<PAGE>
                                                 EXHIBIT 4(a)

         -----GOLDEN
      --------AMERICAN                      DEFERRED COMBINATION
    ----------LIFE INSURANCE                VARIABLE AND FIXED
       -------COMPANY                       ANNUITY CERTIFICATE

Golden American is a stock company domiciled in Delaware.
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant            Owner                                                 |
| [THOMAS J. DOE]      [JOHN Q. DOE]                                         |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

    This is a legal Contract between its Owner and us.  Please read it
    carefully.  In this contract you or your refers to the Owner shown
    above.  We, our or us refers to Golden American Life Insurance
    Company.  You may allocate this Contract's Accumulation Value among
    the Variable Separate Account, the General Account and the Fixed
    Account shown in the Schedule.

    If this Contract is in force, we will make income payments to you
    starting on the Annuity Commencement Date.  If the Owner dies prior
    to the Annuity Commencement Date, we will pay a death benefit to the
    Beneficiary.  The amount of such benefits is subject to the terms of
    this Contract.

    ALL PAYMENTS AND VALUES, WHEN BASED ON THE INVESTMENT EXPERIENCE OF
    A VARIABLE SEPARATE ACCOUNT DIVISION, MAY INCREASE OR DECREASE,
    DEPENDING ON THE CONTRACT'S INVESTMENT RESULTS.  ALL PAYMENTS AND
    VALUES, WHEN BASED ON THE FIXED ACCOUNT, MAY BE SUBJECT TO A MARKET
    VALUE ADJUSTMENT, THE OPERATION OF WHICH MAY CAUSE SUCH PAYMENTS AND
    VALUES TO INCREASE OR DECREASE.

    RIGHT TO EXAMINE THIS CONTRACT:  YOU MAY RETURN THIS CONTRACT TO US
    OR THE AGENT THROUGH WHOM YOU PURCHASED IT WITHIN 10 DAYS AFTER YOU
    RECEIVE IT.  IF SO RETURNED, WE WILL TREAT THE CONTRACT AS THOUGH IT
    WERE NEVER ISSUED.  UPON RECEIPT WE WILL PROMPTLY REFUND THE
    ACCUMULATION VALUE, ADJUSTED FOR ANY MARKET VALUE ADJUSTMENT, PLUS
    ANY CHARGES WE HAVE DEDUCTED AS OF THE DATE THE RETURNED CONTRACT IS
    RECEIVED BY US.


    Signed for Golden American Life Insurance Company on the Contract
    Issue Date.


    Customer Service Center             Secretary: /s/ Myles R. Tashman
    1475 Dunwoody Drive
    West Chester, PA  19380             President: /s/ Barnett Chernow


------------------------------------------------------------------------------

    DEFERRED COMBINATION VARIABLE AND FIXED ANNUITY CONTRACT - NO
    DIVIDENDS
    Variable Cash Surrender Values while the Owner is living and prior to
    the Annuity Commencement Date.  Death benefit subject to guaranteed
    minimum.  Additional Premium Payment Option.  Partial Withdrawal
    Option.  Non-participating.  Investment results reflected in values.

GA-IA-1058


<PAGE>
<PAGE>

                             CONTRACT CONTENTS
------------------------------------------------------------------------------
THE SCHEDULE                                      YOUR CERTIFICATE
                                                        BENEFITS.......14

     Payment and Investment Information... 3A       Cash Value Benefit
     The Variable Separate Accounts....... 3B       Partial Withdrawal Option
     The General Account.................. 3C       Proceeds Payable to
     Certificate Facts.................... 3D           the Beneficiary
     Charges and Fees..................... 3E
     Income Plan Factors.................. 3F     CHOOSING AN INCOME
                                                        PLAN...........16

IMPORTANT TERMS .......................... 4

INTRODUCTION TO THIS CERTIFICATE.........  6        Annuity Benefits
                                                    Annuity Commencement Date
                                                        Selection
     The Certificate                                Frequency Selection
     The Owner                                      The Income Plan
     The Annuitant                                  The Annuity Options
     The Beneficiary                                Payment When Named Person
     Change of Owner or Beneficiary                     Dies

                                                  OTHER IMPORTANT
                                                        INFORMATION....18
PREMIUM PAYMENTS AND ALLOCATION CHANGES... 8
                                                    Sending Notice to Us
     Initial Premium Payment                        Reports to Owner
     Additional Premium Payment Option              Assignment - Using this
     Your Right to Change Allocation of                 Certificate as
         Accumulation Value                             Collateral Security
     What Happens if a Variable                     Changing this Certificate
         Separate Account                           Certificate Changes -
         Division is Not Available                      Applicable Tax Law
                                                    Misstatement of Age or Sex
                                                    Non-Participating
HOW WE MEASURE THE CERTIFICATE'S                    Payments We May Defer
 ACCUMULATION VALUE....................... 9        Authority to Make Agreements
                                                    Required Note on Our
                                                        Computations
     The Variable Separate Accounts
     The General Account
     Valuation Period
     Accumulation Value
     Accumulation Value in each Division
     Measurement of Investment Experience
     Charges Deducted from Accumulation Value on
         each Certificate Processing Date


       Copies of any additional Riders and Endorsements are at the back
       of this Certificate.

      THE SCHEDULE

       The Schedule gives specific facts about this Certificate and its
       coverage.  Please refer to the Schedule while reading this
       Certificate.

GA-IA-1058                          2



<PAGE>
<PAGE>

                              THE SCHEDULE
                   PAYMENT AND INVESTMENT INFORMATION
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Annuitant's Issue Age    Annuitant's Sex       Owner's Issue Age           |
| [55]                     [MALE]                [35]                        |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Certificate Date         Issue Date            Residence Status            |
| [JANUARY 1, 1994]        [JANUARY 1, 1994]     DELAWARE                    |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

INITIAL INVESTMENT

    Initial Premium Payment received:            [$10,000]

    Your initial Accumulation Value has been invested as follows:

                                               Percentage of
                 Divisions                   Accumulation Value
                 ---------                   ------------------
            [Multiple Allocation                    10%
               Fully Managed                        10%
            Capital Appreciation                    10%
              Rising Dividends                      10%
                 All-Growth                         10%
                Real Estate                         10%
                Hard Assets                          5%
              Emerging Markets                       5%
              Limited Maturity                       5%
                    Bond                             5%
                Liquid Asset                         5%
                Value Equity                         5%
              Strategic Equity                       5%
               Managed Global                        5%]
          Fixed Allocation - 1 Year
          -------------------------      -------------------------
                   Total                            100%
                   =====                            ====


ADDITIONAL PREMIUM PAYMENT INFORMATION

    [We will accept additional premium payments until either the
    Annuitant or Owner reaches the Attained Age of 85.  The minimum
    additional payment which may be made is [$500.00].]

    [In no event may you contribute to your IRA for the taxable year in
    which you attain age 70 1/2 and thereafter (except for rollover
    contributions).  The minimum additional payment which may be made is
    [$250.00].]

GA-IA-1058                          3A1


<PAGE>
<PAGE>

                              THE SCHEDULE
           PAYMENT AND INVESTMENT INFORMATION (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Annuitant's Issue Age    Annuitant's Sex       Owner's Issue Age           |
| [55]                     [MALE]                [35]                        |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Contract Date            Issue Date            Residence Status            |
| [JANUARY 1, 1994]        [JANUARY 1, 1994]     DELAWARE                    |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

ACCUMULATION VALUE ALLOCATION RULES

    The maximum number of Divisions in which you may be invested at any
    one time is [sixteen].  You are allowed unlimited allocation changes
    per Contract Year without charge.  We reserve the right to impose a
    charge for any allocation change in excess of [twelve] per Contract
    Year.  The Excess Allocation Charge is shown in the Schedule.
    Allocations into and out of the Guaranteed Interest Divisions are
    subject to restrictions (see General Account).

ALLOCATION CHANGES BY TELEPHONE

    You may request allocation changes by telephone during our telephone
    request business hours.  You may call our Customer Service Center at
    1-800-366-0066 to make allocation changes by using the personal
    identification number you will receive.  You may also mail any
    notice or request for allocation changes to our Customer Service
    Center at the address shown on the cover page.

GA-IA-1058                          3A2


<PAGE>
<PAGE>

                              THE SCHEDULE
                   THE VARIABLE SEPARATE ACCOUNTS
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

DIVISIONS INVESTING IN SHARES OF A MUTUAL FUND

    Separate Account B (the "Account") is a unit investment trust
    Separate Account, organized in and governed by the laws of the State
    of Delaware, our state of domicile. The Account is divided into
    Divisions.  Each Division listed below invests in shares of the
    mutual fund portfolio (the "Series") designated.  Each portfolio is
    a part of The GCG Trust managed by Directed Services, Inc.


              SERIES                             SERIES
              ------                             ------
              [Multiple Allocation               Real Estate
              Fully Managed                      Hard Assets
              Value Equity                       Emerging Markets
              Small Cap                          Limited Maturity Bond
              Capital Appreciation               Liquid Assets
              Rising Dividend                    Strategic Equity
              Capital Growth                     Managed Global
              Developing World                   Global Fixed Income
              Large Cap Value                    Total Return
              Growth                             All-Cap
              Mid-Cap Growth                     Investors
              Research                           Equity Income]


GA-IA-1058                          3B


<PAGE>
<PAGE>

                              THE SCHEDULE
                          THE GENERAL ACCOUNT
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

GENERAL ACCOUNT

    [Guaranteed Interest Division
    A Guaranteed Interest Division provides an annual minimum interest
    rate of 3%.  At our sole discretion, we may periodically declare
    higher interest rates for specific Guarantee Periods.  Such rates
    will apply to periods following the date of declaration.  Any
    declaration will be by class and will be based on our future
    expectations.

    Limitations of Allocations
    We reserve the right to restrict allocations into  and out of the
    General Account.  Such limits may be dollar restrictions on
    allocations into the General Account or we may restrict
    reallocations into the General Account.

    Transfers from a Guaranteed Interest Division
    We currently require that an amount allocated to a  Guarantee Period
    not be transferred until the Maturity Date, except pursuant to our
    published rules.  We reserve the right not to allow amounts
    previously transferred from a Guaranteed Interest Division to the
    Variable Separate Account Divisions or to a Fixed Allocation to be
    transferred back to a Guaranteed Interest Division for a period of
    at least six months from the date of transfer.]

GA-IA-1058                          3C


<PAGE>
<PAGE>

                              THE SCHEDULE
                          THE GENERAL ACCOUNT
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

CONTRACT FACTS

    Contract Processing Date
    The Contract Processing Date for your Contract is [April 1] of each
    year.

    Specially Designated Divisions
    When a distribution is made from an investment portfolio underlying a
    Variable Separate Account Division in which reinvestment is not
    available, we will allocate the amount of the distribution to the
    [Liquid Asset Division] unless you specify otherwise.

PARTIAL WITHDRAWALS

    The maximum amount that can be withdrawn each Contract Year is
    described below.  In no event may a Partial Withdrawal exceed 90% of
    the Cash Surrender Value.  After a Partial Withdrawal, the remaining
    Accumulation Value must be at least $100 to keep the Contract in
    force.

    Conventional Partial Withdrawals

    Minimum Withdrawal Amount:         $100.

    Any Conventional Partial Withdrawal is subject to a Market Value
    Adjustment unless withdrawn from a Fixed Allocation within 30 days
    prior to the Maturity Date.

    Systematic Partial Withdrawals
    Systematic Partial Withdrawals may be taken on a monthly, quarterly or
    annual basis.  You select the day withdrawals will be made, but no
    later than the 28th day of the month.

    Minimum Withdrawal Amount:         $100.
    Maximum Withdrawal Amount:

      Variable Separate Account Divisions: 1.25% monthly, 3.75%
                                  quarterly or 15% annually of
                                  Accumulation Value.
      Fixed Allocations and
      Guaranteed Interest Divisions:  Interest earned on a Fixed
                                  Allocation or Guaranteed Interest
                                  Division for the prior month, quarter or
                                  year (depending on the frequency
                                  selected).

    Systematic Partial Withdrawals from  Fixed Allocations are not
    subject to a Market Value Adjustment.

    [IRA Partial Withdrawals for Qualified Plans Only
    IRA Partial Withdrawals may be taken on a monthly, quarterly or annual
    basis.  A minimum withdrawal of $100.00 is required.  You select the
    day the withdrawals will be made, but no later than the 28th day of
    the month.  If you do not elect a day, the Contract Date will be used.
    Systematic Partial Withdrawals and Conventional Partial Withdrawals
    are not allowed when IRA Partial Withdrawals are being taken.  An IRA
    Partial Withdrawal in excess of the maximum amount allowed under the
    Systematic Partial Withdrawal option may be subject to a Market Value
    Adjustment.]

GA-IA-1058                          3D1


<PAGE>
<PAGE>

                              THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

DEATH BENEFITS
    The Death Benefit is the greatest of (i) , (ii) ,and (iii), below,
    where:
      (i)   the Accumulation Value;
      (ii)  the Guaranteed Death Benefit;
      (iii) the Cash Surrender Value;

GUARANTEED DEATH BENEFIT

    On the Contract Date, the Guaranteed Death Benefit is the initial
    premium.  On subsequent Valuation Dates, the guaranteed Death
    Benefit is calculated as follows:

      (1) Start with the Guaranteed Death Benefit from the prior
          Valuation Date;
      (2) Add any additional premiums paid during the current Valuation
          Period to (1);
      (3) Subtract any Prorata Partial Withdrawal Adjustments for any
          Partial Withdrawal made during the current Valuation Period from (2).

PRORATA PARTIAL WITHDRAWAL ADJUSTMENTS

    For any partial withdrawal, the Death Benefit components will be
    reduced by Prorata Partial Withdrawal Adjustments.  The Prorata
    Partial Withdrawal Adjustment to a death benefit component for a
    partial withdrawal is equal to (1) divided by (2), multiplied by
    (3), where:  (1) is the Accumulation Value withdrawn, (2) is the
    Accumulation Value immediately prior to withdrawal, and (3) is the
    amount of the applicable death benefit component immediately prior
    to the withdrawal.

CHANGE OF OWNER

    A change of Owner will result in recalculation of the Death Benefit
    and the Guaranteed Death Benefit.  If the Owner's or the oldest of
    multiple owners' attained age at the time of the change is less than
    [86], the Guaranteed Death Benefit in effect prior to the change
    will remain in effect and the Death Benefit provision shall apply.

    If any owner's or oldest multiple owners attained age is [86] or
    greater at the time of the change, the Guaranteed Death Benefit will
    be zero, and the Death Benefit will then be the cash surrender
    value.

GA-IA-1058                          3D2


<PAGE>
<PAGE>

                              THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

SPOUSAL CONTINUATION UPON DEATH OF OWNER

    If at the Owner's death, the surviving spouse of the deceased Owner
    is the beneficiary and such surviving spouse elects to continue the
    contract as their own pursuant to Internal Revenue Code Section
    72(s) or the equivalent provisions of U.S. Treasury Department rules
    for qualified plans, the following will apply:
     (a) If the Guaranteed Death Benefit as of the date we receive due
         proof of death of the Owner, minus the Accumulation Value, also as
         of that date, is greater than zero we will add such difference to
         the Accumulation Value.  Such addition will be allocated to the
         divisions of the Separate Account in proportion to the Accumulation
         Value in the Separate Account.  If there is no Accumulation Value in
         the Separate Account, the addition will be allocated to the Liquid
         Assets division, or its successor.
     (b) The Guaranteed Death Benefit will continue to apply, with all
         age criteria using the surviving spouse's age as the determining
         age.
    This addition to Accumulation Value is available only to the spouse
    of the owner as of the date of death of the owner if such spouse
    under the provisions if this contract elects to continue the
    contract as their own.

CHOOSING AN INCOME PLAN

    Required Date of Annuity Commencement
    [Distributions from a Contract funding a qualified plan must commence
    no later than [April 1st] of the calendar year following the calendar
    year in which the Owner attains age 70 1/2.]

    The Annuity Commencement Date is required to be the same date as the
    Contract Processing Date in the month following the Annuitant's 90th
    birthday.  In applying the Accumulation Value, we may first collect
    any Premium Taxes due us.

    Minimum Annuity Income Payment
    The minimum monthly annuity income payment that we will make is [$20].

    Optional Benefit Riders - [None.]


GA-IA-1058                          3D3


<PAGE>
<PAGE>

                              THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

ATTAINED AGE

    The Issue Age of the Annuitant or Owner plus the number of full years
    elapsed since the Contract Date.

FIXED ACCOUNT

    Minimum Fixed Allocation
    The minimum allocation to the Fixed Account in any one Fixed
    Allocation is [$250.00].

    Minimum Guaranteed Interest Rate - [3%.]

    Guarantee Periods
    We currently offer Guarantee Periods of [1,2,3,4,5,6,7,8,9 and 10]
    year(s).  We reserve the right to offer Guarantee Periods of
    durations other than those available on the Contract Date.  We also
    reserve the right to cease offering a particular Guarantee Period or
    Periods.

    Index Rate
    The Index Rate is the average of the Ask Yields for the U.S.
    Treasury Strips as reported by a national quoting service for the
    applicable maturity.  The average is based on the period from the
    22nd day of the calendar month two months prior to the calendar
    month of Index Rate determination to the 21st day of the calendar
    month immediately prior to the month of determination.  The
    applicable maturity date for these U.S. Treasury Strips is on or
    next following the last day of the Guarantee Period.  If the Ask
    Yields are no longer available, the Index Rate will be determined
    using a suitable replacement method.

    We currently set the Index Rate once each calendar month.  However,
    we reserve the right to set the Index Rate more frequently than
    monthly, but in no event will such Index Rate be based on a period
    less than 28 days.

GA-IA-1058                          3D4


<PAGE>
<PAGE>

                              THE SCHEDULE
                          CHARGES AND FEES
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

DEDUCTIONS FROM PREMIUMS

    [None.]

DEDUCTIONS FROM ACCUMULATION VALUE

    Initial Administrative Charge
    [None.]

    Administrative Charge
    [None]

    Excess Allocation Charge
    Currently none, however, we reserve the right to charge [$25] for a
    change if you make more than [twelve] allocation changes per
    Contract Year.  Any charge will be deducted in proportion to the
    amount being transferred from each Division.

    [Premium Taxes
    We deduct the amount of any premium or other state and local taxes
    levied by any state or governmental entity when such taxes are
    incurred.

    We reserve the right to defer collection of Premium Taxes until
    surrender or until application of Accumulation Value to an Annuity
    Option. We reserve the right to change the amount we charge for
    Premium Tax charges on future premium payments to conform with
    changes in the law or if the Owner changes state of residence.]

    Deductions from the Divisions
    Mortality and Expense Risk Charge - We deduct a charge from the
    assets in each separate account division on a daily basis at a rate
    of [0.000961%] (equivalent to an annual rate of [0.35%]) for
    mortality and expense risks.  The charge is not deducted from the
    fixed account or general account accumulation values.

    Asset Based Administrative Charge - We deduct [0.000411%] of the
    assets in each Variable Separate Account Division on a daily basis
    (equivalent to an annual rate of [0.15%]) to compensate us for a
    portion of our ongoing administrative expenses.  This charge is not
    deducted from the Fixed Account or General Account values.

CHARGE DEDUCTION DIVISION

    All charges against the Accumulation Value in this Contract will be
    deducted from the [Liquid Asset Division].

GA-IA-1058                          3E


<PAGE>
<PAGE>

                              THE SCHEDULE
                         INCOME PLAN FACTORS
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

    Values for other payment periods, ages or joint life combinations
    are available on request.  Monthly payments are shown for each
    $1,000 applied.

                     TABLE FOR INCOME FOR A FIXED PERIOD

       Fixed                   Fixed                   Fixed
      Period    Monthly       Period    Monthly       Period    Monthly
    of Years     Income     of Years     Income     of Years     Income


       [5         17.95         14         7.28         23         5.00
        6         15.18         15         6.89         24         4.85
        7         13.20         16         6.54         25         4.72
        8         11.71         17         6.24         26         4.60
        9         10.56         18         5.98         27         4.49
       10          9.64         19         5.74         28         4.38
       11          8.88         20         5.53         29         4.28
       12          8.26         21         5.33         30         4.19]
       13          7.73         22         5.16



                          TABLE FOR INCOME FOR LIFE

                    Male/Female         Male/Female         Male/Female
    Age                10 Years            20 Years              Refund
                        Certain             Certain             Certain


    [50              $4.06/3.83          $3.96/3.77          $3.93/3.75
    55                4.43/4.14           4.25/4.05           4.25/4.03
    60                4.90/4.56           4.57/4.37           4.66/4.40
    65                5.51/5.10           4.90/4.73           5.12/4.83
    70                6.26/5.81           5.18/5.07           5.76/5.42
    75                7.11/6.70           5.38/5.33           6.58/6.19
    80                7.99/7.70           5.48/5.46           7.69/7.21
    85                8.72/8.59           5.52/5.51           8.72/8.59
    90                9.23/9.18           5.53/5.53         10.63/10.53]

GA-IA-1058                          3F


<PAGE>
<PAGE>

                           IMPORTANT TERMS
------------------------------------------------------------------------------

ACCUMULATION VALUE - The amount that a Contract provides for
  investment at any time.  Initially, this amount is equal to the
  premium paid.

ANNUITANT - The person designated by the Owner to be the measuring
  life in determining Annuity Payments.

ANNUITY COMMENCEMENT DATE - For each Contract, the date on which
  Annuity Payments begin.

ANNUITY OPTIONS - Options the Owner selects that determine the form
  and amount of annuity payments.

ANNUITY PAYMENT - The periodic payment an Owner receives.  It may be
  either a fixed or a variable amount based on the Annuity Option
  chosen.

ATTAINED AGE - The Issue Age of the Annuitant or Owner plus the
  number of full years elapsed since the Contract Date.

BENEFICIARY - The person designated to receive benefits in the case
  of the death of the Owner.

BUSINESS DAY - Any day the New York Stock Exchange ("NYSE") is open
  for trading, exclusive of federal holidays, or any day on which
  the Securities and Exchange Commission ("SEC") requires that
  mutual funds, unit investment trusts or other investment
  portfolios be valued.

CASH SURRENDER VALUE - The amount the Owner receives upon surrender
  of the Contract.

CONTRACT ANNIVERSARY - The anniversary of the Contract Date.

CONTRACT DATE - The date we received the initial premium and upon
  which we begin determining the Contract values.  It may not be
  the same as the Contract Issue Date.  This date is used to
  determine Contract months, processing dates, years, and
  anniversaries.

CONTRACT ISSUE DATE - The date the Contract is issued at our
  Customer Service Center.

CONTRACT PROCESSING DATES - The days when we deduct certain charges
  from the Accumulation Value.  If the Contract Processing Date is
  not a Valuation Date, it will be on the next succeeding Valuation
  date.  The Contract Processing Date will be on the Contract
  Anniversary of each year.

CONTRACT PROCESSING PERIOD - The period between successive Contract
  Processing Dates unless it is the first Contract Processing
  Period.  In that case, it is the period from the Contract Date to
  the first Contract Processing Date.

CONTRACT YEAR - The period between Contract Anniversaries.

CHARGE DEDUCTION DIVISION - The Division from which all charges are
  deducted if so designated or elected by the Owner.

CONTINGENT ANNUITANT - The person designated by the Owner who, upon
  the Annuitant's death prior to the Annuity Commencement Date,
  becomes the Annuitant.

CONTRACT ISSUE DATE - The date the contract is issued at our
  Customer Service Center.

GA-IA-1058                          4


<PAGE>
<PAGE>

------------------------------------------------------------------------------
                     IMPORTANT TERMS (continued)

EXPERIENCE FACTOR - The factor which reflects the investment
  experience of the portfolio in which a Variable Separate Account
  Division invests and also reflects the charges assessed against
  the Division for a Valuation Period.

FIXED ACCOUNT - This is the Separate Account established to support
  Fixed Allocations.

FIXED ALLOCATION - An amount allocated to the Fixed Account that is
  credited with a Guaranteed Interest Rate for a specified
  Guarantee Period.

GUARANTEED DEATH BENEFIT INTEREST RATE - The annual rate at which
  the Guaranteed Death Benefit is calculated, if applicable.

GUARANTEE PERIOD - The period of years a rate of interest is
  guaranteed to be credited to a Fixed Allocation or allocations to
  a Guaranteed Interest Division.

GUARANTEED INTEREST DIVISION - An investment option available in the
  General Account, an account which contains all of our assets
  other than those held in our Separate Accounts.

GUARANTEED INTEREST RATE - The effective annual interest rate which
  we will credit for a specified Guarantee Period.

GUARANTEED MINIMUM INTEREST RATE - The minimum interest rate which
  can be declared by us for Fixed Allocations or allocations to a
  Guaranteed Interest Division.

INDEX OF INVESTMENT EXPERIENCE - The index that measures the
  performance of a Variable Separate Account Division.

INITIAL PREMIUM - The payment amount required to put each Contract
  in effect.

ISSUE AGE - The Annuitant's or Owner's age on the last birthday on
  or before the Contract Date.

MARKET VALUE ADJUSTMENT - A positive or negative adjustment to a
  Fixed Allocation.  It may apply if all or part of a Fixed
  Allocation is withdrawn, transferred, or applied to an Annuity
  Option prior to the end of the Guarantee Period.

MATURITY DATE - The date on which a Guarantee Period matures.

OWNER - The person who owns a Contract and is entitled to exercise
  all rights of the Contract.  This person's death also initiates
  payment of the death benefit.

RIDERS - Riders add provisions or change the terms of the Contract.

SPECIALLY DESIGNATED DIVISION - Distributions from a portfolio
  underlying a Division in which reinvestment is not available will
  be allocated to this Division unless you specify otherwise.

VALUATION DATE - The day at the end of  a Valuation Period when each
  Division is valued.

VALUATION PERIOD - Each business day together with any non-business
  days before it.

VARIABLE SEPARATE ACCOUNT DIVISION - An investment option available
  in the Variable Separate Account shown in the Schedule.

GA-IA-1058                          5


<PAGE>
<PAGE>

                    INTRODUCTION TO THIS CONTRACT
------------------------------------------------------------------------------

THE CONTRACT

    This is a legal Contract between you and us.  We provide benefits as
    stated in this Contract.  In return, you supply us with the Initial
    Premium Payment required to put this Contract in effect.

    This Contract, together with any Riders or Endorsements, constitutes
    the entire Contract.  Riders and Endorsements add provisions or
    change the terms of the basic Contract.

THE OWNER

    You are the Owner of this Contract.  You are also the Annuitant
    unless another Annuitant has been named by you and is shown in the
    Schedule.  You have the rights and options described in this
    Contract, including but not limited to the right to receive the
    Annuity Benefits on the Annuity Commencement Date.

    One or more people may own this Contract.  If there are multiple
    Owners named, the age of the oldest Owner will be used to determine
    the applicable death benefit.  In the case of a sole Owner who dies
    prior to the Annuity Commencement Date, we will pay the Beneficiary
    the death benefit then due.  If the sole Owner is not an
    individual, we will treat the Annuitant as Owner for the purpose of
    determining when the Owner dies under the death benefit provision
    (if there is no Contingent Annuitant), and the Annuitant's age will
    determine the applicable death benefit payable to the Beneficiary.
    The sole Owner's estate will be the Beneficiary if no Beneficiary
    designation is in effect, or if the designated Beneficiary has
    predeceased the Owner.  In the case of a joint Owner of the Contract
    dying prior to the Annuity Commencement Date, the surviving Owner(s)
    will be deemed as the Beneficiary(ies).

THE ANNUITANT

    The Annuitant is the measuring life of the Annuity Benefits provided
    under this Contract.  You may name a Contingent Annuitant.  The
    Annuitant may not be changed during the Annuitant's lifetime.

    If the Annuitant dies before the Annuity Commencement Date, the
    Contingent Annuitant becomes the Annuitant.  You will be the
    Contingent Annuitant unless you name someone else.  The Annuitant
    must be a natural person.  If the Annuitant dies and no Contingent
    Annuitant has been named, we will allow you sixty days to designate
    someone other than yourself as an Annuitant.  If all Owners are not
    individuals and, through the operation of this provision, an Owner
    becomes Annuitant, we will pay the death proceeds to the
    Beneficiary.  If there are joint Owners, we will treat the youngest
    of the Owners as the Contingent Annuitant designated, unless you
    elect otherwise.

THE BENEFICIARY

    The Beneficiary is the person to whom we pay death proceeds if any
    Owner dies prior to the Annuity Commencement Date.  See Proceeds
    Payable to the Beneficiary for more information.  We pay death
    proceeds to the primary Beneficiary (unless there are joint Owners
    in which case the death benefit proceeds are payable to the
    surviving Owner).  If the primary Beneficiary dies before the Owner,
    the death proceeds are paid to the Contingent Beneficiary, if any.
    If there is no surviving Beneficiary, we pay the death proceeds to
    the Owner's estate.

GA-IA-1058                          6


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<PAGE>

              INTRODUCTION TO THIS CONTRACT (continued)
------------------------------------------------------------------------------

    One or more persons may be named as primary Beneficiary or
    contingent Beneficiary.  In the case of more than one Beneficiary,
    we will assume any death proceeds are to be paid in equal shares to
    the surviving Beneficiaries.  You can specify other than equal
    shares.

    You have the right to change Beneficiaries, unless you designate the
    primary Beneficiary irrevocable.  When an irrevocable Beneficiary
    has been designated, you and the irrevocable Beneficiary may have to
    act together to exercise the rights and options under this Contract.

CHANGE OF OWNER OR BENEFICIARY

    During your lifetime and while this Contract is in effect you can
    transfer ownership of this Contract or change the Beneficiary.  To
    make any of these changes, you must send us written notice of the
    change in a form satisfactory to us.  The change will take effect as
    of the day the notice is signed.  The change will not affect any
    payment made or action taken by us before recording the change at
    our Customer Service Center.  A Change of Owner may affect the
    amount of death benefit payable under this Contract.  See Proceeds
    Payable to Beneficiary.

GA-IA-1058                          7


<PAGE>
<PAGE>

               PREMIUM PAYMENTS AND ALLOCATION CHARGES
------------------------------------------------------------------------------

INITIAL PREMIUM PAYMENT

    The Initial Premium Payment is required to put this Contract in
    effect.  The amount of the Initial Premium Payment is shown in the
    Schedule.

ADDITIONAL PREMIUM PAYMENT OPTION

    You may make additional premium payments under this Contract after
    the end of the Right to Examine period.  Restrictions on additional
    premium payments, such as the Attained Age of the Annuitant or Owner
    and the timing and amount of each payment, are shown in the
    Schedule. We reserve the right to defer acceptance of or to return
    any additional premium payments.

    As of the date we receive and accept your additional premium
    payment:

         (1) The Accumulation Value will increase by the amount of
             the premium payment less any premium deductions as shown in
             the Schedule.
         (2) The increase in the Accumulation Value will be
             allocated among the Divisions of the Variable Separate
             Account and General Account and allocations to the Fixed
             Account in accordance with your instructions.  If you do not
             provide such instructions, allocation will be among the
             Divisions of the Variable Separate Account and General
             Account and allocations to the Fixed Account in proportion
             to the amount of Accumulation Value in each Division or
             Fixed Allocation.

    Where to Make Payments
    Remit the premium payments to our Customer Service Center at the
    address shown on the cover page.  On request we will give you a
    receipt signed by our treasurer.

YOUR RIGHT TO CHANGE ALLOCATION OF ACCUMULATION VALUE

    You may change the allocation of the Accumulation Value among the
    Divisions and Fixed Allocations after the end of the Right to
    Examine period.  The number of free allocation changes each year
    that we will allow is shown in the Schedule.  To make an allocation
    change, you must provide us with satisfactory notice at our Customer
    Service Center.  The change will take effect when we receive the
    notice.  Restrictions for reallocation into and out of Divisions of
    the Variable Separate Account and General Account and allocations to
    the Fixed Account are shown in the Schedule.  An allocation from the
    Fixed Account may be subject to a Market Value Adjustment.  See the
    Schedule.

WHAT HAPPENS IF A VARIABLE SEPARATE ACCOUNT DIVISION IS NOT AVAILABLE

    When a distribution is made from an investment portfolio supporting
    a unit investment trust Separate Account Division in which
    reinvestment is not available, we will allocate the distribution to
    the Specially Designated Division shown in the Schedule unless you
    specify otherwise.

    Such a distribution may occur when an investment portfolio or
    Division matures, when distribution from a portfolio or Division
    cannot be reinvested in the portfolio or Division due to the
    unavailability of securities, or for other reasons.  When this
    occurs because of maturity, we will send written notice to you
    thirty days in advance of such date.  To elect an allocation to
    other than the Specially Designated Division shown in the Schedule,
    you must provide satisfactory notice to us at least seven days prior
    to the date the investment matures.  Such allocations will not be
    counted as an allocation change of the Accumulation Value for
    purposes of the number of free allocations permitted.

GA-IA-1058                          8


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<PAGE>

          HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE
------------------------------------------------------------------------------

    The variable Annuity Benefits under this Contract are provided
    through investments which may be made in our Separate Accounts.

THE VARIABLE SEPARATE ACCOUNTS

    These accounts, which are designated in the Schedule, are kept
    separate from our General Account and any other Separate Accounts we
    may have.  They are used to support Variable Annuity Contracts and
    may be used for other purposes permitted by applicable laws and
    regulations.  We own the assets in the Separate Accounts.  Assets
    equal to the reserves and other liabilities of the accounts will not
    be charged with liabilities that arise from any other business we
    conduct; but, we may transfer to our General Account assets which
    exceed the reserves and other liabilities of the Variable Separate
    Accounts.  Income and realized and unrealized gains or losses from
    assets in these Variable Separate Accounts are credited to or
    charged against the account without regard to other income, gains or
    losses in our other investment accounts.

    The Variable Separate Account will invest in mutual funds, unit
    investment trusts and other investment portfolios which we determine
    to be suitable for this Contract's purposes.  The Variable Separate
    Account is treated as a unit investment trust under Federal
    securities laws.  It is registered with the Securities and Exchange
    Commission ("SEC") under the Investment Company Act of 1940.  The
    Variable Separate Account is also governed by state law as
    designated in the Schedule.  The trusts may offer non-registered
    series.

    Variable Separate Account Divisions
    A unit investment trust Separate Account includes Divisions, each
    investing in a designated investment portfolio.  The Divisions and
    the investment portfolios designated may be managed by a separate
    investment adviser.  Such adviser may be registered under the
    Investment Advisers Act of 1940.

    Changes within the Variable Separate Accounts
    We may, from time to time, make additional Variable Separate Account
    Divisions available to you.  These Divisions will invest in
    investment portfolios we find suitable for the contract.  We also
    have the right to eliminate Divisions from a Variable Separate
    Account, to combine two or more Divisions or to substitute a new
    portfolio for the portfolio in which a Division invests.  A
    substitution may become necessary if, in our judgment, a portfolio
    or Division no longer suits the purpose of the contract.  This may
    happen due to a change in laws or regulations, or a change in a
    portfolio's investment objectives or restrictions, or because the
    portfolio or Division is no longer available for investment, or for
    some other reason.  We may get prior approval from the insurance
    department of our state of domicile before making such a
    substitution.  We will also get any required approval from the SEC
    and any other required approvals before making such a substitution.

    Subject to any required regulatory approvals, we reserve the right
    to transfer assets of the Variable Separate Account which we
    determine to be associated with the class of contracts to which the
    contract belongs, to another Variable Separate Account or Division.

    When permitted by law, we reserve the right to:
         (1) deregister a Variable Separate Account under the
             Investment Company Act of 1940;
         (2) operate a Variable Separate Account as a management
             company under the Investment Company Act of 1940, if it is
             operating as a unit investment trust;
         (3) operate a Variable Separate Account as a unit
             investment trust under the Investment Company Act of 1940,
             if it is operating as a managed Variable Separate Account;
         (4) restrict or eliminate any voting rights of Owners, or
             other persons who have voting rights to a Variable Separate
             Account; and,
         (5) combine a Variable Separate Account with other Variable
             Separate Accounts.

GA-IA-1058                          9


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    HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE (continued)
------------------------------------------------------------------------------

THE GENERAL ACCOUNT

    The General Account contains all assets of the Company other than
    those in the Separate Accounts we establish.  The Guaranteed
    Interest Divisions available for investment are shown in the
    Schedule.  We may, from time to time, offer other Divisions where
    assets are held in our General Account.

VALUATION PERIOD

    Each Division and Fixed Allocation will be valued at the end of each
    Valuation Period on a Valuation Date.  A Valuation Period is each
    Business Day together with any non-Business Days before it.  A
    Business Day is any day the New York Stock Exchange (NYSE) is open
    for trading, and the SEC requires mutual funds, unit investment
    trusts, or other investment portfolios to value their securities.

ACCUMULATION VALUE

    The Accumulation Value of this Contract is the sum of the amounts in
    each of the Divisions of the Variable Separate Account and General
    Account and allocations to the Fixed Account.  You select the
    Divisions of the Variable Separate Account and General Account and
    allocations to the Fixed Account to which to allocate the
    Accumulation Value.  The maximum number of Divisions and Fixed
    Allocations to which the Accumulation Value may be allocated at any
    one time is shown in the Schedule.

ACCUMULATION VALUE IN EACH DIVISION AND FIXED ALLOCATION

    On the Contract Date
    On the Contract Date, the Accumulation Value is allocated to each
    Division and Fixed Allocation as elected by you, subject to certain
    terms and conditions imposed by us.  We reserve the right to
    allocate premium to the Specially Designated Division during any
    Right to Examine Contract period.  After such time, allocation will
    be made proportionately in accordance with the initial allocation(s)
    as elected by you.

    On each Valuation Date
    At the end of each subsequent Valuation Period, the amount of
    Accumulation Value in each Division and Fixed Allocation will be
    calculated as follows:
         (1) We take the Accumulation Value in the Division or Fixed
             Allocation at the end of the preceding Valuation Period.
         (2) We multiply (1) by the Variable Separate Account
             Division's Net Rate of Return for the current Valuation
             Period or we calculate the interest to be credited to a
             Fixed Allocation or to a Guaranteed Interest Division for
             the current Valuation Period.
         (3) We add (1) and (2).
         (4) We add to (3) any additional premium payments (less any
             premium deductions as shown in the Schedule) allocated to
             the Division or Fixed Allocation during the current
             Valuation Period.
         (5) We add or subtract allocations to or from that Division
             or Fixed Allocation during the current Valuation Period.
         (6) We subtract from (5) any Partial Withdrawals which are
             allocated to the Division or Fixed Allocation  during the
             current Valuation Period.
         (7) We subtract from (6) the amounts allocated to that
             Division or Fixed Allocation for:
              (a) any charges due for the Optional Benefit Riders as
                  shown in the Schedule;
              (b) any deductions from Accumulation Value as shown in
                  the Schedule.
    All amounts in (7) are allocated to each Division or Fixed
    Allocation  in the proportion that (6) bears to the Accumulation
    Value unless the Charge Deduction Division has been specified (see
    the Schedule).

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    HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE (continued)
------------------------------------------------------------------------------

FIXED ACCOUNT

    The Fixed Account is a Separate Account under state insurance law
    and is not required to be registered with the Securities and
    Exchange Commission under the Investment Company Act of 1940.  The
    Fixed Account includes various Fixed Allocations which we credit
    with fixed rates of interest for the Guarantee Period or Periods you
    select.  We reset the interest rates for new Fixed Allocations
    periodically based on our sole discretion.

    Guarantee Periods
    Each Fixed Allocation is guaranteed an interest rate or rates for a
    period, a Guarantee Period.  The Guaranteed Interest Rates for a
    Fixed Allocation are effective for the entire period.  The Maturity
    Date of a Guarantee Period will be on the last day of the calendar
    month in which the Guarantee Period ends.  Withdrawals and transfers
    made during a Guarantee Period may be subject to a Market Value
    Adjustment unless made within thirty days prior to the Maturity
    Date.

    Upon the expiry of a Guarantee Period, we will transfer the
    Accumulation Value of the expiring Fixed Allocation to a Fixed
    Allocation with a Guarantee Period equal in length to the expiring
    Guarantee Period, unless you select another period prior to a
    Maturity Date.  We will notify you at least thirty days prior to a
    Maturity Date of your options for renewal.  If the period remaining
    from the expiry of the previous Guarantee Period to the Annuity
    Commencement Date is less than the period you have elected or the
    period expiring, the next shortest period then available that will
    not extend beyond the Annuity Commencement Date will be offered to
    you.  If a period is not available, the Accumulation Value will be
    transferred to the Specially Designated Division.

    We will declare Guaranteed Interest Rates for the then available
    Fixed Allocation Guarantee Periods.  These interest rates are based
    solely on our expectation as to our future earnings.  Declared
    Guaranteed Interest Rates are subject to change at any time prior to
    application to specific Fixed Allocations, although in no event will
    the rates be less than the Minimum Guaranteed Interest Rate (see the
    Schedule).

    Market Value Adjustments
    A Market Value Adjustment will be applied to a Fixed Allocation upon
    withdrawal, transfer or application to an Income Plan if made more
    than thirty days prior to such Fixed Allocation's Maturity Date,
    except on Systematic Partial Withdrawals and IRA Partial
    Withdrawals.  The Market Value Adjustment is applied to each Fixed
    Allocation separately.

    The Market Value Adjustment is determined by multiplying the amount
    of the Accumulation Value withdrawn, transferred or applied to an
    Income Plan by the following factor:

                                              N/365
                            (    1  +  I    )
                            -----------------           -1
                            (1 + J  +  .0025)

    Where I is the Index Rate for a Fixed Allocation on the first day of
    the applicable Guarantee Period; J is the Index Rate for new Fixed
    Allocations with Guarantee Periods equal to the number of years
    (fractional years rounded up to the next full year) remaining in the
    Guarantee Period at the time of calculation; and N is the remaining
    number of days in the Guarantee Period at the time of calculation.
    (The Index Rate is described in the Schedule.)

    Market Value Adjustments will be applied as follows:
          (1) For a Partial Withdrawal, partial transfer or in the
              case where a portion of an allocation is applied to an
              Income Plan, the Market Value Adjustment will be calculated
              on the total amount that must be withdrawn, transferred or
              applied to an Income Plan in order to provide the amount
              requested.

GA-IA-1058                          11


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    HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE (continued)
------------------------------------------------------------------------------

         (2) If the Market Value Adjustment is negative, it will be
             assessed first against any remaining Accumulation Value in
             the particular Fixed Allocation.  Any remaining Market Value
             Adjustment will be applied against the amount withdrawn,
             transferred or applied to an Income Plan.
         (3) If the Market Value Adjustment is positive, it will be
             credited to any remaining Accumulation Value in the
             particular Fixed Allocation.  If a cash surrender, full
             transfer or full application to an Income Plan has been
             requested, the Market Value Adjustment is added to the
             amount withdrawn, transferred or applied to an Income Plan.

MEASUREMENT OF INVESTMENT EXPERIENCE

    Index of Investment Experience
    The Investment Experience of a Variable Separate Account Division is
    determined on each Valuation Date.  We use an Index to measure
    changes in each Division's experience during a Valuation Period.  We
    set the Index at $10 when the first investments in a Division are
    made.  The Index for a current Valuation Period equals the Index for
    the preceding Valuation Period multiplied by the Experience Factor
    for the current Valuation Period.

    How We Determine the Experience Factor
    For Divisions of a unit investment trust Separate Account the
    Experience Factor reflects the Investment Experience of the
    portfolio in which the Division invests as well as the charges
    assessed against the Division for a Valuation Period.  The factor is
    calculated as follows:
         (1) We take the net asset value of the portfolio in which
             the Division invests at the end of the current Valuation
             Period.
         (2) We add to (1) the amount of any dividend or capital
             gains distribution declared for the investment portfolio and
             reinvested in such portfolio during the current Valuation
             Period.  We subtract from that amount a charge for our
             taxes, if any.
         (3) We divide (2) by the net asset value of the portfolio
             at the end of the preceding Valuation Period.
         (4) We subtract the daily Mortality and Expense Risk Charge
             for each Division shown in the Schedule for each day in the
             Valuation Period.
         (5) We subtract the daily Asset Based Administrative Charge
             shown in the Schedule for each day in the Valuation Period.

    Calculations for Divisions investing in unit investment trusts are
      on a per unit basis.

    Net Rate of Return for a Variable Separate Account Division
    The Net Rate of Return for a Variable Separate Account Division
    during a Valuation Period is the Experience Factor for that
    Valuation Period minus one.

    Interest Credited to a Guaranteed Interest Division
    Accumulation Value allocated to a Guaranteed Interest Division will
    be credited with the Guaranteed Interest Rate for the Guarantee
    Period in effect on the date the premium or reallocation is applied.
    Once applied, such rate will be guaranteed until the Maturity Date
    of that Guarantee Period.  Interest will be credited daily at a rate
    to yield the declared annual Guaranteed Interest Rate.  No
    Guaranteed Interest Rate will be less than the Minimum Interest Rate
    shown in the Schedule.

    Interest Credited to a Fixed Allocation
    A Fixed Allocation will be credited with the Guaranteed Interest
    Rate for the Guarantee Period in effect on the date the premium or
    reallocation is applied.  Once applied, such rate will be guaranteed
    until that Fixed Allocation's Maturity Date.  Interest will be
    credited daily at a rate to yield the declared annual Guaranteed
    Interest Rate.

    We periodically declare Guaranteed Interest Rates for then available
    Guarantee Periods. No Guaranteed Interest Rate will be less than the
    Minimum Interest Rate shown in the Schedule.

GA-IA-1058                          12


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    HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE (continued)
------------------------------------------------------------------------------

CHARGES DEDUCTED FROM ACCUMULATION VALUE ON EACH CONTRACT PROCESSING DATE

    Expense charges and fees are shown in the Schedule.

    Charge Deduction Division Option
    We will deduct all charges against the Accumulation Value of this
    Contract from the Charge Deduction Division if you elected this
    option on the application (see the Schedule).  If you did not elect
    this Option or if the charges are greater than the amount in the
    Charge Deduction Division, the charges against the Accumulation
    Value will be deducted as follows:

         (1) If these charges are less than the Accumulation Value
             in the Variable Separate Account Divisions, they will be
             deducted proportionately from all Divisions.
         (2) If these charges exceed the Accumulation Value in the
             Variable Separate Account Divisions, any excess over such
             value will be deducted proportionately from any Fixed
             Allocations and Guaranteed Interest Divisions.

    Any charges taken from the Fixed Account or the General Account will
    be taken from the Fixed Allocations or Guaranteed Interest Divisions
    starting with the Guarantee Period nearest its Maturity Date until
    such charges have been paid.

    At any time while this Contract is in effect, you may change your
    election of this Option.  To do this you must send us a written
    request to our Customer Service Center.  Any change will take effect
    within seven days of the date we receive your request.

GA-IA-1058                          13


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<PAGE>

                       YOUR CONTRACT BENEFITS
------------------------------------------------------------------------------

    While this Contract is in effect, there are important rights and
    benefits that are available to you.  We discuss these rights and
    benefits in this section.

CASH VALUE BENEFIT

    Cash Surrender Value
    The Cash Surrender Value, while the Annuitant is living and before
    the Annuity Commencement Date, is determined as follows:
         (1) We take the Contract's Accumulation Value;
         (2) We adjust for any applicable Market Value Adjustment;
         (3) We deduct any charges shown in the Schedule that have
             been incurred but not yet deducted, including;
              (a) any administrative fee that has not yet been
                  deducted;
              (b) the pro rata part of any charges for Optional
                  Benefit Riders; and
              (c) any applicable premium or other tax.

    Cancelling to Receive the Cash Surrender Value
    At any time while the Annuitant is living and before the Annuity
    Commencement Date, you may surrender this Contract to us.  To do
    this, you must return this Contract with a signed request for
    cancellation to our Customer Service Center.

    The Cash Surrender Value will vary daily.  We will determine the
    Cash Surrender Value as of the date we receive the Contract and your
    signed request in our Customer Service Center.  All benefits under
    this Contract will then end.

    We will usually pay the Cash Surrender Value within seven days; but,
    we may delay payment as described in the Payments We May Defer
    provision.

PARTIAL WITHDRAWAL OPTION

    After the Contract Date, you may make Partial Withdrawals.  The
    minimum amount that may be withdrawn is shown in the Schedule.  To
    take a Partial Withdrawal, you must provide us satisfactory notice
    at our Customer Service Center.

PROCEEDS PAYABLE TO THE BENEFICIARY

    Prior to the Annuity Commencement Date
    If the sole Owner dies prior to the Annuity Commencement Date, we
    will pay the Beneficiary the death benefit.  If there are joint
    Owners and any Owner dies, we will pay the surviving Owners the
    death benefit.  We will pay the amount on receipt of due proof of
    the Owner's death at our Customer Service Center.  Such amount may
    be received in a single lump sum or applied to any of the Annuity
    Options (see Choosing an Income Plan).  When the Owner (or all
    Owners where there are joint Owners) is not an individual, the death
    benefit will become payable on the death of the Annuitant prior to
    the Annuity Commencement Date (unless a Contingent Annuitant
    survived the Annuitant).  Only one death benefit is payable under
    this Contract.  In all events, distributions under the Contract must
    be made as required by applicable law.

GA-IA-1058                          14


<PAGE>
<PAGE>

                 YOUR CONTRACT BENEFITS (continued)
------------------------------------------------------------------------------

    How to Claim Payments to Beneficiary
    We must receive proof of the Owner's (or the Annuitant's) death
    before we will make any payments to the Beneficiary.  We will
    calculate the death benefit as of the date we receive due proof of
    death.  The Beneficiary should contact our Customer Service Center
    for instructions.

    Guaranteed Death Benefits

    The Guaranteed Death Benefit is as shown in the Schedule.  A change
    of Owner will affect the Guaranteed Death Benefit, as shown in the
    Schedule.

GA-IA-1058                          15


<PAGE>
<PAGE>

                       CHOOSING AN INCOME PLAN
------------------------------------------------------------------------------

ANNUITY BENEFITS

    If the Annuitant and Owner are living on the Annuity Commencement
    Date, we will begin making payments to the Owner.  We will make
    these payment under the Annuity Option (or Options) as chosen in the
    application or as subsequently selected.  You may choose or change
    an Annuity Option by making a written request at least 30 days prior
    to the Annuity Commencement Date.  Unless you have chosen otherwise,
    Option 2 on a 10-year period certain basis will become effective.
    The amounts of the payments will be determined by applying the
    Accumulation Value on the Annuity Commencement Date in accordance
    with the Annuity Options section below (see Payments We Defer).
    Before we pay any Annuity Benefits, we require the return of this
    Contract.  If this Contract has been lost, we require the applicable
    lost Contract form.

ANNUITY COMMENCEMENT DATE SELECTION

    You select the Annuity Commencement Date.  You may select any date
    following the fifth Contract Anniversary but before the required
    date of Annuity Commencement as shown in the Schedule.  If you do
    not select a date, the Annuity Commencement Date will be in the
    month following the required date of Annuity Commencement.

FREQUENCY SELECTION

    You may choose the frequency of the Annuity Payments.  They may be
    monthly, quarterly, semi-annually or annually.  If we do not receive
    written notice from you, the payments will be made monthly.

THE INCOME PLAN

    While this Contract is in effect and before the Annuity Commencement
    Date, you may chose one or more Annuity Options for the payment of
    death benefits proceeds.  If, at the time of the Owner's death, no
    Option has been chosen for paying the death benefit proceeds, the
    Beneficiary may choose an Option within one year.  You may also
    elect an Annuity Option on surrender of the Contract for its Cash
    Surrender Value.  For each Option we will issue a separate written
    agreement putting the Option into effect.

    Our approval is needed for any Option where:
         (1) the person named to receive payment is other than the
             Owner or Beneficiary; or
         (2) the person named is not a natural person, such as a
             corporation; or
         (3) any income payment would be less than the minimum
             annuity income payment shown in the Schedule.

THE ANNUITY OPTIONS

    There are four Options to choose from.  They are:

    Option 1.  Income for a Fixed Period
    Payment is made in equal installments for a fixed number of years.
    We guarantee each monthly payment will be at least the Income for
    Fixed Period amount shown in the Schedule.  Values for annual,
    semiannual or quarterly payments are available on request.

GA-IA-1058                          16


<PAGE>
<PAGE>

                 CHOOSING AN INCOME PLAN (continued)
------------------------------------------------------------------------------

    Option 2.  Income for Life
    Payment is made to the person named in equal monthly installments
    and guaranteed for at least a period certain.  The period certain
    can be 10 or 20 years.  Other periods certain are available on
    request.  A refund certain may be chosen instead.  Under this
    arrangement, income is guaranteed until payments equal the amount
    applied.  If the person named lives beyond the guaranteed period,
    payments continue until his or her death.

    We guarantee each payment will be at least the amount shown in the
    Schedule.  By age, we mean the named person's age on his or her last
    birthday before the Option's effective date.  Amounts for ages not
    shown are available on request.

    Option 3.  Joint Life Income
    This Option is available if there are two persons named to receive
    payments.  At least one of the persons named must be either the
    Owner or Beneficiary of this Contract.  Monthly payments are
    guaranteed and are made as long as at least one of the named persons
    is living.  The monthly payment amounts are available upon request.
    Such amounts are guaranteed and will be calculated on the same basis
    as the Table for Income for Life, however, the amounts will be based
    on two lives.

    Option 4.  Annuity Plan
    An amount can be applied under any other settlement option we offer
    for the Contract on the Option's effective date.


    The minimum rates for Option 1 are based on 3% interest, compounded
    annually.  The minimum rates for Options 2 and 3 are based on 3%
    interest, compounded annually, and the Annuity 2000 Mortality Table.
    We may pay a higher rate at our discretion.

    PAYMENT WHEN NAMED PERSON DIES

    When the person named to receive payment dies, we will pay any
    amounts still due as provided by the Option agreement.  The amounts
    still due are determined as follows:
         (1) For Option 1 or for any remaining guaranteed payments
             in Option 2, payments will be continued.
         (2) For Option 3, no amounts are payable after both named
             persons have died.
         (3) For Option 4, the annuity agreement will state the
             amount due, if any.

GA-IA-1058                          17


<PAGE>
<PAGE>

                     OTHER IMPORTANT INFORMATION
------------------------------------------------------------------------------

SENDING NOTICE TO US

    Whenever written notice is required, send it to our Customer Service
    Center.  The address of our Customer Service Center is shown on the
    cover page.  Please include your Contract number in all
    correspondence.

REPORTS TO OWNER

    We will send you a report at least once during each Contract Year.
    The report will show the Accumulation Value and the Cash Surrender
    Value as of the end of the Contract Processing Period.  The report
    will also show the allocation of the Accumulation Value as of such
    date and the amounts deducted from or added to the Accumulation
    Value since the last report.  The report will also include any
    information that may be currently required by the insurance
    supervisory official of the jurisdiction in which the Contract is
    delivered.

    We will also send you copies of any shareholder reports of the
    portfolios in which the Divisions of the Variable Separate Account
    invest, as well as any other reports, notices or documents required
    by law to be furnished to Owners.

ASSIGNMENT - USING THIS CONTRACT AS COLLATERAL SECURITY

    You can assign this Contract as collateral security for a loan or
    other obligation.  This does not change the ownership.  Your rights
    and any Beneficiary's right are subject to the terms of the
    assignment.  To make or release an assignment, we must receive
    written notice satisfactory to us, at our Customer Service Center.
    We are not responsible for the validity of any assignment.

CHANGING THIS CONTRACT

    This Contract or any additional benefit riders may be changed to
    another annuity plan according to our rules at the time of the
    change.

CONTRACT CHANGES - APPLICABLE TAX LAW

    We reserve the right to make changes in this Contract or its Riders
    to the extent we deem it necessary to continue to qualify this
    Contract as an annuity.  Any such changes will apply uniformly to
    all Contracts that are affected.  You will be given advance written
    notice of such changes.

MISSTATEMENT OF AGE OR SEX

    If an age or sex has been misstated, the amounts payable or benefits
    provided by this Contract will be those that the premium payment
    made would have bought at the correct age or sex.

NON-PARTICIPATING

    This Contract does not participate in the divisible surplus of
    Golden American Life Insurance Company.

GA-IA-1058                          18


<PAGE>
<PAGE>

                 OTHER IMPORTANT INFORMATION (continued)
------------------------------------------------------------------------------

PAYMENTS WE MAY DEFER

    We may not be able to determine the value of the assets of the Variable
    Separate Account Divisions because:
         (1) The NYSE is closed for trading;
         (2) the SEC determines that a state of emergency exists;
         (3) an order or pronouncement of the SEC permits a delay for
             the protection of Owners; or
         (4) the check used to pay the premium has not cleared through
             the banking system.  This may take up to 15 days.

    During such times, as to amounts allocated to the Divisions of the
    Variable Separate Account, we may delay;
         (1) determination and payment of the Cash Surrender Value;
         (2) determination and payment of any death benefit if death
             occurs before the Annuity Commencement Date;
         (3) allocation changes of the Accumulation Value; or,
         (4) application of the Accumulation Value under an income plan.

    As to the amounts allocated to a Guaranteed Interest Division of the
    General Account and as to amounts allocated to Fixed Allocations of the
    Fixed Account, we may, at any time, defer payment of the Cash Surrender
    Value for up to six months after we receive a request for it.  We will
    allow interest of at least 3.00% a year on any Cash Surrender Value
    payment derived from the Fixed Allocations or the Guaranteed Interest
    Divisions that we defer 30 days or more.

AUTHORITY TO MAKE AGREEMENTS

    All agreements made by us must be signed by one of our officers.  No
    other person, including an insurance agent or broker, can:
         (1) change any of this Contract's terms;
         (2) extend the time for premium payments; or
         (3) make any agreement binding on us.

REQUIRED NOTE ON OUR COMPUTATIONS

    We have filed a detailed statement of our computations with the
    insurance supervisory official in the jurisdiction where this Contract
    is delivered.  The values are not less than those required by the law of
    that state or jurisdiction.  Any benefit provided by an attached
    Optional Benefit Rider will not increase these values unless otherwise
    stated in that Rider.

GA-IA-1058                          19


<PAGE>
<PAGE>
























DEFERRED COMBINATION VARIABLE AND FIXED ANNUITY CONTRACT - NO
DIVIDENDS
------------------------------------------------------------------------------

Variable Cash Surrender Values while the Annuitant and Owner are
living and prior to the Annuity Commencement Date.  Death benefit
subject to guaranteed minimum.  Additional Premium Payment Option.
Partial Withdrawal Option.  Non-participating.  Investment results
reflected in values.

GA-IA-1058


<PAGE>
<PAGE>

                            THE SCHEDULE
                           CONTRACT FACTS
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

CONTRACT FACTS

    Contract Processing Date
    The Contract Processing Date for your Contract is [April 1] of each
    year.

    Specially Designated Divisions
    When a distribution is made from an investment portfolio underlying a
    Variable Separate Account Division in which reinvestment is not
    available, we will allocate the amount of the distribution to the
    [Liquid Asset Division] unless you specify otherwise.

PARTIAL WITHDRAWALS

    The maximum amount that can be withdrawn each Contract Year is
    described below.  In no event may a Partial Withdrawal exceed 90% of
    the Cash Surrender Value.  After a Partial Withdrawal, the remaining
    Accumulation Value must be at least $100 to keep the Contract in
    force.

    Conventional Partial Withdrawals

    Minimum Withdrawal Amount:         $100.

    Any Conventional Partial Withdrawal is subject to a Market Value
    Adjustment unless withdrawn from a Fixed Allocation within 30 days
    prior to the Maturity Date.

    Systematic Partial Withdrawals
    Systematic Partial Withdrawals may be taken on a monthly, quarterly or
    annual basis.  You select the day withdrawals will be made, but no
    later than the 28th day of the month.

    Minimum Withdrawal Amount:         $100.
    Maximum Withdrawal Amount:

      Variable Separate Account Divisions: 1.25% monthly, 3.75%
                                  quarterly or 15% annually of
                                  Accumulation Value.
      Fixed Allocations and
      Guaranteed Interest Divisions:  Interest earned on a Fixed
                                  Allocation or Guaranteed Interest
                                  Division for the prior month, quarter or
                                  year (depending on the frequency
                                  selected).

    Systematic Partial Withdrawals from  Fixed Allocations are not
    subject to a Market Value Adjustment.

    [IRA Partial Withdrawals for Qualified Plans Only
    IRA Partial Withdrawals may be taken on a monthly, quarterly or annual
    basis.  A minimum withdrawal of $100.00 is required.  You select the
    day the withdrawals will be made, but no later than the 28th day of
    the month.  If you do not elect a day, the Contract Date will be used.
    Systematic Partial Withdrawals and Conventional Partial Withdrawals
    are not allowed when IRA Partial Withdrawals are being taken.  An IRA
    Partial Withdrawal in excess of the maximum amount allowed under the
    Systematic Partial Withdrawal option may be subject to a Market Value
    Adjustment.]

GA-IA-1058                          3D1


<PAGE>
<PAGE>

                              THE SCHEDULE
                       CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

           [Alternate schedule page Ratchet Death Benefit]
DEATH BENEFIT

    [The Death Benefit is the greatest of (i) , (ii) , (iii), and (iv)
    below, where:
      (i)   the Accumulation Value ;
      (ii)  the Guaranteed Death Benefit;
      (iii) the Cash Surrender Value;
      (iv)  the sum of premiums paid, reduced by Prorata Partial Withdrawal
            Adjustment(s) for Accumulation Value withdrawn.

GUARANTEED DEATH BENEFIT
    On the Contract Date, the Guaranteed Death Benefit is the initial
    premium.  On subsequent Valuation Dates, the Guaranteed Death
    Benefit is calculated as follows:

      (1) Start with the Guaranteed Death Benefit from the prior
          Valuation Date;
      (2) Add to (1) any additional premium paid since the prior
          Valuation Date and subtract from (1) any Prorata Partial Withdrawal
          Adjustments for any Partial Withdrawals taken since the prior
          Valuation Date.
      (3) On a Valuation Date that occurs on or prior to the owner's
          attained age [80], which is also a Contract Anniversary, we set the
          Guaranteed Death Benefit equal to the greater of (2) or the
          Accumulation Value as of such date.
    On all other Valuation Dates, the Guaranteed Death Benefit is equal
    to (2).

PRORATA PARTIAL WITHDRAWAL ADJUSTMENTS

    For any partial withdrawal, the Death Benefit components will be
    reduced by Prorata Partial Withdrawal Adjustments.  The Prorata
    Partial Withdrawal Adjustment to a death benefit component for a
    partial withdrawal is equal to (1) divided by (2), multiplied by
    (3), where:  (1) is the Accumulation Value withdrawn, (2) is the
    Accumulation Value immediately prior to withdrawal, and (3) is the
    amount of the applicable death benefit component immediately prior
    to the withdrawal.]

CHANGE OF OWNER

    A change of Owner from a sole owner to a sole owner (where there
    have never been multiple owners designated) will result in
    recalculation of the Death Benefit and the Guaranteed Death Benefit.
    If the new owner's attained age at the time of the change is less
    than [80], the Guaranteed Death Benefit in effect prior to the
    change will remain in effect and the Death Benefit provision will
    apply.  If the new owner's attained age at the time of the change is
    [80] or greater, but not greater than [85]:
    (a) the Guaranteed Death Benefit following the change will be zero;
        and
    (b)  the Death Benefit will then be the greatest of:
      1) the cash surrender value;
      2) the accumulation value prior to the date of death; and
      3) the sum of the premiums paid, reduced by Prorata Partial
         Withdrawal Adjustments for any Accumulation Value Withdrawn.

GA-IA-1058                          3D2


<PAGE>
<PAGE>

                            THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

CHANGE OF OWNER (CONT)

    If ownership changes result in multiple owners of a contract or if
    there has ever been multiple owners, the Guaranteed Death Benefit
    shall be set to zero.  If the oldest owner is age [85] or younger at
    the time of the change, the Death Benefit will then be the greatest
    of: (b) 1, (b) 2 or (b) 3 above.
    If any owner's or oldest multiple owners, attained age is [86] or
    greater at the time of the change, the Guaranteed Death Benefit will
    be zero, and the Death Benefit thereafter will be the cash surrender
    value.

    When a change of owner reduces the Guaranteed Death Benefit to zero,
    there will be a reduction in the mortality and expense risk charge.

SPOUSAL CONTINUATION UPON DEATH OF OWNER

    If at the Owner's death, the surviving spouse of the deceased Owner
    is the beneficiary and such surviving spouse elects to continue the
    contract as their own pursuant to Internal Revenue Code Section
    72(s) or the equivalent provisions of U.S. Treasury Department rules
    for qualified plans, the following will apply:
     (a) If the Guaranteed Death Benefit as of the date we receive due
         proof of death of the Owner, minus the Accumulation Value, also as
         of that date, is greater than zero we will add such difference to
         the Accumulation Value.  Such addition will be allocated to the
         divisions of the Separate Account in proportion to the Accumulation
         Value in the Separate Account.  If there is no Accumulation Value in
         the Separate Account, the addition will be allocated to the Liquid
         Assets division, or its successor.
     (b) The Guaranteed Death Benefit will continue to apply, with all
         age criteria using the surviving spouse's age as the determining
         age.

    This addition to Accumulation Value is available only to the spouse
    of the owner as of the date of death of the owner if such spouse
    under the provisions if this contract elects to continue the
    contract as their own.

CHOOSING AN INCOME PLAN

    Required Date of Annuity Commencement
    [Distributions from a Contract funding a qualified plan must commence
    no later than [April 1st] of the calendar year following the calendar
    year in which the Owner attains age 70 1/2.]

    The Annuity Commencement Date is required to be the same date as the
    Contract Processing Date in the month following the Annuitant's[ 90]th
    birthday.  In applying the Accumulation Value, we may first collect
    any Premium Taxes due us.
    Minimum Annuity Income Payment
    The minimum monthly annuity income payment that we will make is [$20].

    Optional Benefit Riders - [None.]

GA-IA-1058                          3D3


<PAGE>
<PAGE>

                            THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

ATTAINED AGE

    The Issue Age of the Annuitant or Owner plus the number of full years
    elapsed since the Contract Date.

FIXED ACCOUNT

    Minimum Fixed Allocation
    The minimum allocation to the Fixed Account in any one Fixed
    Allocation is [$250.00].

    Minimum Guaranteed Interest Rate - [3%.]

    Guarantee Periods
    We currently offer Guarantee Periods of [1,2,3,4,5,6,7,8,9 and 10]
    year(s).  We reserve the right to offer Guarantee Periods of
    durations other than those available on the Contract Date.  We also
    reserve the right to cease offering a particular Guarantee Period or
    Periods.

    Index Rate
    The Index Rate is the average of the Ask Yields for the U.S.
    Treasury Strips as reported by a national quoting service for the
    applicable maturity.  The average is based on the period from the
    22nd day of the calendar month two months prior to the calendar
    month of Index Rate determination to the 21st day of the calendar
    month immediately prior to the month of determination.  The
    applicable maturity date for these U.S. Treasury Strips is on or
    next following the last day of the Guarantee Period.  If the Ask
    Yields are no longer available, the Index Rate will be determined
    using a suitable replacement method.

    We currently set the Index Rate once each calendar month.  However,
    we reserve the right to set the Index Rate more frequently than
    monthly, but in no event will such Index Rate be based on a period
    less than 28 days.

GA-IA-1058                          3D4


<PAGE>
<PAGE>

                            THE SCHEDULE
                          CHARGES AND FEES
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

DEDUCTIONS FROM PREMIUMS

    [None.]

DEDUCTIONS FROM ACCUMULATION VALUE

    Initial Administrative Charge
    [None.]

    Administrative Charge
    [None]

    Excess Allocation Charge
    Currently none, however, we reserve the right to charge [$25] for a
    change if you make more than [twelve] allocation changes per
    Contract Year.  Any charge will be deducted in proportion to the
    amount being transferred from each Division.

    [Premium Taxes
    We deduct the amount of any premium or other state and local taxes
    levied by any state or governmental entity when such taxes are
    incurred.

    We reserve the right to defer collection of Premium Taxes until
    surrender or until application of Accumulation Value to an Annuity
    Option. We reserve the right to change the amount we charge for
    Premium Tax charges on future premium payments to conform with
    changes in the law or if the Owner changes state of residence.]

    Deductions from the Divisions
    Mortality and Expense Risk Charge - We deduct a charge from the
    assets in each separate account division on a daily basis at a rate
    of [0.001373%] (equivalent to an annual rate of [0.50%]) for
    mortality and expense risks.  The charge is not deducted from the
    fixed account or general account accumulation values.

    Asset Based Administrative Charge - We deduct [0.000411%] of the
    assets in each Variable Separate Account Division on a daily basis
    (equivalent to an annual rate of [0.15%]) to compensate us for a
    portion of our ongoing administrative expenses.  This charge is not
    deducted from the Fixed Account or General Account values.

CHARGE DEDUCTION DIVISION

    All charges against the Accumulation Value in this Contract will be
    deducted from the [Liquid Asset Division].

GA-IA-1058                          3E


<PAGE>
<PAGE>

                              THE SCHEDULE
                          THE GENERAL ACCOUNT
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

    Values for other payment periods, ages or joint life combinations
    are available on request.  Monthly payments are shown for each
    $1,000 applied.

                     TABLE FOR INCOME FOR A FIXED PERIOD

       Fixed                   Fixed                   Fixed
      Period    Monthly       Period    Monthly       Period    Monthly
    of Years     Income     of Years     Income     of Years     Income


       [5         17.95         14         7.28         23         5.00
        6         15.18         15         6.89         24         4.85
        7         13.20         16         6.54         25         4.72
        8         11.71         17         6.24         26         4.60
        9         10.56         18         5.98         27         4.49
       10          9.64         19         5.74         28         4.38
       11          8.88         20         5.53         29         4.28
       12          8.26         21         5.33         30         4.19]
       13          7.73         22         5.16



                          TABLE FOR INCOME FOR LIFE

                    Male/Female         Male/Female         Male/Female
    Age                10 Years            20 Years              Refund
                        Certain             Certain             Certain


   [50               $4.06/3.83          $3.96/3.77          $3.93/3.75
    55                4.43/4.14           4.25/4.05           4.25/4.03
    60                4.90/4.56           4.57/4.37           4.66/4.40
    65                5.51/5.10           4.90/4.73           5.12/4.83
    70                6.26/5.81           5.18/5.07           5.76/5.42
    75                7.11/6.70           5.38/5.33           6.58/6.19
    80                7.99/7.70           5.48/5.46           7.69/7.21
    85                8.72/8.59           5.52/5.51           8.72/8.59
    90                9.23/9.18           5.53/5.53         10.63/10.53]

GA-IA-1058                          3F


<PAGE>
<PAGE>

                              THE SCHEDULE
                             CONTRACT FACTS
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

CONTRACT FACTS

    Contract Processing Date
    The Contract Processing Date for your Contract is [April 1] of each
    year.

    Specially Designated Divisions
    When a distribution is made from an investment portfolio underlying a
    Variable Separate Account Division in which reinvestment is not
    available, we will allocate the amount of the distribution to the
    [Liquid Asset Division] unless you specify otherwise.

PARTIAL WITHDRAWALS

    The maximum amount that can be withdrawn each Contract Year is
    described below.  In no event may a Partial Withdrawal exceed 90% of
    the Cash Surrender Value.  After a Partial Withdrawal, the remaining
    Accumulation Value must be at least $100 to keep the Contract in
    force.

    Conventional Partial Withdrawals

    Minimum Withdrawal Amount:         $100.

    Any Conventional Partial Withdrawal is subject to a Market Value
    Adjustment unless withdrawn from a Fixed Allocation within 30 days
    prior to the Maturity Date.

    Systematic Partial Withdrawals
    Systematic Partial Withdrawals may be taken on a monthly, quarterly or
    annual basis.  You select the day withdrawals will be made, but no
    later than the 28th day of the month.

    Minimum Withdrawal Amount:         $100.
    Maximum Withdrawal Amount:

      Variable Separate Account Divisions: 1.25% monthly, 3.75%
                                  quarterly or 15% annually of
                                  Accumulation Value.
      Fixed Allocations and
      Guaranteed Interest Divisions:  Interest earned on a Fixed
                                  Allocation or Guaranteed Interest
                                  Division for the prior month, quarter or
                                  year (depending on the frequency
                                  selected).

    Systematic Partial Withdrawals from  Fixed Allocations are not
    subject to a Market Value Adjustment.

    [IRA Partial Withdrawals for Qualified Plans Only
    IRA Partial Withdrawals may be taken on a monthly, quarterly or annual
    basis.  A minimum withdrawal of $100.00 is required.  You select the
    day the withdrawals will be made, but no later than the 28th day of
    the month.  If you do not elect a day, the Contract Date will be used.
    Systematic Partial Withdrawals and Conventional Partial Withdrawals
    are not allowed when IRA Partial Withdrawals are being taken.  An IRA
    Partial Withdrawal in excess of the maximum amount allowed under the
    Systematic Partial Withdrawal option may be subject to a Market Value
    Adjustment.]

GA-IA-1058                          3D1


<PAGE>
<PAGE>

                          THE SCHEDULE
                   CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

           [Alternate schedule page 7% Enhanced Death Benefit]
    [DEATH BENEFIT
    The Death Benefit is the greatest of (i), (ii), (iii), and (iv)
    below, where:
        (i)  the Accumulation Value;
        (ii) the lesser of (a) and (b)
             (a)  the Guaranteed Death Benefit, and
             (b)  the Maximum Guaranteed Death Benefit;
        (iii)     the Cash Surrender Value;
        (iv) the sum of premiums paid, reduced by Prorata Partial
             Withdrawal Adjustment(s) for Accumulation Value withdrawn.

    GUARANTEED DEATH BENEFIT

    On the Contract Date, the Guaranteed Death Benefit is the initial
    premium.  On subsequent Valuation Dates, the guaranteed Death
    Benefit is calculated as follows:

        (1)  Start with the Guaranteed Death Benefit on the prior
             valuation date;
        (2)  Calculate interest on (1) for the current valuation period
             at the Guaranteed Death Benefit Interest Rate;
        (3)  Add (1) and (2);
        (4)  Add to (3) any additional premiums paid during the current
             valuation period;
        (5)  Subtract from (4) the amount of any Special Partial
             Withdrawal Adjustments and Prorata Partial Withdrawal Adjustments
             for any partial withdrawals made during the current valuation
             period.

    Transfer of Accumulation Value to or from Special Funds will
    result in a corresponding reallocation of the Guaranteed Death
    Benefit.

    GUARANTEED DEATH BENEFIT INTEREST RATE

    The Guaranteed Death Benefit Interest Rate is [7%] compounded
    annually, except:
     (a) For any portion of the Guaranteed Death Benefit attributable
         to Accumulation Value allocated to Special Funds, the Guaranteed
         Death Benefit Interest Rate is the lesser of: (1) [7%]
         (compounded annually) and (2) the interest rate, positive or
         negative, providing  a yield on the Guaranteed Death Benefit for
         Special Funds equal to the net return for the current valuation
         period on the Accumulation Value allocated to Special Funds; and
     (b) For any valuation period ending after the contract
         anniversary on which the Owner attains age [80], or after the
         Maximum Guaranteed Death Benefit has been reached, the Guaranteed
         eath Benefit Interest Rate is [0%].

GA-IA-1058                          3D2


<PAGE>
<PAGE>

                            THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

SPECIAL FUNDS

    The Special Funds are [the Liquid Assets Division, the Limited
    Maturity Bond Division, the Fixed Allocations, and the Guaranteed
    Interest Division].  The Company reserves the right to classify
    newly available divisions as Special Funds from the date of their
    availability to the Owner.  The Company may reclassify an existing
    division as a Special Fund or remove such designation.  Such
    reclassification shall be made with 30 days notice to contract
    owners, and will apply to amounts transferred or otherwise added to
    such division after the date of change.

MAXIMUM GUARANTEED DEATH BENEFIT

    The Maximum Guaranteed Death Benefit is equal to [three] times
    premium paid, reduced by the amount of any Special and Prorata
    Partial Withdrawal Adjustments.  Any addition due to spousal
    continuation will not affect the Maximum Guaranteed Death Benefit or
    the Guaranteed Death Benefit.

SPECIAL AND PRORATA PARTIAL WITHDRAWAL ADJUSTMENTS

    For any partial withdrawal, the Death Benefit components will be
    reduced by Prorata or Special Partial Withdrawal Adjustments.  A
    Prorata Partial Withdrawal Adjustment will be made unless a Special
    Partial Withdrawal Adjustment applies to that component for the
    withdrawal. Special Partial Withdrawal Adjustments are made when
    partial withdrawals in a contract year do not exceed [7%] of the sum
    of cumulative premiums, but only if partial withdrawals in each
    prior contract year did not exceed [7%] of the sum of cumulative
    premiums paid prior to that year.  The Special Partial Withdrawal
    Adjustment is equal to the amount of Accumulation Value withdrawn.
    Special Partial Withdrawal Adjustments are applicable only in the
    calculation of the Maximum Guaranteed Death Benefit and the
    Guaranteed Death Benefit, and in all other cases withdrawals are
    treated as Prorata Partial Withdrawal Adjustment.

    The Prorata Partial Withdrawal Adjustment to a death benefit
    component is equal to (1) divided by (2), multiplied by (3), where:
    (1) is the Accumulation Value withdrawn, (2) is the Accumulation
    Value immediately prior to withdrawal, and (3) is the amount of the
    applicable death benefit component immediately prior to the
    withdrawal.
CHANGE OF OWNER

    A change of Owner from a sole owner to a sole owner (where there
    have never been multiple owners designated) will result in
    recalculation of the Death Benefit and the Guaranteed Death Benefit.
    If the new owner's attained age at the time of the change is less
    than [80], the Guaranteed Death Benefit in effect prior to the
    change will remain in effect and the Death Benefit provision will
    apply.  If the new owner's attained age at the time of the change is
    [80] or greater, but not greater than [85]:
          (a) the Guaranteed Death Benefit following the change will be zero;
              and
          (b) the Death Benefit will then be the greatest of:
              1) the cash surrender value;
              2) the accumulation value prior to death; and
              3) the sum of the premiums paid, reduced by Prorata Partial
                 Withdrawal Adjustments for any Accumulation Value Withdrawn.

GA-IA-1058                          3D3


<PAGE>
<PAGE>
                            THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

CHANGE OF OWNER (CONT)

    If ownership changes result in multiple owners of a contract or if
    there has ever been multiple owners, the Guaranteed Death Benefit
    shall be set to zero.  If the oldest owner is age [85] or younger at
    the time of the change, the Death Benefit will then be the greatest
    of: (b) 1, (b) 2 or (b) 3 above.
    If any owner's or oldest multiple owners, attained age is [86] or
    greater at the time of the change, the Guaranteed Death Benefit will
    be zero, and the Death Benefit thereafter will be the cash surrender
    value.

    When a change of owner reduces the Guaranteed Death Benefit to zero,
    there will be a reduction in the mortality and expense risk charge.

SPOUSAL CONTINUATION UPON DEATH OF OWNER

    If at the Owner's death, the surviving spouse of the deceased Owner
    is the beneficiary and such surviving spouse elects to continue the
    contract as their own pursuant to Internal Revenue Code Section
    72(s) or the equivalent provisions of U.S. Treasury Department rules
    for qualified plans, the following will apply:
      (a) If the Guaranteed Death Benefit as of the date we receive due
          proof of death of the Owner, minus the Accumulation Value, also as
          of that date, is greater than zero we will add such difference to
          the Accumulation Value.  Such addition will be allocated to the
          divisions of the Separate Account in proportion to the Accumulation
          Value in the Separate Account.  If there is no Accumulation Value in
          the Separate Account, the addition will be allocated to the Liquid
          Assets division, or its successor.
      (b) The Guaranteed Death Benefit will continue to apply, with all
          age criteria using the surviving spouse's age as the determining
          age.

    This addition to Accumulation Value is available only to the spouse
    of the owner as of the date of death of the owner if such spouse
    under the provisions if this contract elects to continue the
    contract as their own.

CHOOSING AN INCOME PLAN

    Required Date of Annuity Commencement
    [Distributions from a Contract funding a qualified plan must commence
    no later than [April 1st] of the calendar year following the calendar
    year in which the Owner attains age 70 1/2.]

    The Annuity Commencement Date is required to be the same date as the
    Contract Processing Date in the month following the Annuitant's[ 90]th
    birthday.  In applying the Accumulation Value, we may first collect
    any Premium Taxes due us.

    Minimum Annuity Income Payment
    The minimum monthly annuity income payment that we will make is [$20].
    Optional Benefit Riders - [None.]

GA-IA-1058                          3D4


<PAGE>
<PAGE>

                            THE SCHEDULE
                          CHARGES AND FEES
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

DEDUCTIONS FROM PREMIUMS

    [None.]

DEDUCTIONS FROM ACCUMULATION VALUE

    Initial Administrative Charge
    [None.]

    Administrative Charge
    [None]

    Excess Allocation Charge
    Currently none, however, we reserve the right to charge [$25] for a
    change if you make more than [twelve] allocation changes per
    Contract Year.  Any charge will be deducted in proportion to the
    amount being transferred from each Division.

    [Premium Taxes
    We deduct the amount of any premium or other state and local taxes
    levied by any state or governmental entity when such taxes are
    incurred.

    We reserve the right to defer collection of Premium Taxes until
    surrender or until application of Accumulation Value to an Annuity
    Option. We reserve the right to change the amount we charge for
    Premium Tax charges on future premium payments to conform with
    changes in the law or if the Owner changes state of residence.]

    Deductions from the Divisions
    Mortality and Expense Risk Charge - We deduct a charge from the
    assets in each separate account division on a daily basis at a rate
    of [0.001925%] (equivalent to an annual rate of [0.70%]) for
    mortality and expense risks.  The charge is not deducted from the
    fixed account or general account accumulation values.

    Asset Based Administrative Charge - We deduct [0.000411%] of the
    assets in each Variable Separate Account Division on a daily basis
    (equivalent to an annual rate of [0.15%]) to compensate us for a
    portion of our ongoing administrative expenses.  This charge is not
    deducted from the Fixed Account or General Account values.

CHARGE DEDUCTION DIVISION

    All charges against the Accumulation Value in this Contract will be
    deducted from the [Liquid Asset Division].

GA-IA-1058                          3E


<PAGE>
<PAGE>

                            THE SCHEDULE
                         INCOME PLAN FACTORS
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

    Values for other payment periods, ages or joint life combinations
    are available on request.  Monthly payments are shown for each
    $1,000 applied.

                     TABLE FOR INCOME FOR A FIXED PERIOD

       Fixed                   Fixed                   Fixed
      Period    Monthly       Period    Monthly       Period    Monthly
    of Years     Income     of Years     Income     of Years     Income


       [5         17.95         14         7.28         23         5.00
        6         15.18         15         6.89         24         4.85
        7         13.20         16         6.54         25         4.72
        8         11.71         17         6.24         26         4.60
        9         10.56         18         5.98         27         4.49
       10          9.64         19         5.74         28         4.38
       11          8.88         20         5.53         29         4.28
       12          8.26         21         5.33         30         4.19]
       13          7.73         22         5.16



                          TABLE FOR INCOME FOR LIFE

                    Male/Female         Male/Female         Male/Female
    Age                10 Years            20 Years              Refund
                        Certain             Certain             Certain


    [50               $4.06/3.83          $3.96/3.77          $3.93/3.75
     55                4.43/4.14           4.25/4.05           4.25/4.03
     60                4.90/4.56           4.57/4.37           4.66/4.40
     65                5.51/5.10           4.90/4.73           5.12/4.83
     70                6.26/5.81           5.18/5.07           5.76/5.42
     75                7.11/6.70           5.38/5.33           6.58/6.19
     80                7.99/7.70           5.48/5.46           7.69/7.21
     85                8.72/8.59           5.52/5.51           8.72/8.59
     90                9.23/9.18           5.53/5.53          10.63/10.53]

GA-IA-1058                          3F


<PAGE>
<PAGE>

                            THE SCHEDULE
                           CONTRACT FACTS
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

CONTRACT FACTS

    Contract Processing Date
    The Contract Processing Date for your Contract is [April 1] of each
    year.

    Specially Designated Divisions
    When a distribution is made from an investment portfolio underlying a
    Variable Separate Account Division in which reinvestment is not
    available, we will allocate the amount of the distribution to the
    [Liquid Asset Division] unless you specify otherwise.

PARTIAL WITHDRAWALS

    The maximum amount that can be withdrawn each Contract Year is
    described below.  In no event may a Partial Withdrawal exceed 90% of
    the Cash Surrender Value.  After a Partial Withdrawal, the remaining
    Accumulation Value must be at least $100 to keep the Contract in
    force.

    Conventional Partial Withdrawals

    Minimum Withdrawal Amount:         $100.

    Any Conventional Partial Withdrawal is subject to a Market Value
    Adjustment unless withdrawn from a Fixed Allocation within 30 days
    prior to the Maturity Date.

    Systematic Partial Withdrawals
    Systematic Partial Withdrawals may be taken on a monthly, quarterly or
    annual basis.  You select the day withdrawals will be made, but no
    later than the 28th day of the month.

    Minimum Withdrawal Amount:         $100.
    Maximum Withdrawal Amount:

      Variable Separate Account Divisions: 1.25% monthly, 3.75%
                                  quarterly or 15% annually of
                                  Accumulation Value.
      Fixed Allocations and
      Guaranteed Interest Divisions:  Interest earned on a Fixed
                                  Allocation or Guaranteed Interest
                                  Division for the prior month, quarter or
                                  year (depending on the frequency
                                  selected).

    Systematic Partial Withdrawals from  Fixed Allocations are not
    subject to a Market Value Adjustment.

    [IRA Partial Withdrawals for Qualified Plans Only
    IRA Partial Withdrawals may be taken on a monthly, quarterly or annual
    basis.  A minimum withdrawal of $100.00 is required.  You select the
    day the withdrawals will be made, but no later than the 28th day of
    the month.  If you do not elect a day, the Contract Date will be used.
    Systematic Partial Withdrawals and Conventional Partial Withdrawals
    are not allowed when IRA Partial Withdrawals are being taken.  An IRA
    Partial Withdrawal in excess of the maximum amount allowed under the
    Systematic Partial Withdrawal option may be subject to a Market Value
    Adjustment.]

GA-IA-1058                          3D1


<PAGE>
<PAGE>

                          THE SCHEDULE
                   CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

           [Alternative schedule pages option 4 death benefit]
    DEATH BENEFIT

    The Death Benefit is the greatest of (i) , (ii) , (iii), (iv) and
    (v)  below, where:
        (i)   the Accumulation Value;
        (ii)  the lesser of (a) and (b):
              (a)  the Guaranteed Death Benefit, and
              (b)  the Maximum Guaranteed Death Benefit;
        (iii) the Cash Surrender Value;
        (iv)  the sum of premiums paid, reduced by Prorata Partial
              Withdrawal Adjustment(s) for Accumulation Value withdrawn, and
        (v)   the Alternate Death Benefit.

    GUARANTEED DEATH BENEFIT

    On the Contract Date, the Guaranteed Death Benefit is the initial
    premium.  On subsequent Valuation Dates, the guaranteed Death
    Benefit is calculated as follows:

      (1)  Start with the Guaranteed Death Benefit on the prior
           valuation date;
      (2)  Calculate interest on (1) for the current valuation period
           at the Guaranteed Death Benefit Interest Rate;
      (3)  Add (1) and (2);
      (4)  Add to (3) any additional premiums paid during the current
           valuation period;
      (5)  Subtract from (4) the amount of any Special Partial
           Withdrawal Adjustments and Prorata Partial Withdrawal Adjustments
           for any partial withdrawals made during the current valuation
           period.

    Transfer of Accumulation Value to or from Special Funds will
    result in a corresponding reallocation of Guaranteed Death
    Benefit.

    GUARANTEED DEATH BENEFIT INTEREST RATE

    The Guaranteed Death Benefit Interest Rate is [7%] compounded
    annually, except:
    (a)  For any portion of the Guaranteed Death Benefit attributable
         to Accumulation Value allocated to Special Funds, the Guaranteed
         Death Benefit Interest Rate is the lesser of: (1) [7%]
         (compounded annually) and (2) the interest rate, positive or
         negative, providing a yield on the Guaranteed Death Benefit for
         Special Funds equal to the net return for the current valuation
         period on the Accumulation Value allocated to Special Funds; and
    (b)  For any valuation period ending after the contract
         anniversary on which the Owner attains age [80], or after the
         Maximum Guaranteed Death Benefit has been reached, the Guaranteed
         Death Benefit Interest Rate is [0%].

GA-IA-1058                          3D2


<PAGE>
<PAGE>

                            THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

SPECIAL FUNDS

    Special Funds are [the Liquid Assets Division, the Limited Maturity
    Bond Division, the Fixed Allocations, and the Guaranteed Interest
    Division].  The Company reserves the right to classify newly
    available divisions as Special Funds from the date of their
    availability to the Owner.  The Company may reclassify an existing
    division as a Special Fund or remove such designation.  Such
    reclassification shall be made with 30 days notice to contract
    owners, and will apply to amounts transferred or otherwise added to
    such division after the date of change.

MAXIMUM GUARANTEED DEATH BENEFIT

    The Maximum Guaranteed Death Benefit is equal to [three] times
    premium paid reduced by the amount of any Special and Prorata
    Partial Withdrawal Adjustments.  Any addition due to spousal
    continuation will not affect the Maximum Guaranteed Death Benefit or
    the Guaranteed Death Benefit.

SPECIAL AND PRORATA PARTIAL WITHDRAWAL ADJUSTMENTS

    For any partial withdrawal, the Death Benefit components will be
    reduced by Prorata or Special Partial Withdrawal Adjustments.  A
    Prorata Partial Withdrawal Adjustment will be made unless a Special
    Partial Withdrawal Adjustment applies to that component for the
    withdrawal. Special Partial Withdrawal Adjustments are made when
    partial withdrawals in a contract year do not exceed [7%] of the sum
    of cumulative premiums but only if partial withdrawals in each prior
    contract year did not exceed [7%] of the sum of cumulative premiums
    paid.   The Special Partial Withdrawal Adjustment is equal to the
    amount of Accumulation Value withdrawn.  Special Partial Withdrawal
    Adjustments are applicable only in the calculation of the Maximum
    Guaranteed Death Benefit and the Guaranteed Death Benefit, in all
    other cases including the Alternate Guaranteed Death Benefit,
    withdrawals are treated as Prorata Partial Withdrawal Adjustment.

    The Prorata Partial Withdrawal Adjustment to a death benefit
    component for a partial withdrawal is equal to (1) divided by (2),
    multiplied by (3), where:  (1) is the Accumulation Value withdrawn,
    (2) is the Accumulation Value immediately prior to withdrawal, and
    (3) is the amount of the applicable death benefit component
    immediately prior to the withdrawal.

ALTERNATE GUARANTEED DEATH BENEFIT
    On the Contract Date, the Alternate Guaranteed Death Benefit is the
    initial premium.  On subsequent Valuation Dates, the Alternate
    Guaranteed Death Benefit is calculated as follows:

      (1)  Start with the Alternate Guaranteed Death Benefit from the
           prior Valuation Date;
      (2)  Add to (1) any additional premium paid  since the prior
           Valuation Date and subtract from (1) any Prorata Partial
           Withdrawal Adjustments for any Partial Withdrawals taken
           since the prior Valuation Date.
      (3)  On a Valuation Date that occurs on or prior to the owner's
           attained age [80], which is also a Contract Anniversary, we set
           the Guaranteed Death Benefit equal to the greater of (2) or the
           Accumulation Value as of such date.
    On all other Valuation Dates, the Alternate Guaranteed Death Benefit
    is equal to (2).

GA-IA-1058                          3D3


<PAGE>
<PAGE>

                            THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

CHANGE OF OWNER
    A change of Owner from a sole owner to a sole owner (where there
    have never been multiple owners designated) will result in
    recalculation of the Death Benefit, the Guaranteed Death Benefit the
    Alternate Death Benefit, and the Maximum Guaranteed Death Benefit.
    If the new owner's attained age at the time of the change is less
    than [80], the Guaranteed Death Benefit, the Alternate Death
    Benefit, and the Maximum Guaranteed Death Benefit in effect prior to
    the change will remain in effect and the Death Benefit provision
    shall apply.  If the new owner's attained age at the time of the
    change is [80] or greater, but not greater than [85]:
      (a)  the Guaranteed Death Benefit, the Alternative Death Benefit,
           and the Maximum Guaranteed Death Benefit following the change will
           be zero; and
      (b)  the Death Benefit will then be the greatest of:
           1)  the cash surrender value;
           2)  the accumulation value prior to the date of death; and
           3)  the sum of the premiums paid, reduced by Prorata Partial
               Withdrawal Adjustments for any Accumulation Value withdrawn.

    If ownership change results in multiple owners of a contract or if
    there has ever been multiple owners, the Guaranteed Death Benefit,
    the Alternate Death Benefit and the Maximum Guaranteed Death Benefit
    shall be set to zero.  If the oldest owner is age [85] or younger at
    the time of the change, the Death Benefit will then be the greatest
    of: (b) 1, (b) 2 or (b) 3 above.

    If any owner's or oldest multiple owner's attained age is [86] or
    greater at the time of the change, the Guaranteed Death Benefit, the
    Alternate Death Benefit and the Maximum Guaranteed Death Benefit
    will be zero, and the Death Benefit will then be the cash surrender
    value.

    When a change of owner reduces the Guaranteed Death Benefit, the
    Alternate Death Benefit and the Maximum Guaranteed Death Benefit to
    zero, there will be a reduction in the mortality and expense risk
    charge.

SPOUSAL CONTINUATION UPON DEATH OF OWNER

    If at the Owner's death, the surviving spouse of the deceased Owner
    is the beneficiary and such surviving spouse elects to continue the
    contract as their own pursuant to Internal Revenue Code Section
    72(s) or the equivalent provisions of U.S. Treasury Department rules
    for qualified plans, the following will apply:
     (a)  If the greater of: A) the lesser of 1) the Guaranteed Death
          Benefit and 2) the Maximum Guaranteed Death Benefit, or B) the
          Alternate Death Benefit as of the date we receive due proof of death
          of the Owner, minus the Accumulation Value, also as of that date, is
          greater than zero we will add such difference to the Accumulation
          Value.  Such addition will be allocated to the divisions of the
          Separate Account in proportion to the Accumulation Value in the
          Separate Account.  If there is no Accumulation Value in the Separate
          Account, the addition will be allocated to the Liquid Assets
          division, or its successor.
     (b)  The Guaranteed Death Benefit, the Alternate Death Benefit and
          the Maximum Guaranteed Death Benefit will continue to apply, with
          all age criteria using the surviving spouse's age as the determining
          age.  The Guaranteed Death Benefit shall be reallocated to the
          Special and other funds in proportion to the Accumulation Value.

GA-IA-1058                          3D4


<PAGE>
<PAGE>

                            THE SCHEDULE
                     CONTRACT FACTS (continued)
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

SPOUSAL CONTINUATION (CONT)

    This addition to Accumulation Value is available only to the spouse
    of the owner as of the date of death of the owner if such spouse
    under the provisions if this contract elects to continue the
    contract as their own.

CHOOSING AN INCOME PLAN

    Required Date of Annuity Commencement
    [Distributions from a Contract funding a qualified plan must commence
    no later than [April 1st] of the calendar year following the calendar
    year in which the Owner attains age 70 1/2.]

    The Annuity Commencement Date is required to be the same date as the
    Contract Processing Date in the month following the Annuitant's[ 90]th
    birthday.  In applying the Accumulation Value, we may first collect
    any Premium Taxes due us.

    Minimum Annuity Income Payment
    The minimum monthly annuity income payment that we will make is [$20].
    Optional Benefit Riders - [None.]

GA-IA-1058                          3D5


<PAGE>
<PAGE>

                            THE SCHEDULE
                          CHARGES AND FEES
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

DEDUCTIONS FROM PREMIUMS

    [None.]

DEDUCTIONS FROM ACCUMULATION VALUE

    Initial Administrative Charge
    [None.]

    Administrative Charge
    [None]

    Excess Allocation Charge
    Currently none, however, we reserve the right to charge [$25] for a
    change if you make more than [twelve] allocation changes per
    Contract Year.  Any charge will be deducted in proportion to the
    amount being transferred from each Division.

    [Premium Taxes
    We deduct the amount of any premium or other state and local taxes
    levied by any state or governmental entity when such taxes are
    incurred.

    We reserve the right to defer collection of Premium Taxes until
    surrender or until application of Accumulation Value to an Annuity
    Option. We reserve the right to change the amount we charge for
    Premium Tax charges on future premium payments to conform with
    changes in the law or if the Owner changes state of residence.]

    Deductions from the Divisions
    Mortality and Expense Risk Charge - We deduct a charge from the
    assets in each separate account division on a daily basis at a rate
    of [0.002192%] (equivalent to an annual rate of [0.80%]) for
    mortality and expense risks.  The charge is not deducted from the
    fixed account or general account accumulation values.

    Asset Based Administrative Charge - We deduct [0.000411%] of the
    assets in each Variable Separate Account Division on a daily basis
    (equivalent to an annual rate of [0.15%]) to compensate us for a
    portion of our ongoing administrative expenses.  This charge is not
    deducted from the Fixed Account or General Account values.

CHARGE DEDUCTION DIVISION

    All charges against the Accumulation Value in this Contract will be
    deducted from the [Liquid Asset Division].

GA-IA-1058                          3E


<PAGE>
<PAGE>

                            THE SCHEDULE
                         INCOME PLAN FACTORS
------------------------------------------------------------------------------

|----------------------------------------------------------------------------|
| Annuitant                Owner                                             |
| [THOMAS J. DOE]          [JOHN Q. DOE]                                     |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2053]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]     [123456]                    |
------------------------------------------------------------------------------

    Values for other payment periods, ages or joint life combinations
    are available on request.  Monthly payments are shown for each
    $1,000 applied.

                     TABLE FOR INCOME FOR A FIXED PERIOD

       Fixed                   Fixed                   Fixed
      Period    Monthly       Period    Monthly       Period    Monthly
    of Years     Income     of Years     Income     of Years     Income


       [5         17.95         14         7.28         23         5.00
        6         15.18         15         6.89         24         4.85
        7         13.20         16         6.54         25         4.72
        8         11.71         17         6.24         26         4.60
        9         10.56         18         5.98         27         4.49
       10          9.64         19         5.74         28         4.38
       11          8.88         20         5.53         29         4.28
       12          8.26         21         5.33         30         4.19]
       13          7.73         22         5.16



                          TABLE FOR INCOME FOR LIFE

                    Male/Female         Male/Female         Male/Female
    Age                10 Years            20 Years              Refund
                        Certain             Certain             Certain


   [50               $4.06/3.83          $3.96/3.77          $3.93/3.75
    55                4.43/4.14           4.25/4.05           4.25/4.03
    60                4.90/4.56           4.57/4.37           4.66/4.40
    65                5.51/5.10           4.90/4.73           5.12/4.83
    70                6.26/5.81           5.18/5.07           5.76/5.42
    75                7.11/6.70           5.38/5.33           6.58/6.19
    80                7.99/7.70           5.48/5.46           7.69/7.21
    85                8.72/8.59           5.52/5.51           8.72/8.59
    90                9.23/9.18           5.53/5.53         10.63/10.53]


GA-IA-1058                          3F


<PAGE>