Exhibit 4(n)


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
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	8
	ACCUMULATION UNITS	8
	ACCUMULATION UNIT VALUE	8
	 	 
	CONTRACT VALUE	8
	 	 
	SUBSCRIPTION FEE	8
	DEDUCTION FOR SUBSCRIPTION FEE	8
	DEDUCTION FOR TRANSACTION FEE	9
	TRANSFERS	9
	TRANSFERS DURING THE ACCUMULATION PERIOD	9
	 	 
	WITHDRAWAL PROVISIONS	9
	WITHDRAWALS	9
	 	 
	PROCEEDS PAYABLE ON DEATH	10
	DEATH OF OWNER DURING THE ACCUMULATION PERIOD	10
	DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD	10
	DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD	10
	DEATH OF OWNER DURING THE ANNUITY PERIOD	10
	DEATH OF ANNUITANT	10
	PAYMENT OF DEATH BENEFIT	11
	BENEFICIARY	11
	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	12








 






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TABLE
OF CONTENTS





	ANNUITY PROVISIONS	12
	GENERAL	12
	ANNUITY DATE	12
	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	13
	MORTALITY TABLES	13
	 	 
	GENERAL PROVISIONS	13
	THE CONTRACT	13
	MISSTATEMENT OF AGE	13
	INCONTESTABILITY	13
	MODIFICATION	13
	NON-PARTICIPATING	13
	EVIDENCE OF SURVIVAL	13
	PROOF OF AGE	13
	PROTECTION OF PROCEEDS	13
	REPORTS	13
	TAXES	13
	REGULATORY REQUIREMENTS	14
	PAYMENTS TO THIRD PARTIES	14
	PAYMENTS FROM THIRD PARTIES	14
	 	 
	ANNUITY OPTION TABLES	15






 



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CONTRACT
SCHEDULE


 


	OWNER: 	«FIRSTNAM» «LASTNAME»
	CONTRACT ISSUE DATE:	«COVISS»
	JOINT OWNER:  	«JFIRSTNM» «JLASTNAM»
	ANNUITY DATE:  	«EXPDAT»
	CONTRACT NUMBER: 	«POLNUM»
	PURCHASE PAYMENTS:	 


	INITIAL PURCHASE PAYMENT:  	 	«INITPREM»
	 	 	 
	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, in the amounts
shown in the table below, 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).


 


	Transfers 1-10 per Contract year	$49.99\transfer
	Transfers 11-20 per Contract year	$39.99\transfer
	Transfers 21-30 per Contract year	$29.99\transfer
	Transfers 31+ per Contract year	$19.99\transfer


 






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CONTRACT
SCHEDULE (continued)


 


 


The Company may increase the Transaction Fee, or modify
the table above. However, the Transaction Fee will never be greater than $74.99 for a single transfer.


 


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, the Company reserves the right to impose a fee for excessive transfers after
properly notifying the customer.


TRANSFER FEE: Except for the Transaction
Fee described above, if any, there are no transfer fee restrictions; however, the Company reserves the right to impose a fee at
a later date for excessive transfers after properly notifying the customer. 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; however, the Company reserves the right to change the minimum amount required for transfers
in the future.


MINIMUM AMOUNT WHICH MUST REMAIN
IN EACH ACCOUNT AFTER A TRANSFER: There is no minimum amount; however, the Company reserves the right to change the minimum amount
required to remain in each account after a transfer.


WITHDRAWALS:


CONTINGENT DEFERRED SALES CHARGE:
NONE


WITHDRAWAL CHARGE: NONE


MINIMUM PARTIAL WITHDRAWAL: $500
from each Sub-Account. This requirement is waived if the partial withdrawal is pursuant to the Systematic Withdrawal Program.


MINIMUM CONTRACT VALUE WHICH MUST
REMAIN IN CONTRACT AFTER A PARTIAL WITHDRAWAL: There is no minimum amount; however, the Company reserves the right to change the
minimum amount required to remain in the contract after a partial withdrawal.


MINIMUM CONTRACT VALUE WHICH MUST
REMAIN IN ANY SUB-ACCOUNT AFTER A PARTIAL WITHDRAWAL: There is no minimum amount; however, the Company reserves the right to change
the minimum amount required to remain in any Sub-Account after a partial withdrawal.


SEPARATE ACCOUNTS:


Variable Account:Jefferson
National Life Annuity Account G.


RIDERS: [None]


 


 


ADMINISTRATIVE OFFICE:


 


	
        Jefferson National Life Insurance Company

        Administrative Office

        9920 Corporate Campus Drive, Suite 1000

        Louisville, KY 40223

        (866) 667-0561
	 	 
	 
	 
	 


 




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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.


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.



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DEFINITIONS
(continued)


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.


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.


 


WEBSITE: www.jeffnat.com


 


 


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.


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






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SEPARATE
ACCOUNT PROVISIONS (continued)



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.


 


 


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, in the amounts shown in the table below, 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






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TRANSACTION
FEE (continued)


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.


 


	Transfers 1-10 per Contract year	$49.99\transfer
	Transfers 11-20 per Contract year	$39.99\transfer
	Transfers 21-30 per Contract year	$29.99\transfer
	Transfers 31+ per Contract year	$19.99\transfer


 



 


The Company may increase the Transaction Fee, or modify the table
above. However, the Transaction Fee will never be greater than $74.99 for a single transfer.


 


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
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, at any time and without prior notice to any party, 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.



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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 proceeds to be paid to other Beneficiaries will be placed into a money market account until
the Company receives Authorized Requests from each remaining 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 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.


 






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PROCEEDS
PAYABLE ON DEATH (continued)


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.


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. The change will take effect as of the date the Authorized Request is received. 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. The change will become effective as of the
date the Authorized Request is received. 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






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OWNER,
ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS (continued)



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 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 maximum date permitted under state
law.


Prior to the Annuity Date, 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.


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%.



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ANNUITY
PROVISIONS (continued)


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 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.


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.


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 state and federal law.


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.


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 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.






    	13



    	 



    


GENERAL
PROVISIONS (continued)


REGULATORY REQUIREMENTS: All values payable under any
Contract will not be less than the minimum benefits required by the laws and regulations of the states in which the Contract is
delivered.


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.


 




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	OPTION 3 TABLE	OPTION 1 AND 2 TABLES	 
	 	 	MALE	 
	 	 	 
	 	 	Monthly Installments for Life 	 
	 	 	with Guaranteed Period	 
	 	 	(1)	 	(2)	 
	No. of years payable	Mothly Installments	Lifetime Only	 	5 Year Certain and Life	10 Year Certain and Life	20 Year Certain and Life	Age of Payee When First Installment is Payable
	3	28.18	 	 	 	 	 	 
	4	 21.24	 	 	 	 	 	 
	5	 17.08	2.67	 	2.67	2.66	2.62	50
	6	 14.30	2.73	 	2.73	2.72	2.67	51
	7	 12.32	2.80	 	2.79	2.78	2.73	52
	8	10.83	2.87	 	2.86	2.85	2.79	53
	9	9.68	2.94	 	2.93	2.92	2.85	54
	10	8.75	3.01	 	3.01	2.99	2.91	55
	11	 7.99	3.09	 	3.09	3.07	2.97	56
	12	 7.36	3.18	 	3.17	3.15	3.04	57
	13	 6.83	3.27	 	3.26	3.24	3.11	58
	14	 6.37	3.36	 	3.35	3.33	3.18	59
	15	 5.98	3.46	 	3.45	3.42	3.25	60
	16	 5.63	3.57	 	3.56	3.52	3.33	61
	17	 5.33	3.69	 	3.67	3.63	3.40	62
	18	 5.05	3.81	 	3.79	3.74	3.48	63
	19	 4.81	3.94	 	3.92	3.86	3.55	64
	20	 4.59	4.08	 	4.06	3.98	3.63	65







 




    	15



    	 



    

 


JEFFERSON
NATIONAL LIFE INSURANCE COMPANY


Administrative Office: [9920 Corporate Campus
Dr., Suite 1000]


[Louisville, Kentucky 40223]


Telephone: [1-866-667-0561]


 





	OPTION 3 TABLE	OPTION 1 AND 2 TABLES	 
	 	 	FEMALE	 
	 	 	 
	 	 	Monthly Installments for Life 	 
	 	 	with Guaranteed Period	 
	 	 	(1)	 	(2)	 
	No. of years payable	Mothly Installments	Lifetime Only	 	5 Year Certain and Life	10 Year Certain and Life	20 Year Certain and Life	Age of Payee When First Installment is Payable
	3	 28.18	 	 	 	 	 	 
	4	 21.24	 	 	 	 	 	 
	5	 17.08	2.59	 	2.59	2.58	2.56	50
	6	 14.30	2.65	 	2.65	2.64	2.61	51
	7	 12.32	2.71	 	2.70	2.70	2.66	52
	8	 10.83	2.77	 	2.77	2.76	2.72	53
	9	 9.68	2.83	 	2.83	2.82	2.78	54
	10	 8.75	2.90	 	2.90	2.89	2.84	55
	11	 7.99	2.98	 	2.97	2.96	2.90	56
	12	 7.36	3.05	 	3.05	3.04	2.96	57
	13	 6.83	3.13	 	3.13	3.11	3.03	58
	14	 6.37	3.22	 	3.22	3.20	3.10	59
	15	 5.98	3.31	 	3.31	3.28	3.17	60
	16	 5.63	3.41	 	3.40	3.38	3.25	61
	17	 5.33	3.51	 	3.50	3.47	3.32	62
	18	5.05	3.62	 	3.61	3.58	3.40	63
	19	 4.81	3.74	 	3.73	3.69	3.48	64
	20	 4.59	3.86	 	3.85	3.80	3.56	65














    	16



    	 



    
 

 

 


[MONUMENT ADVISOR]


INDIVIDUAL FLEXIBLE PREMIUM

DEFERRED VARIABLE ANNUITY CONTRACT


Non-participating


 


 


 






    	17