Document

ANNUITY SCHEDULE




ANNUITY NUMBER: [001-00001]    ISSUE DATE:  [July 1, 2021]


TYPE OF BUSINESS:  [Beneficiary Non-Qualified]


OWNER:  [John Doe DCD FBO Jack Doe]               DATE OF BIRTH:              SEX: 




KEY LIFE:  [Jack Doe]        DATE OF BIRTH:  [October 21,1975]    SEX:  [Male]


PURCHASE PAYMENT:  [$100,000]


PURCHASE PAYMENT AGE LIMITATION:  No Additional Purchase Payments accepted


MINIMUM ADDITIONAL PURCHASE PAYMENT:  Not Applicable


MINIMUM ADDITIONAL PURCHASE PAYMENT UNDER AUTOMATIC PURCHASE PLANS:  Not Applicable


CONTINGENT DEFERRED SALES CHARGE:    None
        
MINIMUM WITHDRAWAL AMOUNT:  [$100]


MINIMUM SURRENDER VALUE AFTER A PARTIAL WITHDRAWAL:  [$2,000]


MINIMUM INVESTMENT OPTION AMOUNT:  [$50] 


INSURANCE CHARGE: 


              MORTALITY AND EXPENSE RISK CHARGE:  


              For Net Purchase Payments less than $[1,000,000] the Insurance Charge is [X.XX%]


              For Net Purchase Payments of $[1,000,000] or more the Insurance Charge is reduced to [X.XX%]


             ADMINISTRATION CHARGE: [0.15%]


ANNUAL MAINTENANCE FEE:   The fee is waived if the sum of the Purchase Payments at the time the Fee is due is greater than or equal to [$100,000.]  


FUND ACCESS CHARGE:  The Fund Access Charge will not exceed [0.70]%.


Sub-Account                                                         Fund Access Charge


[American Funds Insurance Series® Blue Chip Income and Growth Fund - Class 1        [0.35%]
American Funds Insurance Series® Bond Fund - Class 1                                 [0.35%]
American Funds Insurance Series® Growth Fund - Class 1                    [0.35%]    
American Funds Insurance Series® Growth-Income Fund - Class 1                [0.35%]
American Funds Insurance Series® U.S. Government/AAA-Rated Securities Fund - Class 1     [0.35%]
American Funds Insurance Series® Asset Allocation Fund - Class 1                [0.35%]
American Funds Insurance Series® Ultra-Short Bond Fund - Class 1                [0.35%]
DFA VA Global Moderate Allocation Portfolio                            [0.35%]
VA International Small Portfolio                                             [0.35%]
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VA International Value Portfolio                                             [0.35%]
VA Global Bond Portfolio                                    [0.35%]
VA Short-Term Fixed Portfolio                                    [0.35%]
VA U.S. Large Value Portfolio                                    [0.35%]
VA U.S. Targeted Value Portfolio]                                [0.35%]


TRANSFER FEE:  [$10 per transfer after the twentieth transfer in any Contract Year.]


MINIMUM TRANSFER AMOUNT:  [$50.  We may waive the Minimum Transfer Amount.]


MAXIMUM NUMBER OF TRANSFERS:  Currently, there are no limits on the number of transfers that can be made among Sub-accounts in an Annuity Year.  We may restrict the number of transfers among Sub-accounts per Annuity Year, but in no event will the Maximum Number of Transfers be less than [20].


LATEST AVAILABLE ANNUITY DATE Not Applicable


EARLIEST AVAILABLE ANNUITY DATE:  Not Applicable


MINIMUM ANNUITY PAYMENT:  Not Applicable


ANNUITY SCHEDULE (Continued)


MINIMUM SURRENDER VALUE AT ANNUITIZATION:  Not Applicable


MISSTATEMENT OF AGE OR SEX INTEREST RATE [1%]


VARIABLE SEPARATE ACCOUNT(S): [Pruco Life Flexible Premium Variable Annuity Account]


RIDERS AND ENDORSEMENTS MADE A PART OF THE ANNUITY ON THE ISSUE DATE:
[Beneficiary Annuity Endorsement]






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