Exhibit 4.a



 Exhibit (4)(a) 
 Form of Variable Annuity Contract (A Unit) 







 

 
 A MISSOURI STOCK COMPANY • HOME OFFICE: JEFFERSON CITY, MISSOURI 65101 
 ADMINISTRATIVE OFFICE: CEDAR RAPIDS, IOWA 52499 
 1-800-866-6007 
 We, Providian Life and Health Insurance Company, have issued this Contract on the life of the Annuitant in consideration of
our receipt of your Initial Purchase Payment. 
 This plan provides a monthly Annuity Payment for the life of the Annuitant. Payments start on the Annuity
Date. 
 Benefits under this Contract when based on the investment experience of a separate account are variable and are not guaranteed as to amount. 

 FREE LOOK PERIOD - RIGHT TO CANCEL CONTRACT 
 If for
any reason you are not satisfied with this Contract, you may return it to us within 10 days (20 days if this Contract is replacing a previously existing life insurance or annuity contract) of the date you received it. You may return it by delivering
or mailing it to our Administrative Office, Mail Station 4210, 4333 Edgewood Road NE, Cedar Rapids, IA 52499, or to the agent from whom you purchased this Contract. If returned, the Contracts shall be void from the Contract Date. We will refund the
Purchase Payment(s) you paid or, if greater, the Accumulated Value. 
 This is a legal contract between you and us. READ THE CONTRACT CAREFULLY.

 We have caused this Contract to be signed by our President and Secretary. 
  

					
	/s/ Susan E. Martin	 		 	/s/ David J. Miller
	Susan E. Martin	 		 	David J. Miller
	Secretary	 		 	President

 Flexible Premium Multi-Funded Variable Deferred Annuity Contract 
 The Details Of The Variable Provision Begin On Page 6 
 Nonparticipating 
 THE GUARANTEED EQUITY FIXED ACCOUNT OPTION DOES NOT PROVIDE CASH SURRENDER VALUES PRIOR TO THE END OF THE GUARANTEE
PERIOD 
  

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 Index 
  

			
	 	  	Page No.
	 Right to Cancel Contract
	  	1
	 Contract Schedule Page
	  	3
	 Definitions
	  	4
	 The Separate Account
	  	6
	 Exchanging Units
	  	6
	 Partial or Full Withdrawals
	  	6
	 Systematic Withdrawal Option
	  	7
	 Dollar Cost Averaging
	  	7
	 Accumulated Value
	  	7
	 Death Benefit
	  	8
	 Ownership, Assignment and Beneficiary
	  	8
	 Death of Annuitant
	  	8
	 Death of Annuitant’s Beneficiary
	  	9
	 Death of Owner
	  	9
	 General Provisions
	  	9
	 Annuity Payment Options
	  	10
	 Annuity Tables
	  	11

  

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 Contract Schedule Page 
 Please address all correspondence to Providian Life and Health Insurance Company, Administrative Office, Mail Station 4210, Cedar Rapids, Iowa 52499. Include the Contract Number on all correspondence in order to facilitate the processing of
the request. 
 Contract Schedule 
  

							
	 Contract Owner:
	  	MOVE TO CR VARIABLE PRINT	  	Contract Number:	    	PRTM0INA1CA
	 Joint Owner:
	  	N/A	  	Contract Date:	    	01/01/1997
	 Annuitant:
	  	MOVE TO CR VARIABLE PRINT	  	Annuity Date:	    	12/01/2054
	 Annuitant’s Beneficiary:
	  	N/A	  	Initial Purchase Payment:	    	$5,000.00

 Each Subaccount of the Providian Life and Health Insurance Company Separate Account V offered in this Contract
invests in a corresponding portfolio of the Providian Life and Health Marquee Fund(s) (the “Fund(s)”). These portfolios are listed below. The allocation of the initial Net Purchase Payment that you chose is also shown below. Your initial
Net Purchase Payment will be invested in the Fidelity Money Market Portfolio until the end of the Free Look Period, at which time it will be invested as shown below. 
 Separate Account Allocations 
  

				
	 Fidelity Money Market Portfolio
	  	0	%
	 Fidelity Asset Manager Portfolio
	  	0	%
	 Fidelity Equity Income Portfolio
	  	0	%
	 Fidelity Growth Portfolio
	  	0	%
	 Dreyfus Growth & Income Portfolio
	  	0	%
	 Dreyfus Quality Bond Portfolio
	  	0	%
	T. Rowe Price Equity Income Portfolio	  	0	%
	T. Rowe Price International Portfolio	  	0	%
	T. Rowe Price New American Growth Portfolio	  	0	%
	OpCap Advisors Managed Portfolio	  	0	%
	OpCap Advisors Small Cap Portfolio	  	0	%
	OpCap Advisors US Gov’t Income Portfolio	  	0	%

 Fixed Account Allocations 
  


				
	 One-Year Guaranteed Index Rate Option
	  	100	%
	 Five-Year Guaranteed Index Rate Option
	  	0	%
	 Five-Year Guaranteed Equity Option
	  	0	%

 Contract Charges: 
  

	•	 	 Sales load for Purchase Payments within the following dollar ranges: 


  

				
	 Dollar Amount
	  	Sales Load	 
	 $0 to 99,999.99
	  	5.75	%
	 $100,000 to 249,999.99
	  	4.75	%
	 $250,000 to 499,999.99
	  	3.75	%
	 $500,000 to 999,999.99
	  	2.75	%
	 $1 Million or more
	  	1.75	%

 The Purchase Payment breakpoints described above shall be applied on an aggregated basis so that all prior
Purchase Payments are added to the amount of any additional Purchase Payment before the calculation is made. (Example: You make an Initial Purchase Payment of $80,000 with a sales load of 5.75%. An Additional Purchase Payment of $40,000 is made,
bringing the total Purchase Payments received to $120,000. The sales load applicable to that $40,000 would be 4.75%.) 
  

	•	 	 Daily charge corresponding to an annual charge of .15% of the value of the Subaccounts, plus a $30 annual fee to cover the cost of administering the Contract



  

	•	 	 Daily charge corresponding to an annual charge of .65% of the value of the Subaccounts per year for mortality and expense risk. 


  

	•	 	 We have the right to charge an administrative fee of $15 for each exchange after the first 12 exchanges made in any Contract Year. 


  

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 Definitions 
 Whenever
used in this Contract, the following shall mean: 
 Adjusted Death Benefit 
 During the first six Contract Years, the Adjusted Death Benefit will be equal to the sum of all Net Purchase Payments made less any partial withdrawals. During each subsequent six-year period, the Adjusted Death
Benefit will be equal to the Death Benefit on the last day of the previous six-year period, plus any Net Purchase Payments made, less any partial withdrawals made during the current six-year period. For any six-year period after the one in which the
Annuitant attains age 75, the Adjusted Death Benefit will be equal to the Death Benefit on the last day of the six-year period before age 75 occurs, plus any Net Purchase Payments subsequently made, less any partial withdrawals subsequently taken.

 Annuitant 
 The person whose life is used to determine
the duration of any Annuity Payments and upon whose death, prior to the Annuity Date, benefits under this Contract are paid. 
 Annuitant’s
Beneficiary 
 The person or persons to whom any benefits are due upon the Annuitant’s death. 
 Annuity Date 
 The date on which Annuity Payments begin. The Annuity
Date is always the first day of a month. 
 Annuity Payment 
 One of a series of payments made under an Annuity Payment Option. Annuity Payments are based on the lifetime or life expectancy of the Annuitant unless an Annuity Income option which pays only for a Period Certain is elected. 
 Annuity Payment Option 
 One of several ways in which the Accumulated
Value of this Contract can be paid. Under a Fixed Annuity Option, the dollar amount of each Annuity Payment does not change over time. Under a Variable Annuity Option, the dollar amount of each Annuity Payment may change over time, depending upon
the investment experience of the underlying portfolio or portfolios you choose. Annuity Payments are based on the Contract’s Accumulated Value as of 10 Business Days prior to the Annuity Date. 
 Annuity Unit 
 Unit of measure used to calculate Variable Annuity
Payments. 
 Business Day 
 A day when the New York Stock
Exchange is open for trading. 
 Contract Anniversary 
 Any anniversary of the Contract Date. 
 Contract Date 
 The date of issue of this Contract. 
 Contract Year 
 A period of 12 months starting with the Contract Date or any Contract Anniversary. 
 Death Benefit 
 The Contract’s Accumulated Value on the date we receive proof of the Annuitant’s death or, if greater, the Adjusted Death Benefit. 
 Exchange 
 One Exchange will be deemed to occur with each voluntary
transfer from any Subaccount. 
 Initial Purchase Payment 
 The first payment you make to purchase this Contract. The Initial Purchase Payment must be at least $5,000 for Non-Qualified Contracts and $2,000 (or $50 if payments are to be made by monthly payroll deduction) for Qualified Contracts. In
no event, however, can the Initial Purchase Payment be greater than $1,000,000, without our consent. The Initial Purchase Payment less any sales load and applicable Premium Tax, if any, will be credited to your Accumulated Value within two Business
Days after we receive your Initial Purchase Payment. 
 Net Purchase Payment 
 Any Purchase Payment less the applicable sales load and Premium Tax, if any. 
  

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 Non-Qualified Contract 
 Any contract other than those described under the Qualified Contract definition in this Definitions section. 
 Owner’s Designated
Beneficiary 
 The person you designate to receive your interest in this Contract if you die before the Annuity Date, pursuant to Section 72(s) of
the Internal Revenue Code of 1986, as amended. 
 Payee 
 You, the Annuitant, the Beneficiary, or any other person, estate, or legal entity to whom benefits are to be paid. 
 Premium Tax 

A regulatory tax that may be assessed by your state on the Purchase Payments you make to this Contract. The amount which we must pay as Premium Tax will be deducted
from each Purchase Payment or from your Accumulated Value as it is incurred by us. 
 Proof of Death 
 A certified death certificate; a certified decree from a court of competent jurisdiction as to the finding of death; a written statement by a medical doctor who attended
the deceased; or any other proof satisfactory to us. 
 Purchase Payment 
 An amount you invest in this Contract. Purchase Payments after the Initial Purchase Payment may be made at anytime prior to the Annuity Date as long as the Annuitant is living. Each Purchase Payment after the Initial
Purchase Payment must be at least $1,000 for Non-Qualified Contracts or $50 for Qualified Contracts. The total of all Purchase Payments may not exceed $1,000,000 without our consent. Net Purchase Payments received prior to the close of the New York
Stock Exchange will be credited to your Accumulated Value at the close of business that same day. Net Purchase Payments received after the close of the New York Stock Exchange will be credited the following Business Day. 
 Qualified Contract 
 An annuity contract as defined under Sections
401(a), 403(b) and 408(b) of the Internal Revenue Code of 1986, as amended (the “Code”). 
 SEC 
 The Securities and Exchange Commission. 
 Separate Account 

The Providian Life and Health Insurance Company Separate Account V. The Separate Account consists of assets that are segregated by us and invested in the Fund(s) as
shown on the schedule Page. The investment performance of the Separate Account is independent of the performance of the general assets of the Company. 
 Subaccount 
 That portion of the Separate Account which invests in shares of the Fund(s) portfolios. Each Subaccount will invest only in a
single portfolio. The investment performance of each Subaccount is linked directly to the investment performance of the underlying portfolio of the Fund(s). 
 We, Us, Ours 
 “We” means Providian Life and Health Insurance Company. “Us,” “our” and “ours” also
refer to Providian Life and Health Insurance Company. 
 Written Request (or Written Notice) 
 Any notice, change or request in writing by you to us. It is how you let us know any requests you have or changes you want to make to this Contract. Such request must be
in a format and content acceptable to us. A signature guarantee may be required for your protection. 
 You, Your, Yours 
 “You” refers to the purchaser (“Owner”) of this Contract unless another Owner is named by you, the purchaser. The term shall also include any person
named as Joint Owner. A Joint Owner shares ownership in all respects with the Owner. The Owner has the right to assign ownership to a person or party other than himself. “Your” and “Yours” also refer to the
Owner and the Joint Owner. 
  

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 The Separate Account 
 Nature of the Separate Account 
 The Separate Account is registered with the SEC under the Investment Company Act of 1940 as a Unit
Investment Trust type of investment company. It is also subject to the laws of Missouri. We established the Separate Account to support variable annuity contracts. We own the assets of the Separate Account and keep them separate from the assets of
our general investment account. 
 We use the assets of the Separate Account to buy shares in the Fund(s). The Separate Account has Subaccounts which are
invested in corresponding specific portfolios of the Fund(s). Income and realized and unrealized gains and losses from assets in each Subaccount are credited to, or charged against, the Subaccount without regard to income, gains or losses in our
other investment accounts. 
 We will determine the value of the assets in the Separate Account at the end of each Business Day. In order to determine the
value of an asset on a day that is not a Business Day, we will use the value of that asset as of the end of the next Business Day on which trading takes place. 
 We will always keep assets in the Separate Account with a value at least equal to the total investment amount under contracts similar to this one. To the extent those assets do not exceed this total, we use them to support only those
contracts and do not use those assets to support any other business. We may use any excess over this amount in any way we choose. 
 Subaccounts

 The Separate Account has several Subaccounts. Each Subaccount invests in a corresponding portfolio of the Fund(s). The portfolios available on the
Contract Date are listed on the Contract Schedule Page. 
 Allocations to the Subaccounts 
 You determine, using whole percentages, what portion of the initial Net Purchase Payment will be allocated among the Subaccounts at the end of the Free Look Period. The
Contract Schedule Page will show your initial allocation percentages. You may choose to allocate nothing to a particular Subaccount. The minimum balance for each Subaccount must be at least $1,000. 
 You may change the allocation percentages for additional Net Purchase Payments at anytime. The change will take effect on the date we receive notice from you by phone or
in writing. 
 Exchanging Units 
 Exchanges

 You may make as many exchanges among Subaccounts during a Contract Year as you wish, provided you maintain a minimum balance of $1,000 in any
Subaccount to which you have allocated Net Purchase Payments. Exchanges may be subject to an Administrative Charge, as shown on the Contract Schedule Page. 
 Exchanges may be made by phone or in writing. 
 If you make an exchange from one Subaccount to any of the other Subaccounts at anytime prior to the
Annuity Date, we will reduce the value of that Subaccount by the amount exchanged. 
 Partial or Full Withdrawals 
 You may make a partial or full withdrawal of your Accumulated Value at anytime before the Annuity Date. You may not make a partial or full withdrawal after the Annuity
Date. You may elect to have the full withdrawal amount paid in a lump sum, or you may elect to have it all paid out under an Annuity Payment Option. 
 On
the date we receive your Written Request for a partial withdrawal, the Accumulated Value will be reduced by an amount equal to the withdrawal amount, subject to the following: 
  

	1.	Partial withdrawals will be deducted as directed by you in your Written Request for partial withdrawal. In the absence of specific direction from you, we will make deductions from
the Subaccounts to which you have allocated Net Purchase Payments on a pro rata basis. 

  

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	2.	The minimum partial withdrawal is $500. 

  

	3.	If a partial withdrawal or exchange would reduce the value in a Subaccount to less than $1,000, the remaining balance in that Subaccount will be transferred to the other Subaccounts
in which the Contract’s Accumulated Value is then allocated on a pro rata basis. If the balance under this Contract is less than $1,000, we reserve the right to liquidate the account. You will be notified if your balance is below the minimum,
and will be given 60 days in which to make an additional Purchase Payment. 

 On the date we receive your Written Request for full withdrawal,
the amount payable is the Accumulated Value. 
 Systematic Withdrawal Option 
 You may elect to have a specified dollar amount withdrawn from that portion of your Contract’s Accumulated Value which is allocated to the Subaccounts, on a monthly, quarterly, semiannual or annual basis. The
minimum amount for each withdrawal is $250. 
 You may elect this option by completing a Systematic Withdrawal Request Form. We must receive it at least 30
days prior to the date you want systematic withdrawals to begin. We will process each systematic withdrawal on the date and at the frequency specified by you in your Systematic Withdrawal Request Form. We will forward the withdrawal amount to you
within 10 Business Days of the process date. 
 You may change the amount to be withdrawn or elect to cancel this option at anytime provided we receive
Written Notice at least 30 days prior to the next systematic withdrawal date. 
 We reserve the right to discontinue offering this systematic withdrawal
option upon 30 days Written Notice. We also reserve the right to charge a fee for administering this option. Any fee we may charge will be shown on the Contract Schedule Page. 
 Dollar Cost Averaging 
 If you have at least $5,000 of Accumulated Value in the money market portfolio, you may elect
to have a specified dollar amount transferred from that Subaccount to other Subaccounts on a monthly basis. 
 The minimum amount you may transfer each month
is $250 for each Subaccount. The maximum amount you may transfer is equal to the value of the money market portfolio when you made your election, divided by 12. You may change the amount to be transferred once each Contract Year provided we receive
notice by phone or in writing at least seven days prior to the next transfer date. 
 We will make this transfer on the same date each month as the Contract
Date. The dollar amount will be allocated to the Subaccounts in the proportions you specified in your notice. If, on any transfer date, the value the money market portfolio is equal to or less than the amount you elected to have transferred, we will
transfer the entire amount and this option will no longer be in effect. 
 You may cancel this option at anytime provided we receive notice by phone or in
writing at least seven days prior to the next transfer date. 
 Accumulated Value 
 Accumulated Value 
 On the Contract Date, the Accumulated Value is equal to your initial Net Purchase Payment. On any
Business Day after the Contract Date, the Accumulated Value is equal to the Accumulated Value from the previous Business Day. 
 PLUS: 
  

	1.	Any Additional Net Purchase Payments received; and 

  

	2.	Any increase in the value of the Subaccount(s), due to investment results, to which the Accumulated Value is allocated; 

  

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 LESS: 
  

	1.	Any decrease in the value of the Subaccount(s), due to investment results, to which the Accumulated Value is allocated; 

  

	2.	A charge, as described on the Contract Schedule Page, for mortality and expense risks assumed by us; 

  

	3.	A charge, as described on the Contract Schedule Page, to cover our costs in administering the Contract; 

  

	4.	An administrative charge, as described on the Contract Schedule Page, for certain exchanges made; and 

  

	5.	Any withdrawals. 

 Death Benefit 
 Death Benefit Prior to the Annuity Date 
 We will pay the Death Benefit
to the Annuitant’s Beneficiary when we receive proof that the Annuitant died prior to the Annuity Date. The Death Benefit may be paid as a lump sum cash benefit or an annuity payment benefit. If you and the Annuitant are the same person and the
Annuitant’s Beneficiary is your surviving spouse, then the Annuitant’s Beneficiary may elect to be treated as the Owner’s Designated Beneficiary pursuant to the “Owner’s Death Before Entire Interest is Distributed”
provision. 
 Ownership, Assignment and Beneficiary 
 Ownership of the Contract 
 The Annuitant is the Owner unless you have designated another person as Owner. During the Annuitant’s
lifetime, all rights and privileges under this Contract may be exercised solely by you. From time to time, we may require proof that the Annuitant is still living. 
 Assignment of the Contract 
 We are not responsible for the validity or effect of any assignment. No assignment will be recognized until we
receive Written Notice. The interest of any Annuitant’s Beneficiary which the assignor has the right to change shall be subordinate to the interest of an assignee. Any amount paid to the assignee shall be paid in one sum, notwithstanding any
settlement agreement in effect at the time the assignment was executed. We shall not be liable as to any payment or other settlement made by us before we acknowledged the notice. 
 Annuitant’s Beneficiary 
 You may name an Annuitant’s Beneficiary in writing. You may make this designation
irrevocable by a Written Notice filed and approved by us. An irrevocable Annuitant’s Beneficiary may be changed only with his or her own written consent. Changes in Annuitant’s Beneficiary must be made by Written Notice to us. The change
will take effect on the date the notice is signed. We will acknowledge in writing receipt of the notice. The change will not affect any payment made or other action taken before we acknowledged the notice. 
 Death of Annuitant 
 Annuitant’s Death Prior to Annuity Date

 If the Owner and the annuitant are different and the Annuitant dies prior to the Annuity Date, the following will apply unless you have made other
provisions: 
  

	1.	If there is more than one Annuitant’s Beneficiary, each will share equally. 

  

	2.	If one of two or more Annuitant’s Beneficiaries has already died, that share of the death benefit will be paid equally to the survivor(s). 

  

	3.	If no Annuitant’s Beneficiary is living, the proceeds will be paid to you, your legal representatives or assigns. 

  

	4.	If an Annuitant’s Beneficiary dies at the same time as the Annuitant, the proceeds will be paid as though the Annuitant’s Beneficiary had died first.


  

	5.	If an Annuitant’s Beneficiary dies within 15 days after the Annuitant’s death and before we receive due proof of the Annuitant’s death, proceeds will be paid as
though the Annuitant’s Beneficiary had died first. 

 The Annuitant’s Beneficiary may choose to receive a lump sum payment or to
receive a series of payments under one of the Annuity Payment Options available under the Contract. 
  

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 Annuitant’s Death After Annuity Date 
 If the Annuitant dies on or after the Annuity Date, any unpaid Payments Certain will be paid to the Annuitant’s Beneficiary. 
 Death of Annuitant’s Beneficiary 
 Death of Annuitant’s Beneficiary 
 If an Annuitant’s Beneficiary who is currently receiving Annuity Payments dies, any remaining Payments Certain will be paid to that Annuitant’s
Beneficiary’s named beneficiary as they come due. 
 Death of Owner 
 Owner’s Death Before Entire Interest is Distributed 
 If you die before the entire interest in the Contract is
distributed: 
  

	1.	The following applies: 

  

	 	(a)	If you die on or after the Annuity Date, the remaining portion of such interest will be distributed at least as rapidly as under the method of distribution being used as of the date
of death; and 

  

	 	(b)	If you die before the Annuity Date, the entire interest in this Contract will be distributed as follows: 

  

	 	1)	within five years after the date of the Owner’s death; 

  

	 	2)	over the lifetime of the Owner’s Designated Beneficiary of this Contract; or 

  

	 	3)	over a period that does not exceed the life expectancy, as defined by Internal Revenue Code regulations, of the Owner’s Designated Beneficiary of this Contract.


 Subparagraphs 2) and 3) apply only to individuals, and such payments must start within one year of the date of such
Owner’s death. For IRAs, any annuity option chosen must meet the requirements of the Internal Revenue Code. 
  

	2.	Special rule where surviving spouse is the Owner’s Designated Beneficiary: If the Owner’s Designated Beneficiary is your surviving spouse, then subparagraph (b) above
shall be applied by treating your spouse as the original contract owner. The surviving spouse may elect to become the owner under the contract and to treat the Contract as his or her own. 

 Special Rules for Nonnatural Owners 
 If a nonnatural person is named
as Owner of this Contract, then the Annuitant shall be treated as the Owner and the entire interest in this Contract must be distributed within five years of (1) the Annuitant’s death prior to the Annuity Date, or (2) a change in the
Annuitant. 
 General Provisions 
 Entire Contract 

 The entire contract consists of this Contract, including any riders or endorsements. Changes to this Contract are not valid unless we make them in writing.
They must be signed by one of our Executive Officers. No agent has the authority to change this Contract or to waive any of its provisions. 
 Incontestability 
 This Contract is incontestable from the Contract Date. 
 Nonparticipating 
 This Contract is nonparticipating. This means we do not pay dividends on it. The Contract will not
share in our profits or surplus. 
 Protection of Proceeds and Payments 
 To the extent permitted by law, neither the proceeds nor any payments under this Contract shall be subject to the claims of creditors or legal process. 
 Annual Statement 
 You win receive an annual statement once each year. It will show such things as the beginning and
ending account values, as well as any Additional Purchase Payments, withdrawals, exchanges, or charges for the year that apply to this Contract. The statement may contain other information required by law or regulation. 
  

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 Misstatement of Age or Sex 
 If the Annuitant’s age or sex is misstated, payments will be adjusted to the amount which would have been provided for at the correct age or sex. If payments have already commenced and the misstatement has caused an underpayment, the
full amount due will be paid with the next scheduled payment. If the misstatement has caused an overpayment, the amount due will be deducted from one or more future payments. 
 Deferment of Payment 
 If a lump sum or cash withdrawal is to be paid from the Separate Account, payment will be made
within seven calendar days from the date the election becomes effective. 
 We may defer payment in cases where the New York Stock Exchange is closed or
trading has been restricted by the SEC, or when the SEC allows us to defer payments in order to protect our Contract Owners. 
 Contract Amendment 

 We will amend this Contract from time to time in cases where we are acting to comply with the United States Internal Revenue Code and/or regulations of the
United States Treasury Department, or are acting to maintain the tax-deferred status of this Contract, pursuant to those provisions or regulations. 
 Rights Reserved by the Company 
 Subject to any required approval by the SEC, the Missouri Department of Insurance, and any other regulatory
authority, we reserve the right to take certain actions. These actions include: 
  

	1.	To deregister the Separate Account under the Investment Company Act of 1940; 

  

	2.	To combine any two or more separate accounts; 

  

	3.	To operate the Separate Account as a management investment company or any other form permitted by law; 

  

	4.	To substitute shares of another fund or units of a trust if shares of the Fund(s) are not available, or if, in our judgment, further investment in such shares is no longer
appropriate; and 

  

	5.	To add or delete funds (including the Fund(s)), portfolios and corresponding Subaccounts. 

 Annuity Payment Options 
 You may elect that Annuity Payments be received on a fixed basis, a variable basis, or some
combination of both. 
 Proceeds 
 The Normal Annuity Date
is the first day of the month following the Annuitant’s 85th birthday. However, you may choose to advance or defer the Annuity Date. You must make this request in writing at least 30 days prior to the requested Annuity Date and during the
Annuitant’s lifetime. On the Annuity Date the proceeds to be applied under a Payment Option will be equal to the Contract’s Accumulated Value 10 Business Days prior to the Annuity Date less any applicable Premium Tax. 
 Annuity Payments 
 Annuity Payments are made monthly starting on the
Annuity Date. The Annuity Payments are guaranteed to be no less than the amount provided by the Annuity Tables. The minimum payment is $100. The number of payments made in a year may be adjusted to maintain this minimum. If the Accumulated Value is
less than $5,000, we have the right to pay that amount in a lump sum. We may require proof of the Annuitant’s age before making payments. From time to time, we may require proof that the Annuitant is living. 
 Payment Options 
  

	1.	Life Annuity - We will make monthly Annuity Payments for the life of the Annuitant, ceasing with the last payment due prior to his death. 

  

	2.	Life Annuity with 120, 180 or 240 Monthly Payments Certain - We will make monthly Annuity Payments for the life of the Annuitant, or if the Annuitant dies for 120, 180 or 240 months
as elected. If, at any given age, the same amount would be payable for different periods certain, we will deem an election to have been made for the longest period certain which could have been elected at such age for such amount.


  

	3.	Installment or Unit Refund Life Annuity - We will make monthly Annuity Payments for the life of an Annuitant, with a Period Certain determined by dividing the Accumulated Value by
the first Annuity Payment. 

  

	4.	Joint and Last Survivor Annuity - We will make monthly Annuity Payments for the life of two Annuitants and thereafter for the life of the Survivor, ceasing with the last payment due
prior to the Survivor’s death. 

  

	5.	Designated Period Annuity - We will make monthly Annuity Payments for a Period Certain which may be from 10 to 30 years, as elected. This option is available on a fixed basis only.


  

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 Annuity Tables 
 The
Annuity Tables show the guaranteed minimum amount of monthly Annuity Payment for each $1,000 of Accumulated Value for each Fixed Annuity Option. We may, at the time of election of a Fixed Annuity Payment Option, offer more favorable rates in lieu of
the guaranteed rates shown in the Annuity Tables. The amount of each Annuity Payment will depend on the Annuitant’s sex and age on the birthday nearest to the date the first Annuity Payment is due. 
 We base the tables for the first four Options on the 1983 Table “A” Mortality Table projected for mortality improvement to the year 2000 using Projection Scale
G and an interest rate of 4% a year. The table for Option 5 is based on an interest rate of 4% a year. On request we will furnish the amount of monthly Annuity Payment per $1,000 applied for any ages not shown. We will treat any Payee who is over
age 85 at the date Annuity Payments begin as being age 85 on that date. 
 Fixed Payment Amounts 
 With respect to a Fixed Payment Option, the amounts shown on the tables represent the guaranteed minimum for each Annuity Payment. 
 Variable Payment Amounts 
 With respect to a Variable Payment Option,
the amounts shown on the tables represent the first Annuity Payment, based on the assumed interest rate of 4%. The amount of each Annuity Payment after the first is determined by means of Annuity Units. 
 The number of Annuity Units is determined by dividing the first Annuity Payment by the Annuity Unit value for the selected Subaccount 10 Business Days prior to the
Annuity Date. The number of Annuity Units for the Subaccount then remains fixed, unless an exchange of Annuity Units is made. After the first Annuity Payment, the dollar amount of each subsequent Annuity Payment is equal to the number of annuity
units multiplied by the Annuity Unit Value for the Subaccount 10 Business Days before the due date of the Annuity Payment. 
 The Annuity Unit Value for each
Subaccount was established at $10. The Annuity Unit Value for any subsequent Business Day is equal to (a) times (b) times (c), where: 
  

	(a)	is the Annuity Unit Value on the immediately preceding Business Day; 

  

	(b)	is the Net Investment Factor for the day; 

  

	(c)	is the Investment Result Adjustment Factor (.99989255 per day), which recognizes an assumed interest rate of 4% per year used in determining the Annuity Payment Amounts.


 The Net Investment Factor is a factor applied to a Subaccount that reflects daily changes in the value of the Subaccount due to: 

 

	(a)	Any increase or decrease in the value of the Subaccount due to investment results. 

  

	(b)	A charge, as described on the Contract Schedule Page, for mortality and expense risks assumed by us. 

  

	(c)	A charge, as described on the Contract Schedule Page, to cover the cost of administering the account. 

 When annuity payments begin, neither expenses actually incurred other than taxes on the investment return, nor mortality actually experienced, shall adversely affect the dollar amount of variable annuity payments.

  

 Page 11 









					
		 	Annuity Tables	 	
		 	Guaranteed Minimum	 	
	Option One	 	Amount of Monthly Payment	 	
	Two and Three	 	For Each $1,000 Applied	 	
			
	Male	 	Single Life Annuities	 	

  

																													
	 Age of
 Payee
	 	Monthly
Payments Certain	 	 Age of
 Payee
	 	Monthly Payments Certain	 	 Installment
 Refund
	 	 Age of
 Payee
	 	Monthly Payments Certain	 	 Installment
 Refund

	 	120	 	240	 	 	None	 	120	 	180	 	240	 	 	 	None	 	120	 	180	 	240	 
	20	 	3.73	 	3.72	 	43	 	4.29	 	4.27	 	4.25	 	4.22	 	4.22	 	65	 	6.28	 	6.05	 	5.77	 	5.41	 	5.84
	21	 	3.74	 	3.73	 	44	 	4.34	 	4.32	 	4.29	 	4.26	 	4.26	 	66	 	6.45	 	6.18	 	5.86	 	5.47	 	5.97
	22	 	3.75	 	3.74	 	45	 	4.39	 	4.36	 	4.34	 	4.30	 	4.31	 	67	 	6.63	 	6.32	 	5.96	 	5.53	 	6.10
	23	 	3.76	 	3.75	 	46	 	4.44	 	4.42	 	4.38	 	4.34	 	4.35	 	68	 	6.83	 	6.47	 	6.06	 	5.58	 	6.25
	24	 	3.77	 	3.76	 	47	 	4.49	 	4.47	 	4.43	 	4.38	 	4.40	 	69	 	7.04	 	6.62	 	6.16	 	5.63	 	6.40
	25	 	3.78	 	3.77	 	48	 	4.55	 	4.52	 	4.48	 	4.43	 	4.45	 	70	 	7.27	 	6.78	 	6.26	 	5.68	 	6.56
	26	 	3.80	 	3.78	 	49	 	4.61	 	4.58	 	4.54	 	4.48	 	4.50	 	71	 	7.51	 	6.94	 	6.35	 	5.72	 	6.72
	27	 	3.81	 	3.80	 	50	 	4.68	 	4.64	 	4.59	 	4.53	 	4.56	 	72	 	7.76	 	7.10	 	6.44	 	5.76	 	6.90
	28	 	3.83	 	3.81	 	51	 	4.75	 	4.70	 	4.65	 	4.58	 	4.62	 	73	 	8.03	 	7.27	 	6.53	 	5.80	 	7.09
	29	 	3.84	 	3.83	 	52	 	4.82	 	4.77	 	4.71	 	4.63	 	4.68	 	74	 	8.32	 	7.44	 	6.62	 	5.83	 	7.28
	30	 	3.86	 	3.85	 	53	 	4.89	 	4.84	 	4.78	 	4.69	 	4.74	 	75	 	8.63	 	7.61	 	6.70	 	5.86	 	7.49
	31	 	3.88	 	3.87	 	54	 	4.97	 	4.92	 	4.84	 	4.74	 	4.81	 	76	 	8.97	 	7.78	 	6.78	 	5.89	 	7.71
	32	 	3.91	 	3.89	 	55	 	5.06	 	4.99	 	4.91	 	4.80	 	4.88	 	77	 	9.32	 	7.96	 	6.85	 	5.91	 	7.95
	33	 	3.93	 	3.91	 	56	 	5.15	 	5.08	 	4.99	 	4.86	 	4.96	 	78	 	9.71	 	8.13	 	6.92	 	5.93	 	8.20
	34	 	3.95	 	3.93	 	57	 	5.24	 	5.16	 	5.06	 	4.92	 	5.03	 	79	 	10.12	 	8.30	 	6.98	 	5.95	 	8.46
	35	 	3.98	 	3.96	 	58	 	5.34	 	5.25	 	5.14	 	4.98	 	5.12	 	80	 	10.56	 	8.46	 	7.04	 	5.96	 	8.74
	36	 	4.01	 	3.99	 	59	 	5.45	 	5.35	 	5.22	 	5.04	 	5.20	 	81	 	11.02	 	8.62	 	7.09	 	5.98	 	9.04
	37	 	4.04	 	4.01	 	60	 	5.57	 	5.45	 	5.31	 	5.10	 	5.30	 	82	 	11.53	 	8.77	 	7.14	 	5.99	 	9.36
	38	 	4.08	 	4.04	 	61	 	5.69	 	5.56	 	5.39	 	5.17	 	5.39	 	83	 	12.06	 	8.92	 	7.18	 	5.99	 	9.69
	39	 	4.11	 	4.07	 	62	 	5.82	 	5.67	 	5.48	 	5.23	 	5.50	 	84	 	12.63	 	9.06	 	7.21	 	6.00	 	10.04
	40	 	4.15	 	4.11	 	63	 	5.96	 	5.79	 	5.58	 	5.29	 	5.60	 	85 &	 		 		 		 		 	
	41	 	4.19	 	4.14	 	64	 	6.11	 	5.92	 	5.67	 	5.35	 	5.72	 	Over	 	13.23	 	9.19	 	7.24	 	6.00	 	10.42
	42	 	4.23	 	4.18	 		 		 		 		 		 		 		 		 		 		 		 	
															
	Female	 		 		 		 		 		 		 		 		 		 		 		 		 		 	
	 Age of
 Payee
	 	Monthly
Payments Certain	 	 Age of
 Payee
	 	Monthly Payments Certain	 	 Installment
 Refund
	 	 Age of
 Payee
	 	 Monthly Payments Certain
	 	 Installment
 Refund

	 	120	 	240	 	 	None	 	120	 	180	 	240	 	 	 	None	 	120	 	180	 	240	 
	20	 	3.67	 	3.67	 	43	 	4.05	 	4.05	 	4.04	 	4.02	 	4.02	 	65	 	5.60	 	5.49	 	5.36	 	5.16	 	5.36
	21	 	3.68	 	3.67	 	44	 	4.09	 	4.08	 	4.07	 	4.06	 	4.06	 	66	 	5.73	 	5.61	 	5.46	 	5.23	 	5.46
	22	 	3.68	 	3.68	 	45	 	4.13	 	4.12	 	4.11	 	4.09	 	4.09	 	67	 	5.87	 	5.73	 	5.50	 	5.30	 	5.58
	23	 	3.69	 	3.68	 	46	 	4.17	 	4.16	 	4.15	 	4.13	 	4.13	 	68	 	6.02	 	5.86	 	5.66	 	5.37	 	5.70
	24	 	3.69	 	3.69	 	47	 	4.21	 	4.20	 	4.19	 	4.17	 	4.17	 	69	 	6.18	 	6.00	 	5.76	 	5.43	 	5.83
	25	 	3.70	 	3.70	 	48	 	4.26	 	4.24	 	4.23	 	4.20	 	4.21	 	70	 	6.36	 	6.15	 	5.87	 	5.50	 	5.96
	26	 	3.71	 	3.70	 	49	 	4.30	 	4.29	 	4.27	 	4.25	 	4.25	 	71	 	6.55	 	6.30	 	5.98	 	5.56	 	6.11
	27	 	3.72	 	3.71	 	50	 	4.35	 	4.34	 	4.32	 	4.29	 	4.30	 	72	 	6.76	 	6.46	 	6.09	 	5.62	 	6.26
	28	 	3.73	 	3.72	 	51	 	4.41	 	4.39	 	4.37	 	4.33	 	4.34	 	73	 	6.98	 	6.63	 	6.20	 	5.67	 	6.43
	29	 	3.74	 	3.73	 	52	 	4.46	 	4.44	 	4.42	 	4.38	 	4.39	 	74	 	7.22	 	6.80	 	6.31	 	5.72	 	6.61
	30	 	3.75	 	3.75	 	53	 	4.52	 	4.50	 	4.47	 	4.43	 	4.45	 	75	 	7.49	 	6.98	 	6.41	 	5.77	 	6.79
	31	 	3.77	 	3.76	 	54	 	4.59	 	4.56	 	4.53	 	4.48	 	4.50	 	76	 	7.77	 	7.17	 	6.52	 	5.81	 	6.99
	32	 	3.78	 	3.77	 	55	 	4.65	 	4.63	 	4.59	 	4.53	 	4.56	 	77	 	8.07	 	7.36	 	6.61	 	5.84	 	7.21
	33	 	3.80	 	3.79	 	56	 	4.72	 	4.69	 	4.65	 	4.59	 	4.62	 	78	 	8.40	 	7.55	 	6.71	 	5.87	 	7.43
	34	 	3.81	 	3.80	 	57	 	4.80	 	4.76	 	4.72	 	4.65	 	4.69	 	79	 	8.75	 	7.75	 	6.79	 	5.90	 	7.68
	35	 	3.83	 	3.82	 	58	 	4.88	 	4.84	 	4.78	 	4.71	 	4.75	 	80	 	9.14	 	7.95	 	6.87	 	5.92	 	7.93
	36	 	3.85	 	3.84	 	59	 	4.96	 	4.92	 	4.86	 	4.77	 	4.83	 	81	 	9.55	 	8.14	 	6.95	 	5.94	 	8.21
	37	 	3.88	 	3.86	 	60	 	5.05	 	5.00	 	4.93	 	4.83	 	4.90	 	82	 	10.00	 	8.33	 	7.01	 	5.96	 	8.51
	38	 	3.90	 	3.89	 	61	 	5.15	 	5.09	 	5.01	 	4.89	 	4.98	 	83	 	10.49	 	8.51	 	7.07	 	5.97	 	8.82
	39	 	3.93	 	3.91	 	62	 	5.25	 	5.18	 	5.09	 	4.96	 	5.07	 	84	 	11.02	 	8.69	 	7.12	 	5.98	 	9.16
	40	 	3.95	 	3.94	 	63	 	5.36	 	5.28	 	5.18	 	5.03	 	5.16	 	85 &	 		 		 		 		 	
	41	 	3.98	 	3.96	 	64	 	5.47	 	5.38	 	5.27	 	5.10	 	5.26	 	Over	 	11.59	 	8.86	 	7.17	 	5.99	 	9.51
	42	 	4.01	 	3.99	 		 		 		 		 		 		 		 		 		 		 		 	

  

 Page 12 









					
		 	Guaranteed Minimum	 	
	Option	 	Amount of Monthly Payment	 	
	Four	 	For Each $1,000 Applied (cont’d)	 	
			
		 	Joint and Last Survivor Annuity	 	

  

																																													
	Age of
Male	 	Age of Female Payee	 	Age of
Male
	Payee	 	55	 	56	 	57	 	58	 	59	 	60	 	61	 	62	 	63	 	64	 	65	 	66	 	67	 	68	 	69	 	70	 	71	 	72	 	73	 	74	 	75	 	Payee
	50	 	4.21	 	4.23	 	4.25	 	4.28	 	4.30	 	4.32	 	4.34	 	4.36	 	4.38	 	4.40	 	4.42	 	4.43	 	4.45	 	4.47	 	4.48	 	4.50	 	4.51	 	4.52	 	4.54	 	4.55	 	4.56	 	50
	51	 	4.23	 	4.25	 	4.28	 	4.30	 	4.33	 	4.35	 	4.37	 	4.39	 	4.42	 	4.44	 	4.46	 	4.48	 	4.49	 	4.51	 	4.53	 	4.54	 	4.56	 	4.58	 	4.59	 	4.60	 	4.61	 	51
	52	 	4.25	 	4.28	 	4.30	 	4.33	 	4.36	 	4.38	 	4.40	 	4.43	 	4.45	 	4.47	 	4.50	 	4.52	 	4.54	 	4.56	 	4.58	 	4.59	 	4.61	 	4.63	 	4.64	 	4.66	 	4.67	 	52
	53	 	4.27	 	4.30	 	4.33	 	4.36	 	4.38	 	4.41	 	4.44	 	4.46	 	4.49	 	4.51	 	4.54	 	4.56	 	4.58	 	4.60	 	4.62	 	4.64	 	4.66	 	4.68	 	4.70	 	4.71	 	4.73	 	53
	54	 	4.29	 	4.32	 	4.35	 	4.38	 	4.41	 	4.44	 	4.47	 	4.50	 	4.53	 	4.55	 	4.58	 	4.60	 	4.63	 	4.65	 	4.67	 	4.70	 	4.72	 	4.74	 	4.76	 	4.77	 	4.79	 	54
	55	 	4.31	 	4.35	 	4.38	 	4.41	 	4.44	 	4.47	 	4.50	 	4.53	 	4.56	 	4.59	 	4.62	 	4.65	 	4.67	 	4.70	 	4.72	 	4.75	 	4.77	 	4.79	 	4.82	 	4.84	 	4.85	 	55
	56	 	4.33	 	4.37	 	4.40	 	4.43	 	4.47	 	4.50	 	4.53	 	4.57	 	4.60	 	4.63	 	4.66	 	4.69	 	4.72	 	4.75	 	4.78	 	4.80	 	4.83	 	4.85	 	4.88	 	4.90	 	4.92	 	56
	57	 	4.35	 	4.39	 	4.42	 	4.46	 	4.50	 	4.53	 	4.57	 	4.60	 	4.64	 	4.67	 	4.70	 	4.74	 	4.77	 	4.80	 	4.83	 	4.86	 	4.89	 	4.91	 	4.94	 	4.96	 	4.99	 	57
	58	 	4.37	 	4.41	 	4.45	 	4.48	 	4.52	 	4.56	 	4.60	 	4.64	 	4.67	 	4.71	 	4.75	 	4.78	 	4.82	 	4.85	 	4.88	 	4.91	 	4.95	 	4.97	 	5.00	 	5.03	 	5.06	 	58
	59	 	4.39	 	4.43	 	4.47	 	4.51	 	4.55	 	4.59	 	4.63	 	4.67	 	4.71	 	4.75	 	4.79	 	4.83	 	4.86	 	4.90	 	4.94	 	4.97	 	5.01	 	5.04	 	5.07	 	5.10	 	5.13	 	59
	60	 	4.41	 	4.45	 	4.49	 	4.53	 	4.57	 	4.62	 	4.66	 	4.70	 	4.74	 	4.79	 	4.83	 	4.87	 	4.91	 	4.95	 	4.99	 	5.03	 	5.07	 	5.10	 	5.14	 	5.17	 	5.20	 	60
	61	 	4.43	 	4.47	 	4.51	 	4.55	 	4.60	 	4.64	 	4.69	 	4.73	 	4.78	 	4.83	 	4.87	 	4.92	 	4.96	 	5.00	 	5.05	 	5.09	 	5.13	 	5.17	 	5.21	 	5.24	 	5.28	 	61
	62	 	4.44	 	4.49	 	4.53	 	4.58	 	4.62	 	4.67	 	4.72	 	4.77	 	4.81	 	4.86	 	4.91	 	4.96	 	5.01	 	5.05	 	5.10	 	5.15	 	5.19	 	5.24	 	5.28	 	5.32	 	5.36	 	62
	63	 	4.46	 	4.50	 	4.55	 	4.60	 	4.65	 	4.70	 	4.75	 	4.80	 	4.85	 	4.90	 	4.95	 	5.00	 	5.05	 	5.11	 	5.16	 	5.21	 	5.25	 	5.30	 	5.35	 	5.39	 	5.44	 	63
	64	 	4.47	 	4.52	 	4.57	 	4.62	 	4.67	 	4.72	 	4.77	 	4.83	 	4.88	 	4.94	 	4.99	 	5.05	 	5.10	 	5.16	 	5.21	 	5.26	 	5.32	 	5.37	 	5.42	 	5.47	 	5.52	 	64
	65	 	4.48	 	4.53	 	4.58	 	4.64	 	4.69	 	4.74	 	4.80	 	4.86	 	4.91	 	4.97	 	5.03	 	5.09	 	5.15	 	5.21	 	5.27	 	5.32	 	5.38	 	5.44	 	5.49	 	5.55	 	5.60	 	65
	66	 	4.50	 	4.55	 	4.60	 	4.65	 	4.71	 	4.77	 	4.82	 	4.88	 	4.94	 	5.01	 	5.07	 	5.13	 	5.19	 	5.26	 	5.32	 	5.38	 	5.44	 	5.51	 	5.57	 	5.63	 	5.69	 	66
	67	 	4.51	 	4.56	 	4.62	 	4.67	 	4.73	 	4.79	 	4.85	 	4.91	 	4.97	 	5.04	 	5.10	 	5.17	 	5.24	 	5.30	 	5.37	 	5.44	 	5.51	 	5.57	 	5.64	 	5.71	 	5.77	 	67
	68	 	4.52	 	4.57	 	4.63	 	4.69	 	4.75	 	4.81	 	4.87	 	4.94	 	5.00	 	5.07	 	5.14	 	5.21	 	5.28	 	5.35	 	5.42	 	5.50	 	5.57	 	5.64	 	5.71	 	5.79	 	5.85	 	68
	69	 	4.53	 	4.59	 	4.64	 	4.70	 	4.76	 	4.83	 	4.89	 	4.96	 	5.03	 	5.10	 	5.17	 	5.25	 	5.32	 	5.40	 	5.47	 	5.55	 	5.63	 	5.71	 	5.79	 	5.86	 	5.94	 	69
	70	 	4.54	 	4.60	 	4.66	 	4.72	 	4.78	 	4.85	 	4.91	 	4.98	 	5.05	 	5.13	 	5.20	 	5.28	 	5.36	 	5.44	 	5.52	 	5.60	 	5.69	 	5.77	 	5.86	 	5.94	 	6.02	 	70
	71	 	4.55	 	4.61	 	4.67	 	4.73	 	4.80	 	4.86	 	4.93	 	5.00	 	5.08	 	5.16	 	5.23	 	5.31	 	5.40	 	5.48	 	5.57	 	5.66	 	5.75	 	5.84	 	5.93	 	6.02	 	6.11	 	71
	72	 	4.56	 	4.62	 	4.68	 	4.74	 	4.81	 	4.88	 	4.95	 	5.02	 	5.10	 	5.18	 	5.26	 	5.35	 	5.43	 	5.52	 	5.61	 	5.71	 	5.80	 	5.90	 	5.99	 	6.09	 	6.19	 	72
	73	 	4.57	 	4.63	 	4.69	 	4.75	 	4.82	 	4.89	 	4.97	 	5.04	 	5.12	 	5.20	 	5.29	 	5.38	 	5.47	 	5.56	 	5.66	 	5.76	 	5.86	 	5.96	 	6.06	 	6.16	 	6.27	 	73
	74	 	4.58	 	4.64	 	4.70	 	4.77	 	4.83	 	4.91	 	4.98	 	5.06	 	5.14	 	5.23	 	5.32	 	5.41	 	5.50	 	5.60	 	5.70	 	5.80	 	5.91	 	6.02	 	6.12	 	6.24	 	6.35	 	74
	75	 	4.58	 	4.64	 	4.71	 	4.78	 	4.85	 	4.92	 	5.00	 	5.08	 	5.16	 	5.25	 	5.34	 	5.43	 	5.53	 	5.63	 	5.74	 	5.85	 	5.96	 	6.07	 	6.19	 	6.30	 	6.42	 	75
	76	 	4.59	 	4.65	 	4.72	 	4.78	 	4.86	 	4.93	 	5.01	 	5.09	 	5.18	 	5.27	 	5.36	 	5.46	 	5.56	 	5.67	 	5.77	 	5.89	 	6.00	 	6.12	 	6.25	 	6.37	 	6.50	 	76
	77	 	4.59	 	4.66	 	4.72	 	4.79	 	4.87	 	4.94	 	5.02	 	5.11	 	5.19	 	5.29	 	5.38	 	5.48	 	5.59	 	5.70	 	5.81	 	5.93	 	6.05	 	6.17	 	6.30	 	6.44	 	6.57	 	77
	78	 	4.60	 	4.66	 	4.73	 	4.80	 	4.87	 	4.95	 	5.03	 	5.12	 	5.21	 	5.30	 	5.40	 	5.51	 	5.61	 	5.73	 	5.84	 	5.96	 	6.09	 	6.22	 	6.36	 	6.50	 	6.64	 	78
	79	 	4.61	 	4.67	 	4.74	 	4.81	 	4.88	 	4.96	 	5.04	 	5.13	 	5.22	 	5.32	 	5.42	 	5.53	 	5.64	 	5.75	 	5.87	 	6.00	 	6.13	 	6.27	 	6.41	 	6.56	 	6.71	 	79
	80	 	4.61	 	4.67	 	4.74	 	4.81	 	4.89	 	4.97	 	5.05	 	5.14	 	5.24	 	5.33	 	5.44	 	5.55	 	5.66	 	5.78	 	5.90	 	6.03	 	6.17	 	6.31	 	6.46	 	6.61	 	6.77	 	80

 Monthly payment for ages not shown will be furnished by the Company on request. 
  

					
	Option	 	
	Five	 	Payment for a Designated Period	 	

  

														
						
	Years of
Payments	 	Amount of
Monthly
Payment	 	Years of
Payments	 	Amount of
Monthly
Payment	 	Years of
Payments	 	Amount of
Monthly
Payment
	10	 	$	10.06	 	17	 	$	6.71	 	24	 	$	5.35
	11	 	 	9.31	 	18	 	 	6.44	 	25	 	 	5.22
	12	 	 	8.69	 	19	 	 	6.21	 	26	 	 	5.10
	13	 	 	8.17	 	20	 	 	6.00	 	27	 	 	5.00
	14	 	 	7.72	 	21	 	 	5.81	 	28	 	 	4.90
	15	 	 	7.34	 	22	 	 	5.64	 	29	 	 	4.80
	16	 	 	7.00	 	23	 	 	5.49	 	30	 	 	4.72

  

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 Flexible Premium Multi-Funded Variable Annuity Contract 
 Details Of The Variable Provisions Begin On Page 6 
 Nonparticipating 
 Providian Life and Health Insurance Company 
 A Missouri Stock Company 
 Administrative Offices: 
 Cedar Rapids, Iowa 52499