<PAGE>

                                  CONTRACT DATA
<TABLE>
<S>                                      <C>
Contract Number:          [9920-SAMPLE]  Contract Date:   [November 1, 2006]
Initial Purchase Payment: [$25,000]      Retirement Date: [November 1, 2046]
Annuitant:                [John Doe]     Contract Type:   [Non-Qualified]
Contract Owner:           [John Doe]
</TABLE>

Upon issuance of this contract your initial purchase payment has been applied
as shown below. You may make additional payments and change the purchase
payment allocation as provided in this contract. For more information, please
refer to the Purchase Payments Provision.

<TABLE>
<CAPTION>
   Allocation                                                        Payment
                                                                   Allocation
                                                                   Percentage
<S>                                                                  <C>
   AEL One-Year Fixed Account                                        [___%
   [6-month DCA Fixed Account                                         ___%
   12-month DCA Fixed Account                                         ___%
   1 Year Guarantee Period Account                                    ___%
   2 Year Guarantee Period Account                                    ___%
   3 Year Guarantee Period Account                                    ___%
   4 Year Guarantee Period Account                                    ___%
   5 Year Guarantee Period Account                                    ___%
   6 Year Guarantee Period Account                                    ___%
   7 Year Guarantee Period Account                                    ___%
   8 Year Guarantee Period Account                                    ___%
   9 Year Guarantee Period Account                                    ___%
   10 Year Guarantee Period Account                                   ___%
   AIM V.I. Basic Value Fund - Series II Shares                       ___%
   AIM V.I. Capital Development Fund - Series II Shares               ___%
   AIM V.I. Mid Cap Core Equity Fund - Series II Shares               ___%
   AllianceBernstein VP Growth and Income Portfolio (Class B)         ___%
   AllianceBernstein VP International Value Portfolio (Class B)       ___%
   AllianceBernstein VP Total Return Portfolio (Class B)              ___%
   American Century(R) VP Inflation Protection, Class II              ___%
   American Century(R) VP International, Class II                     ___%
   American Century(R) VP Ultra, Class II                             ___%
   American Century(R) VP Value, Class II                             ___%
   Colonial Small Cap Value Fund, Variable Series, Class B            ___%
   Columbia High Yield Fund, Variable Series, Class B                 ___%
   Dreyfus IP Midcap Stock Portfolio, Service Share Class             ___%
   Dreyfus IP Technology Growth Portfolio, Service Share Class        ___%
   Dreyfus VIF Appreciation Portfolio, Service Share Class            ___%
   Dreyfus VIF International Value Portfolio, Service Share Class     ___%
   Fidelity VIP Contrafund(R) Portfolio Service Class 2               ___%
   Fidelity VIP Growth Portfolio Service Class 2                      ___%
   Fidelity VIP Investment Grade Bond Portfolio Service Class 2       ___%
   Fidelity VIP Mid Cap Portfolio Service Class 2                     ___%
   Fidelity VIP Overseas Portfolio Service Class 2                    ___%
   FTVIPT Franklin Income Securities Fund - Class 2                   ___%
   FTVIPT Franklin Rising Dividends Securities Fund - Class 2         ___%
   FTVIPT Franklin Small-Mid Cap Growth Securities Fund - Class 2     ___%
   FTVIPT Mutual Shares Securities Fund - Class 2                     ___%
   FTVIPT Templeton Growth Securities Fund - Class 2                  ___%
   FTVIPT Templeton Global Income Securities Fund - Class 2           ___%
   Goldman Sachs VIT Mid Cap Value Fund ]                             ___%
                                                                      ___%]
</TABLE>

273954DPSG1                                                         Page 2[.0]
<page>

                            CONTRACT DATA - Continued
<TABLE>
<S>                                <C>
Contract Number: [9920-SAMPLE]     Contract Date: [November 1, 2006]
</TABLE>

<TABLE>
<S>                                                                    <C>
   [MFS(R) Investors Growth Stock Series - Service Class               [___%
   MFS(R) New Discovery Series - Service Class                          ___%
   MFS(R) Total Return Series - Service Class                           ___%
   MFS(R) Utilities Series - Service Class                              ___%
   Oppenheimer Capital Appreciation Fund/VA, Service Shares             ___%
   Oppenheimer Global Securities Fund/VA, Service Shares                ___%
   Oppenheimer Main Street Small Cap Fund/VA, Service Shares            ___%
   Oppenheimer Strategic Bond Fund/VA, Service Shares                   ___%
   Putnam VT Health Sciences Fund - Class IB Shares                     ___%
   Putnam VT International Equity Fund - Class IB Shares                ___%
   Putnam VT Small Cap Value Fund - Class IB Shares                     ___%
   Putnam VT Vista Fund - Class IB Shares                               ___%
   RiverSource(SM) VP - Cash Management Fund                            ___%
   RiverSource(SM) VP - Diversified Bond Fund                           ___%
   RiverSource(SM) VP - Diversified Equity Income Fund                  ___%
   RiverSource(SM) VP - Emerging Markets Fund                           ___%
   RiverSource(SM) VP - Global Inflation Protected Securities Fund      ___%
   RiverSource(SM) VP - Growth Fund                                     ___%
   RiverSource(SM) VP - High Yield Bond Fund                            ___%
   RiverSource(SM) VP - International Opportunity Fund                  ___%
   RiverSource(SM) VP - Income Opportunities Fund                       ___%
   RiverSource(SM) VP - Large Cap Equity Fund                           ___%
   RiverSource(SM) VP - Large Cap Value Fund                            ___%
   RiverSource(SM) VP - Mid Cap Growth Fund                             ___%
   RiverSource(SM) VP - S&P 500 Index Fund                              ___%
   RiverSource(SM) VP - Select Value Fund                               ___%
   RiverSource(SM) VP - Short Duration US Government Fund               ___%
   RiverSource(SM) VP -Small Cap Value Fund                             ___%
   Van Kampen LIT Comstock Portfolio Class II Shares                    ___%
   Van Kampen UIF U.S. Real Estate Portfolio Class II Shares            ___%
   Wanger International Small Cap                                       ___%
   Wanger US Smaller Companies]                                         ___%
                                                                        ___%]
</TABLE>

[Portfolio Navigator Asset Allocation Program model: [model name] ]

                            [Purchase Payment Credits

<TABLE>
<CAPTION>
      Cumulative Net Purchase Payment Amount   Net Purchase Payment Credit Percentage
      --------------------------------------   --------------------------------------
<S>                                                            <C>
               [$ 0  -   $24,999                               [0%
            $25,000  -   $99,999                                4%
           $100,000  -  $249,999                                5%
           $250,000  +]                                         6%]
</TABLE>

Purchase payment credits are not vested until [12 months] after being credited
in the case of a free look cancellation, a death claim payment, annuitization
or a full withdrawal not subject to withdrawal charges.]

[Death Benefit: Return of Purchase Payment]
[Death Benefit: Maximum Anniversary Value]
[Death Benefit: 5% Accumulation]
[Death Benefit: Enhanced]

273954DPSG1                                                        Page 2[.1 ]
<page>

                            CONTRACT DATA - Continued
<TABLE>
<S>                              <C>
Contract Number: [9920-SAMPLE]   Contract Date: [November 1, 2006]
</TABLE>

<TABLE>
<S>                                             <C>
[Guaranteed Minimum Accumulation Benefit Rider  Initial Annual Rider Charge of [0.55%]
Duration of Waiting Period:  [10] Years         Maximum Annual Rider Charge of 1.75%
Automatic Step-up Percentage: [80%]
</TABLE>

[Allocation Restrictions/Limitations: This rider requires specific investment
allocations to, or Asset Allocation Models containing, certain variable
subaccounts, Guarantee Period Accounts, if applicable, the One-Year Fixed
Account, if applicable, and the DCA Fixed Account, if applicable. Changes to
allocations or Asset Allocation Models may increase the Annual Rider Charge.]]

<TABLE>
<S>                                                     <C>
[Guaranteed Minimum Lifetime Withdrawal Benefit Rider   Initial Annual Rider Charge [0.60%]
                                                        Maximum Annual Rider Charge [1.50%]
Maximum RBA and GBA                                     [$5,000,000 ]
Maximum ALP                                             [$300,000 ]
GBP Percentage                                          [7%]
ALP Percentage                                          [6%]
Annual Lifetime Payment Attained Age                    Age [65]
Waiting Period                                          [3] Years
</TABLE>

[Allocation Restrictions/Limitations: This rider requires specific investment
allocations to, or Asset Allocation Models containing, certain variable
subaccounts, Guarantee Period Accounts, if applicable, the One-Year Fixed
Account, if applicable, and the DCA Fixed Account, if applicable. Changes to
allocations or Asset Allocation Models may increase the Annual Rider Charge.]]

<TABLE>
<S>                                       <C>
[Guaranteed Minimum Income Benefit Rider  Initial Annual Rider Charge of [0.30%]
(Maximum Anniversary Value Benefit Base)  Maximum Annual Rider Charge of [1.50%]
</TABLE>

[Allocation Restrictions/Limitations: This rider requires specific investment
allocations to, or Asset Allocation Models containing, certain variable
subaccounts, Guarantee Period Accounts, if applicable, the One-Year Fixed
Account, if applicable, and the DCA Fixed Account, if applicable. Changes to
allocations or Asset Allocation Models may increase the Annual Rider Charge.]]

<TABLE>
<S>                                       <C>
[Guaranteed Minimum Income Benefit Rider  Initial Annual Rider Charge of [0.60%]
(5% Accumulation Benefit Base)            Maximum Annual Rider Charge of [1.75%]
</TABLE>

[Allocation Restrictions/Limitations: This rider requires specific investment
allocations to, or Asset Allocation Models containing, certain variable
subaccounts, Guarantee Period Accounts, if applicable, the One-Year Fixed
Account, if applicable, and the DCA Fixed Account, if applicable. Changes to
allocations or Asset Allocation Models may increase the Annual Rider Charge.
Excluded investment options from the variable account floor: [RiverSource(SM)
VP Cash Management Fund, Guarantee Period Accounts, if applicable, and the
One-Year Fixed Account, if applicable.]]]

<TABLE>
<S>                                       <C>
[Guaranteed Minimum Income Benefit Rider  Initial Annual Rider Charge of 0.[65%]
(Greater of Maximum Anniversary Value     Maximum Annual Rider Charge of [2.00%]
Benefit Base and 5% Accumulation
Benefit Base)
</TABLE>

[Allocation Restrictions/Limitations: This rider requires specific investment
allocations to, or Asset Allocation Models containing, certain variable
subaccounts, Guarantee Period Accounts, if applicable, the One-Year Fixed
Account, if applicable, and the DCA Fixed Account, if applicable. Changes to
allocations or Asset Allocation Models may increase the Annual Rider Charge.
Excluded investment options from the variable account floor: [RiverSource(SM)
VP Cash Management Fund, Guarantee Period Accounts, if applicable, and the
One-Year Fixed Account, if applicable.]]]

<TABLE>
<CAPTION>
[Benefit Protector Death Benefit Rider                Annual Charge of [0.25%]
<S>                                                            <C>
   Rider Benefit Percentage                                    [40%]
   Maximum Earnings at Death Percentage                        [250%]]
</TABLE>

273954DPSG1                                                         Page 2[.2]
<page>

                            CONTRACT DATA - Continued

<TABLE>
<S>                              <C>
Contract Number: [9920-SAMPLE]   Contract Date: [November 1, 2006]
</TABLE>

<TABLE>
<CAPTION>
[Benefit Protector Plus Death Benefit Rider           Annual Charge of [0.40%]
<S>                                                             <C>
         Rider Benefit Percentage                               [40%]
         Maximum Earnings at Death Percentage                   [250%]
         Purchase Payment Percentage Schedule
            Death Occurring in Contract Years                Percentage
                       1 - 2                                    [ 0%]
                       3 - 4                                    [10%]
                       5 and later                              [20%]]
</TABLE>

Withdrawal Charge Schedule: If you withdraw all or a portion of this contract,
a withdrawal charge may apply. A withdrawal charge applies if all or part of
the purchase payments withdrawn is from payments received as shown below.

<TABLE>
<CAPTION>
   Years From Purchase Payment Receipt   Withdrawal Charge
   -----------------------------------   -----------------
<S>                                      <C>
                     1                   8.0% of purchase payment withdrawn
                     2                   8.0% of purchase payment withdrawn
                     3                   8.0% of purchase payment withdrawn
                     4                   8.0% of purchase payment withdrawn
                     5                   7.0% of purchase payment withdrawn
                     6                   6.0% of purchase payment withdrawn
                     7                   6.0% of purchase payment withdrawn
                     8                   4.0% of purchase payment withdrawn
                     9                   2.0% of purchase payment withdrawn
                     10+                 0.0% of purchase payment withdrawn
</TABLE>

You may withdraw the greater of 10 percent of your prior contract anniversary
contract value or contract earnings each contract year without incurring a
withdrawal charge. For more information, please refer to the Withdrawal Charge
Provision.

Annual Mortality and Expense Risk Charge: [1.60% - 2.00% of the daily net
asset value]

Annual Variable Account Administrative Charge: [0.15% of the daily net asset
value]

Annual Contract Administrative Charge: [$40], waived at contract values of
[$50,000] or more

The Maximum Total AEL Variable Annuity Purchase Payment Per Annuitant Life :
[$1,000,000]

The Minimum Additional Purchase Payment: [$100]

The Minimum Investment in any Guarantee Period Account: [$1,000]

The Guaranteed Minimum Effective Interest Rate to be credited to the AEL Fixed
Account is [X]%.

One-Year Fixed Account Purchase Payment and Transfer Limits:

      1.    Payments to the One-Year Fixed Account:
               Limited to [30%] of each payment.

      2.    Transfers to the One-Year Fixed Account:
               Limited to transfer amounts which result in the One-Year Fixed
               Account Contract Value (after the transfer) being no more than
               [30%] of the total Contract Value.

      3.    Transfers (including automated transfers under a dollar cost
      averaging arrangement) from the One-Year Fixed Account:
            Limited to the greater of:

                  a.    [$10,000]; or

                  b.    [30%] of the One-Year Fixed Account Contract Value at
                        the beginning of the contract year.

273954DPSG1                                                         Page 2[.3]
<page>

                            CONTRACT DATA - Continued

<TABLE>
<S>                                <C>
Contract Number: [9920-SAMPLE]     Contract Date: [November 1, 2006]
</TABLE>

MARKET VALUE ADJUSTMENT
-----------------------

All payments and values based on the Guarantee Period Account(s) are subject
to a Market Value Adjustment formula, the operation of which may result in
upward and downward adjustments in amounts payable. For more information,
please refer to the Market Value Adjustment Provision.

273954DPSG1                                                         Page 2[.4]