Exhibit 4(a)



 EXHIBIT 4(a) 
 FORM OF POLICY 








			
	 




 A Stock Company (Hereafter called the Company, we, our or us)
	 	 Administrative and Home Office:

4333 Edgewood Road N.E.

Cedar Rapids, Iowa 52499

(319) 355-8511

www.transamericaannuities.com


 READ YOUR POLICY CAREFULLY 

This policy is a legal contract between the Owner and Transamerica Life Insurance Company issued in consideration of the payment of an
initial premium. 
 Amounts withdrawn or Surrendered may be subject to an excess interest adjustment reflecting changes in
interest rates. The excess interest adjustment may result in both upward and downward adjustments in partial withdrawals, Surrender benefits or amounts available for annuitizations, as applicable. The value held in the Separate Account may increase
or decrease in value. Policy Value and benefits based on Separate Account assets are not guaranteed and will decrease and increase with investment experience. 
 We agree to provide annuity payments, to pay withdrawal or Surrender benefits, or to pay death proceeds in accordance with this policy, as applicable. 

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

 RIGHT TO CANCEL 
 You may cancel this policy by delivering or mailing a written notice in Good Order to us or Your registered representative. You must return the policy to us before close of business on the 10th 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 Premium Payments paid less prior withdrawals, if any, plus or minus the accumulated gains or losses, if any, in the Separate Account on the date of the
cancellation, unless otherwise required by law. 
 If this policy is a replacement of another annuity or life insurance policy,
the Right to Cancel period is extended to 30 days. 
 Any questions or complaints pertaining to this policy may be directed to
our Administrative Office. You may contact the State Department of Insurance at XXX-XXX-XXXX. 
 Signed for us at our home
office. 
  

							
		 	



    	  	    



	  	
		 	SECRETARY    	  	  PRESIDENT	  	

 Flexible Premium Deferred Variable Annuity 

With Excess Interest Adjustment 
 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 7 and 10)

 Non-Participating 

  

			
	ICC12 VA(2)0513	  	Page 1









 TABLE OF CONTENTS 

 

					
	 Definitions
	  	 	3	  
		
	 Policy Data Pages
	  	 	5	  
		
	 General Provisions
	  	 	6	  
		
	 Premium Payments
	  	 	9	  
		
	 Cash Value and Withdrawals
	  	 	9	  
		
	 Policy Value
	  	 	12	  
		
	 Separate Account
	  	 	12	  
		
	 Transfers
	  	 	14	  
		
	 Death Proceeds
	  	 	16	  
		
	 Income Options
	  	 	18	  
		
	 Fixed Account
	  	 	21	  
		
	 Income Option Tables
	  	 	22	  


  

			
	ICC12 VA(2)0513	  	Page 2









 SECTION 1 – DEFINITIONS 

Adjusted Policy Value – The Policy Value increased or decreased by any applicable excess interest adjustment. This value may
be used to fund one of the income options. 
 Annuitant – The person on whose life any annuity payments involving
life contingencies will be based. 
 Annuity Commencement Date – The date an income option has been selected, all
necessary paperwork is in Good Order, and the Company has issued a supplementary contract. In no event can this date be earlier than the third Policy Anniversary, or later than the last day of the month following the month in which the Annuitant
attains age 99. You may elect an Annuity Commencement Date at any time by giving the Company 30 days written notice. If You do not elect an Annuity Commencement Date prior to the last available Annuity Commencement Date, annuity payments will begin
as outlined in Section 10. 
 Cash Value –The amount as defined in Section 5 that is available for
Surrender. 
 Commissioner - The primary Insurance Regulator for the State in which this policy has been issued.

 DCA Source Account - The Money Market Subaccount and/or other Subaccount(s) as identified by the Company and the DCA
Fixed Account Option, if offered, which are permitted to be used in conjunction with Dollar Cost Averaging. 
 Decedent -
The deceased Annuitant or Owner. 
 Earnings – An amount equal to the Policy Value at the time a withdrawal or
Surrender is made, minus the sum of all Premium Payments, reduced by all prior withdrawals deemed to have been from premium, if any. 
 Fixed Account Guaranteed Minimum Effective Annual Interest Rate – If the Fixed Account is offered, the minimum guaranteed credited rate used to determine the Fixed Account portion of Your
Policy Value prior to the Annuity Commencement Date. This rate will apply for the life of the policy and is shown in Section 2 - Policy Data. 
 Good Order – The receipt by the Company, at our Administrative Office, of all information, documentation, instructions and/or Premium Payment deemed necessary by the Company, in its sole
discretion, to issue the policy or execute any transaction pursuant to the terms of the policy. 
 Guaranteed Period Option
or GPO – An Investment Option offered within the Fixed Account which credits a guaranteed interest rate for a specified period of time. 
 Investment Options – Any of the Subaccounts of the Separate Account and any of the options of the Fixed Account, if offered. 

IIPRC – The Interstate Insurance Product Regulation Commission. 

Market Day – Any day and for so long as the New York Stock Exchange is open for business. 

Minimum Nonforfeiture Interest Rate - The interest rate shown in Section 2 - Policy Data which is used to determine the
Minimum Required Cash Value as defined in the nonforfeiture law. This rate is not the credited rate used to determine Your policy’s Cash Value. 
 Minimum Required Cash Value – The minimum amount we will pay You on Surrender, which is equal to the sum of (1) and (2), where: 

	 	(1)	 Is the Fixed Account portion of the Minimum Required Cash Value, equal to 87.5% of premiums and transfers to the Fixed Account, less prior requested
withdrawals and transfers from the Fixed Account, less a $50 deduction at the beginning of each Policy Year, all accumulated at the Minimum Nonforfeiture Interest Rate shown in Section 2 - Policy Data; and 



	 	(2)	 Is the Separate Account portion of the Policy Value. 



  

			
	ICC12 VA(2)0513	  	Page 3









 Owner – The person who may exercise all rights and privileges under the policy.

 Policy Anniversary – The anniversary of the Policy Date for each year the policy remains in force. If a certain
date does not exist in a given month, the first day of the following month will be used. 
 Policy Date – The date,
shown in Section 2 - Policy Data, on which this policy becomes effective. 
 Policy Value – The amount
described in Section 6, which represents the value of Your Investment Options. 
 Policy Year – The 12-month
period following the Policy Date shown in Section 2 - Policy Data. The first Policy Year starts on the Policy Date. Each subsequent Policy Year starts on the anniversary of the Policy Date. 

Premium Payment – An amount paid to us by or on behalf of an Owner, as consideration for the benefits provided under this
policy. 
 Separate Account – The separate investment account(s) established by us, under the Investment Company Act
of 1940, as amended (the “1940 Act”), to which Premium Payments under the policy may be allocated. 
 Subaccount
– A division within the Separate Account, the assets of which are invested in a specified underlying fund portfolio. 

Surrender – A full withdrawal of Cash Value and termination of this policy. 

Valuation Period - The period of time from one determination of the value of each Subaccount to the next. Such determinations are
made when the values of the assets and liabilities of each Subaccount are calculated. This is generally the close of business on each Market Day. 
 You, Your – The Owner of this policy. Unless otherwise specified, the Annuitant and the Owner shall be the same person. If a joint Owner is named, reference to “You” or
“Your” in this policy will apply to both the Owner and any joint Owner. 

  

			
	ICC12 VA(2)0513	  	Page 4









 SECTION 2 – POLICY DATA 

Policy Information 
  

			
	  
 Policy Number:
  
	 	12345
	  

Policy Date:

 
	 	May 1, 2013
	  

Income Tax Status of the Policy:
  
	 	Non-Qualified
	  

Initial Premium Payment:

 
	 	$5,000.00
	 Last
Available Annuity
 Commencement Date:
	 	May 31, 2077
	  

Death Benefit Option:

 
	 	Policy Value


Annuitant(s) Information 
  

			
	  
 Annuitant(s):
  
	 	 John
Doe

	  

Primary Annuitant’s Issue Age/Sex:

 
	 	 35 /
Male


 Owner(s) Information 

 

			
	  
 Owner(s):
  
	 	John Doe
	  

Primary Owner’s Issue Age/Sex:
  
	 	35 / Male


Rate Information for Fixed Account, if offered 
  

			
	Fixed Account Guaranteed Minimum Effective Annual Interest Rate:*	 	0.25%
	Minimum Nonforfeiture Interest Rate:**	 	1.00%

 *This rate applies for the life of the policy. 
 **This rate applies for the life of the policy. This rate is used in the calculation of Your Minimum Required Cash Value. Your Minimum Required Cash Value reflects a 12.50% reduction in premiums and
transfers to the Fixed Account and a $50 annual expense allowance. See the definition of Minimum Required Cash Value for the details of this calculation. 
 Regarding the Excess Interest Adjustment (EIA) feature: 

	 	a.	 The guaranteed elements used to determine any EIA are the minimum guaranteed and current declared interest rates applicable to the Fixed Account;




	 	b.	 Declared interest rates used in computing any EIA may change from time to time (subject to Fixed Account Guaranteed Minimum Effective Annual
Interest Rate), which may affect the benefits available under Your policy; and 



	 	c.	 The U.S. Treasury rate may be used as a substitute for the current declared interest rate in the EIA formula as specified in Your policy.




  

			
	ICC12 PD(2)0513	  	Page 5(a)










 SECTION 2 – POLICY DATA (continued) 

 

 Minimum Premium Payments 

 

					
	 Minimum Initial Premium

Payment:
	 	
Non-Qualified - $5,000
 Qualified -
$1,000

	 	 
	 Minimum
Subsequent Premium
 Payment:
	 	$50


Maximum Premium Payments (without prior Company Approval) 

 

					
	 	 	  
 Issue Age 0-80*
  
	  	  

Issue Age 81+*
  

	 Total during
the 1st Policy
 Year:
	 	$1,000,000	  	$500,000
	 Total during
each Policy Year
 After 1st Policy Anniversary:
	 	 Non-qualified - $25,000

Qualified - Lesser of $60,000 or IRS Contribution limit
	  	 Non-qualified - $25,000

Qualified - Lesser of $60,000 or IRS Contribution limit

	 Cumulative
Maximum Premiums -
 Life of Policy:
	 	$1,000,000	  	$500,000


* Issue Age is the greater of the Owner(s)’ or Annuitant(s)’ age. 
 Mortality and Expense Risk Fee and Administrative Charge 
  

					
	 Before the Annuity
 Commencement Date:
	 	0.45%
	 After the
Annuity
 Commencement Date:
	 	0.45%

 The amount paid on Surrender will never be less than the greater of the following amounts: 

	 	a.	Cash Value described in Section 5; and 


	 	b.	Minimum Required Cash Value. 


  

			
	ICC12 PD(2)0513	  	Page 5(b)










 SECTION 2 – POLICY DATA (continued) 

 

 Service Charge 

 

			
	Service Charge at the Time of Issue:	 	$35
	Maximum Annual Service Charge:	 	$50

 The Company may waive some or all of Your service charge each year based on Your Policy Value, Premium Payments made or
active participation in specific online or e-delivery service programs at the time a service charge is assessed. 
  

	1.	If Your Policy Value or sum of Premium Payments minus all withdrawals equals or exceeds: 


$50,000 = up to a $35 fee waiver 
 $250,000 = up to a $50 fee waiver 
  

	2.	Enrollment in specific online or e-delivery service programs may result in up to a $15 fee waiver. 


Transfer Minimums and Charges Before the Annuity Commencement Date 

 

			
	 Transfers Allowed Without

Charges in any One Policy Year:
	 	12
	 Charges
After Allowable
 Transfers in any One Policy Year:
	 	$10
	 Minimum
Transfer
 Amount from a Subaccount:
	 	$500 or the entire Subaccount Policy Value, if less
	 Minimum
Transfer
 Amount from a GPO:
	 	$50


Fixed Account Transfer Maximum Before the Annuity Commencement Date 

 

			
	Maximum Transfer from the GPO when EIA has no Impact or a Positive Impact:	 	100% of the GPO’s Value
	Maximum Transfer from the GPO when EIA has a Negative
Impact:	 	25% of the GPO’s
Value

 Dollar Cost Averaging (DCA) 

 

			
	DCA Source Account Minimum:	 	$3,000
	 Minimum
Amount
 of each Transfer:
	 	$500
	 Minimum
Time
 DCA can be Scheduled:
	 	6 months
	 Maximum
Time
 DCA can be Scheduled:
	 	24 months


  

			
	ICC12 PD(2)0513	  	Page 5(c)










 SECTION 2 – POLICY DATA (continued) 

 

 Fund Facilitation Fee 
 A Fund Facilitation Fee may be charged in addition to any policy fees and charges, and will be used in the calculation of net investment factor as described in Section 7 of the policy. The Fund
Facilitation Fee will only be charged when money is allocated to one of the Subaccounts listed with a Fund Facilitation Fee. The Fund Facilitation Fee is an annualized percentage taken from the daily net asset values of a fund share held in that
Subaccount. 
 We may update Fund Facilitation Fee funds and charge up to the maximum of 0.30% for Subaccounts made available
subsequent to the Policy Date. The Subaccount(s) as of Your Policy Date which include this fee are listed below with the current fee noted after the Subaccount name. 
 Initial Investment Options: 
  

			
	 Fixed Account(s) :
	  	TA BlackRock Tactical Allocation
	 1 Year Fixed Guaranteed Period
	  	TA Clarion Global Real Estate Securities
	 3 Year Fixed Guaranteed Period
	  	TA Efficient Markets
	 5 Year Fixed Guaranteed Period
	  	(Investing in Vanguard®ETFs
and
	 7 Year Fixed Guaranteed Period
	  	Dimensional Fund Advisors Mutual Funds)
		  	TA Hanlon Income
	 Subaccounts:
	  	TA International Moderate Growth
	 AllianceBernstein Balanced Wealth Strategy
	  	TA Janus Balanced
	 Portfolio (0.20%)
	  	TA JPMorgan Core Bond
	 American Funds - Asset Allocation Fund (0.30%)
	  	TA JPMorgan Enhanced Index
	 American Funds - Bond Fund (0.30%)
	  	TA JPMorgan Mid Cap Value
	 American Funds - Growth Fund (0.30%)
	  	TA JPMorgan Tactical Allocation
	 American Funds - Growth - Income Fund (0.30%)
	  	TA Jennison Growth
	 American Funds - International Fund (0.30%)
	  	TA Legg Mason Dynamic Allocation - Balanced
	 Equity Index Portfolio (0.20%)
	  	TA Legg Mason Dynamic Allocation - Growth
	 Fidelity VIP Balanced Portfolio
	  	TA Market Participation Strategy
	 Fidelity VIP Contrafund®Portfolio
	  	TA MFS International Equity
	 Fidelity VIP Mid Cap Portfolio
	  	TA Morgan Stanley Active International Allocation
	 Fidelity VIP Value Strategies Portfolio
	  	TA Morgan Stanley Mid-Cap Growth
	 GEI Total Return Fund (0.20%)
	  	TA Multi-Managed Balanced
	 International Portfolio (0.20%)
	  	TA Multi Managed Large Cap Core
	 Mid-Cap Index Portfolio (0.20%)
	  	TA PIMCO Real Return TIPS
	 REIT Index Portfolio (0.20%)
	  	TA PIMCO Tactical - Balanced
	 Short-Term Investment-Grade Portfolio (0.20%)
	  	TA PIMCO Tactical - Conservative
	 TA AEGON High Yield Bond
	  	TA PIMCO Tactical - Growth
	 TA AEGON Money Market
	  	TA PIMCO Total Return
	 TA AEGON Tactical Vanguard ETF - Balanced
	  	TA Systematic Small/Mid Cap Value
	 TA AEGON Tactical Vanguard ETF - Conservative
	  	TA T. Rowe Price Small Cap
	 TA AEGON Tactical Vanguard ETF - Growth
	  	TA Third Avenue Value
	 TA AEGON U.S. Government Securities
	  	TA Vanguard ETF Index - Aggressive Growth
	 TA AllianceBernstein Dynamic Allocation
	  	TA Vanguard ETF Index - Balanced
	 TA Asset Allocation - Conservative
	  	TA Vanguard ETF Index - Conservative
	 TA Asset Allocation - Growth
	  	TA Vanguard ETF Index - Growth
	 TA Asset Allocation - Moderate
	  	TA WMC Diversified Growth
	 TA Asset Allocation - Moderate Growth
	  	Total Bond Market Index Portfolio (0.20%)
	 TA BlackRock Global Allocation (0.10%)
	  	Wanger International
	 TA BlackRock Large Cap Value
	  	Wanger USA


  

			
	ICC12 PD(2)0513	  	Page 5(d)









 SECTION 3 – GENERAL PROVISIONS 

The Contract 
 The entire
contract consists of this policy and any applications, endorsements or riders. If any portion of this policy or rider attached hereto shall be found to be invalid, unenforceable or illegal, the remainder shall not in any way be affected or impaired
thereby, but shall have the same force and effect as if the invalid, unenforceable or illegal portion had not been inserted. 

Modification of Policy 
 No change in this policy is valid unless made in writing by us and approved by one of our authorized officers. We may pay You more than Your then current Policy Value for Your voluntary participation in
certain promotional offerings. We will notify You of the terms of any such programs. 
 Tax Qualification and Change of Law

 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, retroactively or prospectively, to reflect any amendment or
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, You must provide written notice to us, and Your refusal may result in adverse tax consequences. We reserve the right to amend this policy or riders attached to, as necessary to comply with specific direction provided by our
state or federal regulators, through change of law, rule, regulation, bulletin, regulatory directives or agreements. 

Non-Participating 
 This policy will not share in our profits. 
 Form Approval 

This policy is approved under the authority of the IIPRC and issued under the IIPRC standards. Any provision of this policy that on the
provision’s effective date is in conflict with IIPRC standards for this product type is hereby amended to conform to the IIPRC standards for this product type as of the provision’s effective date. 

Age or Sex Corrections 
 We may require proof of the Annuitant’s or Owner’s age and/or sex before any payments associated with the death benefit or any rider(s) attached to this policy are made. If the age and/or sex of
the Annuitant or Owner is incorrectly stated, we will base any such payment associated with the death benefit and/or rider benefit proceeds on the Annuitant’s or Owner’s correct age and/or 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. 
 We may require
proof of the Annuitant’s age and/or sex before starting annuity payments. If the age and/or sex (or both) of the Annuitant is incorrectly stated, we will correct the amount payable based upon the Annuitant’s correct age and/or sex, if
applicable. Any underpayment made by us will be paid with the next payment. Any overpayment by us will be deducted from future payments. Any underpayment or overpayment will include annual interest at a rate of 1% per year, from the date of the
underpayment or overpayment to the date of the adjustment. 
 Incontestability 

This policy shall be incontestable from the Policy Date, except in instances involving fraud. 

Involuntary Cashout 
 If, at anytime, Your Adjusted Policy Value is below $2,000, and there have been no Premium Payments made to the policy within the last two Policy Years, we reserve the right to terminate the policy and
pay the greater of: 

	 	a.	 The Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of the Policy Value; or 




	 	b.	 The Adjusted Policy Value. 



  

			
	ICC12 VA(2)0513	  	Page 6









 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. 
 Rights of Owner 
 The Owner may, while the Annuitant is living: 

	 	a.	Assign this policy; 


	 	b.	Surrender the policy to us; 


	 	c.	Amend or modify the policy with our consent; 


	 	d.	Receive annuity payments or name a payee to receive the payments; and 


	 	e.	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. 

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. You must send written notification, to our Administrative Office, which contains all necessary information to make the change. Any Owner
change made, unless otherwise specified by the Owner, shall take effect on the date the notification is signed by the Owner, when received in Good Order, subject to any payments made or actions taken by us prior to receipt of the notification. No
change will apply to any payment we made before the written notice was received. 
 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. A change in Ownership due to death is outlined further in Section 9. 

Assignment 
 In the case
of a non-tax-qualified annuity, this policy may be assigned. You must send written notification, to our Administrative Office, which contains all necessary information to make the change. Any assignment made, unless otherwise specified by the Owner,
shall take effect on the date the notification is signed by the Owner, when received in Good Order, subject to any payments made or actions taken by us prior to receipt of the notification. 

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. Assignment does not change the benefit or amount of the policy. 
 This policy may be applied
for and issued to qualify as a tax-qualified annuity under certain sections of the Internal Revenue Code (IRC). Ownership of this policy is then restricted so it will comply with provisions of the IRC. 

Assignment of this policy may result in adverse tax consequences. 
 Beneficiary 
 Amounts payable upon death in accordance with Section 9,
may be payable to the designated beneficiary or beneficiaries. Such beneficiary(ies) must be named and may be changed without beneficiary consent (unless irrevocably designated or required by law) by notifying us in writing, on a form acceptable to
us. Unless otherwise specified by You, the change will take effect upon the date You sign it, whether or not You are living when we receive it, subject to any payments made or actions taken by the Company prior to receipt of this notice. The notice
must have been postmarked (or show other evidence of delivery that is acceptable to us) on or before the Decedent’s date of death. Your most recent beneficiary change notice will replace any prior beneficiary designations. No change will apply
to any payment we made before the written notice was received by us. If an irrevocable beneficiary dies, You may designate a new beneficiary. 
 You may elect the method of payment for each named beneficiary, subject to our then current rules, prior to the date of death of the Decedent. When no such election is made as to a specific beneficiary,
such beneficiary must elect the method of payment within 60 days of the date we receive all required documentation, in Good Order, to pay the amount payable to that beneficiary. 

If there is more than one beneficiary at any level (primary or contingent), and You failed to specify their interest, they will share
equally. 

  

			
	ICC12 VA(2)0513	  	Page 7










	a.	General Distribution Rules 

 Unless You have provided other specific instructions to us, amounts payable upon death will be paid in accordance with Section 9 and as outlined below: 

	 	1.	 If a primary beneficiary is alive at the time of Decedent’s death, payment will be made to the primary beneficiary;




	 	2.	 If a primary beneficiary dies before the Decedent and there are additional living primary beneficiaries, the deceased primary beneficiary’s
interest will be shared proportionately with all living primary beneficiaries; 



	 	3.	 When all primary beneficiaries die before the Decedent’s death, payment will be made to the living contingent beneficiary(ies), if any;




	 	4.	 If a contingent beneficiary dies before the Decedent and there are additional living contingent beneficiaries, the deceased contingent
beneficiary’s interest will be shared proportionately with all living contingent beneficiaries; 



	 	5.	 In the event no primary or contingent beneficiaries have been named and/or all have died before the Decedent, the Owner’s estate will become
the beneficiary; 



	 	6.	 If a primary or contingent beneficiary dies after the Decedent’s death, but prior to death proceeds being payable to the beneficiary, payment
will be made to the beneficiary’s estate. 


  

	b.	 Other Specific Instructions 


 You may provide specific instructions to the Company which direct that upon the death of a beneficiary, that their interest pass to a specific contingent beneficiary(ies) or per stirpes. 

	 	1.	 Per Stirpes: If You provide instructions that a specific primary or contingent beneficiary’s share be passed per stirpes, we will pay that
beneficiary’s share to their identifiable lineal descendants who are living at the time of Decedent’s death. 



	 	2.	 Specific Contingent: If You provide instructions that a specific primary or contingent beneficiary’s share be passed to a specified contingent
beneficiary(ies), we will pay that specific beneficiary’s share to those identifiable specific contingent beneficiaries who are living (or in existence) at the time of Decedent’s death. 



A deceased beneficiary share will be distributed as outlined under General Distributions Rules above. 

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 

Payment of any amount due from the Separate Account for a Surrender, withdrawal or death proceeds will generally occur within seven days
from the date we receive in Good Order all required information. We may defer payments or transfers from the Separate Account if: 

	 	a.	 The New York Stock Exchange is closed other than for usual weekends or holidays or trading on the Exchange is otherwise restricted;




	 	b.	 An emergency exists as defined by the Securities and Exchange Commission (SEC) or the SEC requires that trading be restricted; or




	 	c.	 The SEC permits a delay for the protection of Owners. 


 When permitted by law, we may defer (with prior authorization from the Commissioner) payment of any transfers, withdrawals or Surrender proceeds from the Fixed Account, if offered, for up to 6 months from
the date we receive Your request. If the Owner or Annuitant 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 interest rate will be the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 - Policy Data, unless otherwise required by law. 

If we delay payment of any transactions as noted above, we will disclose to You the specified date on which the above transactions will
be effective and the reason for the delay. 

  

			
	ICC12 VA(2)0513	  	Page 8









 Reports to Owner 
 We will give You a report at least once each Policy Year, and may provide it more often. This report will show the start date and end date for the current period and include the following information:


	 	a.	 The amounts credited or debited to the Policy Value during the current report period; 



	 	b.	 The Policy Value at start and end date of the current report period; 



	 	c.	 The number and value of the accumulation units held in each Separate Account; 



	 	d.	 The Cash Value, which is after the application of any Excess Interest Adjustment (EIA), at start and end date of the current report period;




	 	e.	 The death benefit at the end of the current report period; 



	 	f.	 The dollar amount in the Fixed Account, if any; and 



	 	g.	 The EIA formula used to determine the Cash Value. 


 A report as described above will be mailed to Your last known address as shown in our records. The information provided will be as of a date not more than four months prior to the date of the mailing. We
will provide copies of the report available to You upon request at no additional cost. 
 SECTION 4 – PREMIUM PAYMENTS

 Payment of Premiums 
 Premium Payments may be made any time while this policy is in force and prior to the Annuity Commencement Date, subject to the minimums and maximums as specified in Section 2 – Policy Data.

 Premium Payment Date 
 The Premium Payment date is the date the Premium Payment is credited to the policy. The initial Premium Payment will be credited to the policy within two Market Days after the Market Day we receive it and
Your complete policy information in Good Order. Subsequent Premium Payments will be credited to the policy as of the Market Day the Premium Payment and required information are received in Good Order. 

Allocation of Premium Payments 
 Premium Payments may be applied to various Investment Options, which we make available. For the initial Premium Payment, You must indicate what percentage to allocate to various Investment Options. For
additional Premium Payments, allocations will be what is currently indicated by You. Each percentage may be either zero or any whole number; however, the allocation among all Investment Options must total 100%. 

Change of Allocation 
 You may change allocations for additional Premium Payments by providing us instructions. The allocation change will apply to Premium Payments received on or after the date we receive the allocation change
in Good Order. We will allocate subsequent Premium Payments the same way, unless You request a different allocation. 

Premium Taxes 
 Your state may impose premium taxes on the Premium Payments You make. We currently do not deduct for these taxes at the time You make a Premium Payment unless required by the applicable state law.
Generally, we will deduct the total amount of premium taxes, if any, from the Policy Value when You begin receiving annuity payments, You Surrender the policy, or death proceeds are paid. 

SECTION 5 – CASH VALUE AND WITHDRAWALS 
 A. Cash Value 
 On or before the Annuity Commencement Date, You may make
withdrawals or Surrender the Cash Value. The Cash Value is equal to the Adjusted Policy Value. Information on the current amount of Your Cash Value is available upon request. We must receive Your withdrawal or Surrender request, in Good Order,
before the Annuity Commencement Date. 

  

			
	ICC12 VA(2)0513	  	Page 9









 There is no Cash Value once an income option has been selected, all necessary instructions
are received in Good Order, and the Company has issued a supplementary contract. 
 Excess Interest Adjustment

 The Excess Interest Adjustment (EIA) is only applied to transactions affecting the Guaranteed Period Options (GPO) of the
Fixed Account, if offered, and is based on any change in interest rates from the time the affected guaranteed period(s) started until the time the EIA occurs. The EIA may be positive or negative. 

An EIA applies in the following situations: 

	 	1.	 When You withdraw or Surrender Your Cash Value; 



	 	2.	 When You exercise an income option; 



	 	3.	 When You transfer out of a GPO; or 



	 	4.	 When a death benefit is calculated. However, the death benefit will not be reduced if the EIA results in a decrease in the Cash Value available to
You. 


 The EIA is applied as follows: 

	 	1.	 The EIA is only applied when the transactions occur prior to the end of the GPO; 



	 	2.	 Transfers to the GPO of the Fixed Account are considered Premium Payments for purposes of determining the EIA; 



	 	3.	 The EIA may affect the death benefit defined in Section 9; 



	 	4.	 If interest rates have decreased from the time the affected GPO started until the time the transaction occurs, the EIA will result in additional
funds available to You; 



	 	5.	 If interest rates have increased from the time the affected GPO started until the time the transaction occurs, the EIA will result in a decrease in
the funds available to You; 



	 	6.	 Certain amounts are not subject to the EIA as provided in Sections 5, 8 and 11; and 



	 	7.	 Upon Surrender, the cumulative interest credited to the GPO of the Fixed Account at the time of Surrender will not be subject to an EIA.



 The formula for determining the amount of the EIA is as follows: 

EIA = S x (G-C) x (M/12) where: 

	 	“S”	 Is the amount (before premium taxes and the application of any Guaranteed Minimum Death Benefits, if any) being Surrendered, withdrawn, transferred,
paid upon death, or applied to an income option that is subject to EIA; 



	 	“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 GPO 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; and 



	 	“M”	 Is the number of months remaining in the guaranteed period for “S”, rounded up to the next higher whole number of months.



 The EIA for each GPO will not reduce the Adjusted Policy Value for that GPO below the amount allocated,
less any prior withdrawals and transfers from that GPO, plus interest at the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 - Policy Data. 

B. Withdrawals and Surrenders 
 You may, on or before the Annuity Commmencement Date, withdraw all (Surrender) or a portion (withdrawal) of the amount available under this policy, provided we receive Your request, in Good Order, while
this policy is in effect and before the Annuity Commencement Date. The minimum withdrawal is $500, with the exception of systematic payouts and required minimum distributions. 
 You may specify that the withdrawal be taken from one or more specific Investment Options or pro rata from all Investment Options. If You do not specify the Investment Option from which the withdrawal is
to be made, the withdrawal will be taken pro rata from all Investment Options relative to the value in each Investment Option. 

  

			
	ICC12 VA(2)0513	  	Page 10









 Withdrawals will reduce the amount of the death proceeds. Withdrawals and Surrenders will
normally be effective as of the end of the Market Day the request is received in Good Order. 
 The gross withdrawal is the
total amount which will be deducted from Your Policy Value as a result of each withdrawal. The gross withdrawal may be more than Your requested withdrawal amount, depending on whether EIA applies at the time of the withdrawal. 

The gross withdrawal = R - E, where: 
 “R” Is the requested withdrawal; and 
 “E” Is
the EIA. 
 Withdrawals in the amount of the cumulative interest in the GPO(s) of the Fixed Account, at the time of withdrawal,
may be withdrawn from the GPO(s) of the Fixed Account free of any EIA. 
 Systematic Payout Option 

A Systematic Payout Option (SPO) is a series of pre-scheduled withdrawals. Beginning in the first Policy Year, a SPO is available on a
monthly, quarterly, semi-annual or annual basis. At the time a SPO is made, each such payout must be at least $50. Monthly and quarterly SPO’s must be sent through electronic funds transfer directly to a checking, savings or other similar
financial account. You may stop SPO payouts at any time with a 30 day written notice sent to our Administrative Office. 

Required Minimum Distribution 
 For tax-qualified plans and policies, withdrawals taken to satisfy required minimum distribution requirements under Section 401(a)(9) of the Internal Revenue Code (IRC) are available with no EIA. The
amount available from this policy with respect to the required minimum distribution is based solely on this policy. 
 Any
amount requested in excess of the IRC required minimum distribution will have the appropriate EIA applied. 
 Minimum Values

 Benefits available under this policy, including any paid up annuity values, Cash Values, or death benefits, are not less
than the minimum benefits required by section 7B and 7G of the Model Variable Annuity Regulation, model # 250 or successor models. Minimum benefits will be increased to reflect any guaranteed additional amounts credited to the policy and will be
decreased by prior withdrawals. 
 Minimum Required Cash Value 

The Minimum Required Cash Value is the amount prescribed by the nonforfeiture law, and is the minimum amount required to be paid to You on
Surrender. 
 The minimum amount is determined differently than Your policy’s Cash Value, and is described in
Section 2 - Policy Data. The minimum amount for the Fixed Account, if offered, is calculated according to a procedure specified in the law using a prescribed Minimum Nonforfeiture Interest Rate, which will be fixed at issue and determined as
follows: 
 On the Policy Date, the Minimum Nonforfeiture Interest Rate is equal to an “average Five Year Constant Maturity
Treasury rate”, less 1.25%, but such rate will not be less than 1% nor more than 3%. The averaged rate is determined by averaging the daily Treasury rates for the first 10 Market Days of the month immediately preceding the calendar quarter in
which Your policy is issued. The average of these ten Treasury rates is rounded to the nearest 0.05% before the deduction of 1.25%. For example, if Your policy was issued on any Market Day during the third calendar quarter, Your Minimum
Nonforfeiture Interest Rate would be determined by averaging the first ten Market Days’ Five Year Constant Maturity Treasury rates for the month of June during the same calendar year, rounding that result to the nearest 0.05%, then deducting
1.25% (with the resulting rate not being less than 1% nor more than 3%). 

  

			
	ICC12 VA(2)0513	  	Page 11









 SECTION 6 – POLICY VALUE 

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

	 	a.	 Premium Payment(s); minus 



	 	b.	 Gross withdrawals (withdrawals plus or minus any EIA); plus 



	 	c.	 Interest credited to the Fixed Account (if any); plus 



	 	d.	 Accumulated gains in the Separate Account; minus 



	 	e.	 Accumulated losses in the Separate Account; minus 



	 	f.	 Service charges, rider fees, premium taxes, and transfer fees if any. 



Service Charge 
 On each Policy Anniversary prior to the Annuity Commencement Date and at the time of Surrender, we may deduct an annual service charge as set forth in Section 2 - Policy Data. 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 or the maximum, as shown in Section 2 -
Policy Data, on the Policy Anniversary or at the time of Surrender. 
 SECTION 7 – 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(s), 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 pro-rata 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 the Valuation Period, which we establish in good faith. 
 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 are transferred. 

  

			
	ICC12 VA(2)0513	  	Page 12









 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 Separate Accounts; 



	 	e.	 Create new Separate Accounts; 



	 	f.	 Add new Separate Accounts 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 mutual fund. 



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. Expenses and mortality results will not adversely affect the dollar amounts of variable benefits or other variable contractual payments or values. The mortality and expense risk
fee and the administrative charge is specified in Section 2 - Policy Data. 
 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 Market Day to Market 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 Market 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. 

  

			
	ICC12 VA(2)0513	  	Page 13









 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 in Section 2 - Policy Data, 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. 
 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 within certain limitations. 
 Transfers of Policy Value from the Guaranteed Period Options (GPO)
of the Fixed Account, if offered, prior to the end of that GPO are subject to an EIA. Such transfers are limited to the maximum Fixed Account transfer limits shown in Section 2 - Policy Data, less values previously transferred out of that GPO
during the current Policy Year. Transfer minimums and charges shown in Section 2 - Policy Data, may also apply to transfers out of the GPO. 
 Transfers of interest credited in the GPO’s 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 is subject to transfer minimums and charges as set forth in Section 2 - Policy Data and will not be subject to an EIA. 
 You may choose which GPO to transfer to or from; however, any GPO elected may not extend beyond the last available Annuity Commencement Date shown in Section 2 - Policy Data. 

Transfers of Policy Value from the Separate Account are subject to a minimum and charges as set forth in Section 2 - Policy Data. If
the remaining Subaccount Policy Value is less than the minimum transfer amount, as shown in Section 2 - Policy Data, we reserve the right to include that amount as part of the transfer. Transfers among multiple Investment Options will be
treated as one transfer in determining the number of transfers that have occurred. 
 If You want to transfer the value of the
variable units You must provide written notification with the following information provided: 

	 	1.	 The Investment Option from which the transfer is to be made; 



	 	2.	 The amount of the transfer; and 



	 	3.	 The Investment Option(s) to receive the transferred amount. 



The policy was not designed for the use of market timers or frequent or disruptive traders. Such transfers may be harmful to the
underlying fund portfolios and increase transaction costs. We have developed policies and procedures with respect to market timing and disruptive trading (which vary for certain Subaccounts at the request of the corresponding underlying fund
portfolios). 

  

			
	ICC12 VA(2)0513	  	Page 14









 We employ various means in an attempt to detect market timing and disruptive trading.
However, despite our monitoring, we may not be able to detect nor halt all harmful trading. If we determine You are engaged in market timing or disruptive trading, we may take one or more actions in an attempt to halt such trading. Your ability to
make transfers is subject to modification or restriction if we determine, in our sole discretion, that Your exercise of the transfer privilege may disadvantage or potentially harm the rights or interests of other Owners (or others having an interest
in the variable insurance products). Transfer restrictions may take the form of loss of expedited transfer privilege. We consider transfers by telephone, fax, overnight mail, or the Internet to be “expedited” transfers. This means that we
would accept only an original signature transmitted to us only by U.S. mail. We may also restrict the transfer privileges of others acting on Your behalf, including Your registered representative or an asset allocation or investment advisory
service. 
 We reserve the right to reject any Premium Payments or transfer requests from any person without prior notice, if,
in our judgment: 

	 	1.	 The payment or transfer, or series of transfers, would have a negative impact on an underlying fund portfolio’s operations; or




	 	2.	 If an underlying fund portfolio would reject or has rejected our purchase order or has instructed us not to allow that purchase or transfer; or




	 	3.	 Because of a history of market timing or disruptive trading. 



Dollar Cost Averaging 
 Prior to the Annuity Commencement Date, You may enroll in Dollar Cost Averaging (DCA) by instructing us to automatically make periodic transfers of Policy Value from a DCA Source Account without waiting
for further instructions from You. A DCA program will begin once we have received, in Good Order, all necessary information and the minimum required amount. 
 You must provide us with the following information to initiate DCA: 

	 	1.	 The date on which the transfers are to begin. Your request will normally be effective the day after the effective date of the policy. If a certain
date does not exist in a given month, the first day of the following month will be used; 



	 	2.	 The DCA Source Account from which the transfers are to be made. To begin dollar cost averaging, the value of the DCA Source Account is subject to
minimums as described in Section 2 - Policy Data; 



	 	3.	 The amount and frequency of the transfers. You may choose monthly or quarterly transfers. The amount of each transfer is subject to minimums as
described in Section 2 - Policy Data; and 



	 	4.	 The Investment Option(s) to receive the transferred amounts. You may choose one or more Investment Options. If You select more than one Investment
Option, Your request must specify how the transferred amounts are to be allocated among these Investments Options and cannot include Your DCA Source Account. 


 Transfers must be scheduled for a minimum or maximum length of time as specified in Section 2 - Policy Data. DCA 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 DCA program will result in higher Policy Values or will otherwise be successful. 

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. Any amounts in the DCA Source Account or Fixed Account, if offered, are ignored for the purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at any time. Rebalancing will cease as soon as we receive a
request for any 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 offered. If You want to transfer the value of the variable units You must provide written notification with the following information provided: 

	 	1.	 The Investment Option from which the transfer is to be made; 



	 	2.	 The amount of the transfer; and 



	 	3.	The Investment Option(s) to receive the transferred amount. 


  

			
	ICC12 VA(2)0513	  	Page 15









 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. We reserve the right to limit transfers between the Subaccounts or to the Fixed Accounts to once per Policy Year. 
 After the Annuity Commencement Date, no transfers may be made from the Fixed Account, if offered, to any other Investment Option. 
 SECTION 9 - DEATH PROCEEDS 
 A. DEATH PRIOR TO THE ANNUITY COMMENCEMENT DATE

 The amount payable upon death will be determined and made payable upon receipt, in Good Order, of satisfactory proof of
death, written directions from each eligible recipient regarding how they wish to receive the amount payable, and any other documents, forms and information that we need (collectively referred to as “due proof of death”). Not withstanding
the foregoing, we may confer with a variety of resources and/or other affiliates in order to ascertain or verify whether the Annuitant or any other relevant life in being is or may have become deceased during the term of this policy. Any such
activities or efforts by us in no manner abrogate, waive or otherwise diminish Your continued obligation to provide us with timely notice in writing of due proof of death in Good Order. 

The amount of the death benefit payable will be the greatest of: 

 

	 	1.	 The Policy Value on the date we receive due proof of death and an election of method of settlement; 



	 	2.	 The Cash Value on the date we receive due proof of death and an election of method of settlement; 



	 	3.	 The Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of the Policy Value, on the date we receive due proof
and an election of method of settlement; or 



	 	4.	 The Guaranteed Minimum Death Benefit (GMDB), if any, on the date of death, plus any additional Premium Payments received, less any gross withdrawals
from the date of death to the date of payment of death proceeds. 


 The Owner(s) may elect the method of
payment of death proceeds for each named beneficiary, subject to our then current rules, prior to the date of the applicable Decedent’s death. When no such election is made as to a specific beneficiary, such beneficiary must elect the method of
payment within 60 days of the date we receive all required documentation, in Good Order, to pay the death proceeds to that beneficiary. 
 Guaranteed Minimum Death Benefit 
 If elected, the GMDB will establish a
minimum death benefit payable under the policy. Your election, if any, is shown in Section 2 - Policy Data. You may not change Your election after the policy is issued. 
 Death of Annuitant Prior To The Annuity Commencement Date 
 A death benefit
will be payable if the Annuitant dies prior to the Annuity Commencement Date. 
  

	 	1.	 Non-Natural Owner(s) 


 For purposes of determining who receives the death benefit for a policy owned by a non-natural Owner, we will apply the rules for Individual Owner(s) as provided below in 2(a) or (b). 

 

	 	2.	 Individual Owner(s) 



	 	(a)	 Surviving Owner 


 If there is a surviving Owner(s) when the Annuitant dies, the surviving Owner(s) will receive the death benefit (i.e., the surviving Owner(s) takes the place of any beneficiary designation). 

 

	 	(b)	 No surviving Owner 


 If there is no surviving Owner, the death benefit is payable to the named beneficiary(ies). If no beneficiary(ies) are named, the death benefit will be payable to the Owner’s estate. 

  

			
	ICC12 VA(2)0513	  	Page 16









 Death of Owner Prior To The Annuity Commencement Date 

If the Owner is not the Annuitant and the Owner dies before the Annuitant, under certain circumstances, an amount equal to the Cash Value,
as of the date we receive due proof of death, will be paid. 
 If You are not also the Annuitant and in the event of
simultaneous deaths of both You and the Annuitant, the death proceeds will be calculated under the Death of Annuitant provisions. 
  

	 	1.	 Non-Natural Owner(s) 


 If the policy is owned by a trust using the grantor’s social security number as its taxpayer identification number, the death of the grantor will be treated as the death of the Owner. 

If there is a change in the Annuitant, such change will be treated as the death of the non-natural Owner and we will pay
an amount equal to the Cash Value as of the day we receive, in Good Order, the request to change the Annuitant. 
  

	 	2.	 Individual Owner(s) 


 If You die while the Annuitant is living, the Cash Value will be paid to the first among the following who is living or in existence: 

	 	a.	 The surviving Owner(s); 



	 	b.	 Primary beneficiary(ies); 



	 	c.	 Contingent beneficiary(ies); or 



	 	d.	 Deceased Owner’s estate. 


  

	 	3.	 Joint Owner(s) 


 If there is a joint Owner, the Cash Value will be payable upon the death of the first Owner, unless the surviving joint Owner is the spouse. 

Non-Spouse Individual Beneficiary: 
 If the beneficiary is an individual who is not eligible to continue the contract as noted below, the amount payable must be distributed by the end of 5 years after the date of Decedent’s death, or
payments must begin no later than one year after the date of Decedent’s death and must be made for a period certain or for the beneficiary’s lifetime, so long as the period certain does not exceed the beneficiary’s life expectancy.

 If the beneficiary is not a natural person, the death proceeds must be distributed by the end of 5 years after the date of
Decedent’s death. 
 Spousal Beneficiary 
 A spousal beneficiary, who is the sole beneficiary, may elect to continue this policy as Owner rather than receiving the amount payable when they are the deceased Owner’s surviving spouse.

 If the surviving spouse does not elect to continue the contract, the amount payable must be distributed by the end of 5 years
after the date of the Decedent’s death, or payments must begin no later than one year after the Decedent’s death and must be made for a period certain or for the beneficiary’s lifetime, so long as the period certain does not exceed
the beneficiary’s life expectancy. 
 If a death benefit is payable and 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. The spousal continuation election is
only available once per policy. 

  

			
	ICC12 VA(2)0513	  	Page 17









 B. DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE 

In the event of a death after the Annuity Commencement Date, the amount payable will depend on the income 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 beneficiary(ies) at least as rapidly as under the method of
distribution being used as of the date of that death. 
 C. ADDITIONAL TAX INFORMATION 

In any event, the death proceeds will be paid in accordance with Section 72(s) of the IRC. For purposes of applying the non-natural
Owner death rules of Section 72(s)(6), we will apply the Annuitant death rules set forth earlier in this section. 
 These
distribution rules do not apply to an annuity provided under a plan described in Section 401(a), 403(a), 403(b), 408 or 408A of the IRC or to an annuity that is a qualified funding asset as defined in Code Section 130(d) of the IRC.

 SECTION 10 – INCOME OPTIONS 
 A. GENERAL PAYMENT PROVISIONS 
 Payment 

You may use the Adjusted Policy Value or the Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of
the Policy Value, if greater, on the Annuity Commencement Date. If the policy is in force on the last available Annuity Commencement Date, we will make annuity payments to the payee under Option 2(b), with 10 years certain, or if elected, under one
or more of the other options described in this section, or any other method of payment if we agree. However, the option(s) elected must provide for lifetime income or income for a period of at least 120 months. Payments will be made at 1, 3, 6 or 12
month intervals. We reserve the right to avoid making payments of less than $20.00. 
 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. 

Adjusted Age 
 Payments under Options 2 and 4 and the first payment under Options 2-V and 4-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 2025
	  	Actual Age
	 2025 - 2032
	  	Actual Age minus 1
	 2033 - 2040
	  	Actual Age minus 2
	 2041 - 2048
	  	Actual Age minus 3
	 2049 - 2055
	  	Actual Age minus 4
	 After 2055
	  	Determined by us

 Election of Optional Method of Payment 

You may elect, in a manner acceptable to us, income options 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 is to be applied to provide each type of payment. You must also specify which Subaccounts to allocate policy proceeds. The amount of a combined
payment will be the sum of the variable and fixed payments. Payments under a variable income option will reflect the investment performance of the selected Subaccount of the Separate Account. 

Qualified Plans and Policies 
 Certain income options may not be available or may be limited for qualified plans and qualified policies in order to ensure compliance with the IRC. 

  

			
	ICC12 VA(2)0513	  	Page 18









 Proof of Age 
 We may require proof of the age of any person who has an annuity purchased under Options 2, 2-V, 4 and 4-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 an income option. 

Supplementary Contract 
 Once proceeds become payable and an income 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 INCOME OPTIONS 

Guaranteed Income Options 
 The fixed income option is determined by multiplying each $1,000 of policy proceeds allocated to a fixed income option by the amounts shown in Section 12 for the option You select. Options 1 and 3
are based on a guaranteed interest rate of 0.25%. Options 2 and 4 are based on a guaranteed interest rate of 0.25% and the “Annuity 2000” (male, female and unisex if required by law) mortality table projected for improvement using
projection scale G. The rates were projected dynamically using an assumed Annuity Commencement Date of 2020. The “Annuity 2000” mortality rates are adjusted based on improvements in mortality to more appropriately reflect increased
longevity. 
 Option 1 – Income for a Specified Period 

We will make level payments only for the fixed period You choose. Payments should not exceed the Annuitant’s life expectancy. 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. No funds will remain at the end of the specified period. 

Option 2 – Life Income 
 You may choose between: 

	 	a.	 Life Only – We will make level payments only during the Annuitant’s lifetime;* or 



	 	b.	 Life 10 Years Period Certain – We will make level payments for the longer of: 



	 	1.	 The Annuitant’s lifetime; or 



	 	2.	 10 years, whichever is longer; or 


  

	 	c.	 Guaranteed Return of policy proceeds – We will make level payments for the longer of: 



	 	1.	 The Annuitant’s lifetime; or 



	 	2.	 Until the total dollar amount of payments made to You equals the amount applied to this option. 



*Option 2(a) is not available for adjusted ages greater than 85. 

Option 3 – Income of a Specified Amount 
 Payments are made for any specified amount until the amount applied to this option, with interest, is exhausted. Payments should not exceed the Annuitant’s life expectancy. 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 policy proceeds with interest are exhausted, payments will be continued to that person’s beneficiary. 

Option 4 – Joint and Survivor Annuity 
 You may choose between: 

	 	a.	 Life Only – We will make level payments only during the Annuitants’ lifetimes;** or 



	 	b.	 Life and 10 Years Period Certain – We will make level payments for the longer of: 



	 	1.	 The Annuitant’s lifetime and a joint Annuitant of Your selection; or 



	 	2.	 10 years, whichever is longer. 


 **Option 4(a) is not available for adjusted ages greater than 85. 

  

			
	ICC12 VA(2)0513	  	Page 19









 Current Income Options 

The amounts shown in the tables in Section 12 are the guaranteed amounts. Payments at the time of their commencement will not be less
than those that would be provided by the application of the policy proceeds to purchase a single premium immediate annuity policy at purchase rates offered by the Company at the time to the same class of Annuitants. 

C. VARIABLE INCOME OPTIONS 
 Variable Annuity Units 
 The policy proceeds You tell us to apply to a
variable income 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 Market Day is equal to “a” x “b” x “c”, where: 

	 	“a”	 Is the variable annuity unit value for that Subaccount on the immediately preceding Market 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 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 after the Annuity Commencement Date. This factor is less than
or equal to, on an annual basis, the percentage shown in Section 2 - Policy Data, of the daily net asset value of a fund share held in that Subaccount. 


 Determination of the First Variable Payment 
 The amount of the first
variable payment is determined by multiplying $1,000 of policy proceeds allocated to a variable income option by the amounts shown in Section 13 for the variable option You select. The tables are based on a 3% 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 rates were projected dynamically using an assumed Annuity Commencement Date of
2020. The “Annuity 2000” mortality rates are adjusted based on improvements in mortality to more appropriately reflect increased longevity. 
 Option 2-V – Life Income 
 You may choose between: 

	 	a.	 Life Only – Payments will be made during the lifetime of the Annuitant;* or 



	 	b.	 Life and 10 Years Period 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. 



*Option 2-V(a) is not available for adjusted age(s) greater than 85. 

Option 4-V – Joint and Survivor Annuity 

Life Only - Payments are made during the joint lifetime of the Annuitant and a joint Annuitant of Your selection. Payments
will be made as long as either person is living. Option 4-V is not available for adjusted ages greater than 85. 

  

			
	ICC12 VA(2)0513	  	Page 20









 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 such Subaccount on the Annuity
Commencement Date. 
 The smallest annual rate of investment return that would have to be earned on the assets of the Separate
Account so that the dollar amount of variable income payments will not decrease is 5.50%. 
 SECTION 11 – FIXED ACCOUNT

 We may make available a Fixed Account as an Investment Option. The Fixed Account, if offered, may be comprised of one or
more options shown below. Premium Payments applied to and any amount transferred to the Fixed Account will be credited interest based on a fixed rate. The interest rates we set will be credited for increments of at least one year measured from each
Premium Payment or transfer date. If the Fixed Account is available, these rates will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 – Policy Data. We reserve the right at our sole
discretion, to limit or refuse Premium Payments and/or transfers allocated to any of the Fixed Account options, if we are crediting an interest rate equal to or less than the Minimum Nonforfeiture Annual Interest Rate. 

Guaranteed Period Options 
 We may offer optional Guaranteed Period Options, into which Premium Payments may be paid or amounts transferred. The current interest rate we set for Policy Value allocated to each Guaranteed Period
Option (GPO) is guaranteed until the end of that guaranteed period. 
 We will notify You before the end of the GPO. You may
elect to have the Policy Value in the GPO transferred to any Investment Option, including any GPO we then make available. However, any GPO elected may not extend beyond the last available Annuity Commencement Date. If we do not receive instructions
from You in Good Order before the end of the GPO regarding how the Policy Value in that GPO is to be allocated, we will allocate the Policy Value in that GPO to the Money Market Subaccount available in Your policy. No Excess Interest Adjustment
(EIA) applies at the end of a GPO. 
 When funds are withdrawn or transferred from a GPO, the Policy Value associated with the
oldest Premium Payment is considered to be withdrawn or transferred first. If the amount withdrawn or transferred exceeds the Policy Value associated with the oldest premium, the Policy Value associated with the next oldest Premium Payment is
considered to be withdrawn or transferred next, and so on until the Policy Value associated with the most recent premium is considered to be withdrawn or transferred (this is a First-In, First-Out, or FIFO, basis). 

Withdrawals, Surrenders, transfers and amounts applied to an income option from the GPO(s) may be subject to an EIA. Amounts received
during the right to cancel period are not subject to an EIA. 
 Dollar Cost Averaging Fixed Account Option 

We may offer a Dollar Cost Averaging (DCA) Fixed Account Option (a “DCA Source Account”) separate from the Guaranteed Period
Options. This option will have a one-year interest rate guarantee. 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 in Section 2 - Policy Data. The DCA Fixed Account Option will only be available under a Dollar Cost Averaging program as described in Section 8. 

  

			
	ICC12 VA(2)0513	  	Page 21









 APPENDIX 
 SECTION 12 - GUARANTEED FIXED INCOME OPTION TABLES 
 The amounts shown in
these tables are the guaranteed amounts for each $1,000 of the policy proceeds. 
 Higher current amounts may be available at the
time of settlement. 
  

																																											
	Option 1	  	  	 	  	Option 2(a)	 	  	Option 2(b)	 	  	Option 2(c)	 
	
Number
 of
Years
 Payable
	  	Amount of
Monthly
Installment	  	  	 	  	 Monthly Installment For

Life No Period Certain

 
	 	  	 Monthly Installment For

Life 10 Years Certain

 
	 	  	 Monthly Installment For

Life Guaranteed Return
of Policy Proceeds
	 
	.	  	  	  	Age*	 	  	Male	 	  	Female	 	  	Unisex	 	  	Male	 	  	Female	 	  	Unisex	 	  	Male	 	  	Female	 	  	Unisex	 
	 	  	 	  	 	50  	  	  	 	$2.22	  	  	 	$2.00	  	  	 	$2.07	  	  	 	$2.21	  	  	 	$2.00	  	  	 	$2.06	  	  	 	$1.85	  	  	 	$1.74	  	  	 	$1.78	  
	 	  		  	 	51  	  	  	 	2.27	  	  	 	2.05	  	  	 	2.12	  	  	 	2.26	  	  	 	2.05	  	  	 	2.11	  	  	 	1.89	  	  	 	1.78	  	  	 	1.80	  
	 	  		  	 	52  	  	  	 	2.33	  	  	 	2.10	  	  	 	2.17	  	  	 	2.32	  	  	 	2.10	  	  	 	2.17	  	  	 	1.91	  	  	 	1.80	  	  	 	1.84	  
	 	  		  	 	53  	  	  	 	2.40	  	  	 	2.15	  	  	 	2.23	  	  	 	2.39	  	  	 	2.15	  	  	 	2.22	  	  	 	1.95	  	  	 	1.84	  	  	 	1.88	  
	 	  		  	 	54  	  	  	 	2.46	  	  	 	2.21	  	  	 	2.29	  	  	 	2.45	  	  	 	2.21	  	  	 	2.28	  	  	 	1.99	  	  	 	1.88	  	  	 	1.91	  
	 	  		  	 	55  	  	  	 	2.54	  	  	 	2.27	  	  	 	2.35	  	  	 	2.52	  	  	 	2.26	  	  	 	2.34	  	  	 	2.03	  	  	 	1.91	  	  	 	1.95	  
	 	  		  	 	56  	  	  	 	2.61	  	  	 	2.33	  	  	 	2.42	  	  	 	2.59	  	  	 	2.33	  	  	 	2.41	  	  	 	2.07	  	  	 	1.95	  	  	 	1.99	  
	 	  		  	 	57  	  	  	 	2.69	  	  	 	2.40	  	  	 	2.49	  	  	 	2.67	  	  	 	2.39	  	  	 	2.48	  	  	 	2.13	  	  	 	1.99	  	  	 	2.03	  
	 	  		  	 	58  	  	  	 	2.77	  	  	 	2.47	  	  	 	2.56	  	  	 	2.75	  	  	 	2.46	  	  	 	2.55	  	  	 	2.17	  	  	 	2.03	  	  	 	2.07	  
	 10
	  	8.44	  	 	59  	  	  	 	2.86	  	  	 	2.54	  	  	 	2.64	  	  	 	2.83	  	  	 	2.53	  	  	 	2.62	  	  	 	2.21	  	  	 	2.07	  	  	 	2.13	  
	 11
	  	7.68	  	 	60  	  	  	 	2.95	  	  	 	2.62	  	  	 	2.72	  	  	 	2.92	  	  	 	2.61	  	  	 	2.70	  	  	 	2.26	  	  	 	2.13	  	  	 	2.17	  
	 12
	  	7.05	  	 	61  	  	  	 	3.05	  	  	 	2.70	  	  	 	2.81	  	  	 	3.02	  	  	 	2.69	  	  	 	2.79	  	  	 	2.32	  	  	 	2.17	  	  	 	2.21	  
	 13
	  	6.51	  	 	62  	  	  	 	3.16	  	  	 	2.79	  	  	 	2.90	  	  	 	3.11	  	  	 	2.77	  	  	 	2.88	  	  	 	2.38	  	  	 	2.22	  	  	 	2.26	  
	 14
	  	6.06	  	 	63  	  	  	 	3.27	  	  	 	2.88	  	  	 	3.00	  	  	 	3.22	  	  	 	2.86	  	  	 	2.97	  	  	 	2.44	  	  	 	2.28	  	  	 	2.33	  
	 15
	  	5.66	  	 	64  	  	  	 	3.39	  	  	 	2.98	  	  	 	3.10	  	  	 	3.33	  	  	 	2.95	  	  	 	3.07	  	  	 	2.49	  	  	 	2.34	  	  	 	2.39	  
	 16
	  	5.31	  	 	65  	  	  	 	3.51	  	  	 	3.09	  	  	 	3.21	  	  	 	3.45	  	  	 	3.05	  	  	 	3.17	  	  	 	2.55	  	  	 	2.39	  	  	 	2.43	  
	 17
	  	5.01	  	 	66  	  	  	 	3.65	  	  	 	3.20	  	  	 	3.33	  	  	 	3.57	  	  	 	3.16	  	  	 	3.28	  	  	 	2.61	  	  	 	2.44	  	  	 	2.49	  
	 18
	  	4.73	  	 	67  	  	  	 	3.79	  	  	 	3.32	  	  	 	3.46	  	  	 	3.70	  	  	 	3.27	  	  	 	3.40	  	  	 	2.69	  	  	 	2.50	  	  	 	2.55	  
	 19
	  	4.49	  	 	68  	  	  	 	3.95	  	  	 	3.44	  	  	 	3.59	  	  	 	3.83	  	  	 	3.39	  	  	 	3.53	  	  	 	2.75	  	  	 	2.57	  	  	 	2.64	  
	 20
	  	4.27	  	 	69  	  	  	 	4.11	  	  	 	3.58	  	  	 	3.74	  	  	 	3.97	  	  	 	3.52	  	  	 	3.66	  	  	 	2.82	  	  	 	2.64	  	  	 	2.69	  
	 	  		  	 	70  	  	  	 	4.29	  	  	 	3.73	  	  	 	3.89	  	  	 	4.12	  	  	 	3.65	  	  	 	3.79	  	  	 	2.90	  	  	 	2.72	  	  	 	2.77	  
	 	  		  	 	71  	  	  	 	4.47	  	  	 	3.89	  	  	 	4.06	  	  	 	4.27	  	  	 	3.80	  	  	 	3.94	  	  	 	3.00	  	  	 	2.79	  	  	 	2.84	  
	 	  		  	 	72  	  	  	 	4.67	  	  	 	4.06	  	  	 	4.24	  	  	 	4.43	  	  	 	3.95	  	  	 	4.09	  	  	 	3.08	  	  	 	2.86	  	  	 	2.93	  
	 	  		  	 	73  	  	  	 	4.88	  	  	 	4.24	  	  	 	4.43	  	  	 	4.59	  	  	 	4.11	  	  	 	4.25	  	  	 	3.15	  	  	 	2.94	  	  	 	3.02	  
	 	  		  	 	74  	  	  	 	5.10	  	  	 	4.44	  	  	 	4.64	  	  	 	4.76	  	  	 	4.27	  	  	 	4.42	  	  	 	3.25	  	  	 	3.06	  	  	 	3.12	  
	 	  		  	 	75  	  	  	 	5.34	  	  	 	4.65	  	  	 	4.86	  	  	 	4.94	  	  	 	4.45	  	  	 	4.60	  	  	 	3.35	  	  	 	3.13	  	  	 	3.20	  
	 	  		  	 	76  	  	  	 	5.60	  	  	 	4.88	  	  	 	5.09	  	  	 	5.12	  	  	 	4.63	  	  	 	4.78	  	  	 	3.46	  	  	 	3.21	  	  	 	3.30	  
	 	  		  	 	77  	  	  	 	5.88	  	  	 	5.13	  	  	 	5.35	  	  	 	5.31	  	  	 	4.82	  	  	 	4.97	  	  	 	3.60	  	  	 	3.35	  	  	 	3.41	  
	 	  		  	 	78  	  	  	 	6.17	  	  	 	5.40	  	  	 	5.63	  	  	 	5.50	  	  	 	5.02	  	  	 	5.17	  	  	 	3.66	  	  	 	3.44	  	  	 	3.51	  
	 	  		  	 	79  	  	  	 	6.49	  	  	 	5.69	  	  	 	5.92	  	  	 	5.69	  	  	 	5.22	  	  	 	5.37	  	  	 	3.81	  	  	 	3.53	  	  	 	3.62	  
	 	  		  	 	80  	  	  	 	6.82	  	  	 	6.00	  	  	 	6.24	  	  	 	5.88	  	  	 	5.43	  	  	 	5.57	  	  	 	3.89	  	  	 	3.68	  	  	 	3.74	  
	 	  		  	 	81  	  	  	 	7.19	  	  	 	6.34	  	  	 	6.59	  	  	 	6.08	  	  	 	5.65	  	  	 	5.78	  	  	 	4.06	  	  	 	3.81	  	  	 	3.87	  
	 	  		  	 	82  	  	  	 	7.58	  	  	 	6.70	  	  	 	6.96	  	  	 	6.27	  	  	 	5.86	  	  	 	5.99	  	  	 	4.20	  	  	 	3.89	  	  	 	4.00	  
	 	  		  	 	83  	  	  	 	7.99	  	  	 	7.10	  	  	 	7.36	  	  	 	6.46	  	  	 	6.08	  	  	 	6.20	  	  	 	4.34	  	  	 	4.09	  	  	 	4.16	  
	 	  		  	 	84  	  	  	 	8.44	  	  	 	7.53	  	  	 	7.80	  	  	 	6.65	  	  	 	6.29	  	  	 	6.40	  	  	 	4.50	  	  	 	4.23	  	  	 	4.32	  
	 	  		  	 	85  	  	  	 	8.92	  	  	 	7.99	  	  	 	8.27	  	  	 	6.83	  	  	 	6.49	  	  	 	6.60	  	  	 	4.70	  	  	 	4.40	  	  	 	4.49	  
	 	  		  	 	86  	  	  				  				  				  	 	7.00	  	  	 	6.69	  	  	 	6.79	  	  	 	4.89	  	  	 	4.54	  	  	 	4.74	  
	 	  		  	 	87  	  	  				  				  				  	 	7.17	  	  	 	6.88	  	  	 	6.97	  	  	 	5.11	  	  	 	4.71	  	  	 	4.84	  
	 	  		  	 	88  	  	  				  				  				  	 	7.32	  	  	 	7.06	  	  	 	7.14	  	  	 	5.28	  	  	 	4.90	  	  	 	5.08	  
	 	  		  	 	89  	  	  				  				  				  	 	7.47	  	  	 	7.23	  	  	 	7.31	  	  	 	5.53	  	  	 	5.19	  	  	 	5.27	  
	 	  		  	 	90  	  	  				  				  				  	 	7.60	  	  	 	7.39	  	  	 	7.46	  	  	 	5.73	  	  	 	5.39	  	  	 	5.48	  
	 	  		  	 	91  	  	  				  				  				  	 	7.73	  	  	 	7.53	  	  	 	7.59	  	  	 	5.88	  	  	 	5.63	  	  	 	5.79	  
	 	  		  	 	92  	  	  				  				  				  	 	7.84	  	  	 	7.66	  	  	 	7.72	  	  	 	6.17	  	  	 	5.78	  	  	 	5.97	  
	 	  		  	 	93  	  	  				  				  				  	 	7.95	  	  	 	7.79	  	  	 	7.84	  	  	 	6.44	  	  	 	6.02	  	  	 	6.17	  
	 	  		  	 	94  	  	  				  				  				  	 	8.04	  	  	 	7.90	  	  	 	7.94	  	  	 	6.79	  	  	 	6.46	  	  	 	6.52	  
	 	  		  	 	95  	  	  				  				  				  	 	8.12	  	  	 	8.00	  	  	 	8.04	  	  	 	7.13	  	  	 	6.73	  	  	 	6.83	  
	 	  		  	 	96  	  	  				  				  				  	 	8.20	  	  	 	8.09	  	  	 	8.13	  	  	 	7.40	  	  	 	6.89	  	  	 	7.17	  
	 	  		  	 	97  	  	  				  				  				  	 	8.26	  	  	 	8.17	  	  	 	8.20	  	  	 	7.91	  	  	 	7.53	  	  	 	7.66	  
	 	  		  	 	98  	  	  				  				  				  	 	8.31	  	  	 	8.24	  	  	 	8.27	  	  	 	8.19	  	  	 	7.84	  	  	 	7.75	  
	 	  	 	  	 	99  	  	  	 	 	 	  	 	 	 	  	 	 	 	  	 	8.35	  	  	 	8.30	  	  	 	8.32	  	  	 	8.82	  	  	 	8.18	  	  	 	8.57	  

 *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 (if the
option is available based on Adjusted Age as described in Section 10). 

  

			
	ICC12 AP(2)0513	  	Page 22(a)










 APPENDIX (continued) 
  

 Option 4(a) 

Monthly Installment For Joint and Survivor 

															
	 Adjusted Age

of

Male
Annuitant*
	  	  

Adjusted Age of Female Annuitant*

	  	15 Years
Less Than
Male	  	12 Years
Less Than
Male	  	 9 Years

Less Than
Male
	  	 6 Years

Less Than
Male
	  	 3 Years

Less Than
Male
	  	 Same As
Male

 
	  	 3
Years
 More Than
Male

	
50
	  	$1.45	  	$1.51	  	$1.58	  	$1.66	  	$1.73	  	$1.80	  	$1.87
	
55
	  	  1.58	  	  1.66	  	  1.75	  	  1.84	  	  1.93	  	  2.02	  	  2.10
	
60
	  	  1.75	  	  1.85	  	  1.95	  	  2.07	  	  2.18	  	  2.29	  	  2.41
	
65
	  	  1.95	  	  2.08	  	  2.21	  	  2.36	  	  2.51	  	  2.66	  	  2.81
	
70
	  	  2.21	  	  2.37	  	  2.55	  	  2.74	  	  2.94	  	  3.15	  	  3.35
	
75
	  	  2.54	  	  2.76	  	  3.00	  	  3.26	  	  3.54	  	  3.83	  	  4.11
	
80
	  	  2.99	  	  3.29	  	  3.62	  	  3.99	  	  4.39	  	  4.79	  	  5.18
	 85
	  	  3.60	  	  4.02	  	  4.50	  	  5.03	  	  5.59	  	  6.17	  	  6.71

 Monthly Installment For Unisex Joint and Survivor 

															
	 Adjusted Age

of

First

Annuitant*
	  	  

Adjusted Age of Joint Annuitant*

	  	15 Years
Less Than
First	  	12 Years
Less Than
First	  	 9 Years

Less Than
First
	  	 6 Years

Less Than
First
	  	 3 Years

Less Than
First
	  	 Same As
First

 
	  	 3
Years
 More Than
First

	
50
	  	$1.47	  	$1.53	  	$1.60	  	$1.66	  	$1.72	  	$1.78	  	$1.84
	
55
	  	  1.61	  	  1.68	  	  1.76	  	  1.84	  	  1.92	  	  2.00	  	  2.06
	
60
	  	  1.78	  	  1.87	  	  1.97	  	  2.07	  	  2.17	  	  2.27	  	  2.36
	
65
	  	  1.99	  	  2.11	  	  2.24	  	  2.37	  	  2.50	  	  2.62	  	  2.74
	
70
	  	  2.26	  	  2.41	  	  2.58	  	  2.76	  	  2.93	  	  3.11	  	  3.27
	
75
	  	  2.60	  	  2.81	  	  3.04	  	  3.28	  	  3.53	  	  3.77	  	  4.00
	
80
	  	  3.07	  	  3.36	  	  3.68	  	  4.02	  	  4.37	  	  4.71	  	  5.04
	 85
	  	  3.71	  	  4.12	  	  4.58	  	  5.07	  	  5.57	  	  6.07	  	  
6.54

 Option 4(b) 

Monthly Installment For Joint and Survivor (Life with 10 year Certain) 

															
	 Adjusted Age

of

Male
Annuitant*
	  	  

Adjusted Age of Female Annuitant*

	  	15 Years
Less Than
Male	  	12 Years
Less Than
Male	  	 9 Years

Less Than
Male
	  	 6 Years

Less Than
Male
	  	 3 Years

Less Than
Male
	  	 Same As
Male

 
	  	 3
Years
 More Than
Male

	
50
	  	$1.45	  	$1.51	  	$1.58	  	$1.66	  	$1.73	  	$1.80	  	$1.87
	
55
	  	  1.58	  	  1.66	  	  1.75	  	  1.84	  	  1.93	  	  2.02	  	  2.10
	
60
	  	  1.75	  	  1.85	  	  1.95	  	  2.07	  	  2.18	  	  2.29	  	  2.41
	
65
	  	  1.95	  	  2.08	  	  2.21	  	  2.36	  	  2.51	  	  2.66	  	  2.80
	
70
	  	  2.21	  	  2.37	  	  2.55	  	  2.74	  	  2.94	  	  3.14	  	  3.34
	
75
	  	  2.54	  	  2.76	  	  3.00	  	  3.25	  	  3.53	  	  3.80	  	  4.07
	
80
	  	  2.98	  	  3.27	  	  3.60	  	  3.95	  	  4.32	  	  4.68	  	  5.02
	 85
	  	  3.58	  	  3.97	  	  4.41	  	  4.88	  	  5.34	  	  5.76	  	  
6.11

 Monthly Installment For Unisex Joint and Survivor (Life with 10
year Certain) 

															
	 Adjusted Age

of

First

Annuitant*
	  	  

Adjusted Age of Joint Annuitant*

	  	15 Years
Less Than
Male	  	12 Years
Less Than
Male	  	 9 Years

Less Than
Male
	  	 6 Years

Less Than
Male
	  	 3 Years

Less Than
Male
	  	 Same As
Male

 
	  	 3
Years
 More Than
Male

	
50
	  	$1.47	  	$1.53	  	$1.60	  	$1.66	  	$1.72	  	$1.78	  	$1.84
	
55
	  	  1.61	  	  1.68	  	  1.76	  	  1.84	  	  1.92	  	  2.00	  	  2.06
	
60
	  	  1.78	  	  1.87	  	  1.97	  	  2.07	  	  2.17	  	  2.27	  	  2.36
	
65
	  	  1.99	  	  2.11	  	  2.24	  	  2.37	  	  2.50	  	  2.62	  	  2.74
	
70
	  	  2.25	  	  2.41	  	  2.58	  	  2.75	  	  2.93	  	  3.10	  	  3.26
	
75
	  	  2.60	  	  2.81	  	  3.04	  	  3.27	  	  3.52	  	  3.75	  	  3.96
	
80
	  	  3.06	  	  3.35	  	  3.66	  	  3.98	  	  4.31	  	  4.62	  	  4.90
	 85
	  	  3.68	  	  4.06	  	  4.48	  	  4.91	  	  5.33	  	  5.70	  	  6.00

 *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 (if the
option is available based on Adjusted Age as described in Section 10). 

  

			
	ICC12 AP(2)0513	  	Page 22(b)










 APPENDIX (continued) 
  

 SECTION 13 - VARIABLE INCOME OPTION TABLES 

BASED ON ASSUMED INVESTMENT RETURN 
 The amounts shown in these tables are the initial payment amounts based on a 3.0% Assumed Investment Return for each $1,000 of the policy proceeds. 

 

													
	  	  	Option 2-V(a)	  	Option
2-V(b)
	  	  	  
 Monthly Installment For
 Life No Period Certain
	  	  

Monthly Installment For
 Life 10 Years Certain

	Age*	  	Male	  	Female	  	Unisex	  	Male	  	Female	  	Unisex
	
50
	  	$3.70	  	$3.47	  	$3.54	  	$3.68	  	$3.47	  	$3.53
	
51
	  	  3.76	  	  3.52	  	  3.59	  	  3.74	  	  3.51	  	  3.58
	
52
	  	  3.82	  	  3.57	  	  3.65	  	  3.80	  	  3.56	  	  3.63
	
53
	  	  3.88	  	  3.62	  	  3.70	  	  3.86	  	  3.61	  	  3.69
	
54
	  	  3.95	  	  3.68	  	  3.76	  	  3.92	  	  3.66	  	  3.74
	
55
	  	  4.02	  	  3.73	  	  3.82	  	  3.99	  	  3.72	  	  3.80
	
56
	  	  4.09	  	  3.80	  	  3.89	  	  4.06	  	  3.78	  	  3.87
	
57
	  	  4.17	  	  3.86	  	  3.96	  	  4.13	  	  3.84	  	  3.93
	
58
	  	  4.25	  	  3.93	  	  4.03	  	  4.21	  	  3.91	  	  4.00
	
59
	  	  4.34	  	  4.00	  	  4.11	  	  4.30	  	  3.98	  	  4.08
	
60
	  	  4.44	  	  4.08	  	  4.19	  	  4.38	  	  4.05	  	  4.15
	
61
	  	  4.54	  	  4.16	  	  4.28	  	  4.48	  	  4.13	  	  4.24
	
62
	  	  4.65	  	  4.25	  	  4.37	  	  4.57	  	  4.21	  	  4.32
	
63
	  	  4.76	  	  4.34	  	  4.47	  	  4.68	  	  4.30	  	  4.42
	
64
	  	  4.89	  	  4.44	  	  4.58	  	  4.79	  	  4.39	  	  4.51
	
65
	  	  5.02	  	  4.55	  	  4.69	  	  4.90	  	  4.49	  	  4.62
	
66
	  	  5.16	  	  4.66	  	  4.81	  	  5.02	  	  4.60	  	  4.73
	
67
	  	  5.31	  	  4.78	  	  4.94	  	  5.15	  	  4.71	  	  4.84
	
68
	  	  5.47	  	  4.91	  	  5.08	  	  5.28	  	  4.83	  	  4.97
	
69
	  	  5.64	  	  5.05	  	  5.23	  	  5.42	  	  4.95	  	  5.10
	
70
	  	  5.82	  	  5.21	  	  5.39	  	  5.56	  	  5.09	  	  5.23
	
71
	  	  6.01	  	  5.37	  	  5.56	  	  5.71	  	  5.23	  	  5.38
	
72
	  	  6.22	  	  5.55	  	  5.75	  	  5.86	  	  5.37	  	  5.53
	
73
	  	  6.44	  	  5.74	  	  5.95	  	  6.02	  	  5.53	  	  5.68
	
74
	  	  6.67	  	  5.94	  	  6.16	  	  6.19	  	  5.70	  	  5.85
	
75
	  	  6.92	  	  6.17	  	  6.39	  	  6.36	  	  5.87	  	  6.02
	
76
	  	  7.18	  	  6.40	  	  6.64	  	  6.53	  	  6.05	  	  6.20
	
77
	  	  7.47	  	  6.66	  	  6.90	  	  6.71	  	  6.23	  	  6.38
	
78
	  	  7.77	  	  6.94	  	  7.19	  	  6.89	  	  6.42	  	  6.57
	
79
	  	  8.10	  	  7.24	  	  7.49	  	  7.07	  	  6.62	  	  6.76
	
80
	  	  8.45	  	  7.56	  	  7.83	  	  7.25	  	  6.82	  	  6.96
	
81
	  	  8.82	  	  7.92	  	  8.19	  	  7.44	  	  7.02	  	  7.15
	
82
	  	  9.23	  	  8.30	  	  8.57	  	  7.62	  	  7.23	  	  7.35
	
83
	  	  9.66	  	  8.71	  	  8.99	  	  7.79	  	  7.43	  	  7.54
	
84
	  	 10.12	  	  9.16	  	  9.44	  	  7.96	  	  7.63	  	  7.73
	
85
	  	 10.61	  	  9.64	  	  9.93	  	  8.13	  	  7.82	  	  7.92
	
86
	  		  		  	 	  	  8.29	  	  8.00	  	  8.09
	
87
	  		  		  	 	  	  8.44	  	  8.18	  	  8.26
	
88
	  		  		  	 	  	  8.58	  	  8.34	  	  8.42
	
89
	  		  		  	 	  	  8.71	  	  8.50	  	  8.57
	
90
	  		  		  	 	  	  8.84	  	  8.64	  	  8.70
	
91
	  		  		  	 	  	  8.95	  	  8.77	  	  8.83
	
92
	  		  		  	 	  	  9.06	  	  8.89	  	  8.95
	
93
	  		  		  	 	  	  9.15	  	  9.01	  	  9.06
	
94
	  		  		  	 	  	  9.24	  	  9.11	  	  9.15
	
95
	  		  		  	 	  	  9.32	  	  9.20	  	  9.24
	
96
	  		  		  	 	  	  9.39	  	  9.29	  	  9.32
	
97
	  		  		  	 	  	  9.45	  	  9.36	  	  9.39
	
98
	  		  		  	 	  	  9.49	  	  9.43	  	  9.45
	 99
	  	 	  	 	  	 	  	  9.53	  	  9.48	  	  9.50

 *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 (if the option is available based on Adjusted Age as described in Section 10). 

  

			
	ICC12 AP(2)0513	  	Page 22(c)










 APPENDIX (continued) 
  

 Option 4-V 
 Monthly Installment For Joint and Survivor 
  

															
	 Adjusted Age

of

Male
Annuitant*
	  	Adjusted Age of Female
Annuitant*
	  	15 Years
Less Than
Male	  	12 Years
Less Than
Male	  	 9 Years

Less Than
Male
	  	 6 Years

Less Than
Male
	  	 3 Years

Less Than
Male
	  	Same As
Male	  	 3
Years
 More Than
Male

	
50
	  	$2.96	  	$3.01	  	$3.06	  	$3.12	  	$3.18	  	$3.24	  	$3.31
	
55
	  	  3.07	  	  3.14	  	  3.21	  	  3.28	  	  3.36	  	  3.44	  	  3.52
	
60
	  	  3.21	  	  3.30	  	  3.39	  	  3.49	  	  3.59	  	  3.70	  	  3.81
	
65
	  	  3.40	  	  3.51	  	  3.64	  	  3.77	  	  3.91	  	  4.05	  	  4.20
	
70
	  	  3.64	  	  3.79	  	  3.96	  	  4.14	  	  4.34	  	  4.54	  	  4.74
	
75
	  	  3.97	  	  4.17	  	  4.41	  	  4.66	  	  4.93	  	  5.22	  	  5.50
	
80
	  	  4.41	  	  4.70	  	  5.03	  	  5.39	  	  5.79	  	  6.19	  	  6.60
	 85
	  	  5.03	  	  5.45	  	  5.92	  	  6.45	  	  7.02	  	  7.59	  	  8.15

 Monthly Installment For Unisex Joint and Survivor 

 

															
	 Adjusted Age

of

First

Annuitant*
	  	Adjusted Age of Joint
Annuitant*
	  	 15
Years
Less Than
 First
	  	12 Years
Less Than
First	  	9 Years
Less Than
First	  	6 Years
Less Than
First	  	3 Years
Less Than
First	  	Same As
First	  	3 Years
More Than
First
	
50
	  	$2.97	  	$3.02	  	$3.07	  	$3.12	  	$3.18	  	$3.23	  	$3.28
	
55
	  	  3.09	  	  3.15	  	  3.22	  	  3.29	  	  3.35	  	  3.42	  	  3.48
	
60
	  	  3.24	  	  3.32	  	  3.41	  	  3.49	  	  3.58	  	  3.67	  	  3.76
	
65
	  	  3.43	  	  3.54	  	  3.65	  	  3.77	  	  3.89	  	  4.02	  	  4.13
	
70
	  	  3.68	  	  3.83	  	  3.98	  	  4.15	  	  4.32	  	  4.49	  	  4.65
	
75
	  	  4.02	  	  4.22	  	  4.44	  	  4.67	  	  4.92	  	  5.16	  	  5.39
	
80
	  	  4.49	  	  4.77	  	  5.08	  	  5.42	  	  5.76	  	  6.11	  	  6.45
	 85
	  	  5.14	  	  5.54	  	  6.00	  	  6.48	  	  6.99	  	  7.50	  	  7.97

 *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 (if the
option is available based on Adjusted Age as described in Section 10). 

  

			
	ICC12 AP(2)0513	  	Page 22(d)









  
  

 
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 A Stock Company (Hereafter called the Company, we, our or us)
	  	 Administrative and Home Office:
 4333 Edgewood Road N.E.
 Cedar Rapids, Iowa 52499

(319) 355-8511

www.transamericaannuities.com



  

			
	ICC12 VA(2)0513	  	Page 23