<PAGE>

                                                                    EXHIBIT 4(c)

                                CONTRACT SCHEDULE

MERRILL LYNCH LIFE INSURANCE COMPANY       Contract Number:    [%999999999]
Service Center:                            Contract Date:      [January 3, 2005]
[P.O. Box 44222]
[Jacksonville, FL 32231-4222]              Financial Advisor:
[1-800-535-5549]                           [JOE BROKER]

CONTRACT INFORMATION

Contract Form:            ML-VA-010 - Flexible Premium Deferred Variable Annuity
Surrender Charge Period:  [7 Years]
Type of Contract:         [Non-Qualified]

Owner(s) Information:

       Name(s)                                   Sex      Age [Nearest Birthday]
       [John Doe]                                [M]     [65]

       Maximum Owner Age:           [80]

Annuitant(s) Information:

       Name(s)                                   Sex      Age [Nearest Birthday]
       [Joe Smith]                               [M]     [55]

       Maximum Annuitant Age:       [80]

Beneficiary(s) Information:
   Primary Beneficiary

       Name(s)                                Relationship            Percentage
       [Mary Doe]                              [Spouse]                 [100]%

   Contingent Beneficiary

       Name(s)                                Relationship            Percentage
       [Anne Doe]                              [Daughter]                [100]%

CONTRACT TERMINATION

This Contract will terminate upon the occurrence of any of the following events:

      a.    the date the Contract is returned under the RIGHT TO REVIEW CONTRACT
            provision;

      b.    the date of payment of the entire Surrender Value;

      c.    the date of the last Death Benefit payment to the last Beneficiary;
            or

      d.    the date of the final annuity payment.

                                     - 5A -
<PAGE>

                               CONTRACT SCHEDULE

                                           Contract Number:    [%999999999]

INACTIVE CONTRACT

[This Contract will be terminated by Us if, at the end of any Valuation Period:

      1.    no Premium payments have been received during the prior [24] months;
            and

      2.    the total of all Premium payments made, less any partial
            withdrawals, is less than $[2,000]; and

      3.    the Contract Value is less than $[2,000].]

PREMIUMS

Initial Premium:                                                      $[       ]

Initial Net Premium:                                                  $[       ]

Allocation of Initial Net Premium:

      [On the Contract Date, the Initial Net Premium will be allocated to the
      [Money Market Subaccount.] On the [14th day] following the Contract Date,
      the Account Value will be reallocated as shown in the Investment Options
      section of this Contract Schedule.]

Allocation of Additional Net Premiums:

      [Additional Net Premiums will be allocated at the end of the Valuation
      Period during which the additional Premium payment is received and
      accepted at Our Service Center. If an additional Premium payment is
      received during the first [14 days] following the Contract Date, the
      additional Net Premium will be allocated to the [Money Market Subaccount.]
      On the [14th day] following the Contract Date, the Account Value will be
      reallocated as shown in the Investment Options section of this Contract
      Schedule. Thereafter any additional Net Premiums will be allocated
      according to any instructions the Owner provides at the time of such
      Premium payment, or, if none are received, according to the allocation
      instructions We have on file, subject to any allocation requirements
      imposed by Us.]

We reserve the right to impose restrictions on allocations of Premiums.

Premium Load - See the Fees and Charges section of this Contract Schedule.

PREMIUM REQUIREMENTS AND LIMITATIONS

Minimum Additional Premiums:                                  $ [50]

Maximum Total Premium Limit:

      [This limit applies to each Owner based on that Owner's age on the date of
      each Premium payment (the Annuitant's age if the Owner is a non-natural
      person).

            If an Owner is under age [70]: The total of all Premiums paid under
            this Contract and any other annuity contract(s) issued by Us, or by
            an affiliated insurance company, to that Owner is limited to $
            [1,000,000] without Our prior approval.

            If an Owner is age [70] or over: The total of all Premiums paid
            under this Contract and any other annuity contract(s) issued by Us,
            or by an affiliated insurance company, to that Owner is limited to $
            [500,000] without Our prior approval.]

[No additional Premiums can be paid on or after the Owner's (or older
Co-Owner's) age [85].]

We reserve the right to refuse to accept any Premium payment.

                                     - 5B -
<PAGE>

                                CONTRACT SCHEDULE
                                            Contract Number:    [%999999999]

INVESTMENT OPTIONS

Separate Account:     [Merrill Lynch Life Variable Annuity Separate Account [A]]

Allocation Guidelines and Restrictions:

      [1.]  [At any one time, Net Premiums and Account Value may be allocated
            among up to [20] of the available subaccounts.]

      [2.]  [All allocations must be in whole percentages.]

      [3.]  [The minimum amount which may be allocated to any subaccount is
            [$1,000].]

      [4.]  We reserve the right to impose restrictions on allocations to
            certain subaccounts.

<TABLE>
<CAPTION>
                                              Current
                                            Asset-Based
                                             Insurance      Allocation
Investment Category         Subaccount         Charge       Percentage
-------------------         ----------     --------------   ----------
<S>                         <C>             <C>             <C>
[Large Cap Value]             [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%

[Large Cap Growth]            [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%

[Mid & Small Cap]             [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
                              [ X  ]           [xxx]%         [xxx]%
</TABLE>

                                     - 5C -

<PAGE>

                                CONTRACT SCHEDULE
                                            Contract Number:    [%999999999]

INVESTMENT OPTIONS (CONTINUED)

<TABLE>
<CAPTION>
                                             Current Asset-
                                                 Based
                                               Insurance      Allocation
Investment Category          Subaccount          Charge       Percentage
-------------------          ----------      --------------   ----------
<S>                          <C>             <C>              <C>
[International]               [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
[Money Market]                [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
[Fixed Income]                [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
[Other]                       [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                              [  X   ]           [xxx]%         [xxx]%
                                      Total                       100%
</TABLE>

                                     - 5D -

<PAGE>

                                CONTRACT SCHEDULE
                                            Contract Number:    [%999999999]

FEES AND CHARGES

Asset-Based Insurance Charge:
                  Current Annual       [see table in Investment Options section]
                  Maximum Annual       [2.00] %

      [The daily Asset-Based Insurance Charge is [1/365th of the annual charge].
      The Asset-Based Insurance Charge will be deducted daily in the
      determination of the Net Investment Factor for each subaccount.]

      We reserve the right to apply different current Asset-Based Insurance
      Charges to designated subaccounts. The current Asset-Based Insurance
      Charge that applies to each subaccount on the Contract Date is shown in
      the table in the Investment Options section above.

Contract Fee:

                     [Current     [$50]              Maximum   [$75]

      [If, on a Contract Anniversary on or prior to the Annuity Date, or on the
      date of a full withdrawal, or on the Annuity Date, both the Contract Value
      and Premiums less withdrawals, are less than $[50,000], We will deduct a
      Contract Fee.]

      [The fee will be deducted from each subaccount in the ratio of your
      interest in each subaccount to your Account Value.]

      We reserve the right not to deduct a Contract Fee from designated
      subaccounts which may be made available in the future.]

 Premium Tax Charge:

      [Any charges made by Us attributable to premium taxes imposed by a state
      or other governmental unit will be deducted at the Annuity Date. In those
      jurisdictions that do not allow Us to reduce our current taxable premium
      income by the amount of any withdrawal or death benefit, We will also
      deduct a charge for those taxes on any withdrawal or death benefit paid
      under this Contract.]

Premium Load:
                     [None]

Transfer Fee:

                     [Current  $  [25]               Maximum  $ [30]

      [A Transfer Fee will be collected for each transfer in a Contract Year in
      excess of the number of transfers allowed without a fee as shown in the
      Transfers section of this Contract Schedule.]

      [The Transfer Fee will be deducted from each transfer in the ratio of the
      amount transferred from each subaccount to the total amount transferred
      prior to the deduction of the Transfer Fee.]]

                                     - 5E -

<PAGE>

                                CONTRACT SCHEDULE
                                            Contract Number:    [%999999999]

FEES AND CHARGES (CONTINUED)

Redemption Fee:

      We reserve the right to impose a Redemption Fee, or to collect any
      Redemption Fee imposed by any Fund, or as required by any regulatory
      authority.

Surrender Charge:

      [A Surrender Charge may apply upon:

            (i)   a partial or full withdrawal of the Surrender Value; or

            (ii)  application of a portion or all of the Annuity Value to an
                  Annuity Option.

      The Surrender Charge is a percentage of the amount of each Premium
      withdrawn in excess of the Free Withdrawal Amount described in this
      Contract Schedule. The applicable Surrender Charge for each Premium is
      determined as follows:

<TABLE>
<CAPTION>
[Number of Complete                      Surrender
  Years Since the                         Charge
  Premium Payment                        Percentage
-------------------                      ----------
<S>                                      <C>
    less than 1                             7%
         1                                  6%
         2                                  5%
         3                                  4%
         4                                  3%
         5                                  2%
         6                                  1%
         7+                                 0%    ]
</TABLE>

      For a full withdrawal, the Surrender Charge will be deducted from the
      Contract Value prior to payment of the Surrender Value. [For partial
      withdrawals, unless you specify otherwise, the Surrender Charge will be
      deducted from the requested withdrawal amount prior to payment.]

      For the purpose of determining the Surrender Charge, partial and full
      withdrawals in a Contract Year assume Gain is withdrawn first, followed by
      Premiums on a First-In, First-Out (FIFO) basis.

      Gain is the excess, if any, of (i) over (ii) where:

            (i)   is the Contract Value just prior to the withdrawal; and

            (ii)  is the sum of all Premiums paid less any prior withdrawal of
                  those Premiums.

      We reserve the right not to deduct the Surrender Charge from designated
      subaccounts which may be made available in the future.]

                                     - 5F -
<PAGE>

                                CONTRACT SCHEDULE
                                            Contract Number:    [%999999999]

FEES AND CHARGES (CONTINUED)

Free Withdrawal Amount:

      [Each Contract Year, You may withdraw a portion of Your Contract Value
      without deduction of a Surrender Charge. This amount is known as the Free
      Withdrawal Amount. The Free Withdrawal Amount available each Contract Year
      is [the greater of (i) or (ii) where:

            (i)   is (a) less (b), where:

                  (a)   is the sum of: [10]% of each Premium subject to a
                        Surrender Charge, but not greater than the Remaining
                        Premium as of the beginning of the Contract Year; and

                  (b)   is any prior withdrawals during the Contract Year; and

            (ii)  is Gain in the Contract, plus Remaining Premiums no longer
                  subject to a Surrender Charge.

      Remaining Premium is the Premium less prior withdrawals of that Premium.

      Gain is defined in the Surrender Charge section of this Contract
      Schedule.] ]

Other Contract Charges:      [None]

Optional Rider Charges:      If You have elected any optional Rider, the charges
                             for such Rider are described on the Contract
                             Schedule page applicable to that Rider.

CONTRACT CREDITS

                             [None]

                                     - 5G -
<PAGE>

                                CONTRACT SCHEDULE
                                            Contract Number:    [%999999999]

TRANSFERS

Requirements and Limitations:

      [No transfers allowed during the first [14 days] following the Contract
      Date.]

      Number of transfers allowed each Contract Year before the Transfer Fee
      applies:                                                              [12]

      [Minimum Transfer Amount:

      The minimum amount of a transfer, from one or multiple subaccounts, is
      $[1,000] or the remaining Account Value in a subaccount, if less than
      $[1,000]. ]

      Minimum Value in a subaccount after a transfer:                  $ [1,000]

      We reserve the right to impose additional limitations on Your ability to
      make transfers to or from designated subaccounts which may be made
      available in the future.

      We reserve the right, in accordance with applicable law, to modify or
      terminate the transfer privilege at any time. The right to make any
      transfer will be limited by any requirements and limitations in effect at
      the time of such transfer.

Transfer Fee - See the Fees and Charges section of this Contract Schedule.

Redemption Fee - See the Fees and Charges section of this Contract Schedule.

WITHDRAWALS

Requirements and Limitations:

      Minimum Withdrawal Amount:                                       $   [100]

      Minimum Surrender Value after a partial withdrawal:              $ [5,000]

      We reserve the right to impose additional limitations on Your ability to
      take withdrawals from designated subaccounts which may be made available
      in the future.

Deduction of Partial Withdrawals:

      [Unless you specify otherwise or unless restrictions apply, partial
      withdrawals will be deducted from each subaccount in the ratio of your
      interest in each subaccount to your Account Value.]

Surrender Charge - See the Fees and Charges section of this Contract Schedule.

Free Withdrawal Amount - See the Fees and Charges section of this Contract
Schedule.

                                     - 5H -
<PAGE>

                                CONTRACT SCHEDULE
                                            Contract Number:    [%999999999]

DEATH BENEFIT INFORMATION

Eligible Spousal Beneficiary:                 A spousal Beneficiary [whose age
                                              as of the Contract Date was not
                                              greater than the Maximum Owner Age
                                              shown on this Contract Schedule]

Death Benefit Payment Election Period:        [60] days from our receipt of a
                                              certified death certificate or
                                              other legal proof of death
                                              acceptable to Us

Default Death Benefit Payment Option:
      For an Eligible Spousal Beneficiary      [Spousal Beneficiary Continuation
                                               Option]
      For any other Beneficiary                [Payment Option 1- Lump Sum
                                               Payment]

ANNUITY PERIOD INFORMATION

Requirements and Limitations:

      The Annuity Date may not be later than the Maturity Date.

      [The Annuity Date may not be earlier than the [first] Contract
      Anniversary.]

      [A change of Annuitant may not cause the Maturity Date to be later than
      the Maturity Date established on the Contract Date.]

Annuity Date:                                                      [Jan 1, 2045]

Maturity Age:                                                               [95]

Maturity Date:                                                     [Jan 1, 2045]

        [The Maturity Date is the birthday on which the oldest Annuitant
        reaches the Maturity Age.]

Guaranteed Payout Rates:

      [The guaranteed payout rates will be based on the Annuitant's Adjusted
      Age, the Guaranteed Mortality Table, if applicable, and the Guaranteed
      Interest Rate.

      Adjusted Age: For Annuity Dates from [January 1, 2025] through [December
      31, 2034], the Annuitant's Adjusted Age will be his/her actual age reduced
      by [one year]. For each subsequent [10 year] period, the Adjusted Age for
      the prior [10 year] period will be reduced by [an additional year].

      For example:

<TABLE>
<CAPTION>
         ANNUITY DATE                                       ADJUSTED AGE
         ------------                                       ------------
<S>                                                <C>
before Dec. 31, 2024                               actual age
Jan. 1, 2025 through Dec. 31, 2034                 subtract 1 year from actual age
Jan. 1, 2035 through Dec. 31, 2044                 subtract 2 years from actual age
Jan. 1, 2045 through Dec. 31, 2054                 subtract 3 years from actual age
Jan. 1, 2055 through Dec. 31, 2064                 subtract 4 years from actual age]
</TABLE>

      Guaranteed Mortality Table: [Annuity 2000 Mortality Table projected to
      year 2025 under Scale G.]

      Guaranteed Interest Rate: [1.50%]

                                     - 5I -
<PAGE>

                                CONTRACT SCHEDULE
                                            Contract Number:    [%999999999]

ANNUITY PERIOD INFORMATION (CONTINUED)

Minimum Annuity Payment:                                      $    [20]

Minimum Annuity Value:                                        $ [2,000]

Default Annuity Option:
      For a single Annuitant -    [Option 2 - Life Annuity with Payments
                                  Guaranteed 10 Years]
      For Joint Annuitants -      [Option 4 - Joint and Survivor Life Annuity
                                  with Payments Guaranteed 10 Years]

Present Value Interest Rate:      [The interest rate We use on the Annuity Date
                                  to compute the amount of the annuity payments]

ENDORSEMENTS AND RIDERS ATTACHED TO THIS CONTRACT

        [None]
        [Bonus Endorsement]
        [Guaranteed Minimum Death Benefit Rider - Return of Premium]
        [Guaranteed Minimum Death Benefit Rider - Maximum Anniversary Value]
        [Guaranteed Minimum Death Benefit Rider - Roll-Up]
        [Guaranteed Minimum Death Benefit Rider - Greater of Maximum
                                                  Anniversary Value and Roll-Up]
        [Additional Death Benefit Rider]
        [Guaranteed Minimum Income Benefit Rider]
        [Spousal Beneficiary Continuation Option Endorsement]

                                     - 5J -
<PAGE>

                                CONTRACT SCHEDULE

                       THIS PAGE INTENTIONALLY LEFT BLANK.

{NOTE TO JAX: This is an optional page to be used only when needed to provide an
even number of schedule pages.}

                                     - 5K -