Exhibit 4(p)


JEFFERSON
NATIONAL LIFE INSURANCE COMPANY


 


Home Office:
Dallas, Texas 75201


Administrative
Office: [9920 Corporate Campus Drive, Suite 1000, Louisville, Kentucky 40223] Telephone: [1-866-667-0561]


 


A Stock
Company





 


Jefferson National Life Insurance
Company (the "Company") agrees with the Owner to provide benefits to the Owner, subject to the provisions set forth in
this Contract and in consideration of Purchase Payments received from the Owner.


 


 





RIGHT TO EXAMINE CONTRACT: Within
10 days, or 30 days if a replacement contract, of the date of receipt of this Contract by the Owner, it may be returned by delivering
or mailing it to the Company at its Administrative Office or to the Agent through whom it was purchased. When the Contract is received
by the Company, it will be voided as if it had never been in force. The Company will refund the Contract Value computed as of the
Business Day the Company receives the returned contract at its Administrative Office.


 





 


THIS IS A LEGAL CONTRACT
BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY


 





 


 





	 	 
	Secretary
	President


 





 


 


[MONUMENT
ADVISOR] INDIVIDUAL FLEXIBLE PREMIUM


DEFERRED VARIABLE ANNUITY
CONTRACT Non-participating


 


 


INCOME PAYMENTS, WITHDRAWAL
VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE
AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.




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TABLE
OF CONTENTS


 


 


	CONTRACT SCHEDULE 	4
	 	 
	DEFINITIONS 	6
	 	 
	PURCHASE PAYMENT PROVISIONS 	7
	PURCHASE PAYMENTS 	7
	ALLOCATION OF PURCHASE PAYMENTS 	7
	 	 
	SEPARATE ACCOUNT PROVISIONS 	7
	THE SEPARATE ACCOUNTS 	7
	VARIABLE ACCOUNT 	7
	VALUATION OF ASSETS 	7
	ACCUMULATION UNITS 	7
	ACCUMULATION UNIT VALUE	7
	 	 
	CONTRACT VALUE 	8
	 	 
	SUBSCRIPTION FEE 	8
	DEDUCTION FOR SUBSCRIPTION FEE 	8
	DEDUCTION FOR TRANSACTION FEE	8
	 	 
	TRANSFERS 	8
	TRANSFERS DURING THE ACCUMULATION PERIOD	8
	 	 
	WITHDRAWAL PROVISIONS	9
	WITHDRAWALS	9
	 	 
	PROCEEDS PAYABLE ON DEATH 	9
	DEATH OF OWNER DURING THE ACCUMULATION PERIOD 	9
	DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 	9
	DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD	9
	DEATH OF OWNER DURING THE ANNUITY PERIOD 	10
	DEATH OF ANNUITANT 	10
	PAYMENT OF DEATH BENEFIT 	10
	BENEFICIARY 	10
	CHANGE OF BENEFICIARY 	11
	 	 
	SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 	11
	 	 
	OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 	11
	OWNER 	11
	JOINT OWNER	11
	ANNUITANT 	11
	ASSIGNMENT OF A CONTRACT 	11


 




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TABLE
OF CONTENTS


 


	ANNUITY PROVISIONS 	11
	GENERAL	11
	ANNUITY DATE 	11
	SELECTION OF AN ANNUITY OPTION	12
	FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS 	12
	ANNUITY OPTIONS	12
	OPTION 1. LIFETIME ONLY ANNUITY: 	12
	OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS 	12
	OPTION 3. PAYMENT FOR A FIXED PERIOD: 	12
	OPTION 4. JOINT AND SURVIVOR ANNUITY 	12
	ANNUITY 	12
	FIXED ANNUITY 	12
	 	 
	MORTALITY TABLES 	12
	 	 
	GENERAL PROVISIONS 	13
	THE CONTRACT	13
	MISSTATEMENT OF AGE 	13
	MISSTATEMENT OF GENDER 	13
	INCONTESTABILITY 	13
	MODIFICATION	13
	NON-PARTICIPATING 	13
	EVIDENCE OF SURVIVAL 	13
	PROOF OF AGE 	13
	PROTECTION OF PROCEEDS 	13
	REPORTS 	13
	TAXES 	13
	 	 
	CONFORMITY WITH INTERSTATE INSURANCE PRODUCT REGULATION COMMISSION	 
	STANDARDS  	14
	PAYMENTS TO THIRD PARTIES 	14
	PAYMENTS FROM THIRD PARTIES	14
	 	 
	ANNUITY OPTION TABLES 	15-17


 


 




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CONTRACT
SCHEDULE


 


 


	OWNER: 	[John Doe]
	CONTRACT ISSUE DATE:	[MA]
	JOINT OWNER:	[Jane Doe] 
	ANNUITANT: 	[Jane Doe] 
	ANNUITANT AGE:	[ 0-100 ]
	ANNUITANT GENDER:	[Male/Female]
	ANNUITY DATE:	The  Annuity  Date  must  be  at  least  two  (2)  years  after  the Contract Issue Date 
	CONTRACT NUMBER: 	[12345678] 
	PURCHASE PAYMENTS:	 
	     INITIAL PURCHASE PAYMENT:	        [$25,000.00] 
	     MINIMUM TOTAL PURCHASE PAYMENT:	        $[25,000.00]
	     MAXIMUM TOTAL PURCHASE PAYMENT:	        $[10,000,000.00] without prior Company approval




 


ALLOCATION
GUIDELINES:


	1.		The Owner, Registered Representative or Financial Advisor can select from all available
investment options. The Company reserves the right to change this in the future.



	2.		If the Purchase Payments and forms required to issue a Contract are in good order,
the initial Purchase Payment will be credited to the Contract within two (2) business days after receipt at the Administrative
Office. Additional Purchase Payments will be credited to the Contract as of the Valuation Period when they are received.



	3.		Allocation percentages must be in whole numbers. Each allocation must be at least
1%.



BENEFICIARY:


As
designated by the Owner at the Contract Issue Date, unless subsequently changed.


SUBSCRIPTION
FEE:


The
Subscription Fee is $20.00 and is deducted each month. The Subscription Fee will be deducted on a pro-rata basis first from the
balance of any money market account(s), and then pro-rata from the balance of any other account(s). The Subscription Fee is deducted
at Death and upon full surrender of the Contract.


MORTALITY
AND EXPENSE RISK CHARGE:


NONE


ADMINISTRATIVE
CHARGE:


NONE


DISTRIBUTION
EXPENSE CHARGE:


NONE


TRANSACTION
FEE:


The
Company imposes a Transaction Fee for transfers into and transfers out of certain Sub-Accounts. A listing of the Sub-Accounts
for which the Company imposes a Transaction Fee is available at the Company’s Website or upon request. The Transaction Fee
is waived for transfers required for payment of the Subscription Fee or fees charged by any investment adviser you hire. Transaction
Fees are charged twice – once for the transfer out, and once for the transfer in – when transferring between two Sub-Accounts
that impose Transaction Fees. The Transaction Fee will be deducted first from the Sub-Accounts affected, then pro-rata first from
the balance of any money market account(s), and then pro-rata from the balance of any other account(s). The Transaction Fee will
never be greater than $74.99 for a single transfer and the Company may charge a lesser Transaction Fee amount.




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CONTRACT SCHEDULE (continued)


 

TRANSFERS:



NUMBER
OF TRANSFERS PERMITTED: Subject to the Company’s administrative rules regarding active trading, there are no limits on the
number of transfers that can be made during the Accumulation Period; however, if, in the Company’s opinion there is frequent
trading occurring that is harming other Contract Owners, restrictions may be imposed on the number of transfers permitted.


 


TRANSFER
FEE: There are no transfer fee restrictions. The Company reserves the right to impose any fees charged by the underlying Sub-Account
Portfolio.


MINIMUM
AMOUNT TO BE TRANSFERRED: There is no minimum amount for transfers.


MINIMUM
AMOUNT WHICH MUST REMAIN IN EACH ACCOUNT AFTER A TRANSFER: There is no minimum amount.


WITHDRAWALS:


CONTINGENT
DEFERRED SALES CHARGE: NONE


WITHDRAWAL CHARGE: NONE


MINIMUM
PARTIAL WITHDRAWAL: There is no minimum amount.


MINIMUM
CONTRACT VALUE WHICH MUST REMAIN IN CONTRACT AFTER A PARTIAL WITHDRAWAL: There is no minimum amount.


MINIMUM
CONTRACT VALUE WHICH MUST REMAIN IN ANY SUB-ACCOUNT AFTER A PARTIAL WITHDRAWAL: There is no minimum amount.


SEPARATE
ACCOUNTS:


Variable
Account: Jefferson National Life Annuity Account G. 


RIDERS:
[Gross Minimum Death Benefit and/or Asset Allocation Model]


ADMINISTRATIVE
OFFICE:


[Jefferson
National Life Insurance Company

Administrative Office

9920 Corporate Campus Drive, Suite 1000

Louisville, KY 40223

(866) 667-0561]


WEBSITE:
[www.jeffnat.com]


 


Jurisdiction
of Issue: [MA]


Department
of Insurance Phone Number: [1-888-283-3757]




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DEFINITIONS


 


ACCOUNT(S):
One or more of the Sub-Accounts of the Variable Account.


ACCUMULATION
PERIOD: The period prior to the Annuity Date during which Purchase Payments may be made by an Owner.


ACCUMULATION
UNIT: A unit of measure used to determine the value of an Owner's interest in a Sub-Account of the Variable Account during
the Accumulation Period.


ADJUSTED
CONTRACT VALUE: The Contract Value less any applicable Premium Tax, less any applicable


Subscription
Fee less any applicable Transaction Fee. This amount is applied to the applicable Annuity Tables to determine Annuity Payments.


AGE:
The age of any Owner or Annuitant on his/her last birthday. For Joint Owners, all provisions which are based on age are based
on the Age of the older of the Joint Owners.


ADMINISTRATIVE
OFFICE: The office indicated on the Contract Schedule of this Contract to which notices, requests and Purchase Payments must
be sent. All sums payable to the Company under this Contract are payable at the Administrative Office or an address designated
by the Company.


ANNUITANT:
The natural person on whose life Annuity Payments are based. On or after the Annuity Date, the Annuitant shall also include
any Joint Annuitant. In the event of Joint Annuitant’s, both Annuitant’s lives are used to determine Annuity Payments.


ANNUITY
DATE: The date on which Annuity Payments begin. The Annuity Date must be at least two (2) years after the Contract Issue Date.


ANNUITY
OPTIONS: Options available for Annuity Payments.


ANNUITY
PAYMENTS: The series of payments made to the Owner or any named payee after the Annuity Date under the Annuity Option selected.


ANNUITY
PERIOD: The period of time beginning with the Annuity Date during which Annuity Payments are made.


ANNUITY
UNIT: An accounting unit of measure used to calculate the amount of Annuity Payments. 


AUTHORIZED REQUEST: A request,
in a form satisfactory to the Company, which is received by the Administrative Office.


BENEFICIARY:
The person(s) or entity(ies) who will receive the death benefit payable under this Contract.


COMPANY:
Jefferson National Life Insurance Company.


CONTRACT
ANNIVERSARY: An anniversary of the Contract Issue Date.


CONTRACT
ISSUE DATE: The later of the date on the cover of the Contract or the date Purchase Payments are received. The Contract Issue
Date is shown on the Contract Schedule.


CONTRACT
VALUE: The dollar value as of any Valuation Period of all amounts in the Contract.


CONTRACT
WITHDRAWAL VALUE: The Contract Value less any applicable Premium Tax, less any applicable Subscription Fee less any applicable
Transaction Fee.


CONTRACT
YEAR: The first Contract Year is the annual period which begins on the Contract Issue Date. Subsequent Contract Years begin
on each anniversary of the Contract Issue Date.


ELIGIBLE
FUND: An investment entity that is made available for this Contract.


FINANCIAL
ADVISOR: An investment adviser selected by a Contract Owner to provide a Contract Owner’s asset allocation and investment
advisory services.


FIXED
ANNUITY: A series of payments made during the Annuity Period which are guaranteed as to dollar amount by the Company.


NET PURCHASE
PAYMENT: A Purchase Payment less any applicable Premium Tax, less any applicable Transaction Fee.


OWNER:
The person(s) who own(s) the Contract.


PORTFOLIO:
A segment of an eligible fund which constitutes a separate and distinct class of shares. 


PREMIUM TAX: Any premium taxes
incurred to any governmental entity and assessed against Purchase Payments or Contract Value.


PURCHASE
PAYMENT: A payment made by or for an Owner with respect to this Contract.


REGISTERED
REPRESENTATIVE: A person who is licensed by the National Association of Securities Dealers, Inc. (“NASD”) to sell
variable products and is sponsored by an NASD member broker/dealer that is party to a selling group agreement with the Company.


SUB-ACCOUNT:
Separate Account assets are divided into Sub-Accounts. Each Sub-Account will invest its assets in shares of a single Eligible
Fund or a single Portfolio of an Eligible Fund.


VALUATION
DATE: Each day on which the New York Stock Exchange ("NYSE") or applicable bond market is open for business.




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DEFINITIONS
(continued)


 


VALUATION
PERIOD: The period of time beginning at the close of business of the NYSE (or applicable bond market) on each Valuation Date
and ending at the close of business for the next succeeding Valuation Date.


VARIABLE ACCOUNT: A separate account designated
on the Contract Schedule which provides investment options where the benefits are variable and are not guaranteed as to dollar
amount.


PURCHASE PAYMENT PROVISIONS


 


PURCHASE
PAYMENTS: The initial Purchase Payment for an Owner is due on the Contract Issue Date. Subject to the maximum and minimum
amounts shown on the Contract Schedule, the Owner may make subsequent Purchase Payments and may increase or decrease or change
the frequency of such payments. The Company reserves the right to reject any application or Purchase Payment.


ALLOCATION
OF PURCHASE PAYMENTS: Net Purchase Payments are allocated to one or more of the Sub- Accounts of the Variable Account in accordance
with the selections made by the Owner, Registered Representative or Financial Advisor. The allocation of the initial Net Purchase
Payment for an Owner is made in accordance with the selection made by the Owner, Registered Representative or Financial Advisor
at the Contract Issue Date. Unless otherwise changed by the Owner, Registered Representative or Financial Advisor, subsequent
Net Purchase Payments are allocated in the same manner as the initial Net Purchase Payment. Allocation of the Net Purchase Payments
is subject to the Allocation Guidelines shown on the Contract Schedule. The Company reserves the right to allocate initial Net
Purchase Payments to the Money Market Sub-Account until the expiration of the Right to Examine period.


 


SEPARATE ACCOUNT PROVISIONS


 


THE SEPARATE
ACCOUNTS: The Separate Account is designated on the Contract Schedule and consists of assets set aside by the Company, which
are kept separate from that of the general assets and all other separate account assets of the Company. The Contract shall provide
all income, gains, and losses, whether or not realized, from assets allocated to a separate account shall be credited to or charged
against such account without regard to other income, gains or losses of the Company.


VARIABLE
ACCOUNT: The assets of the Variable Account equal to reserves and other liabilities will not be charged with liabilities arising
out of any other business the Company may conduct.


The Variable
Account assets are divided into Sub-Accounts. The assets of the Sub-Accounts are allocated to the Eligible Fund(s) and the Portfolio(s),
if any, within an Eligible Fund. The Company may, from time to time, add additional Eligible Fund(s) or Portfolio(s). The Owner,
Registered Representative or Financial Advisor may be permitted to transfer Contract Values or allocate Net Purchase Payments
to the additional Sub-Account(s) within the Variable Account. However, the right to make such transfers or allocations will be
limited by the terms and conditions imposed by the Company.


Should the
shares of any such Eligible Fund(s) or any Portfolio(s) within an Eligible Fund become unavailable for investment by the Variable
Account, or the Company's Board of Directors deems further investment in these shares inappropriate, the Company may limit further
purchase of such shares or substitute shares of another Eligible Fund or Portfolio for shares already purchased under a Contract.


VALUATION
OF ASSETS: The assets of the Accounts are valued at their fair market value in accordance with procedures of the Company.


ACCUMULATION
UNITS: Accumulation Units shall be used to account for all amounts allocated to or withdrawn from the Sub-Accounts of the
Variable Account as a result of Net Purchase Payments, withdrawals, transfers, or fees and charges. The Company will determine
the number of Accumulation Units of a Sub-Account purchased or canceled. This will be done by dividing the amount allocated to
(or the amount withdrawn from) the Sub-Account by the dollar value of one Accumulation Unit of the Sub-Account as of the end of
the Valuation Period during which the request for the transaction is received at the Administrative Office.


ACCUMULATION
UNIT VALUE: The Accumulation Unit Value for each Sub-Account was arbitrarily set initially at $10. Subsequent Accumulation
Unit Values for each Sub-Account are determined by multiplying the Accumulation Unit Value for the immediately preceding Valuation
Period by the Net Investment Factor for the Sub-Account for the current period.




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SEPARATE
ACCOUNT PROVISIONS (continued)


 


The
Net Investment Factor for each Sub-Account is determined by dividing A by B where:






	A is		(i) the net asset value per share of the Eligible Fund or Portfolio of an Eligible
Fund held by the Sub-Account at the end of the current Valuation Period; plus





(ii)
any dividend or capital gains per share declared on behalf of such Eligible Fund or


Portfolio
that has an ex-dividend date within the current Valuation Period; plus




(iii)
a charge factor, if any, for any taxes or any tax reserve established by the Company as a result of the operation or maintenance
of the Sub-Account.




	B is		the net asset value per share of the Eligible Fund or Portfolio held by the Sub-Account
for the immediately preceding Valuation Period.





The
Accumulation Unit Value may increase or decrease from Valuation Period to Valuation Period.


 


CONTRACT VALUE


 


The Contract
Value for any Valuation Period is the sum of the Contract Value in each of the Sub-Accounts of the Variable Account.




The
Contract Value in a Sub-Account of the Variable Account is determined by multiplying the number of Accumulation Units allocated
to the Owner's Account for the Sub-Account by the Accumulation Unit Value. Withdrawals will result in the cancellation of Accumulation
Units in a Sub-Account.


 


SUBSCRIPTION FEE


 


DEDUCTION
FOR SUBSCRIPTION FEE: During the Accumulation Period, each month the Company deducts a Subscription Fee from the Contract
Value for reimbursement of expenses relating to maintenance and administration of the Contract. The Subscription Fee amount is
shown on the Contract Schedule Page. The Subscription Fee will be deducted on a pro-rata basis first from the balance of any money
market account(s), and then pro-rata from the balance of any other account(s). The Subscription Fee is also deducted at Death
and upon full surrender of the Contract.


TRANSACTION FEE


 


DEDUCTION
FOR TRANSACTION FEE: During the Accumulation Period, the Company imposes a Transaction Fee for transfers into and transfers
out of certain Sub-Accounts. A listing of the Sub-Accounts for which the Company imposes a Transaction Fee is available at the
Company’s Website or upon request. The Transaction Fee is waived for transfers required for payment of the Subscription
Fee or fees charged by any Financial Advisor you hire. Transaction Fees are charged twice – once for the transfer out, and
once for the transfer in – when transferring between two Sub-Accounts that impose Transaction Fees. The Transaction Fee
will be deducted first from the Sub-Accounts affected, then pro-rata first from the balance of any money market account(s), and
then pro-rata from the balance of any other account(s). If approved by us, you may elect to have these fees charged to your Financial
Advisor, rather than deducted from your Contract. In the event we agree to this, but the applicable Transaction Fees are not paid
within thirty (30) days by your Financial Advisor, we reserve the right to deduct the applicable Transaction Fees from your Contract.
In any event, we reserve the right to deduct any applicable Transaction Fee upon full surrender of the Contract.




Certain
Transaction Fee funds may only be available if you are advised by an approved Financial Advisor.


TRANSFERS


 


TRANSFERS
DURING THE ACCUMULATION PERIOD: Subject to any limitation imposed by the Company on the number of transfers during the Accumulation
Period shown on the Contract Schedule, an Owner, Registered Representative or Financial Advisor may transfer all or part of the
Contract Value in a Sub-Account without the imposition of any transfer fee (other than applicable Transaction Fees, if any) if
there have been no more than the




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TRANSFERS (continued)


number
of Transfers Permitted shown on the Contract Schedule for the Contract Year.


All transfers are subject to the following:




	1.		The minimum amount which can be transferred from a Sub-Account is shown on the Contract
Schedule.





	2.		The Company reserves the right, pursuant to the Company’s administrative rules
and/or state requirements, at any time and with prior notice to you and/or your Registered Representative or Financial Advisor,
to terminate, suspend or modify the transfer privilege described above or to block one or more trades pursuant to company administrative
rules.





If an Owner,
Registered Representative or Financial Advisor, or other authorized person elects to use this transfer privilege, the Company
will not be liable for transfers made in accordance with instructions received from such person. All amounts and Annuity Units
will be determined as of the end of the Valuation Period during which the request for transfer is received at the Administrative
Office.




The
Contract is not designed for professional market timing organizations. The Company reserves the right to modify (including terminating)
the transfer privileges described above.


WITHDRAWAL PROVISIONS


 


WITHDRAWALS:
During the Accumulation Period, the Owner may, upon an Authorized Request, make a total or partial withdrawal of the Contract
Withdrawal Value.


The Owner
must specify by an Authorized Request which Sub-Account is the source of the partial withdrawal.


The Company
will pay the amount of any withdrawal from the Variable Account within seven (7) days of receipt of an Authorized Request unless
the Suspension or Deferral of Payments Provision is in effect.


Each
partial withdrawal must be for an amount which is not less than the amount shown on the Contract Schedule. The minimum Contract
Value which must remain in the Contract after a partial withdrawal is shown on the Contract Schedule.


 


PROCEEDS PAYABLE ON DEATH


 


DEATH
OF OWNER DURING THE ACCUMULATION PERIOD: Upon the death of the Owner, or any Joint Owner, during the Accumulation Period,
the death benefit will be paid to the Beneficiary(ies) designated by the Owner. If there are multiple Beneficiaries, the first
Beneficiary will be paid his share of any proceeds once his Authorized Request is received. The remaining death benefit proceeds
will remain invested in the Investment Portfolios in accordance with the allocation instructions given by the Owner until the
death benefit is paid or until new instructions are given by the beneficiary.




Upon the
death of any Joint Owner, the surviving Joint Owner, if any, will be treated as the Primary Beneficiary. Any other Beneficiary
designation on record at the time of death will be treated as a contingent Beneficiary. Unless restricted by Owner, a Beneficiary
may request that the death benefit be paid under one of the Death Benefit Options below. If the Beneficiary is the spouse of the
Owner, he or she may elect to continue the Contract at the then current Contract Value in his or her own name and exercise all
the Owner's rights under the Contract.




DEATH
BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD: The death benefit will be the Contract Value determined as of the end of the
Valuation Period during which the Company receives both due proof of death and an election for the payment method, reduced by
the applicable portion of the Subscription Fee, and any applicable Transaction Fee.






DEATH
BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD: A non-spousal Beneficiary must elect the death benefit to be paid under one
of the following options in the event of the death of the Owner or any Joint Owner during the Accumulation Period:


	Option 1 -		lump sum payment of the death benefit; or





	Option 2 -		the payment of the entire death benefit within 5 years of the date of the death of
the Owner or any Joint Owner; or



	Option 3 -		payment of the death benefit under an Annuity Option over the lifetime of the Beneficiary
or





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PROCEEDS
PAYABLE ON DEATH (Continued)


over
a period not extending beyond the life expectancy of the Beneficiary with distribution beginning within one year of the date of
death of the Owner or any Joint Owner.


Any portion
of the death benefit not applied under Option 3 within one year of the date of the Owner's death, must be distributed within five
years of the date of death.




A spousal
Beneficiary may elect to continue the Contract in his or her own name at the then current Contract Value, elect a lump sum payment
of the death benefit or apply the death benefit to an Annuity Option.


If a lump
sum payment is requested, the amount will be paid within seven (7) days of receipt of proof of death and an Authorized Request,
unless the Suspension or Deferral of Payments Provision is in effect.


Payment
to the Beneficiary, other than in a lump sum, may only be elected during the sixty-day period beginning with the date of receipt
of proof of death.




DEATH
OF OWNER DURING THE ANNUITY PERIOD: If the Owner, or any Joint Owner, who is not the Annuitant, dies during the Annuity Period,
any remaining payments under the Annuity Option elected will continue at least as rapidly as under the method of distribution
in effect at such Owner's or Joint Owner's death. Upon the death of any Owner during the Annuity Period, the Beneficiary becomes
the Owner. Upon the death of any Joint Owner during the Annuity Period, the surviving Joint Owner, if any, will be treated as
the Primary Beneficiary. Any other Beneficiary designation on record at the time of death will be treated as a Contingent Beneficiary.




DEATH
OF ANNUITANT: Upon the death of an Annuitant, who is not the Owner, during the Accumulation Period, the Owner will automatically
become the Annuitant. The Owner may designate a new Annuitant, subject to the Company’s underwriting rules then in effect.
If the Owner is a non-natural person, the death of an Annuitant will be treated as the death of the Owner and proceeds will be
paid to the Beneficiary of record.




Upon the
death of the Annuitant during the Annuity Period, the death benefit, if any, will be as specified in the Annuity Option elected.
Death benefits will be paid at least as rapidly as under the method of distribution in effect at the Annuitant's death.




PAYMENT
OF DEATH BENEFIT: The Company will require due proof of death and an Authorized Request before any death benefit is paid.
Due proof of death will be:




	1.		a certified death certificate; or





	2.		a certified decree of a court of competent jurisdiction as to the finding of death;
or





	3.		any other proof satisfactory to the Company.





All death
benefits will be paid in accordance with applicable law or regulations governing death benefit payments, and in accordance with
Company administrative procedures.




BENEFICIARY:
The Beneficiary designation in effect on the Contract Issue Date will remain in effect until changed. The Beneficiary is entitled
to receive the benefits to be paid at the death of the Owner.


Unless the
Owner provides otherwise, the death benefit will be paid in equal shares to the survivor(s) as follows:




	1.		to the Primary Beneficiary(ies) who survive the Owner's and/or the Annuitant's death,
as applicable; or if there are none





	2.		to the Contingent Beneficiary(ies) who survive the Owner's and/or the Annuitant's
death, as applicable; or if there are none





	3.		to the estate of the Owner.



 




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PROCEEDS
PAYABLE ON DEATH (Continued)


CHANGE
OF BENEFICIARY: Subject to the rights of any irrevocable Beneficiary(ies), the Owner may change the Primary Beneficiary(ies)
or Contingent Beneficiary(ies). A change may be made by an Authorized Request. Unless otherwise specified by the Owner, the change
shall take effect on the date the notice is signed by the Owner. The Company will not be liable for any payment made or action
taken before it records the change.


SUSPENSION OR DEFERRAL
OF PAYMENTS PROVISION


 


The Company
reserves the right to suspend or postpone payments from the Variable Account for a withdrawal or transfer for any period when:




	1.		the New York Stock Exchange (or applicable bond market) is closed (other than customary
weekend and holiday closings);



	2.		trading on the New York Stock Exchange (or applicable bond market) is restricted;



	3.		an emergency exists as a result of which disposal of securities held in the Variable
Account is not reasonably practicable or it is not reasonably practicable to determine the value of the Variable Account's net
assets; or



	4.		during any other period when
the Securities and Exchange Commission, by order, so permits for the protection of Owners; provided that applicable rules and
regulations of the Securities and Exchange Commission will govern as to whether the conditions described in (2) and (3) exist



OWNER, ANNUITANT, OWNERSHIP,
ASSIGNMENT PROVISIONS


 


OWNER:
The Owner has all interest and right to amounts held in his or her Contract. The Owner is the person designated as such on
the Contract Issue Date, unless changed.




The Owner
may change owners of the Contract at any time by Authorized Request. A change of Owner will automatically revoke any prior designation
of Owner. Unless otherwise specified by the Owner, the change shall take effect on the date the notice is signed by the Owner.
The Company will not be liable for any payment made or action taken before it records the change.




JOINT
OWNER: A Contract may be owned by Joint Owners. Upon the death of either Owner, the surviving Owner will be the Primary Beneficiary.
Any other Beneficiary designation will be treated as a Contingent Beneficiary unless otherwise indicated in an Authorized Request.




ANNUITANT:
The Annuitant is the person on whose life Annuity Payments are based. The Annuitant is the person designated by the Owner
at the Contract Issue Date, unless changed prior to the Annuity Date. The Owner may not change the Annuitant except in the event
that the Annuitant dies prior to the Annuity Date. The Annuitant may not be changed in a Contract which is owned by a non-natural
person. Any change of Annuitant is subject to the Company's underwriting rules then in effect.




ASSIGNMENT
OF A CONTRACT: An Authorized Request specifying the terms of an assignment of a Contract must be provided to the Administrative
Office. The assignment shall take effect on the date the notice of assignment is signed, unless otherwise specified by the Owner;
however, the Company will not be liable for any payment made or action taken before it records the assignment.


The Company
will not be responsible for the validity or tax consequences of any assignment. Any assignment made after the death benefit has
become payable will be valid only with Company consent.


If
the Contract is assigned, the Owner's rights may only be exercised with the consent of the assignee of record.


ANNUITY PROVISIONS



 


GENERAL:
On the Annuity Date, the Adjusted Contract Value will be applied under the Annuity Option selected by the Owner.




ANNUITY
DATE: The Annuity Date must be at least two (2) years after the Contract Issue Date. The Annuity Date may not be later than
the date on which the Annuitant reaches attained age 100 (the “Maximum Maturity Date”). The Contract will automatically
be forced into Annuitization for a guaranteed period of ten years if the Owner does not select an Annuity Date on or before the
Maximum Maturity Date. It is understood that upon the death of the Annuitant, any amounts remaining under the guaranteed period
will be distributed to the Beneficiary




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ANNUITY
PROVISIONS (Continued)


at
least as rapidly as under the method of distribution being used as of the date of the Annuitant’s death. Prior to the Annuity
Date, subject to the limitations set forth above, the Owner subject to the above, may change the Annuity Date by an Authorized
Request. Any change must be requested at least thirty (30) days prior to the new Annuity Date.




SELECTION
OF AN ANNUITY OPTION: An Annuity Option may be selected by an Authorized Request of the Owner. If no Annuity Option is selected,
Option 2 with 120 monthly payments guaranteed will automatically be applied. Prior to the Annuity Date, the Owner can change the
Annuity Option selected by an Authorized Request. Any change must be requested at least thirty (30) days prior to the Annuity
Date. The Company does not offer a Single Premium Immediate Annuity (“SPIA”), however, if the Company should offer
SPIA contracts in the future, the Annuity Payments at the time of commencement will never be less than those that would be provided
by the application of the cash surrender value to purchase a SPIA, at purchase rates offered by the Company at the time to the
same class of annuitants.




FREQUENCY
AND AMOUNT OF ANNUITY PAYMENTS: Annuity Payments are paid in monthly installments. The Adjusted Contract Value is applied
to the Annuity Table for the Annuity Option selected. If the Adjusted Contract Value to be applied under an Annuity Option is
less than $5,000, the Company reserves the right to make a lump sum payment in lieu of Annuity Payments. If the Annuity Payment
would be or become less than $50, the Company reserves the right to reduce the frequency of payments to an interval which will
result in each payment being at least $50.




ANNUITY
OPTIONS: The following Annuity Options or any other annuity option acceptable to the Company may be selected:


OPTION
1. LIFETIME ONLY ANNUITY: The Company will make monthly payments during the life of the Annuitant. If this option is elected,
it is understood and agreed that payments shall cease immediately upon the death of the Annuitant and the annuity will terminate
without further value.


OPTION
2. LIFETIME ANNUITY WITH GUARANTEED PERIODS: The Company will make monthly payments for the guaranteed period selected and
thereafter for the life of the Annuitant. If this option is elected, it is understood and agreed that upon the death of the Annuitant,
any amounts remaining under the guaranteed period selected will be distributed to the Beneficiary at least as rapidly as under
the method of distribution being used as of the date of the Annuitant's death. The guaranteed period may be five (5) years, ten
(10) years or twenty (20) years.


OPTION
3. PAYMENT FOR A FIXED PERIOD: The Company will make monthly payments for a fixed period of 3 to 20 years.


OPTION
4. JOINT AND SURVIVOR ANNUITY: The Company will make monthly payments during the joint life time of the Annuitant and a Joint
Annuitant. Payments will continue during the lifetime of the surviving Annuitant and will be computed on the basis of 100%, 50%
or 66 2/3% of the Annuity Payment (or limits) in effect during the joint life time.




ANNUITY:
The Adjusted Contract Value is allocated to the General Account and the Annuity is paid as a Fixed Annuity. Unless the Owner
specifies otherwise, the payee of the Annuity Payments shall be the Owner. The Adjusted Contract Value will be applied to the
applicable Annuity Table based upon the Annuity Option selected by the Owner. The amount of the first payment for each $1,000
of Adjusted Contract Value is shown in the Annuity Tables based on an effective annual interest rate of 1.0%.




FIXED
ANNUITY: The Owner may elect to have the Adjusted Contract Value applied to provide a Fixed Annuity. The dollar amount of
each Fixed Annuity Payment shall be determined in accordance with Annuity Tables contained in this Contract which are based on
the minimum guaranteed interest rate of 1.0% per year.




MORTALITY
TABLES: The Annuity 2000 Mortality Table with (i) Male-Female sex distinction; (ii) adjustments based on percentages of Projection
Scale G; and (iii) a 1.0% interest rate is used in establishing the Annuity Table. The age in the Annuity Table is the Annuitant’s
Adjusted Age. Adjusted Age is the Annuitant’s Age when the annuity payment begins, reduced by 1 year for every 5 years that
has elapsed since January 1, 2012. For example, the Adjusted Age for an Annuitant whose annuity payments begin in 2017, and whose
Age is 67 at the time the first annuity payment is due, would be 66. The dollar amount of an Annuity Payment for any Age or




    	12



    	 



    

ANNUITY
PROVISIONS (Continued)


combination
of ages not shown in the tables, or for any other form of Annuity Option agreed to by the Company, will be provided by the Company
upon Formal Request.


 




GENERAL PROVISIONS


 


THE CONTRACT:
The entire Contract consists of this Contract, the Application, if any, and any riders or endorsements attached to this Contract.
All statements made in an application for the issuance of the Contract shall, in the absence of fraud, be deemed representations,
and not warranties. This Contract may be changed or altered only by the President or Vice President and the Secretary of the Company.
A change or alteration must be made in writing. The Company reserves the right to deduct from Your Contract Value amounts paid
to You in excess of amounts owed to You as a result of Company's administrative error.




MISSTATEMENT
OF AGE: If the Age of any Annuitant has been misstated, any Annuity benefits payable will be the Annuity benefits provided
by the correct Age. After Annuity Payments have begun, any underpayments will be made up in one sum with the next Annuity Payment.
Any overpayments will be deducted from future Annuity Payments until the total is repaid. Any underpayment or overpayment by the
Company on account of misstatement of age, shall with an interest rate of 1% compounded annually, be charged/credited against
the current or next succeeding payments to be made by the Company.




MISSTATEMENT
OF GENDER: If the Gender of any Annuitant has been misstated at time of application, any Annuity benefits payable will be
the Annuity benefits provided by the correct Gender. After Annuity Payments have begun, any underpayments will be made up in one
sum with the next Annuity Payment. Any overpayments will be deducted from future Annuity Payments until the total is repaid. Any
underpayment or overpayment by the Company on account of misstatement of gender, shall with an interest rate of 1% compounded
annually, be charged/credited against the current or next succeeding payments to be made by the Company.




INCONTESTABILITY:
This Contract will not be contestable from the date of issue.




MODIFICATION:
This Contract may be modified in order to maintain compliance with applicable provisions or requirements of the Internal Revenue
Code.




NON-PARTICIPATING:
This Contract will not share in any distribution of dividends.




EVIDENCE
OF SURVIVAL: The Company may require satisfactory evidence of the continued survival of any person(s) on whose life Annuity
Payments are based.




PROOF
OF AGE: The Company may require evidence of Age of any Annuitant and any Owner.




PROTECTION
OF PROCEEDS: To the extent permitted by law, death benefits and Annuity Payments shall be free from legal process and the
claim of any creditor other than the person entitled to them under any Contract. No payment and no amount under this Contract
can be taken or assigned in advance of its payment date unless the Company receives the Owner's consent.




REPORTS:
At least once each calendar year, the Company will furnish each Owner with a report showing the Contract Value and any other
information as may be required by law. The Company will also furnish an annual report of the Variable Account. The reports shall
provide information as of a date of not more than four months prior to the date of mailing and include:




	1.		The beginning and end dates of the current report;



	2.		The Contract Value at the beginning and end of the current report;



	3.		The amounts credited or debited during the current report period and



	4.		The Contract Withdrawal Value (ending value) as of the end of the current report period.





TAXES:
Any taxes paid to any governmental entity relating to any Contract will be deducted from the Purchase Payment or Contract
Value when incurred. The Company will, in its sole discretion, determine when taxes have resulted from: the investment experience
of the Variable Account; receipt by the Company of the Purchase Payments; or commencement of Annuity Payments. The Company may,
in its sole discretion, pay taxes when due and deduct that amount from the Contract Value at a later date. Payment at an earlier
date does not waive any right the Company may have to deduct amounts at a later date. The Company reserves the right to establish
a provision for federal income taxes if it determines, in its sole discretion, that it will incur a tax as a result of the




    	13



    	 



    

GENERAL
PROVISIONS (continued)


 


operation
of the Variable Account. The Company will deduct for any income taxes incurred by it as a result of the operation of the Variable
Account whether or not there was a provision for taxes and whether or not it was sufficient. The Company will deduct any withholding
taxes required by applicable law.




CONFORMITY
WITH INTERSTATE INSURANCE PRODUCT REGULATION COMMISSION STANDARDS: This contract was approved under the authority of the Interstate
Insurance Product Regulation Commission Standards (IIPRC) and issued under the commission standards. Any provision within this
Contract on the Contract Issue Date that is in conflict with the IIPRC standards for this product type is hereby amended to conform
to the IIPRC standards for this product type as of the Contract Issue Date. Paid-up annuity, cash surrender value, and death benefits
available under this contract are not less than the minimum benefits required by Section 7 of the NAIC Model Variable Annuity
Regulation, model #250.




PAYMENTS
TO THIRD PARTIES: The Company may sponsor conferences or otherwise remunerate broker/dealers, registered representatives or
other third parties for marketing or other services.




PAYMENTS
FROM THIRD PARTIES: The Company may enter into certain agreements under which it is reimbursed by a Portfolio’s advisors,
distributors and/or affiliates for the administrative or distribution services the Company provides to the Portfolio.




    	14



    	 



    

	OPTION 3 TABLE	OPTIONS 1 AND 2 TABLES	 
	 	 	 	Male	 	 	 
	 	 	 	(2)	 
	No. of 

years 

payable	Monthly 

installments	(1)

Life Only	5 Year 

Certain & 

Life	10 Year 

Certain & 

Life	20 Year 

Certain & 

Life	Age of Payee 

When First 

Installment is 

Payable
	3	$	 28.18 	 	 	 	 	 
	4	21.24 	 	 	 	 	 
	5	17.08 	2.70	2.70	2.69	2.64	50
	6	14.30 	2.76	2.76	2.75	2.70	51
	7	12.32 	2.83	2.83	2.81	2.75	52
	8	10.83 	2.90	2.89	2.88	2.81	53
	9	9.68 	2.97	2.97	2.95	2.88	54
	10	8.75 	3.05	3.05	3.03	2.94	55
	11	7.99 	3.13	3.13	3.11	3.00	56
	12	7.36 	3.22	3.21	3.19	3.07	57
	13	6.83 	3.31	3.30	3.28	3.14	58
	14	6.37 	3.41	3.40	3.37	3.21	59
	15	5.98 	3.51	3.50	3.47	3.29	60
	16	5.63 	3.62	3.61	3.57	3.36	61
	17	5.33 	3.74	3.73	3.68	3.44	62
	18	5.05 	3.87	3.85	3.79	3.51	63
	19	4.81 	4.00	3.98	3.91	3.59	64
	20	4.59 	4.15	4.12	4.04	3.67	65




    	15



    	 



    

 


	OPTION 3 TABLE	OPTIONS 1 AND 2 TABLES	 
	 	 	 	Female	 	 	 
	 	 	 	(2)	 
	No. of 

years 

payable	Monthly 

installments	(1)

Life Only	5 Year 

Certain & 

Life	10 Year 

Certain & 

Life	20 Year 

Certain & 

Life	Age of Payee 

When First 

Installment is 

Payable
	3	$	 28.18 	 	 	 	 	 
	4	21.24 	 	 	 	 	 
	5	17.08 	2.62	2.62	2.61	2.58	50
	6	14.30 	2.67	2.67	2.67	2.63	51
	7	12.32 	2.74	2.73	2.73	2.69	52
	8	10.83 	2.80	2.80	2.79	2.75	53
	9	9.68 	2.87	2.86	2.85	2.80	54
	10	8.75 	2.94	2.93	2.92	2.87	55
	11	7.99 	3.01	3.01	3.00	2.93	56
	12	7.36 	3.09	3.09	3.07	3.00	57
	13	6.83 	3.18	3.17	3.15	3.06	58
	14	6.37 	3.26	3.26	3.24	3.14	59
	15	5.98 	3.36	3.35	3.33	3.21	60
	16	5.63 	3.46	3.45	3.42	3.28	61
	17	5.33 	3.56	3.55	3.52	3.36	62
	18	5.05 	3.68	3.67	3.63	3.44	63
	19	4.81 	3.80	3.78	3.74	3.52	64
	20	4.59 	3.92	3.91	3.86	3.60	65


 




    	16



    	 



    

 


	Option 4 tables
	 	 	 	 	 	 
	Joint and 100% Survivor
	 	male age →
	female 

age↓	55 	60 	65 	70 	75 
	55	2.56 	2.68 	2.77 	2.84 	2.88 
	60	2.70 	2.88 	3.04 	3.16 	3.24 
	65	2.81 	3.06 	3.30 	3.51 	3.67 
	70	2.90 	3.21 	3.55 	3.88 	4.17 
	75	2.96 	3.33 	3.76 	4.23 	4.69 
	 	 	 	 	 	 
	Joint and 66 2/3% Survivor
	 	male age →
	female 

age↓	55 	60 	65 	70 	75 
	55	2.84 	3.01 	3.19 	3.37 	3.55 
	60	3.02 	3.23 	3.46 	3.70 	3.92 
	65	3.20 	3.47 	3.77 	4.07 	4.38 
	70	3.40 	3.72 	4.10 	4.50 	4.92 
	75	3.60 	3.98 	4.44 	4.97 	5.54 
	 	 	 	 	 	 
	Joint and 50% Survivor
	 	male age →
	female 

age↓	55 	60 	65 	70 	75 
	55	3.00 	3.21 	3.45 	3.72 	4.00 
	60	3.20 	3.44 	3.72 	4.04 	4.38 
	65	3.44 	3.72 	4.05 	4.42 	4.83 
	70	3.72 	4.04 	4.43 	4.88 	5.39 
	75	4.03 	4.41 	4.88 	5.44 	6.07 


 





 


 




    	17



    	 



    

 


 


 


 


 


 


 


 


[MONUMENT ADVISOR] INDIVIDUAL FLEXIBLE
PREMIUM


DEFERRED VARIABLE ANNUITY CONTRACT


Non-participating


 


 


 


 


 


 


 


 








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