<PAGE>

                                 Exhibit (4)(a)
                                 Form of Policy

<PAGE>

                                                        Home Office:
                                                        4333 Edgewood Road N.E.
[LOGO](R) Transamerica Life                             Cedar Rapids, Iowa 52499
          Insurance Company                             (319)398-8511
          A Stock Company (Hereafter called the Company, we, our or us)
================================================================================

                              ANNUITANT: [John Doe]

                              OWNER(S): [John Doe]

                           POLICY NUMBER: [07 - 12345]

                         POLICY DATE: [October 15, 2003]

                                    WE AGREE

..    To provide annuity payments as set forth in Section 10 of this policy,

..    Or to pay withdrawal benefits in accordance with Section 5 of this policy,

..    Or to pay death proceeds in accordance with Section 9 of this policy.

These agreements are subject to the provisions of this policy. This policy is
issued in consideration of the payment of the initial premium.

Withdrawals may be subject to surrender charges and / or an excess interest
adjustment reflecting changes in interest rates in accordance with Section 5 of
this policy. Transfers and amounts applied to an income option may also be
subject to an excess interest adjustment in accordance with Sections 5, 8, and
10, respectively, of this policy.

                             20 DAY RIGHT TO CANCEL

You may cancel this policy by delivering or mailing a written notice or sending
a telegram to us or your agent. You must return the policy before midnight of
the twentieth day after the day you receive it. Notice given by mail and return
of the policy by mail are effective on being postmarked, properly addressed, and
postage prepaid.

We will pay you an amount equal to the sum of:

..    the premiums paid;

..    less prior withdrawals, if any; plus or minus

..    the accumulated gains or losses, if any, in the separate account on the
     date of cancellation;

unless otherwise required by law.

                        Signed for us at our home office.


               /s/ Craig Vermie               /s/ Larry N. Norman
           ------------------------         -------------------------
                  SECRETARY                        PRESIDENT

     This policy is a legal contract between the policyowner and the Company.
                         READ YOUR POLICY CAREFULLY

                   FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY
                   INCOME PAYABLE AT ANNUITY COMMENCEMENT DATE
         BENEFITS BASED ON THE PERFORMANCE OF THE SEPARATE ACCOUNT ARE
                         VARIABLE AND ARE NOT GUARANTEED
                  AS TO DOLLAR AMOUNT (SEE SECTIONS 6 AND 10C)
                                NON-PARTICIPATING

AV1025 101 178 903

<PAGE>

                             SECTION 1 - DEFINITIONS

ADJUSTED POLICY VALUE - The policy value increased or decreased by any excess
interest adjustment.

ANNUITANT - The person whose life annuity payments will be based on.

ANNUITY COMMENCEMENT DATE - The date the payments under an income option will
begin. This date may be changed by the owner as described in Section 11.

CASH VALUE - The amount, defined in Section 5, that is available for partial or
full surrenders.

CUMULATIVE EARNINGS - An amount equal to the policy value at the time a lump sum
payout or systematic payout option payout is made, minus the sum of all premium
payments reduced by all prior partial withdrawals deemed to have been from
premium, if any.

CUSTODIAL CARE - Care designed essentially to help a person with the activities
of daily living which does not require the continuous attention of trained
medical or paramedical personnel.

DISTRIBUTION - A disbursement of funds from the policy value or cash value.
Policy value and cash value will be reduced by any distribution.

EARNINGS - The gains, if any, in the policy value.

GAINS - Cumulative earnings, if any, in the policy value.

HOSPITAL - An institution which 1) is operated pursuant to the laws of the
jurisdiction in which it is located, 2) operates primarily for the care and
treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour
nursing service by or under the supervision of registered graduate professional
nurses, 4) is supervised by a staff of one or more licensed physicians, and 5)
has medical, surgical and diagnostic facilities or access to such facilities.

INCOME OPTIONS - Options as described in Section 10.

INVESTMENT OPTIONS - Any of the guaranteed fixed account options and any of the
subaccounts of the separate account.

NURSING CARE - Care prescribed by a physician and performed or supervised by a
registered graduate nurse. Such care includes nursing and rehabilitation
services available 24 hours.

NURSING FACILITY - A facility which 1) is operated pursuant to the laws of the
jurisdiction in which it is located, 2) provides care prescribed by a physician
and performed or supervised by a registered graduate nurse on a 24 hour basis,
or provides care designed essentially to help a person with the activities of
daily living which does require the continuous attention of trained medical or
paramedical personnel, and 3) is not, other than incidentally, a hospital, a
home for the aged, a retirement home, a rest home, a community living center or
a place mainly for the treatment of alcoholism, mental illness, or drug abuse.

PAYEE - The person to whom annuity payments will be made.

PHYSICIAN - Doctor of Medicine or Doctor of Osteopathy who is licensed as such
and operating within the scope of the license.

POLICY ANNIVERSARY - The anniversary of the policy date for each year the policy
remains in force.

POLICY DATE - The date shown on the Policy Data page of this policy and the date
on which this policy becomes effective.

POLICY VALUE - Amount defined in Section 4, that can be used to fund one of the
income options.

POLICY YEAR - The 12-month period following the policy date shown on the Policy
Data page. The first policy year starts on the policy date. Each subsequent year
starts on the anniversary of the policy date.

SEPARATE ACCOUNT - The separate investment account(s) established by us, as
described in Section 6.

SUBACCOUNT - A division of the separate account, as described in Section 6.

SURRENDER - A partial or full withdrawal of funds from the policy value or cash
value.

TERMINAL CONDITION - A condition resulting from an accident or illness which, as
determined by a physician, has reduced life expectancy to not more than 12
months, despite appropriate medical care.

WITHDRAWAL - A disbursement of funds from the policy value or cash value. Policy
value and cash value will be reduced by any distribution.

YOU, YOUR - The owner of this policy. Unless otherwise specified, the annuitant
and the owner shall be one and the same person. If a joint owner is named,
reference to "you" or "your" in this policy will apply to both the owner and
joint owner.

AVB1025                              Page 2

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                             SECTION 2 - POLICY DATA

POLICY NUMBER: [07 - 12345]                ANNUITANT: [John Doe]

INITIAL PREMIUM
PAYMENT: [$5,000.00]                   ISSUE AGE/SEX: [35 / Male]

POLICY DATE: [October 15, 2003]             OWNER(S): [John Doe]

ANNUITY
COMMENCEMENT
DATE: [January 5, 2063]                  BENEFICIARY: [Jene Doe]

Fixed Account Guaranteed Minimum Effective Annual Interest Rate: [1.50%]

Before the Annuity Commencement Date:

     Mortality and Expense Risk Fee and Administrative Charge: [.85%]

After the Annuity Commencement Date:

     Mortality and Expense Risk Fee and Administrative Charge: [1.25%]

AV1025SP                             Page 3

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                          SECTION 3 - PREMIUM PAYMENTS

PAYMENT OF PREMIUMS

Premium payments may be made any time while this policy is in force before the
annuity commencement date. You may start or stop, increase or decrease, or skip
any premium payments.

MAXIMUM AND MINIMUM PREMIUM PAYMENT

The minimum initial premium payment is $5,000. If this policy is being issued in
connection with certain tax-qualified plans (such as IRAs, pension plans, or
specially sponsored programs), the minimum initial premium payment is $1,000. No
minimum initial premium payment will be required for 403(b) annuities. The
minimum subsequent premium payment we will accept is $50. The maximum total
premium payments which we will accept without prior Company approval is
$1,000,000 for issue ages 0-80. For issue ages over 80, the maximum total
premium payments which we will accept without prior Company approval is
$500,000. The premium payments may not be more than the amount permitted by law
if this is a tax-qualified annuity. We reserve the right to refuse any premium
payment.

PREMIUM PAYMENT DATE

The premium payment date is the date on which the premium payment is credited to
the policy. The initial premium payment less any applicable premium taxes will
be credited to the policy within two business days of receipt of the premium
payment and the information needed. Subsequent additional premium payments, less
any applicable premium taxes, will be credited to the policy as of the business
day the premium payment and required information are received. A business day is
any day that the New York Stock Exchange is open for trading.

ALLOCATION OF PREMIUM PAYMENTS

We will allocate your premium payment to the investment options you select. Your
allocation must be in whole percentages and must total 100%. We will generally
allocate subsequent premium payments the same way unless you request a different
allocation.

CHANGE OF ALLOCATION

You may change the allocation of premium payments to various investment options
by providing us notice containing the facts that we need. Premium payments
received after the date on which we receive your notice will be applied on the
basis of the new allocation.

PREMIUM TAXES

Any taxes paid by us to any governmental entity relating to this policy will be
deducted from the premium payment or policy value when incurred. We will, at our
sole discretion, determine when taxes relate to the policy, including when they
have resulted from: the investment experience of the separate account; receipt
by us of the premium payments; or commencement of annuity payments. We may, at
our sole discretion, pay taxes when due and deduct that amount from your policy
value at a later date. Payment at an earlier date does not waive any right we
may have to deduct amounts at a later date. We will deduct any withholding taxes
required by applicable law.

                            SECTION 4 - POLICY VALUE

POLICY VALUE

On or before the annuity commencement date, the policy value is the sum of your
separate account value and your fixed account value, minus service charges,
premium taxes, rider fees, and transfer fees, if any.

ADJUSTED POLICY VALUE

The adjusted policy value is the policy value increased or decreased by any
excess interest adjustment.

You may use the adjusted policy value on the annuity commencement date to
provide lifetime income or income for a period of no less than 60 months under
the income options in Section 10.

SERVICE CHARGE

On each policy anniversary and at the time of full surrender during any policy
year before the annuity commencement date, we reserve the right to assess a
service charge up to $35 for policy administration expenses. The service charge
will be deducted from each investment option in proportion to the portion of
policy value (prior to such charge) in each investment option. In no event will
the service charge exceed 2% of the policy value on the policy anniversary or at
the time of full surrender.

The service charge will not be deducted on a policy anniversary or at the time
of full surrender if, at that time, (1) the sum of all premium payments less the
sum of all withdrawals taken equals or exceeds $50,000; or (2) the policy value
equals or exceeds $50,000.

M1672                                Page 4

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                 SECTION 5 - CASH VALUE AND PARTIAL WITHDRAWALS

CASH VALUE

On or before the annuity commencement date, the cash value is equal to the
adjusted policy value less any surrender charges. Information on the current
amount of your policy's cash value is available upon request. The cash value may
be partially withdrawn or will be paid in the event of a full surrender of the
policy. We must receive your written partial withdrawal or surrender request
before the annuity commencement date. After the annuity commencement date, there
is no cash value.

EXCESS INTEREST ADJUSTMENT

Full surrenders, partial withdrawals, transfers, and amounts applied to a
payment option (prior to the end of any guaranteed payment option) from
guaranteed period options of the fixed account described in Section 7 will be
subject to an excess interest adjustment except as provided for in the partial
withdrawals provision below.

An excess interest adjustment also applies when death proceeds are calculated.
However, if the net effect of all excess interest adjustments is negative, we
will not reduce the death proceeds.

The excess interest adjustment is based on any change in interest rates from the
time the affected guaranteed period option started until the time the excess
interest adjustment occurs. The excess interest adjustment is applied as
follows:

1)   The excess interest adjustment is only applied when the transactions occur
     prior to the end of any guaranteed period option;
2)   Transfers to the guaranteed period options of the fixed account are
     considered premium payments for purposes of determining the excess interest
     adjustment;
3)   The excess interest adjustment is distinct from, and is applied prior to,
     the surrender charge;
4)   If interest rates have decreased from the time the affected guaranteed
     period(s) started until the time the transaction occurs, the excess
     interest adjustment will result in additional funds available to you;
5)   If interest rates have increased from the time the affected guaranteed
     period(s) started until the time the transaction occurs, the excess
     interest adjustment will result in a decrease in the funds available to
     you;
6)   Certain amounts are not subject to the excess interest adjustment as
     provided in Sections 5, 7, and 8;
7)   The excess interest adjustment for each guaranteed period option will not
     reduce the adjusted policy value for that guaranteed period option below
     the amount paid into that guaranteed period option, less any prior
     withdrawals and transfers from that guaranteed period option, as they
     occur, all accumulated at the Fixed Account Guaranteed Minimum Effective
     Annual Interest Rate shown on Page 3.

The formula for determining the amount of the excess interest adjustment is as
follows:

Excess Interest Adjustment = S x (G-C) x (M/12)
where: S    is the amount (before surrender charges and premium taxes, if any)
            being surrendered, partially withdrawn, transferred, or applied to a
            payment option that is subject to the excess interest adjustment.
       G    is the guaranteed interest rate for the guaranteed period applicable
            to "S".
       C    is the current guaranteed interest rate then being offered on new
            premium payments for the next longer guaranteed period than "M". If
            this policy form or such a guaranteed period option is no longer
            offered, "C" will be the U.S. Treasury rate for the next longer
            maturity (in whole years) than "M" on the 25th day of the previous
            calendar month, plus up to 2%.
       M    is the number of months remaining in the guaranteed period for "S",
            rounded up to the next higher whole number of months.

U1672                                Page 5

<PAGE>

                              SECTION 5 - CONTINUED

PARTIAL WITHDRAWALS

We will pay you a portion of the cash value as a partial withdrawal provided we
receive your written request while the policy is in effect and before the
annuity commencement date. Partial withdrawals will be deducted in proportion to
the amount of policy value in each investment option unless you tell us
otherwise. If your request for a partial withdrawal from any investment option
is less than or equal to the cash value in that option, we will pay the amount
of your request. However, if your request for a partial withdrawal from any
investment option is greater than the cash value in that option, we will pay you
the cash value of that investment option.

The gross partial withdrawal is the total amount which will be deducted from
your policy value as a result of each partial withdrawal. The gross partial
withdrawal may be more or less than your requested partial withdrawal amount
depending on whether surrender charges and/or excess interest adjustments apply
at the time you request the partial withdrawal.

The formula for determining the gross partial withdrawal is as follows:

Gross Partial Withdrawal = R - E + SC, where:

R    is the requested partial withdrawal;
E    is the excess interest adjustment; and
SC   is the surrender charge on (EPW - E); where
EPW  is the excess partial withdrawal amount (the portion of the requested
     partial withdrawal that is subject to surrender charge).

The excess partial withdrawal amount is the portion of the requested partial
withdrawal that is subject to surrender charge. For example, if the requested
withdrawal amount is $1,000, and the surrender charge-free amount is $200, then
the excess partial withdrawal would be $800. Excess partial withdrawals will
reduce the policy value by an amount equal to (X-Y+Z) where:

X    is excess partial withdrawal
A    is amount of partial withdrawal subject to excess interest adjustment.
Y    is excess interest adjustment = (A) x (G-C) x (M/12) where G, C and M are
     defined in the excess interest adjustment provision above, with "A"
     substituted for "S" in the definitions of G and M.
Z    is surrender charge on X minus Y.

If any partial withdrawal reduces the cash value below $500, we reserve the
right to pay the full cash value and terminate the policy.

We may delay payment of the cash value from the fixed account for up to 6 months
after we receive the surrender or partial withdrawal request. If the annuitant
dies before a surrender or partial withdrawal is processed, the request will be
processed before the death proceeds are determined.

Each partial withdrawal consists of a portion that is subject to a surrender
charge (that is, the excess partial withdrawal) and a remaining portion that is
free from surrender charge (that is, the surrender charge-free amount). Either
portion may be zero (0) depending on the partial withdrawal requested and prior
amounts withdrawn.

Partial withdrawals in the amount of the cumulative interest in the guaranteed
period option(s) of the fixed account at the time of withdrawal may be withdrawn
from the GPO(s) of the fixed account free of any excess interest adjustment.

Amounts withdrawn under one of the options below may reduce the amount available
free of surrender charges under another option. Surrender charges and/or excess
interest adjustment may be waived as described below:

LUMP SUM

Beginning in the first policy year, you may withdraw, free from surrender
charges, a lump sum amount equal to the greater of A or B where:

A    is the cumulative earnings, if any, in the policy value; and

B    is an amount equal to 10% of the total premium payments.

The minimum partial withdrawal under this option is $500. We reserve the right
to limit the availability of this partial withdrawal option to once per policy
year.

P1632                                Page 6

<PAGE>

                              SECTION 5 - CONTINUED

SYSTEMATIC PAYOUT OPTION

Beginning in the first policy year, a systematic payout option (SPO) is
available on a monthly, quarterly, semi-annual, or annual basis. At the time a
SPO payout is made, such payout must be at least $50 and may not exceed the
greater of A or B, divided by the number of payouts made per year (e.g. 12 for
monthly), where:

A    is the cumulative earnings, if any, in the policy value; and

B    is an amount equal to 10% of the total premium payments.

No surrender charges will apply to the SPO payout. Monthly and quarterly payouts
must be sent through electronic funds transfer directly to a checking or savings
account. You may stop SPO payouts by giving us 30 days' written notice.

Once you have elected a SPO, you must wait a minimum time before the first SPO
payment 1 month for monthly, 3 months for quarterly, 6 months for semi-annual,
or 12 months for annual.

If you are receiving SPO payouts and a lump sum withdrawal is taken, such that
future SPO payouts in that policy year will exceed the total annual surrender
charge-free amount, then we will adjust future SPO payouts to reflect your
remaining surrender charge-free amount for that policy year, if any. Your SPO
payouts will be reduced on your next scheduled SPO payout, based on any
remaining surrender charge-free amount. If, after a lump sum withdrawal is
taken, there is no remaining surrender charge free amount, the SPO will be
stopped.

MINIMUM REQUIRED DISTRIBUTION

Partial withdrawals taken to satisfy minimum distribution requirements with
respect to this policy under Section 401(a)(9) of the Internal Revenue Code are
available free of surrender charges.

Systematic minimum required distributions must be at least $50 or a lump sum
distribution is available if systematic minimum required distributions are less
than $50.

NURSING CARE AND TERMINAL CONDITION WITHDRAWAL OPTION

Beginning in the first policy year, if the owner or owner's spouse (annuitant or
annuitant's spouse if the owner is not a natural person) has been 1) confined in
a hospital or nursing facility for 30 consecutive days or 2) diagnosed as having
a terminal condition and the confinement begins or diagnosis is made on or after
the policy date, you may elect to withdraw all or a portion of the policy value
without surrender charges and without an excess interest adjustment. The minimum
withdrawal under this option is $1000. This option is available even during the
policy years other partial withdrawal options were exercised prior to nursing
care.

For nursing care, we must receive each withdrawal request and proof of
eligibility with each request no later than 90 days following the date that
confinement has ceased, unless it can be shown that it was not reasonably
possible to provide the notice and proof within the above time period and that
the notice and proof were given as soon as reasonably possible. However, in no
event, except the absence of legal capacity, shall the notice and proof be
provided later than one year following the date that confinement has ceased.
Proof of confinement may be a physician's statement or a statement from a
hospital or nursing facility administrator.

For a terminal condition, we must receive each withdrawal request and the
applicable proof of eligibility no later than one year following diagnosis of
the terminal condition. Proof of a terminal condition is required only with the
initial withdrawal request and must be furnished by the owner's, owner's
spouse's, annuitant's, or annuitant's spouse's physician.

UNEMPLOYMENT WAIVER

Beginning in the first policy year, you may withdraw all or a portion of the
policy value free of any surrender charges and free of any excess interest
adjustment if the owner or owner's spouse (annuitant or annuitant's spouse, if
the owner is not a natural person) becomes unemployed. In order to qualify, you
1) must have been employed full-time for at least two years prior to your
becoming unemployed, 2) must have been employed full-time on your policy date,
3) must have been unemployed for at least 60 consecutive days at the time of
withdrawal and 4) must have a minimum cash value at the time of withdrawal of
$5000. Proof of unemployment will consist of providing us with a determination
letter from the applicable State's Department of Labor, which verifies that you
qualify for and are receiving unemployment benefits at the time of withdrawal.
The determination letter must be received by us no later than 15 days following
the date of the withdrawal request.

PB1632                               Page 7

<PAGE>

                              SECTION 5 - CONTINUED

SURRENDER CHARGES

Amounts withdrawn in excess of the surrender charge-free amount specified in the
withdrawal provisions above are subject to a surrender charge. The amount of
this charge, if any, will be a percentage, as shown in the table below, of the
amount of premium withdrawn:

Number of Years
 Since Premium      Percentage of
 Payment Date     Premium Withdrawn
---------------   -----------------
      0-1                 5%
      1-2                 4%
      2-3                 3%
      3-4                 2%
      4-5                 1%
      5 or more           0%

For surrender charge purposes, all earnings are considered to be withdrawn
first. After all earnings are withdrawn then the oldest premium payment is the
first premium payment considered to be withdrawn. If the amount withdrawn
exceeds this, the next oldest premium payment is considered to be withdrawn, and
so on until the most recent premium payments are deemed to be withdrawn (the
procedure being applied to Withdrawals of premium is a "First-In, First-Out" or
FIFO procedure).

GUARANTEED RETURN OF FIXED ACCOUNT PREMIUM PAYMENTS

Upon full surrender of the policy, you will always receive at least the premium
payments made to, less prior withdrawals and transfers from, the fixed account.

MINIMUM VALUES

Benefits available under this policy, including any paid up annuity or death
benefits that may be available, are not less than those required by any statute
of the state in which the policy is delivered.

                          SECTION 6 - SEPARATE ACCOUNT

SEPARATE ACCOUNT

We have established and will maintain one or more separate accounts, under the
laws of the state of Iowa. Any realized or unrealized income, net gains and
losses from the assets of the separate account are credited to or charged
against it without regard to our other income, gains, or losses. Assets are put
in the separate account for this policy, as well as for other variable annuity
policies. Any separate account may invest assets in shares of one or more mutual
fund portfolio, or in the case of a managed separate account, direct investments
in stocks or other securities as permitted by law. Fund shares refer to shares
of underlying mutual funds or prorata ownership of the assets held in a
subaccount of a managed separate account. Fund shares are purchased, redeemed,
and valued on behalf of the separate account.

The separate account is divided into subaccounts. Each subaccount invests
exclusively in shares of one of the portfolios of an underlying fund. We reserve
the right to add or remove any subaccount of the separate account.

The assets of the separate account are our property. These assets will equal or
exceed the reserves and other contract liabilities of the separate account.
These assets will not be chargeable with liabilities arising out of any other
business we conduct. We reserve the right, subject to regulations governing the
separate account, to transfer assets of a subaccount, in excess of the reserves
and other contract liabilities with respect to that subaccount to another
subaccount or to our general account.

We will determine the fair market value of the assets of the separate account in
accordance with a method of valuation, which we establish in good faith.
Valuation period means the period of time from one determination of the value of
each subaccount to the next. Such determinations are made when the value of the
assets and liabilities of each subaccount is calculated. This is generally the
close of business on each day on which the New York Stock Exchange is open.

We also reserve the right to transfer assets of the separate account, which we
determine to be associated with the class of policies to which this policy
belongs, to another separate account. If this type of transfer is made, the term
"separate account", as used in the policy, shall then mean the separate account
to which the assets were transferred.

We also reserve the right, when permitted by law, to:

(a)  deregister the separate account under the Investment Company Act of 1940;
(b)  manage the separate account under the direction of a committee at any time;
(c)  restrict or eliminate any voting rights of policy owners or other persons
     who have voting rights as to the separate account;
(d)  combine the separate account with one or more other separate accounts;
(e)  create new separate accounts;
(f)  add new subaccounts to or remove existing subaccounts from the separate
     account, or combine subaccounts; and
(g)  add new underlying mutual funds, remove existing mutual funds, or
     substitute a new fund for an existing fund.

V1552                                Page 8

<PAGE>

                              SECTION 6 - CONTINUED

The net asset value of a fund share is the per-share value calculated by the
mutual fund or, in the case of a managed separate account, by the Company. The
net asset value is computed by adding the value of the subaccount's investments,
cash and other assets, subtracting its liabilities, and then dividing by the
number of shares outstanding. Net asset values of fund shares reflect investment
advisory fees and other expenses incurred in managing a mutual fund or a managed
separate account.

CHANGE IN INVESTMENT OBJECTIVE OR POLICY OF A MUTUAL FUND

If required by law or regulation, an investment policy of the separate account
will only be changed if approved by the appropriate insurance official of the
state of Iowa or deemed approved in accordance with such law or regulation. If
so required, the process for obtaining such approval is filed with the insurance
official of the state or district in which this policy is delivered.

CHARGES AND DEDUCTIONS

The mortality and expense risk fee and the administrative charge are each
deducted both before and after the annuity commencement date to compensate for
changes in mortality and expenses not anticipated by the mortality and
administration charges guaranteed in the policy. The service charge is deducted
prior to the annuity commencement date only.

If the mortality and expense risk fee is more than sufficient, the Company will
retain the balance as profit or may reduce this fee in the future.

ACCUMULATION UNITS

The policy value in the separate account before the annuity commencement date is
represented by accumulation units. The dollar value of accumulation units for
each subaccount will change from business day to business day reflecting the
investment experience of the subaccount. Accumulation units shall be used to
account for all amounts allocated to or withdrawn from a subaccount of the
separate account as a result of premium payments, partial withdrawals,
transfers, or fees and charges.

Transfers and premium payments allocated to the subaccounts will be applied to
provide accumulation units in those subaccounts. The number of accumulation
units purchased in a subaccount will be determined by dividing the dollar amount
allocated to or transferred to that subaccount, by the value of an accumulation
unit for that subaccount on the premium payment or transfer date.

The number of accumulation units withdrawn or transferred from the subaccounts
will be determined by dividing the dollar amount withdrawn or transferred by the
value of an accumulation unit for that subaccount on the withdrawal or transfer
date.

We set the initial accumulation unit value for each subaccount. Subsequent
accumulation unit values for each subaccount are determined by multiplying the
accumulation unit value for the immediately preceding valuation period by the
new investment factor of the subaccount for the current valuation period.

The net investment factor used to calculate the value of an accumulation unit in
each subaccount for the valuation period is determined by dividing (a) by (b)
and subtracting (c) from the result where:

(a)  is the result of:
     (1)  the net asset value of a fund share held in that subaccount determined
          as of the end of the current valuation period; plus
     (2)  the per share amount of any dividend or capital gain distributions
          made by the fund for shares held in that subaccount if the ex-dividend
          date occurs during the valuation period; plus or minus
     (3)  a per share credit or charge for any taxes reserved for, which we
          determine to have resulted from the investment operations of that
          subaccount.
(b)  is the net asset value of a fund share held in that subaccount determined
     as of the end of the immediately preceding valuation period.
(c)  is a factor representing the mortality and expense risk fee and
     administrative charge before the annuity commencement date. This factor is
     less than or equal to, on an annual basis, the percentage shown on the
     Policy Data page of the daily net asset value of a fund share held in that
     subaccount.

Since the net investment factor may be greater or less than one, the
accumulation unit value may increase or decrease.

VB1552                               Page 9

<PAGE>

                            SECTION 7 - FIXED ACCOUNT

FIXED ACCOUNT

The fixed account is comprised of guaranteed period options and the dollar cost
averaging fixed account option that we may choose to offer. Premium payments
applied to and any amounts transferred to the fixed account will reflect a fixed
interest rate. The interest rates we set will be credited for increments of at
least one year measured from each premium payment or transfer date. These rates
will never be less than the Fixed Account Guaranteed Minimum Effective Annual
Interest Rate shown on Page 3.

Upon full surrender of the policy, the cash value will never be less than that
required by the nonforfeiture laws of your state.

We reserve the right, at our sole discretion, to refuse premium payments or
transfers allocated to any of the fixed account options.

GUARANTEED PERIOD OPTIONS

We may offer Guaranteed Period Options in the fixed account, into which premium
payments may be paid or amounts transferred. The current interest rate we set
for funds entering each guaranteed period option is guaranteed until the end of
that option's guaranteed period. At that time, the premium payment made or
amount transferred into the guaranteed period option, less any withdrawals or
transfers from that guaranteed period option, plus accrued interest, may be
rolled into a new guaranteed period option or may be transferred to any
subaccount(s) within the separate account(s).

You may choose the investment option(s) you want the funds transferred into by
giving us a written notice within 30 days before the end of the expiring
option's guaranteed period. However, any guaranteed period elected may not
extend beyond the maximum annuity commencement date defined in Section 11. In
the absence of such election, the funds will be rolled into a new guaranteed
period option which is the same as the expiring guaranteed period option unless
that guaranteed period option is no longer offered. In that case, the funds will
be rolled into the next shorter guaranteed period option available, otherwise
the next longer guaranteed period option available. You will be mailed a notice
of completion of the rollover with the new interest rate applicable. The new
guaranteed period option will be deemed as accepted if we do not receive a
written rejection within 30 days from the postmark date of the completion
notice. We reserve the right at our sole discretion, for new premium payments or
transfers to offer or not to offer any guaranteed period option. If we do not
offer a guaranteed period option and we have not received directions from you in
a form and manner acceptable to us, how the premium payments or funds
transferred are to be allocated, the funds will be placed in any available fixed
account option at the lowest crediting rate then applicable, or otherwise may be
refused as a fixed account premium/transfer. If that occurs, we will require
instructions as to which subaccounts to allocate such premiums/transfers.

When funds are withdrawn or transferred from a guaranteed period option, the
policy value associated with the oldest premium payment or transfer is
considered to be withdrawn or transferred first. If the amount withdrawn or
transferred exceeds the policy value associated with the oldest premium, the
policy value associated with the next oldest premium payment or transfer is
considered to be withdrawn or transferred next and so on until the policy value
associated with the most recent premium payment or transfer is considered to be
withdrawn or transferred.

Partial withdrawals, surrenders, transfers (except those transfers made at the
end of a guaranteed period option), and amounts applied to an income option from
the guaranteed period option(s) are subject to an excess interest adjustment as
described in Section 5.

DOLLAR COST AVERAGING FIXED ACCOUNT OPTION

We may offer a dollar cost averaging fixed account option separate from the
guaranteed period options. This option will have a one-year interest rate
guarantee. The current interest rate we set for the dollar cost averaging fixed
account may differ from the rates credited on the one-year guaranteed period
option in the fixed account. In addition, the current interest rate we credit
may vary on different portions of the dollar cost averaging fixed account. The
credited interest rate will never be less than the Fixed Account Guaranteed
Minimum Effective Annual Interest Rate shown on Page 3. The dollar cost
averaging fixed account option will only be available under a dollar cost
averaging program as described in Section 8.

L1143                                Page 10

<PAGE>

                              SECTION 8 - TRANSFERS

A.   TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE

Prior to the annuity commencement date, you may transfer the policy values from
one investment option to another by notifying us in a form and manner acceptable
to us.

Transfers of policy value from the guaranteed period options of the fixed
account prior to the end of that guaranteed period option are subject to an
excess interest adjustment. No excess interest adjustment will apply to policy
value transfers at the end of a guaranteed period.

If the excess interest adjustment at the time of such policy value transfer
results in a decrease in the funds available to you, then the maximum policy
value transfer is 25% of that guaranteed period option's policy value, less
policy values previously transferred out of that guaranteed period option during
the current policy year. Each such transfer must be separated by a period of 12
months.

If the excess interest adjustment at the time of such policy value transfer
results in additional funds available to you, no maximum will apply to such
policy values transferred from the guaranteed period option.

Transfers of policy value from the separate account are subject to a minimum of
$500 or the entire subaccount policy value, if less. However, if the remaining
subaccount policy value is less than $500, we reserve the right to include that
amount as part of the transfer.

Transfers of interest credited in the guaranteed period options to other
Investment Options are allowed on a "First-In, First-Out" basis. Such transfers
may be made monthly, quarterly, semi-annually, or annually. Each such transfer
must be at least $50 and will not be subject to an excess interest adjustment.

You may choose which guaranteed period option to transfer to or from, however,
any guaranteed period option elected may not extend beyond the maximum annuity
commencement date defined in Section 11.

We reserve the right to limit transfers to no more than 12 in any one policy
year. Any transfers in excess of 12 per policy year may be charged a $10 per
transfer fee. Transfers among multiple investment options will be treated as one
transfer in determining the number of transfers that have occurred. We also
reserve the right, at our sole discretion, to refuse transfers allocated to any
of the fixed account options.

This policy is not designed for professional market timing organizations or
other persons that use programmed, large, or frequent transfers. The use of such
transfers may be disruptive to an underlying portfolio. We reserve the right to
reject any transfer request from any person in the interest of overall fund
management or, if, in our judgment, an underlying fund would be unable to invest
effectively in accordance with its investment objectives and policies or would
otherwise be potentially adversely affected or if an underlying fund would
reject our purchase order. We also reserve the right to revoke your telephone,
fax, and electronic transfer privileges at any time without revoking all owner's
telephone, fax and electronic transfer privileges.

DOLLAR COST AVERAGING OPTION

Prior to the annuity commencement date, you may instruct us to automatically
transfer a specified amount from source accounts made available by us to any
other subaccount(s) of the separate account. The automatic transfers can occur
monthly or quarterly. You may change the subaccounts to which these transfers
are allocated as permitted by us from time to time.

Transfers will continue until the elected source account is depleted. The amount
transferred each time must be at least $500. All transfers from the source
account will be the same amount as the initial transfer. Transfers must be
scheduled for at least 6 months, but not more than 24 months or for at least 4
quarters, but not more than 8 quarters each time the dollar cost averaging
program is started or restarted following termination of the program for any
reason.

Dollar cost averaging results in the purchase of more accumulation units when
the value of the accumulation unit is low, and fewer accumulation units when the
value of the accumulation unit is high. However, there is no guarantee that the
dollar cost averaging program will result in higher policy values or will
otherwise be successful.

Dollar cost averaging may be discontinued before its scheduled completion by
sending written notice to us. If dollar cost averaging is discontinued prior to
the end of the scheduled period, all remaining funds in the dollar cost
averaging fixed account will be transferred at that time. Unless we are notified
otherwise the funds remaining in the dollar cost averaging fixed account will be
transferred to the subaccounts in the percentages currently indicated. While
dollar cost averaging is in effect asset rebalancing is not available.

LB1143                               Page 11

<PAGE>

                              SECTION 8 - CONTINUED

ASSET REBALANCING

Prior to the annuity commencement date, you may instruct us to automatically
transfer amounts among the subaccounts of the separate account on a regular
basis to maintain a desired allocation of the policy value among the various
subaccounts offered. Rebalancing will occur on a monthly, quarterly,
semi-annual, or annual basis, beginning on a date selected by you. You must
select the percentage of the policy value desired in each of the various
subaccounts offered (totaling 100%). Any amounts in the fixed account are
ignored for the purposes of asset rebalancing. Rebalancing can be started,
stopped or changed at any time. Asset rebalancing is not available while dollar
cost averaging is in effect. Rebalancing will cease as soon as we receive a
request for any other transfer.

B.   TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE

After the annuity commencement date, you may transfer the value of the variable
annuity units from one subaccount to another within the separate account or to
the fixed account. If you want to transfer the value of the variable annuity
units, you must provide a signed notice, containing the facts that we need. We
reserve the right to limit transfers between the subaccounts or to the fixed
accounts to once per policy year.

The minimum amount which may be transferred is the lesser of $10 monthly income
or the entire monthly income of the variable annuity units in the subaccount
from which the transfer is being made. If the monthly income of the remaining
units in a subaccount is less than $10, we have the right to include the value
of those variable annuity units as part of the transfer.

After the annuity commencement date, no transfers may be made from the fixed
account to any other investment options.

                           SECTION 9 - DEATH PROCEEDS

A.   DEATH PROCEEDS PRIOR TO ANNUITY COMMENCEMENT DATE

The amount of death proceeds will be the greater of (a) or (b) where:

(a)  is the policy value on the date we receive due proof of death and an
     election of a method of settlement; and
(b)  is the cash value on the date we receive due proof of death and an
     election of a method of settlement.

For purposes of this policy, proof of death means:

(a)  a certified copy of the death certificate; or
(b)  a certified copy of a decree of a court of competent jurisdiction as to a
     finding of death; and
(c)  any other proof or other documents required by us.

Where there are joint annuitants, the death proceeds becomes payable only upon
the death of the surviving annuitant, subject to the distribution requirements
under Subsection B.II. below.

If You have not directed how death proceeds are to be paid by the date of death,
the beneficiary may make such election within one year of the date we receive
due proof of the owner's or annuitant's death as described in Subsection B
below. The beneficiary may elect to receive the death proceeds as a lump sum or
in payments as described in Subsection B below. We will pay interest on death
proceeds as required by law.

We must distribute death proceeds or continue making payments under an income
option under this annuity policy as required in Internal Revenue Code Section
72(s). The requirements of Internal Revenue Code Section 72(s) will override any
provision of this policy to the contrary.

B.   DEATH PRIOR TO ANNUITY COMMENCEMENT DATE

Payment of death proceeds depends on the relationships between the owner,
annuitant, and beneficiary as outlined below.

If there are surviving owners, the surviving owners automatically take the place
of any beneficiary designation.

D569                                 Page 12

<PAGE>

                              SECTION 9 - CONTINUED

I.   Annuitant Death

     When we have due proof that the annuitant died before the annuity
     commencement date, the death proceeds are payable to the beneficiary. If no
     beneficiary is designated and there is no surviving owner, the owner's
     estate will become the beneficiary.

     a)   When the beneficiary is the deceased annuitant's surviving spouse. The
          beneficiary may elect to continue this policy as owner and annuitant
          rather than receiving the death proceeds.

          If the policy is continued, all current surrender charges will be
          waived; however, any premium received after the deceased annuitant's
          death will be subject to any applicable surrender charges.

          If the beneficiary elects to have the death proceeds paid rather than
          continue the policy, the death proceeds must be distributed pursuant
          to subsections b)(1) and (2) below.

     b)   When the beneficiary is an individual who is not the deceased
          annuitant's surviving spouse. The death proceeds must be distributed:

          (1)  by the end of 5 years after the date of the deceased annuitant's
               death, or
          (2)  payments must begin no later than one year after the deceased
               annuitant's death and must be made for a period certain or for
               this beneficiary's lifetime, so long as any period certain does
               not exceed this beneficiary's life expectancy (as defined by the
               Internal Revenue Code and regulations adopted under that Code).
               Election of this option must be made at least 60 days prior to
               the one year anniversary of the annuitant's death.

     c)   When the beneficiary is not a natural person. The death proceeds must
          be distributed within 5 years after the annuitant's death.

II.  Owner Death

     At the death of any owner, all current surrender charges will be waived;
     however, any premium received after the deceased owner's death will be
     subject to any applicable surrender charges.

     If the deceased owner is also the annuitant. Subsection B.I. "Annuitant
     Death" above applies.

     If an owner or joint owner who is not an annuitant dies prior to the
     annuity commencement date and before the entire interest in the policy is
     distributed, the successor owner as defined below will become the new
     owner, and no death proceeds are payable. The person or entity first listed
     below who is alive or in existence on the date of that death will become
     the successor owner:

     a)   surviving owner;
     b)   primary beneficiary;
     c)   contingent beneficiary; or
     d)   deceased owner's estate.

     The successor owner will need to take distributions according to a), b), or
     c) below:

     a)   If the sole successor owner is the deceased owner's spouse, we will
          continue this policy with the successor owner as the new owner.

     b)   If the successor owner is an individual who is not the deceased
          owner's spouse, the adjusted policy value must be distributed:

          (1)  by the end of 5 years after the date of the deceased owner's
               death, or

          (2)  payments must begin no later than one year after the deceased
               owner's death and must be made for a period certain or for the
               successor owner's lifetime, so long as any period certain does
               not exceed the successor owner's life expectancy (as defined by
               the Internal Revenue Code and regulations adopted under that
               Code). Election of this option must be made at least 60 days
               prior to the one year anniversary of the deceased owner's death.

     c)   If the successor owner is not a natural person, the adjusted policy
          value must be distributed within 5 years after the owner's death.

DB569                                Page 13

<PAGE>

                              SECTION 9 - CONTINUED

C.   DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE

The death proceeds on or after the annuity commencement date depend on the
payment option selected. If any owner dies on or after the annuity commencement
date, but before the entire interest in the policy is distributed, the remaining
portion of such interest in the policy will be distributed to the beneficiary at
least as rapidly as under the method of distribution being used as of the date
of that death.

D.   AN OWNER IS NOT AN INDIVIDUAL

If any owner is not an individual, then for purposes of the provisions in
subsection B or C above, (1) the primary annuitant will be treated as the owner
of the policy, and (2) the death of, or any change in, the primary annuitant,
will be treated as the death of the owner.

                           SECTION 10 - INCOME OPTIONS

A.   GENERAL PAYMENT PROVISIONS

Payment

If this policy is in force on the annuity commencement date, we will use the
fixed account portion and/or the separate account portion of the adjusted policy
value to make payments under an income option to the payee under fixed income
option 2 and/or variable income option 3-V, respectively, with 1O years certain,
or if elected, under one or more of the other income options described in this
section, or any other method of payment if we agree. However, the income option
elected must provide for lifetime income or income for a period of at least 60
months. You will become the annuitant upon annuitization, unless the owner is
not a natural person. Payments will be made at 1, 3, 6, or 12-month intervals.
We reserve the right to change the frequency of payments to avoid making
payments of less than $50.

Before the annuity commencement date, if the death proceeds become payable, or
if you surrender this policy, we will pay any proceeds in one sum, or if
elected, all or part of these proceeds may be applied to one or more of the
income options described in this section, or any other method of payment if we
agree.

Adjusted Age

Payments under fixed income options 2 and 4 and the first payment under variable
income options 3-V and 5-V are determined based on the adjusted age of the
annuitant. The adjusted age is the annuitant's actual age on the annuitant's
nearest birthday, at the annuity commencement date, adjusted as follows:

     Annuity
Commencement Date      Adjusted Age
-----------------      ------------
   Before 2010      Actual Age
   2010 - 2019      Actual Age minus 1
   2020 - 2026      Actual Age minus 2
   2027 - 2033      Actual Age minus 3
   2034 - 2040      Actual Age minus 4
   After 2040       Determined by Us

Election of Optional Method of Payment

Before the annuity commencement date, you can elect or change an income option.
You may elect in a notice in a form and manner acceptable to us, income options
that may be either variable, fixed, or a combination of both. If you elect a
combination, you must also tell us what part of the adjusted policy value on the
annuity commencement date are to be applied to provide each type of payment (You
must also specify which subaccounts.) The amount of a combined payment will be
the sum of the variable and fixed payments. Payments under a variable income
option will reflect the investment performance of the selected subaccount(s) of
the separate account.

Payee

Unless you specify otherwise, the payee shall be the annuitant, or the
beneficiary as described in Section 11.

In the event of the death of a payee who is not the annuitant prior to the end
of payments pursuant to the terms of the income option chosen, payments will be
continued to the beneficiary or their present value may be paid in a single sum.

Proof of Age

We may require proof of the age of any person who elects income options 2, 3-V,
4 and 5-V of this Section before we make the first payment.

Minimum Proceeds

If the proceeds are less than $2,000, we reserve the right to pay them out as a
lump sum instead of applying them to an income option.

Premium Tax

We may be required by law to pay premium tax on the amount applied to an income
option. If so, we will deduct the premium tax before applying the proceeds.

Supplementary Contract

Once proceeds become payable and an income option has been selected, we will
issue a supplementary contract to reflect the terms of the selected income
option. The supplemental contract will name the payee(s) and will describe the
payment schedule.

S1259                                Page 14

<PAGE>

                             SECTION 10 - CONTINUED

B.   FIXED INCOME OPTIONS

Guaranteed Income Options

The amount of the fixed payment is determined by multiplying each $1,000 of
policy proceeds allocated to fixed income option 1, 2, or 4 by the amounts shown
on pages 18 and 19 for the option you select. Income options 1 and 3 are based
on the guaranteed interest rate shown on page 18. Income options 2 and 4 are
based on the guaranteed interest rate shown on page 18 and the "Annuity 2000"
(male, female, and unisex if required by law) mortality table projected for
improvement using projection scale G.

Fixed Income Option 1 - Income for a Specified Period

We will make level payments only for the specific period you choose. The
specified period may not exceed your life expectancy. No funds will remain at
the end of the specified period.

Fixed Income Option 2 - Life Income

You may choose between:

(a)  No Period Certain - We will make level payments only during the annuitant's
     lifetime
(b)  10 Years Certain - We will make level payments for the longer of the
     annuitant's lifetime or ten years.
(c)  Guaranteed Return of Policy Proceeds - We will make level payments for the
     longer of the annuitant's lifetime or until the total dollar amount of
     payments equals the amount applied to this option.
(d)  Life with Emergency Cash (SM) - We will make level payments during the
     annuitants lifetime, but the annuity may be surrendered (in full or part).
     The emergency cash value is equal to a multiple of the payment where that
     multiple reduces over time to zero at age 101. We will apply a surrender
     charge. Should the annuitant die before age 101 (or, for qualified
     policies, the applicable age based on IRS Life Expectancy tablet(s) if
     earlier), the same value would be payable, but without the surrender
     charge.

Fixed income options 2(a) and 2(d) are not available for annuitant adjusted
age(s) greater than 85.

Fixed Income Option 3 - Income of a Specified Amount

We will make payments for any specified amount you choose until the amount
applied to this option, with interest, is exhausted. The duration of the
payments may not exceed the annuitant's life expectancy. This will be a series
of level payments followed by a smaller final payment.

Fixed Income Option 4 - Joint and Survivor Annuity

You may choose between:

(a)  No Period Certain - We will make payments during the joint lifetime of the
     annuitant and a joint annuitant of your choosing. We will make payments as
     long as either person is living.

(b)  Life with Emergency Cash (SM) - We will make level payments during the
     joint lifetime of the annuitant and a joint annuitant of your choosing. We
     will make payments as long as either person is living, but the annuity may
     be surrendered (in full or part). The emergency cash value is equal to a
     multiple of the payment, where that multiple reduces over time to zero at
     age 101 of the younger annuitant. We will apply a surrender charge. Should
     the last surviving annuitant die before age 101 (or, for qualified
     policies, the applicable age based on IRS Life Expectancy table(s) if
     earlier), the same value would be payable, but without the surrender
     charge.

Fixed income options 4(a) and 4(b) are not available for annuitant adjusted
age(s) greater than 85.

Current Income Options

The amounts shown in the tables on pages 18 and 19 are the guaranteed amounts.
You may obtain current amounts we offer to individuals of the same class,
subject to availability as described under "Guaranteed Income Options" above.

SB1259                               Page 15

<PAGE>

                             SECTION 10 - CONTINUED

C.   VARIABLE INCOME OPTIONS

Variable Annuity Units

We will use the adjusted policy value you tell us to apply to a variable income
option to purchase variable annuity units in your chosen subaccounts. The dollar
value of variable annuity units in your chosen subaccounts will increase or
decrease reflecting the investment experience of your chosen subaccounts. The
value of a variable annuity unit in a particular subaccount on any business day
is equal to (a) multiplied by (b) multiplied by (c), where:

(a)  is the variable annuity unit value for that subaccount on the immediately
     preceding business day;
(b)  is the net investment factor for that subaccount for the valuation period;
     and
(c)  is the assumed investment return adjustment factor for the valuation
     period.

The assumed investment return adjustment factor for the valuation period is the
product of daily discount factors which reflect the effective annual assumed
investment return shown on page 20.

The net investment factor used to calculate the value of a variable annuity unit
in each subaccount for the valuation period is determined by dividing (a) by (b)
and subtracting (c) from the result, where:

(a)  is the net result of:

     (1)  the net asset value of a fund share held in that subaccount determined
          as of the end of the current valuation period; plus
     (2)  the per share amount of any dividend or capital gain distributions
          made by the fund for shares held in that subaccount if the ex-dividend
          date occurs during the valuation period; plus or minus
     (3)  a per share credit or charge for any taxes reserved for, which we
          determine to have resulted from the investment operations of the
          subaccount.

(b)  is the net asset value of a fund share held in that subaccount determined
     as of the end of the immediately preceding valuation period.

(c)  is a factor representing the mortality and expense risk fee and
     administrative charge applicable after the annuity commencement date. This
     factor is less than or equal to, on an annual basis, the percentage shown
     on the Policy Data page, plus any additional fee applicable to the initial
     payment guarantee of the daily net asset value of a fund share held in the
     separate account for that subaccount.

Determination of the First Variable Payment

The amount of the first variable payment is determined by multiplying each
$1,000 of adjusted policy value allocated to a variable income option by the
amounts shown on the variable income option table for the variable income option
you select. The tables are based on the effective annual assumed investment
return shown on page 20 and the "Annuity 2000" (male, female, and unisex if
required by law) mortality table projected for improvement using projection
scale G.

Variable Income Option 3-V - Life Income You may choose between:

(a)  No Period Certain - We will make payments during the lifetime of the
     annuitant.

(b)  10 Years Certain - We will make payments for the longer of the annuitant's
     lifetime or ten years.

(c)  Life with Emergency Cash (SM) - We will make payments during the
     annuitant's lifetime, but the annuity may be surrendered (in full or part).
     The emergency value is equal to a multiple of the supportable payment (see
     definition below), where that multiple reduces over time to zero at age
     101. We will apply a surrender charge. Should the annuitant die before age
     101 (or, for qualified policies, the applicable age based on IRS Life
     Expectancy table(s) if earlier), the same value would be payable, but
     without the surrender charge.

Variable Income Options 3-V(a) and 3-V(c) are not available for adjusted age(s)
greater than 85.

C938                                 Page 16

<PAGE>

                             SECTION 10 - CONTINUED

Variable Income Option 5-V - Joint and Survivor Annuity

You may choose between:

(a)  No Period Certain - We will make payments as long as either the annuitant
     or the joint annuitant is living.

(b)  Life with Emergency Cash (SM) - We will make payments during the joint
     lifetime of the annuitant and a joint annuitant of your selection. Payments
     will be made as long as either person is living, but the annuity may be
     surrendered (in full or part). The emergency cash value is equal to a
     multiple of the supportable payment (see definition below), where that
     multiple reduces over time to zero at age 101 of the younger annuitant. We
     will apply a surrender charge. Should the last surviving annuitant die
     before age 101 (or, for qualified policies, the applicable age based on IRS
     Life Expectancy table(s) if earlier), the same value would be payable, but
     without the surrender charge.

Variable Income Options 5-V(a) and 5-V(b) are not available for annuitant
adjusted age(s) greater than 85.

Initial Payment Guarantee

At the time you annuitize, you may elect an initial payment guarantee under
which we guarantee your variable annuity payments will never be less than a
percentage of the initial variable annuity payment. You cannot terminate the
initial payment guarantee after you have elected it. The percentage applicable
to the initial payment and the additional fee for this option will be those
currently applicable at the time of annuitization.

Supportable Payment

The supportable payment is the sum of each selected subaccount's variable
annuity unit value times the number of variable annuity units. The variable
annuity units are adjusted to reflect the year-to-date difference between the
stabilized payment and the payment had they not been stabilized. Supportable
payments are used to determine surrender values, death benefits and transfers.

Determination of Subsequent Variable Payments Without Stabilization

The number of variable annuity units in each selected subaccount is determined
by dividing the first variable annuity payment allocated to the subaccount by
the variable annuity unit value of that subaccount on the annuity commencement
date. The amount of each variable annuity payment after the first payment will
increase or decrease according to the value of the variable annuity units which
reflect the investment experience of the selected subaccounts. Each variable
annuity payment after the first payment will be equal to the number of variable
annuity units in the selected subaccounts multiplied by the variable annuity
unit value on the date the payment is made.

Determination of Subsequent Variable Payments With Stabilization

If "Life with Emergency Cash" is chosen (Variable Income Option 3-V(c) or
5-V(b)). or if the initial payment guarantee is chosen, variable annuity
payments during the first year following the annuity commencement date will be
stabilized to equal the initial payment. On each anniversary of the annuity
commencement date, the stabilized variable annuity payment will be increased or
decreased (but never below the guaranteed payment if the initial payment
guarantee is chosen) and held level for that year. On each anniversary of the
annuity commencement date, the stabilized variable annuity payment will equal
the supportable payment at that time (or if the initial payment guarantee is
chosen, the stabilized variable payment will equal the greater of the guaranteed
payment or the supportable payment at that time).

If the payment without stabilization (at any payment date during the year) is
greater than the stabilized variable annuity payment for that year, the excess
will be used to purchase additional annuity units (as described below). If the
payment without stabilization (at any payment date during the year) is less than
the stabilized variable annuity payment for that year, annuity units will be
redeemed (as described below) to fund the deficiency.

Purchase/Redemption of Annuity Units with Stabilized Variable Annuity Payments

The number of annuity units purchased or redeemed is equal to the annuity income
purchased or redeemed, respectively, divided by the annuity unit value for each
respective subaccount. Purchases and redemptions of annuity income will be
allocated to each subaccount on a proportionate basis. The amount of annuity
income purchased or redeemed is the difference between the payment without
stabilization during that year and the stabilized variable annuity payment,
times an attained adjusted age nearest birthday payment factor divided by
$1,000. The payment factor will reflect any remaining guaranteed payments, if
any, and is determined using the same assumptions for mortality and interest as
the payment factors listed in this policy for Variable Income Options 3-V and
5-V.

CB938                                Page 17

<PAGE>

                       GUARANTEED FIXED INCOME OPTIONS **

   The amounts shown in these tables are the guaranteed amounts for each 1,000
     of the proceeds. Higher current amounts may be available at the time of
                                   settlement.

<TABLE>
<CAPTION>
---------------------------------------------------------------------------------------------------------------------------------
       Option 1                   Option 2 (a)              Option 2 (b)              Option 2 (C)              Option 2 (d)
---------------------------------------------------------------------------------------------------------------------------------
 Number
   of     Amount of            Monthly Installment                               Monthly Installment For    Monthly Installment
 Years     Monthly             For Life No Period      Monthly Installment For   Life Guaranteed Return        For Life With
Payable  Installment                Certain             Life 10 Years Certain      of Policy Proceeds       Emergency Cash (SM)
---------------------------------------------------------------------------------------------------------------------------------
                      Age*   Male    Female   Unisex   Male   Female   Unisex    Male    Female   Unisex   Male   Female   Unisex
---------------------------------------------------------------------------------------------------------------------------------
<S>         <C>        <C>  <C>      <C>      <C>     <C>      <C>      <C>     <C>      <C>      <C>     <C>      <C>      <C>
                       50   $ 2.97   $ 2.86   $ 2.90  $2.96    $2.86    $2.89   $ 2.79   $ 2.74   $ 2.76  $2.69    $2.66    $2.67
                       51     3.04     2.92     2.96   3.02     2.91     2.94     2.84     2.79     2.80   2.74     2.70     2.72
                       52     3.10     2.98     3.02   3.08     2.97     3.01     2.89     2.84     2.85   2.79     2.75     2.76
                       53     3.18     3.05     3.09   3.16     3.03     3.07     2.94     2.89     2.90   2.84     2.80     2.81
   5        17.28      54     3.25     3.11     3.15   3.22     3.10     3.14     3.00     2.94     2.96   2.89     2.85     2.86
   6        14.51      55     3.33     3.18     3.23   3.30     3.17     3.21     3.06     3.00     3.02   2.94     2.90     2.91
   7        12.63      56     3.41     3.26     3.30   3.38     3.24     3.28     3.12     3.06     3.07   3.00     2.96     2.97
   8        11.04      57     3.50     3.34     3.39   3.46     3.32     3.36     3.18     3.12     3.14   3.06     3.01     3.03
   9         9.89      58     3.60     3.47     3.47   3.55     3.39     3.44     3.25     3.18     3.20   3.12     3.07     3.08
  10         8.98      59     3.69     3.51     3.56   3.65     3.48     3.53     3.32     3.25     3.27   3.18     3.13     3.15
  11         8.21      60     3.80     3.60     3.66   3.75     3.57     3.62     3.39     3.32     3.34   3.25     3.20     3.21
  12         7.58      61     3.91     3.70     3.76   3.85     3.66     3.72     3.48     3.39     3.41   3.32     3.27     3.28
  13         7.05      62     4.03     3.81     3.87   3.96     3.76     3.82     3.54     3.47     3.49   3.35     3.34     3.35
  14         6.59      63     4.16     3.92     3.99   4.07     3.87     3.93     3.63     3.55     3.57   3.47     3.41     3.43
  15         6.20      64     4.30     4.04     4.12   4.20     3.98     4.04     3.72     3.63     3.66   3.55     3.49     3.51
  16         5.85      65     4.45     4.16     4.25   4.32     4.09     4.16     3.81     3.72     3.75   3.63     3.57     3.59
  17         5.55      66     4.60     4.30     4.39   4.46     4.22     4.29     3.91     3.81     3.84   3.72     3.66     3.68
  18         5.27      67     4.77     4.45     4.54   4.60     4.35     4.42     4.01     3.91     3.94   3.81     3.75     3.77
  19         5.03      68     4.95     4.60     4.71   4.75     4.49     4.57     4.11     4.01     4.04   3.90     3.85     3.86
  20         4.81      69     5.14     4.77     4.88   4.90     4.64     4.71     4.23     4.12     4.15   4.01     3.95     3.96
                       70     5.34     4.95     5.07   5.06     4.79     4.87     4.34     4.24     4.27   4.11     4.05     4.07
                       71     5.56     5.16     5.27   5.22     4.95     5.03     4.47     4.36     4.39   4.22     4.17     4.18
                       72     5.79     5.36     5.49   5.39     5.12     5.20     4.60     4.49     4.52   4.34     4.29     4.30
                       73     6.03     5.59     5.72   5.56     5.30     5.38     4.73     4.62     4.66   4.46     4.40     4.42
                       74     6.30     5.83     5.97   5.74     5.49     5.57     4.88     4.77     4.80   4.59     4.54     4.55
                       75     6.58     6.10     6.24   5.93     5.68     5.76     5.03     4.92     4.95   4.72     4.67     4.69
                       76     6.88     6.39     6.53   6.11     5.88     5.95     5.18     5.08     5.11   4.85     4.81     4.82
                       77     7.20     6.70     6.85   6.30     6.09     6.15     5.36     5.25     5.28   5.00     4.96     4.97
                       78     7.55     7.03     7.19   6.49     6.30     6.36     5.53     5.43     5.46   5.15     5.12     5.12
                       79     7.92     7.40     7.55   6.68     6.51     6.56     5.71     5.61     5.64   5.31     5.26     5.29
                       80     8.32     7.79     7.95   6.87     6.72     6.77     5.90     5.81     5.84   5.48     5.45     5.46
                       81     8.75     8.22     8.38   7.06     6.93     6.97     6.11     6.02     6.05   5.67     5.84     5.64
                       82     9.20     8.69     8.84   7.24     7.13     7.16     6.32     6.24     6.27   5.84     5.83     5.84
                       83     9.69     9.19     9.34   7.41     7.33     7.36     6.55     6.48     6.50   6.05     6.04     6.04
                       84    10.21     9.74     9.88   7.58     7.52     7.54     6.78     6.72     6.74   6.24     6.24     6.24
                       85    10.77    10.33    10.46   7.74     7.69     7.71     7.03     6.98     7.00   6.48     6.48     6.48
                       86                              7.89     7.86     7.87     7.29     7.26     7.27
                       87                              8.03     8.01     8.01     7.57     7.54     7.55
                       88                              8.16     8.15     8.15     7.86     7.84     7.85
                       89                              8.28     8.27     8.27     8.17     8.15     8.16
                       90                              8.38     8.38     8.38     8.49     8.48     8.48
                       91                              8.48     8.48     8.48     8.83     8.82     8.83
                       92                              8.57     8.57     8.57     9.19     9.18     9.19
                       93                              8.65     8.64     8.65     9.58     9.56     9.57
                       94                              8.72     8.71     8.71    10.00     9.97     9.98
                       95                              8.78     8.77     8.77    10.45    10.40    10.42
---------------------------------------------------------------------------------------------------------------------------------
</TABLE>

*Adjusted age as defined in Section 10.A.

** The guaranteed fixed income amounts are based on a guaranteed interest rate
of [1.5%.]

Dollar amounts of monthly, quarterly, semi-annual and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company (if the option is available based on
adjusted age as described in Section 10).

T1031                                Page 18

<PAGE>

                            Fixed Income Option 4 (a)
                 Monthly Installment For Joint and Full Survivor

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------
                                       Adjusted Age of Female Annuitant*
Adjusted Age   -------------------------------------------------------------------------------
     of         15 Years    12 Years    9 Years     6 Years     3 Years               3 Years
    Male       Less Than   Less Than   Less Than   Less Than   Less Than   Same As   More Than
 Annuitant*       Male        Male        Male        Male        Male       Male       Male
----------------------------------------------------------------------------------------------
<S>              <C>         <C>         <C>         <C>         <C>        <C>        <C>
     50          $2.20       $2.27       $2.34       $2.41       $2.48      $2.55      $2.62
     55           2.35        2.44        2.52        2.61        2.71       2.80       2.88
     60           2.54        2.64        2.76        2.88        2.99       3.11       3.23
     65           2.77        2.91        3.06        3.22        3.38       3.54       3.69
     70           3.08        3.26        3.46        3.67        3.89       4.11       4.33
     75           3.47        3.72        3.99        4.29        4.60       4.93       5.24
     80           4.01        4.35        4.74        5.17        5.62       6.08       6.53
     85           4.75        5.25        5.81        6.44        7.09       7.76       8.36
----------------------------------------------------------------------------------------------
</TABLE>

             Monthly Installment For Unisex Joint and Full Survivor

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------
                                       Adjusted Age of Joint Annuitant*
Adjusted Age   -------------------------------------------------------------------------------
     of         15 Years    12 Years    9 Years     6 Years     3 Years               3 Years
   First       Less Than   Less Than   Less Than   Less Than   Less Than   Same As   More Than
 Annuitant*      First       First       First       First       First      First      First
----------------------------------------------------------------------------------------------
<S>              <C>         <C>         <C>         <C>         <C>        <C>        <C>
     50          $2.20       $2.27       $2.34       $2.41       $2.48      $2.55      $2.61
     55           2.36        2.44        2.53        2.62        2.70       2.79       2.87
     60           2.56        2.65        2.76        2.88        2.99       3.10       3.20
     65           2.79        2.92        3.07        3.22        3.37       3.52       3.68
     70           3.10        3.28        3.47        3.67        3.88       4.09       4.28
     75           3.60        3.75        4.02        4.30        4.60       4.89       5.16
     80           4.06        4.40        4.78        5.19        5.62       6.04       6.44
     85           4.83        5.32        5.87        6.47        7.10       7.71       8.28
----------------------------------------------------------------------------------------------
</TABLE>

                            Fixed Income Option 4 (b)
                 Monthly Installment For Joint and Full Survivor
                         (Life with Emergency Cash (SM))

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------
                                       Adjusted Age of Joint Annuitant*
Adjusted Age   -------------------------------------------------------------------------------
     of         15 Years    12 Years    9 Years     6 Years     3 Years               3 Years
    Male       Less Than   Less Than   Less Than   Less Than   Less Than   Same As   More Than
 Annuitant*       Male        Male        Male        Male        Male       Male       Male
----------------------------------------------------------------------------------------------
<S>              <C>         <C>         <C>         <C>         <C>        <C>        <C>
     50          $2.16       $2.21       $2.28       $2.35       $2.42      $2.49      $2.54
     55           2.28        2.36        2.45        2.53        2.62       2.70       2.77
     60           2.45        2.54        2.65        2.76        2.87       2.97       3.06
     65           2.64        2.77        2.90        3.04        3.18       3.31       3.42
     70           2.89        3.04        3.21        3.39        3.57       3.75       3.89
     75           3.19        3.39        3.61        3.84        4.08       4.30       4.47
     80           3.57        3.83        4.12        4.42        4.73       5.02       5.23
     85           4.06        4.41        4.78        5.17        5.57       5.98       6.23
----------------------------------------------------------------------------------------------
</TABLE>

             Monthly Installment For Unisex Joint and Full Survivor
                         (Life with Emergency Cash (SM))

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------
                                       Adjusted Age of Joint Annuitant*
Adjusted Age   -------------------------------------------------------------------------------
     of         15 Years    12 Years    9 Years     6 Years     3 Years               3 Years
   First       Less Than   Less Than   Less Than   Less Than   Less Than   Same As   More Than
 Annuitant*      First       First       First       First       First      First      First
----------------------------------------------------------------------------------------------
<S>              <C>         <C>         <C>         <C>         <C>        <C>        <C>
     50          $2.16       $2.22       $2.28       $2.35       $2.42      $2.49      $2.54
     55           2.29        2.37        2.45        2.53        2.62       2.70       2.76
     60           2.45        2.56        2.65        2.76        2.87       2.97       3.05
     65           2.65        2.78        2.91        3.04        3.18       3.31       3.40
     70           2.90        3.06        3.22        3.40        3.57       3.74       3.86
     75           3.21        3.41        3.62        3.86        4.08       4.29       4.45
     80           3.60        3.86        4.14        4.44        4.73       5.02       5.21
     85           4.08        4.43        4.80        5.18        5.58       5.97       6.21
----------------------------------------------------------------------------------------------
</TABLE>

* Adjusted age as defined in Section 10.A.

Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company (if the option is available based on
adjusted age as described in Section 10).

TB1031                               Page 19

<PAGE>

                             VARIABLE INCOME OPTIONS
                      BASED ON ASSUMED INVESTMENT RETURN ..

   The amounts shown in these tables are the initial payment amounts based on
      a [5.0%] assumed investment return for each $1,000 of the proceeds.

<TABLE>
<CAPTION>
-------------------------------------------------------------------------------------------------
              Option 3-V (a)                 Option 3-V (b)                 Option 3-V (c)
-------------------------------------------------------------------------------------------------
       Monthly Installment for Life   Monthly Installment for Life   Monthly Installment for Life
             No Period Certain              10 Years Certain           With Emergency Cash (SM)
-------------------------------------------------------------------------------------------------
Age*      Male    Female   Unisex        Male    Female   Unisex         Male   Female   Unisex
-------------------------------------------------------------------------------------------------
<S>      <C>      <C>      <C>          <C>      <C>      <C>           <C>      <C>     <C>
 50      $ 5.07   $ 4.93   $ 4.98       $ 5.04   $ 4.92   $ 4.95        $4.83    $4.76   $4.78
 51        5.13     4.99     5.03         5.09     4.96     5.00         4.87     4.80    4.82
 52        5.19     5.04     5.08         5.15     5.01     5.05         4.92     4.84    4.86
 53        5.26     5.10     5.14         5.21     5.07     5.11         4.96     4.88    4.91
 54        5.33     _.16     5.21         5.27     5.12     5.17         5.01     4.93    4.95
 55        5.40     _.22     5.27         5.34     5.18     6.23         5.06     4.98    5.00
 56        5.48     5.29     5.36         5.41     5.25     5.30         5.12     5.03    5.05
 57        5.57     5.36     5.42         5.49     5.32     5.37         5.18     5.08    5.11
 58        5.66     5.44     5.50         5.57     5.39     5.44         5.24     5.14    5.17
 59        5.75     5.52     5.59         5.66     5.47     5.52         5.31     5.20    5.23
 60        5.85     5.61     5.68         5.75     5.55     5.61         5.37     5.26    5.29
 61        5.97     5.70     5.78         5.85     5.63     5.70         5.46     5.33    5.37
 62        6.09     5.81     5.89         5.95     5.72     5.79         5.5_     5.40    5.44
 63        6.21     5.91     6.00         6.06     5.82     5.89         5.61     5.48    5.52
 64        6.35     _.03     6.13         6.17     5.92     6.00         5.70     5.56    5.60
 65        6.50     6.16     6.26         6.29     6.03     6.11         5.79     5.65    5.69
 66        6.66     6.29     6.40         6.42     6.15     6.23         5.89     5.75    5.79
 67        6.83     6.43     6.55         6.65     6.27     6.36         6.00     5.85    5.89
 68        7.01     6.59     6.71         6.69     6.40     6.49         6.11     5.96    6.00
 69        7.21     6.76     6.89         6.83     6.54     6.63         6.23     6.07    6.12
 70        7.41     6.94     7.08         6.98     6.69     6.77         6.36     6.20    6.25
 71        7._3     7.14     7.28         7.13     6.84     6.93         6.49     6.33    6.38
 72        7.87     7.35     7._0         7.28     7.00     7.09         6.63     6.46    6.52
 73        8.12     7.58     7.74         7.45     7.17     7.25         6.7_     6.62    6.66
 74        8.39     7.83     8.00         7.61     7.34     7.42         6.94     6.78    6.83
 75        8.68     8.11     8.28         7.78     7.52     7.60         7.11     6.95    7.00
 76        8.99     8.40     8.58         7.95     7.71     7.78         7.29     7.13    7.18
 77        9.32     8.72     8.90         8.12     7.80     7.97         7.47     7.33    7.36
 78        9.68     9.07     9.25         8.29     8.09     8.16         7.68     7.52    7.57
 79       10.06     9.45     9.63         8.47     8.29     8.34         7.88     7.74    7.79
 80       10.47     9.85    10.04         8.64     8.48     8.53         8.11     7.88    8.01
 81       10.91    10.30    10.48         8.80     8._7     8.71         8.34     8.29    8.26
 82       11.38    10.78    10.96         8.97     8.86     8.89         8._0     8.48    8.53
 83       11.88    11.30    11.47         9.12     9.04     9.0_         8.84     8.75    8.77
 84       12.42    11.87    12.03         9.27     9.21     9.23         9.09     9.01    9.05
 85       12.99    12.48    12.63         9.41     9.37     9.38         9.35     9.31    9.32
 86                                       9.54     9.51     9.52
 87                                       9.67     9.85     9.65
 88                                       9.78     9.77     9.77
 89                                       9.89     9.88     9.88
 90                                       9.98     9.98     9.98
 91                                      10.07    10.07    10.07
 92                                      10.15    10.15    10.15
 93                                      10.22    10.22    10.22
 94                                      10.28    10.28    10.2_
 95                                      10.34    10.33    10.33
-------------------------------------------------------------------------------------------------
</TABLE>

* Adjusted age as defined in Section 10.A.

** The discount factor per day which corresponds to the assumed investment
return of [5.0%] is [99986634.]

Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company (if the option is available based on
adjusted age as described in Section 10).

H1322                                Page 20

<PAGE>

                         Variable Income Option 5-V (a)
                 Monthly Installment For Joint and Full Survivor

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------
                                      Adjusted Age of Female Annuitant*
Adjusted Age   -------------------------------------------------------------------------------
    of          15 Years    12 Years    9 Years     6 Years     3 Years               3 Years
   Male        Less Than   Less Than   Less Than   Less Than   Less Than   Same As   More Than
 Annuitant*       Male        Male        Male        Male        Male       Male       Male
----------------------------------------------------------------------------------------------
<S>              <C>         <C>         <C>         <C>         <C>        <C>        <C>
     50          $4.37       $4.42       $4.46       $4.51       $4.66      $4.62      $ 4.67
     55           4.48        4.54        4.60        4.67        4.74       4.81        4.88
     60           4.62        4.70        4.79        4.88        4.98       5.08        5.18
     65           4.81        4.92        5.04        5.17        5.31       5.46        5.61
     70           5.07        5.23        5.40        5.59        6.79       6.00        6.22
     75           5.43        5.66        5.90        6.18        6.48       6.79        7.11
     80           5.94        6.26        6.63        7.04        7.49       7.95        8.40
     85           6.67        7.15        7.70        8.31        8.97       9.63       10.26
----------------------------------------------------------------------------------------------
</TABLE>

             Monthly Installment For Unisex Joint and Full Survivor

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------
                                      Adjusted Age of Joint Annuitant*
Adjusted Age   -------------------------------------------------------------------------------
    of          15 Years    12 Years    9 Years     6 Years     3 Years               3 Years
   First       Less Than   Less Than   Less Than   Less Than   Less Than   Same As   More Than
 Annuitant*      First       First       First       First       First      First      First
----------------------------------------------------------------------------------------------
<S>              <C>         <C>         <C>         <C>         <C>        <C>        <C>
     50          $4.38       $4.42       $4.47       $4.51       $4.56      $4.61      $ 4.66
     55           4.48        4.54        4.60        4.67        4.73       4.80        4.87
     60           4.63        4.70        4.79        4.88        4.97       5.07        5.16
     65           4.82        4.93        5.06        5.17        5.30       5.44        5.57
     70           5.09        5.24        5.41        5.59        5.78       5.97        6.16
     75           5.46        5.68        5.93        6.19        6.47       6.75        7.03
     80           5.99        6.31        6.67        7.07        7.48       7.90        8.30
     85           6.75        7.23        7.76        8.35        8.97       9.59       10.17
----------------------------------------------------------------------------------------------
* Adjusted age as defined in Section 10.A
----------------------------------------------------------------------------------------------
</TABLE>

                         Variable Income Option 5-V (b)
                 Monthly Installment For Joint and Full Survivor
                        (Life with Emergency Cash (SM))

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------
                                      Adjusted Age of Female Annuitant*
Adjusted Age   -------------------------------------------------------------------------------
    of          15 Years    12 Years    9 Years     6 Years     3 Years               3 Years
   Male        Less Than   Less Than   Less Than   Less Than   Less Than   Same As   More Than
 Annuitant*      First       First       First       First       First      First      First
----------------------------------------------------------------------------------------------
<S>              <C>         <C>         <C>         <C>         <C>        <C>        <C>
     50          $4.34       $4.38       $4.42       $4.47       $4.51      $4.57      $4.61
     55           4.43        4.48        4.54        4.60        4.67       4.74       4.79
     6O           4.55        4.82        4.70        4.78        4.88       4.97       5.06
     65           4.71        4.80        4.91        5.03        5.16       5.30       5.41
     70           4.92        5.05        5.21        5.38        5.56       5.76       5.91
     75           5.21        5.40        5.61        5.66        6.12       6.40       6.61
     80           5.61        5.88        6.19        6.53        6.90       7.29       7.56
     85           6.16        6.64        6.98        7.46        7.95       8.41       8.76
----------------------------------------------------------------------------------------------
</TABLE>

             Monthly Installment For Unisex Joint and Full Survivor
                        (Life with Emergency Cash (SM))

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------
                                      Adjusted Age of Joint Annuitant*
Adjusted Age   -------------------------------------------------------------------------------
    of          15 Years    12 Years    9 Years     6 Years     3 Years               3 Years
   First       Less Than   Less Than   Less Than   Less Than   Less Than   Same As   More Than
 Annuitant*      First       First       First       First       First      First      First
----------------------------------------------------------------------------------------------
<S>              <C>         <C>         <C>         <C>         <C>        <C>        <C>
     50          $4.34       $4.38       $4.42       $4.47       $4.51      $4.56      $4.60
     55           4.43        4.48        4.54        4.60        4.67       4.73       4.78
     60           4.55        4.62        4.70        4.78        4.87       4.96       5.03
     65           4.71        4.81        4.92        5.03        5.16       5.29       5.38
     70           4.93        5.07        5.22        5.38        5.56       5.74       5.87
     75           5.23        5.42        5.63        5.87        6.12       6.38       6.56
     80           5.64        5.91        6.21        6.55        6.90       7.26       7.51
     85           6.21        6.58        7.02        7.48        7.97       8.41       8.74
----------------------------------------------------------------------------------------------
* Adjusted age as defined in Section 10.A
----------------------------------------------------------------------------------------------
</TABLE>

Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company (if the option is available based on
adjusted age as described in Section 10).

J1322                                Page 21

<PAGE>

                         SECTION 11 - GENERAL PROVISIONS

THE CONTRACT

This policy, which includes any attached endorsements and riders, constitutes
the entire contract between you and us.

MODIFICATION OF POLICY

No change in this policy is valid unless made in writing by us and approved by
one of our authorized officers. No agent or registered representative has
authority to change or waive any provision of Your policy.

TAX QUALIFICATION

This policy is intended to qualify as an annuity contract for federal income tax
purposes. The provisions of this policy are to be interpreted to maintain such
qualification, notwithstanding any other provisions to the contrary. To maintain
such tax qualification, we reserve the right to amend this policy to reflect any
clarifications that may be needed or are appropriate to maintain such tax
qualification or to conform this policy to any applicable changes in the tax
qualification requirements. We will send you a copy in the event of any such
amendment. If you refuse such an amendment it must be by giving us written
notice, and your refusal may result in adverse tax consequences.

NON-PARTICIPATING

This policy will not share in our profits or surplus.

AGE OR SEX CORRECTIONS

If the age or sex of the annuitant has been misstated, the benefits will be
those, which the premiums paid, would have purchased for the correct age and
sex. Any underpayment made by us will be paid with the next payment. Any
overpayment made by us will be deducted from future payments. Any underpayment
or overpayment will include interest from the date of the incorrect payment to
the date of the adjustment.

INCONTESTABILITY

This policy shall be incontestable from the policy date.

EVIDENCE OF SURVIVAL

We have the right to require evidence satisfactory to us that a person was alive
if a payment is based on that person being alive. No payment will be made until
we receive the evidence of continued survival.

SETTLEMENT

Any payment by us under this policy is payable at our administrative office.

RIGHTS OF OWNER

Prior to the annuity commencement date, the owner may, while the annuitant is
living:

     1.   Assign this policy.
     2.   Surrender the policy to us.
     3.   Amend or modify the policy with our consent.
     4.   Elect to receive annuity payments or name a payee to receive the
          payments.
     5.   Exercise, receive, and enjoy every other right and benefit contained
          in the policy.

The use of these rights may be subject to the consent of any assignee,
irrevocable beneficiary, and of the spouse in a community or marital property
state.

CHANGE OF OWNERSHIP

As permitted by law, you can change the owner of this policy by notifying us in
writing in a form and manner acceptable to us. When a change takes effect, all
rights of ownership in this policy will pass to the new owner.

A change of owner will not be effective until it is recorded in our records.
After it has been so recorded, the change will take effect as of the date you
signed the notice. However, if the annuitant dies before the notice has been so
recorded, it will not be effective as to those proceeds we have paid before the
change was recorded in our records.

We may require that the change be endorsed in the policy. Changing the owner
does not change the beneficiary or the annuitant.

A change of ownership may result in adverse tax consequences.

COMMUNITY OR MARITAL PROPERTY

Unless we are notified in accordance with applicable law of a community or
marital property interest in this policy, We are not bound by any such interest.

ANNUITY COMMENCEMENT DATE

The annuity commencement date is the date payments begin under an income option.
In no event can this date be later than the last day of the month following the
month in which the annuitant attains age 95. You may change the annuity
commencement date at any time by giving us 30 days' written notice.

ASSIGNMENT

Before the annuity commencement date, you may assign this policy as permitted by
law. The assignment must be in writing and filed with us. We assume no
responsibility for the validity of any assignment. Any claim made under an
assignment shall be subject to proof of interest and the extent of the
assignment.

Assignment of this policy may result in adverse tax consequences.

R314                                 Page 22

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                             SECTION 11 - CONTINUED

BENEFICIARY

Death proceeds, when payable in accordance with Section 9, are payable to the
designated beneficiary or beneficiaries. Prior to the annuitants death, you may
name or change a beneficiary, without the beneficiary's consent (unless
irrevocably designated or required by law) at any time by notifying us in
writing in a form and manner acceptable to us. The change will take effect upon
the date you sign it, whether or not you are living when we receive it. The
notice must have been postmarked (or show other evidence of delivery that is
acceptable to us) on or before the date of the annuitant's death. Your most
recent change of beneficiary notice will replace any prior beneficiary
designations in their entirety. No change will apply to any payment we made
before the written notice was received. If an irrevocable beneficiary dies, you
may designate a new beneficiary.

You may direct the manner of payment of death proceeds pursuant to the terms of
this policy, subject to applicable law. In the absence of such direction, the
beneficiary may elect the manner of payment or make an election of any option.

Only those beneficiaries living or in existence at the time of the annuitant's
death will be eligible to receive a share of the death proceeds. If both primary
and contingent beneficiaries have been named, payment will be made to the named
primary beneficiaries living or in existence at the time the death proceeds
become payable. Payment will be made to the named contingent beneficiaries only
if all primary beneficiaries have died before the death proceeds become payable.

If death proceeds are payable to more than one beneficiary and you failed to
specify their interest, they will share equally. If any beneficiary is alive at
the time the death proceeds become payable, but dies before receiving their
payment, their share will be paid to their estate.

PROTECTION OF PROCEEDS

The policy and payments under it will be exempt from the claims of creditors to
the extent permitted by law. Unless you so direct by filing written notice with
us, no beneficiary may assign any payments under this policy before the payments
are due. To the extent permitted by law, no payments under this policy will be
subject to the claims of creditors of any beneficiary.

DEFERMENT

We will pay any partial withdrawals or surrender proceeds from the separate
account within 7 days after all requirements have been met. However, it may
happen that the New York Stock Exchange is closed for trading (other than the
usual weekend or holiday closings), or the Securities and Exchange Commission
restricts trading or determines that an emergency exists. If so, it may not be
practical for us to determine the investment experience of the separate account.
In that case, we may defer transfers among the subaccounts and to the fixed
account, and determination or payment of partial withdrawals or surrender
proceeds.

When permitted by law, we may defer paying any partial withdrawals or surrender
proceeds from the fixed account for up to 6 months from the date we receive your
request. If the annuitant dies after the request is made, but before the request
is processed, the request will be processed before the death proceeds are
determined.

REPORTS TO OWNER

We will give you an annual report at least once each policy year. This report
will show the number and value of the accumulation units held in each of the
subaccounts as well as the value of the fixed account. It will also show the
death benefit, cash value, and any other facts required by law or regulation.
The report will be sent to you at the most current address we have recorded for
you.

RB314                                Page 23

<PAGE>

                                                        Home Office:
                                                        4333 Edgewood Road N.E.
[LOGO](R) Transamerica Life                             Cedar Rapids, Iowa 52499
          Insurance Company                             (319)398-8511
          A Stock Company (Hereafter called the Company, we, our or us)

                                      INDEX

                                                                            Page
                                                                            ----

Accumulation Units .........................................................   9
Adjusted Age ...............................................................  14
Adjusted Policy Value ......................................................   4
Age or Sex Corrections .....................................................  22
Annuity Commencement Date ..................................................  22
Assignment .................................................................  22
Beneficiary ................................................................  23
Cash Value .................................................................   5
Contract ...................................................................  22
Death Proceeds .............................................................  12
Definitions ................................................................   2
Dollar Cost Averaging Option ...............................................  11
Evidence of Survival .......................................................  22
Excess Interest Adjustment .................................................   5
Fixed Account ..............................................................  10
Guaranteed Periods .........................................................  10
Guaranteed Return of Fixed Account Premium Payments ........................   8
Income Options .............................................................  14
income Option Tables .......................................................  18
Incontestability ...........................................................  22
Modification of Policy .....................................................  22
Non-participating ..........................................................  22
Option to Change Annuity Commencement Date .................................  22
Partial Withdrawals ........................................................   6
Payee ......................................................................  14
Payment of Premiums ........................................................   4
Policy Data Page ...........................................................   3
Policy Value ...............................................................   4
Proof of Age ...............................................................  14
Protection of Proceeds .....................................................  23
Right to Cancel ............................................................   1
Rights of Owner ............................................................  22
Separate Account ...........................................................   8
Service Charge .............................................................   4
Settlement .................................................................  22
Surrender Charges ..........................................................   8
Tax Qualification ..........................................................  22
Transfers ..................................................................  11

                   FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY
                   INCOME PAYABLE AT ANNUITY COMMENCEMENT DATE
            BENEFITS BASED ON THE PERFORMANCE OF THE SEPARATE ACCOUNT
ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT (SEE SECTIONS 6 AND 10C)
                                NON-PARTICIPATING

Y1033