[LETTERHEAD OF AILIFE(R)]

We issue this certificate in consideration of the application and the payment of
the Single Premium, subject to the terms of the Group Immediate Variable Annuity
Contract, Number [ ] ("Group Contract"). We will make annuity payments to the
Annuitant, and Joint Annuitant if any, as set forth in this Certificate
beginning on the Income Start Date.

READ YOUR CERTIFICATE CAREFULLY

RIGHT TO CANCEL THIS CERTIFICATE

This Certificate may be returned within 10 days after You receive it. It can be
mailed or delivered to Us. Return of this Certificate by mail is effective as of
the date of its postmark, properly addressed and postage pre-paid. As of the
return date, We will promptly refund the Single Premium adjusted by investment
performance. This may be more or less than the Single Premium paid. For all
other purposes the returned Certificate will be treated as if We had never
issued it.

This is a Variable Annuity Income Certificate. Variable Annuity Income is not
guaranteed as to dollar amount and may increase or decrease on the Income Change
Dates depending on the experience of the Variable Account identified in the
Certificate Schedule. You may also select a Fixed Annuity Income, which provides
a guaranteed income. The Fixed Annuity Income amount will remain the same unless
the Certificate requires a reduction in amount.

Signed by the Company:


          /s/ Elizabeth M. Tuck                    /s/ [ILLEGIBLE]
                Secretary                               President

                             CERTIFICATE OF COVERAGE

                    SINGLE PREMIUM IMMEDIATE VARIABLE ANNUITY
                                NONPARTICIPATING

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                                TABLE OF CONTENTS

CERTIFICATE SCHEDULE...........................................................3

DEFINITIONS....................................................................5

CERTIFICATE....................................................................6

OWNERSHIP PROVISIONS...........................................................6

SINGLE PREMIUM PAYMENT.........................................................7

SEPARATE ACCOUNT...............................................................7

SUBACCOUNTS....................................................................7

INVESTMENT OPTIONS.............................................................7

ANNUITY UNITS..................................................................7

ANNUITY INCOME PAYMENT DATES...................................................8

DETERMINATION OF THE INITIAL ANNUITY INCOME....................................8

DETERMINATION OF SUBSEQUENT VARIABLE ANNUITY INCOME............................8

ANNUITY INCOME VALUATION DATES.................................................8

TRANSFERS AMONG INVESTMENT OPTIONS.............................................8

FIXED ANNUITY INCOME...........................................................9

DEATH BENEFITS.................................................................9

ANNUITY INCOME OPTIONS.........................................................9

DELAY OF BENEFIT PAYMENT.......................................................9

GENERAL PROVISIONS............................................................10


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                                   DEFINITIONS

In addition to the other definitions set forth in this Certificate, the
following terms shall have their respective meanings as set forth below. In
addition, the masculine form of any term shall be construed as including the
feminine form of that term.

Annuitant is the designated person shown in the Certificate Schedule who
receives annuity income.

Annuity Income Option is the type of arrangement under which annuity income
payments are made.

Annuity Income Valuation Date is the date as of which annuity income amounts are
calculated.

Annuity Unit is an accounting unit of measure used to calculate variable annuity
income amounts.

Annuity Unit Value is the value of one Annuity Unit.

Assumed Investment Return (AIR) is the net investment return that will cause
Variable Annuity Income to remain level. The AIR is shown in the Certificate
Schedule and is used in calculating the initial and subsequent variable annuity
income amounts.

Beneficiary is the person(s) who may receive certain benefits when there is no
longer a living Annuitant or Joint Annuitant.

Certificate is a statement of benefits provided to each Owner.

Certificate Date is the date the Certificate becomes effective, and is shown in
the Certificate Schedule.

Certificate Year is the year between anniversaries based on the Certificate
Date.

Fixed Annuity Income provides a guaranteed income which amount will be the same
on each payment date unless the Certificate requires a change. The amount of the
income is set forth in the Certificate Schedule.

Income Change Dates are the dates, as specified in the Certificate Schedule, on
which the amount of Variable Annuity Income is changed.

Income Start Date is the date shown in the Certificate Schedule when the annuity
income payment begins.

Investment Options are the available portfolios in which the Subaccounts invest.
The Separate Account is divided into Subaccounts and each Subaccount invests
exclusively in shares of a specific investment portfolio.

Joint Annuitant, if any, is named in the Certificate. If living after the death
of the Annuitant, the Joint Annuitant receives annuity income.

Net Single Premium is the Single Premium less any taxes related to the premium
payment.

Owner(s) is the person or persons shown as Owner(s) in the Certificate Schedule
and who may exercise the rights and benefits described in the Certificate.

Single Premium is the purchase payment shown in the Certificate Schedule.

Subaccount means a division of the Company's Separate Account which invests in a
particular investment portfolio.

Valuation Date means each day that the New York Stock Exchange is open for
trading, except for normal business holidays.


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                             DEFINITIONS (Continued)

Valuation Period means the period between the close of business on any Valuation
Date and the close of business on the next succeeding Valuation Date.

Variable Annuity Income provides income that is not guaranteed and is related to
the investment experience of the selected Investment Option. Generally the
income amount will change on each Income Change Date.

We, Our, Us, Company refers to American International Life Assurance Company of
New York.

You, Your refers to the Owner of this Certificate.

                                   CERTIFICATE

This Certificate shall contain a statement of the benefits to which You are
entitled. Such Certificate shall in no way void or modify any of the provisions
of the Group Contract.

                              OWNERSHIP PROVISIONS

OWNER

The Owner is named in the Certificate Schedule and is the person who exercises
all the rights contained in the Certificate, subject to the rights of:

1.    any assignee under an assignment filed with the Company's administrative
      office, if such assignment is permitted under the Certificate; and

2.    any irrevocably named Beneficiary.

ASSIGNMENT

Unless prohibited by the terms of this Certificate, You may assign it by sending
a copy of the assignment to Our administrative office. We are not responsible
for the validity of the assignment. Your rights and those of any revocably named
person will be subject to the assignment. An assignment will not affect any
payments We may make or actions We may take before such assignment has been
recorded at Our administrative office. A change in ownership or an assignment
may result in adverse tax consequences.

CHANGE OF BENEFICIARY

To change a Beneficiary, a written request for a change of Beneficiary, dated
and signed by You, the Owner, must be received at Our administrative office.
After the change has been recorded, it will take effect as of the date the
request was signed. However, the change will not affect any benefits paid or
actions taken before the change is recorded in Our administrative office. A
written consent from the Beneficiary is required for a change of an irrevocable
Beneficiary.


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<PAGE>

                             SINGLE PREMIUM PAYMENT

SINGLE PREMIUM PAYMENT

Your Single Premium Payment is shown on the Certificate Schedule. Any taxes
related to the premium payment are deducted by the Company and the balance (the
"Net Single Premium") is available for allocation between Fixed and Variable
Annuity Income.

ALLOCATION OF THE PREMIUM

You, the Owner, determine the allocation of the Net Single Premium between Fixed
and Variable Annuity Income. The allocation is shown on the Certificate
Schedule.

All of the Net Single Premium allocated for Variable Annuity Income is placed in
Subaccounts, each of which invests in a specific Investment Option. The Owner
selects the percentages to be placed in the Subaccount(s). All of the Net Single
Premium allocated for Fixed Annuity Income is placed in the Company's General
Account.

                                SEPARATE ACCOUNT

The Separate Account is established and maintained by the Company for the
purpose of investing amounts allocated to it from variable contracts issued by
the Company. The assets of the Separate Account are owned by the Company, are
held separately from other assets of the Company and are not chargeable with
liabilities arising out of any other business of the Company, except to the
extent that Separate Account assets exceed Separate Account liabilities arising
under the contracts supported by the Separate Account. Income, gains or losses,
whether or not realized, are credited to or charged against the subaccounts of
the Separate Account without regard to income, gains or losses arising out of
any of our other businesses. Nothing contained in this Certificate shall be
construed as to give You any rights, title or interest in any of the assets held
by the Separate Account. We have the right to transfer to Our General Account
any assets of the Separate Account which are in excess of the liabilities of the
Separate Account.

                                   SUBACCOUNTS

The Separate Account is made up of one or more Subaccounts, each of which
invests in a portfolio of a specific Investment Option available under the
Certificate. The Company reserves the right, subject to compliance with
applicable law, to make additions to, deletions from, or substitutions for the
shares that are held by any Subaccount or that the Subaccount may purchase.

                               INVESTMENT OPTIONS

The Investment Options you selected in the application are listed on the
Certificate Schedule. The Subaccount may invest in mutual funds, unit investment
trusts and other investments which the Company determines to be suitable for the
Certificate. Interests in an Investment Option are purchased at their net asset
value and valued on each Valuation Date. The Owner shares in the income, gains
and losses of the Investment Options for which the Owner's premiums have been
allocated. The Company does not guarantee the investment performance of the
Subaccounts. The Owner bears the full investment risk for amounts allocated to
Subaccounts.

                                  ANNUITY UNITS

The Annuity Unit Value will vary from Valuation Date to Valuation Date with the
investment experience of the portfolio in which the Subaccount invests. For each
Subaccount You select, the premium amount allocated to it is converted into
Annuity Units, as follows: the number of Annuity Units is determined as of the
Valuation Date by dividing that premium amount by the Annuity Unit Value for
that Subaccount.

In determining Variable Annuity Unit values, the Company makes a Mortality and
Expense Risk Charge against the daily value of the assets of each Subaccount.
The amount of the charge is shown in the Certificate Schedule.


                                       7
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                          ANNUITY INCOME PAYMENT DATES

Variable Annuity Income will commence on the Income Start Date. Periodically, as
stated in the Certificate Schedule, the same amount is paid to the Annuitant or
Joint Annuitant if applicable, until the next Income Change Date, which is
stated in the Certificate Schedule.

If periodic benefit payments payable to any payee under the Certificate are less
than $100, the Company reserves the right to make payments less frequently, and
will make these payments in an aggregate amount not later than the first day of
the period to which the payment applies.

                   DETERMINATION OF THE INITIAL ANNUITY INCOME

The following factors determine the amount of the first Annuity Income payment:

1.    the amount of the premium allocated to provide Variable Annuity Income and
      the Assumed Investment Return;
2.    the amount of premium allocated to provide Fixed Annuity Income payments
      and the prevailing interest rates;
3.    the age and sex of the Annuitant, and Joint Annuitant if any;
4.    the Annuity Income Option selected;
5.    the frequency of Annuity Income payments;
6.    the deduction of any applicable premium taxes; and
7.    the time period from the Certificate Date to the Income Start Date.

               DETERMINATION OF SUBSEQUENT VARIABLE ANNUITY INCOME

As of an Annuity Income Valuation Date, We recalculate the Variable Annuity
Income to reflect the investment performance of the each Subaccount You
selected, adjusted by the Assumed Investment Return factor. The Variable Annuity
Income will remain level until the next Income Change Date. Subsequent Variable
Annuity Income may be more or less than the previously calculated payment
depending on whether the net investment performance of the selected Subaccount
is greater or less than the Assumed Investment Return.

                         ANNUITY INCOME VALUATION DATES

The initial Annuity Income Valuation Date shall be coincident with the
Certificate Date. Each subsequent Annuity Income Valuation Date shall be no
earlier than seven business days prior to the next Income Change Date and in no
event shall be later than that date. Any revision to the Variable Annuity Income
in connection with an Annuity Income Valuation Date shall be effective as of
such Income Change Date and shall remain fixed until the next following Income
Change Date thereafter.

                       TRANSFERS AMONG INVESTMENT OPTIONS

RIGHT TO TRANSFER

Subject to the "Transfer Restrictions" below, amounts allocated to Subaccounts
for Variable Annuity Income may be transferred among available Investment
Options at any time. [The Company reserves the right to charge a transfer fee as
shown on the Certificate Schedule.] Amounts allocated for Variable Annuity
Income may be reallocated for Fixed Annuity Income. However, once amounts are
allocated for Fixed Annuity Income they cannot be reallocated for Variable
Annuity Income.

METHOD USED TO EFFECT TRANSFERS

Transfers among Investment Options are effected by transfers of Annuity Units
among the Subaccounts. The number of Annuity Units is affected by such
transfers. The number of Annuity Units attributable to the Variable Annuity
Income to be transferred is multiplied by the current Annuity Unit Value of the
Subaccount from which the Owner is transferring. This value is divided by the
current Annuity Unit Value of the Subaccount into which the Variable Annuity
Income is being transferred. The result of this division is the number of
additional Annuity Units allocated to the new Subaccount as a consequence of the
transfer. The total Variable Annuity Income, which may be affected by investment
experience after any transfer, will be calculated on the Annuity Income
Valuation Date next following the date of the transfer.


                                       8
<PAGE>

                 TRANSFERS AMONG INVESTMENT OPTIONS (continued)

TRANSFER RESTRICTIONS

1.    The Company reserves the right to limit the number of transfers among the
      Subaccounts to no more than one (1) on any Valuation Date.

2.    Transfers will take effect as of the Valuation Date next following the
      date on which the Company receives the transfer request.

3.    The allocation of Variable Annuity Income after any transfer must result
      in at least [five percent (5%)] of the total Variable Annuity Income being
      derived from each of the utilized Subaccounts.

4.    Amounts allocated for Fixed Annuity Income may not be reallocated for
      Variable Annuity Income.

                              FIXED ANNUITY INCOME

Fixed Annuity Income represents obligations of the Company's General Account.
The Owner may select this payment on the application, and if so selected, the
payment amount is shown on the Certificate Schedule. At any time thereafter, an
Owner may elect to transfer any or all of the Certificate's Variable Annuity
Income to Fixed Annuity Income. Transfers may not be made from Fixed Annuity
Income to Variable Annuity Income.

                                 DEATH BENEFITS

If neither the Annuitant nor Joint Annuitant, if any, is alive on the Income
Start Date, the Certificate will be cancelled and the Company will pay a refund
to the Owner if living, or if not, to the Owner's estate. The amount of the
refund will be equal to the sum of the following: (1) the portion of the Net
Single Premium allocated for Variable Annuity Income, adjusted up or down for
investment performance; (2) the portion of the Net Single Premium allocated for
Fixed Annuity Income, including any accumulated interest; and (3) the
difference, if any, between the Single Premium Payment and the Net Single
Premium.

If an Annuitant dies after the Income Start Date, benefit continuation will be
determined by the Annuity Income Option in effect for the Certificate.

                             ANNUITY INCOME OPTIONS

The Annuity Income Option is selected by the Owner and is shown on the
Certificate Schedule.

                            DELAY OF BENEFIT PAYMENT

We will make any payment under this Certificate within seven (7) days of its due
date or within seven (7) days of a request received in good order. However, We
reserve the right to suspend or postpone any type of payment or reallocation
from the Separate Account for any period when:

1.    The New York Stock Exchange is closed for other than customary weekend and
      holiday closings;
2.    Trading on the New York Stock Exchange is restricted;
3.    An emergency exists as a result of which it is not reasonable or
      practicable to dispose of securities held in the Separate Account or
      determine their value; or
4.    The Securities and Exchange Commission so permits delay for the protection
      of security holders.


                                       9
<PAGE>

                               GENERAL PROVISIONS

SENDING US NOTICE

All written requests must be sent to Our Administrative Office to the attention
of: Pension Administration Department, P.O. Box 1834, Wilmington, DE 19899.
Please include Your Certificate number.

NON-PARTICIPATION IN SURPLUS

This Certificate does not share in any distribution of the Company's profits or
surplus.

MISSTATEMENT OF AGE OR SEX

The Company may require proof of age and sex of the Annuitant and Joint
Annuitant, if any, before making any annuity income payments. If the Annuitant's
or Joint Annuitant's age or sex has been misstated, the Company will change the
benefits to those which the Net Single Premium would have purchased had the
correct age or sex been stated. If a misstatement is not discovered until after
the Income Start Date, the Company will take the following action: (1)
underpayments will be paid in one sum with the next annuity income payment
including interest at the annual rate of 3%, unless a higher interest rate is
legally required; (2) overpayments including interest at the annual rate of 3%,
unless a higher interest rate is legally required, will be deducted from future
annuity income payments until the total is repaid.

ENTIRE CONTRACT

The entire contract consists of the Group Contract, this Certificate, and any
attached endorsement, rider or application. Nothing in the Group Contract
invalidates or impairs any right granted to You under this Certificate. Only Our
authorized Officer may act on Our behalf to change or alter this Certificate.
Any change, modification or waiver must be made in writing.

CERTIFICATE TO CONFORM TO INTERNAL REVENUE CODE

All terms of this Certificate will be interpreted in accordance with the
applicable provisions of the Internal Revenue Code ("Code"). The Company
reserves the right to make changes to the Certificate in order to conform to the
applicable provisions of the Code.

MODIFICATION OF CERTIFICATE

This Certificate may not be modified by Us, without Your consent except as may
be required by applicable law. If the state insurance laws or regulations, the
federal securities or tax laws or regulations under which this Certificate would
qualify as an annuity change, We may amend this Certificate to comply with these
changes.

SEVERABILITY

Should one or more provisions of this Certificate be held by a court of law to
be invalid, void or unenforceable, the remaining provisions will continue in
full force.

FACILITY OF PAYMENT

If a payee is unable to give a valid receipt for a payment made under this
Certificate, We may make payments to the person, who, in Our opinion is caring
for that payee until claim is made by his duly appointed guardian or other legal
representative.

REPORTS

If You are receiving Variable Annuity Income, We will send You a report showing
the number of Annuity Units in each Subaccount and the value of each Annuity
Unit at least once per year and each time You transfer Annuity Units among
Subaccounts or to the General Account. The reports will be sent to Your last
known address.


                                       10
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                         GENERAL PROVISIONS (Continued)

TAXES

Any premium related taxes paid to any governmental entity will be charged
against the Single Premium prior to it being allocated as a Net Single Premium
to the Separate Account or Guaranteed Account.

If We incur taxes due to the operation of the Separate Account, We may make
charges for such taxes.

EVIDENCE OF SURVIVAL

Where any benefits under this Certificate are contingent upon the recipient
being alive on a given date, We may require proof satisfactory to Us that the
condition has been met.

CONTINUATION OF CERTIFICATE COVERAGE

If the Group Contract under which this Certificate is issued should terminate,
coverage may be continued under this Certificate unless it is surrendered or
otherwise ends in accordance with its terms.


                                       11
<PAGE>

                            [LETTERHEAD OF AILIFE(R)]

                             CERTIFICATE OF COVERAGE

                    SINGLE PREMIUM IMMEDIATE VARIABLE ANNUITY
                                NONPARTICIPATING

<PAGE>

                              CERTIFICATE SCHEDULE
            AMERICAN INTERNATIONAL LIFE ASSURANCE COMPANY OF NEW YORK
            80 Pine Street, New York, NY 10005, Phone: (212) 770-7000

                 Customer Service office: Pension Administration Department
                                          P.O. Box 1834, Wilmington, DE 19899
                                          Phone: (877) 299-1724

GROUP CONTRACTHOLDER:                           ABC Corp
GROUP CONTRACT NUMBER:                          0001
CERTIFICATE NUMBER:                             1001
OWNER:                                          John Doe
CERTIFICATE DATE:                               November 1, 2000
INCOME START DATE:                              January 1, 2001
ANNUITANT:                                      John Doe
DATE OF BIRTH:                                  January 1, 1946
[SEX:                                           Male]
[JOINT ANNUITANT:                               Jane Doe]
[DATE OF BIRTH:                                 January 1, 1947]
[SEX:                                           Female]
[SINGLE PURCHASE PAYMENT:                       $250,000.00]

MORTALITY AND EXPENSE RISK CHARGE: Equal to an annual basis of [ ] of the
average daily net assets of the Separate Account.

[TRANSFER FEE: [$10.00] However, we will not make a charge for the first [12]
transfers in any Certificate Year.]

[SURRENDER CHARGE: A charge of [ $200.00 ] for a partial or complete surrender.]

                               INVESTMENT OPTIONS

[EQUITY GROWTH]                                 [MONEY MARKET]
[FIXED INCOME]                                  [TECHNOLOGY]
[INTERNATIONAL MAGNUM]                          [VALUE]
[MIDCAP GROWTH]

                                 ANNUITY INCOME

ANNUITY INCOME OPTION:                          [Life Annuity]
FREQUENCY OF ANNUITY INCOME:                    [Monthly]
[GUARANTEE PERIOD:]
[REDUCED ANNUITY PERCENTAGE TO JOINT ANNUITANT AFTER DEATH OF ANNUITANT: __%]
INITIAL PERCENTAGE ALLOCATION OF PURCHASE PAYMENT TO PROVIDE:
        Fixed Annuity Income: [ %]      Variable Annuity Income: [ %]
[FIXED ANNUITY INCOME AMOUNT ON INCOME START DATE: $__]
[ESTIMATED VARIABLE ANNUITY INCOME AMOUNT ON INCOME START DATE: $__]
ASSUMED INVESTMENT RETURN: [ %] PER ANNUM
INCOME CHANGE DATES: [January 1 and July 1]


                                       3