p-rilaxschxi10x21






P-RILA-SCH-I(10/21) 5    ANNUITY SCHEDULE PAGE      ANNUITY NUMBER: [001-00001] ISSUE DATE:  [March 1, 2013]    TYPE OF BUSINESS:  [Non-Qualified]    OWNER:  [John Doe]            DATE OF BIRTH:  [October 21, 1972] SEX:  [Male]    [OWNER:  [Mary Doe]            DATE OF BIRTH:  [October 15, 1972] SEX:  [Female]]    ANNUITANT:  [John Doe]     DATE OF BIRTH:  [October 21,1972] SEX:  [Male]    [JOINT ANNUITANT:  [Mary Doe]     DATE OF BIRTH:  [January 15, 1952] SEX:  [Female]]    [CONTINGENT ANNUITANT: [Mary Doe] DATE OF BIRTH: [January 15, 1952] SEX: [Female]]      ALLOCATION OF INITIAL PUCHASE PAYMENT    PURCHASE PAYMENT:  [$100,000.00]    INDEX STRATEGY ALLOCATION PERCENTAGE(S):    [Point to Point with Cap Index Strategy   XX%     [Index Name] [Index Term]  [$XXXX.XX] [XX.XX% Buffer]      Tiered Participation Rate Index Strategy   XX%     [Index Name] [Index Term]  [$XXXX.XX] [XX.XX% Buffer]      Step Rate Plus Index Strategy   XX%     [Index Name] [Index Term]  [$XXXX.XX] [XX.XX% Buffer]]      VARIABLE SUB-ACCOUNT ALLOCATION PERCENTAGE:  [VA Fund 1]     XX%]  [VA Fund 2]     XX%]  [VA Fund 3]     XX%]  [VA Fund 4]     XX%]  [VA Fund 5]     XX%]         HOLDING ACCOUNT PERIOD: [30] Days from the Issue Date    PURCHASE PAYMENT AGE LIMITATION: [Purchase Payments may be accepted up to and including the day  prior to the later of: the oldest Owner’s [86th] birthday (the Annuitant’s [86th] birthday if the Annuity is owned by an  entity), or the first anniversary of the Issue Date, unless otherwise required by applicable law or regulation to  maintain the tax status of this Annuity.]     MINIMUM ADDITIONAL PURCHASE PAYMENT:  [$100]    MINIMUM ADDITIONAL PURCHASE PAYMENT UNDER AUTOMATIC PURCHASE PLANS:  [$50]      





 






P-RILA-SCH-I(10/21) 6    ANNUITY SCHEDULE PAGE (continued)    WITHDRAWALS    MINIMUM WITHDRAWAL AMOUNT:  [$100]    MINIMUM SURRENDER VALUE AFTER A PARTIAL WITHDRAWAL:  [$2,000]    ALLOCATION OF ACCOUNT VALUE    MINIMUM VARIABLE SUB-ACCOUNT AMOUNT:  [$20]    MINIMUM INDEX STRATEGY AMOUNT:  [$2,000]    CHARGES    INSURANCE CHARGE:     MORTALITY AND EXPENSE RISK CHARGE: [     For Purchase Payments less than $1,000,000 the Insurance Charge is [.35%]      For Purchase Payments of $1,000,000 or more the Insurance Charge is reduced to [.25%]]     ADMINISTRATION CHARGE: [0.15%]    CONTINGENT DEFERRED SALES CHARGE: NONE    ADVISORY FEES: We treat Advisory Fee payments as an expense of the Annuity and not a taxable distribution  if (1) your Annuity is being used in conjunction with a “qualified” retirement plan (plans meeting the requirements  of Sections 401, 403 or 408 of the Code) or (2) your non-qualified Annuity satisfies the requirements of Private  Letter Ruling 201945005 (“PLR”) issued by the IRS to PALAC. In accordance with the PLR, Advisory Fee  payments from your non-qualified Annuity are treated as an expense as long as your investment adviser attests  to Prudential that the PLR requirements have been met, including that the advisory fees will not exceed [1.50]%  of the Annuity’s Account Value in a calendar year. In relation to the Death Benefit, we will treat any Advisory  Fees that are deducted as withdrawals that reduce the Death Benefit.     ANNUITIZATION    LATEST AVAILABLE ANNUITY DATE:  [The first day of the calendar month next following the oldest Owner’s  or Annuitant’s 95th birthday.]    EARLIEST AVAILABLE ANNUITY DATE:  [Three years from the Issue Date]    MINIMUM ANNUITY PAYMENT:  [$100 per month]    MINIMUM SURRENDER VALUE AT ANNUITIZATION:  [$2,000]    ANNUITY TABLES    The rates in Tables 1 and 2 below are applied to the Account Value on the Annuity Date to compute the  minimum amount of the annuity payment for the payout options described below. Table 1 is used to compute the  minimum annuity payment under Option 1 (Payments for Life with 120 Months Period Certain). Table 2 is used  to compute the minimum initial annuity payment under Option 2 (Joint and Last Survivor).            





 






P-RILA-SCH-I(10/21) 7    ANNUITY SCHEDULE PAGE (continued)    BASIS OF COMPUTATION FOR ANNUITY OPTIONS: [We use an interest rate of 0.25% per year. The  adjusted age is the Annuitant’s age as of the Annuitant’s last birthday prior to the date on which the first payment  is due, adjusted as shown in the “Translation of Adjusted Age” table below. The actuarial basis of the Annuity  Options is the Annuity 2000 valuation mortality table, with four-year age setback and projected mortality  improvement factors (modified Scale G) projected from the age at annuitization to the age at which the  probability of survival is needed in the calculation of the annuity payment.    Translation of Adjusted Age  Calendar Year in Which  First Payment Is Due  Adjusted Age Calendar Year in Which  First Payment Is Due  Adjusted Age  2020 through 2029 Actual Age minus 2 2070 through 2079 Actual Age minus 7  2030 through 2039 Actual Age minus 3 2080 through 2089 Actual Age minus 8  2040 through 2049 Actual Age minus 4 2090 through 2099 Actual Age minus 9  2050 through 2059 Actual Age minus 5 2100 through 2109   Actual Age minus 10  2060 through 2069 Actual Age minus 6 2110 through 2119 Actual Age minus 11]    AMOUNT OF MONTHLY PAYMENT FOR EACH $1,000 APPLIED    [ANNUITY OPTION 1 Table – Payments for Life with 120 Months Period Certain  Adjusted  Age Male Female  Adjusted  Age Male Female  Adjusted  Age Male Female  41 1.76 1.62 61 2.90 2.60 81 5.83 5.39  42 1.79 1.65 62 2.99 2.68 82 6.03 5.61  43 1.83 1.68 63 3.09 2.76 83 6.22 5.83  44 1.87 1.72 64 3.19 2.85 84 6.41 6.05  45 1.91 1.75 65 3.30 2.94 85 6.60 6.27  46 1.96 1.79 66 3.41 3.04 86 6.78 6.48  47 2.00 1.83 67 3.53 3.15 87 6.96 6.69  48 2.05 1.87 68 3.65 3.26 88 7.12 6.89  49 2.10 1.91 69 3.78 3.37 89 7.28 7.08  50 2.15 1.95 70 3.92 3.50 90 7.43 7.25  51 2.20 2.00 71 4.07 3.63 91 7.56 7.41  52 2.26 2.05 72 4.22 3.77 92 7.69 7.56  53 2.32 2.10 73 4.38 3.91 93 7.80 7.69  54 2.38 2.15 74 4.54 4.07 94 7.91 7.81  55 2.44 2.20 75 4.71 4.23 95 8.00 7.92]  56 2.51 2.26 76 4.89 4.40        57 2.58 2.32 77 5.07 4.59        58 2.65 2.39 78 5.25 4.78        59 2.73 2.45 79 5.44 4.97        60 2.81 2.53 80 5.64 5.18                                                                                                                       





 






P-RILA-SCH-I(10/21) 8    ANNUITY SCHEDULE PAGE (continued)    [ANNUITY OPTION 2 Table - Joint and Last Survivor  Male  Adjusted  Age  Female Adjusted Age  45 50 55 60 65 70 75 80 85 90 95  45 1.59 1.68 1.75 1.80 1.84 1.87   1.89 1.90   1.91   1.91   1.91  50 1.64 1.76 1.86 1.95 2.02 2.07 2.11 2.13 2.14 2.15 2.15  55 1.68 1.82 1.96 2.09 2.21 2.30 2.36 2.40 2.43 2.44 2.45  60 1.71 1.87 2.05 2.22 2.39 2.54 2.65 2.73 2.78 2.81 2.82  65 1.73 1.90 2.11 2.33 2.56 2.79 2.98 3.13 3.23 3.29 3.32  70 1.74 1.92 2.15 2.41 2.70 3.02 3.32 3.58 3.78 3.90 3.97  75 1.74 1.94 2.17 2.46 2.81 3.21 3.64 4.06 4.42 4.68 4.84  80 1.75 1.95 2.19 2.50 2.88 3.35 3.91 4.52 5.12 5.60 5.94  85 1.75 1.95 2.20 2.51 2.92 3.44 4.10 4.91 5.79 6.62 7.26  90 1.75 1.95 2.20 2.53 2.94 3.49 4.23 5.19 6.36 7.62 8.73  95 1.75 1.95 2.21 2.53 2.96 3.52 4.30 5.37 6.78 8.47 10.15]    SEPARATE ACCOUNT(S):    VARIABLE SEPARATE ACCOUNT(S): [Pruco Life Flexible Premium Variable Annuity Account]    INDEX STRATEGIES SEPARATE ACCOUNT(S): [Pruco Life Insurance Company Index Strategies Separate  Account]      RIDERS AND ENDORSEMENTS MADE A PART OF THE ANNUITY ON THE ISSUE DATE:  [Medically Related Surrender Endorsement  Point to Point with Cap Index Strategy Endorsement  Tiered Participation Rate Index Strategy Endorsment  Step Rate Plus Index Strategy Endorsement]