.26     6.34    6.05    5.86      5.92    5.65     5.55    5.58
                        75      7.46      6.94    7.09     6.70    6.45     6.53    6.22    6.04      6.09    5.81     5.70    5.73
                        76      7.77      7.23    7.39     6.88    6.65     6.72    6.40    6.22      6.27    5.97     5.87    5.90
                        77      8.10      7.55    7.71     7.07    6.85     6.91    6.60    6.42      6.47    6.14     6.05    6.08
                        78      8.45      7.89    8.05     7.25    7.05     7.11    6.80    6.63      6.68    6.33     6.24    6.25
                        79      8.83      8.26    8.43     7.43    7.26     7.31    7.01    6.85      6.90    6.52     6.43    6.45
                        80      9.23      8.66    8.83     7.61    7.46     7.51    7.24    7.08      7.13    6.71     6.62    6.65
                        81      9.66      9.10    9.27     7.79    7.66     7.70    7.47    7.33      7.37    6.92     6.84    6.85
                        82     10.13      9.57    9.74     7.97    7.86     7.89    7.72    7.59      7.63    7.13     7.07    7.08
                        83     10.62     10.09   10.24     8.13    8.05     8.07    7.98    7.86      7.90    7.34     7.29    7.30
                        84     11.15     10.64   10.79     8.29    8.23     8.25    8.26    8.15      8.18    7.57     7.55    7.56
                        85     11.72     11.24   11.38     8.44    8.40     8.41    8.55    8.45      8.48    7.81     7.80    7.80
                        86     12.32     11.89   12.02     8.59    8.56     8.56    8.85    8.77      8.80    8.10     8.06    8.06
                        87     12.97     12.59   12.70     8.72    8.70     8.71    9.17    9.11      9.12    8.38     8.37    8.37
                        88     13.65     13.33   13.42     8.84    8.83     8.83    9.50    9.45      9.47    8.67     8.67    8.67
                        89     14.38     14.11   14.19     8.95    8.95     8.95    9.85    9.82      9.83    8.99     8.99    8.99
                        90     15.16     14.94   15.00     9.06    9.05     9.05   10.22   10.19     10.20    9.33     9.33    9.33
                        91     15.97     15.80   15.85     9.15    9.15     9.15   10.61   10.59     10.59    9.76     9.76    9.76
                        92     16.84     16.70   16.74     9.23    9.23     9.23   11.01   11.00     11.00   10.18    10.18   10.18
                        93     17.75     17.63   17.67     9.31    9.31     9.31   11.45   11.42     11.43   10.62    10.61   10.61
                        94     18.72     18.60   18.64     9.37    9.37     9.37   11.92   11.88     11.89   11.07    11.06   11.07
                        95     19.77     19.62   19.66     9.43    9.43     9.43   12.42   12.36     12.38   11.57    11.46   11.47
--------- ------------ ----- -------- --------- -------- ------- -------- ------- ------- --------- -------- -------- --------------
</TABLE>

*Adjusted Age as defined in Section 10.A.

Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.

T890                                Page 18

<PAGE>

                               Option 5, Table VI

                 Monthly Installment For Joint and Full Survivor

<TABLE>
<CAPTION>
------------------ ------------------------------------------------------------------------------------------------------------
     Age of                                                  Age of Female Annuitant*

                   ------------------------------------------------------------------------------------------------------------
      Male            15 Years        12 Years        9 Years         6 Years         3 Years         Same As        3 Years
                      Less Than       Less Than      Less Than       Less Than       Less Than         Male         More Than
   Annuitant*           Male            Male           Male            Male            Male                           Male
------------------ ------------------------------------------------------------------------------------------------------------
<S>                <C>             <C>             <C>            <C>              <C>            <C>             <C>
       50              $3.06           $3.12           $3.19          $3.25            $3.31          $3.38          $3.44
       55               3.20            3.27            3.35           3.44             3.52           3.61           3.69
       60               3.37            3.47            3.57           3.68             3.79           3.91           4.02
       65               3.59            3.72            3.86           4.01             4.16           4.32           4.47
       70               3.88            4.06            4.25           4.45             4.67           4.89           5.11
------------------ --------------- --------------- -------------- ---------------- -------------- --------------- -------------
</TABLE>

             Monthly Installment For Unisex Joint and Full Survivor

<TABLE>
<CAPTION>
------------------ --------------- --------------- -------------- ---------------- -------------- --------------- -------------
     Age of                                                  Age of Joint Annuitant*

                   ------------------------------------------------------------------------------------------------------------
      First          15 Years        12 Years         9 Years        6 Years         3 Years         Same As        3 Years
                     Less Than       Less Than       Less Than      Less Than       Less Than         First        More Than
   Annuitant*          First           First           First          First           First                          First
------------------ ------------------------------------------------------------------------------------------------------------
<S>                <C>             <C>             <C>            <C>              <C>            <C>             <C>
       50              $3.07           $3.13           $3.19          $3.25            $3.31          $3.37          $3.43
       55               3.20            3.28            3.36           3.44             3.52           3.60           3.67
       60               3.38            3.48            3.58           3.68             3.79           3.89           4.00
       65               3.61            3.73            3.87           4.01             4.16           4.30           4.44
       70               3.90            4.07            4.26           4.46             4.66           4.86           5.05
-------------------------------------------------- -------------- ---------------- -------------- --------------- -------------
*Adjusted Age as defined in Section 10.A.
-------------------------------------------------------------------------------------------------------------------------------
</TABLE>

                               Option 5, Table VII
    Monthly Installment for Joint & Full Survivor (Life with Emergency Cash)

<TABLE>
<CAPTION>
------------------ ------------------------------------------------------------------------------------------------------------
     Age of                                                  Age of Female Annuitant*

                   ------------------------------------------------------------------------------------------------------------
      Male            15 Years        12 Years        9 Years         6 Years         3 Years         Same As        3 Years
                      Less Than       Less Than      Less Than       Less Than       Less Than         Male         More Than
   Annuitant*           Male            Male           Male            Male            Male                           Male
------------------ ------------------------------------------------------------------------------------------------------------
<S>                <C>             <C>             <C>            <C>              <C>            <C>             <C>
       50             $3.02           $3.08           $3.13           $3.20           $3.26          $3.32          $3.37
       55              3.14            3.21            3.29            3.36            3.45           3.53           3.59
       60              3.29            3.38            3.48            3.58            3.69           3.80           3.88
       65              3.48            3.60            3.72            3.86            4.00           4.15           4.26
       70              3.72            3.88            4.05            4.23            4.42           4.62           4.77
------------------ --------------- --------------- -------------- ---------------- -------------- --------------- -------------
</TABLE>

 Monthly Installment for Unisex Joint & Full Survivor (Life with Emergency Cash)

<TABLE>
<CAPTION>
------------------ ------------------------------------------------------------------------------------------------------------
     Age of                                                    Age of Joint Annuitant

                   ------------------------------------------------------------------------------------------------------------
      First          15 Years        12 Years        9 Years         6 Years         3 Years        Same as        3 Years
                    Less Than       Less Than       Less Than       Less Than       Less Than        First        More Than
   Annuitant*         First           First           First           First           First                         First
------------------ ------------------------------------------------------------------------------------------------------------
<S>                <C>             <C>             <C>            <C>              <C>            <C>             <C>
       50             $3.02           $3.08           $3.14           $3.20           $3.26          $3.32          $3.36
       55              3.14            3.21            3.29            3.37            3.44           3.52           3.58
       60              3.30            3.39            3.48            3.58            3.68           3.79           3.86
       65              3.49            3.61            3.73            3.86            4.00           4.14           4.24
       70              3.74            3.89            4.06            4.24            4.42           4.60           4.74
------------------ --------------- --------------- -------------- ---------------- -------------- --------------- -------------
*Adjusted Age as defined in Section 10.A.
-------------------------------------------------------------------------------------------------------------------------------
</TABLE>

Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.

TB890                              Page 19

<PAGE>

                            VARIABLE PAYMENT OPTIONS
                       BASED ON ASSUMED INVESTMENT RETURN

  The amounts shown in these tables are the initial payment amounts based on a
        5.0% Assumed Investment Return for each $1,000 of the proceeds.

<TABLE>
<CAPTION>
-----------------------------------------------------------------------------------------------------------------------------------
                      Option 3-V, Table II                     Option 3-V, Table III                  Option 3-V, Table IV
-----------------------------------------------------------------------------------------------------------------------------------
                  Monthly Installment for Life             Monthly Installment for Life           Monthly Installment for Life
                        No Period Certain                        10 Years Certain                      With Emergency Cash
-----------------------------------------------------------------------------------------------------------------------------------
<S>          <C>          <C>           <C>           <C>          <C>           <C>           <C>         <C>          <C>
   Age*           Male       Female        Unisex          Male       Female        Unisex        Male       Female       Unisex
    50           $5.07       $4.93         $4.98          $5.04        $4.92        $4.95        $4.83        $4.76       $4.78
    51            5.13        4.99          5.03           5.09         4.96         5.00         4.87         4.80        4.82
    52            5.19        5.04          5.08           5.15         5.01         5.05         4.92         4.84        4.86
    53            5.26        5.10          5.14           5.21         5.07         5.11         4.96         4.88        4.91
    54            5.33        5.16          5.21           5.27         5.12         5.17         5.01         4.93        4.95
    55            5.40        5.22          5.27           5.34         5.18         5.23         5.06         4.98        5.00
    56            5.48        5.29          5.35           5.41         5.25         5.30         5.12         5.03        5.05
    57            5.57        5.36          5.42           5.49         5.32         5.37         5.18         5.08        5.11
    58            5.66        5.44          5.50           5.57         5.39         5.44         5.24         5.14        5.17
    59            5.75        5.52          5.59           5.66         5.47         5.52         5.31         5.20        5.23
    60            5.85        5.61          5.68           5.75         5.55         5.61         5.37         5.26        5.29
    61            5.97        5.70          5.78           5.85         5.63         5.70         5.45         5.33        5.37
    62            6.09        5.81          5.89           5.95         5.72         5.79         5.53         5.40        5.44
    63            6.21        5.91          6.00           6.06         5.82         5.89         5.61         5.48        5.52
    64            6.35        6.03          6.13           6.17         5.92         6.00         5.70         5.56        5.60
    65            6.50        6.16          6.26           6.29         6.03         6.11         5.79         5.65        5.69
    66            6.66        6.29          6.40           6.42         6.15         6.23         5.89         5.75        5.79
    67            6.83        6.43          6.55           6.55         6.27         6.36         6.00         5.85        5.89
    68            7.01        6.59          6.71           6.69         6.40         6.49         6.11         5.96        6.00
    69            7.21        6.76          6.89           6.83         6.54         6.63         6.23         6.07        6.12
    70            7.41        6.94          7.08           6.98         6.69         6.77         6.36         6.20        6.25
    71            7.63        7.14          7.28           7.13         6.84         6.93         6.49         6.33        6.38
    72            7.87        7.35          7.50           7.28         7.00         7.09         6.63         6.46        6.52
    73            8.12        7.58          7.74           7.45         7.17         7.25         6.78         6.62        6.66
    74            8.39        7.83          8.00           7.61         7.34         7.42         6.94         6.78        6.83
    75            8.68        8.11          8.28           7.78         7.52         7.60         7.11         6.95        7.00
    76            8.99        8.40          8.58           7.95         7.71         7.78         7.29         7.13        7.18
    77            9.32        8.72          8.90           8.12         7.90         7.97         7.47         7.33        7.36
    78            9.68        9.07          9.25           8.29         8.09         8.16         7.68         7.52        7.57
    79           10.06        9.45          9.63           8.47         8.29         8.34         7.88         7.74        7.79
    80           10.47        9.85         10.04           8.64         8.48         8.53         8.11         7.98        8.01
    81           10.91       10.30         10.48           8.80         8.67         8.71         8.34         8.23        8.26
    82           11.38       10.78         10.96           8.97         8.86         8.89         8.60         8.48        8.53
    83           11.88       11.30         11.47           9.12         9.04         9.06         8.84         8.75        8.77
    84           12.42       11.87         12.03           9.27         9.21         9.23         9.09         9.01        9.05
    85           12.99       12.48         12.63           9.41         9.37         9.38         9.35         9.31        9.32
    86           13.60       13.13         13.27           9.54         9.51         9.52         9.67         9.60        9.61
    87           14.26       13.84         13.96           9.67         9.65         9.65         9.96         9.90        9.91
    88           14.95       14.59         14.70           9.78         9.77         9.77        10.28        10.27       10.27
    89           15.69       15.39         15.48           9.89         9.88         9.88        10.61        10.61       10.61
    90           16.47       16.23         16.30           9.98         9.98         9.98        10.97        10.97       10.97
    91           17.29       17.10         17.16          10.07        10.07        10.07        11.36        11.36       11.36
    92           18.16       18.01         18.05          10.15        10.15        10.15        11.86        11.85       11.85
    93           19.07       18.95         18.98          10.22        10.22        10.22        12.33        12.32       12.32
    94           20.05       19.92         19.96          10.28        10.28        10.28        12.94        12.93       12.93
    95           21.09       20.94         20.99          10.34        10.33        10.33        13.47        13.45       13.46
-----------------------------------------------------------------------------------------------------------------------------------
</TABLE>

 *Adjusted Age as defined in Section 10.A.

 Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
 shown in the above tables will be calculated on the same basis as those shown
 and may be obtained from the Company.

 H994                                Page 20

<PAGE>

                               Option 5V, Table V

                 Monthly Installment For Joint and Full Survivor


<TABLE>
<CAPTION>
------------------ --------------------------------------------------------------------------------------------------------------
     Age of                                                  Age of Female Annuitant*

                   --------------------------------------------------------------------------------------------------------------
      Male            15 Years        12 Years        9 Years         6 Years         3 Years         Same As      3 Years More
                   Less Than Male  Less Than Male    Less Than    Less Than Male     Less Than         Male          Than Male
   Annuitant*                                          Male                            Male
------------------ --------------------------------------------------------------------------------------------------------------
<S>                <C>             <C>               <C>          <C>                <C>             <C>           <C>
       50              $4.37           $4.42           $4.46          $4.51            $4.56          $4.62            $4.67
       55               4.48            4.54            4.60           4.67             4.74           4.81             4.88
       60               4.62            4.70            4.79           4.88             4.98           5.08             5.18
       65               4.81            4.92            5.04           5.17             5.31           5.46             5.61
       70               5.07            5.23            5.40           5.59             5.79           6.00             6.22
------------------ --------------- --------------- -------------- ---------------- -------------- ---------------- --------------
</TABLE>

             Monthly Installment For Unisex Joint and Full Survivor

<TABLE>
<CAPTION>
------------------ --------------------------------------------------------------------------------------------------------------
     Age of                                                  Age of Joint Annuitant*

                   --------------------------------------------------------------------------------------------------------------
      First          15 Years        12 Years         9 Years         6 Years         3 Years         Same As      3 Years More
                     Less Than       Less Than       Less Than    Less Than First    Less Than         First        Than First
   Annuitant*          First           First           First                           First
------------------ --------------------------------------------------------------------------------------------------------------
<S>                <C>             <C>               <C>          <C>                <C>             <C>           <C>
       50              $4.38           $4.42           $4.47          $4.51            $4.56          $4.61            $4.66
       55               4.48            4.54            4.60           4.67             4.73           4.80             4.87
       60               4.63            4.70            4.79           4.88             4.97           5.07             5.16
       65               4.82            4.93            5.05           5.17             5.30           5.44             5.57
       70               5.09            5.24            5.41           5.59             5.78           5.97             6.16
-------------------------------------------------- -------------- ---------------- -------------- ---------------- --------------
*Adjusted Age as defined in Section 10.A
-------------------------------------------------- -------------- ---------------- -------------- ---------------- --------------
</TABLE>


                               Option 5V, Table VI

   Monthly Installment For Joint and Full Survivor (Life with Emergency Cash)


<TABLE>
<CAPTION>
------------------ --------------------------------------------------------------------------------------------------------------
     Age of                                                  Age of Female Annuitant*

                   --------------------------------------------------------------------------------------------------------------
      Male            15 Years        12 Years        9 Years         6 Years         3 Years         Same As      3 Years More
                   Less Than Male  Less Than Male    Less Than    Less Than Male     Less Than         Male          Than Male
   Annuitant*                                          Male                            Male
------------------ --------------------------------------------------------------------------------------------------------------
<S>                <C>             <C>               <C>          <C>                <C>             <C>           <C>
       50              $4.34           $4.38           $4.42          $4.47            $4.51          $4.57            $4.61
       55               4.43            4.48            4.54           4.60             4.67           4.74             4.79
       60               4.55            4.62            4.70           4.78             4.88           4.97             5.05
       65               4.71            4.80            4.91           5.03             5.16           5.30             5.41
       70               4.92            5.05            5.21           5.38             5.56           5.76             5.91
------------------ --------------- --------------- -------------- ---------------- -------------- ---------------- --------------
</TABLE>

   Monthly Installment For Unisex Joint and Full Survivor (Life with emergency
                                     Cash)

<TABLE>
<CAPTION>
------------------ --------------------------------------------------------------------------------------------------------------
     Age of                                                  Age of Joint Annuitant*

                   --------------------------------------------------------------------------------------------------------------
      First          15 Years        12 Years         9 Years         6 Years         3 Years         Same As      3 Years More
                     Less Than       Less Than       Less Than    Less Than First    Less Than         First        Than First
   Annuitant*          First           First           First                           First
------------------ --------------------------------------------------------------------------------------------------------------
<S>                <C>             <C>               <C>          <C>                <C>             <C>           <C>
       50              $4.34           $4.38           $4.42          $4.47            $4.51          $4.56            $4.60
       55               4.43            4.48            4.54           4.60             4.67           4.73             4.78
       60               4.55            4.62            4.70           4.78             4.87           4.96             5.03
       65               4.71            4.81            4.92           5.03             5.16           5.29             5.38
       70               4.93            5.07            5.22           5.38             5.56           5.74             5.87
-------------------------------------------------- -------------- ---------------- -------------- ---------------- --------------
*Adjusted Age as defined in Section 10.A
-------------------------------------------------- -------------- ---------------- -------------- ---------------- --------------
</TABLE>


 Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
 shown in the above tables will be calculated on the same basis as those shown
 and may be obtained from the Company.

 J994                                Page 21

<PAGE>

                         SECTION 11 - GENERAL PROVISIONS

THE CONTRACT
The entire contract consists of this policy, and endorsements, if any.

MODIFICATION OF POLICY
No change in this policy is valid unless made in writing by us and approved by
one of our officers. No Registered Representative has authority to change or
waive any provision of Your policy.

TAX QUALIFICATION
This policy is intended to qualify as an annuity contract for federal income tax
purposes. The provisions of this policy are to be interpreted to maintain such
qualification, notwithstanding any other provisions to the contrary. To maintain
such tax qualification, we reserve the right to amend this policy to reflect any
clarifications that may be needed or are appropriate to maintain such tax
qualification or to conform this policy to any applicable changes in the tax
qualification requirements. We will send You a copy in the event of any such
amendment. If You refuse such an amendment it must be by giving us written
notice, and Your refusal may result in adverse tax consequences.

NON-PARTICIPATING
This policy will not share in our surplus earnings.

AGE OR SEX CORRECTIONS
If the age or sex of the Annuitant has been misstated, the benefits will be
those, which the premiums paid, would have purchased for the correct age and
sex. If required by law to ignore differences in the sex of the Annuitant, the
annuity payments will be determined using the unisex factors in Section 10.

Any underpayment made by us will be paid with the next payment. Any overpayment
made by us will be deducted from future payments. Any underpayment or
overpayment, will include interest at 5% per year, from the date of the wrong
payment to the date of the adjustment.

INCONTESTABILITY
This policy shall be incontestable from the Policy Date.

EVIDENCE OF SURVIVAL
We have the right to require satisfactory evidence that a person was alive if a
payment is based on that person being alive. No payment will be made until we
receive the evidence.

SETTLEMENT
Any payment by us under this policy is payable at our Home Office.

RIGHTS OF OWNER
The owner may, while the Annuitant is living:
  1.  Assign this policy.
  2.  Surrender the policy to us.
  3.  Amend or modify the policy with our consent.
  4.  Receive annuity payments or name a Payee to receive the payments.
  5.  Exercise, receive and enjoy every other right and benefit contained in the
      policy.

The use of these rights may be subject to the consent of any assignee or
irrevocable beneficiary; and of the spouse in a community or marital property
state.

Unless we have been notified of a community or marital property interest in this
policy, we will rely on our good faith belief that no such interest exists and
will assume no responsibility for inquiry.

SUCCESSOR OWNER
A successor owner will be the new owner as described in Section 9, C, II.

CHANGE OF OWNERSHIP
In the case of a non-tax-qualified annuity, You can change the owner of this
policy, from yourself to a new owner, in a notice You sign which gives us the
facts that we need. When this change takes effect, all rights of ownership in
this policy will pass to the new owner.

A change of owner will not be effective until it is recorded in our records.
After it has been so recorded, the change will take effect as of the date You
signed the notice. However, if the Annuitant dies before the notice has been so
recorded, it will not be effective as to those proceeds we have paid before the
change was recorded in our records.

We may require that the change be endorsed in the policy. Changing the owner
does not change the beneficiary or the Annuitant.

A change of ownership may result in adverse tax consequences.

ANNUITY COMMENCEMENT DATE
The Annuity Commencement Date is the date annuity payments begin. This date may
not be later than the last day of the policy month starting after the Annuitant
attains age 85, except as expressly allowed by us (within state restrictions),
but in no event later than the last day of the policy month following the month
in which the Annuitant attains age 95. You may change the Annuity Commencement
Date at any time before the Annuity Commencement Date by giving us 30 days'
written notice.

R141                                 Page 22



<PAGE>

                             SECTION 11 - CONTINUED

ASSIGNMENT
(a)  In the case of a non tax-qualified annuity, this Policy may be assigned.
     The assignment must be in writing and filed with us.

(b)  We assume no responsibility for the validity of any assignment. Any claim
     made under an assignment shall be subject to proof of interest and the
     extent of the assignment.

(c)  This policy may be applied for and issued to qualify as a tax-qualified
     annuity under certain sections of the Internal Revenue Code. Ownership of
     this policy is then restricted so that it will comply with provisions of
     the Internal Revenue Code.

Assignment of this policy may result in adverse tax consequences.

BENEFICIARY
Death proceeds, when payable in accordance with Section 9, are payable to the
designated beneficiary or beneficiaries. Such beneficiary(ies) must be named and
may be changed without consent (unless irrevocably designated or required by
law) by notifying us in writing on a form acceptable to us. The change will take
effect upon the date You sign it, whether or not You are living when we receive
it. The notice must have been postmarked (or show other evidence of delivery
that is acceptable to us) on or before the date of death. Your most recent
change of beneficiary notice will replace any prior beneficiary designations. No
change will apply to any payment we made before the written notice was received.
If an irrevocable beneficiary dies, You may designate a new beneficiary.

You may direct that the beneficiary shall not have the right to withdraw, assign
or commute any sum payable under an option. In the absence of such election or
direction, the beneficiary may change the manner of payment or make an election
of any option.

If any primary or contingent beneficiary dies before the Annuitant, that
beneficiary's interest in this policy ends with that beneficiary's death. Only
those beneficiaries living at the time of the Annuitant's death will be eligible
to receive their share of the death proceeds. In the event no primary or
contingent beneficiaries have been named and all primary beneficiaries have died
before the death proceeds become payable, the owner(s) will become the
beneficiary(ies) unless elected otherwise in accordance with Section 9. If both
primary and contingent beneficiaries have been named, payment will be made to
the named primary beneficiaries living at the time the death proceeds become
payable. If there is more than one beneficiary and You failed to specify their
interest, they will share equally. Payment will be made to the named contingent
beneficiary(ies) only, if all primary beneficiaries have died before the death
proceeds become payable. If any primary beneficiary is alive at the time the
death proceeds become payable, but dies before receiving their payment, their
share will be paid to their estate.

PROTECTION OF PROCEEDS
Unless You so direct by filing written notice with us, no beneficiary may assign
any payments under this policy before the same are due. To the extent permitted
by law, no payments under this policy will be subject to the claims of creditors
of any beneficiary.

DEFERMENT
We will pay any partial Withdrawals or Surrender proceeds from the Separate
Account within 7 days after we receive all requirements that we need. However,
it may happen that the New York Stock Exchange is closed for trading (other than
the usual weekend or holiday closings), or the Securities and Exchange
Commission restricts trading or determines that an emergency exists. If so, it
may not be practical for us to determine the investment experience of the
Separate Account. In that case, we may defer transfers among the Subaccounts and
to the Fixed Account, and determination or payment of partial Withdrawals or
Surrender proceeds.

When permitted by law, we may defer paying any partial Withdrawals or Surrender
proceeds from the Fixed Account for up to 6 months from the date we receive Your
request. If the owner dies after the request is received, but before the request
is processed, the request will be processed before the death proceeds are
determined. Interest will be paid on any amount deferred for 30 days or more.
This rate will be the Fixed Account Guaranteed Minimum Effective Annual Interest
Rate shown on Page 3, unless otherwise required by law.

REPORTS TO OWNER
We will give You an annual report at least once each Policy Year. This report
will show the number and value of the accumulation units held in each of the
Subaccounts as well as the value of the Fixed Account. It will also give You the
Death Benefit, Cash Value, and any other facts required by law or regulation.

RB141                                Page 23

<PAGE>

            [LETTERHEAD OF TRANSAMERICA LIFE INSURANCE COMPANY]
[LOGO](R)   A Stock Company  (Hereafter called the Company, we, our or us)

                                      INDEX

                                                                            Page

Accumulation Units ..............................................              9
Adjusted Policy Value ...........................................              5
Age or Sex Corrections ..........................................             22
Annuity Commencement Date .......................................             22
Annuity Payments ................................................             14
Assignment ......................................................             23
Beneficiary .....................................................             23
Cash Value ......................................................              5
Contract ........................................................             22
Death Proceeds ..................................................     12, 13, 14
Definitions .....................................................              2
Dollar Cost Averaging Option ....................................             11
Evidence of Survival ............................................             22
Fixed Account ...................................................             10
Guaranteed Minimum Death Benefit ................................             12
Guaranteed Return of Fixed Account Premium Payments .............              8
Guaranteed Periods ..............................................             10
Incontestability ................................................             22
Modification of Policy ..........................................             22
Non-participating ...............................................             22
Option to Change Annuity Commencement Date ......................             22
Partial Withdrawals .............................................              6
Payee ...........................................................             15
Payment of Premiums .............................................              4
Payment Option Tables ........................................... 18, 19, 20, 21
Policy Data Page ................................................              3
Policy Value ....................................................              4
Premium Enhancement .............................................              4
Proof of Age ....................................................             15
Protection of Proceeds ..........................................             23
Right to Cancel .................................................              1
Rights of Owner .................................................             22
Separate Account ................................................           8, 9
Service Charge ..................................................              5
Settlement ......................................................             22
Surrender Charges ...............................................              8
Transfers .......................................................         10, 11


                   Flexible Premium Deferred Variable Annuity
                   Income Payable At Annuity Commencement Date
            Benefits Based On The Performance Of The Separate Account
             Are Variable And Are Not Guaranteed As To Dollar Amount
                            (See Sections 6 and 10C)
                                Non-Participating

Y740