Document:

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                                                               Exhibit (4)(a)(1)

                     FIRST SUNAMERICA LIFE INSURANCE COMPANY
                       A STOCK COMPANY NEW YORK, NEW YORK

CONTRACT NUMBER [P9999999999]

OWNER [JOHN DOE]

      EXECUTIVE OFFICE                                  ANNUITY SERVICE CENTER
733 THIRD AVENUE, 4th FLOOR                                  PO BOX 54299
  NEW YORK, NEW YORK 10017                            LOS ANGELES, CA 90054-0299

FIRST SUNAMERICA LIFE INSURANCE COMPANY ("We", "Us", the "Company", or "First
SunAmerica") agrees to provide benefits to the Owner in accordance with the
provisions set forth in this Contract and in consideration of the Application
and Purchase Payments We receive.

THE VALUE OF AMOUNTS ALLOCATED TO THE SEPARATE ACCOUNT DURING THE ACCUMULATION
AND ANNUITY PERIODS IS NOT GUARANTEED, AND WILL INCREASE OR DECREASE BASED UPON
THE INVESTMENT EXPERIENCE OF THE VARIABLE PORTFOLIOS YOU CHOOSE.

THE SEPARATE ACCOUNT CHARGE IS CHARGED AGAINST THE ASSETS OF THE SEPARATE
ACCOUNT. THIS CHARGE INCLUDES FEES FOR MORTALITY AND EXPENSE RISK AND THE
DISTRIBUTION EXPENSE. ON AN ANNUALIZED BASIS THE CHARGE EQUALS 1.40%. THESE
CHARGES ARE ASSESSED, ON A SIMPLE INTEREST BASIS, AS A PERCENTAGE OF THE AVERAGE
DAILY ENDING VALUE OF THE ASSETS ATTRIBUTABLE TO THE ACCUMULATION UNITS OF THE
VARIABLE PORTFOLIOS TO WHICH YOUR CONTRACT VALUE IS ALLOCATED. THE DAILY CHARGE
IS 1/365TH OF THE ANNUALIZED CHARGE. THUS, THE SMALLEST ANNUAL EFFECTIVE RATE OF
THE INVESTMENT RETURN THAT WOULD HAVE TO BE EARNED ON ASSETS OF THE SEPARATE
ACCOUNT SO THAT THE DOLLAR AMOUNT OF VARIABLE ANNUITY PAYMENTS WILL NOT DECREASE
IS 4.96%, COMPOUNDED DAILY. THE CONTRACT'S RATE OF RETURN IS BASED ON COMPOUND
INTEREST.

RIGHT TO EXAMINE - IF, WITHIN 10 DAYS OF RECEIPT OF THIS CONTRACT (60 DAYS IF
THE CONTRACT REPLACED ANY OTHER LIFE INSURANCE OR ANNUITY CONTRACT(S)) YOU ARE
NOT SATISFIED WITH IT, YOU MAY RETURN THIS CONTRACT TO OUR ANNUITY SERVICE
CENTER OR TO THE AGENT THROUGH WHOM THE CONTRACT WAS PURCHASED. THE COMPANY WILL
REFUND THE PURCHASE PAYMENT OR THE CONTRACT VALUE, WHICHEVER IS GREATER,
COMPUTED AS OF THE BUSINESS DAY DURING WHICH WE RECEIVE THE CONTRACT. UPON SUCH
REFUND, THE CONTRACT SHALL BE VOID.

For Individual Retirement Annuities, or if a refund of the Purchase Payment(s)
is otherwise required We reserve the right to allocate your Purchase Payment(s)
to the Cash Management Portfolio until the end of the Right To Examine period.
Thereafter, allocations will be made as selected by You on Your Application.

                  THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY.

                                        /s/ Jay S. Wintrob
                                        ----------------------------------------
                                        Jay S. Wintrob
                                        President

                      INDIVIDUAL VARIABLE ANNUITY CONTRACT
                                Nonparticipating

                                        1

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                                TABLE OF CONTENTS

<TABLE>
<S>                                                                      <C>
CONTRACT DATA PAGE....................................................    PAGE 3

DEFINITIONS...........................................................    PAGE 4

PURCHASE PAYMENT PROVISIONS...........................................    PAGE 7

ACCUMULATION PROVISIONS...............................................    PAGE 7

CHARGES AND DEDUCTIONS................................................    PAGE 8

TRANSFER PROVISIONS...................................................    PAGE 8

WITHDRAWAL PROVISIONS.................................................    PAGE 9

DEATH PROVISIONS......................................................    PAGE 9

ANNUITY PROVISIONS....................................................   PAGE 11

GENERAL PROVISIONS....................................................   PAGE 13

ANNUITY PAYMENT OPTIONS...............................................   PAGE 16

FIXED ANNUITY PAYMENT OPTIONS TABLE...................................   PAGE 17

VARIABLE ANNUITY PAYMENT OPTIONS TABLE................................   PAGE 20
</TABLE>

                                        2

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                               CONTRACT DATA PAGE

<TABLE>
<S>                                    <C>
CONTRACT NUMBER:                       ANNUITY SERVICE CENTER:
     [P9999999999]                     P. O. BOX 54299
                                       LOS ANGELES, CA 90054-0299
OWNER:
     [JOHN DOE]                        AGE AT ISSUE: [35]

ANNUITANT:                             INITIAL PURCHASE PAYMENT: [$5,000.00]
     [JOHN DOE]
                                       CONTRACT DATE: [December 1, 2007]
SPECIFIED ANNUITY DATE:
     [December 1, 2026]                ANNUAL CONTRACT MAINTENANCE
                                       FEE: Current: [$0.00]. Maximum: $50.00.
LATEST ANNUITY DATE:
     [December 1, 2062]

BENEFICIARY:
     As named by You

SEPARATE ACCOUNT:
[FS VARIABLE SEPARATE ACCOUNT]

SEPARATE ACCOUNT CHARGE: 1. 40%
Of the above percentage, the charge
for Guaranteed death benefit risk is
0.10%

TRANSFER FEE:
     Current: [$25.00]. Maximum:
     $25.00. Waived for systematic
     transfers (i.e. DCA) and for
     the first 15 transfers in any
     Contract Year.

OPTIONAL ELECTIONS:                          OPTIONAL ELECTION DETAILS:
Maximum Anniversary Value                    See attached Endorsement FSE-6191-2
</TABLE>

WITHDRAWAL CHARGE SCHEDULE: NONE

                                  FOR INQUIRIES
                               CALL 1-800-996-9786

                                        3
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                                   DEFINITIONS

Defined in this section are some of the words and phrases used in this Contract.
These terms are capitalized when used in the Contract with the meaning set forth
below.

ACCUMULATION UNIT

A unit of measurement used to compute the Contract Value in a Variable Portfolio
prior to the Annuity Date.

AGE

Age as of last birthday.

ANNUITANT

The natural person(s) whose life (lives) is (are) used to determine the annuity
benefits under the Contract. If the Contract is in force and the Annuitant(s) is
(are) alive on the Annuity Date, We will begin payments to the Payee. This
Contract cannot have Joint Annuitants if it is issued in connection with a
tax-qualified retirement plan.

ANNUITY DATE

The date on which annuity payments ("income payments") to the Payee begin. This
date cannot be later than the Latest Annuity Date.

ANNUITY SERVICE CENTER

As specified on the Contract Data Page.

ANNUITY UNIT

A unit of measurement determined on or after the Annuity Date used to compute
annuity payments from the Variable Portfolio(s).

BENEFICIARY

The Beneficiary is as named by You at issue to receive the death benefit under
this Contract upon your death. You may later change Your Beneficiary in a
written request to Us at Our Annuity Service Center.

CONTINUATION DATE

The Date on which We receive, at Our Annuity Service Center: (a) the Spousal
Beneficiary's written request to continue the Contract, and (b) Due Proof of
Death of the Owner. If We receive (a) and (b) on different dates, the
Continuation Date will be the later date.

CONTRACT DATE

The date Your Contract is issued, as shown on the Contract Data Page. It is the
date from which Contract Years and anniversaries are measured.

CONTRACT VALUE

Your share of the Variable Portfolios' Accumulation Unit Values.

CONTRACT YEAR

One year starting from the Contract Date in one calendar year and ending on the
day preceding the anniversary of such date in the succeeding calendar year.

                                        4

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CONTRIBUTION YEAR

A year starting from the date a Purchase Payment is made in one calendar year
and ending on the day preceding the anniversary of such date in succeeding
calendar years.

DEATH BENEFIT ADJUSTMENT

Any increase or reduction to the amount of the death benefit payable to account
for Purchase Payment and/or Withdrawal activity after a specified point in time
which will equal (a), (b), or (c), whichever is applicable, as follows:

          (a)  Where only Purchase Payments are received after the specified
               point in time, the dollar value of the Purchase Payments will be
               added to the death benefit payable; or

          (b)  Where only Withdrawals are made after the specified point in
               time, the Withdrawal will reduce the death benefit payable in the
               same proportion that the Contract Value was reduced at the time
               of the Withdrawal; or

          (c)  Where Purchase Payments have been received and Withdrawals made
               after the specified point in time, the death benefit amount
               payable will be adjusted by Purchase Payment(s) received after a
               specified point in time, reduced by any Withdrawal, made after
               that specified point in time in the same proportion that the
               Contract Value was reduced at the time of the Withdrawal.

DOLLAR COST AVERAGING (DCA)

An optional program under which You authorize the systematic transfer of
specified amounts or percentages from any source account to any target account.

FIXED ANNUITIZATION

A series of periodic income payments of predetermined amounts that do not vary
with investment experience. Such payments are made from the Company's general
asset account. This Contract provides several fixed annuity payment options.

IRC

The Internal Revenue Code of 1986, as amended, or as it may be amended or
superseded.

JOINT OWNER

Any person named as Joint Owner on the Application and listed on the Contract
Data Page, unless subsequently changed. The Joint Owner, if any, possesses an
undivided interest in this Contract in conjunction with the Owner. All
references within this Contract to Owner will also apply to the Joint Owner.

LATEST ANNUITY DATE

The later of the Owner's 90th birthday or ten years after the Contract Date. If
the Owner is a non-natural person, the Latest Annuity Date is the later of the
Annuitant's 90th birthday or ten years after the Contract Date.

NET PURCHASE PAYMENT

The sum of all Purchase Payment(s), reduced for each Withdrawal in the same
proportion that the Contract Value is reduced by such Withdrawal.

NYSE

New York Stock Exchange.

                                        5

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OWNER

The person or entity named in the Contract who is entitled to exercise all
rights and privileges of ownership under the Contract. Owner means both Joint
Owners, if applicable.

PAYEE

The person receiving payment of annuity benefits under this Contract.

PURCHASE PAYMENTS

Payments in U.S. currency made by or on behalf of the Owner to the Company to
fund the Contract.

REQUIRED DOCUMENTATION

Is: (a) Due Proof of Death that the Owner or the Spousal Beneficiary died before
the Annuity Date; and, (b) an election form specifying the payment options and
(c) any other documentation We may require.

SEPARATE ACCOUNT

A segregated asset account named on the Contract Data Page. The Separate Account
consists of several Variable Portfolios, each investing in shares of the
Underlying Fund(s) of the trust(s). The assets of the Separate Account are not
commingled with the general assets and liabilities of the Company. The value of
amounts allocated to the Variable Portfolios of the Separate Account is not
guaranteed.

SPECIFIED ANNUITY DATE

The anticipated Annuity Date specified by You as shown on the Application. This
date may be changed by You in writing prior to the Annuity Date, but in no event
can it be later than the Latest Annuity Date. If this date is not specified, it
will be the Latest Annuity Date.

SPOUSAL BENEFICIARY

The original deceased Owner's surviving spouse who is designated as the primary
Beneficiary at the time of the Owner's death and may continue the Contract as
the Owner on the Continuation Date.

SUBSEQUENT PURCHASE PAYMENTS

Purchase Payments made after the initial Purchase Payment.

UNDERLYING FUND

The variable investment options in which the corresponding Variable Portfolio(s)
invest.

VARIABLE ANNUITIZATION

A series of periodic income payments which vary in amount according to the
investment experience of one or more Variable Portfolios, as selected by You.
This Contract provides several variable annuity payment options.

VARIABLE PORTFOLIO

One or more divisions of the Separate Account which provides for the variable
investment options available under this Contract. Each Variable Portfolio has
its own investment objective and is invested in the Underlying Fund(s) of the
trusts. A Variable Portfolio is not chargeable with liabilities arising out of
any other Variable Portfolio. The available Variable Portfolios are shown on the
Application. Additional Variable Portfolios may become available in the future.
The Variable Portfolios may also be referred to as a Variable Subaccount and/or
Subaccount.

WE, OUR, US, THE COMPANY

First SunAmerica Life Insurance Company.

                                        6

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WITHDRAWAL(S)

Amount(s) withdrawn from the Contract Value including any charges and fees
applicable to each such withdrawal.

YOU, YOUR

The Owner.

                           PURCHASE PAYMENT PROVISIONS

PURCHASE PAYMENTS

Purchase Payments are flexible. This means that, subject to Company disclosed
restrictions, You may change the amounts, frequency and/or timing of Purchase
Payments. Purchase Payments will be allocated in accordance with instructions
from You to the Variable Portfolio(s). The minimum Purchase Payment that may be
allocated to a Variable Portfolio under the Contract is $100. Subject to prior
Company approval, the maximum of all Purchase Payments made to the Contract may
not exceed $1,000,000.

SUBSTITUTION OF VARIABLE PORTFOLIO

If the shares of an Underlying Fund should no longer be available for investment
by the Separate Account, then We may substitute shares of another Underlying
Fund, for shares already purchased, or to be purchased in the future.
Substitutions of securities will be carried out in accordance with any
applicable state and/or federal laws or regulations.

                             ACCUMULATION PROVISIONS

Prior to the Annuity Date, the Contract Value is the Separate Account
Accumulation Value. If Your Contract Value falls below $2,500, subject to
applicable state and federal laws, rules and regulations, we may terminate Your
Contract and send you the remaining dollar amount.

SEPARATE ACCOUNT ACCUMULATION VALUE

The Separate Account Accumulation Value under the Contract shall be the sum of
the values of the Accumulation Units held in the Variable Portfolios for the
Owner.

NUMBER OF ACCUMULATION UNITS

Your Contract is credited with Accumulation Units of the Separate Account when
amounts are allocated to the Variable Portfolio(s). For that portion of each
Purchase Payment and/or transfer amount allocated to a Variable Portfolio, the
number of Accumulation Units credited is equal to the sum of each Purchase
Payment and/or transfer amount allocated to the Variable Portfolio reduced by
premium taxes, if any:

Divided by

The Accumulation Unit value for that Variable Portfolio for the NYSE business
day in which the Purchase Payment or transfer amount is allocated.

The number of Accumulation Units will be reduced for Withdrawals of Contract
Value, annuitizations, amounts transferred out of a Variable Portfolio, the
Contract Maintenance Fee and applicable charges for optional features as set
forth in endorsements to this Contract. Reductions will be made as of the NYSE
business day in which We receive all requirements for the transaction, as
appropriate.

                                        7

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ACCUMULATION UNIT VALUE (AUV)

The AUV of a Variable Portfolio for any NYSE business day is calculated by
subtracting (2) from (1) and dividing the result by (3) where:

(1)  is the total value at the end of the given NYSE business day of the assets
     attributable to the Variable Portfolio minus any applicable liabilities
     other than those owed to the Contractholders;

(2)  is the amount equal to the daily Separate Account Charge plus the daily
     charge for any optional features that impose a daily charge;

(3)  is the number of Accumulation Units outstanding at the end of the given
     NYSE business day.

                             CHARGES AND DEDUCTIONS

We will deduct the following charges from the Contract:

CONTRACT MAINTENANCE FEE

The charge specified on the Contract Data Page will be deducted on each Contract
anniversary that occurs on or prior to the Annuity Date. It will also be
deducted when the Contract Value is withdrawn in full if the Withdrawal is not
on the Contract anniversary. We also reserve the right to waive the fee for
Contracts with a value of $50,000.00 or greater on the Contract anniversary.

SEPARATE ACCOUNT CHARGE

This charge, as shown on the Contract Data Page, on an annualized basis equals a
percentage of the average daily ending value of the assets attributable to the
Accumulation Units of the Variable Portfolio(s) to which the Contract is
allocated. This charge compensates Us for mortality and expense risks, and
distribution expenses associated with the Contract. We subtract this charge
daily.

                               TRANSFER PROVISIONS

Prior to the Annuity Date, You may transfer all or part of Your Contract Value
from any Variable Portfolio to any other Variable Portfolio(s) subject to
applicable restrictions. The minimum amount that can be transferred and the
amount that can remain in a Variable Portfolio are subject to Company limits. We
reserve the right to charge a fee, as shown on the Contract Data Page, for
transfers if the number of transfers exceeds a limit of fifteen (15) in any
Contract Year. We further reserve the right to restrict Your transfer
privileges, including possible termination of those privileges, if we determine
that a pattern of transfers reflects a market timing strategy or is potentially
harmful to other contract owners.

TRANSFERS OF ACCUMULATION AND ANNUITY UNITS BETWEEN VARIABLE PORTFOLIOS

Prior to and after the Annuity Date, transfers are subject to certain
restrictions. You may transfer all or a portion of Your Contract Value from one
Variable Portfolio to another Variable Portfolio(s). Prior to the Annuity Date,
a transfer will result in the redemption of Accumulation Units in a Variable
Portfolio and the purchase of Accumulation Units in the other Variable
Portfolio. Transfers will be effected at the end of the NYSE business day in
which We receive Your completed request for the transfer.

                                        8

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After the Annuity Date, a transfer will result in the redemption of Annuity
Units in a Variable Portfolio and the purchase of Annuity Units in the other
Variable Portfolio. Transfers will be effected for the last NYSE business day of
the month in which We receive Your request for the transfer.

                              WITHDRAWAL PROVISIONS

On or before the Annuity Date and while the Owner is living, You may withdraw
all or part of Your Contract Value under this Contract by informing Us at Our
Annuity Service Center, subject to the requirement that the amount remaining
after withdrawal must be at least $500. For a full withdrawal, this Contract
must be returned to Our Annuity Service Center. The minimum amount that can be
withdrawn is $1,000, subject to the minimums set forth by the laws of the State
of New York.

Unless You tell Us otherwise in writing, Withdrawals will be deducted from the
Contract Value in proportion to their allocation among any available Variable
Portfolios. Withdrawals will be based on values for the NYSE business day in
which the request for withdrawal and the Contract (in the case of a full
withdrawal), are received at Our Annuity Service Center. Unless the SUSPENSION
OF PAYMENTS section is in effect, payment of withdrawals will be made within
seven calendar days.

SYSTEMATIC WITHDRAWAL PROGRAM

Prior to the Annuity Date, You may elect to participate in a Systematic
Withdrawal Program by informing Us at Our Annuity Service Center. The Systematic
Withdrawal Program allows You to make automatic withdrawals from Your account
monthly, quarterly, semiannually or annually. The minimum systematic withdrawal
amount is $100, provided that the amount remaining after withdrawal is $500. You
may terminate Your participation in the Systematic Withdrawal Program at any
time by sending Us a written request. We reserve the right to modify, suspend or
terminate the Systematic Withdrawal Program at any time.

                                DEATH PROVISIONS

Notwithstanding any provision of this Contract to the contrary, all payments of
benefits under this Contract will be made in a manner that satisfies the
requirements of IRC Section 72(s), as amended from time to time, and complies
with requirements set forth by the laws of the State of New York. If the
Contract is owned by a trust or other non-natural person, We will treat the
death of any Annuitant as the death of the "Primary Annuitant" and as the death
of any Owner.

DUE PROOF OF DEATH

Due Proof of Death means:

          1.   a certified copy of a death certificate; or

          2.   a certified copy of a decree of a court of competent jurisdiction
               as to the finding of death; or

          3.   a written statement by a medical doctor who attended the deceased
               Owner at the time of death; or

          4.   any other proof satisfactory to Us.

                                        9

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DEATH OF OWNER BEFORE THE ANNUITY DATE

We will pay a death benefit to the Beneficiary upon Our receiving all Required
Documentation. Unless You have previously designated a payment option on behalf
of the Beneficiary, the Beneficiary must select one of the following options:

          1.   Immediately collect the death benefit in a lump sum payment. If a
               lump sum payment is elected, payment will be in accordance with
               any applicable laws and regulations governing payments on death;
               or

          2.   Collect the death benefit in the form of one of the Annuity
               Payment Options. If an Annuity Payment Option is desired, an
               option must be elected within 60 days of Our receipt of: (a) Due
               Proof of Death of the Owner; (b) an election form specifying the
               payment option and (c) any other documentation We may require.
               The payments must be over the life of the Beneficiary or over a
               period not extending beyond the life expectancy of the
               Beneficiary. Payments under this option must commence within one
               year after the Owner's death, otherwise, the death benefit will
               be paid in accordance with option 1 above; or

          3.   If eligible, continue the Contract as the Spousal Beneficiary. On
               the Continuation Date, We will contribute to the Contract any
               amount by which the death benefit exceeds the Contract Value,
               calculated as of the Owner's date of death. This amount is not
               considered a Purchase Payment except in the calculation of
               certain death benefits upon the death of the Spousal Beneficiary.
               If this option is elected, no death benefit is paid.

Upon the Spousal Beneficiary's death, the entire interest of the Contract must
be distributed immediately under option 1 or 2 as provided under DEATH OF OWNER
BEFORE THE ANNUITY DATE

AMOUNT OF DEATH BENEFIT

If the Owner was age 82 or younger on the Contract Date, upon Our receipt of all
Required Documentation at Our Annuity Service Center, We will calculate the
death benefit and it will be the greater of:

     (1)  The Contract Value as of the later of (a) the date of death of the
          Owner and (b) the NYSE business day during which We receive all
          Required Documentation at Our Annuity Service Center; or

     (2)  Net Purchase Payment(s) received prior to the Owner's 86th birthday.

     NOTE: In declining market environments, the death benefit payable may be
     less than the Net Purchase Payments received.

SPOUSAL BENEFICIARY CONTINUATION

If the Spousal Beneficiary was age 82 or younger on the Continuation Date, upon
Our receipt of all Required Documentation at Our Annuity Service Center, We will
calculate the death benefit and it will be the greater of:

     (1)  The Contract Value as of the later of (a) the date of death of the
          Spousal Beneficiary and (b) the NYSE business day during which We
          receive all Required Documentation at Our Annuity Service Center; or

                                       10

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     (2)  The Contract Value on the Continuation Date, and a Death Benefit
          Adjustment for Purchase Payment(s) transacted after the Continuation
          Date but prior to the Spousal Beneficiary's 86th birthday and/or
          Withdrawals transacted after the Continuation Date.

If the Spousal Beneficiary was age 83 or older on the Continuation Date, the
death benefit will be the Contract Value as of the later of (a) the date of
death of the Spousal Beneficiary and (b) the NYSE business day during which We
receive all Required Documentation at Our Annuity Service Center.

The death benefit payable will accrue interest at Our current rate from the date
of death to the date the death benefit is distributed.

In any event, the entire interest in the Contract will be distributed within
five years from the date of Owner's death.

DEATH OF OWNER OR ANNUITANT ON OR AFTER THE ANNUITY DATE

If any Owner or Annuitant dies on or after the Annuity Date and before the
entire interest in the Contract has been distributed, We will pay the remaining
portion of the annuity payout to the Beneficiary upon Our receipt of Required
Documentation. For further information pertaining to death of the Annuitant, see
ANNUITY PAYMENT OPTIONS.

BENEFICIARY

The Beneficiary is selected by the Owner. While the Owner is living and before
the Annuity Date, the Owner may change the Beneficiary by written notice in a
form satisfactory to Us. A change in Beneficiary will take effect on the date
the notice is signed by the Owner, subject to any action We have taken before
receipt of such notice. If two or more persons are named as Beneficiaries under
the Contract, those surviving the Owner will share equally unless otherwise
stated; and each must elect to receive their respective portions of the death
benefit according to the options listed under DEATH OF OWNER BEFORE THE ANNUITY
DATE. If the Annuitant survives the Owner, and there are no surviving
Beneficiaries, the Annuitant will be deemed the Beneficiary.

Joint Owners, if applicable, shall be each other's primary Beneficiary. Joint
Annuitants, if any, when the Owner is a non-natural person, shall be each
other's primary Beneficiary. Any other Beneficiary designation will be treated
as a contingent Beneficiary.

If the Owner is also the Annuitant and dies before the Annuity Date, with no
surviving Beneficiaries, upon Our receipt of all Required Documentation we will
calculate the death benefit, and we will pay the death benefit to the estate of
the Owner in accordance with option 1, under DEATH OF OWNER BEFORE THE ANNUITY
DATE.

                               ANNUITY PROVISIONS

ANNUITY DATE

The Owner specifies an anticipated Annuity Date on the Application. The Owner
may change the Annuity Date at any time, at least seven days prior to the
Annuity Date, by written notice to the Company at its Annuity Service Center.
The Annuity Date must always be the first day of the calendar month and must be
at least thirteen (13) months after the Contract Date, but not beyond the Latest
Annuity Date. If no Annuity Date is specified on the Application, the Annuity
Date will be the Latest Annuity Date, as set by the Company.

                                       11

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PAYMENTS TO OWNER

Unless You request otherwise, We will make annuity payments to You. If You want
the annuity payments to be made to some other Payee, We will make such payments
subject to receipt of a written request filed at the Annuity Service Center no
later than thirty (30) days before the due date of the first annuity payment.
All payments will comply with the laws of the State of New York.

Any such request is subject to the rights of any assignee. No payments available
to or being paid to the Payee while the Annuitant is alive can be transferred,
commuted, anticipated or encumbered.

BETTERMENT OF RATES

The amount of the Owner's monthly payment will be at least equal to the monthly
payment produced by the application of an amount equal to the Contract Value of
this Contract to purchase any single consideration immediate annuity contract
offered by the Company at the same time to the same class of annuitants. We are
not currently offering any single premium immediate annuity contracts.

FIXED ANNUITIZATION

If a Fixed Annuitization has been elected, the Contract Value, less any
applicable premium taxes, shall be applied to the payment of the fixed annuity
payment option elected at rates which are at least equal to the annuity rates
based upon the applicable tables in the Contract. In no event will the Fixed
Annuitization be changed once it begins.

AMOUNT OF FIXED ANNUITY PAYMENTS

The amount of each fixed annuity payment will be determined by applying the
portion of the Contract Value allocated by You for Fixed Annuitization, less any
applicable premium taxes, to the annuity table applicable to the fixed annuity
payment option chosen.

AMOUNT OF VARIABLE ANNUITY PAYMENTS

(a)  FIRST VARIABLE ANNUITY PAYMENT: The dollar amount of the first Variable
     Annuitization payment will be determined by applying the portion of the
     Contract Value allocated to the Variable Portfolio(s), less any applicable
     premium taxes, to rates which are at least equal to the annuity rates based
     upon the annuity table applicable to the variable annuity payment option
     chosen. If the Contract Value is allocated to more than one Variable
     Portfolio, the value of Your interest in each Variable Portfolio is applied
     separately to the variable annuity payment option table to determine the
     amount of the first annuity payment attributable to each Variable
     Portfolio.

(b)  NUMBER OF VARIABLE ANNUITY UNITS: The number of Annuity Units for each
     applicable Variable Portfolio is the amount of the first annuity payment
     attributable to that Variable Portfolio divided by the value of the
     applicable Annuity Unit for that Variable Portfolio as of the Annuity Date.
     The number will not change as a result of investment experience.

(c)  VALUE OF EACH VARIABLE ANNUITY UNIT: The value of an Annuity Unit may
     increase or decrease from one month to the next. For any month, the value
     of an Annuity Unit of a particular Variable Portfolio is the value of that
     Annuity Unit as of the last NYSE business day of the preceding month,
     multiplied by the Net Investment Factor for that Variable Portfolio for the
     last NYSE business day of the current month.

                                       12

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The Net Investment Factor for any Variable Portfolio for a certain month is
determined by dividing (1) by (2) and multiplying by (3) where:

          (1)  is the Annuity Unit Value of the Variable Portfolio determined as
               of the last business day at the end of that month,

          (2)  is the Annuity Unit Value of the Variable Portfolio determined as
               of the last business day at the end of the preceding month., and

          (3)  is a factor that neutralizes the assumed investment rate of 3.5%
               per annum upon which the annuity payment tables are based. The
               monthly factor that neutralizes the assumed investment rate of
               3.5% per annum is: 1/1.035(1/12)=0.99713732.

(d)  SUBSEQUENT VARIABLE ANNUITY PAYMENTS: After the first Variable
     Annuitization payment future payments will vary in amount according to the
     investment performance of the applicable Variable Portfolio(s) to which
     Your Purchase Payments are allocated. The amount may change from month to
     month. The amount of each subsequent payment for each Variable Portfolio
     is:

The number of Annuity Units for each Variable Portfolio as determined for the
first annuity payment

Multiplied by

The value of an Annuity Unit for that Variable Portfolio at the end of the month
immediately preceding the month in which payment is due.

We guarantee that the amount of each Variable Annuitization payment will not be
affected by variations in expenses or mortality experience.

                               GENERAL PROVISIONS

ENTIRE CONTRACT

The Entire Contract between You and Us consists of this Contract, the
Application completed by You and attached to this Contract, and any attached
endorsement(s) or rider(s). An agent cannot change the terms or conditions of
this Contract. Any change must be in writing and approved by Us. Only Our
President, Secretary, or one of Our Vice-Presidents can give Our approval.

CHANGE OF ANNUITANT

If the Owner is an individual, the Owner may change the Annuitant(s) at any time
prior to the Annuity Date. To make a change, the Owner must send a written
notice to Us at least 30 days before the Annuity Date. The change will become
effective on the date the notice is signed by the Owner, subject to any action
We have taken before receipt of such notice. If the Owner is a non-natural
person, the Owner may not change the Annuitant.

DEATH OF ANNUITANT

If the natural Owner and Annuitant are different, and the Annuitant dies before
the Annuity Date, the Owner becomes the Annuitant until the Owner elects a new
Annuitant. If there are Joint Annuitants, upon the death of any Annuitant prior
to the Annuity Date, the Owner may elect a new Joint Annuitant. However, if the
Owner is a non-natural person, We will treat the death of any Annuitant as the
death of the "Primary Annuitant" and as the death of the Owner, see DEATH
PROVISIONS.

                                       13

<PAGE>

MISSTATEMENT OF AGE OR SEX

If the Age or sex of any Annuitant has been misstated, future annuity payments
will be adjusted using the correct Age and sex, according to Our rates in effect
on the date that annuity payments were determined. Any overpayment, plus
interest at the rate of 4% per year, will be deducted from the next payment(s)
due. Any underpayment, plus interest at the rate of 4% per year, will be paid in
full with the next payment due.

PROOF OF AGE, SEX, OR SURVIVAL

The Company may require satisfactory proof of correct Age or sex at any time. If
any payment under this Contract depends on the Annuitant being alive, the
Company may require satisfactory proof of survival.

SUSPENSION OF PAYMENTS

We may suspend or postpone any payments from the Variable Portfolios if any of
the following occur:

(a)  the NYSE is closed;

(b)  trading on the NYSE is restricted;

(c)  an emergency exists such that it is not reasonably practical to dispose of
     securities in the Variable Portfolios or to determine the value of its
     assets; or

(d)  the Securities and Exchange Commission, by order, so permits for the
     protection of Owners. Conditions in (b) and (c) will be decided by or in
     accordance with rules of the Securities and Exchange Commission.

CONFORMITY WITH STATE LAWS

The provisions of this Contract will be interpreted by the laws of the State of
New York, the state in which this Contract is delivered. Any provision which, on
the Contract Date, is in conflict with the law of such state is amended to
conform to the minimum requirements of such law.

CHANGES IN LAW

If the laws governing this Contract or the taxation of benefits under the
Contract change, We will amend this Contract, subject to New York Insurance
Department approval, to comply with any changes.

ASSIGNMENT

You may assign this Contract before the Annuity Date, but We will not be bound
by an assignment unless it is received by Us in writing. Your rights and those
of any other person referred to in this Contract will be subject to the
assignment. Certain assignments may be taxable. We do not assume any
responsibility for the validity or tax consequences of any assignment. We
reserve the right to not recognize assignments if it changes the risk profile of
the Owner of the Contract as determined in Our sole discretion.

CLAIMS OF CREDITORS

To the extent permitted by law, no right or proceeds payable under this Contract
will be subject to claims of creditors or legal process.

PREMIUM TAXES OR OTHER TAXES

The Company may deduct from Your Contract Value any premium tax or other taxes
payable to a state or other government entity, if applicable. Should We advance
any amount so due, We are not waiving any right to collect such amount at a
later date. The Company will deduct any withholding taxes required by applicable
law.

WRITTEN NOTICE

Any notice We send to You will be sent to Your address shown in the Application
unless You request otherwise. Any written request or notice to Us must be sent
to Our Annuity Service Center, as specified on the Contract Data Page.

                                       14

<PAGE>

PERIODIC REPORTS

At least once during each Contract Year, We will send You a statement of the
account activity of the Contract. The statement will include all transactions
which have occurred during the accounting period shown on the statement.

INCONTESTABILITY

This Contract shall be incontestable after it has been in force for a period of
two years from the Contract Date during Your lifetime or during the lifetimes of
each of the persons who are required to provide Us with information concerning
their age, sex and identity. The incontestability of this Contract applies to
any statements You make, except as otherwise stated in the Misstatement of Age
or Sex provision. Accurate statements as to Your age, sex and identity are
required as a condition of issuing this Contract.

NONPARTICIPATING

This Contract does not share in Our surplus.

WAIVER

Our waiver of any of the terms and conditions under this Contract will not be
deemed to constitute waiver of the right to enforce strict compliance.

                                       15

<PAGE>

                             ANNUITY PAYMENT OPTIONS

During the Annuitant's life, upon written election and the return of this
Contract to the Company at its Annuity Service Center, the Contract Value may be
applied to provide one of the following options or any annuity payment option
that is mutually agreeable. After one year from the Contract Date, and prior to
the Annuity Date, You can choose one of the options described below. If no
option has been selected by the Annuity Date, You will automatically receive
Option 4 below, with payments for 10 years guaranteed.

OPTIONS 1 & 1V - LIFE ANNUITY, LIFETIME PAYMENTS GUARANTEED

Payments payable to a Payee during the lifetime of the Annuitant. No further
payments are payable after the death of the Annuitant.

OPTIONS 2 & 2V - JOINT AND SURVIVOR LIFE ANNUITY

Payments payable to the Payee during the lifetime of the Annuitant and during
the lifetime of a designated second person. No further payments are payable
after the deaths of both the Annuitant and the designated second person.

OPTIONS 3 & 3V - JOINT AND SURVIVOR LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10
YEARS

Payments are payable to the Payee during the lifetime of the Annuitant and
during the lifetime of a designated second person. If, at the death of the
survivor, payments have been made for less than 10 years, the remaining
guaranteed annuity payments will be continued to the Beneficiary.

OPTIONS 4 & 4V - LIFE ANNUITY WITH PAYMENTS GUARANTEED FOR 10 OR 20 YEARS

Payments payable to the Payee during the lifetime of the Annuitant. If, at the
death of the Annuitant, payments have been made for less than the 10 or 20
years, as selected at the time of annuitization, the remaining guaranteed
annuity payments will be continued to the Beneficiary.

OPTIONS 5 & 5V - FIXED PAYMENTS FOR A SPECIFIED PERIOD CERTAIN

Payments payable to the Payee for any specified period of time for [5] years or
more, but not exceeding [30] years, as selected at the time of annuitization.
The selection must be made for full twelve month periods. In the event of death
of the Annuitant, any remaining annuity payments will be continued to the
Beneficiary. If Variable Annuity Payments are elected under this Annuity Payment
Option, any remaining guaranteed Variable Annuity payments may be redeemed for a
discounted value determined by Us.

                                       16
<PAGE>

                       FIXED ANNUITY PAYMENT OPTIONS TABLE

BASIS OF COMPUTATION

The actuarial basis for the Table of Annuity Rates is the Annuity 2000 Mortality
Table with a guaranteed interest rate of [1.50%], with quinquennial age
setbacks. For every five years that the Contract has been in effect at the time
of annuitization, the Annuitant's age will be set back by one year to determine
the applicable factors. The Fixed Annuity Payment Options Table does not include
any applicable premium tax.

            OPTIONS 1 & 4 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.

    (MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)

<TABLE>
<CAPTION>
                                OPTION 4        OPTION 4
                              LIFE ANNUITY    LIFE ANNUITY
                                 (W/120          (W/240
               OPTION 1         PAYMENTS        PAYMENTS
             LIFE ANNUITY     GUARANTEED)     GUARANTEED)
  AGE OF    --------------   -------------   -------------
ANNUITANT    MALE   FEMALE   MALE   FEMALE   MALE   FEMALE
---------   -----   ------   ----   ------   ----   ------
<S>         <C>     <C>      <C>    <C>      <C>    <C>
    55       3.68     3.38   3.64    3.35    3.48    3.27
    56       3.77     3.46   3.73    3.43    3.55    3.34
    57       3.87     3.54   3.82    3.51    3.62    3.40
    58       3.98     3.63   3.92    3.60    3.69    3.47
    59       4.09     3.73   4.02    3.69    3.76    3.54
    60       4.21     3.83   4.13    3.78    3.83    3.62
    61       4.34     3.93   4.24    3.89    3.90    3.69
    62       4.47     4.05   4.36    3.99    3.97    3.77
    63       4.62     4.17   4.49    4.10    4.04    3.84
    64       4.77     4.30   4.62    4.22    4.10    3.92
    65       4.93     4.44   4.76    4.35    4.17    4.00
    66       5.11     4.58   4.90    4.48    4.24    4.07
    67       5.30     4.74   5.05    4.62    4.30    4.15
    68       5.49     4.91   5.20    4.76    4.36    4.22
    69       5.71     5.09   5.36    4.92    4.41    4.29
    70       5.93     5.29   5.53    5.08    4.47    4.36
    71       6.17     5.50   5.70    5.25    4.51    4.42
    72       6.43     5.73   5.87    5.43    4.56    4.48
    73       6.70     5.98   6.05    5.62    4.60    4.53
    74       6.99     6.24   6.23    5.81    4.63    4.58
    75       7.31     6.53   6.41    6.01    4.67    4.62
    76       7.64     6.84   6.59    6.21    4.69    4.65
    77       8.00     7.18   6.78    6.41    4.72    4.69
    78       8.38     7.55   6.96    6.62    4.74    4.71
    79       8.79     7.94   7.13    6.83    4.75    4.74
    80       9.23     8.37   7.31    7.03    4.77    4.75
    81       9.70     8.84   7.47    7.23    4.78    4.77
    82      10.20     9.34   7.63    7.42    4.79    4.78
    83      10.73     9.88   7.78    7.60    4.80    4.79
    84      11.30    10.47   7.93    7.77    4.80    4.80
    85      11.90    11.10   8.06    7.93    4.81    4.80
</TABLE>

                                       17

<PAGE>

              OPTION 2 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
    (MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
                       JOINT & 100% SURVIVOR LIFE ANNUITY

<TABLE>
<CAPTION>
  AGE OF                AGE OF FEMALE ANNUITANT
   MALE     ----------------------------------------------
ANNUITANT    55     60     65     70     75     80     85
---------   ----   ----   ----   ----   ----   ----   ----
<S>         <C>    <C>    <C>    <C>    <C>    <C>    <C>
    55      3.01   3.18   3.33   3.45   3.54   3.60   3.64
    60      3.12   3.36   3.59   3.78   3.94   4.05   4.12
    65      3.21   3.51   3.83   4.13   4.40   4.61   4.75
    70      3.27   3.63   4.03   4.46   4.89   5.26   5.53
    75      3.32   3.70   4.18   4.74   5.35   5.95   6.45
    80      3.34   3.76   4.29   4.95   5.75   6.62   7.45
    85      3.36   3.79   4.35   5.09   6.05   7.20   8.44
</TABLE>

              OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
    (MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
         JOINT & 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)

<TABLE>
<CAPTION>
  AGE OF                AGE OF FEMALE ANNUITANT
   MALE     ----------------------------------------------
ANNUITANT    55     60     65     70     75     80     85
---------   ----   ----   ----   ----   ----   ----   ----
<S>         <C>    <C>    <C>    <C>    <C>    <C>    <C>
    55      3.01   3.18   3.33   3.45   3.53   3.59   3.62
    60      3.12   3.36   3.58   3.78   3.93   4.03   4.09
    65      3.21   3.51   3.82   4.12   4.38   4.56   4.67
    70      3.27   3.62   4.02   4.44   4.84   5.16   5.36
    75      3.31   3.70   4.16   4.70   5.26   5.76   6.11
    80      3.33   3.74   4.25   4.88   5.59   6.28   6.80
    85      3.35   3.77   4.31   4.99   5.81   6.66   7.35
</TABLE>

              OPTION 3 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
    (MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
         JOINT & 100% SURVIVOR LIFE ANNUITY (W/240 PAYMENTS GUARANTEED)

<TABLE>
<CAPTION>
  AGE OF                AGE OF FEMALE ANNUITANT
   MALE     ----------------------------------------------
ANNUITANT    55     60     65     70     75     80     85
---------   ----   ----   ----   ----   ----   ----   ----
<S>         <C>    <C>    <C>    <C>    <C>    <C>    <C>
    55      3.00   3.16   3.30   3.39   3.45   3.47   3.48
    60      3.11   3.33   3.53   3.68   3.77   3.81   3.82
    65      3.18   3.46   3.72   3.94   4.08   4.15   4.17
    70      3.23   3.54   3.86   4.14   4.33   4.43   4.46
    75      3.26   3.59   3.94   4.27   4.50   4.62   4.66
    80      3.27   3.61   3.98   4.33   4.58   4.71   4.76
    85      3.27   3.62   3.99   4.35   4.61   4.75   4.80
</TABLE>

                                       18

<PAGE>

              OPTION 5 - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
                       FIXED PAYMENT FOR SPECIFIED PERIOD

<TABLE>
<CAPTION>
 NUMBER    MONTHLY
OF YEARS   PAYMENT
--------   -------
<S>        <C>
    5       17.28
    6       14.51
    7       12.53
    8       11.04
    9        9.89
</TABLE>

<TABLE>
<CAPTION>
 NUMBER    MONTHLY
OF YEARS   PAYMENT
--------   -------
<S>        <C>
   10        8.96
   11        8.21
   12        7.58
   13        7.05
   14        6.59
   15        6.20
   16        5.85
</TABLE>

<TABLE>
<CAPTION>
 NUMBER    MONTHLY
OF YEARS   PAYMENT
--------   -------
<S>        <C>
   17        5.55
   18        5.27
   19        5.03
   20        4.81
   21        4.62
   22        4.44
   23        4.28
</TABLE>

<TABLE>
<CAPTION>
 NUMBER    MONTHLY
OF YEARS   PAYMENT
--------   -------
<S>        <C>
   24        4.13
   25        3.99
   26        3.86
   27        3.75
   28        3.64
   29        3.54
   30        3.44
</TABLE>

                                       19
<PAGE>

                     VARIABLE ANNUITY PAYMENT OPTIONS TABLE

BASIS OF COMPUTATION

The actuarial basis for the Table of Annuity Rates is the Annuity 2000 Mortality
Table with an effective annual Assumed Investment Rate of 3.50%, with
quinquennial age setbacks. For every five years that the Contract has been in
effect at the time of annuitization, the Annuitant's age will be set back by one
year to determine the applicable factors. The Variable Annuity Payment Options
Table does not include any applicable premium tax.

            OPTIONS 1V& 4V - TABLE OF MONTHLY INSTALLMENTS PER $1,000

    (MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)

<TABLE>
<CAPTION>
                               OPTION 4V       OPTION 4V
                              LIFE ANNUITY    LIFE ANNUITY
                                 (W/120          (W/240
               OPTION 1V        PAYMENTS        PAYMENTS
             LIFE ANNUITY      GUARANTEED)    GUARANTEED)
  AGE OF    --------------   -------------   -------------
ANNUITANT    MALE   FEMALE   MALE   FEMALE   MALE   FEMALE
---------   -----   ------   ----   ------   ----   ------
<S>         <C>     <C>      <C>    <C>      <C>    <C>
    55       4.80     4.48   4.74    4.45    4.54    4.34
    56       4.89     4.56   4.82    4.52    4.60    4.40
    57       4.99     4.64   4.91    4.60    4.67    4.46
    58       5.09     4.73   5.01    4.68    4.73    4.53
    59       5.21     4.82   5.11    4.77    4.79    4.59
    60       5.33     4.92   5.21    4.86    4.86    4.66
    61       5.45     5.03   5.32    4.96    4.92    4.73
    62       5.59     5.14   5.44    5.06    4.98    4.80
    63       5.73     5.26   5.56    5.17    5.05    4.87
    64       5.89     5.39   5.69    5.29    5.11    4.94
    65       6.06     5.53   5.83    5.41    5.17    5.01
    66       6.24     5.68   5.97    5.54    5.23    5.08
    67       6.43     5.84   6.11    5.67    5.29    5.14
    68       6.63     6.01   6.26    5.82    5.34    5.21
    69       6.84     6.19   6.42    5.97    5.39    5.28
    70       7.07     6.39   6.57    6.12    5.44    5.34
    71       7.32     6.60   6.74    6.29    5.48    5.39
    72       7.58     6.84   6.91    6.46    5.52    5.45
    73       7.86     7.09   7.08    6.64    5.56    5.49
    74       8.16     7.36   7.25    6.83    5.59    5.54
    75       8.47     7.65   7.42    7.02    5.62    5.57
    76       8.82     7.97   7.59    7.22    5.64    5.61
    77       9.18     8.31   7.77    7.41    5.67    5.64
    78       9.57     8.69   7.94    7.61    5.68    5.66
    79       9.99     9.09   8.11    7.81    5.70    5.68
    80      10.43     9.53   8.27    8.00    5.71    5.70
    81      10.91    10.00   8.43    8.19    5.72    5.71
    82      11.42    10.51   8.58    8.38    5.73    5.72
    83      11.96    11.07   8.72    8.55    5.74    5.73
    84      12.53    11.67   8.85    8.71    5.74    5.74
    85      13.15    12.31   8.98    8.86    5.75    5.74
</TABLE>

                                       20

<PAGE>

              OPTION 2V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
    (MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST.)
                       JOINT & 100% SURVIVOR LIFE ANNUITY

<TABLE>
<CAPTION>
  AGE OF                AGE OF FEMALE ANNUITANT
   MALE     ----------------------------------------------
ANNUITANT    55     60     65     70     75     80     85
---------   ----   ----   ----   ----   ----   ----   ----
<S>         <C>    <C>    <C>    <C>    <C>    <C>    <C>
    55      4.09   4.25   4.40   4.52   4.62   4.69   4.74
    60      4.20   4.42   4.64   4.84   5.00   5.13   5.21
    65      4.29   4.56   4.87   5.17   5.45   5.67   5.83
    70      4.35   4.68   5.07   5.49   5.92   6.30   6.60
    75      4.40   4.77   5.23   5.78   6.38   6.99   7.50
    80      4.43   4.83   5.34   6.00   6.79   7.66   8.50
    85      4.45   4.87   5.42   6.15   7.10   8.25   9.49
</TABLE>

              OPTION 3V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
    (MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
        JOINT AND 100% SURVIVOR LIFE ANNUITY (W/120 PAYMENTS GUARANTEED)

<TABLE>
<CAPTION>
  AGE OF                AGE OF FEMALE ANNUITANT
   MALE     ----------------------------------------------
ANNUITANT    55     60     65     70     75     80     85
---------   ----   ----   ----   ----   ----   ----   ----
<S>         <C>    <C>    <C>    <C>    <C>    <C>    <C>
    55      4.08   4.25   4.40   4.52   4.61   4.68   4.71
    60      4.19   4.41   4.63   4.83   4.99   5.10   5.16
    65      4.28   4.56   4.86   5.15   5.41   5.61   5.73
    70      4.35   4.68   5.05   5.46   5.86   6.18   6.40
    75      4.39   4.76   5.20   5.72   6.27   6.76   7.11
    80      4.42   4.81   5.30   5.91   6.60   7.26   7.77
    85      4.44   4.84   5.36   6.03   6.82   7.63   8.29
</TABLE>

              OPTION 3V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
    (MONTHLY INSTALLMENTS FOR AGES NOT SHOWN WILL BE FURNISHED UPON REQUEST)
        JOINT AND 100% SURVIVOR LIFE ANNUITY (W/240 PAYMENTS GUARANTEED)

<TABLE>
<CAPTION>
  AGE OF                AGE OF FEMALE ANNUITANT
   MALE     ----------------------------------------------
ANNUITANT    55     60     65     70     75     80     85
---------   ----   ----   ----   ----   ----   ----   ----
<S>         <C>    <C>    <C>    <C>    <C>    <C>    <C>
    55      4.07   4.22   4.36   4.45   4.51   4.53   4.54
    60      4.17   4.38   4.56   4.71   4.80   4.84   4.85
    65      4.25   4.50   4.74   4.95   5.08   5.14   5.17
    70      4.30   4.58   4.88   5.14   5.31   5.40   5.43
    75      4.32   4.63   4.96   5.25   5.46   5.57   5.61
    80      4.34   4.65   4.99   5.31   5.54   5.66   5.70
    85      4.34   4.66   5.00   5.33   5.57   5.69   5.74
</TABLE>

                                       21

<PAGE>

              OPTION 5V - TABLE OF MONTHLY INSTALLMENTS PER $1,000.
                         PAYMENTS FOR A SPECIFIED PERIOD

<TABLE>
<CAPTION>
 NUMBER    MONTHLY
OF YEARS   PAYMENT
--------   -------
<S>        <C>
    5       17.28
    6       14.51
    7       12.53
    8       11.04
    9        9.89
</TABLE>

<TABLE>
<CAPTION>
 NUMBER    MONTHLY
OF YEARS   PAYMENT
--------   -------
<S>        <C>
   10        8.96
   11        8.21
   12        7.58
   13        7.05
   14        6.59
   15        6.20
   16        5.85
</TABLE>

<TABLE>
<CAPTION>
 NUMBER    MONTHLY
OF YEARS   PAYMENT
--------   -------
<S>        <C>
   17        5.55
   18        5.27
   19        5.03
   20        4.81
   21        4.62
   22        4.44
   23        4.28
</TABLE>

<TABLE>
<CAPTION>
 NUMBER    MONTHLY
OF YEARS   PAYMENT
--------   -------
<S>        <C>
   24        4.13
   25        3.99
   26        3.86
   27        3.75
   28        3.64
   29        3.54
   30        3.44
</TABLE>

                                       22

<PAGE>

                     FIRST SUNAMERICA LIFE INSURANCE COMPANY
                       A STOCK COMPANY NEW YORK, NEW YORK

                      INDIVIDUAL VARIABLE ANNUITY CONTRACT

                                NONPARTICIPATING<PAGE>
                                                                    EXHIBIT 4(g)

                     FIRST SUNAMERICA LIFE INSURANCE COMPANY

                 OPTIONAL GUARANTEED MINIMUM WITHDRAWAL BENEFIT
                                   ENDORSEMENT

Notwithstanding any provision in the Contract or Certificate ("Contract") to the
contrary, this Endorsement becomes a part of the Contract to which it is
attached. Should any provision in this Endorsement conflict with the Contract,
the provisions of this Endorsement will prevail.

Subject to the terms and conditions set forth herein this optional Endorsement
provides a Guaranteed Minimum Withdrawal Benefit ("GMWB") over the lifetime of
the Covered Person(s). You may take Withdrawals under the GMWB as prescribed by
this Endorsement herein while this Endorsement is in effect.

                              ENDORSEMENT DATA PAGE

<Table>
<S>                                <C>           <C>           <C>
COVERED PERSON(S):                 [Jane Doe]

ENDORSEMENT EFFECTIVE DATE:        [November 1, 2007]

BONUS ELECTED:                     [Yes]

                                   -----------------------------------------------------
ELIGIBLE PURCHASE PAYMENTS:        CONTRACT     PERCENTAGE     MAXIMUM ANNUAL ELIGIBLE
                                   YEAR(s)      INCLUDED       PURCHASE PAYMENT
                                   -----------------------------------------------------
                                   1            [100%]         Eligible Purchase
                                                               Payment Limit
                                   -----------------------------------------------------
                                   2-5          [100%]         In each Contract Year
                                                               100% of Purchase Payments
                                                               made in Contract Year 1
                                                               (one) not to exceed
                                                               Eligible Purchase
                                                               Payment Limit
                                   -----------------------------------------------------
                                   6+           [0%]           In each Contract Year 0%
                                                               of Purchase Payments made
                                                               in Contract Year 1 (one)
                                                               not to exceed Eligible
                                                               Purchase Payment Limit
                                   -----------------------------------------------------

ELIGIBLE PURCHASE PAYMENT LIMIT:   The sum of Eligible Purchase Payments cannot
                                   exceed $1,500,000 without prior Company approval

GMWB CHARGE:                       Annual fee of [0.65%] of the Benefit Base
                                   deducted quarterly from Contract Value allocated to
                                   the Variable Portfolio(s) or Subaccount(s)
                                   beginning one quarter following the Endorsement
                                   Effective Date and ending on the termination of
                                   this Endorsement.

BENEFIT BASE EVALUATION PERIOD:    Beginning on the Endorsement Effective Date and
                                   ending 10 years later

BONUS PERCENTAGE:                  6%

BONUS PERIOD:                      Beginning on the Endorsement Effective Date and
                                   ending 10 years later

BONUS AVAILABILITY:                At the end of each Benefit Year during the Bonus
                                   Period if Withdrawals were not made during that
                                   same Benefit Year

GUARANTEED MINIMUM BENEFIT BASE:   [175%] of Eligible Purchase Payments received in
                                   Contract Year 1
</Table>

MAXIMUM ANNUAL WITHDRAWAL PERCENTAGE ("MAWP"):

<Table>
<Caption>
----------------------------------------------
AGE AT FIRST WITHDRAWAL                 MAWP
----------------------------------------------
<S>                                     <C>
At least Age 50 but less than Age 60    4%
----------------------------------------------
At least Age 60 but less than Age 76    5%
----------------------------------------------
Age 76 and over                         6%
----------------------------------------------
</Table>

                                       1
<PAGE>
                                   DEFINITIONS

For purposes of this Endorsement, the following definitions apply. Terms not
defined in this Endorsement shall have the same meaning as defined in the
Contract.

AGE

The attained age as of the Covered Person's last birthday. If there are two
Covered Persons on the Endorsement Data Page, the Age of the younger Covered
Person or the lone surviving Covered Person as of their last birthday.

ANNIVERSARY VALUE

The Contract Value including any applicable Payment Enhancement(s) or Spousal
Beneficiary continuation contribution minus any Ineligible Purchase Payments, as
measured on each Benefit Year anniversary.

BENEFIT BASE

A component of the calculation of the GMWB, which is used to determine the GMWB
Charge and the Maximum Annual Withdrawal Amount.

BENEFIT BASE EVALUATION PERIOD

The period of time over which Anniversary Values are considered in determining
the Benefit Base.

BENEFIT YEAR

Each consecutive one year period starting on the Endorsement Effective Date.

BONUS

An amount that may be added to the Benefit Base during the Bonus Period.

BONUS BASE

A component of the calculation of the GMWB, which is used to determine the
dollar amount of any Bonus during the Bonus Period.

BONUS PERIOD

The period of time over which a Bonus may be added to the Benefit Base.

COVERED PERSON(S)

The person(s) named on the Endorsement Data Page whose lives are used to
determine the amount and duration of Withdrawals under this Endorsement.

ELIGIBLE PURCHASE PAYMENTS

Purchase Payments or portion thereof made on or after the Endorsement Effective
Date as shown on the Endorsement Data Page that are included in the calculation
of the Benefit Base. If this Endorsement is added after the Contract Date, for
purposes of determining the Benefit Base, the Contract Value on the Endorsement
Effective Date is considered the initial Eligible Purchase Payment. Purchase
Payments added prior to the Endorsement Effective Date are not considered
Eligible Purchase Payments. The calculation of Eligible Purchase Payments does
not include Payment Enhancements, if any, or Spousal Beneficiary continuation
contributions.

ENDORSEMENT EFFECTIVE DATE

The date when this Endorsement becomes effective as shown on the Endorsement
Data Page.

EXCESS WITHDRAWAL

A Withdrawal or the portion thereof that: (a) causes the total of all
Withdrawals for that Benefit Year to exceed the Maximum Annual Withdrawal
Amount; or (b) is taken after the Maximum Annual Withdrawal Amount has been
withdrawn, except if taken to meet the Required Minimum Distribution associated
with only the Contract to which this Endorsement is attached.

INELIGIBLE PURCHASE PAYMENTS

Purchase Payments or portions thereof that are not included in the calculation
of the Benefit Base.

MAXIMUM ANNUAL WITHDRAWAL AMOUNT ("MAWA")

The maximum dollar amount available to be withdrawn each Benefit Year under the
GMWB without reducing the Benefit Base and the Bonus Base.

                                       2
<PAGE>

MAXIMUM ANNUAL WITHDRAWAL PERCENTAGE ("MAWP")

The percentage used to determine the MAWA available for withdrawal each Benefit
Year under this Endorsement.

YOU, YOUR

The Covered Person(s) under this Endorsement.

                GUARANTEED MINIMUM WITHDRAWAL BENEFIT PROVISIONS

The Guaranteed Minimum Withdrawal Benefit described in this Endorsement provides
for guaranteed Withdrawals over the lifetime of the Covered Person(s), subject
to the following provisions:

GMWB CHARGE

The GMWB Charge percentage applicable to this Endorsement is as shown on the
Endorsement Data Page. If You surrender Your Contract and this Endorsement has
not been terminated, We will deduct a proportionate charge for the period of
time between the date of the last GMWB charge up to and including the date of
surrender.

CALCULATION OF THE COMPONENTS OF THE GMWB

The MAWA guaranteed under this Endorsement may change over time as a result of
increases or decreases in the Benefit Base as described below.

To determine the GMWB when the Bonus is not available, We use the following
components: Benefit Base Evaluation Period, Benefit Base, MAWP and MAWA. To
determine the GMWB when the Bonus is available, the following additional
components are used: Bonus Period, Bonus Base and Bonus Percentage. The
calculations for each component are detailed below.

BENEFIT BASE

If the GMWB is elected on the Contract Date, the initial Benefit Base is the
initial Eligible Purchase Payment. If the GMWB is elected after the Contract
Date, the initial Benefit Base is equal to the Contract Value on the Endorsement
Effective Date, which is subject to the Eligible Purchase Payment Limit shown on
the Endorsement Data Page. In each subsequent Benefit Year, the Benefit Base
equals the Benefit Base at the beginning of that Benefit Year plus any
subsequent Eligible Purchase Payments made during that Benefit Year, less
adjustments for Excess Withdrawals that occurred during that Benefit Year. The
Benefit Base is determined as detailed below and is not used in the calculation
of Contract Value or any other benefits under the Contract. On Benefit Year
anniversaries during the Benefit Base Evaluation Period, We determine if the
Benefit Base should be increased based on the maximum Anniversary Value or any
available Bonus. The calculation and components of this determination are
detailed below.

         CALCULATION OF THE BENEFIT BASE WHEN BONUS IS NOT AVAILABLE OR AFTER
         BONUS PERIOD

         The Benefit Base on each Benefit Year anniversary is based on the
         maximum Anniversary Value. Maximum Anniversary Value equals the highest
         Anniversary Value on any Benefit Year anniversary occurring during the
         Benefit Base Evaluation Period. On each Benefit Year anniversary
         occurring during the Benefit Base Evaluation Period, the Benefit Base
         is automatically increased to the Anniversary Value when the
         Anniversary Value is greater than both (a) and (b), where:

                  (a)   is the current Benefit Base; and

                  (b)   is all previous maximum Anniversary Values during the
                        Benefit Base Evaluation Period.

         CALCULATION OF THE BENEFIT BASE WHEN BONUS IS AVAILABLE

         The Bonus Base is used to calculate the amount of the Bonus during the
         Bonus Period. The Bonus amount is determined by multiplying the Bonus
         Percentage shown on the Endorsement Data Page by the Bonus Base. The
         initial Bonus Base is equal to the initial Eligible Purchase Payment.
         The Bonus Base is increased each time subsequent Eligible Purchase
         Payments are made. The Bonus Base also increases when the Benefit Base
         is increased as a result of a maximum Anniversary Value being achieved
         that is greater than both the current Benefit Base and all previous
         maximum Anniversary Values. The Bonus Base is decreased each time an
         Excess Withdrawal is taken, in the same proportion by which the
         Contract Value is reduced by the Excess Withdrawal. The Bonus Base is
         not used in the calculation of the Contract Value or any other benefits
         under the Contract.

         On each Benefit Year anniversary during the Bonus Period, We determine
         the amount to which the Bonus Base and / or the Benefit Base could
         increase. The components used to determine this amount are:

                  (a)   the Benefit Base calculated based on the maximum
                        Anniversary Value; and

                                       3
<PAGE>

                  (b)   the Bonus plus the current Benefit Base.

         If (a) is greater than (b), the Bonus Base and the Benefit Base are
         increased to the current Anniversary Value. If (b) is greater than (a),
         the Benefit Base is increased by the Bonus and the Bonus Base remains
         unchanged.

Further, if no Withdrawals are taken during the Bonus Period and at the end of
the Bonus Period the current Benefit Base is less than the Guaranteed Minimum
Benefit Base as shown on the Endorsement Data Page, We will increase the current
Benefit Base so that the resulting Benefit Base after the Bonus Period is equal
to the Guaranteed Minimum Benefit Base.

MAXIMUM ANNUAL WITHDRAWAL AMOUNT ("MAWA")

The MAWA is calculated by multiplying the Benefit Base by the Maximum Annual
Withdrawal Percentage ("MAWP"). The applicable MAWP used to calculate the MAWA
is determined by Your Age at the time You first take a Withdrawal from Your
Contract.

You may withdraw up to the MAWA throughout each Benefit Year without impacting
the annual amount guaranteed for Withdrawal under the GMWB. If You do not
withdraw the entire MAWA in a Benefit Year, You may not carry over any unused
MAWA to any subsequent Benefit Year. In addition Your MAWA for the next Benefit
Year will not be recalculated as a result of taking less than the entire MAWA in
any given Benefit Year.

Withdrawals made under the GMWB are treated like any other Withdrawal under the
Contract for purposes of calculating Contract Value, charges, including
Withdrawal Charges, fees, applicable taxes, and any other benefits under the
Contract.

Increases and decreases in the Benefit Base impact Your MAWA as follows:

INCREASES IN THE BENEFIT BASE

The Benefit Base is increased when an Eligible Purchase Payment is allocated to
Your Contract. If the Benefit Base is increased for Eligible Purchase Payments,
the MAWA will be recalculated upon receipt of the Eligible Purchase Payments by
multiplying the increased Benefit Base by the applicable MAWP. In any Benefit
Year when Eligible Purchase Payments are allocated to Your Contract, any
remaining Withdrawals of MAWA will be based on the increased MAWA. If the
Benefit Base is increased on a Benefit Year anniversary, the MAWA will be
recalculated on that Benefit Year anniversary by multiplying the increased
Benefit Base by the applicable MAWP. The GMWB charge on and after that Benefit
Year anniversary is assessed on the increased Benefit Base.

DECREASES IN THE BENEFIT BASE

Excess Withdrawals reduce Your Benefit Base. Any Excess Withdrawal in a Benefit
Year reduces the Benefit Base in the same proportion by which the Contract Value
is reduced by the Excess Withdrawal. When the Contract Value is less than or
equal to the Benefit Base, Excess Withdrawals will result in a reduction of the
Benefit Base which is greater than the amount of the Excess Withdrawal. As a
result of reduction of the Benefit Base, the MAWA will also be reduced. The new
MAWA will equal the reduced Benefit Base multiplied by the applicable MAWP. The
recalculated MAWA is available for Withdrawal at the beginning of the next
Benefit Year and will be lower than Your previously calculated MAWA.

If You are taking Required Minimum Distributions ("RMD") from the Contract to
which this Endorsement is attached, and the RMD amount based only on the
Contract is greater than the MAWA in any given Benefit Year, no portion of the
RMD Withdrawal will be treated as an Excess Withdrawal. Any portion of a
Withdrawal that is greater than either the MAWA or the RMD amount based only on
the Contract to which this Endorsement is attached will be considered an Excess
Withdrawal.

IF YOUR CONTRACT VALUE IS REDUCED TO ZERO

If Your Contract Value is reduced to zero and the Benefit Base is greater than
zero, a benefit remains payable under this Endorsement, but all other benefits
under the Contract, including Death Benefits, will no longer be available.
However, if Your Contract Value is reduced to zero because of an Excess
Withdrawal, no further benefits will be payable under this Endorsement or the
Contract.

When the Contract Value equals zero and the Benefit Base is greater than zero,
any remaining benefit under this Endorsement must be taken through one of the
following income options:

      1.    The current MAWA, divided equally and paid on a quarterly,
            semi-annual or annual frequency as selected by You until the date of
            Your death(s); or

      2.    Any payment option mutually agreeable between You and Us.

Once You elect an income option, it cannot be changed.

                                       4
<PAGE>

If You do not select a payment option, the remaining benefit will be paid as the
current MAWA on a quarterly basis until the date of Your death(s).

EXTENSION OF THE BENEFIT BASE EVALUATION PERIOD ("EXTENSION")

We may offer You Extension(s) of the Benefit Base Evaluation Period at the end
of the current Benefit Base Evaluation Period, provided You are age 85 or
younger at that time. If You elect such an Extension, You will receive a new
Endorsement with the GMWB Charge and provisions in effect at that time.

LATEST ANNUITY DATE

If there is remaining Contract Value and the Benefit Base is greater than zero
on the Latest Annuity Date, You must select one of the options listed below.

      1.    Annuitize the Contract Value under the Annuity Provisions of the
            Contract; or

      2.    Elect to receive the current MAWA as of the Latest Annuity Date in
            the form of a payment option, divided equally and paid on a
            quarterly, semi-annual or annual frequency as selected by You until
            the date of Your death; or

      3.    Any payment option mutually agreeable between You and Us.

If You do not select an option listed above, on the Latest Annuity Date We will
annuitize the Contract Value under the Annuity Provisions of the Contract,
Options 3 and 3V with 120 Monthly Payments Guaranteed or payments that do not
exceed Your life expectancy as required by the IRS.

INVESTMENT OPTIONS

If the Bonus is elected, We will restrict allocations to the Variable Portfolios
or available Fixed Account Option(s). We will not allow transfers or Purchase
Payment(s) to be allocated into any of the restricted investment option(s) or in
any way that is outside the established restrictions. Established restrictions
are shown on the Application/Enrollment Form. Further, We will require
enrollment in a quarterly automatic asset rebalancing program. We will notify
You if investment restrictions change.

TERMINATION OF WITHDRAWALS OVER TWO LIVES

If there are two Covered Persons, Withdrawals guaranteed for the life of one of
the Covered Persons will terminate if:

      1.    One of the two Covered Persons is removed from the Endorsement due
            to an ownership change; or

      2.    The Covered Persons are no longer married at the time of death of
            the first Covered Person.

Termination of Withdrawals guaranteed for the life of one Covered Person does
not impact any other terms and conditions of this Endorsement.

TERMINATION OF THE GMWB

Once elected, this Endorsement maybe terminated and deduction of any
corresponding GMWB Charge will end after the termination date. You may terminate
the Endorsement if Your termination request is received:

      1.    Through the 5th Benefit Year anniversary, the termination is
            effective on the 5th Benefit Year anniversary;

      2.    After the 5th and through the 10th Benefit Year anniversary, the
            termination is effective on the 10th Benefit Year anniversary;

      3.    In any Benefit Year after the 10th Benefit Year anniversary, the
            termination is effective on the Benefit Year anniversary following
            Our receipt of the election to terminate this Endorsement.

On the Benefit Year anniversary when termination occurs the GMWB Charge will be
deducted.

This Endorsement and the related charge will terminate automatically if:

      1.    The Covered Person dies, or if there were two Covered Persons, upon
            the death of the surviving Covered Person; or,

      2.    A Death Benefit is paid and the Contract is terminated; or,

      3.    The Contract is annuitized; or

      4.    Excess Withdrawals reduce the Contract Value to zero; or

      5.    Any change that removes all Covered Persons; or

      6.    The Contract is terminated for any reason.

If terminated for any reason, the GMWB may not be re-elected or reinstated.

                                       5
<PAGE>

DEATH OF COVERED PERSON(s)

If there is one Covered Person, then upon the death of the Covered Person, this
Endorsement and corresponding charge are terminated.

If there are two Covered Persons, upon the first death, if the surviving Covered
Person elects to continue the Contract, this Endorsement is also continued
subject to the terms and conditions of this Endorsement. Upon the election of
continuation, the Endorsement Effective Date will not change.

Signed for the Company to be effective on the Effective Date.

FIRST SUNAMERICA LIFE INSURANCE COMPANY

              /s/ Jay S. Wintrob
        -----------------------------
                Jay S. Wintrob
                  President

                                       6

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