Exhibit 4(z)



 EXHIBIT 4(z) 
 FORM OF POLICY FOR SEPARATE ACCOUNT VA C 








			
	



	  	 Home Office:
 4333 Edgewood
Road N.E.
 Cedar Rapids, Iowa 52499

(319)398-8511


  

			
	ANNUITANT:        	 	[John Doe]
		
	OWNER(S):        	 	[John Doe]
		
	POLICY NUMBER:        	 	[07 – 12345]
		
	POLICY DATE:        	 	[August 1, 2005]


 


 WE AGREE 

 

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



 

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



 

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


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

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

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



 20 DAY RIGHT TO CANCEL 
 You may cancel this policy by delivering or mailing a written notice or sending a telegram to us or Your agent. You must return the policy before midnight of the twentieth day after the day You receive
it. Notice given by mail and return of the policy by mail are effective on being postmarked, properly addressed and postage prepaid. 
 We will
pay You an amount equal to the sum of: 
  

	 	•	 	 the premiums paid; 


  

	 	•	 	 less prior Withdrawals, if any; plus or minus 


  

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



unless otherwise required by law.


 

  
 Signed for us at our
home office. 
  

			
	



	  	




	SECRETARY	  	PRESIDENT

 This policy is a legal contract between the policyowner and the Company. 

READ YOUR POLICY CAREFULLY 
 Flexible Premium Deferred Variable Annuity 
 Income Payable At Annuity
Commencement Date 
 Benefits Based On The Performance Of The Separate Account Are 

Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C) 

Non-Participating 







 SECTION 1 – DEFINITIONS 

 


 ADJUSTED POLICY VALUE—The Policy Value increased or decreased by any Excess Interest
Adjustment. 
 ANNUITANT—The person whose life annuity payments will be based on. 

ANNUITY COMMENCEMENT DATE—The Date the Annuitant will begin receiving payments from this policy. This date may be changed by the owner as
described in Section 11. 
 CASH VALUE—The amount, defined in Section 5, that is available for partial or full Surrenders.

 CUMULATIVE EARNINGS—An amount equal to the Policy Value at the time a lump sum payout or systematic payout option payout is made,
minus the sum of all premium payments reduced by all prior partial Withdrawals deemed to have been from premium, if any. 
 CUSTODIAL
CARE—Care designed essentially to help a person with the activities of daily living which does not require the continuous attention of trained medical or paramedical personnel. 
 DISTRIBUTION—A disbursement of funds from the Policy Value or Cash Value. Policy Value and Cash Value will be reduced by any Distribution. 

EARNINGS—The Gains, if any, in the Policy Value. 
 GAINS—Cumulative Earnings, if any, in the Policy Value. 
 FIXED ACCOUNT GUARANTEED
MINIMUM EFFECTIVE ANNUAL INTEREST RATE—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 on the Policy Data page. 


 HOSPITAL—An institution which 1) is operated pursuant to the laws of the jurisdiction in which
it is located, 2) operates primarily for the care and treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour nursing service by or under the supervision of registered graduate professional nurses, 4) is supervised by a
staff of one or more licensed Physicians, and 5) has medical, surgical and diagnostic facilities or access to such facilities. 
 INCOME
OPTIONS—Options through which the Distribution of the Adjusted Policy Value can be directed. 
 INVESTMENT OPTIONS—Any of
the Guaranteed Fixed Account Options and any of the Subaccounts of the Separate Account. 
 MINIMUM NONFORFEITURE INTEREST RATE—The
interest rate shown on the Policy Data page and which is used to determine the minimum required cash value as defined in your state’s nonforfeiture law. This rate is not the credited rate used to determine your policy’s cash value, but
rather it is the interest rate used to develop the minimum cash value required by the nonforfeiture law applicable on the policy date for the state or jurisdiction in which the policy is issued.  

MINIMUM REQUIRED CASH VALUE—The minimum amount required to be paid on surrender in accordance with the nonforfeiture law applicable on the
policy date for the state or jurisdiction in which the policy is issued. This minimum value is calculated according to a method described in the law, which is different than the method described in the policy for determining your policy’s cash
value. 

 


  

					
	 AVB1216
	  	Page 2	  	










 SECTION 1 – CONTINUED 

 


 NURSING CARE—Care prescribed by a Physician and performed or supervised by a registered
graduate nurse. Such care includes nursing and rehabilitation services available 24 hours.  
 NURSING FACILITY—A facility
which 1) is operated pursuant to the laws of the jurisdiction in which it is located, 2) provides Nursing Care or Custodial Care, 3) primarily provides Nursing Care under the direction of a licensed Physician, registered graduate professional nurse,
or licensed vocational nurse, except when receiving Custodial Care, and 4) is not other than incidentally a Hospital, a home for the aged, a retirement home, a rest home, a community living center or a place mainly for the treatment of alcoholism,
mental illness or drug abuse. 
 PAYEE—The person to whom annuity payments will be made.  

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

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

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

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



 POLICY YEAR—The 12-month period following the Policy Date shown on the Policy Data page. The
first Policy Year starts on the Policy Date. Each subsequent year starts on the anniversary of the Policy Date. 
 SEPARATE
ACCOUNT—The separate investment account(s) established by us, as described in Section 6. 
 SUBACCOUNT—A division of
the Separate Account, as described in Section 6. 
 SURRENDER—A partial or full Withdrawal of funds from the Policy Value or
Cash Value. 
 TERMINAL CONDITION—A condition resulting from an accident or illness which, as determined by a Physician, has reduced
life expectancy to not more than 12 months, despite appropriate medical care. 
 WITHDRAWAL—A disbursement of funds from the Policy
Value or Cash Value. Policy Value and Cash Value will be reduced by any Distribution. 
 YOU, YOUR—The owner of this policy. Unless
otherwise specified, the Annuitant and the owner shall be one and the same person. If a joint owner is named, reference to “You” or “Your” in this policy will apply to both the owner and joint owner.


 


  

					
	 AVB1216B
	  	Page 2(A)	  	









 SECTION 2 – POLICY DATA 

 

							
	POLICY NUMBER:	 	[07-12345]	 	ANNUITANT:	  	[John Doe]
	INITIAL PREMIUM PAYMENT:	 	[$5,000.00]	 	ISSUE AGE/SEX:	  	[35/Male]
	POLICY DATE:	 	[August 1, 2005]	 	OWNER(S):	  	[John Doe]
	 ANNUITY COMMENCEMENT

DATE:
	 	[April 30, 2065]	 	GUARANTEED MINIMUM DEATH BENEFIT OPTION:	  	Policy Value
	BENEFICIARY:	 	[Jane Doe]	 		  	

 Premium Enhancement Percentage on Initial Premium Payment: [4.00%] 

Fixed Account Guaranteed Minimum Effective Annual Interest Rate: [1.50%] 
 Minimum Nonforfeiture Interest Rate: [2.50%] 
 Before the Annuity Commencement Date:

 [Death Benefit – Policy Value] 
 Mortality and Expense Risk Fee and Administrative Charge: 
  

					
	 Policy Years 1-9
	  	 	1.65	% 
	 Policy Years 10 or more
	  	 	1.20	% 

 After the Annuity Commencement Date: 
 Mortality and Expense Risk Fee and Administrative Charge: [1.25%] 
 The amount paid on Surrender
will never be less than the greatest of the following three amounts: 1) 100% of premium payments made to the Fixed Account, excluding premium enhancements, if any, less prior gross partial Withdrawals and transfers from the Fixed Account, 2) Cash
Value described in Section 5, and 3) Minimum Required Cash Value, equal to 87.5% of premium payments made to the Fixed Account, less prior gross partial Withdrawals and transfers from the Fixed Account, less $50 per year at the beginning of
each year, all accumulated at the Minimum Nonforfeiture Interest Rate shown above. 

  

					
	 AV950SP (Ind)(R)
	  	Page 3	  	









 SECTION 3 – PREMIUM PAYMENTS 

 


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

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

	1)	Exercise of Nursing Care and Terminal Condition Withdrawal Option; 

  

	2)	Exercise of Unemployment Waiver; 

  

	3)	A death benefit is payable; or 

  

	4)	Upon anriuitization. 

 MAXIMUM AND MINIMUM
PREMIUM PAYMENT  
 The premium payments may not be more than the amount permitted by law if this is a tax-qualified annuity. The minimum
initial premium payment is $5,000. If this policy is being used as a tax-qualified annuity, the minimum initial premium is $1,000, except that no minimum initial premium payment will be required for 403(b) annuities. The



 
minimum subsequent premium payment we will accept is $50. The maximum total premium payments which we will accept without prior Company approval is $1,000,000 for issue ages 0-80. For issue ages
over 80, the maximum total premium payments which we will accept without prior Company approval is $500,000. We reserve the right to limit or refuse subsequent premium payments. 
 PREMIUM PAYMENT DATE  
 The premium payment date is the date on which the premium payment is
credited to the policy. The initial premium payment less any applicable premium taxes will be credited to the policy within two business days of receipt of the premium payment and the information needed. Subsequent additional premium payments will
be credited to the policy as of the business day the premium payment and required information are received. A business day is any day that the New York Stock Exchange is open for trading. 
 ALLOCATION OF PREMIUM PAYMENTS  
 Premium payments may be applied to various
Investment Options, which we make available. For 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. Each percent
may be either zero or any whole number; however, the allocation among the Investment Options must total 100%.  
 CHANGE OF
ALLOCATION 
 You may change the allocation of premium payments to various Investment Options by providing us notice containing the
facts that we need. Premium payments received after the date on which we receive Your notice will be applied on the basis of the new allocation. 
 PREMIUM TAXES 
 Your state may impose a premium tax. It may be imposed either when a
premium payment is made, on the Annuity Commencement Date, on the date of death or on the date of full Surrender. When permitted by state law, we will not deduct the premium tax until the Annuity Commencement Date, date of death, or date of full
Surrender. 

 

  
 SECTION 4 –
POLICY VALUE 

 


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

	(a)	premium payments plus corresponding Premium Enhancements; minus 

  

	(b)	Gross Partial Withdrawals (as defined in Section 5); plus 

  

	(c)	interest credited to the Fixed Account (see Section 7); plus 

  

	(d)	accumulated gains in the Separate Account (see Section 6); minus 

  

	(e)	accumulated losses in the Separate Account (see Section 6); minus





	(f)	service charges, premium taxes, rider fees and transfer fees, if any. 

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

 


  

					
	 M1583
	  	Page 4	  	










 SECTION 4 – CONTINUED 

 

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



 
on the Policy Anniversary or at the time of full Surrender. 
 The Service Charge will not
be deducted on a Policy Anniversary or at the time of full Surrender if, at that time, (1) the sum of all premium payments less the sum of all Withdrawals taken equals or exceeds $100,000; or (2) the Policy Value equals or exceeds
$100,000. 

 

  
 SECTION 5 –
CASH VALUE AND PARTIAL WITHDRAWALS 

 


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

There is no Cash Value once an Annuity Income Option has been selected. 
 EXCESS INTEREST ADJUSTMENT 
 Full Surrenders, partial Withdrawals, transfers, and amounts
applied to an Income Option (prior to the end of any Guaranteed Payment Option) from Guaranteed Period Options of the Fixed Account described in Section 7 will be subject to an Excess Interest Adjustment except as provided for in the partial
Withdrawals provision below. 
 An Excess Interest Adjustment applies in the following situations: 

 

	1)	When You withdraw all or any portion of Your Cash Value; 

  

	2)	When You exercise an Income Option; and 

  

	3)	When death proceeds are calculated. However, death proceeds will not be reduced if the Excess Interest Adjustment results in a decrease in the funds available to You.


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

 

	1)	The Excess Interest Adjustment is only applied when the transactions occur prior to the end of any Guaranteed Period Option; 


 

	2)	Transfers to the Guaranteed Period Options of the Fixed Account are considered Premium Payments for purposes of determining the Excess Interest Adjustment;


  

	3)	The Excess Interest Adjustment is distinct from, and is applied prior to, the Surrender charge; 


 

	4)	The Excess Interest Adjustment may affect the death proceeds defined in Section 9; 


	




	5)	If interest rates have decreased from the time the affected Guaranteed Period(s) started until the time the transaction occurs, the Excess Interest Adjustment will
result in additional funds available to You; 

  

	6)	If interest rates have increased from the time the affected Guaranteed Period(s) started until the time the transaction occurs, the Excess Interest Adjustment will
result in decreased funds available to You; 

  

	7)	Certain amounts are not subject to the Excess Interest Adjustment as provided in Sections 5, 7, and 8; and 


 

	8)	Upon full Surrender, the cumulative interest credited to the Guaranteed Period Options of the Fixed Account at the time of Surrender will not be subject to an Excess
Interest Adjustment. 

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

Excess Interest Adjustment = S x (G-C) x (M/12) 
  

	where:	S is the amount (before Surrender charges and premium taxes, if any) being Surrendered, partially withdrawn, transferred, or applied to a Payment Option that is subject
to the Excess Interest Adjustment. 

  

	 	G	is the guaranteed interest rate for the Guaranteed Period applicable to “S”. 


 

	 	C	is the current guaranteed interest rate then being offered on new Premium Payments for the next longer Guaranteed Period than “M”. If this policy form or such
a Guaranteed Period Option is no longer offered, “C” will be the U.S. Treasury rate for the next longer maturity (in whole years) than “M” on the 25th day of the previous calendar month, plus up to 2%. 


 

	 	M	is the number of months remaining in the Guaranteed Period for “S”, rounded up to the next higher whole number of months. 


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


 


  

					
	 U1583
	  	Page 5	  	










 SECTION 5 – CONTINUED 

 


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

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

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

	X	is Excess Partial Withdrawal; 

  

	A	is Amount of partial Withdrawal subject to Excess Interest Adjustment; 

  

	Y	is Excess Interest Adjustment = (A) x (G-C) x (M/12) where G, C and M are defined in the Excess Interest Adjustment provision above, with “A” substituted
for “S” in the definitions of G and M; and 

  

	Z	is Surrender charge on X minus Y. 

 The formula
for determining the Gross Partial Withdrawal is as follows: 
 Gross Partial Withdrawal = R - E + SC, where: 

 

	R	is the requested partial Withdrawal; 

  

	E	is the Excess Interest Adjustment; 

  

	SC	is the Surrender charge on (EPW - E); where 

  

	EPW	is the Excess Partial Withdrawal Amount (the portion of the requested partial Withdrawal that is subject to Surrender charge).




 If any partial Withdrawal reduces the Cash Value below $500, we reserve the right to pay the full Cash
Value and terminate the policy. 
 We may delay (with prior authorization from the Commissioner) payment of the Cash Value from the Fixed
Account for up to 6 months after we receive the request. If the Annuitant dies after we receive the request, but before the request is processed, the request will be processed before the death proceeds are determined. 

Each partial Withdrawal consists of a portion that is subject to a Surrender charge (that is, the Excess Partial Withdrawal) and a remaining portion that
is free from Surrender charge (that is, the Surrender charge-free amount). Either portion may be zero (0) depending on the partial Withdrawal requested and prior amounts withdrawn. 
 Partial Withdrawals in the amount of the cumulative interest in the Guaranteed Period Option(s) of the Fixed Account at the time of Withdrawal may be withdrawn from the GPO(s) of the Fixed Account free of
any Excess Interest Adjustment. 
 Amounts withdrawn under one of the options below may reduce the amount available free of Surrender charges
under another option. Surrender charges and/or EIA may be waived as described below. 
 LUMP SUM 

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

 

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

  

	B	is an amount equal to 10% of the premium payments. 

 The minimum partial Withdrawal under this option is $500. We reserve the right to limit the availability of this partial Withdrawal option to once per year.


 


  

					
	 P1730
	  	Page 6	  	










 SECTION 5 – CONTINUED 

 


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

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

  

	B	is an amount equal to 10% of the premium payments. 

 No Surrender charges or Excess Interest Adjustment will apply to the SPO payout. Monthly and quarterly payouts must be sent through electronic funds transfer directly to a checking or savings account. You
may stop SPO payouts at any time; however, 30 days’ written notice is required to stop SPO payouts. 
 Once You have elected a SPO, You
must wait a minimum time before the first SPO payment: 1 month for monthly, 3 months for quarterly, 6 months for semi-annual, or 12 months for annual. If a Lump Sum Distribution is taken while SPO payments have been elected and the total Withdrawal
will exceed the free amount in that Policy Year, the SPO will be stopped. 
 If You are receiving SPO payouts and a lump sum Withdrawal is taken
under 1. above, such that future SPO payouts in that Policy Year will exceed the total annual Surrender charge-free amount, then we will adjust future SPO payouts to reflect Your remaining Surrender charge-free amount for that Policy Year, if any.
Your SPO payouts will be adjusted on Your next scheduled SPO payout, based on any remaining Surrender charge-free amount. 
 MINIMUM REQUIRED
DISTRIBUTION 
 For tax-qualified plans, partial Withdrawals taken to satisfy minimum Distribution requirements under Section 401 (a)(9)
of the Internal Revenue Code (lRC) are available with no Surrender charges and no Excess Interest Adjustments. The amount available from this policy with respect to the minimum Distribution requirement is based solely on this policy. 

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

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



 NURSING CARE AND TERMINAL CONDITION WITHDRAWAL OPTION 

Beginning in the first Policy Year, if the owner or owner’s spouse (Annuitant or Annuitant’s spouse if the owner is not a natural person) has
been 1) confined in a Hospital or Nursing Facility for 30 consecutive days or 2) diagnosed as having a Terminal Condition, You may elect to withdraw all or a portion of the Policy Value without Surrender charges and without an Excess Interest
Adjustment. The minimum Withdrawal under this option is $1000. This option is available even during the Policy Years other partial Withdrawal options were exercised prior to Nursing Care. 
 For Nursing Care, we must receive each Withdrawal request and proof of eligibility with each request no later than 90 days following the date that confinement has ceased, unless it can be shown that it
was not reasonably possible to provide the notice and proof within the above time period and that the notice and proof were given as soon as reasonably possible. However, in no event, except the absence of legal capacity, shall the notice and proof
be provided later than one year following the date that confinement has ceased. Proof of confinement may be a Physician’s statement or a statement from a Hospital or Nursing Facility administrator. For a Terminal Condition, we must receive each
Withdrawal request and the applicable proof of eligibility no later than one year following diagnosis of the Terminal Condition. Proof of a Terminal Condition is required only with the initial Withdrawal request and must be furnished by the
owner’s, owner’s spouse’s, Annuitant’s, or Annuitant’s spouse’s Physician. 
 UNEMPLOYMENT WAIVER

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

 


  

					
	 PB1730
	  	Page 7	  	










 SECTION 5 – CONTINUED 

 


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

			
	 Number of Years

Since Premium

Payment Date
	  	 Percentage of
 Premium Withdrawn

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

 For Surrender charge purposes, all Earnings (including Premium Enhancement) are considered to be withdrawn first. After
all Earnings are withdrawn then the oldest premium payment is the first premium payment considered to be withdrawn. If the amount withdrawn exceeds this, the next oldest premium payment is considered to be withdrawn, and so on until the most recent
premium payment is deemed to be withdrawn (the procedure being applied to Withdrawals of premium is a “First-In, First-Out” or FIFO procedure). 
 GUARANTEED RETURN OF FIXED ACCOUNT PREMIUM PAYMENTS 
 Upon full Surrender of the policy, You
will always receive at least the premium payments made to, less prior Withdrawals and transfers from, the Fixed Account.



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

 MINIMUM REQUIRED CASH VALUE 

The Minimum Required Cash Value is the amount prescribed by Your state’s/jurisdiction’s minimum cash value 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 on
the Policy Data page. The minimum amount is calculated according to a procedure specified in Your state’s/jurisdiction’s law using a prescribed Minimum Nonforfeiture Interest Rate, which will be fixed and not less than 1% (nor more than
3%) on the Policy Date, such rate 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 the result 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 business 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% occurs. For example, if Your policy was issued on any business day
during the third calendar quarter, Your Minimum Nonforfeiture Interest Rate would be determined by averaging the first ten business 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%).


 

  
 SECTION 6 –
SEPARATE ACCOUNT 

 


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

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



 The assets of the Separate Account are our property. These assets will equal or exceed the reserves and
other contract liabilities of the Separate Account. These assets will not be chargeable with liabilities arising out of any other business we conduct. We reserve the right, subject to regulations governing the Separate Account, to transfer assets of
a Subaccount, in excess of the reserves and other contract liabilities with respect to that Subaccount, to another Subaccount or to our General Account. 
 We will determine the fair market value of the assets of the Separate Account in accordance with a method of valuation, which we establish in good faith. Valuation Period means the period of time from one
determination of the value of each Subaccount to the next. Such determinations are made when the value of the assets and liabilities of each Subaccount is calculated. This is generally the close of business on each day on which the New York Stock
Exchange is open. 

 


  

					
	 V1822
	  	Page 8	  	R










 SECTION 6 – CONTINUED 

 


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

 

	(a)	deregister the Separate Account under the Investment Company Act of 1940; 

  


	(b)	manage the Separate Account under the direction of a committee at any time; 


 

	(c)	restrict or eliminate any voting rights of policy owners or other persons who have voting rights as to the Separate Account; 


 

	(d)	combine the Separate Account with one or more other Separate Accounts; 

  

	(e)	create new Separate Accounts; 

  

	(f)	add new Subaccounts to or remove existing Subaccounts from the Separate Account, or combine Subaccounts; and 


 

	(g)	add new underlying mutual funds, remove existing mutual funds, or substitute a new fund for an existing fund. 


The Net Asset Value of a fund share is the pershare value calculated by the mutual fund or, in the case of a managed Separate Account, by the Company.
The Net Asset Value is computed by adding the value of the Subaccount’s investments, cash and other assets, subtracting its liabilities, and then dividing by the number of shares outstanding. Net Asset Values of fund shares reflect investment
advisory fees and other expenses incurred in managing a mutual fund or a managed Separate Account. 
 CHANGE IN INVESTMENT OBJECTIVE OR
POLICY OF A MUTUAL FUND 
 If required by law or regulation, an investment policy of the Separate Account will only be changed if approved by
the appropriate insurance official of the state of Iowa or deemed approved in accordance with such law or regulation. If so required, the process for obtaining such approval is filed with the insurance official of the state or district in which this
policy is delivered. 
 CHARGES AND DEDUCTIONS 
 The Mortality and Expense Risk Fee and the Administrative Charge are each deducted both before and after the Annuity Commencement Date to compensate for changes in mortality and expenses not anticipated
by the mortality and administration charges guaranteed in the policy. 
 The Service Charge is deducted prior to the Annuity Commencement Date
only. 
 If the Mortality and Expense Risk Fee is more than sufficient, the Company will retain the balance as profit or may reduce this fee in
the future. 


 ACCUMULATION UNITS 
 The Policy Value in the Separate Account before the Annuity Commencement Date is represented by accumulation units. The dollar value of accumulation units for each Subaccount will change from business day
to business day reflecting the investment experience of the Subaccount. 
 Premium Payments allocated to and any amounts transferred to the
Subaccounts will be applied to provide accumulation units in those Subaccounts. The number of accumulation units purchased in a Subaccount will be determined by dividing the amount allocated to or transferred to that Subaccount, by the value of an
accumulation unit for that Subaccount on the premium payment or transfer date. 
 The number of accumulation units withdrawn or transferred from
the Subaccounts will be determined by dividing the amount withdrawn or transferred by the value of an accumulation unit for that Subaccount on the Withdrawal or transfer date. 
 The value of an accumulation unit on any business day is determined by multiplying the value of that unit at the end of the immediately preceding valuation period by the net investment factor for the
valuation period. 
 The net investment factor used to calculate the value of an accumulation unit in each Subaccount for the Valuation Period
is determined by dividing (a) by (b) and subtracting (c) from the result, where: 
  

	(a)	is the result of: 

  

	 	(1)	the net asset value of a fund share held in that Subaccount determined as of the end of the current valuation period; plus 


 

	 	(2)	the per share amount of any dividend or capital gain Distributions made by the fund for shares held in that Subaccount if the ex-dividend date occurs during the
valuation period; plus or minus 

  

	 	(3)	a per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of that Subaccount.


  

	(b)	is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding valuation period. 


 

	(c)	is a factor representing the Mortality and Expense Risk Fee and Administrative Charge before the Annuity Commencement Date. This factor is less than or equal to, on an
annual basis, the percentage shown on the Policy Data Page of the daily net asset value of a fund share held in that Subaccount. 


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


 


  

					
	 VB1822
	  	Page 9	  	R









 SECTION 7 – FIXED ACCOUNT 

 


 FIXED ACCOUNT 
 The Fixed Account is comprised of Guaranteed Period Options and the Dollar Cost Averaging Fixed Option that we may choose to offer. Premium payments applied to and any amounts transferred to the Fixed
Account will reflect a fixed interest rate. The interest rates we set will be credited for increments of at least one year measured from each premium payment or transfer date. These rates will never be less than the Fixed Account Guaranteed Minimum
Effective Annual Interest Rate shown on Page 3. 
 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 in Section 7 if we are crediting an interest rate equal to the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown on page 3. 

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 funds entering each Guaranteed Period Option (GPO) is guaranteed until the end of that option’s Guaranteed
Period. At that time, the premium payment made or amount transferred into the GPO, less any Withdrawals or transfers from that GPO, plus accrued interest, will be rolled into a new GPO or may be transferred to any Subaccount(s) within the Separate
Account(s). 
 You may choose the Investment Option(s) You want the funds transferred into by giving us a written notice within 30 days before
the end of the expiring option’s Guaranteed Period. However, any Guaranteed Period elected may not extend beyond the maximum Annuity Commencement Date defined in Section 11. In the absence of such election, the funds will be rolled into a
new GPO which is the same as the expiring GPO unless that GPO is no longer offered. In that case, the funds will be rolled into the next shorter GPO available, otherwise the next longer GPO available. You will be mailed a notice of



 
completion of the rollover with the new interest rate applicable. The new GPO will be deemed as accepted if we do not receive a written rejection within 30 days from the postmark date of the
completion notice. We reserve the right, at our sole discretion, for new premium payments, transfers, or rollovers to offer or not to offer any GPO. 
 When funds are withdrawn or transferred from a GPO, the Policy Value associated with the oldest premium payment or rollover is considered to be withdrawn/transferred first. If the amount
withdrawn/transferred exceeds the Policy Value associated with the oldest premium, the Policy Value associated with the next oldest premium payment or rollover is considered to be withdrawn/transferred next, and so on until the Policy Value
associated with the most recent premium payment or rollover is considered to be withdrawn/transferred (this is a First-In, First-Out or FIFO basis). 
 Partial Withdrawals, Surrenders, transfers, and amounts applied to a Payment Option from the Guaranteed Period Option(s) are subject to an Excess Interest Adjustment as described in Section 5.

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


 


  

					
	 L1228
	  	Page 10	  	









 SECTION 8 – TRANSFERS 

 



	A.	TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE 

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

Transfers of Policy Value from a GPO prior to the end of that GPO are subject to an Excess Interest Adjustment. If the Excess Interest Adjustment at the
time of such Policy Value transfer results in a decrease in the funds available to You, then the maximum Policy Value transfer is 25% of that GPO’s Policy Value, less Policy Values previously transferred out of that GPO during the current
Policy Year. Each such transfer must be separated by a period of 12 months. 
 If the Excess Interest Adjustment at the time of such Policy
Value results in additional funds available to You, no maximum will apply to such Policy Values transferred from the GPO. No Excess Interest Adjustment will apply to Policy Value transfers at the end of a Guaranteed Period. 

Transfers of interest credited in the GPOs to other Investment Options are allowed on a “First-In, First-Out” basis. Such transfers may be made
monthly, quarterly, semi-annually, or annually. Each such transfer must be at least $50 and will not be subject to an Excess Interest Adjustment. 
 Transfers of Policy Value from the Separate Account are subject to a minimum of $500 or the entire Policy Value in the subaccount, If less. However, if the remaining Subaccount Policy Value is less than
$500, we reserve the right to include that amount as part of the transfer. 
 You may choose which GPO to transfer to or from, however, any GPO
elected may not extend beyond the maximum Annuity Commencement Date defined in Section 11. 
 We reserve the right to limit transfers to no
more than 12 in any one Policy Year. Any transfers in excess of 12 per Policy Year may be charged a $10 per transfer fee. Transfers among multiple Investment Options will be treated as one transfer in determining the number of transfers that
have occurred. We also reserve the right, at our sole discretion, to limit or refuse premium payments and/or transfers allocated to any of the Fixed Account Options in Section 7 if we are crediting an interest rate equal to the Fixed Account
Guaranteed Minimum Effective Annual Interest Rate shown on Page 3.



 The policy was not designed for professional market timing organizations or other persons that use
programmed, large, or frequent transfers. The use of such transfers may be disruptive to an underlying portfolio. We reserve the right to reject any transfer request from any person in the interest of overall fund management or, if, in our judgment,
an underlying fund would be unable. to invest effectively in accordance with its investment objectives and policies or would otherwise be potentially adversely affected or if an underlying fund would reject our purchase order. We also reserve the
right to revoke Your telephone, fax, and electronic transfer privileges at any time without revoking all owner’s telephone, fax and electronic transfer privileges. 
 DOLLAR COST AVERAGING OPTION 
 Prior to the Annuity Commencement Date, You may instruct us
to automatically transfer a specified amount from source account(s) made available by Us to any other Subaccount(s) of the Separate Account. The automatic transfers can occur monthly or quarterly. 

Transfers will continue until the elected source account value is depleted. The amount transferred each time must be at least $500. All transfers from
the source account will be the same amount as the initial transfer. Changes to the Subaccounts to which these transfers are allocated are not restricted. Transfers must be scheduled for at least 6 months, but not more than 24 months or for at least
4 quarters, but not more than 8 quarters each time the Dollar Cost Averaging program is started or restarted following termination of the program for any reason. 
 Dollar Cost Averaging results in the purchase of more accumulation units when the value of the accumulation unit is low, and fewer accumulation units when the value of the accumulation unit is high.
However, there is no guarantee that the Dollar Cost Averaging program will result in higher Policy Values or will otherwise be successful. 

Dollar Cost Averaging may be discontinued before its scheduled completion by sending written notice to us. If Dollar Cost Averaging is discontinued prior
to the end of the scheduled period, all remaining funds in the Dollar Cost Averaging Fixed Account will be transferred at that time. Unless we are notified otherwise the funds remaining in the Dollar Cost Averaging Fixed Account will be transferred
to the Subaccounts in the percentages currently indicated. While Dollar Cost Averaging is in effect, Asset Rebalancing is not available.


 


  

					
	 LB1228
	  	Page 11	  	










 SECTION 8 – CONTINUED 

 


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




	B.	TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE 

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

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

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


 

  
 SECTION 9 –
DEATH PROCEEDS 

 



	A.	DEATH PROCEEDS PRIOR TO ANNUITY COMMENCEMENT DATE 

 The amount of death proceeds will be the greatest of (a), (b), (c), or (d) where: 
  

	(a)	is the Policy Value on the date we receive due proof of death and an election of a method of settlement; 


 

	(b)	is the Cash Value on the date we receive due proof of death and an election of a method of settlement. 


 

	(c)	is the Minimum Required Cash Value, and 

  

	(d)	is the Guaranteed Minimum Death Benefit (GMDB), if any, plus any additional premium payments received, less any Gross Partial Withdrawals from the date of death to the
date of payment of death proceeds. 

 Where there are joint Annuitants, the death benefit becomes payable only upon the death



 of the surviving Annuitant however, distribution requirements under C.II. may apply. 

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

	B.	GUARANTEED MINIMUM DEATH BENEFIT 

 The
amount of the Guaranteed Minimum Death Benefit, if any, is based on the death benefit option shown on the Policy Data Page. You may not change the GMDB option after the policy is issued.


 


  

					
	 D658
	  	Page 12	  	










 SECTION 9 – CONTINUED 

 



	C.	DEATH PRIOR TO ANNUITY COMMENCEMENT DATE 


Death proceeds are payable contingent upon the relationships between the owner, Annuitant, and beneficiary as outlined below. The policy must be
Surrendered upon settlement. 
 If there is a surviving owner(s), the surviving owner(s) automatically takes the place of any beneficiary
designation. 
 I. Annuitant Death 
 When we have due proof that the Annuitant died before the Annuity Commencement Date, the death proceeds are payable to the beneficiary. If no beneficiary is designated or there is no surviving owner, the
owner’s estate will become the beneficiary. 
  

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

 If
the policy is continued, all current surrender charges will be waived; however, any premium received after the deceased Annuitant’s death will be subject to any applicable surrender charges. 

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

 

	 	(1)	by the end of 5 years after the date of the deceased Annuitant’s death, or 


 

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

  

	b)	When the beneficiary is an individual who is not the deceased Annuitant’s surviving spouse. The death proceeds must be distributed as provided in I.a)(1) or
l.a)(2) above. 

  

	c)	When the beneficiary is not a natural person, the death proceeds must be distributed by the end of 5 years after the date of the deceased Annuitant’s death.


  

	II.	Owner Death 

 At death of any
owner, all current surrender charges will be waived, however, any premium received after the deceased owner’s death will be subject to any applicable surrender charges.



 If the deceased owner is also the Annuitant, section C.I. Annuitant Death applies.

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

a) surviving owner; 
 b) primary beneficiary; 
 c) contingent beneficiary; or 

d) deceased owner’s estate. 
 The successor owner will need to take distributions according to a), b), or c) below: 
  

	 	a)	If the sole successor owner is the deceased owner’s spouse, the successor owner can continue the policy tax deferred. 


 

	 	b)	If the successor owner is an individual who is not the deceased owner’s spouse, the greater of the Adjusted Policy Value or the Minimum Required Cash Value must be
distributed: 

  

	 	(1)	by the end of 5 years after the date of the deceased owner’s death, or 


 

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

  

	 	c)	If the successor owner is not a natural person, the greater of the Adjusted Policy Value or the Minimum Required Cash Value must be distributed by the end of 5 years
after the date of the deceased owner’s death. 

  

	D.	DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE 

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

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

 


  

					
	 DB658
	  	Page 13	  	









 SECTION 10 – INCOME OPTIONS 

 


 A. GENERAL PAYMENT PROVISIONS 
 Payment 
 If this policy is in force on the Annuity Commencement Date, we will use the Fixed
Account portion and!or the Separate Account portion of the Adjusted Policy Value (or Minimum Required Cash Value, if greater) to make Income Options to the Payee under Option 3 and/or 3-V, respectively, with 10 years certain, or if elected, under
one or more of the other options described in this section, 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 60 months. You will become the Annuitant at
the Annuity Commencement Date. Payments will be made at 1, 3, 6, or 12-month intervals. We reserve the right to change the frequency of payments to avoid making payments of less than $50.00. 
 Before the Annuity Commencement Date, if the death proceeds become payable or if You Surrender this policy, we will pay any proceeds in one sum, or if elected, all or part of these proceeds may be placed
under one or more of the options described in this section. 
 Adjusted Age 
 Payments under Options 3 and 5 and the first payment under Options 3-V and 5-V are determined based on the adjusted age of the Annuitant. The adjusted age is the Annuitant’s actual age on the
Annuitant’s nearest birthday, at the Annuity Commencement Date, adjusted as follows: 
  

			
	Annuity	  	 
	 Commencement Date
	  	 Adjusted Age

	 Before 2010
	  	Actual Age
	 2010 – 2019
	  	Actual Age minus 1
	 2020 – 2026
	  	Actual Age minus 2
	 2027 – 2033
	  	Actual Age minus 3
	 2034 – 2040
	  	Actual Age minus 4
	 After 2040
	  	Determined by us

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



 Payee 
 Unless You specify otherwise, the Payee shall be the Annuitant, or the beneficiary as defined in the Beneficiary provision in Section 1 1. 
 Proof of Age 
 We may require proof of the age of any person who has an annuity purchased
under Options 3, 3-V, 5 and 5-V of this section before we make the first payment. 
 Minimum Proceeds 

If the proceeds are less than $2,000, we reserve the right to pay them out as a lump sum instead of applying them to an Income Option. 

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

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 Income Option. The supplementary 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 on page 18 for the option You select. Options 1, 2 and 4 are based on a guaranteed interest rate of 1.5%. Options 3 and 5 are based on a guaranteed interest rate of 1.5% and the “Annuity 2000” (male, female, and unisex if
required by law) mortality table projected for improvement using projection scale G. The “Annuity 2000” mortality rates are adjusted based on improvements in mortality since 2000 to more appropriately reflect increased longevity. This is
accomplished using a set of improvement factors referred to as pro jection scale G. 
 Option 1 – Interest Payments 

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


 


  

					
	 S1396
	  	Page 14	  	










 SECTION 10 – CONTINUED 

 


 Option 2 – 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 or their
present value may be paid in a single sum. No funds will remain at the end. 
 Option 3 – Life Income – You may choose between:

  

	1.	No Period Certain – We will make level payments only during the Annuitant’s lifetime. 


 

	2.	10 Years Certain – We will make level payments for the longer of the Annuitant’s lifetime or ten years. 


 

	3.	Guaranteed Return of Policy Proceeds – We will make level payments for the longer of the Annuitant’s lifetime or until the total dollar amount of payments we
made to You equals the amount applied to this option. 

  

	4.	Life with Emergency Cash (SM) – We will make level payments during the Annuitant’s lifetime, but the annuity may be Surrendered (in full or part). The Cash
Value is equal to a multiple of the payment where that multiple reduces over time to zero at age 101. A Surrender charge will be applied. Should the Annuitant die before age 101 (or IRS Age Limitation Date if earlier and the contract is qualified),
the same Cash Value would be payable, but without the Surrender charge. 

 Options 3(1) and 3(4) are not available for Adjusted
Age(s) greater than 85. 
 Option 4 – Income of a Specified Amount Payments are made for any specified amount until the amount applied to
this option, with interest, is exhausted. 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 proceeds with interest are exhausted, payments will be continued to that person’s beneficiary or their present value may be paid in a single sum. 
 Option 5 – Joint and Survivor Annuity – You may choose between: 
  

	1.	No Period Certain – Payments are made during the joint lifetime of the Payee and a




 joint Payee of Your selection. Payments will be made as long as either person is living.

  

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


Options 5(1) and 5(2) are not available for Adjusted Age(s) greater than 85. 
 Current Income Options 
 The amounts shown in the tables on page 18 are the guaranteed
amounts. Current amounts offered to individuals of the same class may be obtained from us, subject to availability as described under Guaranteed Income Options above. 
 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 business day is equal
to (a) multiplied by (b) multiplied by (c), where: 
  

	(a)	is the variable annuity unit value for that Subaccount on the immediately preceding business day; 


 

	(b)	is the net investment factor for that Subaccount for the Valuation Period; and 


 

	(c)	is the assumed investment return adjustment factor for the Valuation Period. 

 The assumed investment return adjustment factor for the valuation period is the product of discount factors of .99986634 per day to recognize the 5.0% effective annual assumed investment return.


 


  

					
	 SB1396
	  	Page 15	  	










 SECTION 10 – CONTINUED 

 


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

	(a)	is the net result of: 

  

	 	(1)	the net asset value of a fund share held in that Subaccount determined as of the end of the current valuation period; plus 


 

	 	(2)	the per share amount of any dividend or capital gain Distributions made by the fund for shares held in that Subaccount if the ex-dividend date occurs during the
Valuation Period; plus or minus 

  

	 	(3)	a per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of the Subaccount. 


 

	(b)	is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding Valuation Period. 


 

	(c)	is a factor representing the Mortality and Expense Risk Fee and Administrative Charge applicable after the Annuity Commencement Date. This factor is less than or equal
to, on an annual basis, the percentage shown on the Policy Data Page, plus any additional fee applicable to the Optional Initial Payment Guarantee of the daily net asset value of a fund share held in the Separate Account for that Subaccount.


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



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

 

	1.	No Period Certain – Payments will be made during the lifetime of the Annuitant. 


 

	2.	10 Years Certain – Payments will be made for the longer of the Annuitant’s lifetime or ten years. In the event of the death of the person receiving payments
prior to the end of the guarantee period for which the election was made, payments will be continued to that person’s beneficiary or their present value may be paid in a single sum. 


 

	3.	Life with Emergency Cash (SM) – We will make payments during the Annuitant’s lifetime, but the annuity may be Surrendered (in full or part). The Cash Value is
equal to a multiple of the Supportable Payment (see definition below), where that multiple reduces over time to zero at age 101. A Surrender charge will be applied. Should the Annuitant die before age 101 (or IRS Age Limitation Date if earlier and
the contract is qualified), the same Cash Value would be payable, but without the Surrender charge. 

 Options 3-V(1) and 3-V(3)
are not available for Adjusted Age(s) greater than 85. 
 Option 5-V – Joint and Survivor Annuity – You may choose between:

  

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


 

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


 Options 5-V(1) and 5-V(2) are not available for Adjusted Age(s) greater than 85.


 


  

					
	 C909
	  	Page 16	  	










 SECTION 10 – CONTINUED 

 


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

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

Determination of Subsequent Variable Payments Without Stabilization 
 The amount of each variable annuity payment after the first will increase or decrease according to the value of the variable annuity units which reflect the investment experience of the selected
Subaccounts. Each variable annuity payment after the first will be equal to the number of variable annuity units in the selected Subaccounts multiplied by the variable annuity unit value on the date the payment is made. The number of variable
annuity units in each selected Subaccount is determined by dividing the first variable annuity payment allocated to the Subaccount by the variable annuity unit value of that Subaccount on the Annuity Commencement Date. 

Determination of Subsequent Variable Payments With Stabilization 
 If “Life with Emergency Cash” is chosen (Option 3-V(3) or 5-V(2)), or if the Optional Initial Payment Guarantee is chosen, variable annuity payments during the first year following the election
date, will be stabilized to equal the initial payment. Your election date is the date



 You elect the “Life with Emergency Cash” option or the “Optional Initial Payment
Guarantee” option. On each anniversary of Your election date, the stabilized variable annuity payment will be increased or decreased (but never below the guaranteed payment if the Optional Initial Payment Guarantee is chosen) and held level for
that year. On each anniversary of Your election date, the stabilized variable annuity payment will equal the Supportable Payment at that time (or if the Optional Initial Payment Guarantee is chosen, the stabilized variable payment will equal the
greater of the guaranteed payment or the Supportable Payment at that time). 
 If the payment without stabilization (at any payment date during
the Policy Year) is greater than the stabilized variable annuity payment for that year, the excess will be used to purchase additional annuity units (as described below). If the payment without stabilization (at any payment date during the Policy
Year) is less than the stabilized variable annuity payment for that year, annuity units will be redeemed (as described below) to fund the deficiency. 
 Purchase/Redemption of Annuity Units with Stabilized Variable Annuity Payments 
 The number
of annuity units purchased or redeemed is equal to the annuity income purchased or redeemed, respectively, divided by the annuity unit value for each respective Subaccount. Purchases and redemptions of annuity income will be allocated to each
Subaccount on a proportionate basis. The amount of annuity income purchased or redeemed is the difference between the payment without stabilization during the Policy Year and the stabilized variable annuity payment, times an attained adjusted age
nearest birthday Payment Factor divided by $1,000. The Payment Factor will reflect any remaining guaranteed payments, if any, and is determined using the same assumptions for mortality and interest as the payment factors listed in this policy for
Options 3-V and 5-V. 

 


  

					
	 CB909
	  	Page 17	  	









 GUARANTEED FIXED INCOME OPTIONS 

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

																																																									
	 Option 2, Table I
	 	 	 	 	 	Option 3, Table II	 	 	Option 3, Table III	 	 	Option 3, Table IV	 	 	Option 3, Table V	 
	 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	 	 	Monthly Installment
For Life With
Emergency Cash (SM)	 
	  	 	 	 	 	Age*	 	 	Male	 	 	Female	 	 	Unisex	 	 	Male	 	 	Female	 	 	Unisex	 	 	Male	 	 	Female	 	 	Unisex	 	 	Male	 	 	Female	 	 	Unisex	 
		 				 	 	50	  	 	$	2.97	  	 	$	2.86	  	 	$	2.90	  	 	$	2.96	  	 	$	2.86	  	 	$	2.89	  	 	$	2.79	  	 	$	2.74	  	 	$	2.76	  	 	$	2.69	  	 	$	2.66	  	 	$	2.67	  
		 				 	 	51	  	 	 	3.04	  	 	 	2.92	  	 	 	2.96	  	 	 	3.02	  	 	 	2.91	  	 	 	2.94	  	 	 	2.84	  	 	 	2.79	  	 	 	2.80	  	 	 	2.74	  	 	 	2.70	  	 	 	2.72	  
		 				 	 	52	  	 	 	3.10	  	 	 	2.98	  	 	 	3.02	  	 	 	3.08	  	 	 	2.97	  	 	 	3.01	  	 	 	2.89	  	 	 	2.84	  	 	 	2.85	  	 	 	2.79	  	 	 	2.75	  	 	 	2.76	  
		 				 	 	53	  	 	 	3.18	  	 	 	3.05	  	 	 	3.09	  	 	 	3.15	  	 	 	3.03	  	 	 	3.07	  	 	 	2.94	  	 	 	2.89	  	 	 	2.90	  	 	 	2.84	  	 	 	2.80	  	 	 	2.81	  
	 5
	 	 	17.28	  	 	 	54	  	 	 	3.25	  	 	 	3.11	  	 	 	3.15	  	 	 	3.22	  	 	 	3.10	  	 	 	3.14	  	 	 	3.00	  	 	 	2.94	  	 	 	2.96	  	 	 	2.89	  	 	 	2.85	  	 	 	2.86	  
	 6
	 	 	14.51	  	 	 	55	  	 	 	3.33	  	 	 	3.18	  	 	 	3.23	  	 	 	3.30	  	 	 	3.17	  	 	 	3.21	  	 	 	3.06	  	 	 	3.00	  	 	 	3.02	  	 	 	2.94	  	 	 	2.90	  	 	 	2.91	  
	 7
	 	 	12.53	  	 	 	56	  	 	 	3.41	  	 	 	3.26	  	 	 	3.30	  	 	 	3.38	  	 	 	3.24	  	 	 	3.28	  	 	 	3.12	  	 	 	3.06	  	 	 	3.07	  	 	 	3.00	  	 	 	2.96	  	 	 	2.97	  
	 8
	 	 	11.04	  	 	 	57	  	 	 	3.50	  	 	 	3.34	  	 	 	3.39	  	 	 	3.46	  	 	 	3.32	  	 	 	3.36	  	 	 	3.18	  	 	 	3.12	  	 	 	3.14	  	 	 	3.06	  	 	 	3.01	  	 	 	3.03	  
	 9
	 	 	9.89	  	 	 	58	  	 	 	3.60	  	 	 	3.42	  	 	 	3.47	  	 	 	3.55	  	 	 	3.39	  	 	 	3.44	  	 	 	3.25	  	 	 	3.18	  	 	 	3.20	  	 	 	3.12	  	 	 	3.07	  	 	 	3.08	  
	 10
	 	 	8.96	  	 	 	59	  	 	 	3.69	  	 	 	3.51	  	 	 	3.56	  	 	 	3.65	  	 	 	3.48	  	 	 	3.53	  	 	 	3.32	  	 	 	3.25	  	 	 	3.27	  	 	 	3.18	  	 	 	3.13	  	 	 	3.15	  
	 11
	 	 	8.21	  	 	 	60	  	 	 	3.80	  	 	 	3.60	  	 	 	3.66	  	 	 	3.75	  	 	 	3.57	  	 	 	3.62	  	 	 	3.39	  	 	 	3.32	  	 	 	3.34	  	 	 	3.25	  	 	 	3.20	  	 	 	3.21	  
	 12
	 	 	7.58	  	 	 	61	  	 	 	3.91	  	 	 	3.70	  	 	 	3.76	  	 	 	3.85	  	 	 	3.66	  	 	 	3.72	  	 	 	3.46	  	 	 	3.39	  	 	 	3.41	  	 	 	3.32	  	 	 	3.27	  	 	 	3.28	  
	 13
	 	 	7.05	  	 	 	62	  	 	 	4.03	  	 	 	3.81	  	 	 	3.87	  	 	 	3.96	  	 	 	3.76	  	 	 	3.82	  	 	 	3.54	  	 	 	3.47	  	 	 	3.49	  	 	 	3.39	  	 	 	3.34	  	 	 	3.35	  
	 14
	 	 	6.59	  	 	 	63	  	 	 	4.16	  	 	 	3.92	  	 	 	3.99	  	 	 	4.07	  	 	 	3.87	  	 	 	3.93	  	 	 	3.63	  	 	 	3.55	  	 	 	3.57	  	 	 	3.47	  	 	 	3.41	  	 	 	3.43	  
	 15
	 	 	6.20	  	 	 	64	  	 	 	4.30	  	 	 	4.04	  	 	 	4.12	  	 	 	4.20	  	 	 	3.98	  	 	 	4.04	  	 	 	3.72	  	 	 	3.63	  	 	 	3.66	  	 	 	3.55	  	 	 	3.49	  	 	 	3.51	  
	 16
	 	 	5.85	  	 	 	65	  	 	 	4.45	  	 	 	4.16	  	 	 	4.25	  	 	 	4.32	  	 	 	4.09	  	 	 	4.16	  	 	 	3.81	  	 	 	3.72	  	 	 	3.75	  	 	 	3.63	  	 	 	3.57	  	 	 	3.59	  
	 17
	 	 	5.55	  	 	 	66	  	 	 	4.60	  	 	 	4.30	  	 	 	4.39	  	 	 	4.46	  	 	 	4.22	  	 	 	4.29	  	 	 	3.91	  	 	 	3.81	  	 	 	3.84	  	 	 	3.72	  	 	 	3.66	  	 	 	3.68	  
	 18
	 	 	5.27	  	 	 	67	  	 	 	4.77	  	 	 	4.45	  	 	 	4.54	  	 	 	4.60	  	 	 	4.35	  	 	 	4.42	  	 	 	4.01	  	 	 	3.91	  	 	 	3.94	  	 	 	3.81	  	 	 	3.75	  	 	 	3.77	  
	 19
	 	 	5.03	  	 	 	68	  	 	 	4.95	  	 	 	4.60	  	 	 	4.71	  	 	 	4.75	  	 	 	4.49	  	 	 	4.57	  	 	 	4.11	  	 	 	4.01	  	 	 	4.04	  	 	 	3.90	  	 	 	3.85	  	 	 	3.86	  
	 20
	 	 	4.81	  	 	 	69	  	 	 	5.14	  	 	 	4.77	  	 	 	4.88	  	 	 	4.90	  	 	 	4.64	  	 	 	4.71	  	 	 	4.23	  	 	 	4.12	  	 	 	4.15	  	 	 	4.01	  	 	 	3.95	  	 	 	3.96	  
		 				 	 	70	  	 	 	5.34	  	 	 	4.95	  	 	 	5.07	  	 	 	5.06	  	 	 	4.79	  	 	 	4.87	  	 	 	4.34	  	 	 	4.24	  	 	 	4.27	  	 	 	4.11	  	 	 	4.05	  	 	 	4.07	  
		 				 	 	71	  	 	 	5.56	  	 	 	5.15	  	 	 	5.27	  	 	 	5.22	  	 	 	4.95	  	 	 	5.03	  	 	 	4.47	  	 	 	4.36	  	 	 	4.39	  	 	 	4.22	  	 	 	4.17	  	 	 	4.18	  
		 				 	 	72	  	 	 	5.79	  	 	 	5.36	  	 	 	5.49	  	 	 	5.39	  	 	 	5.12	  	 	 	5.20	  	 	 	4.60	  	 	 	4.49	  	 	 	4.52	  	 	 	4.34	  	 	 	4.29	  	 	 	4.30	  
		 				 	 	73	  	 	 	6.03	  	 	 	5.59	  	 	 	5.72	  	 	 	5.56	  	 	 	5.30	  	 	 	5.38	  	 	 	4.73	  	 	 	4.62	  	 	 	4.66	  	 	 	4.46	  	 	 	4.40	  	 	 	4.42	  
		 				 	 	74	  	 	 	6.30	  	 	 	5.83	  	 	 	5.97	  	 	 	5.74	  	 	 	5.49	  	 	 	5.57	  	 	 	4.88	  	 	 	4.77	  	 	 	4.80	  	 	 	4.59	  	 	 	4.54	  	 	 	4.55	  
		 				 	 	75	  	 	 	6.58	  	 	 	6.10	  	 	 	6.24	  	 	 	5.93	  	 	 	5.68	  	 	 	5.76	  	 	 	5.03	  	 	 	4.92	  	 	 	4.95	  	 	 	4.72	  	 	 	4.67	  	 	 	4.69	  
		 				 	 	76	  	 	 	6.88	  	 	 	6.39	  	 	 	6.53	  	 	 	6.11	  	 	 	5.88	  	 	 	5.95	  	 	 	5.18	  	 	 	5.08	  	 	 	5.11	  	 	 	4.85	  	 	 	4.81	  	 	 	4.82	  
		 				 	 	77	  	 	 	7.20	  	 	 	6.70	  	 	 	6.85	  	 	 	6.30	  	 	 	6.09	  	 	 	6.15	  	 	 	5.35	  	 	 	5.25	  	 	 	5.28	  	 	 	5.00	  	 	 	4.96	  	 	 	4.97	  
		 				 	 	78	  	 	 	7.55	  	 	 	7.03	  	 	 	7.19	  	 	 	6.49	  	 	 	6.30	  	 	 	6.36	  	 	 	5.53	  	 	 	5.43	  	 	 	5.46	  	 	 	5.15	  	 	 	5.12	  	 	 	5.12	  
		 				 	 	79	  	 	 	7.92	  	 	 	7.40	  	 	 	7.55	  	 	 	6.68	  	 	 	6.51	  	 	 	6.56	  	 	 	5.71	  	 	 	5.61	  	 	 	5.64	  	 	 	5.31	  	 	 	5.28	  	 	 	5.29	  
		 				 	 	80	  	 	 	8.32	  	 	 	7.79	  	 	 	7.95	  	 	 	6.87	  	 	 	6.72	  	 	 	6.77	  	 	 	5.90	  	 	 	5.81	  	 	 	5.84	  	 	 	5.48	  	 	 	5.45	  	 	 	5.46	  
		 				 	 	81	  	 	 	8.75	  	 	 	8.22	  	 	 	8.38	  	 	 	7.06	  	 	 	6.93	  	 	 	6.97	  	 	 	6.11	  	 	 	6.02	  	 	 	6.05	  	 	 	5.67	  	 	 	5.64	  	 	 	5.64	  
		 				 	 	82	  	 	 	9.20	  	 	 	8.69	  	 	 	8.84	  	 	 	7.24	  	 	 	7.13	  	 	 	7.16	  	 	 	6.32	  	 	 	6.24	  	 	 	6.27	  	 	 	5.84	  	 	 	5.83	  	 	 	5.84	  
		 				 	 	83	  	 	 	9.69	  	 	 	9.19	  	 	 	9.34	  	 	 	7.41	  	 	 	7.33	  	 	 	7.36	  	 	 	6.55	  	 	 	6.48	  	 	 	6.50	  	 	 	6.05	  	 	 	6.04	  	 	 	6.04	  
		 				 	 	84	  	 	 	10.21	  	 	 	9.74	  	 	 	9.88	  	 	 	7.58	  	 	 	7.52	  	 	 	7.54	  	 	 	6.78	  	 	 	6.72	  	 	 	6.74	  	 	 	6.24	  	 	 	6.24	  	 	 	6.24	  
		 				 	 	85	  	 	 	10.77	  	 	 	10.33	  	 	 	10.46	  	 	 	7.74	  	 	 	7.69	  	 	 	7.71	  	 	 	7.03	  	 	 	6.98	  	 	 	7.00	  	 	 	6.48	  	 	 	6.48	  	 	 	6.48	  
		 				 	 	86	  	 				 				 				 	 	7.89	  	 	 	7.86	  	 	 	7.87	  	 	 	7.29	  	 	 	7.26	  	 	 	7.27	  	 				 				 			
		 				 	 	87	  	 				 				 				 	 	8.03	  	 	 	8.01	  	 	 	8.01	  	 	 	7.57	  	 	 	7.54	  	 	 	7.55	  	 				 				 			
		 				 	 	88	  	 				 				 				 	 	8.16	  	 	 	8.15	  	 	 	8.15	  	 	 	7.86	  	 	 	7.84	  	 	 	7.85	  	 				 				 			
		 				 	 	89	  	 				 				 				 	 	8.28	  	 	 	8.27	  	 	 	8.27	  	 	 	8.17	  	 	 	8.15	  	 	 	8.16	  	 				 				 			
		 				 	 	90	  	 				 				 				 	 	8.38	  	 	 	8.38	  	 	 	8.38	  	 	 	8.49	  	 	 	8.48	  	 	 	8.48	  	 				 				 			
		 				 	 	91	  	 				 				 				 	 	8.48	  	 	 	8.48	  	 	 	8.48	  	 	 	8.83	  	 	 	8.82	  	 	 	8.83	  	 				 				 			
		 				 	 	92	  	 				 				 				 	 	8.57	  	 	 	8.57	  	 	 	8.57	  	 	 	9.19	  	 	 	9.18	  	 	 	9.19	  	 				 				 			
		 				 	 	93	  	 				 				 				 	 	8.65	  	 	 	8.64	  	 	 	8.65	  	 	 	9.58	  	 	 	9.56	  	 	 	9.57	  	 				 				 			
		 				 	 	94	  	 				 				 				 	 	8.72	  	 	 	8.71	  	 	 	8.71	  	 	 	10.00	  	 	 	9.97	  	 	 	9.98	  	 				 				 			
		 				 	 	95	  	 				 				 				 	 	8.78	  	 	 	8.77	  	 	 	8.77	  	 	 	10.45	  	 	 	10.40	  	 	 	10.42	  	 				 				 			

  

	*	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). 

  

					
	 T994
	  	Page 18	  	









 Option 5, Table VI 

Monthly Installment For Joint and Full 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
	  	$	2.20	  	  	$	2.27	  	  	$	2.34	  	  	$	2.41	  	  	$	2.48	  	  	$	2.55	  	  	$	2.62	  
	 55
	  	 	2.35	  	  	 	2.44	  	  	 	2.52	  	  	 	2.61	  	  	 	2.71	  	  	 	2.80	  	  	 	2.88	  
	 60
	  	 	2.54	  	  	 	2.64	  	  	 	2.76	  	  	 	2.88	  	  	 	2.99	  	  	 	3.11	  	  	 	3.23	  
	 65
	  	 	2.77	  	  	 	2.91	  	  	 	3.06	  	  	 	3.22	  	  	 	3.38	  	  	 	3.54	  	  	 	3.69	  
	 70
	  	 	3.08	  	  	 	3.26	  	  	 	3.46	  	  	 	3.67	  	  	 	3.89	  	  	 	4.11	  	  	 	4.33	  
	 75
	  	 	3.47	  	  	 	3.72	  	  	 	3.99	  	  	 	4.29	  	  	 	4.60	  	  	 	4.93	  	  	 	5.24	  
	 80
	  	 	4.01	  	  	 	4.35	  	  	 	4.74	  	  	 	5.17	  	  	 	5.62	  	  	 	6.08	  	  	 	6.53	  
	 85
	  	 	4.75	  	  	 	5.25	  	  	 	5.81	  	  	 	6.44	  	  	 	7.09	  	  	 	7.75	  	  	 	8.36	  
	
	 Monthly Installment For Unisex Joint and Full 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
	  	$	2.20	  	  	$	2.27	  	  	$	2.34	  	  	$	2.41	  	  	$	2.48	  	  	$	2.55	  	  	$	2.61	  
	 55
	  	 	2.36	  	  	 	2.44	  	  	 	2.53	  	  	 	2.62	  	  	 	2.70	  	  	 	2.79	  	  	 	2.87	  
	 60
	  	 	2.55	  	  	 	2.65	  	  	 	2.76	  	  	 	2.88	  	  	 	2.99	  	  	 	3.10	  	  	 	3.20	  
	 65
	  	 	2.79	  	  	 	2.92	  	  	 	3.07	  	  	 	3.22	  	  	 	3.37	  	  	 	3.52	  	  	 	3.66	  
	 70
	  	 	3.10	  	  	 	3.28	  	  	 	3.47	  	  	 	3.67	  	  	 	3.88	  	  	 	4.09	  	  	 	4.28	  
	 75
	  	 	3.50	  	  	 	3.75	  	  	 	4.02	  	  	 	4.30	  	  	 	4.60	  	  	 	4.89	  	  	 	5.16	  
	 80
	  	 	4.06	  	  	 	4.40	  	  	 	4.78	  	  	 	5.19	  	  	 	5.62	  	  	 	6.04	  	  	 	6.44	  
	 85
	  	 	4.83	  	  	 	5.32	  	  	 	5.87	  	  	 	6.47	  	  	 	7.10	  	  	 	7.71	  	  	 	8.28	  
	
	 Option 5V, Table VII
 Monthly Installment For Joint and Full Survivor (Life with Emergency Cash (SM))
  
	   

  
 

	 	  	Adjusted Age of Joint Annuitant*	 
	 Adjusted Age

of
 Male

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
	  	$	2.15	  	  	$	2.21	  	  	$	2.28	  	  	$	2.35	  	  	$	2.42	  	  	$	2.49	  	  	$	2.54	  
	 55
	  	 	2.28	  	  	 	2.36	  	  	 	2.45	  	  	 	2.53	  	  	 	2.62	  	  	 	2.70	  	  	 	2.77	  
	 60
	  	 	2.45	  	  	 	2.54	  	  	 	2.65	  	  	 	2.76	  	  	 	2.87	  	  	 	2.97	  	  	 	3.06	  
	 65
	  	 	2.64	  	  	 	2.77	  	  	 	2.90	  	  	 	3.04	  	  	 	3.18	  	  	 	3.31	  	  	 	3.42	  
	 70
	  	 	2.89	  	  	 	3.04	  	  	 	3.21	  	  	 	3.39	  	  	 	3.57	  	  	 	3.75	  	  	 	3.89	  
	 75
	  	 	3.19	  	  	 	3.39	  	  	 	3.61	  	  	 	3.84	  	  	 	4.08	  	  	 	4.30	  	  	 	4.47	  
	 80
	  	 	3.57	  	  	 	3.83	  	  	 	4.12	  	  	 	4.42	  	  	 	4.73	  	  	 	5.02	  	  	 	5.23	  
	 85
	  	 	4.06	  	  	 	4.41	  	  	 	4.78	  	  	 	5.17	  	  	 	5.57	  	  	 	5.98	  	  	 	6.23	  
	
	 Monthly Installment For Unisex Joint and Full Survivor (Life with Emergency Cash (SM))

 
	 
	 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
	  	$	2.15	  	  	$	2.22	  	  	$	2.28	  	  	$	2.35	  	  	$	2.42	  	  	$	2.49	  	  	$	2.54	  
	 55
	  	 	2.29	  	  	 	2.37	  	  	 	2.45	  	  	 	2.53	  	  	 	2.62	  	  	 	2.70	  	  	 	2.76	  
	 60
	  	 	2.45	  	  	 	2.55	  	  	 	2.65	  	  	 	2.76	  	  	 	2.87	  	  	 	2.97	  	  	 	3.05	  
	 65
	  	 	2.65	  	  	 	2.78	  	  	 	2.91	  	  	 	3.04	  	  	 	3.18	  	  	 	3.31	  	  	 	3.40	  
	 70
	  	 	2.90	  	  	 	3.06	  	  	 	3.22	  	  	 	3.40	  	  	 	3.57	  	  	 	3.74	  	  	 	3.86	  
	 75
	  	 	3.21	  	  	 	3.41	  	  	 	3.62	  	  	 	3.86	  	  	 	4.08	  	  	 	4.29	  	  	 	4.45	  
	 80
	  	 	3.60	  	  	 	3.86	  	  	 	4.14	  	  	 	4.44	  	  	 	4.73	  	  	 	5.02	  	  	 	5.21	  
	 85
	  	 	4.08	  	  	 	4.43	  	  	 	4.80	  	  	 	5.18	  	  	 	5.58	  	  	 	5.97	  	  	 	6.21	  


	*	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). 

  

					
	 TB994
	  	Page 19	  	









 VARIABLE INCOME OPTIONS 

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

 

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

  

	*	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). 

  

					
	 H1268
	  	Page 20	  	










																													
	 Option 5V, Table V

 
 Monthly Installment For Joint and Full
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
	  	$	4.37	  	  	$	4.42	  	  	$	4.46	  	  	$	4.51	  	  	$	4.56	  	  	$	4.62	  	  	$	4.67	  
	 55
	  	 	4.48	  	  	 	4.54	  	  	 	4.60	  	  	 	4.67	  	  	 	4.74	  	  	 	4.81	  	  	 	4.88	  
	 60
	  	 	4.62	  	  	 	4.70	  	  	 	4.79	  	  	 	4.88	  	  	 	4.98	  	  	 	5.08	  	  	 	5.18	  
	 65
	  	 	4.81	  	  	 	4.92	  	  	 	5.04	  	  	 	5.17	  	  	 	5.31	  	  	 	5.46	  	  	 	5.61	  
	 70
	  	 	5.07	  	  	 	5.23	  	  	 	5.40	  	  	 	5.59	  	  	 	5.79	  	  	 	6.00	  	  	 	6.22	  
	 75
	  	 	5.43	  	  	 	5.65	  	  	 	5.90	  	  	 	6.18	  	  	 	6.48	  	  	 	6.79	  	  	 	7.11	  
	 80
	  	 	5.94	  	  	 	6.26	  	  	 	6.63	  	  	 	7.04	  	  	 	7.49	  	  	 	7.95	  	  	 	8.40	  
	 85
	  	 	6.67	  	  	 	7.15	  	  	 	7.70	  	  	 	8.31	  	  	 	8.97	  	  	 	9.63	  	  	 	10.26	  
	
	 Monthly Installment For Unisex Joint and Full 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
	  	$	4.38	  	  	$	4.42	  	  	$	4.47	  	  	$	4.51	  	  	$	4.56	  	  	$	4.61	  	  	$	4.66	  
	 55
	  	 	4.48	  	  	 	4.54	  	  	 	4.60	  	  	 	4.67	  	  	 	4.73	  	  	 	4.80	  	  	 	4.87	  
	 60
	  	 	4.63	  	  	 	4.70	  	  	 	4.79	  	  	 	4.88	  	  	 	4.97	  	  	 	5.07	  	  	 	5.16	  
	 65
	  	 	4.82	  	  	 	4.93	  	  	 	5.05	  	  	 	5.17	  	  	 	5.30	  	  	 	5.44	  	  	 	5.57	  
	 70
	  	 	5.09	  	  	 	5.24	  	  	 	5.41	  	  	 	5.59	  	  	 	5.78	  	  	 	5.97	  	  	 	6.16	  
	 75
	  	 	5.46	  	  	 	5.68	  	  	 	5.93	  	  	 	6.19	  	  	 	6.47	  	  	 	6.75	  	  	 	7.03	  
	 80
	  	 	5.99	  	  	 	6.31	  	  	 	6.67	  	  	 	7.07	  	  	 	7.48	  	  	 	7.90	  	  	 	8.30	  
	 85
	  	 	6.75	  	  	 	7.23	  	  	 	7.76	  	  	 	8.35	  	  	 	8.97	  	  	 	9.59	  	  	 	10.17	  
	 *  Adjusted Age as defined in Section 10.A
	      

	
	 Option 5V, Table VI

 
 Monthly Installment For Joint and Full Survivor (Life
with Emergency Cash (SM)
  
	 
	 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
	  	$	4.34	  	  	$	4.38	  	  	$	4.42	  	  	$	4.47	  	  	$	4.51	  	  	$	4.57	  	  	$	4.61	  
	 55
	  	 	4.43	  	  	 	4.48	  	  	 	4.54	  	  	 	4.60	  	  	 	4.67	  	  	 	4.74	  	  	 	4.79	  
	 60
	  	 	4.55	  	  	 	4.62	  	  	 	4.70	  	  	 	4.78	  	  	 	4.88	  	  	 	4.97	  	  	 	5.05	  
	 65
	  	 	4.71	  	  	 	4.80	  	  	 	4.91	  	  	 	5.03	  	  	 	5.16	  	  	 	5.30	  	  	 	5.41	  
	 70
	  	 	4.92	  	  	 	5.05	  	  	 	5.21	  	  	 	5.38	  	  	 	5.56	  	  	 	5.76	  	  	 	5.91	  
	 75
	  	 	5.21	  	  	 	5.40	  	  	 	5.61	  	  	 	5.86	  	  	 	6.12	  	  	 	6.40	  	  	 	6.61	  
	 80
	  	 	5.61	  	  	 	5.88	  	  	 	6.19	  	  	 	6.53	  	  	 	6.90	  	  	 	7.29	  	  	 	7.56	  
	 85
	  	 	6.16	  	  	 	6.54	  	  	 	6.98	  	  	 	7.46	  	  	 	7.95	  	  	 	8.41	  	  	 	8.76	  
	
	 Monthly Installment For Unisex Joint and Full Survivor (Life with Emergency Cash (SM)

 
	   
 

	 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
	  	$	4.34	  	  	$	4.38	  	  	$	4.42	  	  	$	4.47	  	  	$	4.51	  	  	$	4.56	  	  	$	4.60	  
	 55
	  	 	4.43	  	  	 	4.48	  	  	 	4.54	  	  	 	4.60	  	  	 	4.67	  	  	 	4.73	  	  	 	4.78	  
	 60
	  	 	4.55	  	  	 	4.62	  	  	 	4.70	  	  	 	4.78	  	  	 	4.87	  	  	 	4.96	  	  	 	5.03	  
	 65
	  	 	4.71	  	  	 	4.81	  	  	 	4.92	  	  	 	5.03	  	  	 	5.16	  	  	 	5.29	  	  	 	5.38	  
	 70
	  	 	4.93	  	  	 	5.07	  	  	 	5.22	  	  	 	5.38	  	  	 	5.56	  	  	 	5.74	  	  	 	5.87	  
	 75
	  	 	5.23	  	  	 	5.42	  	  	 	5.63	  	  	 	5.87	  	  	 	6.12	  	  	 	6.38	  	  	 	6.56	  
	 80
	  	 	5.64	  	  	 	5.91	  	  	 	6.21	  	  	 	6.55	  	  	 	6.90	  	  	 	7.26	  	  	 	7.51	  
	 85
	  	 	6.21	  	  	 	6.58	  	  	 	7.02	  	  	 	7.48	  	  	 	7.97	  	  	 	8.41	  	  	 	8.74	  
	  

*       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). 

  

					
	 J1268
	  	Page 21	  	









 SECTION 11 – GENERAL PROVISIONS 

 


 THE CONTRACT 
 The entire contract consists of this policy, endorsements, and riders, if any. 
 MODIFICATION
OF POLICY 
 No change in this policy is valid unless made in writing by us and approved by one of our officers. No Registered Representative
has authority to change or waive any provision of Your policy. 
 TAX QUALIFICATION 

This policy is intended to qualify as an annuity contract for federal income tax purposes. The provisions of this policy are to be interpreted to maintain
such qualification, notwithstanding any other provisions to the contrary. To maintain such tax qualification, we reserve the right to amend this policy to reflect any clarifications that may be needed or are appropriate to maintain such tax
qualification or to conform this policy to any applicable changes in the tax qualification requirements. We will send You a copy in the event of any such amendment. If You refuse such an amendment it must be by giving us written notice, and Your
refusal may result in adverse tax consequences. 
 NON-PARTICIPATING 
 This policy will not share in our surplus earnings. 
 AGE OR SEX CORRECTIONS 

If the age or sex of the Annuitant has been misstated, the benefits will be those, which the premiums paid, would have purchased for the correct age and
sex. If required by law to ignore differences in the sex of the Annuitant, the annuity payments will be determined using the unisex factors in Section 10. 
 Any underpayment made by us will be paid with the next payment. Any overpayment made by us will be deducted from future payments. Any underpayment or overpayment, will include interest at 5% per
year, from the date of the wrong payment to the date of the adjustment. 
 INCONTESTABILITY 

This policy shall be incontestable from the Policy Date. 
 EVIDENCE OF SURVIVAL 
 We have the right to require satisfactory evidence that a person was
alive if a payment is based on that person being alive. No payment will be made until we receive the evidence. 
 SETTLEMENT 

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



 RIGHTS OF OWNER 
 The owner may, while the Annuitant is living: 

	 	1.	Assign this policy. 

  

	 	2.	Surrender the policy to us. 

  

	 	3.	Amend or modify the policy with our consent. 

  

	 	4.	Receive annuity payments or name a Payee to receive the payments. 

  

	 	5.	Exercise, receive and enjoy every other right and benefit contained in the policy. 

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

Unless we have been notified of a community or marital property interest in this policy, we will rely on our good faith belief that no such interest
exists and will assume no responsibility for inquiry. 
 CHANGE OF OWNERSHIP 
 In the case of a non tax-qualified annuity, You can change the owner of this policy, from yourself to a new owner, in a notice You sign which gives us the facts that we need. When this change takes
effect, all rights of ownership in this policy will pass to the new owner. 
 A change of owner will not be effective until it is recorded in
our records. A fter it has been so recorded, the change will take effect as of the date You signed the notice. However, if the Annuitant dies before the notice has been so recorded, it will not be effective as to those proceeds we have paid before
the change was recorded in our records. 
 We may require that the change be endorsed in the policy. Changing the owner does not change the
beneficiary or the Annuitant. 
 A change of ownership may result in adverse tax consequences. 

ANNUITY COMMENCEMENT DATE 
 The Annuity
Commencement Date is the date annuity payments begin. In no event can this date be later than the last day of the policy month following the month in which the Annuitant attains age 95. You may change the Annuity Commencement Date at any time before
the Annuity Commencement Date by giving us 30 days’ written notice. 

 


  

					
	 R462
	  	Page 22	  	










 SECTION 11 – CONTINUED 

 


 ASSIGNMENT 
  

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


 

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

  

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

 Assignment of this policy may result in adverse
tax consequences. 
 BENEFICIARY 

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

You may direct that the beneficiary shall not have the right to withdraw, assign or commute any sum payable under an option. In the absence of such
election or direction, the beneficiary may change the manner of payment or make an election of any option. 
 If any primary or contingent
beneficiary dies before the Annuitant, that beneficiary’s interest in this policy ends with that beneficiary’s death. Only those beneficiaries living at the time of the Annuitant’s death will be eligible to receive their share of the
death proceeds. In the event no primary or contingent beneficiaries have been named and all primary beneficiaries have died before the death proceeds become payable, the owner(s) will become the beneficiary(ies) unless elected otherwise in
accordance with Section 9. If both primary and contingent beneficiaries have been named, payment will be made to the named



 primary beneficiaries living at the time the death proceeds become payable. If there is more than one
beneficiary and You failed to specify their interest, they will share equally. Payment will be made to the named contingent beneficiary(ies) only, if all primary beneficiaries have died before the death proceeds become payable. If any primary
beneficiary is alive at the time the death proceeds become payable, but dies before receiving their payment, their share will be paid to their estate. 
 PROTECTION OF PROCEEDS 
 Unless You so direct by filing written notice with us, no
beneficiary may assign any payments under this policy before the same are due. To the extent permitted by law, no payments under this policy will be subject to the claims of creditors of any beneficiary. 

DEFERMENT 
 We will pay any partial
Withdrawals or Surrender proceeds from the Separate Account within 7 days after we receive all requirements that we need. However, it may happen that the New York Stock Exchange is closed for trading (other than the usual weekend or holiday
closings), or the Securities and Exchange Commission restricts trading or determines that an emergency exists. If so, it may not be practical for us to determine the investment experience of the Separate Account. In that case, we may defer transfers
among the Subaccounts and to the Fixed Account, and determination or payment of partial Withdrawals or Surrender proceeds. 
 When permitted by
law, we may defer (with prior authorization from the Commissioner) paying any partial Withdrawals or Surrender proceeds from the Fixed Account for up to 6 months from the date we receive Your request. If the owner dies after the request is received,
but before the request is processed, the request will be processed before the death proceeds are determined. Interest will be paid on any amount deferred for 30 days or more. This rate will be the Fixed Account Guaranteed Minimum Effective Annual
Interest Rate shown on Page 3, unless otherwise required by law. 
 REPORTS TO OWNER 

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


 


  

					
	 RB462
	  	Page 23	  	










									
	



	 		 	 Home Office:
 4333 Edgewood Road N.E.
 Cedar Rapids, lowa 52499

(319)398-8511


 INDEX 

 



					
	 	  	Page	 
	 Accumulation Units
	  	 	9	  
	 Adjusted Age
	  	 	14	  
	 Adjusted Policy Value
	  	 	4	  
	 Age or Sex Corrections
	  	 	22	  
	 Annuity Commencement Date
	  	 	22	  
	 Assignment
	  	 	23	  
	 Beneficiary
	  	 	23	  
	 Cash Value
	  	 	5	  
	 Contract
	  	 	22	  
	 Death Proceeds
	  	 	12	  
	 Definitions
	  	 	2	  
	 Dollar Cost Averaging Option
	  	 	11	  
	 Evidence of Survival
	  	 	22	  
	 Excess Interest Adjustment
	  	 	5	  
	 Fixed Account
	  	 	10	  
	 Guaranteed Minimum Death Benefit
	  	 	12	  
	 Guaranteed Periods
	  	 	10	  
	 Guaranteed Return of Fixed Account Premium Payments
	  	 	8	  
	 Income Options
	  	 	14	  





					
	 	  	Page	 
	 Income Option Tables
	  	 	18	  
	 Incontestability
	  	 	22	  
	 Modification of Policy
	  	 	22	  
	 Non-participating
	  	 	22	  
	 Option to Change Annuity Commencement Date
	  	 	22	  
	 Partial Withdrawals
	  	 	6	  
	 Payee
	  	 	14	  
	 Payment of Premiums
	  	 	4	  
	 Policy Data Page
	  	 	3	  
	 Policy Value
	  	 	4	  
	 Premium Enhancement
	  	 	4	  
	 Proof of Age
	  	 	14	  
	 Protection of Proceeds
	  	 	23	  
	 Right to Cancel
	  	 	1	  
	 Rights of Owner
	  	 	22	  
	 Separate Account
	  	 	8	  
	 Service Charge
	  	 	5	  
	 Settlement
	  	 	22	  
	 Surrender Charges
	  	 	8	  
	 Transfers
	  	 	11	  

 
 

  
 Flexible Premium
Deferred Variable Annuity 
 Income Payable At Annuity Commencement Date 

Benefits Based On The Performance Of The Separate Account 
 Are Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C) 
 Non-Participating 

  

					
	 Y955