Document:

Exhibit 4(i)

 EXHIBIT 4(i) 
 FORM OF POLICY RIDER 
 (RETIREMENT INCOME CHOICE 1.6) 

			
	

	  	 Home Office:

[4333 Edgewood Road N.E.]
 [Cedar Rapids, Iowa
52499]
 [(319)355-8511]

	  
	  
	  
	         A Stock Company (Hereafter called the Company, we, our or us)
	  	

 RETIREMENT INCOME CHOICE RIDER 
 This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an individual annuity or the group certificate if the
rider is attached to a group annuity. 
 All provisions of the policy that do not conflict with this rider apply to this rider. In the event of
any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 
 Rider Data Specification 
  

			
	Policy Number:	  	[12345]
	Rider Date:	  	[07/01/2012]
	Growth Rate Percentage:	  	[5.00%]
		
	Rider Fee Percentages:	  	
	Designated Allocation Group A:	  	[1.55%]
	Designated Allocation Group B:	  	[1.10%]
	Designated Allocation Group C:	  	[0.70%]
		
	Annuitant:	  	[John Doe]
		
	Annuitant’s Issue Age/Sex:	  	[35 / Male]

  
  

ARTICLE I 
 You may cancel this
rider on the close of business before midnight of the thirtieth calendar day after you received it and no rider fees will be assessed. 
 If
you elect this rider, 100% of your policy value must be in one or more of the designated investment options. 
 You can generally transfer
between the designated investment options as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If you wish to make a transfer to a
non-designated investment option, this rider must be terminated, as described in Article IV, prior to making the transfer. 
 DEFINITIONS:

 Terms used that are not defined in this rider shall have the same meaning as those in your policy. 

Designated Investment Options 

Investment options authorized for use with this rider and identified by us as designated investment options. 

Excess Withdrawal 
 The excess of a gross
partial withdrawal over the rider withdrawal amount remaining prior to the withdrawal, if any. 
 Gross Partial Withdrawal 

The amount by which will be deducted from your policy value as a result of each partial withdrawal. 

  

					
	RGMB 37 0809 	  	(1	  	(Income-Single) (09/2012)

 ARTICLE I CONTINUED 
 Rider Anniversary 
 The anniversary of the rider date. 

Rider Fee 
 The fees charged for the
benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 
 Rider Monthiversary 

The same day of the month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 

Rider Quarter 
 The last business day of
each rider quarter, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 
 Rider Withdrawal
Amount 
 The maximum amount that can be withdrawn from the policy each rider year without causing an excess withdrawal under the terms of
this rider and thus reducing the withdrawal base. This amount will change if the withdrawal base changes. 
 Rider Year 

Each twelve-month period following the rider date. 
 Valuation Period 
 The period of time from one determination of the value of a subaccount to
the next. Such determinations are made when the value of the assets and liabilities of each subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. 

Withdrawal Base 
 The amount used to
calculate the rider withdrawal amount and the rider fee. This amount cannot be taken as a lump sum. 
 ARTICLE II 

RIDER FEES 
 The rider fee is deducted on
each rider quarter in arrears. The fee is calculated and stored at issue and at each subsequent rider quarter for the upcoming quarter. The rider fee percentage will not change during the first five rider years, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since the previous rider quarter.

 The stored fee will be adjusted for new deposits, transfers among designated investment options and excess withdrawals made during the rider
quarter. 
 Fees will be calculated and stored on the day the rider is issued and at the beginning of each rider quarter. They will be deducted
automatically from each investment option on a pro rata basis at the end of each rider quarter. The annual fee percentages for each designated allocation group are shown on page 1, in the Rider Data Specification section. 

The quarterly fee is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4). 
  

	1)	Withdrawal Base; 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value; 

 

	3)	Total policy value; 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year. 

Please see the Appendix attached to this rider which illustrates how the rider fee is calculated. 

  

					
	RGMB 37 0809 	  	(2	  	(Income-Single) (09/2012)

 ARTICLE III 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that you can receive
up to the rider withdrawal amount each rider year, regardless of the policy value, (either through withdrawals or payments, where payments are equal to the rider withdrawal amount if your policy value equals zero) until the annuitant’s death.

 The withdrawal percentage is determined by the attained age (age at last birthday) of the annuitant at the time of the first withdrawal of
any amount from the policy value taken on or after the rider anniversary following the annuitant’s [59th] birthday. Once the withdrawal percentage is established, it may only be changed by an upgrade or automatic step-up and redetermined at
that time. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age at the time of the automatic step-up. The withdrawal percentages are shown in the table below. 

 

							
	 	 	 Attained Age
	 	Withdrawal
Percentage	 	 
		 	[0 - 58]	 	[0.0%]	 	
		 	[59 - 64]	 	[4.0%]	 	
		 	[65 - 79]	 	[5.0%]	 	
		 	[80 +]	 	[6.0%]	 	

 If the annuitant is not yet [59] on the rider date, the withdrawal percentage will be zero until the rider anniversary
following the annuitant’s [59th] birthday. Withdrawals prior to age 59 1/2 will be subject to the 10% penalty tax. 
 Withdrawals will
reduce the policy value of the policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits and guarantees are no longer available. Also, if the policy
value equals zero, you will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to the rider withdrawal amount. Once the payment amount and frequency are
established, they cannot be changed and no additional withdrawals will be allowed. 
 ISSUE AGE AND SURVIVAL 

The benefits under this rider depend on the annuitant being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the
annuitant. Proof of survival and the issue ages may be required by the Company. 
 If the annuitant’s age has been misstated, this
rider’s fees and benefits will be adjusted to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and
any fees charged for this rider would be returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the rider withdrawal amount to be overstated, any withdrawal in excess of the correct rider
withdrawal amount will be considered an excess withdrawal and will impact the withdrawal base and rider withdrawal amount. If overpayments occurred when the sum of the accumulated values in all the investment options was zero, the amount of that
overpayment will be deducted from one or more future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 

The rider withdrawal amount will be equal to the greater of 1) and 2), where: 

 

	1)	is the withdrawal percentage multiplied by the withdrawal base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st rider anniversary, this amount is based on the initial policy value on the
rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

 

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

 

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living annuitant. The minimum required distributions can not be based on the age of someone who is deceased,

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

 

	 	F)	the minimum required distributions are only for the current rider year. Amounts carried over from past rider years are not considered. 

  

					
	RGMB 37 0809 	  	(3	  	(Income-Single) (09/2012)

 ARTICLE III CONTINUED 
 If any of the above are not true, then 2) is equal to zero and it is not available as a rider withdrawal amount. 
 If you withdraw less than the rider withdrawal amount in a rider year, the unused portion cannot be carried over to the next rider year. 
 WITHDRAWAL BASE 
 The withdrawal base is used to calculate the rider withdrawal amount. On
the rider date, the initial withdrawal base is equal to the policy value (less any premium enhancements if the rider is added in the first policy year). During any rider year, the withdrawal base is increased by subsequent premium payments (not
including premium enhancements, if any), and is reduced for excess withdrawals. 
 On each rider anniversary, the withdrawal base will be set to
the greatest of: 
  

	 	1)	The current withdrawal base; 

  

	 	2)	The policy value on the rider anniversary; 

  

	 	3)	The highest policy value on a rider [monthiversary] for the current rider year; or 

 

	 	4)	The current withdrawal base immediately prior to rider anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any excess withdrawals in the current rider year. Item 4) above will be zero after the [10th]
rider anniversary or if there have been any withdrawals in the current rider year. 
 AUTOMATIC STEP-UP FEATURE 

The rider receives an automatic step-up on the rider anniversary if the withdrawal base is set equal to the policy value or the highest policy value on a
rider [monthiversary.] This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The rider fee and withdrawal percentages may be changed due to an automatic step-up, but
there will be no increase in the rider fee percentage during the first [five] rider years. Following the [fifth] rider anniversary, the rider fee percentage may be increased due to an automatic step-up, but will not increase more than [0.75%] from
the initial rider fee percentages shown on page 1. 
 You have the right to reject an automatic step-up within [30] days following a rider
anniversary, if the rider fee percentage increases. If you reject an automatic step-up, you must notify us in a manner which is acceptable to us, however you are eligible for future automatic step-ups. Changes as a result of the automatic step-up
feature will be reversed. Any increase in the rider fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross partial withdrawals, taken in a rider year, less than or equal to the rider withdrawal amount will not reduce the withdrawal base.
Excess withdrawals will reduce the withdrawal base by the withdrawal base adjustment. The withdrawal base adjustment is the greater of 1) and 2), where: 
  

	1)	is the excess withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the withdrawal base prior to the excess withdrawal amount; and 

  

	 	C)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the withdrawal of the excess withdrawal amount. 

  

					
	RGMB 37 0809 	  	(4	  	(Income-Single) (09/2012)

 ARTICLE IV 
 CONTINUATION 
 In the case of spousal joint owners where one spouse is the annuitant, if the
spouse who is not the annuitant dies and the surviving spouse is the sole beneficiary, the surviving spouse may elect to continue the policy and rider. In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is the
annuitant dies, this rider will terminate. 
 In the case of non-spousal joint owners where an owner who is not the annuitant dies, the
surviving owner (who is also the sole designated beneficiary) may elect to receive lifetime income payments under this rider instead of receiving any benefits applicable to the policy. The lifetime income payments must begin no later than 1 year
after the owner’s death and will be equal to the rider withdrawal amount divided by the number of payments made per year. Once the payments begin, no additional premium payments will be accepted and no additional withdrawals will be paid.

 ANNUITIZATION 
 On the
maximum annuity commencement date, as described in your policy, you will have the option to receive lifetime income payments that are no less than your rider withdrawal amount each year. This option will also guarantee that the sum of all income
payments received over time will equal or exceed the policy value on the maximum annuity commencement date. If the annuitant should die before the sum of all income payments received equals or exceeds the policy value on the maximum annuity
commencement date, the annuitant’s beneficiary will receive a final payment equal to the difference. 
 RIDER UPGRADE 

You may elect, in writing, to upgrade the withdrawal base to the policy value within [30] days after the [fifth] rider anniversary and every [fifth] rider
anniversary thereafter, subject to the issue age restrictions on the new rider. If an upgrade is selected, this rider will terminate and a new rider with the same features will be issued with a new rider date. The new rider will have its own growth
rate percentage and rider fee percentages which may not be the same as this rider’s percentages. 
 At the time upgrade, the rider
withdrawal amount will be recalculated based on the new withdrawal base. 
 The new rider date will be the date the Company receives all
information necessary, at our Home Office, in a written form acceptable to the Company, to process the upgrade. 
 TERMINATION

 This rider will terminate upon the earliest of: 
  

	1)	the date the policy to which this rider is attached terminates; 

  

	2)	the date the policy to which this rider is attached is assigned or if the owner is changed without our approval; 

 

	3)	the date of the annuitant’s death; 

  

	4)	the date you elect to upgrade (as described in Article IV of this rider); 

  

	5)	the date you elect to receive annuity payments under your policy; and 

  

	6)	the date you notify us in writing of your intention to terminate this rider (this date must be within [30] days after the [fifth] rider anniversary and every [fifth]
rider anniversary thereafter). 

 Termination of the rider will result in the loss of all benefits provided by the rider.

 Signed for us at our home office. 
  

			
	

	  	

	SECRETARY	  	PRESIDENT

  

					
	RGMB 37 0809	  	(5	  	(Income-Single) (09/2012)

 APPENDIX 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) divided
by (3) multiplied by (4) where: 
  

	1)	Withdrawal Base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value 

 

	3)	Total policy value 

  

	4)	Number of days in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for additional premium payments and excess withdrawals is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4) where: 

 

	1)	Withdrawal base change (i.e. withdrawal base after the transaction minus the withdrawal base before the transaction) 

 

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total transaction amount 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for fund transfers is calculated as follows: 
 Multiply (1) by (2) divided by (3) multiplied by (4) where: 
  

	1)	Withdrawal base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total policy value 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The following two examples use assumed fees and values listed in the table below. The assumed rider year is not a leap year. 

 

													
	 Designated Allocation Group
	  	Fee	 	 	Initial
Policy Value	 	  	Additional Premium
Used in Example 2	 
	 Group A
	  	 	2.50	% 	 	$	50,000	  	  	$	5,000	  
	 Group B
	  	 	2.40	% 	 	$	30,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	20,000	  	  	$	2,000	  

 Example 1: Calculation at rider issue for first quarter fee assuming an initial withdrawal base of $100,000.

 = 100,000 * [(50,000*0.0250) + (30,000*0.0240) + (20,000*0.0230)] / 100,000 * (91/365) 

= 100,000 * (1,250 + 720 + 460) / 100,000 * (91/365) 
 = 100,000 * 2,430/100,000 * (91/365) 
 = 2,430 * (91/365) 

= $605.84 
 Example 2:
Calculation for first quarter fee assuming initial withdrawal base from Example 1 above, plus adjustment for additional premium payment of $10,000 made with 20 days remaining in the first rider quarter (invested as shown above). The withdrawal
base change and total transaction amount equal $10,000. 
 Fee adjustment as follows: 

= 10,000 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (20/365) 

= 10,000 * (125 + 72 + 46) / 10,000 * (20/365) 
 = 10,000 * 243/10,000 * (20/365) 
 = 243 * (20/365) 

= $13.32 
 Total fee assessed at
end of first rider quarter (assuming no further rider fee adjustments): 
 = 13.32 + 605.84 

= $619.16 

  

					
	RGMB 37 0809 	  	(A-1)	  	(Income-Single) (09/2012)

 The following three examples use assumed fees and values listed in the table below. The assumed rider year
is not a leap year. 
  

																	
	 Designated Allocation Group
	  	Fee	 	 	Policy Value	 	  	Partial Withdrawal
Used in Example 4	 	  	Fund Transfer
Used in Example 5	 
	 Group A
	  	 	2.50	% 	 	$	49,000	  	  	$	-5,000	  	  	$	-5,000	  
	 Group B
	  	 	2.40	% 	 	$	29,000	  	  	$	-3,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	19,000	  	  	$	-2,000	  	  	$	2,000	  

 Example 3: Calculation for second quarter fee at beginning of second rider quarter, assuming withdrawal base of
$110,000 and policy value of $97,000 invested as above. 
 = 110,000 * [(49,000*0.0250) + (29,000*0.0240) + (19,000*0.0230)]
/ 97,000 * (91/365) 
 = 110,000 * (1,225 + 696 + 437) / 97,000 * (91/365) 

= 110,000 * 2,358/97,000 * (91/365) 
 = 2,674.02 * (91/365) 
 = $666.67 

Example 4: Calculation for second quarter fee assuming beginning values as in Example 3 above, plus adjustment for partial withdrawal of $10,000
taken with 40 days remaining in the second rider quarter. Assumes withdrawal percentage of 5%, policy value of $97,000 prior to the transaction and change in withdrawal base as follows: 
 Rider Withdrawal Amount (RWA) = Withdrawal Base * Withdrawal Percentage = 110,000 * .05 = $5,500 

Excess Withdrawal = Difference between assumed withdrawal amount and RWA = 10,000 - 5,500 = $4,500 

Withdrawal Base Adjustment = Max (Excess Withdrawal, Excess Withdrawal * Withdrawal Base prior to withdrawal / Policy Value after RWA has been withdrawn
but before excess withdrawal) = Max [4,500, 4,500 * 110,000 / (97,000-5,500)] = Max (4,500, 5,409.84) = $5,409.84 
 Fee adjustment as follows:

 = -5,409.84 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (40/365) 

= -5,409.84 * (125 + 72 + 46) / 10,000 * (40/365) 
 = -5,409.84 * 243/10,000 * (40/365) 
 = -131.46 * (40/365) 

= $-14.41 
 Total fee assessed
at end of second rider quarter (assuming no further rider fee adjustments): 
 = 666.67 - 14.41 

= $652.26 
 The new Withdrawal
Base = $110,000 - $5,409.84 = $104,590.16 
 Example 5: Calculation for fund transfer occurring during second quarter with 25 days
remaining in the rider quarter, assuming beginning values as in Example 3 and withdrawal adjustment as in Example 4 above. 
 Withdrawal Base =
$104,590.16 and assumed policy value of $90,000. Fund transfer amount of $5,000 as allocated in table above. 
 Fee adjustment as follows:

 = 104,590.16 * [(-5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 90,000 * (25/365) 

= 104,590.16 * (-125 + 72 + 46) / 90,000 * (25/365) 
 = 104,590.16 * -7/90,000 * (25/365) 
 = -8.13 * (25/365) 

= $-0.56 
 Total fee assessed at
end of second rider quarter (assuming no further rider fee adjustments): 
 = 652.26 - 0.56 

= $651.70 

  

					
	RGMB 37 0809 	  	(A-2)	  	(Income-Single) (09/2012)

			
	 

	  	 Home Office:

[4333 Edgewood Road N.E.]
 [Cedar Rapids, Iowa
52499]
 [(319)355-8511]

	  
	  
	  
	 A Stock Company (Hereafter called the Company, we, our or us)
	  	

 RETIREMENT INCOME CHOICE WITH DEATH BENEFIT RIDER 

This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an
individual annuity or the group certificate if the rider is attached to a group annuity. 
 All provisions of the policy that do not conflict
with this rider apply to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

Rider Data Specification 
  

			
	Policy Number:	  	[12345]
	Rider Date:	  	[07/01/2012]
	Growth Rate Percentage:	  	[5.00%]
		
	Rider Fee Percentages:	  	
	Designated Allocation Group A:	  	[1.95%]
	Designated Allocation Group B:	  	[1.50%]
	Designated Allocation Group C:	  	[1.10%]
		
	Annuitant:	  	[John Doe]
		
	Annuitant’s Issue Age/Sex:	  	[35 / Male]

  
  

ARTICLE I 
 You may cancel this
rider on the close of business before midnight of the thirtieth calendar day after you received it and no rider fees will be assessed. 
 If
you elect this rider, 100% of your policy value must be in one or more of the designated investment options. 
 You can generally transfer
between the designated investment options as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If you wish to make a transfer to a
non-designated investment option, this rider must be terminated, as described in Article IV, prior to making the transfer. 
 DEFINITIONS:

 Terms used that are not defined in this rider shall have the same meaning as those in your policy. 

Designated Investment Options 

Investment options authorized for use with this rider and identified by us as designated investment options. 

Excess Withdrawal 
 The excess of a gross
partial withdrawal over the rider withdrawal amount remaining prior to the withdrawal, if any. 
 Gross Partial Withdrawal 

The amount by which will be deducted from your policy value as a result of each partial withdrawal. 

  

					
	RGMB 37 0809 	  	(1	  	(Income/Death-Single) (09/2012)

 ARTICLE I CONTINUED 
 Rider Anniversary 
 The anniversary of the rider date. 

Rider Fee 
 The fees charged for the
benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 
 Rider Monthiversary 

The same day of the month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 

Rider Quarter 
 The last business day of
each rider quarter, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 
 Rider Withdrawal
Amount 
 The maximum amount that can be withdrawn from the policy each rider year without causing an excess withdrawal under the terms of
this rider and thus reducing the withdrawal base. This amount will change if the withdrawal base changes. 
 Rider Year 

Each twelve-month period following the rider date. 
 Valuation Period 
 The period of time from one determination of the value of a subaccount to
the next. Such determinations are made when the value of the assets and liabilities of each subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. 

Withdrawal Base 
 The amount used to
calculate the rider withdrawal amount and the rider fee. This amount cannot be taken as a lump sum. 
 ARTICLE II 

RIDER FEES 
 The rider fee is deducted on
each rider quarter in arrears. The fee is calculated and stored at issue and at each subsequent rider quarter for the upcoming quarter. The rider fee percentage will not change during the first five rider years, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since the previous rider quarter.

 The stored fee will be adjusted for new deposits, transfers among designated investment options and excess withdrawals made during the rider
quarter. 
 Fees will be calculated and stored on the day the rider is issued and at the beginning of each rider quarter. They will be deducted
automatically from each investment option on a pro rata basis at the end of each rider quarter. The annual fee percentages for each designated allocation group are shown on page 1, in the Rider Data Specification section. 

The quarterly fee is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4). 
  

	1)	Withdrawal Base; 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value; 

 

	3)	Total policy value; 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year. 

Please see the Appendix attached to this rider which illustrates how the rider fee is calculated. 

  

					
	RGMB 37 0809 	  	(2	  	(Income/Death-Single) (09/2012)

 ARTICLE III 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that you can receive
up to the rider withdrawal amount each rider year, regardless of the policy value, (either through withdrawals or payments, where payments are equal to the rider withdrawal amount if your policy value equals zero) until the annuitant’s death.

 The withdrawal percentage is determined by the attained age (age at last birthday) of the annuitant at the time of the first withdrawal of
any amount from the policy value taken on or after the rider anniversary following the annuitant’s 59th birthday. Once the withdrawal percentage is established, it may only be changed by an upgrade or automatic step-up and redetermined at that
time. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age at the time of automatic step-up. The withdrawal percentages are shown in the table below. 

 

							
	 	 	 Attained Age
	 	Withdrawal
Percentage	 	 
		 	[0 - 58]	 	[0.0%]	 	
		 	[59 - 64]	 	[4.0%]	 	
		 	[65 - 79]	 	[5.0%]	 	
		 	[80 +]	 	[6.0%]	 	

 If the annuitant is not yet [59] on the rider date, the withdrawal percentage will be zero until the rider anniversary
following the annuitant’s [59th] birthday. Withdrawals prior to age 59 1/2 will be subject to the 10% penalty tax. 
 Withdrawals will
reduce the policy value of the policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits and guarantees are no longer available. Also, if the policy
value equals zero, you will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to the rider withdrawal amount. Once the payment amount and frequency are
established, they cannot be changed and no additional withdrawals will be allowed. 
 ISSUE AGE AND SURVIVAL 

The benefits under this rider depend on the annuitant being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the
annuitant. Proof of survival and the issue ages may be required by the Company. 
 If the annuitant’s age has been misstated, this
rider’s fees and benefits will be adjusted to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and
any fees charged for this rider would be returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the rider withdrawal amount to be overstated, any withdrawal in excess of the correct rider
withdrawal amount will be considered an excess withdrawal and will impact the withdrawal base and rider withdrawal amount. If overpayments occurred when the sum of the accumulated values in all the investment options was zero, the amount of that
overpayment will be deducted from one or more future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 

The rider withdrawal amount will be equal to the greater of 1) and 2), where: 

 

	1)	is the withdrawal percentage multiplied by the withdrawal base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st rider anniversary, this amount is based on the initial policy value on the
rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

 

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

 

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living annuitant. The minimum required distributions can not be based on the age of someone who is deceased,

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

 

	 	F)	the minimum required distributions are only for the current rider year. Amounts carried over from past rider years are not considered. 

  

					
	RGMB 37 0809	  	(3	  	(Income/Death-Single) (09/2012)

 ARTICLE III CONTINUED 
 If any of the above are not true, then 2) is equal to zero and it is not available as a rider withdrawal amount. 
 If you withdraw less than the rider withdrawal amount in a rider year, the unused portion cannot be carried over to the next rider year. 
 WITHDRAWAL BASE 
 The withdrawal base is used to calculate the rider withdrawal amount. On
the rider date, the initial withdrawal base is equal to the policy value (less any premium enhancements if the rider is added in the first policy year). During any rider year, the withdrawal base is increased by subsequent premium payments (not
including premium enhancements, if any), and is reduced for excess withdrawals. 
 On each rider anniversary, the withdrawal base will be set to
the greatest of: 
  

	 	1)	The current withdrawal base; 

  

	 	2)	The policy value on the rider anniversary; 

  

	 	3)	The highest policy value on a rider [monthiversary] for the current rider year; or 

 

	 	4)	The current withdrawal base immediately prior to rider anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any excess withdrawals in the current rider year. Item 4) above will be zero after the [10th]
rider anniversary or if there have been any withdrawals in the current rider year. 
 AUTOMATIC STEP-UP FEATURE 

The rider receives an automatic step-up on the rider anniversary if the withdrawal base is set equal to the policy value or the highest policy value on a
rider [monthiversary.] This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The rider fee and withdrawal percentages may be changed due to an automatic step-up, but
there will be no increase in the rider fee percentage during the first [five] rider years. Following the [fifth] rider anniversary, the rider fee percentage may be increased due to an automatic step-up, but will not increase more than [0.75]% from
the initial rider fee percentages shown on page 1. 
 You have the right to reject an automatic step-up within [30] days following a rider
anniversary, if the rider fee percentage increases. If you reject an automatic step-up, you must notify us in a manner which is acceptable to us, however you are eligible for future automatic step-ups. Changes as a result of the automatic step-up
feature will be reversed. Any increase in the rider fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross partial withdrawals, taken in a rider year, less than or equal to the rider withdrawal amount will not reduce the withdrawal base.
Excess withdrawals will reduce the withdrawal base by the withdrawal base adjustment. The withdrawal base adjustment is the greater of 1) and 2), where: 
  

	1)	is the excess withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the withdrawal base prior to the excess withdrawal amount; and 

  

	 	C)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the withdrawal of the excess withdrawal amount. 

  

					
	RGMB 37 0809	  	(4	  	(Income/Death-Single) (09/2012)

 ARTICLE III CONTINUED 
 RIDER DEATH BENEFIT 
 Upon the annuitant’s death, we will pay an additional death
benefit amount equal to the excess, if any, of the rider death benefit over the greater of the base policy death benefit or the guaranteed minimum death benefit, if applicable, and this rider will then terminate. The rider death benefit on the rider
date is equal to the policy value (less any premium enhancements, if the rider is added in the first policy year). The rider death benefit after the rider date is equal to the rider death benefit on the rider date plus any premiums (not including
premium enhancements, if any) added after the rider date less any rider death benefit adjustments. 
 The rider death benefit does not reset due
to the automatic step-up. 
 RIDER DEATH BENEFIT ADJUSTMENTS 
 Cumulative gross partial withdrawals, taken in a rider year, up to the rider withdrawal amount will reduce the rider death benefit by the same amount (dollar for dollar). Excess withdrawals will reduce
the rider death benefit by the greater of: 
  

	1)	the excess withdrawal amount; and 

  

	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the excess withdrawal; and 

 

	 	C)	is the rider death benefit after the rider withdrawal amount has been withdrawn, but prior to the excess withdrawal. 

ARTICLE IV 
 CONTINUATION

 In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is not the annuitant dies and the surviving spouse is
the sole beneficiary, the surviving spouse may elect to continue the policy and rider. In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is the annuitant dies, this rider will terminate. No additional death
benefit will be paid under this rider at this time. 
 In the case of non-spousal joint owners where an owner who is not the annuitant dies, the
surviving owner (who is also the sole designated beneficiary) may elect to receive lifetime income payments under this rider instead of receiving any benefits applicable to the policy. The lifetime income payments must begin no later than 1 year
after the owner’s death and will be equal to the rider withdrawal amount divided by the number of payments made per year. Once the payments begin, no additional premium payments will be accepted and no additional withdrawals will be paid. If
these payments are elected but the annuitant dies before the rider death benefit equals zero, the annuitant’s beneficiary will receive a death benefit equal to the rider death benefit. 
 ANNUITIZATION 
 On the maximum annuity commencement date, as described in your policy, you
will have the option to receive lifetime income payments that are no less than your rider withdrawal amount each year. This option will also guarantee that the sum of all income payments received over time will equal or exceed the greater of the
policy value or the rider death benefit on the maximum annuity commencement date. If the annuitant should die before the sum of all income payments received equals or exceeds the greater of the policy value or the rider death benefit on the maximum
annuity commencement date, the annuitant’s beneficiary will receive a final payment equal to the difference. 
 RIDER UPGRADE

 You may elect, in writing, to upgrade the withdrawal base to the policy value within [30] days after the [fifth] rider anniversary and
every [fifth] rider anniversary thereafter, subject to the issue age restrictions on the new rider. If an upgrade is selected, this rider will terminate and a new rider with the same features will be issued with a new rider date. The new rider will
have its own growth rate percentage and rider fee percentage which may not be the same as this rider’s percentages. 
 At the time of
upgrade, the rider death benefit will also be upgraded to the policy value and the rider withdrawal amount will be recalculated based on the new withdrawal base. 
 The new rider date will be the date the Company receives all information necessary, at our Home Office, in a written form acceptable to the Company, to process the upgrade. 

  

					
	RGMB 37 0809 	  	(5	  	(Income/Death-Single) (09/2012)

 ARTICLE IV CONTINUED 
 TERMINATION 
 This rider will terminate upon the earliest of: 

 

	1)	the date the policy to which this rider is attached terminates; 

  

	2)	the date the policy to which this rider is attached is assigned or if the owner is changed without our approval; 

 

	3)	the date of the annuitant’s death; 

  

	4)	the date you elect to upgrade (as described in Article IV of this rider); 

  

	5)	the date you elect to receive annuity payments under your policy; and 

  

	6)	the date you notify us in writing of your intention to terminate this rider (this date must be within [30] days after the [fifth] rider anniversary and every [fifth]
rider anniversary thereafter). 

 Termination of the rider will result in the loss of all benefits provided by the rider.

 Signed for us at our home office. 
  

			
	 

	  	 

	 SECRETARY
	  	 PRESIDENT

  

					
	RGMB 37 0809 	  	(6	  	(Income/Death-Single) (09/2012)

 APPENDIX 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) divided
by (3) multiplied by (4) where: 
  

	1)	Withdrawal Base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value 

 

	3)	Total policy value 

  

	4)	Number of days in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for additional premium payments and excess withdrawals is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4) where: 

 

	1)	Withdrawal base change (i.e. withdrawal base after the transaction minus the withdrawal base before the transaction) 

 

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total transaction amount 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for fund transfers is calculated as follows: 
 Multiply (1) by (2) divided by (3) multiplied by (4) where: 
  

	1)	Withdrawal base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total policy value 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The following two examples use assumed fees and values listed in the table below. The assumed rider year is not a leap year. 

 

													
	 Designated Allocation Group
	  	Fee	 	 	Initial
Policy Value	 	  	Additional Premium
Used in Example 2	 
	 Group A
	  	 	2.50	% 	 	$	50,000	  	  	$	5,000	  
	 Group B
	  	 	2.40	% 	 	$	30,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	20,000	  	  	$	2,000	  

 Example 1: Calculation at rider issue for first quarter fee assuming an initial withdrawal base of $100,000.

 = 100,000 * [(50,000*0.0250) + (30,000*0.0240) + (20,000*0.0230)] / 100,000 * (91/365) 

= 100,000 * (1,250 + 720 + 460) / 100,000 * (91/365) 
 = 100,000 * 2,430/100,000 * (91/365) 
 = 2,430 * (91/365) 

= $605.84 
 Example 2:
Calculation for first quarter fee assuming initial withdrawal base from Example 1 above, plus adjustment for additional premium payment of $10,000 made with 20 days remaining in the first rider quarter (invested as shown above). The withdrawal
base change and total transaction amount equal $10,000. 
 Fee adjustment as follows: 

= 10,000 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (20/365) 

= 10,000 * (125 + 72 + 46) / 10,000 * (20/365) 
 = 10,000 * 243/10,000 * (20/365) 
 = 243 * (20/365) 

= $13.32 
 Total fee assessed at
end of first rider quarter (assuming no further rider fee adjustments): 
 = 13.32 + 605.84 

= $619.16 

  

					
	RGMB 37 0809 	  	(A-1)	  	(Income/Death-Single) (09/2012)

 The following three examples use assumed fees and values listed in the table below. The assumed rider year
is not a leap year. 
  

																	
	 Designated Allocation Group
	  	Fee	 	 	Policy Value	 	  	Partial Withdrawal
Used in Example 4	 	  	Fund Transfer
Used in Example 5	 
	 Group A
	  	 	2.50	% 	 	$	49,000	  	  	$	-5,000	  	  	$	-5,000	  
	 Group B
	  	 	2.40	% 	 	$	29,000	  	  	$	-3,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	19,000	  	  	$	-2,000	  	  	$	2,000	  

 Example 3: Calculation for second quarter fee at beginning of second rider quarter, assuming withdrawal base of
$110,000 and policy value of $97,000 invested as above. 
 = 110,000 * [(49,000*0.0250) + (29,000*0.0240) + (19,000*0.0230)]
/ 97,000 * (91/365) 
 = 110,000 * (1,225 + 696 + 437) / 97,000 * (91/365) 

= 110,000 * 2,358/97,000 * (91/365) 
 = 2,674.02 * (91/365) 
 = $666.67 

Example 4: Calculation for second quarter fee assuming beginning values as in Example 3 above, plus adjustment for partial withdrawal of $10,000
taken with 40 days remaining in the second rider quarter. Assumes withdrawal percentage of 5%, policy value of $97,000 prior to the transaction and change in withdrawal base as follows: 
 Rider Withdrawal Amount (RWA) = Withdrawal Base * Withdrawal Percentage = 110,000 * .05 = $5,500 

Excess Withdrawal = Difference between assumed withdrawal amount and RWA = 10,000 - 5,500 = $4,500 

Withdrawal Base Adjustment = Max (Excess Withdrawal, Excess Withdrawal * Withdrawal Base prior to withdrawal / Policy Value after RWA has been withdrawn
but before excess withdrawal) = Max [4,500, 4,500 * 110,000 / (97,000-5,500)] = Max (4,500, 5,409.84) = $5,409.84 
 Fee adjustment as follows:

 = -5,409.84 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (40/365) 

= -5,409.84 * (125 + 72 + 46) / 10,000 * (40/365) 
 = -5,409.84 * 243/10,000 * (40/365) 
 = -131.46 * (40/365) 

= $-14.41 
 Total fee assessed
at end of second rider quarter (assuming no further rider fee adjustments): 
 = 666.67 - 14.41 

= $652.26 
 The new Withdrawal
Base = $110,000 - $5,409.84 = $104,590.16 
 Example 5: Calculation for fund transfer occurring during second quarter with 25 days
remaining in the rider quarter, assuming beginning values as in Example 3 and withdrawal adjustment as in Example 4 above. 
 Withdrawal Base =
$104,590.16 and assumed policy value of $90,000. Fund transfer amount of $5,000 as allocated in table above. 
 Fee adjustment as follows:

 = 104,590.16 * [(-5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 90,000 * (25/365) 

= 104,590.16 * (-125 + 72 + 46) / 90,000 * (25/365) 
 = 104,590.16 * -7/90,000 * (25/365) 
 = -8.13 * (25/365) 

= $-0.56 
 Total fee assessed at
end of second rider quarter (assuming no further rider fee adjustments): 
 = 652.26 - 0.56 

= $651.70 

  

					
	RGMB 37 0809 	  	(A-2)	  	(Income/Death-Single) (09/2012)

			
	 

	  	 Home Office:

[4333 Edgewood Road N.E.]
 [Cedar Rapids, Iowa
52499]
 [(319)355-8511]

	  
	  
	  
	 A Stock Company (Hereafter called the Company, we, our or us)
	  	

 RETIREMENT INCOME CHOICE RIDER 
 This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an individual annuity or the group certificate if the
rider is attached to a group annuity. 
 All provisions of the policy that do not conflict with this rider apply to this rider. In the event of
any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 
 Rider Data Specification 
  

			
	Policy Number:	  	[12345]
	Rider Date:	  	[07/01/2012]
	Growth Rate Percentage:	  	[5.00%]
		
	Rider Fee Percentages:	  	
	Designated Allocation Group A:	  	[1.95%]
	Designated Allocation Group B:	  	[1.40%]
	Designated Allocation Group C:	  	[1.00%]
		
	Annuitant:	  	[John Doe]
		
	Annuitant’s Issue Age/Sex:	  	[35 / Male]

  
  

ARTICLE I 
 You may cancel this
rider on the close of business before midnight of the thirtieth calendar day after you received it and no rider fees will be assessed. 
 If
you elect this rider, 100% of your policy value must be in one or more of the designated investment options. 
 You can generally transfer
between the designated investment options as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If you wish to make a transfer to a
non-designated investment option, this rider must be terminated, as described in Article IV, prior to making the transfer. 
 DEFINITIONS:

 Terms used that are not defined in this rider shall have the same meaning as those in your policy. 

Designated Investment Options 

Investment options authorized for use with this rider and identified by us as designated investment options. 

Excess Withdrawal 
 The excess of a gross
partial withdrawal over the rider withdrawal amount remaining prior to the withdrawal, if any. 
 Gross Partial Withdrawal 

The amount by which will be deducted from your policy value as a result of each partial withdrawal. 

  

					
	RGMB 38 0809 	  	(1)	  	(Income-Single - Enh) (09/2012)

 ARTICLE I CONTINUED 
 Rider Anniversary 
 The anniversary of the rider date. 

Rider Fee 
 The fees charged for the
benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 
 Rider Monthiversary 

The same day of the month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 

Rider Quarter 
 The last business day of
each rider quarter, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 
 Rider Withdrawal
Amount 
 The maximum amount that can be withdrawn from the policy each rider year without causing an excess withdrawal under the terms of
this rider and thus reducing the withdrawal base. This amount will change if the withdrawal base changes. 
 Rider Year 

Each twelve-month period following the rider date. 
 Valuation Period 
 The period of time from one determination of the value of a subaccount to
the next. Such determinations are made when the value of the assets and liabilities of each subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. 

Withdrawal Base 
 The amount used to
calculate the rider withdrawal amount and the rider fee. This amount cannot be taken as a lump sum. 
 ARTICLE II 

RIDER FEES 
 The rider fee is deducted on
each rider quarter in arrears. The fee is calculated and stored at issue and at each subsequent rider quarter for the upcoming quarter. The rider fee percentage will not change during the first five rider years, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since the previous rider quarter.

 The stored fee will be adjusted for new deposits, transfers among designated investment options and excess withdrawals made during the rider
quarter. 
 Fees will be calculated and stored on the day the rider is issued and at the beginning of each rider quarter. They will be deducted
automatically from each investment option on a pro rata basis at the end of each rider quarter. The annual fee percentages for each designated allocation group are shown on page 1, in the Rider Data Specification section. 

The quarterly fee is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4). 
  

	1)	Withdrawal Base; 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value; 

 

	3)	Total policy value; 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year. 

Please see the Appendix attached to this rider which illustrates how the rider fee is calculated. 

  

					
	RGMB 38 0809 	  	(2	  	(Income-Single - Enh) (09/2012)

 ARTICLE III 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that you can
receive up to the rider withdrawal amount each rider year, regardless of the policy value, (either through withdrawals or payments, where payments are equal to the rider withdrawal amount if your policy value equals zero) until the annuitant’s
death. 
 The withdrawal percentage is determined by the attained age (age at last birthday) of the annuitant at the time of the first
withdrawal of any amount from the policy value taken on or after the rider anniversary following the annuitant’s 59th birthday. Once the withdrawal percentage is established, it may only be changed by an upgrade or automatic step-up and
redetermined at that time. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age at the time of the automatic step-up. The withdrawal percentages are shown in the table below. 

 

							
	 	 	 Attained Age
	 	Withdrawal
Percentage	 	 
		 	[0 - 58]	 	[0.0%]	 	
		 	[59 - 64]	 	[4.0%]	 	
		 	[65 - 79]	 	[5.0%]	 	
		 	[80 +]	 	[6.0%]	 	

 If the annuitant is not yet [59] on the rider date, the withdrawal percentage will be zero until the rider anniversary
following the annuitant’s [59th] birthday. Withdrawals prior to age 59 1/2 will be subject to the 10% penalty tax. 
 Withdrawals will
reduce the policy value of the policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits and guarantees are no longer available. Also, if the policy
value equals zero, you will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to the rider withdrawal amount. Once the payment amount and frequency are
established, they cannot be changed and no additional withdrawals will be allowed. 
 ISSUE AGE AND SURVIVAL 

The benefits under this rider depend on the annuitant being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the
annuitant. Proof of survival and the issue ages may be required by the Company. 
 If the annuitant’s age has been misstated, this
rider’s fees and benefits will be adjusted to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and
any fees charged for this rider would be returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the rider withdrawal amount to be overstated, any withdrawal in excess of the correct rider
withdrawal amount will be considered an excess withdrawal and will impact the withdrawal base and rider withdrawal amount. If overpayments occurred when the sum of the accumulated values in all the investment options was zero, the amount of that
overpayment will be deducted from one or more future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 

The rider withdrawal amount will be equal to the greater of 1) and 2), where: 

 

	1)	is the withdrawal percentage multiplied by the withdrawal base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st rider anniversary, this amount is based on the initial policy value on the
rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

 

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

 

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living annuitant. The minimum required distributions can not be based on the age of someone who is deceased,

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

 

	 	F)	the minimum required distributions are only for the current rider year. Amounts carried over from past rider years are not considered. 

  

					
	RGMB 38 0809 	  	(3	  	(Income-Single - Enh) (09/2012)

 ARTICLE III CONTINUED 
 If any of the above are not true, then 2) is equal to zero and it is not available as a rider withdrawal amount. 
 If you withdraw less than the rider withdrawal amount in a rider year, the unused portion cannot be carried over to the next rider year. 
 WITHDRAWAL BASE 
 The withdrawal base is used to calculate the rider withdrawal amount. On
the rider date, the initial withdrawal base is equal to the policy value (less any premium enhancements if the rider is added in the first policy year). During any rider year, the withdrawal base is increased by subsequent premium payments (not
including premium enhancements, if any), and is reduced for excess withdrawals. 
 On each rider anniversary, the withdrawal base will be set to
the greatest of: 
  

	 	1)	The current withdrawal base; 

  

	 	2)	The policy value on the rider anniversary; 

  

	 	3)	The highest policy value on a rider [monthiversary] for the current rider year; or 

 

	 	4)	The current withdrawal base immediately prior to rider anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any excess withdrawals in the current rider year. Item 4) above will be zero after the [10th]
rider anniversary or if there have been any withdrawals in the current rider year. 
 AUTOMATIC STEP-UP FEATURE 

The rider receives an automatic step-up on the rider anniversary if the withdrawal base is set equal to the policy value or the highest policy value on a
rider [monthiversary.] This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The rider fee and withdrawal percentages may be changed due to an automatic step-up, but
there will be no increase in the rider fee percentage during the first [five] rider years. Following the [fifth] rider anniversary, the rider fee percentage may be increased due to an automatic step-up, but will not increase more than [0.75%] from
the initial rider fee percentages shown on page 1. 
 You have the right to reject an automatic step-up within [30] days following a rider
anniversary, if the rider fee percentage increases. If you reject an automatic step-up, you must notify us in a manner which is acceptable to us, however you are eligible for future automatic step-ups. Changes as a result of the automatic step-up
feature will be reversed. Any increase in the rider fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross partial withdrawals, taken in a rider year, less than or equal to the rider withdrawal amount will not reduce the withdrawal base.
Excess withdrawals will reduce the withdrawal base by the withdrawal base adjustment. The withdrawal base adjustment is the greater of 1) and 2), where: 
  

	1)	is the excess withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the withdrawal base prior to the excess withdrawal amount; and 

  

	 	C)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the withdrawal of the excess withdrawal amount. 

  

					
	RGMB 38 0809 	  	(4	  	(Income-Single - Enh) (09/2012)

 ARTICLE III CONTINUED 
 INCOME ENHANCEMENT OPTION 
 THE INCOME ENHANCEMENT OPTION IS NOT LONG
TERM CARE INSURANCE 
 Definitions applicable to this option: 
 Elimination Period - [180] days within the last [365] days. 
 Hospital -
An institution which 1) is operated pursuant to the laws of the jurisdiction in which it is located, 2) operates primarily for the care and treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour nursing service by or
under the supervision of registered graduate professional nurses, 4) is supervised by a staff of one or more licensed physicians, and 5) has medical, surgical and diagnostic facilities or access to such facilities. 

Medical Necessity - Confinement prescribed by a physician based on the individual’s inability to sustain themselves outside of
a hospital or nursing facility due to physical or cognitive ailments. 
 Nursing Facility - A facility, or that part of a
facility, which: 1) is licensed to operate pursuant to the laws and regulations of the state in which it is located as a nursing facility or an Alzheimer’s disease facility; and 2) provides care prescribed by a physician and performed or
supervised by a registered graduate nurse, in addition to room and board accommodations, 24-hour nursing services, 7 days a week by an on-site Registered Nurse and related services on a continuing inpatient basis; and 3) has a planned program of
policies and procedures developed with the advice of, and periodically reviewed by, at least one Doctor; and 4) maintains a clinical record of each patient. 
 A nursing facility may be either a freestanding facility or a distinct part of a facility such as a ward, wing, unit, or swing bed of a hospital or other institution. If the facility complex to which an
insured person is confined consists of wards, wings, floors, units, or swing-beds, the area of the facility in which such insured person is confined must be licensed as a nursing facility and the insured person’s assigned bed must be included
as a part of such license. 
 The term “nursing facility” does not include, for example: 1) a hospital (except as
provided above); 2) a rehabilitation hospital, 
 3) a place which is primarily for treatment of mental or nervous disorders,
drug addiction, or alcoholism; 4) a home for the aged; 5) a rest home, community living center, or a place that provides domestic, resident, retirement or educational care; 6) assisted living facilities; 7) personal care homes; 8) residential care
facilities; 9) adult foster care facilities; 10) congregate care facilities; 11) family and group assisted living facilities; 12) personal care boarding homes; 13) domiciliary care homes; 14) basic care facilities; or 15) similar facilities.

 Physician - A Doctor of Medicine or Doctor of Osteopathy who is licensed as such and operating within the scope of the
license. 
 Waiting Period - [12] months from the rider date. 
 If the annuitant is confined, due to a medical necessity, in a hospital or nursing facility and has been so confined for the elimination period, benefits from this option are available provided that the
waiting period requirement has been satisfied. The elimination period and waiting period do not need to occur consecutively. The income enhancement option provides an increase to the withdrawal percentage (as described in the guaranteed lifetime
withdrawal benefit provision of this Article), until the annuitant is no longer confined as described above. The increase in the withdrawal percentage provided by this option will be as follows: 

 

			
	 Attained Age at

First Withdrawal
	  	Income Enhancement Option
Increase Percentage
	 [59 +]
	  	[50%]

  

					
	RGMB 38 0809 	  	(5	  	(Income-Single - Enh) (09/2012)

 ARTICLE III CONTINUED 
 As an example of the income enhancement option benefit, assume that the first withdrawal under the rider was taken at attained age 72 and the applicable withdrawal percentage is 5.0%. If the qualification
conditions for this option are met at any later date, then the withdrawal percentage will be increased by the income enhancement option increase percentage applicable for attained age 72. The applicable attained age is based on the first withdrawal
of any amount from the policy value under the rider itself, and is not based on any withdrawal under the income enhancement option, unless that withdrawal is also the first withdrawal of any policy value under the rider itself. 

If the income enhancement option increase percentage for attained age 72 is 100%, then the income enhancement option benefit provides an additional 5.0%
to the withdrawal percentage resulting in a total withdrawal percentage of 10.0% while the income enhancement option benefit continues to be available. 
 We will require confirmation of confinement while benefits are being received. Confirmation of confinement must be deemed satisfactory to us. Confirmation of confinement may be a statement from a
physician or a hospital or nursing facility administrator and any other information deemed necessary by us to confirm confinement. When confinement has ceased, the withdrawal percentage will be as indicated in the guaranteed lifetime withdrawal
benefit provision previously described in this Article. If confinement ceases and the rider remains active, you may re-qualify by satisfying the elimination period requirement and the benefits under this option will be available. 

ARTICLE IV 
 CONTINUATION

 In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is not the annuitant dies and the surviving spouse is
the sole beneficiary, the surviving spouse may elect to continue the policy and rider. In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is the annuitant dies, this rider will terminate. 

In the case of non-spousal joint owners where an owner who is not the annuitant dies, the surviving owner (who is also the sole designated beneficiary)
may elect to receive lifetime income payments under this rider instead of receiving any benefits applicable to the policy. The lifetime income payments must begin no later than 1 year after the owner’s death and will be equal to the rider
withdrawal amount divided by the number of payments made per year. Once the payments begin, no additional premium payments will be accepted and no additional withdrawals will be paid. 
 ANNUITIZATION 
 On the maximum annuity commencement date, as described in your policy, you
will have the option to receive lifetime income payments that are no less than your rider withdrawal amount each year. This option will also guarantee that the sum of all income payments received over time will equal or exceed the policy value on
the maximum annuity commencement date. If the annuitant should die before the sum of all income payments received equals or exceeds the policy value on the maximum annuity commencement date, the annuitant’s beneficiary will receive a final
payment equal to the difference. 
 RIDER UPGRADE 
 You may elect, in writing, to upgrade the withdrawal base to the policy value within [30] days after the [fifth] rider anniversary and every [fifth] rider anniversary thereafter, subject to the issue age
restrictions on the new rider. If an upgrade is selected, this rider will terminate and a new rider with the same features will be issued with a new rider date. The new rider will have its own growth rate percentage and rider fee percentages which
may not be the same as this rider’s percentages. 
 At the time upgrade, the rider withdrawal amount will be recalculated based on the new
withdrawal base. 
 The new rider date will be the date the Company receives all information necessary, at our Home Office, in a written form
acceptable to the Company, to process the upgrade. 

  

					
	RGMB 38 0809 	  	(6	  	(Income-Single - Enh) (09/2012)

 ARTICLE IV CONTINUED 
 TERMINATION 
 This rider will terminate upon the earliest of: 

 

	1)	the date the policy to which this rider is attached terminates; 

  

	2)	the date the policy to which this rider is attached is assigned or if the owner is changed without our approval; 

 

	3)	the date of the annuitant’s death; 

  

	4)	the date you elect to upgrade (as described in Article IV of this rider); 

  

	5)	the date you elect to receive annuity payments under your policy; and 

  

	6)	the date you notify us in writing of your intention to terminate this rider (this date must be within [30] days after the [fifth] rider anniversary and every [fifth]
rider anniversary thereafter). 

 Termination of the rider will result in the loss of all benefits provided by the rider.

 Signed for us at our home office. 
  

			
	 

	  	 

	 SECRETARY
	  	 PRESIDENT

  

					
	RGMB 38 0809 	  	(7	  	(Income-Single - Enh) (09/2012)

 APPENDIX 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) divided
by (3) multiplied by (4) where: 
  

	1)	Withdrawal Base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value 

 

	3)	Total policy value 

  

	4)	Number of days in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for additional premium payments and excess withdrawals is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4) where: 

 

	1)	Withdrawal base change (i.e. withdrawal base after the transaction minus the withdrawal base before the transaction) 

 

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total transaction amount 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for fund transfers is calculated as follows: 
 Multiply (1) by (2) divided by (3) multiplied by (4) where: 
  

	1)	Withdrawal base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total policy value 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The following two examples use assumed fees and values listed in the table below. The assumed rider year is not a leap year. 

 

													
	 Designated Allocation Group
	  	Fee	 	 	Initial
Policy Value	 	  	Additional Premium
Used in Example 2	 
	 Group A
	  	 	2.50	% 	 	$	50,000	  	  	$	5,000	  
	 Group B
	  	 	2.40	% 	 	$	30,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	20,000	  	  	$	2,000	  

 Example 1: Calculation at rider issue for first quarter fee assuming an initial withdrawal base of $100,000.

 = 100,000 * [(50,000*0.0250) + (30,000*0.0240) + (20,000*0.0230)] / 100,000 * (91/365) 

= 100,000 * (1,250 + 720 + 460) / 100,000 * (91/365) 
 = 100,000 * 2,430/100,000 * (91/365) 
 = 2,430 * (91/365) 

= $605.84 
 Example 2:
Calculation for first quarter fee assuming initial withdrawal base from Example 1 above, plus adjustment for additional premium payment of $10,000 made with 20 days remaining in the first rider quarter (invested as shown above). The withdrawal
base change and total transaction amount equal $10,000. 
 Fee adjustment as follows: 

= 10,000 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (20/365) 

= 10,000 * (125 + 72 + 46) / 10,000 * (20/365) 
 = 10,000 * 243/10,000 * (20/365) 
 = 243 * (20/365) 

= $13.32 
 Total fee assessed at
end of first rider quarter (assuming no further rider fee adjustments): 
 = 13.32 + 605.84 

= $619.16 

  

					
	RGMB 38 0809 	  	(A-1)	  	 (Income-Single - Enh) (09/2012)

 The following three examples use assumed fees and values listed in the table below. The assumed rider year
is not a leap year. 
  

																	
	 Designated Allocation Group
	  	Fee	 	 	Policy Value	 	  	Partial Withdrawal
Used in Example 4	 	  	Fund Transfer
Used in Example 5	 
	 Group A
	  	 	2.50	% 	 	$	  49,000	  	  	$	-5,000	  	  	$	-5,000	  
	 Group B
	  	 	2.40	% 	 	$	29,000	  	  	$	-3,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	19,000	  	  	$	-2,000	  	  	$	2,000	  

 Example 3: Calculation for second quarter fee at beginning of second rider quarter, assuming withdrawal base of
$110,000 and policy value of $97,000 invested as above. 
 = 110,000 * [(49,000*0.0250) + (29,000*0.0240) + (19,000*0.0230)]
/ 97,000 * (91/365) 
 = 110,000 * (1,225 + 696 + 437) / 97,000 * (91/365) 

= 110,000 * 2,358/97,000 * (91/365) 
 = 2,674.02 * (91/365) 
 = $666.67 

Example 4: Calculation for second quarter fee assuming beginning values as in Example 3 above, plus adjustment for partial withdrawal of $10,000
taken with 40 days remaining in the second rider quarter. Assumes withdrawal percentage of 5%, policy value of $97,000 prior to the transaction and change in withdrawal base as follows: 
 Rider Withdrawal Amount (RWA) = Withdrawal Base * Withdrawal Percentage = 110,000 * .05 = $5,500 

Excess Withdrawal = Difference between assumed withdrawal amount and RWA = 10,000 - 5,500 = $4,500 

Withdrawal Base Adjustment = Max (Excess Withdrawal, Excess Withdrawal * Withdrawal Base prior to withdrawal / Policy Value after RWA has been withdrawn
but before excess withdrawal) = Max [4,500, 4,500 * 110,000 / (97,000-5,500)] = Max (4,500, 5,409.84) = $5,409.84 
 Fee adjustment as follows:

 = -5,409.84 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (40/365) 

= -5,409.84 * (125 + 72 + 46) / 10,000 * (40/365) 
 = -5,409.84 * 243/10,000 * (40/365) 
 = -131.46 * (40/365) 

= $-14.41 
 Total fee assessed
at end of second rider quarter (assuming no further rider fee adjustments): 
 = 666.67 - 14.41 

= $652.26 
 The new Withdrawal
Base = $110,000 - $5,409.84 = $104,590.16 
 Example 5: Calculation for fund transfer occurring during second quarter with 25 days
remaining in the rider quarter, assuming beginning values as in Example 3 and withdrawal adjustment as in Example 4 above. 
 Withdrawal Base =
$104,590.16 and assumed policy value of $90,000. Fund transfer amount of $5,000 as allocated in table above. 
 Fee adjustment as follows:

 = 104,590.16 * [(-5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 90,000 * (25/365) 

= 104,590.16 * (-125 + 72 + 46) / 90,000 * (25/365) 
 = 104,590.16 * -7/90,000 * (25/365) 
 = -8.13 * (25/365) 

= $-0.56 
 Total fee assessed at
end of second rider quarter (assuming no further rider fee adjustments): 
 = 652.26 - 0.56 

= $651.70 

  

					
	RGMB 38 0809 	  	(A-2)	  	(Income-Single - Enh) (09/2012)

			
	

	  	 Home Office:

[4333 Edgewood Road N.E.]
 [Cedar Rapids, Iowa
52499]
 [(319)355-8511]

	  
	  
	  
	 A Stock Company (Hereafter called the Company, we, our or us)
	  	

 RETIREMENT INCOME CHOICE WITH DEATH BENEFIT RIDER 

This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an
individual annuity or the group certificate if the rider is attached to a group annuity. 
 All provisions of the policy that do not conflict
with this rider apply to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

Rider Data Specification 
  

			
	Policy Number:	  	[12345]
	Rider Date:	  	[07/01/2012]
	Growth Rate Percentage:	  	[5.00%]
		
	Rider Fee Percentages:	  	
	Designated Allocation Group A:	  	[2.25%]
	Designated Allocation Group B:	  	[1.80%]
	Designated Allocation Group C:	  	[1.40%]
		
	Annuitant:	  	[John Doe]
		
	Annuitant’s Issue Age/Sex:	  	[35 / Male]

  
  

ARTICLE I 
 You may cancel this
rider on the close of business before midnight of the thirtieth calendar day after you received it and no rider fees will be assessed. 
 If
you elect this rider, 100% of your policy value must be in one or more of the designated investment options. 
 You can generally transfer
between the designated investment options as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If you wish to make a transfer to a
non-designated investment option, this rider must be terminated, as described in Article IV, prior to making the transfer. 
 DEFINITIONS:

 Terms used that are not defined in this rider shall have the same meaning as those in your policy. 

Designated Investment Options 

Investment options authorized for use with this rider and identified by us as designated investment options. 

Excess Withdrawal 
 The excess of a gross
partial withdrawal over the rider withdrawal amount remaining prior to the withdrawal, if any. 
 Gross Partial Withdrawal 

The amount by which will be deducted from your policy value as a result of each partial withdrawal. 

  

					
	RGMB 38 0809 	  	(1	  	(Income/Death-Single - Enh) (09/2012)

 ARTICLE I CONTINUED 
 Rider Anniversary 
 The anniversary of the rider date. 

Rider Fee 
 The fees charged for the
benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 
 Rider Monthiversary 

The same day of the month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 

Rider Quarter 
 The last business day of
each rider quarter, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 
 Rider Withdrawal
Amount 
 The maximum amount that can be withdrawn from the policy each rider year without causing an excess withdrawal under the terms of
this rider and thus reducing the withdrawal base. This amount will change if the withdrawal base changes. 
 Rider Year 

Each twelve-month period following the rider date. 
 Valuation Period 
 The period of time from one determination of the value of a subaccount to
the next. Such determinations are made when the value of the assets and liabilities of each subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. 

Withdrawal Base 
 The amount used to
calculate the rider withdrawal amount and the rider fee. This amount cannot be taken as a lump sum. 
 ARTICLE II 

RIDER FEES 
 The rider fee is deducted on
each rider quarter in arrears. The fee is calculated and stored at issue and at each subsequent rider quarter for the upcoming quarter. The rider fee percentage will not change during the first five rider years, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since the previous rider quarter.

 The stored fee will be adjusted for new deposits, transfers among designated investment options and excess withdrawals made during the rider
quarter. 
 Fees will be calculated and stored on the day the rider is issued and at the beginning of each rider quarter. They will be deducted
automatically from each investment option on a pro rata basis at the end of each rider quarter. The annual fee percentages for each designated allocation group are shown on page 1, in the Rider Data Specification section. 

The quarterly fee is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4). 
  

	1)	Withdrawal Base; 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value; 

 

	3)	Total policy value; 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year. 

Please see the Appendix attached to this rider which illustrates how the rider fee is calculated. 

  

					
	RGMB 38 0809 	  	(2	  	(Income/Death-Single - Enh) (09/2012)

 ARTICLE III 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that you can receive
up to the rider withdrawal amount each rider year, regardless of the policy value, (either through withdrawals or payments, where payments are equal to the rider withdrawal amount if your policy value equals zero) until the annuitant’s death.

 The withdrawal percentage is determined by the attained age (age at last birthday) of the annuitant at the time of the first withdrawal of
any amount from the policy value taken on or after the rider anniversary following the annuitant’s 59th birthday. Once the withdrawal percentage is established, it may only be changed by an upgrade or automatic step-up and redetermined at that
time. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age at the time of the automatic step-up. The withdrawal percentages are shown in the table below. 

 

							
	 	 	Attained Age	 	Withdrawal
Percentage	 	 
		 	[0 -58]	 	[0.0%]	 	
		 	[59 -64]	 	[4.0%]	 	
		 	[65 -79]	 	[5.0%]	 	
		 	[80 +]	 	[6.0%]	 	

 If the annuitant is not yet [59] on the rider date, the withdrawal percentage will be zero until the rider anniversary
following the annuitant’s [59th] birthday. Withdrawals prior to age 59 1/2 will be subject to the 10% penalty tax. 
 Withdrawals will
reduce the policy value of the policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits and guarantees are no longer available. Also, if the policy
value equals zero, you will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to the rider withdrawal amount. Once the payment amount and frequency are
established, they cannot be changed and no additional withdrawals will be allowed. 
 ISSUE AGE AND SURVIVAL 

The benefits under this rider depend on the annuitant being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the
annuitant. Proof of survival and the issue ages may be required by the Company. 
 If the annuitant’s age has been misstated, this
rider’s fees and benefits will be adjusted to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and
any fees charged for this rider would be returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the rider withdrawal amount to be overstated, any withdrawal in excess of the correct rider
withdrawal amount will be considered an excess withdrawal and will impact the withdrawal base and rider withdrawal amount. If overpayments occurred when the sum of the accumulated values in all the investment options was zero, the amount of that
overpayment will be deducted from one or more future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 

The rider withdrawal amount will be equal to the greater of 1) and 2), where: 

 

	1)	is the withdrawal percentage multiplied by the withdrawal base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st rider anniversary, this amount is based on the initial policy value on the
rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

 

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

 

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living annuitant. The minimum required distributions can not be based on the age of someone who is deceased,

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

	 	F)	the minimum required distributions are only for the current rider year. Amounts carried over from past rider years are not considered. 

  

					
	RGMB 38 0809	  	(3	  	(Income/Death-Single - Enh) (09/2012)

 ARTICLE III CONTINUED 
 If any of the above are not true, then 2) is equal to zero and it is not available as a rider withdrawal amount. 
 If you withdraw less than the rider withdrawal amount in a rider year, the unused portion cannot be carried over to the next rider year. 
 WITHDRAWAL BASE 
 The withdrawal base is used to calculate the rider withdrawal amount. On
the rider date, the initial withdrawal base is equal to the policy value (less any premium enhancements if the rider is added in the first policy year). During any rider year, the withdrawal base is increased by subsequent premium payments (not
including premium enhancements, if any), and is reduced for excess withdrawals. 
 On each rider anniversary, the withdrawal base will be set to
the greatest of: 
  

	 	1)	The current withdrawal base; 

  

	 	2)	The policy value on the rider anniversary; 

  

	 	3)	The highest policy value on a rider [monthiversary] for the current rider year; or 

	 	4)	The current withdrawal base immediately prior to rider anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any excess withdrawals in the current rider year. Item 4) above will be zero after the [10th]
rider anniversary or if there have been any withdrawals in the current rider year. 
 AUTOMATIC STEP-UP FEATURE 

The rider receives an automatic step-up on the rider anniversary if the withdrawal base is set equal to the policy value or the highest policy value on a
rider [monthiversary.] This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The rider fee and withdrawal percentages may be changed due to an automatic step-up, but
there will be no increase in the rider fee percentage during the first [five] rider years. Following the [fifth] rider anniversary, the rider fee percentage may be increased due to an automatic step-up, but will not increase more than [0.75%] from
the initial rider fee percentages shown on page 1. 
 You have the right to reject an automatic step-up within [30] days following a rider
anniversary, if the rider fee percentage increases. If you reject an automatic step-up, you must notify us in a manner which is acceptable to us, however you are eligible for future automatic step-ups. Changes as a result of the automatic step-up
feature will be reversed. Any increase in the rider fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross partial withdrawals, taken in a rider year, less than or equal to the rider withdrawal amount will not reduce the withdrawal base.
Excess withdrawals will reduce the withdrawal base by the withdrawal base adjustment. The withdrawal base adjustment is the greater of 1) and 2), where: 
  

	1)	is the excess withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the withdrawal base prior to the excess withdrawal amount; and 

  

	 	C)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the withdrawal of the excess withdrawal amount. 

  

					
	RGMB 38 0809	  	(4	  	(Income/Death-Single - Enh) (09/2012)

 ARTICLE III CONTINUED 
 RIDER DEATH BENEFIT 
 Upon the annuitant’s death, we will pay an additional death
benefit amount equal to the excess, if any, of the rider death benefit over the greater of the base policy death benefit or the guaranteed minimum death benefit, if applicable, and this rider will then terminate. The rider death benefit on the rider
date is equal to the policy value (less any premium enhancements, if the rider is added in the first policy year). The rider death benefit after the rider date is equal to the rider death benefit on the rider date plus any premiums (not including
premium enhancements, if any) added after the rider date less any rider death benefit adjustments. 
 The rider death benefit does not reset due
to the automatic step-up. 
 RIDER DEATH BENEFIT ADJUSTMENTS 
 Cumulative gross partial withdrawals, taken in a rider year, up to the rider withdrawal amount will reduce the rider death benefit by the same amount (dollar for dollar). Excess withdrawals will reduce
the rider death benefit by the greater of: 
  

	1)	the excess withdrawal amount; and 

  

	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the excess withdrawal; and 

 

	 	C)	is the rider death benefit after the rider withdrawal amount has been withdrawn, but prior to the excess withdrawal. 

INCOME ENHANCEMENT OPTION 

THE INCOME ENHANCEMENT OPTION IS NOT LONG TERM CARE INSURANCE 
 Definitions applicable to this option: 
 Elimination Period - [180] days
within the last [365] days. 
 Hospital - An institution which 1) is operated pursuant to the laws of the jurisdiction in
which it is located, 2) operates primarily for the care and treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour nursing service by or under the supervision of registered graduate professional nurses, 4) is supervised by
a staff of one or more licensed physicians, and 5) has medical, surgical and diagnostic facilities or access to such facilities. 

Medical Necessity - Confinement prescribed by a physician based on the individual’s inability to sustain themselves outside of
a hospital or nursing facility due to physical or cognitive ailments. 
 Nursing Facility - A facility, or that part of a
facility, which: 1) is licensed to operate pursuant to the laws and regulations of the state in which it is located as a nursing facility or an Alzheimer’s disease facility; and 2) provides care prescribed by a physician and performed or
supervised by a registered graduate nurse, in addition to room and board accommodations, 24-hour nursing services, 7 days a week by an on-site Registered Nurse and related services on a continuing inpatient basis; and 3) has a planned program of
policies and procedures developed with the advice of, and periodically reviewed by, at least one Doctor; and 4) maintains a clinical record of each patient. 
 A nursing facility may be either a freestanding facility or a distinct part of a facility such as a ward, wing, unit, or swing bed of a hospital or other institution. If the facility complex to which an
insured person is confined consists of wards, wings, floors, units, or swing-beds, the area of the facility in which such insured person is confined must be licensed as a nursing facility and the insured person’s assigned bed must be included
as a part of such license. 
 The term “nursing facility” does not include, for example: 1) a hospital (except as
provided above); 2) a rehabilitation hospital, 
 3) a place which is primarily for treatment of mental or nervous disorders,
drug addiction, or alcoholism; 4) a home for the aged; 5) a rest home, community living center, or a place that provides domestic, resident, retirement or educational care; 6) assisted living facilities; 7) personal care homes; 8) residential care
facilities; 9) adult foster care facilities; 10) congregate care facilities; 11) family and group assisted living facilities; 12) personal care boarding homes; 13) domiciliary care homes; 14) basic care facilities; or 15) similar facilities.

  

					
	RGMB 38 0809	  	(5	  	(Income/Death-Single - Enh) (09/2012)

 ARTICLE III CONTINUED 
 Physician - A Doctor of Medicine or Doctor of Osteopathy who is licensed as such and operating within the scope of the license. 

Waiting Period - [12] months from the rider date. 
 If the annuitant is confined, due to a medical necessity, in a hospital or nursing facility and has been so confined for the elimination period, benefits from this option are available provided that the
waiting period requirement has been satisfied. The elimination period and waiting period do not need to occur consecutively. The income enhancement option provides an increase to the withdrawal percentage (as described in the guaranteed lifetime
withdrawal benefit provision of this Article), until the annuitant is no longer confined as described above. The increase in the withdrawal percentage provided by this option will be as follows: 

 

							
	 	 	 Attained Age at
First Withdrawal
	 	Income Enhancement Option
Increase Percentage	 	 
		 	[59 +]	 	[50%]	 	

 As an example of the income enhancement option benefit, assume that the first withdrawal under the rider was taken at
attained age 
 72 and the applicable withdrawal percentage is 5.0%. If the qualification conditions for this option are met at any later date,
then the withdrawal percentage will be increased by the income enhancement option increase percentage applicable for attained age 72. The applicable attained age is based on the first withdrawal of any amount from the policy value under the rider
itself, and is not based on any withdrawal under the income enhancement option, unless that withdrawal is also the first withdrawal of any policy value under the rider itself. 
 If the income enhancement option increase percentage for attained age 72 is 100%, then the income enhancement option benefit provides an additional 5.0% to the withdrawal percentage resulting in a total
withdrawal percentage of 10.0% while the income enhancement option benefit continues to be available. 
 We will require confirmation of
confinement while benefits are being received. Confirmation of confinement must be deemed satisfactory to us. Confirmation of confinement may be a statement from a physician or a hospital or nursing facility administrator and any other information
deemed necessary by us to confirm confinement. When confinement has ceased, the withdrawal percentage will be as indicated in the guaranteed lifetime withdrawal benefit provision previously described in this Article. If confinement ceases and the
rider remains active, you may re-qualify by satisfying the elimination period requirement and the benefits under this option will be available. 

ARTICLE IV 
 CONTINUATION

 In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is not the annuitant dies and the surviving spouse is
the sole beneficiary, the surviving spouse may elect to continue the policy and rider. In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is the annuitant dies, this rider will terminate. No additional death
benefit will be paid under this rider at this time. 
 In the case of non-spousal joint owners where an owner who is not the annuitant dies, the
surviving owner (who is also the sole designated beneficiary) may elect to receive lifetime income payments under this rider instead of receiving any benefits applicable to the policy. The lifetime income payments must begin no later than 1 year
after the owner’s death and will be equal to the rider withdrawal amount divided by the number of payments made per year. Once the payments begin, no additional premium payments will be accepted and no additional withdrawals will be paid. If
these payments are elected but the annuitant dies before the rider death benefit equals zero, the annuitant’s beneficiary will receive a death benefit equal to the rider death benefit. 
 ANNUITIZATION 
 On the maximum annuity commencement date, as described in your policy, you
will have the option to receive lifetime income payments that are no less than your rider withdrawal amount each year. This option will also guarantee that the sum of all income payments received over time will equal or exceed the greater of the
policy value or the rider death benefit on the maximum annuity commencement date. If the annuitant should die before the sum of all income payments received equals or exceeds the greater of the policy value or the rider death benefit on the maximum
annuity commencement date, the annuitant’s beneficiary will receive a final payment equal to the difference. 

  

					
	RGMB 38 0809	  	(6	  	(Income/Death-Single - Enh) (09/2012)

 ARTICLE IV CONTINUED 
 RIDER UPGRADE 
 You may elect, in writing, to upgrade the withdrawal base to the policy
value within [30] days after the [fifth] rider anniversary and every [fifth] rider anniversary thereafter, subject to the issue age restrictions on the new rider. If an upgrade is selected, this rider will terminate and a new rider with the same
features will be issued with a new rider date. The new rider will have its own growth rate percentage and rider fee percentage which may not be the same as this rider’s percentages. 
 At the time of upgrade, the rider death benefit will also be upgraded to the policy value and the rider withdrawal amount will be recalculated based on the new withdrawal base. 

The new rider date will be the date the Company receives all information necessary, at our Home Office, in a written form acceptable to the Company, to
process the upgrade. 
 TERMINATION 
 This rider will terminate upon the earliest of: 
  

	1)	the date the policy to which this rider is attached terminates; 

  

	2)	the date the policy to which this rider is attached is assigned or if the owner is changed without our approval; 

 

	3)	the date of the annuitant’s death; 

  

	4)	the date you elect to upgrade (as described in Article IV of this rider); 

  

	5)	the date you elect to receive annuity payments under your policy; and 

  

	6)	the date you notify us in writing of your intention to terminate this rider (this date must be within [30] days after the [fifth] rider anniversary and every [fifth]
rider anniversary thereafter). 

 Termination of the rider will result in the loss of all benefits provided by the rider.

 Signed for us at our home office. 
  

			
	

	  	

	SECRETARY	  	PRESIDENT

  

					
	RGMB 38 0809	  	(7	  	(Income/Death-Single - Enh) (09/2012)

 APPENDIX 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) divided
by (3) multiplied by (4) where: 
  

	1)	Withdrawal Base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value 

 

	3)	Total policy value 

  

	4)	Number of days in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for additional premium payments and excess withdrawals is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4) where: 

 

	1)	Withdrawal base change (i.e. withdrawal base after the transaction minus the withdrawal base before the transaction) 

 

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total transaction amount 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for fund transfers is calculated as follows: 
 Multiply (1) by (2) divided by (3) multiplied by (4) where: 
  

	1)	Withdrawal base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total policy value 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The following two examples use assumed fees and values listed in the table below. The assumed rider year is not a leap year. 

 

													
	 Designated Allocation Group
	  	Fee	 	 	Initial
Policy Value	 	  	Additional Premium
Used in Example 2	 
	 Group A
	  	 	2.50	% 	 	$	50,000	  	  	$	5,000	  
	 Group B
	  	 	2.40	% 	 	$	30,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	20,000	  	  	$	2,000	  

 Example 1: Calculation at rider issue for first quarter fee assuming an initial withdrawal base of $100,000.

 = 100,000 * [(50,000*0.0250) + (30,000*0.0240) + (20,000*0.0230)] / 100,000 * (91/365) 

= 100,000 * (1,250 + 720 + 460) / 100,000 * (91/365) 
 = 100,000 * 2,430/100,000 * (91/365) 
 = 2,430 * (91/365) 

= $605.84 
 Example 2:
Calculation for first quarter fee assuming initial withdrawal base from Example 1 above, plus adjustment for additional premium payment of $10,000 made with 20 days remaining in the first rider quarter (invested as shown above). The withdrawal
base change and total transaction amount equal $10,000. 
 Fee adjustment as follows: 

= 10,000 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (20/365) 

= 10,000 * (125 + 72 + 46) / 10,000 * (20/365) 
 = 10,000 * 243/10,000 * (20/365) 
 = 243 * (20/365) 

= $13.32 
 Total fee assessed at
end of first rider quarter (assuming no further rider fee adjustments): 
 = 13.32 + 605.84 

= $619.16 

  

					
	RGMB 38 0809	  	(A-1)	  	(Income/Death-Single - Enh) (09/2012)

 The following three examples use assumed fees and values listed in the table below. The assumed rider year
is not a leap year. 
  

																	
	 Designated Allocation Group
	  	Fee	 	 	Policy Value	 	  	Partial Withdrawal
Used in Example 4	 	  	Fund Transfer
Used in Example 5	 
	 Group A
	  	 	2.50	% 	 	$	49,000	  	  	$	-5,000	  	  	$	-5,000	  
	 Group B
	  	 	2.40	% 	 	$	29,000	  	  	$	-3,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	19,000	  	  	$	-2,000	  	  	$	2,000	  

 Example 3: Calculation for second quarter fee at beginning of second rider quarter, assuming withdrawal base of
$110,000 and policy value of $97,000 invested as above. 
 = 110,000 * [(49,000*0.0250) + (29,000*0.0240) + (19,000*0.0230)]
/ 97,000 * (91/365) 
 = 110,000 * (1,225 + 696 + 437) / 97,000 * (91/365) 

= 110,000 * 2,358/97,000 * (91/365) 
 = 2,674.02 * (91/365) 
 = $666.67 

Example 4: Calculation for second quarter fee assuming beginning values as in Example 3 above, plus adjustment for partial withdrawal of $10,000
taken with 40 days remaining in the second rider quarter. Assumes withdrawal percentage of 5%, policy value of $97,000 prior to the transaction and change in withdrawal base as follows: 
 Rider Withdrawal Amount (RWA) = Withdrawal Base * Withdrawal Percentage = 110,000 * .05 = $5,500 

Excess Withdrawal = Difference between assumed withdrawal amount and RWA = 10,000 - 5,500 = $4,500 

Withdrawal Base Adjustment = Max (Excess Withdrawal, Excess Withdrawal * Withdrawal Base prior to withdrawal / Policy Value after RWA has been withdrawn
but before excess withdrawal) = Max [4,500, 4,500 * 110,000 / (97,000-5,500)] = Max (4,500, 5,409.84) = $5,409.84 
 Fee adjustment as follows:

 = -5,409.84 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (40/365) 

= -5,409.84 * (125 + 72 + 46) / 10,000 * (40/365) 
 = -5,409.84 * 243/10,000 * (40/365) 
 = -131.46 * (40/365) 

= $-14.41 
 Total fee assessed
at end of second rider quarter (assuming no further rider fee adjustments): 
 = 666.67 - 14.41 

= $652.26 
 The new Withdrawal
Base = $110,000 - $5,409.84 = $104,590.16 
 Example 5: Calculation for fund transfer occurring during second quarter with 25 days
remaining in the rider quarter, assuming beginning values as in Example 3 and withdrawal adjustment as in Example 4 above. 
 Withdrawal Base =
$104,590.16 and assumed policy value of $90,000. Fund transfer amount of $5,000 as allocated in table above. 
 Fee adjustment as follows:

 = 104,590.16 * [(-5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 90,000 * (25/365) 

= 104,590.16 * (-125 + 72 + 46) / 90,000 * (25/365) 
 = 104,590.16 * -7/90,000 * (25/365) 
 = -8.13 * (25/365) 

= $-0.56 
 Total fee assessed at
end of second rider quarter (assuming no further rider fee adjustments): 
 = 652.26 - 0.56 

= $651.70 

  

					
	RGMB 38 0809	  	(A-2)	  	(Income/Death-Single - Enh) (09/2012)

			
	

	  	 Home Office:

[4333 Edgewood Road N.E.]
 [Cedar Rapids, Iowa
52499]
 [(319)355-8511]

	  
	  
	  
	 A Stock Company (Hereafter called the Company, we, our or us)
	  	

 RETIREMENT INCOME CHOICE RIDER 
 This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an individual annuity or the group certificate if the
rider is attached to a group annuity. 
 All provisions of the policy that do not conflict with this rider apply to this rider. In the event of
any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 
 Rider Data Specification 
  

			
	 Policy Number:
	  	[12345]
	 Rider Date:
	  	[07/01/2012]
	 Growth Rate Percentage:
	  	[5.00%]
		
	 Rider Fee Percentages:
	  	
	 Designated Allocation Group A:
	  	[1.55%]
	 Designated Allocation Group B:
	  	[1.10%]
	 Designated Allocation Group C:
	  	[0.70%]
		
	 Annuitant:
	  	[John Doe]
		
	 Annuitant’s Issue Age/Sex:
	  	[35 / Male]
	 Annuitant’s Spouse:
	  	[Jane Doe]
	 Annuitant’s Spouse’s Issue Age/Sex:
	  	[35 / Female]

  
  

ARTICLE I 
 You may cancel this
rider on the close of business before midnight of the thirtieth calendar day after you received it and no rider fees will be assessed. 
 If
you elect this rider, 100% of your policy value must be in one or more of the designated investment options. 
 You can generally transfer
between the designated investment options as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If you wish to make a transfer to a
non-designated investment option, this rider must be terminated, as described in Article IV, prior to making the transfer. 
 The
annuitant’s spouse as of the rider date is hereafter referred to as the annuitant’s spouse. As it pertains to the benefits of this rider, the annuitant’s spouse cannot be changed. The annuitant’s spouse must be the sole primary
beneficiary and/or a joint owner. The only living owners allowed on the policy to which this rider is attached are the annuitant and the annuitant’s spouse. 
 DEFINITIONS: 
 Terms used that are not defined in this rider shall have the same meaning as
those in your policy. 
 Designated Investment Options 
 Investment options authorized for use with this rider and identified by us as designated investment options. 
 Excess Withdrawal 
 The excess of a gross partial withdrawal over the rider withdrawal
amount remaining prior to the withdrawal, if any. 

  

					
	RGMB 37 0809	  	(1)	  	(Income-Joint) (09/2012)

 ARTICLE I CONTINUED 
 Gross Partial Withdrawal 
 The amount by which will be deducted from your policy value as a
result of each partial withdrawal. 
 Rider Anniversary 
 The anniversary of the rider date. 
 Rider Fee 

The fees charged for the benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 

Rider Monthiversary 
 The same day of the
month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 
 Rider Quarter

 The last business day of each rider quarter, or the next business day if our Administrative Office or the New York Stock Exchange are
closed. 
 Rider Withdrawal Amount 
 The maximum amount that can be withdrawn from the policy each rider year without causing an excess withdrawal under the terms of this rider and thus reducing the withdrawal base. This amount will change
if the withdrawal base changes. 
 Rider Year 
 Each twelve-month period following the rider date. 
 Valuation Period 

The period of time from one determination of the value of a subaccount to the next. Such determinations are made when the value of the assets and
liabilities of each subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. 

Withdrawal Base 
 The amount used to
calculate the rider withdrawal amount and the rider fee. This amount cannot be taken as a lump sum. 
 ARTICLE II 

RIDER FEES 
 The rider fee is deducted on
each rider quarter in arrears. The fee is calculated and stored at issue and at each subsequent rider quarter for the upcoming quarter. The rider fee percentage will not change during the first five rider years, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since the previous rider quarter.

 The stored fee will be adjusted for new deposits, transfers among designated investment options and excess withdrawals made during the rider
quarter. 
 Fees will be calculated and stored on the day the rider is issued and at the beginning of each rider quarter. They will be deducted
automatically from each investment option on a pro rata basis at the end of each rider quarter. The annual fee percentages for each designated allocation group are shown on page 1, in the Rider Data Specification section. 

The quarterly fee is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4). 
  

	1)	Withdrawal Base; 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value; 

 

	3)	Total policy value; 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year. 

Please see the Appendix attached to this rider which illustrates how the rider fee is calculated. 

  

					
	RGMB 37 0809	  	(2	  	(Income-Joint) (09/2012)

 ARTICLE III 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that you can receive
up to the rider withdrawal amount each rider year, regardless of the policy value, (either through withdrawals or payments, where payments are equal to the rider withdrawal amount if your policy value equals zero) until the annuitant’s or the
annuitant’s spouse’s death, whichever is later. 
 The withdrawal percentage is determined by the attained age (age at last birthday)
of the younger of the living spouses at the time of the first withdrawal of any amount from the policy value taken on or after the rider anniversary following the younger of the living spouse’s [59th] birthday. Once the withdrawal percentage is
established, it may only be changed by an upgrade or automatic step-up and redetermined at that time. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age of the younger of the living spouses at the time of the
automatic step-up. The withdrawal percentages are shown in the table below. 
  

							
	 	 	 Attained Age
	 	Withdrawal
Percentage	 	 
		 	[0 -58]	 	[0.0%]	 	
		 	[59 -64]	 	[3.5%]	 	
		 	[65 -79]	 	[4.5%]	 	
		 	[80 +]	 	[5.5%]	 	

 If the younger of the annuitant and the annuitant’s spouse is not yet [59] on the rider date, the withdrawal
percentage will be zero until the rider anniversary following the younger of the living spouse’s [59th] birthday. Withdrawals prior to age 59 1/2 will be subject to the 10% penalty tax. 
 Withdrawals will reduce the policy value of the policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits
and guarantees are no longer available. Also, if the policy value equals zero, you will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to the rider
withdrawal amount. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be allowed. 

ISSUE AGE AND SURVIVAL 
 The benefits
under this rider depend on the annuitant or annuitant’s spouse being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the annuitant and annuitant’s spouse. Proof of survival and the issue ages may
be required by the Company. 
 If the younger of the spouses’ ages has been misstated, this rider’s fees and benefits will be adjusted
to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and any fees charged for this rider would be
returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the rider withdrawal amount to be overstated, any withdrawal in excess of the correct rider withdrawal amount will be considered an excess
withdrawal and will impact the withdrawal base and rider withdrawal amount. If overpayments occurred when the sum of the accumulated values in all the investment options was zero, the amount of that overpayment will be deducted from one or more
future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 
 The rider withdrawal amount will be equal to the greater of 1) and 2), where: 
  

	1)	is the withdrawal percentage multiplied by the withdrawal base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st rider anniversary, this amount is based on the initial policy value on the
rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

 

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

 

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

  

					
	RGMB 37 0809	  	(3	  	(Income-Joint) (09/2012)

 ARTICLE III CONTINUED 

 

	 	D)	the minimum required distributions are based on age of the living annuitant or the annuitant’s spouse if the annuitant is deceased. The minimum required
distributions can not be based on the age of someone who is deceased, 

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

 

	 	F)	the minimum required distributions are only for the current rider year. Amounts carried over from past rider years are not considered. 

If any of the above are not true, then 2) is equal to zero and it is not available as a rider withdrawal amount. 

If you withdraw less than the rider withdrawal amount in a rider year, the unused portion cannot be carried over to the next rider year. 

WITHDRAWAL BASE 
 The withdrawal base is
used to calculate the rider withdrawal amount. On the rider date, the initial withdrawal base is equal to the policy value (less any premium enhancements if the rider is added in the first policy year). During any rider year, the withdrawal base is
increased by subsequent premium payments (not including premium enhancements, if any), and is reduced for excess withdrawals. 
 On each rider
anniversary, the withdrawal base will be set to the greatest of: 
  

	 	1)	The current withdrawal base; 

  

	 	2)	The policy value on the rider anniversary; 

  

	 	3)	The highest policy value on a rider [monthiversary] for the current rider year; or 

 

	 	4)	The current withdrawal base immediately prior to rider anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any excess withdrawals in the current rider year. Item 4) above will be zero after the [10th]
rider anniversary or if there have been any withdrawals in the current rider year. 
 AUTOMATIC STEP-UP FEATURE 

The rider receives an automatic step-up on the rider anniversary if the withdrawal base is set equal to the policy value or the highest policy value on a
rider [monthiversary.] This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The rider fee and withdrawal percentages may be changed due to an automatic step-up, but
there will be no increase in the rider fee percentage during the first [five] rider years. Following the [fifth] rider anniversary, the rider fee percentage may be increased due to an automatic step-up, but will not increase more than [0.75%] from
the initial rider fee percentages shown on page 1. 
 You have the right to reject an automatic step-up within [30] days following a rider
anniversary, if the rider fee percentage increases. If you reject an automatic step-up, you must notify us in a manner which is acceptable to us, however you are eligible for future automatic step-ups. Changes as a result of the automatic step-up
feature will be reversed. Any increase in the rider fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross partial withdrawals, taken in a rider year, less than or equal to the rider withdrawal amount will not reduce the withdrawal base.
Excess withdrawals will reduce the withdrawal base by the withdrawal base adjustment. The withdrawal base adjustment is the greater of 1) and 2), where: 
  

	1)	is the excess withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the withdrawal base prior to the excess withdrawal amount; and 

  

	 	C)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the withdrawal of the excess withdrawal amount. 

  

					
	RGMB 37 0809	  	(4	  	(Income-Joint) (09/2012)

 ARTICLE IV 
 CONTINUATION 
 In the case of spousal joint owners where one spouse is the annuitant, if the
spouse who is not the annuitant dies and the surviving spouse is the sole beneficiary, the surviving spouse may elect to continue the policy and rider. In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is the
annuitant dies and the surviving spouse is the sole beneficiary, the rider continues until the death of the surviving spouse. 

ANNUITIZATION 
 On the maximum annuity
commencement date, as described in your policy, you will have the option to receive lifetime income payments that are no less than your rider withdrawal amount each year. This option will also guarantee that the sum of all income payments received
over time will equal or exceed the policy value on the maximum annuity commencement date. If the annuitant or annuitant’s spouse should die before the sum of all income payments received equals or exceeds the policy value on the maximum annuity
commencement date, the annuitant’s beneficiary will receive a final payment equal to the difference. 
 RIDER UPGRADE 

You may elect, in writing, to upgrade the withdrawal base to the policy value within [30] days after the [fifth] rider anniversary and every [fifth] rider
anniversary thereafter, subject to the issue age restrictions on the new rider. If an upgrade is selected, this rider will terminate and a new rider with the same features will be issued with a new rider date. The new rider will have its own growth
rate percentage and rider fee percentage which may not be the same as this rider’s percentages. 
 At the time of upgrade the rider
withdrawal amount will be recalculated based on the new withdrawal base. 
 The new rider date will be the date the Company receives all
information necessary, at our Home Office, in a written form acceptable to the Company, to process the upgrade. 
 TERMINATION

 This rider will terminate upon the earliest of: 
  

	1)	the date the policy to which this rider is attached terminates; 

  

	2)	the date the policy to which this rider is attached is assigned or if the owner is changed without our approval; 

 

	3)	the later of the annuitant’s or annuitant’s spouse’s death; 

 

	4)	the date you elect to upgrade (as described in Article IV of this rider); 

  

	5)	the date you elect to receive annuity payments under your policy; and 

  

	6)	the date you notify us in writing of your intention to terminate this rider (this date must be within [30] days after the [fifth] rider anniversary and every [fifth]
rider anniversary thereafter). 

 Termination of the rider will result in the loss of all benefits provided by the rider.

 Signed for us at our home office. 
  

			
	

	  	

	SECRETARY	  	PRESIDENT

  

					
	RGMB 37 0809	  	(5	  	(Income-Joint) (09/2012)

 APPENDIX 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) divided
by (3) multiplied by (4) where: 
  

	1)	Withdrawal Base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value 

 

	3)	Total policy value 

  

	4)	Number of days in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for additional premium payments and excess withdrawals is calculated as follows: Multiply (1) by (2) divided by
(3) multiplied by (4) where: 
  

	1)	Withdrawal base change (i.e. withdrawal base after the transaction minus the withdrawal base before the transaction) 

 

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total transaction amount 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for fund transfers is calculated as follows: 
 Multiply (1) by (2) divided by (3) multiplied by (4) where: 
  

	1)	Withdrawal base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total policy value 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The following two examples use assumed fees and values listed in the table below. The assumed rider year is not a leap year. 

 

													
	 Designated Allocation Group
	  	Fee	 	 	Initial
Policy Value	 	  	Additional Premium
Used in Example 2	 
	 Group A
	  	 	2.50	% 	 	$	50,000	  	  	$	5,000	  
	 Group B
	  	 	2.40	% 	 	$	30,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	20,000	  	  	$	2,000	  

 Example 1: Calculation at rider issue for first quarter fee assuming an initial withdrawal base of $100,000.

 = 100,000 * [(50,000*0.0250) + (30,000*0.0240) + (20,000*0.0230)] / 100,000 * (91/365) 

= 100,000 * (1,250 + 720 + 460) / 100,000 * (91/365) 
 = 100,000 * 2,430/100,000 * (91/365) 
 = 2,430 * (91/365) 

= $605.84 
 Example 2:
Calculation for first quarter fee assuming initial withdrawal base from Example 1 above, plus adjustment for additional premium payment of $10,000 made with 20 days remaining in the first rider quarter (invested as shown above). The withdrawal
base change and total transaction amount equal $10,000. 
 Fee adjustment as follows: 

= 10,000 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (20/365) 

= 10,000 * (125 + 72 + 46) / 10,000 * (20/365) 
 = 10,000 * 243/10,000 * (20/365) 
 = 243 * (20/365) 

= $13.32 
 Total fee assessed at
end of first rider quarter (assuming no further rider fee adjustments): 
 = 13.32 + 605.84 

= $619.16 

  

					
	RGMB 37 0809	  	(A-1)	  	(Income-Joint) (09/2012)

 The following three examples use assumed fees and values listed in the table below. The assumed rider year
is not a leap year. 
  

																	
	 Designated Allocation Group
	  	Fee	 	 	Policy Value	 	  	Partial Withdrawal
Used in Example 4	 	  	Fund Transfer
Used in Example 5	 
	 Group A
	  	 	2.50	% 	 	$	49,000	  	  	$	-5,000	  	  	$	-5,000	  
	 Group B
	  	 	2.40	% 	 	$	29,000	  	  	$	-3,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	19,000	  	  	$	-2,000	  	  	$	2,000	  

 Example 3: Calculation for second quarter fee at beginning of second rider quarter, assuming withdrawal base of
$110,000 and policy value of $97,000 invested as above. 
 = 110,000 * [(49,000*0.0250) + (29,000*0.0240) + (19,000*0.0230)]
/ 97,000 * (91/365) 
 = 110,000 * (1,225 + 696 + 437) / 97,000 * (91/365) 

= 110,000 * 2,358/97,000 * (91/365) 
 = 2,674.02 * (91/365) 
 = $666.67 

Example 4: Calculation for second quarter fee assuming beginning values as in Example 3 above, plus adjustment for partial withdrawal of $10,000
taken with 40 days remaining in the second rider quarter. Assumes withdrawal percentage of 5%, policy value of $97,000 prior to the transaction and change in withdrawal base as follows: 
 Rider Withdrawal Amount (RWA) = Withdrawal Base * Withdrawal Percentage = 110,000 * .05 = $5,500 

Excess Withdrawal = Difference between assumed withdrawal amount and RWA = 10,000 - 5,500 = $4,500 

Withdrawal Base Adjustment = Max (Excess Withdrawal, Excess Withdrawal * Withdrawal Base prior to withdrawal / Policy Value after RWA has been withdrawn
but before excess withdrawal) = Max [4,500, 4,500 * 110,000 / (97,000-5,500)] = Max (4,500, 5,409.84) = $5,409.84 
 Fee adjustment as follows:

 = -5,409.84 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (40/365) 

= -5,409.84 * (125 + 72 + 46) / 10,000 * (40/365) 
 = -5,409.84 * 243/10,000 * (40/365) 
 = -131.46 * (40/365) 

= $-14.41 
 Total fee assessed
at end of second rider quarter (assuming no further rider fee adjustments): 
 = 666.67 - 14.41 

= $652.26 
 The new Withdrawal
Base = $110,000 - $5,409.84 = $104,590.16 
 Example 5: Calculation for fund transfer occurring during second quarter with 25 days
remaining in the rider quarter, assuming beginning values as in Example 3 and withdrawal adjustment as in Example 4 above. 
 Withdrawal Base =
$104,590.16 and assumed policy value of $90,000. Fund transfer amount of $5,000 as allocated in table above. 
 Fee adjustment as follows:

 = 104,590.16 * [(-5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 90,000 * (25/365) 

= 104,590.16 * (-125 + 72 + 46) / 90,000 * (25/365) 
 = 104,590.16 * -7/90,000 * (25/365) 
 = -8.13 * (25/365) 

= $-0.56 
 Total fee assessed at
end of second rider quarter (assuming no further rider fee adjustments): 
 = 652.26 - 0.56 

= $651.70 

  

					
	RGMB 37 0809	  	(A-2)	  	(Income-Joint) (09/2012)

			
	

	  	 Home Office:

[4333 Edgewood Road N.E.]
 [Cedar Rapids, Iowa
52499]
 [(319)355-8511]

	  
	  
	  
	 A Stock Company (Hereafter called the Company, we, our or us)
	  	

 RETIREMENT INCOME CHOICE WITH DEATH BENEFIT RIDER 

This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an
individual annuity or the group certificate if the rider is attached to a group annuity. 
 All provisions of the policy that do not conflict
with this rider apply to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

Rider Data Specification 
  

			
	 Policy Number:
	  	[12345]
	 Rider Date:
	  	[07/01/2012]
	 Growth Rate Percentage:
	  	[5.00%]
		
	 Rider Fee Percentages:
	  	
	 Designated Allocation Group A:
	  	[1.90%]
	 Designated Allocation Group B:
	  	[1.45%]
	 Designated Allocation Group C:
	  	[1.05%]
		
	 Annuitant:
	  	[John Doe]
		
	 Annuitant’s Issue Age/Sex:
	  	[35 / Male]
	 Annuitant’s Spouse:
	  	[Jane Doe]
	 Annuitant’s Spouse’s Issue Age/Sex:
	  	[35 / Female]

  
  

ARTICLE I 
 You may cancel this
rider on the close of business before midnight of the thirtieth calendar day after you received it and no rider fees will be assessed. 
 If
you elect this rider, 100% of your policy value must be in one or more of the designated investment options. 
 You can generally transfer
between the designated investment options as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If you wish to make a transfer to a
non-designated investment option, this rider must be terminated, as described in Article IV, prior to making the transfer. 
 The
annuitant’s spouse as of the rider date is hereafter referred to as the annuitant’s spouse. As it pertains to the benefits of this rider, the annuitant’s spouse cannot be changed. The annuitant’s spouse must be the sole primary
beneficiary and/or a joint owner. The only living owners allowed on the policy to which this rider is attached are the annuitant and the annuitant’s spouse. 
 DEFINITIONS: 
 Terms used that are not defined in this rider shall have the same meaning as
those in your policy. 
 Designated Investment Options 
 Investment options authorized for use with this rider and identified by us as designated investment options. 
 Excess Withdrawal 
 The excess of a gross partial withdrawal over the rider withdrawal
amount remaining prior to the withdrawal, if any. 
  

  

					
	RGMB 37 0809	  	(1	  	(Income/Death-Joint) (09/2012)

 ARTICLE I CONTINUED 
 Gross Partial Withdrawal 
 The amount by which will be deducted from your policy value as a
result of each partial withdrawal. 
 Rider Anniversary 
 The anniversary of the rider date. 
 Rider Fee 

The fees charged for the benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 

Rider Monthiversary 
 The same day of the
month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 
 Rider Quarter

 The last business day of each rider quarter, or the next business day if our Administrative Office or the New York Stock Exchange are
closed. 
 Rider Withdrawal Amount 
 The maximum amount that can be withdrawn from the policy each rider year without causing an excess withdrawal under the terms of this rider and thus reducing the withdrawal base. This amount will change
if the withdrawal base changes. 
 Rider Year 
 Each twelve-month period following the rider date. 
 Valuation Period 

The period of time from one determination of the value of a subaccount to the next. Such determinations are made when the value of the assets and
liabilities of each subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. 

Withdrawal Base 
 The amount used to
calculate the rider withdrawal amount and the rider fee. This amount cannot be taken as a lump sum. 
 ARTICLE II 

RIDER FEES 
 The rider fee is deducted on
each rider quarter in arrears. The fee is calculated and stored at issue and at each subsequent rider quarter for the upcoming quarter. The rider fee percentage will not change during the first five rider years, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since the previous rider quarter.

 The stored fee will be adjusted for new deposits, transfers among designated investment options and excess withdrawals made during the rider
quarter. 
 Fees will be calculated and stored on the day the rider is issued and at the beginning of each rider quarter. They will be deducted
automatically from each investment option on a pro rata basis at the end of each rider quarter. The annual fee percentages for each designated allocation group are shown on page 1, in the Rider Data Specification section. 

The quarterly fee is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4). 
  

	1)	Withdrawal Base; 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value; 

 

	3)	Total policy value; 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year. 

 

	Please	see the Appendix attached to this rider which illustrates how the rider fee is calculated. 

  

					
	RGMB 37 0809	  	(2	  	(Income/Death-Joint) (09/2012)

 ARTICLE III 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that you can receive
up to the rider withdrawal amount each rider year, regardless of the policy value, (either through withdrawals or payments, where payments are equal to the rider withdrawal amount if your policy value equals zero) until the annuitant’s or the
annuitant’s spouse’s death, whichever is later. 
 The withdrawal percentage is determined by the attained age (age at last birthday)
of the younger of the living spouses at the time of the first withdrawal of any amount from the policy value taken on or after the rider anniversary following the younger of the living spouse’s [59th] birthday. Once the withdrawal percentage is
established, it may only be changed by an upgrade or automatic step-up and redetermined at that time. Upon automatic step-up, the withdrawal percentages will be reset based on the attained age of the younger of the living spouses at the time of the
automatic step-up. The withdrawal percentages are shown in the table below. 
  

							
	 	 	 Attained Age
	 	Withdrawal
Percentage	 	 
		 	[0 -58]	 	[0.0%]	 	
		 	[59 -64]	 	[3.5%]	 	
		 	[65 -79]	 	[4.5%]	 	
		 	[80 +]	 	[5.5%]	 	

 If the younger of the annuitant and the annuitant’s spouse is not yet [59] on the rider date, the withdrawal
percentage will be zero until the rider anniversary following the younger of the living spouse’s [59th] birthday. Withdrawals prior to age 59 1/2 will be subject to the 10% penalty tax. 
 Withdrawals will reduce the policy value of the policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits
and guarantees are no longer available. Also, if the policy value equals zero, you will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to the rider
withdrawal amount. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be allowed. 

ISSUE AGE AND SURVIVAL 
 The benefits
under this rider depend on the annuitant or annuitant’s spouse being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the annuitant and annuitant’s spouse. Proof of survival and the issue ages may
be required by the Company. 
 If the younger of the spouses’ ages has been misstated, this rider’s fees and benefits will be adjusted
to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and any fees charged for this rider would be
returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the rider withdrawal amount to be overstated, any withdrawal in excess of the correct rider withdrawal amount will be considered an excess
withdrawal and will impact the withdrawal base and rider withdrawal amount. If overpayments occurred when the sum of the accumulated values in all the investment options was zero, the amount of that overpayment will be deducted from one or more
future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 
 The rider withdrawal amount will be equal to the greater of 1) and 2), where: 
  

	1)	is the withdrawal percentage multiplied by the withdrawal base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st rider anniversary, this amount is based on the initial policy value on the
rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

 

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

 

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

  

					
	RGMB 37 0809	  	(3	  	(Income/Death-Joint) (09/2012)

 ARTICLE III CONTINUED 

 

	 	D)	the minimum required distributions are based on age of the living annuitant or the annuitant’s spouse if the annuitant is deceased. The minimum required
distributions can not be based on the age of someone who is deceased, 

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

 

	 	F)	the minimum required distributions are only for the current rider year. Amounts carried over from past rider years are not considered. 

If any of the above are not true, then 2) is equal to zero and it is not available as a rider withdrawal amount. 

If you withdraw less than the rider withdrawal amount in a rider year, the unused portion cannot be carried over to the next rider year. 

WITHDRAWAL BASE 
 The withdrawal base is
used to calculate the rider withdrawal amount. On the rider date, the initial withdrawal base is equal to the policy value (less any premium enhancements if the rider is added in the first policy year). During any rider year, the withdrawal base is
increased by subsequent premium payments (not including premium enhancements, if any), and is reduced for excess withdrawals. 
 On each rider
anniversary, the withdrawal base will be set to the greatest of: 
  

	 	1)	The current withdrawal base; 

  

	 	2)	The policy value on the rider anniversary; 

  

	 	3)	The highest policy value on a rider [monthiversary] for the current rider year; or 

 

	 	4)	The current withdrawal base immediately prior to rider anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any excess withdrawals in the current rider year. Item 4) above will be zero after the 10th rider
anniversary or if there have been any withdrawals in the current rider year. 
 AUTOMATIC STEP-UP FEATURE 

The rider receives an automatic step-up on the rider anniversary if the withdrawal base is set equal to the policy value or the highest policy value on a
rider [monthiversary.] This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The rider fee and withdrawal percentages may be changed due to an automatic step-up, but
there will be no increase in the rider fee percentage during the first [five] rider years. Following the [fifth] rider anniversary, the rider fee percentage may be increased due to an automatic step-up, but will not increase more than [0.75%] from
the initial rider fee percentages shown on page 1. 
 You have the right to reject an automatic step-up within [30] days following a rider
anniversary, if the rider fee percentage increases. If you reject an automatic step-up, you must notify us in a manner which is acceptable to us, however you are eligible for future automatic step-ups. Changes as a result of the automatic step-up
feature will be reversed. Any increase in the rider fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross partial withdrawals, taken in a rider year, less than or equal to the rider withdrawal amount will not reduce the withdrawal base.
Excess withdrawals will reduce the withdrawal base by the withdrawal base adjustment. The withdrawal base adjustment is the greater of 1) and 2), where: 
  

	1)	is the excess withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the withdrawal base prior to the excess withdrawal amount; and 

  

	 	C)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the withdrawal of the excess withdrawal amount. 

  

					
	RGMB 37 0809	  	(4	  	(Income/Death-Joint) (09/2012)

 ARTICLE III CONTINUED 
 RIDER DEATH BENEFIT 
 Upon the later of the annuitant or the annuitant’s spouse’s
death, we will pay an additional death benefit amount equal to the excess, if any, of the rider death benefit over the greater of the base policy death benefit or the guaranteed minimum death benefit, if applicable, and this rider will then
terminate. The rider death benefit on the rider date is equal to the policy value (less any premium enhancements, if the rider is added in the first policy year). The rider death benefit after the rider date is equal to the rider death benefit on
the rider date plus any premiums (not including premium enhancements, if any) added after the rider date less any rider death benefit adjustments. 
 The rider death benefit does not reset due to the automatic step-up. 
 RIDER DEATH BENEFIT
ADJUSTMENTS 
 Cumulative gross partial withdrawals, taken in a rider year, up to the rider withdrawal amount will reduce the rider death
benefit by the same amount (dollar for dollar). Excess withdrawals will reduce the rider death benefit by the greater of: 
  

	1)	the excess withdrawal amount; and 

  

	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the excess withdrawal; and 

 

	 	C)	is the rider death benefit after the rider withdrawal amount has been withdrawn, but prior to the excess withdrawal. 

ARTICLE IV 
 CONTINUATION

 In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is not the annuitant dies and the surviving spouse is
the sole beneficiary, the surviving spouse may elect to continue the policy and rider. In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is the annuitant dies and the surviving spouse is the sole beneficiary,
the rider continues until the death of the surviving spouse. No additional death benefit will be paid under this rider at this time. 

ANNUITIZATION 
 On the maximum annuity
commencement date, as described in your policy, you will have the option to receive lifetime income payments that are no less than your rider withdrawal amount each year. This option will also guarantee that the sum of all income payments received
over time will equal or exceed the greater of the policy value or the rider death benefit on the maximum annuity commencement date. If the annuitant or annuitant’s spouse should die before the sum of all income payments received equals or
exceeds the greater of the policy value or the rider death benefit on the maximum annuity commencement date, the annuitant’s beneficiary will receive a final payment equal to the difference. 

RIDER UPGRADE 
 You may elect, in
writing, to upgrade the withdrawal base to the policy value within [30] days after the [fifth] rider anniversary and every [fifth] rider anniversary thereafter, subject to the issue age restrictions on the new rider. If an upgrade is selected, this
rider will terminate and a new rider with the same features will be issued with a new rider date. The new rider will have its own growth rate percentage and rider fee percentage which may not be the same as this rider’s percentages. 

At the time of upgrade, the rider death benefit will also be upgraded to the policy value and the rider withdrawal amount will be recalculated based on
the new withdrawal base. 
 The new rider date will be the date the Company receives all information necessary, at our Home Office, in a written
form acceptable to the Company, to process the upgrade. 

  

					
	RGMB 37 0809	  	(5	  	(Income/Death-Joint) (09/2012)

 ARTICLE IV CONTINUED 
 TERMINATION 
 This rider will terminate upon the earliest of: 

 

	1)	the date the policy to which this rider is attached terminates; 

  

	2)	the date the policy to which this rider is attached is assigned or if the owner is changed without our approval; 

 

	3)	the later of the annuitant’s or annuitant’s spouse’s death; 

 

	4)	the date you elect to upgrade (as described in Article IV of this rider); 

  

	5)	the date you elect to receive annuity payments under your policy; and 

  

	6)	the date you notify us in writing of your intention to terminate this rider (this date must be within [30] days after the [fifth] rider anniversary and every [fifth]
rider anniversary thereafter). 

 Termination of the rider will result in the loss of all benefits provided by the rider.

 Signed for us at our home office. 
  

			
	 

	  	 

	SECRETARY	  	PRESIDENT

  

					
	RGMB 37 0809	  	(6	  	(Income/Death-Joint) (09/2012)

 APPENDIX 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) divided
by (3) multiplied by (4) where: 
  

	1)	Withdrawal Base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value 

 

	3)	Total policy value 

  

	4)	Number of days in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for additional premium payments and excess withdrawals is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4) where: 

 

	1)	Withdrawal base change (i.e. withdrawal base after the transaction minus the withdrawal base before the transaction) 

 

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total transaction amount 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for fund transfers is calculated as follows: 
 Multiply (1) by (2) divided by (3) multiplied by (4) where: 
  

	1)	Withdrawal base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total policy value 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The following two examples use assumed fees and values listed in the table below. The assumed rider year is not a leap year. 

 

													
	 Designated Allocation Group
	  	Fee	 	 	Initial
Policy Value	 	  	Additional Premium
Used in Example 2	 
	 Group A
	  	 	2.50	% 	 	$	50,000	  	  	$	5,000	  
	 Group B
	  	 	2.40	% 	 	$	30,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	20,000	  	  	$	2,000	  

 Example 1: Calculation at rider issue for first quarter fee assuming an initial withdrawal base of $100,000.

 = 100,000 * [(50,000*0.0250) + (30,000*0.0240) + (20,000*0.0230)] / 100,000 * (91/365) 

= 100,000 * (1,250 + 720 + 460) / 100,000 * (91/365) 
 = 100,000 * 2,430/100,000 * (91/365) 
 = 2,430 * (91/365) 

= $605.84 
 Example 2:
Calculation for first quarter fee assuming initial withdrawal base from Example 1 above, plus adjustment for additional premium payment of $10,000 made with 20 days remaining in the first rider quarter (invested as shown above). The withdrawal
base change and total transaction amount equal $10,000. 
 Fee adjustment as follows: 

= 10,000 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (20/365) 

= 10,000 * (125 + 72 + 46) / 10,000 * (20/365) 
 = 10,000 * 243/10,000 * (20/365) 
 = 243 * (20/365) 

= $13.32 
 Total fee assessed at
end of first rider quarter (assuming no further rider fee adjustments): 
 = 13.32 + 605.84 

= $619.16 

  

					
	RGMB 37 0809	  	(A-1)	  	(Income/Death-Joint) (09/2012)

 The following three examples use assumed fees and values listed in the table below. The assumed rider year
is not a leap year. 
  

																	
	 Designated Allocation Group
	  	Fee	 	 	Policy Value	 	  	Partial Withdrawal
Used in Example 4	 	  	Fund Transfer
Used in Example 5	 
	 Group A
	  	 	2.50	% 	 	$	49,000	  	  	$	-5,000	  	  	$	-5,000	  
	 Group B
	  	 	2.40	% 	 	$	29,000	  	  	$	-3,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	19,000	  	  	$	-2,000	  	  	$	2,000	  

 Example 3: Calculation for second quarter fee at beginning of second rider quarter, assuming withdrawal base of
$110,000 and policy value of $97,000 invested as above. 
 = 110,000 * [(49,000*0.0250) + (29,000*0.0240) + (19,000*0.0230)]
/ 97,000 * (91/365) 
 = 110,000 * (1,225 + 696 + 437) / 97,000 * (91/365) 

= 110,000 * 2,358/97,000 * (91/365) 
 = 2,674.02 * (91/365) 
 = $666.67 

Example 4: Calculation for second quarter fee assuming beginning values as in Example 3 above, plus adjustment for partial withdrawal of $10,000
taken with 40 days remaining in the second rider quarter. Assumes withdrawal percentage of 5%, policy value of $97,000 prior to the transaction and change in withdrawal base as follows: 
 Rider Withdrawal Amount (RWA) = Withdrawal Base * Withdrawal Percentage = 110,000 * .05 = $5,500 

Excess Withdrawal = Difference between assumed withdrawal amount and RWA = 10,000 - 5,500 = $4,500 

Withdrawal Base Adjustment = Max (Excess Withdrawal, Excess Withdrawal * Withdrawal Base prior to withdrawal / Policy Value after RWA has been withdrawn
but before excess withdrawal) = Max [4,500, 4,500 * 110,000 / (97,000-5,500)] = Max (4,500, 5,409.84) = $5,409.84 
 Fee adjustment as follows:

 = -5,409.84 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (40/365) 

= -5,409.84 * (125 + 72 + 46) / 10,000 * (40/365) 
 = -5,409.84 * 243/10,000 * (40/365) 
 = -131.46 * (40/365) 

= $-14.41 
 Total fee assessed
at end of second rider quarter (assuming no further rider fee adjustments): 
 = 666.67 - 14.41 

= $652.26 
 The new Withdrawal
Base = $110,000 - $5,409.84 = $104,590.16 
 Example 5: Calculation for fund transfer occurring during second quarter with 25 days
remaining in the rider quarter, assuming beginning values as in Example 3 and withdrawal adjustment as in Example 4 above. 
 Withdrawal Base =
$104,590.16 and assumed policy value of $90,000. Fund transfer amount of $5,000 as allocated in table above. 
 Fee adjustment as follows:

 = 104,590.16 * [(-5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 90,000 * (25/365) 

= 104,590.16 * (-125 + 72 + 46) / 90,000 * (25/365) 
 = 104,590.16 * -7/90,000 * (25/365) 
 = -8.13 * (25/365) 

= $-0.56 
 Total fee assessed at
end of second rider quarter (assuming no further rider fee adjustments): 
 = 652.26 - 0.56 

= $651.70 

  

					
	RGMB 37 0809	  	(A-2)	  	(Income/Death-Joint) (09/2012)

			
	

	  	 Home Office:

[4333 Edgewood Road N.E.]
 [Cedar Rapids, Iowa
52499]
 [(319)355-8511]

	  
	  
	  
	 A Stock Company (Hereafter called the Company, we, our or us)
	  	

 RETIREMENT INCOME CHOICE RIDER 
 This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an individual annuity or the group certificate if the
rider is attached to a group annuity. 
 All provisions of the policy that do not conflict with this rider apply to this rider. In the event of
any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 
 Rider Data Specification 
  

			
	 Policy Number:
	  	[12345]
	 Rider Date:
	  	[07/01/2012]
	 Growth Rate Percentage:
	  	[5.00%]
		
	 Rider Fee Percentages:
	  	
	 Designated Allocation Group A:
	  	[2.05%]
	 Designated Allocation Group B:
	  	[1.60%]
	 Designated Allocation Group C:
	  	[1.20%]
		
	 Annuitant:
	  	[John Doe]
		
	 Annuitant’s Issue Age/Sex:
	  	[35 / Male]
	 Annuitant’s Spouse:
	  	[Jane Doe]
	 Annuitant’s Spouse’s Issue Age/Sex:
	  	[35 / Female]

  
  

ARTICLE I 
 You may cancel this
rider on the close of business before midnight of the thirtieth calendar day after you received it and no rider fees will be assessed. 
 If
you elect this rider, 100% of your policy value must be in one or more of the designated investment options. 
 You can generally transfer
between the designated investment options as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If you wish to make a transfer to a
non-designated investment option, this rider must be terminated, as described in Article IV, prior to making the transfer. 
 The
annuitant’s spouse as of the rider date is hereafter referred to as the annuitant’s spouse. As it pertains to the benefits of this rider, the annuitant’s spouse cannot be changed. The annuitant’s spouse must be the sole primary
beneficiary and/or a joint owner. The only living owners allowed on the policy to which this rider is attached are the annuitant and the annuitant’s spouse. 
 DEFINITIONS: 
 Terms used that are not defined in this rider shall have the same meaning as
those in your policy. 
 Designated Investment Options 
 Investment options authorized for use with this rider and identified by us as designated investment options. 
 Excess Withdrawal 
 The excess of a gross partial withdrawal over the rider withdrawal
amount remaining prior to the withdrawal, if any. 

  

					
	RGMB 38 0809	  	(1)	  	(Income-Joint - Enh) (09/2012)

 ARTICLE I CONTINUED 
 Gross Partial Withdrawal 
 The amount by which will be deducted from your policy value as a
result of each partial withdrawal. 
 Rider Anniversary 
 The anniversary of the rider date. 
 Rider Fee 

The fees charged for the benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 

Rider Monthiversary 
 The same day of the
month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 
 Rider Quarter

 The last business day of each rider quarter, or the next business day if our Administrative Office or the New York Stock Exchange are
closed. 
 Rider Withdrawal Amount 
 The maximum amount that can be withdrawn from the policy each rider year without causing an excess withdrawal under the terms of this rider and thus reducing the withdrawal base. This amount will change
if the withdrawal base changes. 
 Rider Year 
 Each twelve-month period following the rider date. 
 Valuation Period 

The period of time from one determination of the value of a subaccount to the next. Such determinations are made when the value of the assets and
liabilities of each subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. 

Withdrawal Base 
 The amount used to
calculate the rider withdrawal amount and the rider fee. This amount cannot be taken as a lump sum. 
 ARTICLE II 

RIDER FEES 
 The rider fee is deducted on
each rider quarter in arrears. The fee is calculated and stored at issue and at each subsequent rider quarter for the upcoming quarter. The rider fee percentage will not change during the first five rider years, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since the previous rider quarter.

 The stored fee will be adjusted for new deposits, transfers among designated investment options and excess withdrawals made during the rider
quarter. 
 Fees will be calculated and stored on the day the rider is issued and at the beginning of each rider quarter. They will be deducted
automatically from each investment option on a pro rata basis at the end of each rider quarter. The annual fee percentages for each designated allocation group are shown on page 1, in the Rider Data Specification section. 

The quarterly fee is calculated as follows:Multiply (1) by (2) divided by (3) multiplied by (4). 

 

	1)	Withdrawal Base; 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value; 

 

	3)	Total policy value; 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year. 

Please see the Appendix attached to this rider which illustrates how the rider fee is calculated. 

  

					
	RGMB 38 0809	  	(2	  	(Income-Joint - Enh) (09/2012)

 ARTICLE III 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that you can receive
up to the rider withdrawal amount each rider year, regardless of the policy value, (either through withdrawals or payments, where payments are equal to the rider withdrawal amount if your policy value equals zero) until the annuitant’s or the
annuitant’s spouse’s death, whichever is later. 
 The withdrawal percentage is determined by the attained age (age at last birthday)
of the younger of the living spouses at the time of the first withdrawal of any amount from the policy value taken on or after the rider anniversary following the younger of the living spouse’s [59th] birthday. Once the withdrawal percentage is
established, it may only be changed by an upgrade or automatic step-up and redetermined at that time. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age of the younger of the living spouses at the time of the
automatic step-up. The withdrawal percentages are shown in the table below. 
  

							
	 	 	 Attained Age
	 	Withdrawal
Percentage	 	 
		 	[0 -58]	 	[0.0%]	 	
		 	[59 -64]	 	[3.5%]	 	
		 	[65 - 79]	 	[4.5%]	 	
		 	[80 +]	 	[5.5%]	 	

 If the younger of the annuitant and the annuitant’s spouse is not yet [59] on the rider date, the withdrawal
percentage will be zero until the rider anniversary following the younger of the living spouse’s [59th] birthday. Withdrawals prior to age 59 1/2 will be subject to the 10% penalty tax. 
 Withdrawals will reduce the policy value of the policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits
and guarantees are no longer available. Also, if the policy value equals zero, you will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to the rider
withdrawal amount. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be allowed. 

ISSUE AGE AND SURVIVAL 
 The benefits
under this rider depend on the annuitant or annuitant’s spouse being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the annuitant and annuitant’s spouse. Proof of survival and the issue ages may
be required by the Company. 
 If the younger of the spouses’ ages has been misstated, this rider’s fees and benefits will be adjusted
to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and any fees charged for this rider would be
returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the rider withdrawal amount to be overstated, any withdrawal in excess of the correct rider withdrawal amount will be considered an excess
withdrawal and will impact the withdrawal base and rider withdrawal amount. If overpayments occurred when the sum of the accumulated values in all the investment options was zero, the amount of that overpayment will be deducted from one or more
future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 
 The rider withdrawal amount will be equal to the greater of 1) and 2), where: 
  

	1)	is the withdrawal percentage multiplied by the withdrawal base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st rider anniversary, this amount is based on the initial policy value on the
rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

 

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

 

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

  

					
	RGMB 38 0809	  	(3	  	(Income-Joint - Enh) (09/2012)

 ARTICLE III CONTINUED 

 

	 	D)	the minimum required distributions are based on age of the living annuitant or the annuitant’s spouse if the annuitant is deceased. The minimum required
distributions can not be based on the age of someone who is deceased, 

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

 

	 	F)	the minimum required distributions are only for the current rider year. Amounts carried over from past rider years are not considered. 

If any of the above are not true, then 2) is equal to zero and it is not available as a rider withdrawal amount. 

If you withdraw less than the rider withdrawal amount in a rider year, the unused portion cannot be carried over to the next rider year. 

WITHDRAWAL BASE 
 The withdrawal base is
used to calculate the rider withdrawal amount. On the rider date, the initial withdrawal base is equal to the policy value (less any premium enhancements if the rider is added in the first policy year). During any rider year, the withdrawal base is
increased by subsequent premium payments (not including premium enhancements, if any), and is reduced for excess withdrawals. 
 On each rider
anniversary, the withdrawal base will be set to the greatest of: 
  

	 	1)	The current withdrawal base; 

  

	 	2)	The policy value on the rider anniversary; 

  

	 	3)	The highest policy value on a rider [monthiversary] for the current rider year; or 

 

	 	4)	The current withdrawal base immediately prior to rider anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any excess withdrawals in the current rider year. Item 4) above will be zero after the [10th]
rider anniversary or if there have been any withdrawals in the current rider year. 
 AUTOMATIC STEP-UP FEATURE 

The rider receives an automatic step-up on the rider anniversary if the withdrawal base is set equal to the policy value or the highest policy value on a
rider [monthiversary.] This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The rider fee and withdrawal percentages may be changed due to an automatic step-up, but
there will be no increase in the rider fee percentage during the first [five] rider years. Following the [fifth] rider anniversary, the rider fee percentage may be increased due to an automatic step-up, but will not increase more than [0.75%] from
the initial rider fee percentages shown on page 1. 
 You have the right to reject an automatic step-up within [30] days following a rider
anniversary, if the rider fee percentage increases. If you reject an automatic step-up, you must notify us in a manner which is acceptable to us, however you are eligible for future automatic step-ups. Changes as a result of the automatic step-up
feature will be reversed. Any increase in the rider fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross partial withdrawals, taken in a rider year, less than or equal to the rider withdrawal amount will not reduce the withdrawal base.
Excess withdrawals will reduce the withdrawal base by the withdrawal base adjustment. The withdrawal base adjustment is the greater of 1) and 2), where: 
  

	1)	is the excess withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the withdrawal base prior to the excess withdrawal amount; and 

  

	 	C)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the withdrawal of the excess withdrawal amount. 

  

					
	RGMB 38 0809	  	(4	  	(Income-Joint - Enh) (09/2012)

 ARTICLE III CONTINUED 
 INCOME ENHANCEMENT OPTION 
 THE INCOME ENHANCEMENT OPTION IS NOT LONG
TERM CARE INSURANCE 
 Definitions applicable to this option: 
 Elimination Period - [180] days within the last [365] days. 
 Hospital -
An institution which 1) is operated pursuant to the laws of the jurisdiction in which it is located, 2) operates primarily for the care and treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour nursing service by or
under the supervision of registered graduate professional nurses, 4) is supervised by a staff of one or more licensed physicians, and 5) has medical, surgical and diagnostic facilities or access to such facilities. 

Medical Necessity - Confinement prescribed by a physician based on the individual’s inability to sustain themselves outside of
a hospital or nursing facility due to physical or cognitive ailments. 
 Nursing Facility - A facility, or that part of a
facility, which: 1) is licensed to operate pursuant to the laws and regulations of the state in which it is located as a nursing facility or an Alzheimer’s disease facility; and 2) provides care prescribed by a physician and performed or
supervised by a registered graduate nurse, in addition to room and board accommodations, 24-hour nursing services, 7 days a week by an on-site Registered Nurse and related services on a continuing inpatient basis; and 3) has a planned program of
policies and procedures developed with the advice of, and periodically reviewed by, at least one Doctor; and 4) maintains a clinical record of each patient. 
 A nursing facility may be either a freestanding facility or a distinct part of a facility such as a ward, wing, unit, or swing bed of a hospital or other institution. If the facility complex to which an
insured person is confined consists of wards, wings, floors, units, or swing-beds, the area of the facility in which such insured person is confined must be licensed as a nursing facility and the insured person’s assigned bed must be included
as a part of such license. 
 The term “nursing facility” does not include, for example: 1) a hospital (except as
provided above); 2) a rehabilitation hospital, 
 3) a place which is primarily for treatment of mental or nervous disorders,
drug addiction, or alcoholism; 4) a home for the aged; 5) a rest home, community living center, or a place that provides domestic, resident, retirement or educational care; 6) assisted living facilities; 7) personal care homes; 8) residential care
facilities; 9) adult foster care facilities; 10) congregate care facilities; 11) family and group assisted living facilities; 12) personal care boarding homes; 13) domiciliary care homes; 14) basic care facilities; or 15) similar facilities.

 Physician - A Doctor of Medicine or Doctor of Osteopathy who is licensed as such and operating within the scope of the
license. 
 Waiting Period - [12] months from the rider date. 
 If either the annuitant or the annuitant’s spouse is confined, due to a medical necessity, in a hospital or nursing facility and has been so confined for the elimination period, benefits from this
option are available provided that the waiting period requirement has been satisfied. The elimination period and waiting period do not need to occur consecutively. The income enhancement option provides an increase to the withdrawal percentage (as
described in the guaranteed lifetime withdrawal benefit provision of this Article), until the qualifying person or persons are no longer confined as described above. The increase in the withdrawal percentage provided by this option will be as
follows: 
  

							
	 	 	 Attained Age at
First Withdrawal
	 	Income Enhancement Option
Increase Percentage	 	 
		 	[59+]	 	[50%]	 	

  

					
	RGMB 38 0809	  	(5	  	(Income-Joint - Enh) (09/2012)

 ARTICLE III CONTINUED 
 As an example of the income enhancement option benefit, assume that the first withdrawal under the rider was taken at attained age 
 72 and the applicable withdrawal percentage is 5.0%. If the qualification conditions for this option are met at any later date, then the withdrawal percentage will be increased by the income enhancement
option increase percentage applicable for attained age 72. The applicable attained age is based on the first withdrawal of any amount from the policy value under the rider itself, and is not based on any withdrawal under the income enhancement
option, unless that withdrawal is also the first withdrawal of any policy value under the rider itself. 
 If the income enhancement option
increase percentage for attained age 72 is 100%, then the income enhancement option benefit provides an additional 5.0% to the withdrawal percentage resulting in a total withdrawal percentage of 10.0% while the income enhancement option benefit
continues to be available. 
 We will require confirmation of confinement while benefits are being received. Confirmation of confinement must be
deemed satisfactory to us. Confirmation of confinement may be a statement from a physician or a hospital or nursing facility administrator and any other information deemed necessary by us to confirm confinement. When confinement has ceased, the
withdrawal percentage will be as indicated in the guaranteed lifetime withdrawal benefit provision previously described in this Article. If confinement ceases and the rider remains active, you may re-qualify by satisfying the elimination period
requirement and the benefits under this option will be available. 
 ARTICLE IV 

CONTINUATION 
 In the case of spousal
joint owners where one spouse is the annuitant, if the spouse who is not the annuitant dies and the surviving spouse is the sole beneficiary, the surviving spouse may elect to continue the policy and rider. In the case of spousal joint owners where
one spouse is the annuitant, if the spouse who is the annuitant dies and the surviving spouse is the sole beneficiary, the rider continues until the death of the surviving spouse. 
 ANNUITIZATION 
 On the maximum annuity commencement date, as described in your policy, you
will have the option to receive lifetime income payments that are no less than your rider withdrawal amount each year. This option will also guarantee that the sum of all income payments received over time will equal or exceed the policy value on
the maximum annuity commencement date. If the annuitant or annuitant’s spouse should die before the sum of all income payments received equals or exceeds the policy value on the maximum annuity commencement date, the annuitant’s
beneficiary will receive a final payment equal to the difference. 
 RIDER UPGRADE 

You may elect, in writing, to upgrade the withdrawal base to the policy value within [30] days after the [fifth] rider anniversary and every [fifth] rider
anniversary thereafter, subject to the issue age restrictions on the new rider. If an upgrade is selected, this rider will terminate and a new rider with the same features will be issued with a new rider date. The new rider will have its own growth
rate percentage and rider fee percentage which may not be the same as this rider’s percentages. 
 At the time of upgrade the rider
withdrawal amount will be recalculated based on the new withdrawal base. 
 The new rider date will be the date the Company receives all
information necessary, at our Home Office, in a written form acceptable to the Company, to process the upgrade. 

  

					
	RGMB 38 0809	  	(6	  	(Income-Joint - Enh) (09/2012)

 ARTICLE IV CONTINUED 
 TERMINATION 
 This rider will terminate upon the earliest of: 

 

	1)	the date the policy to which this rider is attached terminates; 

  

	2)	the date the policy to which this rider is attached is assigned or if the owner is changed without our approval; 

 

	3)	the later of the annuitant’s or annuitant’s spouse’s death; 

 

	4)	the date you elect to upgrade (as described in Article IV of this rider); 

  

	5)	the date you elect to receive annuity payments under your policy; and 

  

	6)	the date you notify us in writing of your intention to terminate this rider (this date must be within [30] days after the [fifth] rider anniversary and every [fifth]
rider anniversary thereafter). 

 Termination of the rider will result in the loss of all benefits provided by the rider.

 Signed for us at our home office. 
  

			
	 

	  	 

	SECRETARY	  	PRESIDENT

  

					
	RGMB 38 0809	  	(7	  	(Income-Joint - Enh) (09/2012)

 APPENDIX 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) divided
by (3) multiplied by (4) where: 
  

	1)	Withdrawal Base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value 

 

	3)	Total policy value 

  

	4)	Number of days in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for additional premium payments and excess withdrawals is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4) where: 

 

	1)	Withdrawal base change (i.e. withdrawal base after the transaction minus the withdrawal base before the transaction) 

 

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total transaction amount 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for fund transfers is calculated as follows: 
 Multiply (1) by (2) divided by (3) multiplied by (4) where: 
  

	1)	Withdrawal base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total policy value 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The following two examples use assumed fees and values listed in the table below. The assumed rider year is not a leap year. 

 

													
	 Designated Allocation Group
	  	Fee	 	 	Initial
Policy Value	 	  	Additional Premium
Used in Example 2	 
	 Group A
	  	 	2.50	% 	 	$	50,000	  	  	$	5,000	  
	 Group B
	  	 	2.40	% 	 	$	30,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	20,000	  	  	$	2,000	  

 Example 1: Calculation at rider issue for first quarter fee assuming an initial withdrawal base of $100,000.

 = 100,000 * [(50,000*0.0250) + (30,000*0.0240) + (20,000*0.0230)] / 100,000 * (91/365) 

= 100,000 * (1,250 + 720 + 460) / 100,000 * (91/365) 
 = 100,000 * 2,430/100,000 * (91/365) 
 = 2,430 * (91/365) 

= $605.84 
 Example 2:
Calculation for first quarter fee assuming initial withdrawal base from Example 1 above, plus adjustment for additional premium payment of $10,000 made with 20 days remaining in the first rider quarter (invested as shown above). The withdrawal
base change and total transaction amount equal $10,000. 
 Fee adjustment as follows: 

= 10,000 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (20/365) 

= 10,000 * (125 + 72 + 46) / 10,000 * (20/365) 
 = 10,000 * 243/10,000 * (20/365) 
 = 243 * (20/365) 

= $13.32 
 Total fee assessed at
end of first rider quarter (assuming no further rider fee adjustments): 
 = 13.32 + 605.84 

= $619.16 
  

  

					
	RGMB 38 0809	  	(A-1)	  	(Income-Joint - Enh) (09/2012)

 The following three examples use assumed fees and values listed in the table below. The assumed rider year
is not a leap year. 
  

																	
	 Designated Allocation Group
	  	Fee	 	 	Policy Value	 	  	Partial Withdrawal
Used in Example 4	 	  	Fund Transfer
Used in Example 5	 
	 Group A
	  	 	2.50	% 	 	$	49,000	  	  	$	-5,000	  	  	$	-5,000	  
	 Group B
	  	 	2.40	% 	 	$	29,000	  	  	$	-3,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	19,000	  	  	$	-2,000	  	  	$	2,000	  

 Example 3: Calculation for second quarter fee at beginning of second rider quarter, assuming withdrawal base of
$110,000 and policy value of $97,000 invested as above. 
 = 110,000 * [(49,000*0.0250) + (29,000*0.0240) + (19,000*0.0230)]
/ 97,000 * (91/365) 
 = 110,000 * (1,225 + 696 + 437) / 97,000 * (91/365) 

= 110,000 * 2,358/97,000 * (91/365) 
 = 2,674.02 * (91/365) 
 = $666.67 

Example 4: Calculation for second quarter fee assuming beginning values as in Example 3 above, plus adjustment for partial withdrawal of $10,000
taken with 40 days remaining in the second rider quarter. Assumes withdrawal percentage of 5%, policy value of $97,000 prior to the transaction and change in withdrawal base as follows: 
 Rider Withdrawal Amount (RWA) = Withdrawal Base * Withdrawal Percentage = 110,000 * .05 = $5,500 

Excess Withdrawal = Difference between assumed withdrawal amount and RWA = 10,000 - 5,500 = $4,500 

Withdrawal Base Adjustment = Max (Excess Withdrawal, Excess Withdrawal * Withdrawal Base prior to withdrawal / Policy Value after RWA has been withdrawn
but before excess withdrawal) = Max [4,500, 4,500 * 110,000 / (97,000-5,500)] = Max (4,500, 5,409.84) = $5,409.84 
 Fee adjustment as follows:

 = -5,409.84 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (40/365) 

= -5,409.84 * (125 + 72 + 46) / 10,000 * (40/365) 
 = -5,409.84 * 243/10,000 * (40/365) 
 = -131.46 * (40/365) 

= $-14.41 
 Total fee assessed
at end of second rider quarter (assuming no further rider fee adjustments): 
 = 666.67 - 14.41 

= $652.26 
 The new Withdrawal
Base = $110,000 -$5,409.84 = $104,590.16 
 Example 5: Calculation for fund transfer occurring during second quarter with 25 days
remaining in the rider quarter, assuming beginning values as in Example 3 and withdrawal adjustment as in Example 4 above. 
 Withdrawal Base =
$104,590.16 and assumed policy value of $90,000. Fund transfer amount of $5,000 as allocated in table above. Fee adjustment as follows: 
 = 104,590.16 * [(-5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 90,000 * (25/365) 
 = 104,590.16 * (-125 + 72 + 46) / 90,000 * (25/365) 
 = 104,590.16 * -7/90,000 *
(25/365) 
 = -8.13 * (25/365) 
 = $-0.56 
 Total fee assessed at end of second rider quarter (assuming no further rider fee
adjustments): 
 = 652.26 - 0.56 
 = $651.70 

  

					
	RGMB 38 0809	  	(A-2)	  	(Income-Joint - Enh) (09/2012)

			
	 

	  	 Home Office:

[4333 Edgewood Road N.E.]
 [Cedar Rapids, Iowa
52499]
 [(319)355-8511]

	  
	  
	  
	 A Stock Company (Hereafter called the Company, we, our or us)
	  	

 RETIREMENT INCOME CHOICE WITH DEATH BENEFIT RIDER 

This rider is issued as a part of the policy (contract) to which it is attached. Policy refers to the individual policy if the rider is attached to an
individual annuity or the group certificate if the rider is attached to a group annuity. 
 All provisions of the policy that do not conflict
with this rider apply to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

Rider Data Specification 
  

			
	 Policy Number:
	  	[12345]
	 Rider Date:
	  	[07/01/2012]
	 Growth Rate Percentage:
	  	[5.00%]
		
	 Rider Fee Percentages:
	  	
	 Designated Allocation Group A:
	  	[2.40%]
	 Designated Allocation Group B:
	  	[1.95%]
	 Designated Allocation Group C:
	  	[1.55%]
		
	 Annuitant:
	  	[John Doe]
		
	 Annuitant’s Issue Age/Sex:
	  	[35 / Male]
	 Annuitant’s Spouse:
	  	[Jane Doe]
	 Annuitant’s Spouse’s Issue Age/Sex:
	  	[35 / Female]

  
  

ARTICLE I 
 You may cancel this
rider on the close of business before midnight of the thirtieth calendar day after you received it and no rider fees will be assessed. 
 If
you elect this rider, 100% of your policy value must be in one or more of the designated investment options. 
 You can generally transfer
between the designated investment options as permitted under your policy; however, you cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If you wish to make a transfer to a
non-designated investment option, this rider must be terminated, as described in Article IV, prior to making the transfer. 
 The
annuitant’s spouse as of the rider date is hereafter referred to as the annuitant’s spouse. As it pertains to the benefits of this rider, the annuitant’s spouse cannot be changed. The annuitant’s spouse must be the sole primary
beneficiary and/or a joint owner. The only living owners allowed on the policy to which this rider is attached are the annuitant and the annuitant’s spouse. 
 DEFINITIONS: 
 Terms used that are not defined in this rider shall have the same meaning as
those in your policy. 
 Designated Investment Options 
 Investment options authorized for use with this rider and identified by us as designated investment options. 
 Excess Withdrawal 
 The excess of a gross partial withdrawal over the rider withdrawal
amount remaining prior to the withdrawal, if any. 

  

					
	RGMB 38 0809 	  	(1	  	(Income/Death-Joint - Enh) (09/2012)

 ARTICLE I CONTINUED 
 Gross Partial Withdrawal 
 The amount by which will be deducted from your policy value as a
result of each partial withdrawal. 
 Rider Anniversary 
 The anniversary of the rider date. 
 Rider Fee 

The fees charged for the benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 

Rider Monthiversary 
 The same day of the
month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. 
 Rider Quarter

 The last business day of each rider quarter, or the next business day if our Administrative Office or the New York Stock Exchange are
closed. 
 Rider Withdrawal Amount 
 The maximum amount that can be withdrawn from the policy each rider year without causing an excess withdrawal under the terms of this rider and thus reducing the withdrawal base. This amount will change
if the withdrawal base changes. 
 Rider Year 
 Each twelve-month period following the rider date. 
 Valuation Period 

The period of time from one determination of the value of a subaccount to the next. Such determinations are made when the value of the assets and
liabilities of each subaccount is calculated. This is generally the close of business on each day on which the New York Stock Exchange is open. 

Withdrawal Base 
 The amount used to
calculate the rider withdrawal amount and the rider fee. This amount cannot be taken as a lump sum. 
 ARTICLE II 

RIDER FEES 
 The rider fee is deducted on
each rider quarter in arrears. The fee is calculated and stored at issue and at each subsequent rider quarter for the upcoming quarter. The rider fee percentage will not change during the first five rider years, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the number of days that have elapsed since the previous rider quarter.

 The stored fee will be adjusted for new deposits, transfers among designated investment options and excess withdrawals made during the rider
quarter. 
 Fees will be calculated and stored on the day the rider is issued and at the beginning of each rider quarter. They will be deducted
automatically from each investment option on a pro rata basis at the end of each rider quarter. The annual fee percentages for each designated allocation group are shown on page 1, in the Rider Data Specification section. 

The quarterly fee is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4). 
  

	1)	Withdrawal Base; 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value; 

 

	3)	Total policy value; 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year. 

Please see the Appendix attached to this rider which illustrates how the rider fee is calculated. 

  

					
	RGMB 38 0809	  	(2	  	(Income/Death-Joint - Enh) (09/2012)

 ARTICLE III 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that you can receive
up to the rider withdrawal amount each rider year, regardless of the policy value, (either through withdrawals or payments, where payments are equal to the rider withdrawal amount if your policy value equals zero) until the annuitant’s or the
annuitant’s spouse’s death, whichever is later. 
 The withdrawal percentage is determined by the attained age (age at last birthday)
of the younger of the living spouses at the time of the first withdrawal of any amount from the policy value taken on or after the rider anniversary following the younger of the living spouse’s [59th] birthday. Once the withdrawal percentage is
established, it may only be changed by an upgrade or automatic step-up and redetermined at that time. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age of the younger of the living spouses at the time of the
automatic step-up. The withdrawal percentages are shown in the table below. 
  

							
	 	 	 Attained
Age
	 	Withdrawal
Percentage	 	 
		 	[0 - 58]	 	[0.0%]	 	
		 	[59 - 64]	 	[3.5%]	 	
		 	[65 - 79]	 	[4.5%]	 	
		 	[80 +]	 	[5.5%]	 	

 If the younger of the annuitant and the annuitant’s spouse is not yet [59] on the rider date, the withdrawal
percentage will be zero until the rider anniversary following the younger of the living spouse’s [59th] birthday. Withdrawals prior to age 59 1/2 will be subject to the 10% penalty tax. 
 Withdrawals will reduce the policy value of the policy to which this rider is attached. If the policy value equals zero, you cannot make subsequent premium payments and all other policy features, benefits
and guarantees are no longer available. Also, if the policy value equals zero, you will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to the rider
withdrawal amount. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be allowed. 

ISSUE AGE AND SURVIVAL 
 The benefits
under this rider depend on the annuitant or annuitant’s spouse being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the annuitant and annuitant’s spouse. Proof of survival and the issue ages may
be required by the Company. 
 If the younger of the spouses’ ages has been misstated, this rider’s fees and benefits will be adjusted
to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and any fees charged for this rider would be
returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the rider withdrawal amount to be overstated, any withdrawal in excess of the correct rider withdrawal amount will be considered an excess
withdrawal and will impact the withdrawal base and rider withdrawal amount. If overpayments occurred when the sum of the accumulated values in all the investment options was zero, the amount of that overpayment will be deducted from one or more
future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 
 The rider withdrawal amount will be equal to the greater of 1) and 2), where: 
  

	1)	is the withdrawal percentage multiplied by the withdrawal base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st rider anniversary, this amount is based on the initial policy value on the
rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

 

	 	B)	the minimum required distributions do not start prior to the annuitant’s attained age 70 1/2, 

 

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

  

					
	RGMB 38 0809	  	(3	  	(Income/Death-Joint - Enh) (09/2012)

 ARTICLE III CONTINUED 

 

	 	D)	the minimum required distributions are based on age of the living annuitant or the annuitant’s spouse if the annuitant is deceased. The minimum required
distributions can not be based on the age of someone who is deceased, 

  

	 	E)	the minimum required distributions are based only on the policy to which this rider is attached, and 

 

	 	F)	the minimum required distributions are only for the current rider year. Amounts carried over from past rider years are not considered. 

If any of the above are not true, then 2) is equal to zero and it is not available as a rider withdrawal amount. 

If you withdraw less than the rider withdrawal amount in a rider year, the unused portion cannot be carried over to the next rider year. 

WITHDRAWAL BASE 
 The withdrawal base is
used to calculate the rider withdrawal amount. On the rider date, the initial withdrawal base is equal to the policy value (less any premium enhancements if the rider is added in the first policy year). During any rider year, the withdrawal base is
increased by subsequent premium payments (not including premium enhancements, if any), and is reduced for excess withdrawals. 
 On each rider
anniversary, the withdrawal base will be set to the greatest of: 
  

	 	1)	The current withdrawal base; 

  

	 	2)	The policy value on the rider anniversary; 

  

	 	3)	The highest policy value on a rider [monthiversary] for the current rider year; or 

 

	 	4)	The current withdrawal base immediately prior to rider anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any excess withdrawals in the current rider year. Item 4) above will be zero after the [10th]
rider anniversary or if there have been any withdrawals in the current rider year. 
 AUTOMATIC STEP-UP FEATURE 

The rider receives an automatic step-up on the rider anniversary if the withdrawal base is set equal to the policy value or the highest policy value on a
rider [monthiversary.] This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The rider fee and withdrawal percentages may be changed due to an automatic step-up, but
there will be no increase in the rider fee percentage during the first [five] rider years. Following the [fifth] rider anniversary, the rider fee percentage may be increased due to an automatic step-up, but will not increase more than [0.75%] from
the initial rider fee percentages shown on page 1. 
 You have the right to reject an automatic step-up within [30] days following a rider
anniversary, if the rider fee percentage increases. If you reject an automatic step-up, you must notify us in a manner which is acceptable to us, however you are eligible for future automatic step-ups. Changes as a result of the automatic step-up
feature will be reversed. Any increase in the rider fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross partial withdrawals, taken in a rider year, less than or equal to the rider withdrawal amount will not reduce the withdrawal base.
Excess withdrawals will reduce the withdrawal base by the withdrawal base adjustment. The withdrawal base adjustment is the greater of 1) and 2), where: 
  

	1)	is the excess withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the withdrawal base prior to the excess withdrawal amount; and 

  

	 	C)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the withdrawal of the excess withdrawal amount. 

  

					
	RGMB 38 0809	  	(4	  	(Income/Death-Joint - Enh) (09/2012)

 ARTICLE III CONTINUED 
 RIDER DEATH BENEFIT 
 Upon the later of the annuitant or the annuitant’s spouse’s
death, we will pay an additional death benefit amount equal to the excess, if any, of the rider death benefit over the greater of the base policy death benefit or the guaranteed minimum death benefit, if applicable, and this rider will then
terminate. The rider death benefit on the rider date is equal to the policy value (less any premium enhancements, if the rider is added in the first policy year). The rider death benefit after the rider date is equal to the rider death benefit on
the rider date plus any premiums (not including premium enhancements, if any) added after the rider date less any rider death benefit adjustments. 
 The rider death benefit does not reset due to the automatic step-up. 
 RIDER DEATH BENEFIT
ADJUSTMENTS 
 Cumulative gross partial withdrawals, taken in a rider year, up to the rider withdrawal amount will reduce the rider death
benefit by the same amount (dollar for dollar). Excess withdrawals will reduce the rider death benefit by the greater of: 
  

	1)	the excess withdrawal amount; and 

  

	2)	the result of (A divided by B), multiplied by C, where: 

  

	 	A)	is the excess withdrawal; 

  

	 	B)	is the policy value after the rider withdrawal amount has been withdrawn, but prior to the excess withdrawal; and 

 

	 	C)	is the rider death benefit after the rider withdrawal amount has been withdrawn, but prior to the excess withdrawal. 

INCOME ENHANCEMENT OPTION 

THE INCOME ENHANCEMENT OPTION IS NOT LONG TERM CARE INSURANCE 
 Definitions applicable to this option: 
 Elimination Period - [180] days
within the last [365] days. 
 Hospital - An institution which 1) is operated pursuant to the laws of the jurisdiction in
which it is located, 2) operates primarily for the care and treatment of sick and injured persons on an inpatient basis, 3) provides 24-hour nursing service by or under the supervision of registered graduate professional nurses, 4) is supervised by
a staff of one or more licensed physicians, and 5) has medical, surgical and diagnostic facilities or access to such facilities. 

Medical Necessity - Confinement prescribed by a physician based on the individual’s inability to sustain themselves outside of
a hospital or nursing facility due to physical or cognitive ailments. 
 Nursing Facility - A facility, or that part of a
facility, which: 1) is licensed to operate pursuant to the laws and regulations of the state in which it is located as a nursing facility or an Alzheimer’s disease facility; and 2) provides care prescribed by a physician and performed or
supervised by a registered graduate nurse, in addition to room and board accommodations, 24-hour nursing services, 7 days a week by an on-site Registered Nurse and related services on a continuing inpatient basis; and 3) has a planned program of
policies and procedures developed with the advice of, and periodically reviewed by, at least one Doctor; and 4) maintains a clinical record of each patient. 
 A nursing facility may be either a freestanding facility or a distinct part of a facility such as a ward, wing, unit, or swing bed of a hospital or other institution. If the facility complex to which an
insured person is confined consists of wards, wings, floors, units, or swing-beds, the area of the facility in which such insured person is confined must be licensed as a nursing facility and the insured person’s assigned bed must be included
as a part of such license. 
 The term “nursing facility” does not include, for example: 1) a hospital (except as
provided above); 2) a rehabilitation hospital, 
 3) a place which is primarily for treatment of mental or nervous disorders,
drug addiction, or alcoholism; 4) a home for the aged; 5) a rest home, community living center, or a place that provides domestic, resident, retirement or educational care; 6) assisted living facilities; 7) personal care homes; 8) residential care
facilities; 9) adult foster care facilities; 10) congregate care facilities; 11) family and group assisted living facilities; 12) personal care boarding homes; 13) domiciliary care homes; 14) basic care facilities; or 15) similar facilities.

  

					
	RGMB 38 0809	  	(5	  	(Income/Death-Joint - Enh) (09/2012)

 ARTICLE III CONTINUED 
 Physician - A Doctor of Medicine or Doctor of Osteopathy who is licensed as such and operating within the scope of the license. 

Waiting Period -[12] months from the rider date. 
 If either the annuitant or the annuitant’s spouse is confined, due to a medical necessity, in a hospital or nursing facility and has been so confined for the elimination period, benefits from this
option are available provided that the waiting period requirement has been satisfied. The elimination period and waiting period do not need to occur consecutively. The income enhancement option provides an increase to the withdrawal percentage (as
described in the guaranteed lifetime withdrawal benefit provision of this Article), until the qualifying person or persons are no longer confined as described above. The increase in the withdrawal percentage provided by this option will be as
follows: 
  

							
	 	 	 Attained Age at

First Withdrawal
	 	Income Enhancement Option
Increase
Percentage	 	 
		 	[59 +]	 	[50%]	 	

 As an example of the income enhancement option benefit, assume that the first withdrawal under the rider was taken at
attained age 
 72 and the applicable withdrawal percentage is 5.0%. If the qualification conditions for this option are met at any later date,
then the withdrawal percentage will be increased by the income enhancement option increase percentage applicable for attained age 72. The applicable attained age is based on the first withdrawal of any amount from the policy value under the rider
itself, and is not based on any withdrawal under the income enhancement option, unless that withdrawal is also the first withdrawal of any policy value under the rider itself. 
 If the income enhancement option increase percentage for attained age 72 is 100%, then the income enhancement option benefit provides an additional 5.0% to the withdrawal percentage resulting in a total
withdrawal percentage of 10.0% while the income enhancement option benefit continues to be available. 
 We will require confirmation of
confinement while benefits are being received. Confirmation of confinement must be deemed satisfactory to us. Confirmation of confinement may be a statement from a physician or a hospital or nursing facility administrator and any other information
deemed necessary by us to confirm confinement. When confinement has ceased, the withdrawal percentage will be as indicated in the guaranteed lifetime withdrawal benefit provision previously described in this Article. If confinement ceases and the
rider remains active, you may re-qualify by satisfying the elimination period requirement and the benefits under this option will be available. 

ARTICLE IV 
 CONTINUATION

 In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is not the annuitant dies and the surviving
spouse is the sole beneficiary, the surviving spouse may elect to continue the policy and rider. In the case of spousal joint owners where one spouse is the annuitant, if the spouse who is the annuitant dies and the surviving spouse is the sole
beneficiary, the rider continues until the death of the surviving spouse. No additional death benefit will be paid under this rider at this time. 
 ANNUITIZATION 
 On the maximum annuity commencement date, as described in your policy, you
will have the option to receive lifetime income payments that are no less than your rider withdrawal amount each year. This option will also guarantee that the sum of all income payments received over time will equal or exceed the greater of the
policy value or the rider death benefit on the maximum annuity commencement date. If the annuitant or annuitant’s spouse should die before the sum of all income payments received equals or exceeds the greater of the policy value or the rider
death benefit on the maximum annuity commencement date, the annuitant’s beneficiary will receive a final payment equal to the difference. 

  

					
	RGMB 38 0809	  	(6	  	(Income/Death-Joint - Enh) (09/2012)

 ARTICLE IV CONTINUED 
 RIDER UPGRADE 
 You may elect, in writing, to upgrade the withdrawal base to the policy
value within [30] days after the [fifth] rider anniversary and every [fifth] rider anniversary thereafter, subject to the issue age restrictions on the new rider. If an upgrade is selected, this rider will terminate and a new rider with the same
features will be issued with a new rider date. The new rider will have its own growth rate percentage and rider fee percentage which may not be the same as this rider’s percentages. 
 At the time of upgrade, the rider death benefit will also be upgraded to the policy value and the rider withdrawal amount will be recalculated based on the new withdrawal base. 

The new rider date will be the date the Company receives all information necessary, at our Home Office, in a written form acceptable to the Company, to
process the upgrade. 
 TERMINATION 
 This rider will terminate upon the earliest of: 
  

	1)	the date the policy to which this rider is attached terminates; 

	2)	the date the policy to which this rider is attached is assigned or if the owner is changed without our approval; 

	3)	the later of the annuitant’s or annuitant’s spouse’s death; 

	4)	the date you elect to upgrade (as described in Article IV of this rider); 

	5)	the date you elect to receive annuity payments under your policy; and 

	6)	the date you notify us in writing of your intention to terminate this rider (this date must be within [30] days after the [fifth] rider anniversary and every [fifth]
rider anniversary thereafter). 

 Termination of the rider will result in the loss of all benefits provided by the rider.

 Signed for us at our home office. 
  

			
	 

	  	 

	SECRETARY	  	PRESIDENT

  

					
	RGMB 38 0809	  	(7	  	(Income/Death-Joint - Enh) (09/2012)

 APPENDIX 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) divided
by (3) multiplied by (4) where: 
  

	1)	Withdrawal Base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group value 

 

	3)	Total policy value 

  

	4)	Number of days in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for additional premium payments and excess withdrawals is calculated as follows: 

Multiply (1) by (2) divided by (3) multiplied by (4) where: 

 

	1)	Withdrawal base change (i.e. withdrawal base after the transaction minus the withdrawal base before the transaction) 

 

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total transaction amount 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The fee adjustment for fund transfers is calculated as follows: 
 Multiply (1) by (2) divided by (3) multiplied by (4) where: 
  

	1)	Withdrawal base 

  

	2)	Sum of each designated allocation group rider fee percentage multiplied by the applicable designated allocation group transaction amount 

 

	3)	Total policy value 

  

	4)	Number of days remaining in the rider quarter divided by the number of days within the applicable rider year 

The following two examples use assumed fees and values listed in the table below. The assumed rider year is not a leap year. 

 

													
	 Designated Allocation Group
	  	Fee	 	 	Initial
Policy Value	 	  	Additional Premium
Used in Example 2	 
	 Group A
	  	 	2.50	% 	 	$	50,000	  	  	$	5,000	  
	 Group B
	  	 	2.40	% 	 	$	30,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	20,000	  	  	$	2,000	  

 Example 1: Calculation at rider issue for first quarter fee assuming an initial withdrawal base of $100,000.

 = 100,000 * [(50,000*0.0250) + (30,000*0.0240) + (20,000*0.0230)] / 100,000 * (91/365) 

= 100,000 * (1,250 + 720 + 460) / 100,000 * (91/365) 
 = 100,000 * 2,430/100,000 * (91/365) 
 = 2,430 * (91/365) 

= $605.84 
 Example 2:
Calculation for first quarter fee assuming initial withdrawal base from Example 1 above, plus adjustment for additional premium payment of $10,000 made with 20 days remaining in the first rider quarter (invested as shown above). The withdrawal
base change and total transaction amount equal $10,000. 
 Fee adjustment as follows: 

= 10,000 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (20/365) 

= 10,000 * (125 + 72 + 46) / 10,000 * (20/365) 
 = 10,000 * 243/10,000 * (20/365) 
 = 243 * (20/365) 

= $13.32 
 Total fee assessed at
end of first rider quarter (assuming no further rider fee adjustments): 
 = 13.32 + 605.84 

= $619.16 

  

					
	RGMB 38 0809	  	(A-1)	  	(Income/Death-Joint - Enh) (09/2012)

 The following three examples use assumed fees and values listed in the table below. The assumed rider year
is not a leap year. 
  

																	
	 Designated Allocation Group
	  	Fee	 	 	Policy Value	 	  	Partial Withdrawal
Used in Example 4	 	  	Fund Transfer
Used in Example 5	 
	 Group A
	  	 	2.50	% 	 	$	49,000	  	  	$	-5,000	  	  	$	-5,000	  
	 Group B
	  	 	2.40	% 	 	$	29,000	  	  	$	-3,000	  	  	$	3,000	  
	 Group C
	  	 	2.30	% 	 	$	19,000	  	  	$	-2,000	  	  	$	2,000	  

 Example 3: Calculation for second quarter fee at beginning of second rider quarter, assuming withdrawal base of
$110,000 and policy value of $97,000 invested as above. 
 = 110,000 * [(49,000*0.0250) + (29,000*0.0240) + (19,000*0.0230)]
/ 97,000 * (91/365) 
 = 110,000 * (1,225 + 696 + 437) / 97,000 * (91/365) 

= 110,000 * 2,358/97,000 * (91/365) 
 = 2,674.02 * (91/365) 
 = $666.67 

Example 4: Calculation for second quarter fee assuming beginning values as in Example 3 above, plus adjustment for partial withdrawal of $10,000
taken with 40 days remaining in the second rider quarter. Assumes withdrawal percentage of 5%, policy value of $97,000 prior to the transaction and change in withdrawal base as follows: 
 Rider Withdrawal Amount (RWA) = Withdrawal Base * Withdrawal Percentage = 110,000 * .05 = $5,500 

Excess Withdrawal = Difference between assumed withdrawal amount and RWA = 10,000 - 5,500 = $4,500 

Withdrawal Base Adjustment = Max (Excess Withdrawal, Excess Withdrawal * Withdrawal Base prior to withdrawal / Policy Value after RWA has been withdrawn
but before excess withdrawal) = Max [4,500, 4,500 * 110,000 / (97,000-5,500)] = Max (4,500, 5,409.84) = $5,409.84 
 Fee adjustment as follows:

 = -5,409.84 * [(5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 10,000 * (40/365) 

= -5,409.84 * (125 + 72 + 46) / 10,000 * (40/365) 
 = -5,409.84 * 243/10,000 * (40/365) 
 = -131.46 * (40/365) 

= $-14.41 
 Total fee assessed
at end of second rider quarter (assuming no further rider fee adjustments): 
 = 666.67 - 14.41 

= $652.26 
 The new Withdrawal
Base = $110,000 - $5,409.84 = $104,590.16 
 Example 5: Calculation for fund transfer occurring during second quarter with 25 days
remaining in the rider quarter, assuming beginning values as in Example 3 and withdrawal adjustment as in Example 4 above. 
 Withdrawal Base =
$104,590.16 and assumed policy value of $90,000. Fund transfer amount of $5,000 as allocated in table above. Fee adjustment as follows: 
 = 104,590.16 * [(-5,000*0.0250) + (3,000*0.0240) + (2,000*0.0230)] / 90,000 * (25/365) 
 = 104,590.16 * (-125 + 72 + 46) / 90,000 * (25/365) 
 = 104,590.16 * -7/90,000 *
(25/365) 
 = -8.13 * (25/365) 
 = $-0.56 
 Total fee assessed at end of second rider quarter (assuming no further rider fee
adjustments): 
 = 652.26 - 0.56 
 = $651.70 

  

					
	RGMB 38 0809	  	(A-2)	  	(Income/Death-Joint - Enh) (09/2012)Exhibit 4(a)

 EXHIBIT 4(a) 
 FORM OF POLICY 

			
	 

 A Stock Company (Hereafter called the Company, we, our or us)
	  	Administrative and Home Office:
4333 Edgewood Road N.E.
Cedar Rapids, Iowa 52499 (319) 355-8511
www.transamericaannuities.com

 READ YOUR POLICY CAREFULLY 

This policy is a legal contract between the Owner and Transamerica Life Insurance Company issued in consideration of the payment of an
initial premium. 
 Amounts withdrawn or Surrendered may be subject to an excess interest adjustment reflecting changes in
interest rates. The excess interest adjustment may result in both upward and downward adjustments in partial withdrawals, Surrender benefits or amounts available for annuitizations, as applicable. The value held in the Separate Account may increase
or decrease in value. Policy Value and benefits based on Separate Account assets are not guaranteed and will decrease and increase with investment experience. 
 We agree to provide annuity payments, to pay withdrawal or Surrender benefits, or to pay death proceeds in accordance with this policy, as applicable. 

This policy may be applied for and issued to qualify as a tax-qualified annuity under applicable sections of the Internal Revenue Code.

 RIGHT TO CANCEL 
 You may cancel this policy by delivering or mailing a written notice in Good Order to us or Your registered representative. You must return the policy to us before close of business on the 10th day after
the day You receive it. Notice given by mail and return of the policy by mail are effective on being postmarked, properly addressed and postage prepaid. 
 We will pay You an amount equal to the sum of the Premium Payments paid less prior withdrawals, if any, plus or minus the accumulated gains or losses, if any, in the Separate Account on the date of the
cancellation, unless otherwise required by law. 
 If this policy is a replacement of another annuity or life insurance policy,
the Right to Cancel period is extended to 30 days. 
 Any questions or complaints pertaining to this policy may be directed to
our Administrative Office. You may contact the State Department of Insurance at XXX-XXX-XXXX. 
 Signed for us at our home
office. 
  

							
		 	 

 SECRETARY
	  	 

 PRESIDENT
	 	

 Flexible Premium Deferred Variable Annuity 

With Excess Interest Adjustment 
 Income Payable At Annuity Commencement Date 
 Benefits Based On The
Performance Of The Separate Account Are Variable 
 And Are Not Guaranteed As To Dollar Amount (See Sections 7 and 10)

 Non-Participating 

  

			
	ICC12 VA(2)0513	  	Page 1

 TABLE OF CONTENTS 

 

					
		
	 Definitions
	  	 	3	  
		
	 Policy Data Pages
	  	 	5	  
		
	 General Provisions
	  	 	6	  
		
	 Premium Payments
	  	 	9	  
		
	 Cash Value and Withdrawals
	  	 	9	  
		
	 Policy Value
	  	 	12	  
		
	 Separate Account
	  	 	12	  
		
	 Transfers
	  	 	14	  
		
	 Death Proceeds
	  	 	16	  
		
	 Income Options
	  	 	18	  
		
	 Fixed Account
	  	 	21	  
		
	 Income Option Tables
	  	 	22	  

  

			
	ICC12 VA(2)0513	  	Page 2

 SECTION 1 – DEFINITIONS 

Adjusted Policy Value – The Policy Value increased or decreased by any applicable excess interest adjustment. This value may
be used to fund one of the income options. 
 Annuitant – The person on whose life any annuity payments involving
life contingencies will be based. 
 Annuity Commencement Date – The date an income option has been selected, all
necessary paperwork is in Good Order, and the Company has issued a supplementary contract. In no event can this date be earlier than the third Policy Anniversary, or later than the last day of the month following the month in which the Annuitant
attains age 99. You may elect an Annuity Commencement Date at any time by giving the Company 30 days written notice. If You do not elect an Annuity Commencement Date prior to the last available Annuity Commencement Date, annuity payments will begin
as outlined in Section 10. 
 Cash Value –The amount as defined in Section 5 that is available for
Surrender. 
 Commissioner - The primary Insurance Regulator for the State in which this policy has been issued.

 DCA Source Account - The Money Market Subaccount and/or other Subaccount(s) as identified by the Company and the DCA
Fixed Account Option, if offered, which are permitted to be used in conjunction with Dollar Cost Averaging. 
 Decedent -
The deceased Annuitant or Owner. 
 Earnings – An amount equal to the Policy Value at the time a withdrawal or
Surrender is made, minus the sum of all Premium Payments, reduced by all prior withdrawals deemed to have been from premium, if any. 
 Fixed Account Guaranteed Minimum Effective Annual Interest Rate – If the Fixed Account is offered, the minimum guaranteed credited rate used to determine the Fixed Account portion of Your
Policy Value prior to the Annuity Commencement Date. This rate will apply for the life of the policy and is shown in Section 2 - Policy Data. 
 Good Order – The receipt by the Company, at our Administrative Office, of all information, documentation, instructions and/or Premium Payment deemed necessary by the Company, in its sole
discretion, to issue the policy or execute any transaction pursuant to the terms of the policy. 
 Guaranteed Period Option
or GPO – An Investment Option offered within the Fixed Account which credits a guaranteed interest rate for a specified period of time. 
 Investment Options – Any of the Subaccounts of the Separate Account and any of the options of the Fixed Account, if offered. 

IIPRC - The Interstate Insurance Product Regulation Commission. 

Market Day – Any day and for so long as the New York Stock Exchange is open for business. 

Minimum Nonforfeiture Interest Rate - The interest rate shown in Section 2 - Policy Data which is used to determine the
Minimum Required Cash Value as defined in the nonforfeiture law. This rate is not the credited rate used to determine Your policy’s Cash Value. 
 Minimum Required Cash Value – The minimum amount we will pay You on Surrender, which is equal to the sum of (1) and (2), where: 

	 	(1)	 Is the Fixed Account portion of the Minimum Required Cash Value, equal to 87.5% of premiums and transfers to the Fixed Account, less prior requested
withdrawals and transfers from the Fixed Account, less a $50 deduction at the beginning of each Policy Year, all accumulated at the Minimum Nonforfeiture Interest Rate shown in Section 2 - Policy Data; and 

	 	(2)	Is the Separate Account portion of the Policy Value. 

  

			
	ICC12 VA(2)0513	  	Page 3

 Owner – The person who may exercise all rights and privileges under the policy.

 Policy Anniversary – The anniversary of the Policy Date for each year the policy remains in force. If a certain
date does not exist in a given month, the first day of the following month will be used. 
 Policy Date – The date,
shown in Section 2 - Policy Data, on which this policy becomes effective. 
 Policy Value – The amount
described in Section 6, which represents the value of Your Investment Options. 
 Policy Year – The 12-month
period following the Policy Date shown in Section 2 - Policy Data. The first Policy Year starts on the Policy Date. Each subsequent Policy Year starts on the anniversary of the Policy Date. 

Premium Payment – An amount paid to us by or on behalf of an Owner, as consideration for the benefits provided under this
policy. 
 Separate Account – The separate investment account(s) established by us, under the Investment Company Act
of 1940, as amended (the “1940 Act”), to which Premium Payments under the policy may be allocated. 
 Subaccount
– A division within the Separate Account, the assets of which are invested in a specified underlying fund portfolio. 

Surrender – A full withdrawal of Cash Value and termination of this policy. 

Valuation Period - The period of time from one determination of the value of each Subaccount to the next. Such determinations are
made when the values of the assets and liabilities of each Subaccount are calculated. This is generally the close of business on each Market Day. 
 You, Your – The Owner of this policy. Unless otherwise specified, the Annuitant and the Owner shall be the same person. If a joint Owner is named, reference to “You” or
“Your” in this policy will apply to both the Owner and any joint Owner. 

  

			
	ICC12 VA(2)0513	  	Page 4

 SECTION 2 – POLICY DATA 

Policy Information 
  

			
	  
 Policy
Number:
  
	  	  

12345
  

	  
 Policy
Date:
  
	  	  

May 1, 2013
  

	  
 Income Tax
Status of the Policy:
  
	  	  

Non-Qualified
  

	  
 Initial
Premium Payment:
  
	  	  

$5,000.00
  

	  
 Last
Available Annuity Commencement Date:
  
	  	  

May 31, 2077

	  
 Death Benefit
Option:
  
	  	  

Policy Value

 

 Annuitant(s) Information 
  

			
	  

Annuitant(s):
  
	  	  

John Doe
  

	  
 Primary
Annuitant’s Issue Age/Sex:
  
	  	  

35 / Male

 

 Owner(s) Information 
  
  

			
	  

Owner(s):
  

 
	  	  

John Doe
  

	  
 Primary
Owner’s Issue Age/Sex:
  
	  	  

35 / Male

 

 Rate Information for Fixed Account, if offered 
  

			
	  
 Fixed Account
Guaranteed Minimum Effective Annual Interest Rate:*
  
	  	  

0.25%

	  
 Minimum
Nonforfeiture Interest Rate:**
  
	  	1.00%

 *This rate applies for the life of the policy. 
 **This rate applies for the life of the policy. This rate is used in the calculation of Your Minimum Required Cash Value. Your Minimum Required Cash Value reflects a 12.50% reduction in premiums and
transfers to the Fixed Account and a $50 annual expense allowance. See the definition of Minimum Required Cash Value for the details of this calculation. 
 Regarding the Excess Interest Adjustment (EIA) feature: 

	 	a.	 The guaranteed elements used to determine any EIA are the minimum guaranteed and current declared interest rates applicable to the Fixed Account;

	 	b.	 Declared interest rates used in computing any EIA may change from time to time (subject to Fixed Account Guaranteed Minimum Effective Annual
Interest Rate), which may affect the benefits available under Your policy; and 

	 	c.	 The U.S. Treasury rate may be used as a substitute for the current declared interest rate in the EIA formula as specified in Your policy.

  

			
	ICC12 PDB50513	  	Page 5(a)

 SECTION 2 – POLICY DATA (continued) 

Minimum Premium Payments 
  

					
	 Minimum Initial Premium

Payment:
	  	
Non-Qualified - $5,000
 Qualified -
$1,000

	 Minimum Subsequent Premium

Payment:
	  	$50

 Maximum Premium Payments (without prior Company Approval) 

 

					
	  	  	Issue Age 0-80*	  	Issue Age 81+*
	 Total during the 1st Policy

Year:
	  	$1,000,000	  	$500,000
	 Total during each Policy Year

After 1st Policy Anniversary:
	  	 Non-qualified - $25,000

Qualified - Lesser of $60,000 or IRS

Contribution limit
	  	 Non-qualified -
$25,000
 Qualified - Lesser of $60,000 or IRS
 Contribution limit

	 Cumulative Maximum Premiums -

Life of Policy:
	  	$1,000,000	  	$500,000

  

	*	Issue Age is the greater of the Owner(s)’ or Annuitant(s)’ age. 

 Mortality and Expense Risk Fee and Administrative Charge 
  

					
	 Before the Annuity
 Commencement Date:

 
	  	
0.85%
  

	 After the Annuity
 Commencement Date:
  
	  	
1.25%
  

 Withdrawal/Surrender Charges 

 

													
	 Number of Years Since Premium

Payment Date:
  
	 	0-1	 	1-2	 	2-3	 	3-4	 	4-5	 	         
       5 or more
	 Charge (% of Premium
 Withdrawn or Surrendered):
  
	 	5%	 	4%	 	3%	 	2%	 	1%	 	0%

 The amount paid on Surrender will never be less than the greater of the following amounts: 

	 	a.	Cash Value described in Section 5; and 

	 	b.	Minimum Required Cash Value. 

  

			
	ICC12 PDB50513	  	Page 5(b)

 SECTION 2 – POLICY DATA (continued) 

Service Charge 
  

			
	  
 Service
Charge at the Time of Issue:
  
	  	  

$35
  

	  
 Maximum
Annual Service Charge:
  
	  	  

$50

 

 The Company may waive some or all of Your service charge each year based on Your Policy Value, Premium Payments made or active participation in specific online or e-delivery service programs at the time a
service charge is assessed. 
 1. If Your Policy Value or sum of Premium Payments minus all withdrawals equals
or exceeds: 

									
		 	 $50,000
	 	 	=	  	  	up to a $35 fee waiver
		 	 $250,000
	 	 	=	  	  	up to a $50 fee waiver

 2. Enrollment in specific online or e-delivery service programs may
result in up to a $15 fee waiver. 
 Transfer Minimums and Charges Before the Annuity Commencement Date 

 

			
	 Transfers Allowed Without

Charges in any One Policy Year:
	  	12
	 Charges After Allowable

Transfers in any One Policy Year:
	  	$10
	 Minimum Transfer
 Amount from a Subaccount:
	  	$500 or the entire Subaccount Policy Value, if
less
	 Minimum Transfer
 Amount from a GPO:
	  	$50

 Fixed Account Transfer Maximum Before the Annuity Commencement Date 

 

			
	 Maximum Transfer from the GPO

when EIA has no Impact or a
 Positive
Impact:
	  	100% of the GPO’s Value
	Maximum Transfer from the GPO when EIA has a Negative Impact:	  	25% of the GPO’s Value

 Dollar Cost Averaging (DCA) 

 

			
	 DCA Source Account
 Minimum:
	  	$3,000
	 Minimum Amount
 of each Transfer:
	  	$500
	 Minimum Time
 DCA can be Scheduled:
	  	6 months
	 Maximum Time
 DCA can be Scheduled:
	  	24 months

  

			
	ICC12 PDB50513	  	Page 5(c)

 SECTION 2 – POLICY DATA (continued) 

Fund Facilitation Fee 
 A
Fund Facilitation Fee may be charged in addition to any policy fees and charges, and will be used in the calculation of net investment factor as described in Section 7 of the policy. The Fund Facilitation Fee will only be charged when money is
allocated to one of the Subaccounts listed with a Fund Facilitation Fee. The Fund Facilitation Fee is an annualized percentage taken from the daily net asset values of a fund share held in that Subaccount. 

We may update Fund Facilitation Fee funds and charge up to the maximum of 0.30% for Subaccounts made available subsequent to the Policy
Date. The Subaccount(s) as of Your Policy Date which include this fee are listed below with the current fee noted after the Subaccount name. 
 Initial Investment Options: 
 Fixed Account(s) : 

1 Year Fixed Guaranteed Period 
 3 Year Fixed
Guaranteed Period 
 5 Year Fixed Guaranteed Period 
 7 Year Fixed Guaranteed Period 
 Subaccounts: 

TA AEGON Money Market 
 TA AEGON Tactical
Vanguard ETF - Balanced 
 TA AEGON Tactical Vanguard ETF - Conservative 
 TA AEGON Tactical Vanguard ETF - Growth 
 TA AEGON U.S. Government Securities 

TA Legg Mason Dynamic Allocation - Balanced 
 TA
Legg Mason Dynamic Allocation - Growth 
 TA PIMCO Total Return 
 TA Vanguard ETF - Aggressive Growth 
 TA Vanguard ETF - Balanced 

TA Vanguard ETF - Conservative 
 TA Vanguard ETF
- Growth 

  

			
	ICC12 PDB50513	  	Page 5(d)

 SECTION 3 – GENERAL PROVISIONS 

The Contract 
 The entire
contract consists of this policy and any applications, endorsements or riders. If any portion of this policy or rider attached hereto shall be found to be invalid, unenforceable or illegal, the remainder shall not in any way be affected or impaired
thereby, but shall have the same force and effect as if the invalid, unenforceable or illegal portion had not been inserted. 
 Modification
of Policy 
 No change in this policy is valid unless made in writing by us and approved by one of our authorized officers.
We may pay You more than Your then current Policy Value for Your voluntary participation in certain promotional offerings. We will notify You of the terms of any such programs. 
 Tax Qualification and Change of Law 
 This policy is intended to qualify as
an annuity contract for federal income tax purposes. The provisions of this policy are to be interpreted to maintain such qualification, notwithstanding any other provisions to the contrary. To maintain such tax qualification, we reserve the right
to amend this policy, retroactively or prospectively, to reflect any amendment or clarifications that may be needed or are appropriate to maintain such tax qualification or to conform this policy to any applicable changes in the tax qualification
requirements. We will send You a copy in the event of any such amendment. If You refuse such an amendment, You must provide written notice to us, and Your refusal may result in adverse tax consequences. We reserve the right to amend this policy or
riders attached to, as necessary to comply with specific direction provided by our state or federal regulators, through change of law, rule, regulation, bulletin, regulatory directives or agreements. 

Non-Participating 
 This policy will not
share in our profits. 
 Form Approval 
 This policy is approved under the authority of the IIPRC and issued under the IIPRC standards. Any provision of this policy that on the provision’s effective date is in conflict with IIPRC standards
for this product type is hereby amended to conform to the IIPRC standards for this product type as of the provision’s effective date. 

Age or Sex Corrections 

We may require proof of the Annuitant’s or Owner’s age and/or sex before any payments associated with the death benefit or any
rider(s) attached to this policy are made. If the age and/or sex of the Annuitant or Owner is incorrectly stated, we will base any such payment associated with the death benefit and/or rider benefit proceeds on the Annuitant’s or Owner’s
correct age and/or sex. If required by law to ignore differences in the sex of the Annuitant, the annuity payments will be determined using the unisex factors in Section 10. 

We may require proof of the Annuitant’s age and/or sex before starting annuity payments. If the age and/or sex (or both) of the
Annuitant is incorrectly stated, we will correct the amount payable based upon the Annuitant’s correct age and/or sex, if applicable. Any underpayment made by us will be paid with the next payment. Any overpayment by us will be deducted from
future payments. Any underpayment or overpayment will include annual interest at a rate of 1% per year, from the date of the underpayment or overpayment to the date of the adjustment. 
 Incontestability 
 This policy shall be incontestable from the Policy Date,
except in instances involving fraud. 
 Involuntary Cashout 
 If, at anytime, Your Adjusted Policy Value is below $2,000, and there have been no Premium Payments made to the policy within the last two Policy Years, we reserve the right to terminate the policy and
pay the greater of: 

	 	a.	 The Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of the Policy Value; or 

	 	b.	 The Adjusted Policy Value. 

  

			
	ICC12 VA(2)0513	  	Page 6

 Evidence of Survival 
 We have the right to require satisfactory evidence that a person was alive if a payment is based on that person being alive. 
 Rights of Owner 
 The Owner may, while the Annuitant is living: 

	 	a.	 Assign this policy; 

	 	b.	 Surrender the policy to us; 

	 	c.	 Amend or modify the policy with our consent; 

	 	d.	 Receive annuity payments or name a payee to receive the payments; and 

	 	e.	 Exercise, receive and enjoy every other right and benefit contained in the policy. 

The use of these rights may be subject to the consent of any assignee or irrevocable beneficiary, and of the spouse in a community or
marital property state. Unless we have been notified of a community or marital property interest in this policy, we will rely on our good faith belief that no such interest exists and will assume no responsibility for inquiry. 

Change of Ownership 
 In
the case of a non-tax-qualified annuity, You can change the Owner of this policy from Yourself to a new Owner. You must send written notification, to our Administrative Office, which contains all necessary information to make the change. Any Owner
change made, unless otherwise specified by the Owner, shall take effect on the date the notification is signed by the Owner, when received in Good Order, subject to any payments made or actions taken by us prior to receipt of the notification. No
change will apply to any payment we made before the written notice was received. 
 We may require that the change be endorsed
in the policy. Changing the Owner does not change the beneficiary or the Annuitant. A change of Ownership may result in adverse tax consequences. A change in Ownership due to death is outlined further in Section 9. 

Assignment 
 In the case
of a non-tax-qualified annuity, this policy may be assigned. You must send written notification, to our Administrative Office, which contains all necessary information to make the change. Any assignment made, unless otherwise specified by the Owner,
shall take effect on the date the notification is signed by the Owner, when received in Good Order, subject to any payments made or actions taken by us prior to receipt of the notification. 

We assume no responsibility for the validity of any assignment. Any claim made under an assignment shall be subject to proof of interest
and the extent of the assignment. Assignment does not change the benefit or amount of the policy. 
 This policy may be applied
for and issued to qualify as a tax-qualified annuity under certain sections of the Internal Revenue Code (IRC). Ownership of this policy is then restricted so it will comply with provisions of the IRC. 

Assignment of this policy may result in adverse tax consequences. 
 Beneficiary 
 Amounts payable upon death in accordance with Section 9,
may be payable to the designated beneficiary or beneficiaries. Such beneficiary(ies) must be named and may be changed without beneficiary consent (unless irrevocably designated or required by law) by notifying us in writing, on a form acceptable to
us. Unless otherwise specified by You, the change will take effect upon the date You sign it, whether or not You are living when we receive it, subject to any payments made or actions taken by the Company prior to receipt of this notice. The notice
must have been postmarked (or show other evidence of delivery that is acceptable to us) on or before the Decedent’s date of death. Your most recent beneficiary change notice will replace any prior beneficiary designations. No change will apply
to any payment we made before the written notice was received by us. If an irrevocable beneficiary dies, You may designate a new beneficiary. 
 You may elect the method of payment for each named beneficiary, subject to our then current rules, prior to the date of death of the Decedent. When no such election is made as to a specific beneficiary,
such beneficiary must elect the method of payment within 60 days of the date we receive all required documentation, in Good Order, to pay the amount payable to that beneficiary. 

If there is more than one beneficiary at any level (primary or contingent), and You failed to specify their interest, they will share
equally. 

  

			
	ICC12 VA(2)0513	  	Page 7

	 	a.	General Distribution Rules 

Unless You have provided other specific instructions to us, amounts payable upon death will be paid in accordance with Section 9 and
as outlined below: 

	 	1.	 If a primary beneficiary is alive at the time of Decedent’s death, payment will be made to the primary beneficiary;

	 	2.	 If a primary beneficiary dies before the Decedent and there are additional living primary beneficiaries, the deceased primary beneficiary’s
interest will be shared proportionately with all living primary beneficiaries; 

	 	3.	 When all primary beneficiaries die before the Decedent’s death, payment will be made to the living contingent beneficiary(ies), if any;

	 	4.	 If a contingent beneficiary dies before the Decedent and there are additional living contingent beneficiaries, the deceased contingent
beneficiary’s interest will be shared proportionately with all living contingent beneficiaries; 

	 	5.	 In the event no primary or contingent beneficiaries have been named and/or all have died before the Decedent, the Owner’s estate will become
the beneficiary; 

	 	6.	 If a primary or contingent beneficiary dies after the Decedent’s death, but prior to death proceeds being payable to the beneficiary, payment
will be made to the beneficiary’s estate. 

  

	 	b.	Other Specific Instructions 

 You may provide specific instructions to the Company which direct that upon the death of a beneficiary, that their interest pass to a specific contingent beneficiary(ies) or per stirpes. 

	 	1.	 Per Stirpes: If You provide instructions that a specific primary or contingent beneficiary’s share be passed per stirpes, we will pay that
beneficiary’s share to their identifiable lineal descendants who are living at the time of Decedent’s death. 

	 	2.	 Specific Contingent: If You provide instructions that a specific primary or contingent beneficiary’s share be passed to a specified contingent
beneficiary(ies), we will pay that specific beneficiary’s share to those identifiable specific contingent beneficiaries who are living (or in existence) at the time of Decedent’s death. 

A deceased beneficiary share will be distributed as outlined under General Distributions Rules above. 

Protection of Proceeds 

Unless You so direct by filing written notice with us, no beneficiary may assign any payments under this policy before the same are due.
To the extent permitted by law, no payments under this policy will be subject to the claims of creditors of any beneficiary. 
 Deferment

 Payment of any amount due from the Separate Account for a Surrender, withdrawal or death proceeds will generally occur
within seven days from the date we receive in Good Order all required information. We may defer payments or transfers from the Separate Account if: 

	 	a.	 The New York Stock Exchange is closed other than for usual weekends or holidays or trading on the Exchange is otherwise restricted;

	 	b.	 An emergency exists as defined by the Securities and Exchange Commission (SEC) or the SEC requires that trading be restricted; or

	 	c.	 The SEC permits a delay for the protection of Owners. 

 When permitted by law, we may defer (with prior authorization from the Commissioner) payment of any transfers, withdrawals or Surrender proceeds from the Fixed Account, if offered, for up to 6 months from
the date we receive Your request. If the Owner or Annuitant dies after the request is received, but before the request is processed, the request will be processed before the death proceeds are determined. Interest will be paid on any amount deferred
for 30 days or more. This interest rate will be the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 - Policy Data, unless otherwise required by law. 

If we delay payment of any transactions as noted above, we will disclose to You the specified date on which the above transactions will
be effective and the reason for the delay. 

  

			
	ICC12 VA(2)0513	  	Page 8

 Reports to Owner 
 We will give You a report at least once each Policy Year, and may provide it more often. This report will show the start date and end date for the current period and include the following information:

	 	a.	 The amounts credited or debited to the Policy Value during the current report period; 

	 	b.	 The Policy Value at start and end date of the current report period; 

	 	c.	 The number and value of the accumulation units held in each Separate Account; 

	 	d.	 The Cash Value, which is after the application of any Excess Interest Adjustment (EIA), at start and end date of the current report period;

	 	e.	 The death benefit at the end of the current report period; 

	 	f.	 The dollar amount in the Fixed Account, if any; and 

	 	g.	 The EIA formula used to determine the Cash Value. 

 A report as described above will be mailed to Your last known address as shown in our records. The information provided will be as of a date not more than four months prior to the date of the mailing. We
will provide copies of the report available to You upon request at no additional cost. 
 SECTION 4 – PREMIUM PAYMENTS

 Payment of Premiums 
 Premium Payments may be made any time while this policy is in force and prior to the Annuity Commencement Date, subject to the minimums and maximums as specified in Section 2 – Policy Data.

 Premium Payment Date 
 The Premium Payment date is the date the Premium Payment is credited to the policy. The initial Premium Payment will be credited to the policy within two Market Days after the Market Day we receive it and
Your complete policy information in Good Order. Subsequent Premium Payments will be credited to the policy as of the Market Day the Premium Payment and required information are received in Good Order. 

Allocation of Premium Payments 
 Premium Payments may be applied to various Investment Options, which we make available. For the initial Premium Payment, You must indicate what percentage to allocate to various Investment Options. For
additional Premium Payments, allocations will be what is currently indicated by You. Each percentage may be either zero or any whole number; however, the allocation among all Investment Options must total 100%. 

Change of Allocation 

You may change allocations for additional Premium Payments by providing us instructions. The allocation change will apply to Premium
Payments received on or after the date we receive the allocation change in Good Order. We will allocate subsequent Premium Payments the same way, unless You request a different allocation. 
 Premium Taxes 
 Your state may impose premium taxes on the Premium Payments
You make. We currently do not deduct for these taxes at the time You make a Premium Payment unless required by the applicable state law. Generally, we will deduct the total amount of premium taxes, if any, from the Policy Value when You begin
receiving annuity payments, You Surrender the policy, or death proceeds are paid. 
 SECTION 5 – CASH VALUE AND
WITHDRAWALS 
 A. Cash Value 
 On or before the Annuity Commencement Date, You may make withdrawals or Surrender the Cash Value. The Cash Value is equal to the Adjusted Policy Value. Information on the current amount of Your Cash Value
is available upon request. We must receive Your withdrawal or Surrender request, in Good Order, before the Annuity Commencement Date. 

  

			
	ICC12 VA(2)0513	  	Page 9

 There is no Cash Value once an income option has been selected, all necessary instructions
are received in Good Order, and the Company has issued a supplementary contract. 
 Excess Interest Adjustment 

The Excess Interest Adjustment (EIA) is only applied to transactions affecting the Guaranteed Period Options (GPO) of the Fixed Account,
if offered, and is based on any change in interest rates from the time the affected guaranteed period(s) started until the time the EIA occurs. The EIA may be positive or negative. 

An EIA applies in the following situations: 

	 	1.	 When You withdraw or Surrender Your Cash Value; 

	 	2.	 When You exercise an income option; 

	 	3.	 When You transfer out of a GPO; or 

	 	4.	 When a death benefit is calculated. However, the death benefit will not be reduced if the EIA results in a decrease in the Cash Value available to
You. 

 The EIA is applied as follows: 

	 	1.	 The EIA is only applied when the transactions occur prior to the end of the GPO; 

	 	2.	 Transfers to the GPO of the Fixed Account are considered Premium Payments for purposes of determining the EIA; 

	 	3.	 The EIA may affect the death benefit defined in Section 9; 

	 	4.	 If interest rates have decreased from the time the affected GPO started until the time the transaction occurs, the EIA will result in additional
funds available to You; 

	 	5.	 If interest rates have increased from the time the affected GPO started until the time the transaction occurs, the EIA will result in a decrease in
the funds available to You; 

	 	6.	 Certain amounts are not subject to the EIA as provided in Sections 5, 8 and 11; and 

	 	7.	 Upon Surrender, the cumulative interest credited to the GPO of the Fixed Account at the time of Surrender will not be subject to an EIA.

 The formula for determining the amount of the EIA is as follows: 

			
	         EIA
	 	= S x (G-C) x (M/12) where:
	         “S”
	 	 Is the amount (before premium taxes and the application of any Guaranteed Minimum Death Benefits, if any) being Surrendered, withdrawn, transferred, paid upon
death, or applied to an income option that is subject to EIA;

	 “G”
	 	Is the guaranteed interest rate for the guaranteed period applicable to “S”;
	 “C”
	 	 Is the current guaranteed interest rate then being offered on new Premium Payments for the next longer guaranteed period than “M”. If this policy
form or such a GPO is no longer offered, “C” will be the U.S. Treasury rate for the next longer maturity (in whole years) than “M” on the 25th day of the previous calendar month; and

	 “M”
	 	 Is the number of months remaining in the guaranteed period for “S”, rounded up to the next higher whole number of months.

 The EIA for each GPO will not reduce the Adjusted Policy Value for that GPO below the amount allocated,
less any prior withdrawals and transfers from that GPO, plus interest at the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 - Policy Data. 
 B. Withdrawals and Surrenders 
 You may, on or before the Annuity
Commmencement Date, withdraw all (Surrender) or a portion (withdrawal) of the amount available under this policy, provided we receive Your request, in Good Order, while this policy is in effect and before the Annuity Commencement Date. The minimum
withdrawal is $500, with the exception of systematic payouts and required minimum distributions. 
 You may specify that the
withdrawal be taken from one or more specific Investment Options or pro rata from all Investment Options. If You do not specify the Investment Option from which the withdrawal is to be made, the withdrawal will be taken pro rata from all Investment
Options relative to the value in each Investment Option. 

  

			
	ICC12 VA(2)0513	  	Page 10

 Withdrawals will reduce the amount of the death proceeds. Withdrawals and Surrenders will
normally be effective as of the end of the Market Day the request is received in Good Order. 
 The gross withdrawal is the
total amount which will be deducted from Your Policy Value as a result of each withdrawal. The gross withdrawal may be more than Your requested withdrawal amount, depending on whether EIA applies at the time of the withdrawal. 

The gross withdrawal = R – E, where: 
 “R” Is the requested withdrawal; and 
 “E” Is the EIA.

 Withdrawals in the amount of the cumulative interest in the GPO(s) of the Fixed Account, at the time of withdrawal, may be
withdrawn from the GPO(s) of the Fixed Account free of any EIA. 
 Systematic Payout Option 

A Systematic Payout Option (SPO) is a series of pre-scheduled withdrawals. Beginning in the first Policy Year, a SPO is available on a
monthly, quarterly, semi-annual or annual basis. At the time a SPO is made, each such payout must be at least $50. Monthly and quarterly SPO’s must be sent through electronic funds transfer directly to a checking, savings or other similar
financial account. You may stop SPO payouts at any time with a 30 day written notice sent to our Administrative Office. 
 Required Minimum
Distribution 
 For tax-qualified plans and policies, withdrawals taken to satisfy required minimum distribution requirements
under Section 401(a)(9) of the Internal Revenue Code (IRC) are available with no EIA. The amount available from this policy with respect to the required minimum distribution is based solely on this policy. 

Any amount requested in excess of the IRC required minimum distribution will have the appropriate EIA applied. 

Minimum Values 
 Benefits
available under this policy, including any paid up annuity values, Cash Values, or death benefits, are not less than the minimum benefits required by section 7B and 7G of the Model Variable Annuity Regulation, model # 250 or successor models.
Minimum benefits will be increased to reflect any guaranteed additional amounts credited to the policy and will be decreased by prior withdrawals. 
 Minimum Required Cash Value 
 The Minimum Required Cash Value is the amount
prescribed by the nonforfeiture law, and is the minimum amount required to be paid to You on Surrender. 
 The minimum amount is
determined differently than Your policy’s Cash Value, and is described in Section 2 - Policy Data. The minimum amount for the Fixed Account, if offered, is calculated according to a procedure specified in the law using a prescribed Minimum
Nonforfeiture Interest Rate, which will be fixed at issue and determined as follows: 
 On the Policy Date, the Minimum
Nonforfeiture Interest Rate is equal to an “average Five Year Constant Maturity Treasury rate”, less 1.25%, but such rate will not be less than 1% nor more than 3%. The averaged rate is determined by averaging the daily Treasury rates for
the first 10 Market Days of the month immediately preceding the calendar quarter in which Your policy is issued. The average of these ten Treasury rates is rounded to the nearest 0.05% before the deduction of 1.25%. For example, if Your policy was
issued on any Market Day during the third calendar quarter, Your Minimum Nonforfeiture Interest Rate would be determined by averaging the first ten Market Days’ Five Year Constant Maturity Treasury rates for the month of June during the same
calendar year, rounding that result to the nearest 0.05%, then deducting 1.25% (with the resulting rate not being less than 1% nor more than 3%). 

  

			
	ICC12 VA(2)0513	  	Page 11

 SECTION 6 – POLICY VALUE 

Policy Value 
 On or
before the Annuity Commencement Date, the Policy Value is equal to Your: 

	 	a.	 Premium Payment(s); minus 

	 	b.	 Gross withdrawals (withdrawals plus or minus any EIA); plus 

	 	c.	 Interest credited to the Fixed Account (if any); plus 

	 	d.	 Accumulated gains in the Separate Account; minus 

	 	e.	 Accumulated losses in the Separate Account; minus 

	 	f.	 Service charges, rider fees, premium taxes, and transfer fees if any. 

 Service Charge 
 On each Policy Anniversary prior to the Annuity
Commencement Date and at the time of Surrender, we may deduct an annual service charge as set forth in Section 2 - Policy Data. The service charge will be deducted from each Investment Option in proportion to the portion of Policy Value (prior
to such charge) in each Investment Option. In no event will the service charge exceed 2% of the Policy Value or the maximum, as shown in Section 2 - Policy Data, on the Policy Anniversary or at the time of Surrender. 

SECTION 7 – SEPARATE ACCOUNT 
 Separate Account 
 We have established and will maintain one or more
Separate Account(s), under the laws of the state of Iowa. Any realized or unrealized income, net gains and losses from the assets of the Separate Account are credited to or charged against it without regard to our other income, gains or losses.
Assets are put in the Separate Account for this policy, as well as for other variable annuity policies. Any Separate Account may invest assets in shares of one or more mutual fund portfolio(s), or in the case of a managed Separate Account, direct
investments in stocks or other securities as permitted by law. Fund shares refer to shares of underlying mutual funds or pro-rata ownership of the assets held in a Subaccount of a managed Separate Account. Fund shares are purchased, redeemed and
valued on behalf of the Separate Account. 
 The Separate Account is divided into Subaccounts. Each Subaccount invests
exclusively in shares of one of the portfolios of an underlying fund. We reserve the right to add or remove any Subaccount of the Separate Account. 
 The assets of the Separate Account are our property. These assets will equal or exceed the reserves and other contract liabilities of the Separate Account. These assets will not be chargeable with
liabilities arising out of any other business we conduct. We reserve the right, subject to regulations governing the Separate Account, to transfer assets of a Subaccount, in excess of the reserves and other contract liabilities with respect to that
Subaccount, to another Subaccount or to our General Account. 
 We will determine the fair market value of the assets of the
Separate Account in accordance with the Valuation Period, which we establish in good faith. 
 We also reserve the right to
transfer assets of the Separate Account, which we determine to be associated with the class of policies to which this policy belongs, to another Separate Account. If this type of transfer is made, the term “Separate Account”, as used in
the policy shall then mean the Separate Account to which the assets are transferred. 

  

			
	ICC12 VA(2)0513	  	Page 12

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

	 	a.	 Deregister the Separate Account under the Investment Company Act of 1940; 

	 	b.	 Manage the Separate Account under the direction of a committee at any time; 

	 	c.	 Restrict or eliminate any voting rights of policy Owners or other persons who have voting rights as to the Separate Account;

	 	d.	 Combine the Separate Account with one or more Separate Accounts; 

	 	e.	 Create new Separate Accounts; 

	 	f.	 Add new Separate Accounts to or remove existing Subaccounts from the Separate Account, or combine Subaccounts; and 

	 	g.	 Add new underlying mutual funds, remove existing mutual funds, or substitute a new fund for an existing mutual fund. 

The net asset value of a fund share is the per-share value calculated by the mutual fund or, in the case of a managed Separate Account,
by the Company. The net asset value is computed by adding the value of the Subaccount’s investments, cash and other assets, subtracting its liabilities, and then dividing by the number of shares outstanding. Net asset values of fund shares
reflect investment advisory fees and other expenses incurred in managing a mutual fund or a managed Separate Account. 
 Change in Investment
Objective or Policy of a Mutual Fund 
 If required by law or regulation, an investment policy of the Separate Account will only be changed
if approved by the appropriate insurance official of the state of Iowa or deemed approved in accordance with such law or regulation. If so required, the process for obtaining such approval is filed with the insurance official of the state or
district in which this policy is delivered. 
 Charges and Deductions 

The mortality and expense risk fee and the administrative charge are each deducted, both before and after the Annuity Commencement Date,
to compensate for changes in mortality and expenses not anticipated by the mortality and administration charges guaranteed in the policy. Expenses and mortality results will not adversely affect the dollar amounts of variable benefits or other
variable contractual payments or values. The mortality and expense risk fee and the administrative charge is specified in Section 2 - Policy Data. 
 Accumulation Units 
 The Policy Value in the Separate Account before the
Annuity Commencement Date is represented by accumulation units. The dollar value of accumulation units for each Subaccount will change from Market Day to Market Day reflecting the investment experience of the Subaccount. 

Premium Payments allocated to and any amounts transferred to the Subaccounts will be applied to provide accumulation units in those
Subaccounts. The number of accumulation units purchased in a Subaccount will be determined by dividing the amount allocated to or transferred to that Subaccount by the value of an accumulation unit for that Subaccount on the Premium Payment or
transfer date. 
 The number of accumulation units withdrawn or transferred from the Subaccounts will be determined by dividing
the amount withdrawn or transferred by the value of an accumulation unit for that Subaccount on the withdrawal or transfer date. 
 The value of an accumulation unit on any Market Day is determined by multiplying the value of that unit at the end of the immediately preceding Valuation Period by the net investment factor for the
Valuation Period. 

  

			
	ICC12 VA(2)0513	  	Page 13

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

	 	(a)	 Is the result of: 

	 	1.	 The net asset value of a fund share held in that Subaccount determined as of the end of the current Valuation Period; plus

	 	2.	 The per share amount of any dividend or capital gain distributions made by the fund for shares held in that Subaccount if the ex-dividend date
occurs during the Valuation Period; plus or minus 

	 	3.	 A per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of that Subaccount.

	 	(b)	 Is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding Valuation Period.

	 	(c)	 Is a factor representing the mortality and expense risk fee and administrative charge before the Annuity Commencement Date. This factor is less than
or equal to, on an annual basis, the percentage shown in Section 2 - Policy Data, of the daily net asset value of a fund share held in that Subaccount. 

 Since the net investment factor may be greater or less than one, the accumulation unit value may increase or decrease. 
 SECTION 8 – TRANSFERS 
 A. TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE

 Prior to the Annuity Commencement Date, You may transfer the value of the accumulation units from one Investment Option to
another within certain limitations. 
 Transfers of Policy Value from the Guaranteed Period Options (GPO) of the Fixed Account,
if offered, prior to the end of that GPO are subject to an EIA. Such transfers are limited to the maximum Fixed Account transfer limits shown in Section 2 - Policy Data, less values previously transferred out of that GPO during the current
Policy Year. Transfer minimums and charges shown in Section 2 - Policy Data, may also apply to transfers out of the GPO. 

Transfers of interest credited in the GPO’s to other Investment Options are allowed on a “First-In, First-Out” basis. Such
transfers may be made monthly, quarterly, semi-annually, or annually. Each such transfer is subject to transfer minimums and charges as set forth in Section 2 - Policy Data and will not be subject to an EIA. 

You may choose which GPO to transfer to or from; however, any GPO elected may not extend beyond the last available Annuity Commencement
Date shown in Section 2 - Policy Data. 
 Transfers of Policy Value from the Separate Account are subject to a minimum and
charges as set forth in Section 2 - Policy Data. If the remaining Subaccount Policy Value is less than the minimum transfer amount, as shown in Section 2 - Policy Data, we reserve the right to include that amount as part of the transfer.
Transfers among multiple Investment Options will be treated as one transfer in determining the number of transfers that have occurred. 
 If You want to transfer the value of the variable units You must provide written notification with the following information provided: 

	 	1.	 The Investment Option from which the transfer is to be made; 

	 	2.	 The amount of the transfer; and 

	 	3.	 The Investment Option(s) to receive the transferred amount. 

The policy was not designed for the use of market timers or frequent or disruptive traders. Such transfers may be harmful to the
underlying fund portfolios and increase transaction costs. We have developed policies and procedures with respect to market timing and disruptive trading (which vary for certain Subaccounts at the request of the corresponding underlying fund
portfolios). 

  

			
	ICC12 VA(2)0513	  	Page 14

 We employ various means in an attempt to detect market timing and disruptive trading.
However, despite our monitoring, we may not be able to detect nor halt all harmful trading. If we determine You are engaged in market timing or disruptive trading, we may take one or more actions in an attempt to halt such trading. Your ability to
make transfers is subject to modification or restriction if we determine, in our sole discretion, that Your exercise of the transfer privilege may disadvantage or potentially harm the rights or interests of other Owners (or others having an interest
in the variable insurance products). Transfer restrictions may take the form of loss of expedited transfer privilege. We consider transfers by telephone, fax, overnight mail, or the Internet to be “expedited” transfers. This means that we
would accept only an original signature transmitted to us only by U.S. mail. We may also restrict the transfer privileges of others acting on Your behalf, including Your registered representative or an asset allocation or investment advisory
service. 
 We reserve the right to reject any Premium Payments or transfer requests from any person without prior notice, if,
in our judgment: 

	 	1.	 The payment or transfer, or series of transfers, would have a negative impact on an underlying fund portfolio’s operations; or

	 	2.	 If an underlying fund portfolio would reject or has rejected our purchase order or has instructed us not to allow that purchase or transfer; or

	 	3.	 Because of a history of market timing or disruptive trading. 

 Dollar Cost Averaging 
 Prior to the Annuity Commencement Date, You may
enroll in Dollar Cost Averaging (DCA) by instructing us to automatically make periodic transfers of Policy Value from a DCA Source Account without waiting for further instructions from You. A DCA program will begin once we have received, in Good
Order, all necessary information and the minimum required amount. 
 You must provide us with the following information to
initiate DCA: 

	 	1.	 The date on which the transfers are to begin. Your request will normally be effective the day after the effective date of the policy. If a certain
date does not exist in a given month, the first day of the following month will be used; 

	 	2.	 The DCA Source Account from which the transfers are to be made. To begin dollar cost averaging, the value of the DCA Source Account is subject to
minimums as described in Section 2 - Policy Data; 

	 	3.	 The amount and frequency of the transfers. You may choose monthly or quarterly transfers. The amount of each transfer is subject to minimums as
described in Section 2 - Policy Data; and 

	 	4.	 The Investment Option(s) to receive the transferred amounts. You may choose one or more Investment Options. If You select more than one Investment
Option, Your request must specify how the transferred amounts are to be allocated among these Investments Options and cannot include Your DCA Source Account. 

 Transfers must be scheduled for a minimum or maximum length of time as specified in Section 2 - Policy Data. DCA results in the purchase of more accumulation units when the value of the accumulation
unit is low, and fewer accumulation units when the value of the accumulation unit is high. However, there is no guarantee that the DCA program will result in higher Policy Values or will otherwise be successful. 

Asset Rebalancing 
 Prior
to the Annuity Commencement Date, You may instruct us to automatically transfer amounts among the Subaccounts of the Separate Account on a regular basis to maintain a desired allocation of the Policy Value among the various Subaccounts offered.
Rebalancing will occur on a monthly, quarterly, semi-annual, or annual basis, beginning on a date selected by You. You must select the percentage of the Policy Value desired in each of the various Subaccounts offered. Any amounts in the DCA Source
Account or Fixed Account, if offered, are ignored for the purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at any time. Rebalancing will cease as soon as we receive a request for any transfer. 

B. TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE 
 After the Annuity Commencement Date, You may transfer the value of the variable annuity units from one Subaccount to another within the Separate Account or to the Fixed Account, if offered. If You want to
transfer the value of the variable units You must provide written notification with the following information provided: 

	 	1.	 The Investment Option from which the transfer is to be made; 

	 	2.	 The amount of the transfer; and 

	 	3.	 The Investment Option(s) to receive the transferred amount. 

  

			
	ICC12 VA(2)0513	  	Page 15

 The minimum amount which may be transferred is the lesser of $10 monthly income or the
entire monthly income of the variable annuity units in the Subaccount from which the transfer is being made. If the monthly income of the remaining units in a Subaccount is less than $10, we have the right to include the value of those variable
annuity units as part of the transfer. We reserve the right to limit transfers between the Subaccounts or to the Fixed Accounts to once per Policy Year. 
 After the Annuity Commencement Date, no transfers may be made from the Fixed Account, if offered, to any other Investment Option. 
 SECTION 9 - DEATH PROCEEDS 
 A. DEATH PRIOR TO THE ANNUITY COMMENCEMENT DATE

 The amount payable upon death will be determined and made payable upon receipt, in Good Order, of satisfactory proof of
death, written directions from each eligible recipient regarding how they wish to receive the amount payable, and any other documents, forms and information that we need (collectively referred to as “due proof of death”). Not withstanding
the foregoing, we may confer with a variety of resources and/or other affiliates in order to ascertain or verify whether the Annuitant or any other relevant life in being is or may have become deceased during the term of this policy. Any such
activities or efforts by us in no manner abrogate, waive or otherwise diminish Your continued obligation to provide us with timely notice in writing of due proof of death in Good Order. 

The amount of the death benefit payable will be the greatest of: 

	 	1.	 The Policy Value on the date we receive due proof of death and an election of method of settlement; 

	 	2.	 The Cash Value on the date we receive due proof of death and an election of method of settlement; 

	 	3.	 The Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of the Policy Value, on the date we receive due proof
and an election of method of settlement; or 

	 	4.	 The Guaranteed Minimum Death Benefit (GMDB), if any, on the date of death, plus any additional Premium Payments received, less any gross withdrawals
from the date of death to the date of payment of death proceeds. 

 The Owner(s) may elect the method of
payment of death proceeds for each named beneficiary, subject to our then current rules, prior to the date of the applicable Decedent’s death. When no such election is made as to a specific beneficiary, such beneficiary must elect the method of
payment within 60 days of the date we receive all required documentation, in Good Order, to pay the death proceeds to that beneficiary. 

Guaranteed Minimum Death Benefit 
 If elected, the GMDB will establish a minimum death benefit payable under the policy. Your election, if any, is shown in Section 2 - Policy Data. You may not change Your election after the policy is
issued. 
 Death of Annuitant Prior To The Annuity Commencement Date 

A death benefit will be payable if the Annuitant dies prior to the Annuity Commencement Date. 

 

	 	1.	Non-Natural Owner(s) 

 For purposes of determining who receives the death benefit for a policy owned by a non-natural Owner, we will apply the rules for Individual Owner(s) as provided below in 2(a) or (b). 

 

	 	2.	Individual Owner(s) 

	 	(a)	 Surviving Owner 

 If there is a surviving Owner(s) when the Annuitant dies, the surviving Owner(s) will receive the death benefit (i.e., the surviving Owner(s) takes the place of any beneficiary designation). 

 

	 	(b)	 No surviving Owner 

 If there is no surviving Owner, the death benefit is payable to the named beneficiary(ies). If no beneficiary(ies) are named, the death benefit will be payable to the Owner’s estate. 

  

			
	ICC12 VA(2)0513	  	Page 16

 Death of Owner Prior To The Annuity Commencement Date 

If the Owner is not the Annuitant and the Owner dies before the Annuitant, under certain circumstances, an amount equal to the Cash Value,
as of the date we receive due proof of death, will be paid. 
 If You are not also the Annuitant and in the event of
simultaneous deaths of both You and the Annuitant, the death proceeds will be calculated under the Death of Annuitant provisions. 
  

	 	1.	Non-Natural Owner(s) 

 If the policy is owned by a trust using the grantor’s social security number as its taxpayer identification number, the death of the grantor will be treated as the death of the Owner. 

If there is a change in the Annuitant, such change will be treated as the death of the non-natural Owner and we will pay
an amount equal to the Cash Value as of the day we receive, in Good Order, the request to change the Annuitant. 
  

	 	2.	Individual Owner(s) 

 If You die while the Annuitant is living, the Cash Value will be paid to the first among the following who is living or in existence: 

	 	a.	 The surviving Owner(s); 

	 	b.	 Primary beneficiary(ies); 

	 	c.	 Contingent beneficiary(ies); or 

	 	d.	 Deceased Owner’s estate. 

  

	 	3.	Joint Owner(s) 

 If there is a joint Owner, the Cash Value will be payable upon the death of the first Owner, unless the surviving joint Owner is the spouse. 
 Non-Spouse Individual Beneficiary: 
 If the beneficiary is an individual who
is not eligible to continue the contract as noted below, the amount payable must be distributed by the end of 5 years after the date of Decedent’s death, or payments must begin no later than one year after the date of Decedent’s death and
must be made for a period certain or for the beneficiary’s lifetime, so long as the period certain does not exceed the beneficiary’s life expectancy. 
 If the beneficiary is not a natural person, the death proceeds must be distributed by the end of 5 years after the date of Decedent’s death. 
 Spousal Beneficiary 
 A spousal beneficiary, who is the sole beneficiary,
may elect to continue this policy as Owner rather than receiving the amount payable when they are the deceased Owner’s surviving spouse. 
 If the surviving spouse does not elect to continue the contract, the amount payable must be distributed by the end of 5 years after the date of the Decedent’s death, or payments must begin no later
than one year after the Decedent’s death and must be made for a period certain or for the beneficiary’s lifetime, so long as the period certain does not exceed the beneficiary’s life expectancy. 

If a death benefit is payable and the policy is continued, an amount equal to the excess, if any, of the Guaranteed Minimum Death Benefit
over the Policy Value will then be added to the Policy Value. This is a one-time only Policy Value adjustment applied at the time the policy is continued. The spousal continuation election is only available once per policy. 

  

			
	ICC12 VA(2)0513	  	Page 17

 B. DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE 

In the event of a death after the Annuity Commencement Date, the amount payable will depend on the income option selected. If any Owner
dies on or after the Annuity Commencement Date, but before the entire interest in the policy is distributed, the remaining portion of such interest in the policy will be distributed to the beneficiary(ies) at least as rapidly as under the method of
distribution being used as of the date of that death. 
 C. ADDITIONAL TAX INFORMATION 

In any event, the death proceeds will be paid in accordance with Section 72(s) of the IRC. For purposes of applying the non-natural
Owner death rules of Section 72(s)(6), we will apply the Annuitant death rules set forth earlier in this section. 
 These
distribution rules do not apply to an annuity provided under a plan described in Section 401(a), 403(a), 403(b), 408 or 408A of the IRC or to an annuity that is a qualified funding asset as defined in Code Section 130(d) of the IRC.

 SECTION 10 – INCOME OPTIONS 
 A. GENERAL PAYMENT PROVISIONS 
 Payment 

You may use the Adjusted Policy Value or the Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of
the Policy Value, if greater, on the Annuity Commencement Date. If the policy is in force on the last available Annuity Commencement Date, we will make annuity payments to the payee under Option 2(b), with 10 years certain, or if elected, under one
or more of the other options described in this section, or any other method of payment if we agree. However, the option(s) elected must provide for lifetime income or income for a period of at least 120 months. Payments will be made at 1, 3, 6 or 12
month intervals. We reserve the right to avoid making payments of less than $20.00. 
 Before the Annuity Commencement Date, if
the death proceeds become payable or if You Surrender this policy, we will pay any proceeds in one sum, or if elected, all or part of these proceeds may be placed under one or more of the options described in this section. 

Adjusted Age 
 Payments
under Options 2 and 4 and the first payment under Options 2-V and 4-V are determined based on the adjusted age of the Annuitant. The adjusted age is the Annuitant’s actual age on the Annuitant’s nearest birthday, at the Annuity
Commencement Date, adjusted as follows: 
  

			
	           Annuity

Commencement Date
	  	 Adjusted Age

	Before 2025	  	Actual Age
	2025 - 2032	  	Actual Age minus 1
	2033 - 2040	  	Actual Age minus 2
	2041 - 2048	  	Actual Age minus 3
	2049 - 2055	  	Actual Age minus 4
	After 2055	  	Determined by us

 Election of Optional Method of Payment 
 You may elect, in a manner acceptable to us, income options that may be either variable, fixed, or a combination of both. If You elect a combination, You must also tell us what part of the policy proceeds
on the Annuity Commencement Date is to be applied to provide each type of payment. You must also specify which Subaccounts to allocate policy proceeds. The amount of a combined payment will be the sum of the variable and fixed payments. Payments
under a variable income option will reflect the investment performance of the selected Subaccount of the Separate Account. 
 Qualified Plans
and Policies 
 Certain income options may not be available or may be limited for qualified plans and qualified policies in
order to ensure compliance with the IRC. 

  

			
	ICC12 VA(2)0513	  	Page 18

 Proof of Age 
 We may require proof of the age of any person who has an annuity purchased under Options 2, 2-V, 4 and 4-V of this section before we make the first payment. 

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

Supplementary Contract 

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

Guaranteed Income Options 

The fixed income option is determined by multiplying each $1,000 of policy proceeds allocated to a fixed income option by the amounts
shown in Section 12 for the option You select. Options 1 and 3 are based on a guaranteed interest rate of 0.25%. Options 2 and 4 are based on a guaranteed interest rate of 0.25% and the “Annuity 2000” (male, female and unisex if
required by law) mortality table projected for improvement using projection scale G. The rates were projected dynamically using an assumed Annuity Commencement Date of 2020. The “Annuity 2000” mortality rates are adjusted based on
improvements in mortality to more appropriately reflect increased longevity. 
 Option 1 – Income for a Specified Period 

We will make level payments only for the fixed period You choose. Payments should not exceed the Annuitant’s life expectancy. In the
event of the death of the person receiving payments prior to the end of the fixed period elected, payments will be continued to that person’s beneficiary. No funds will remain at the end of the specified period. 

Option 2 – Life Income 
 You may
choose between: 

	 	a.	 Life Only – We will make level payments only during the Annuitant’s lifetime;* or 

	 	b.	 Life 10 Years Period Certain – We will make level payments for the longer of: 

	 	1.	 The Annuitant’s lifetime; or 

	 	2.	 10 years, whichever is longer; or 

  

	 	c.	 Guaranteed Return of policy proceeds – We will make level payments for the longer of: 

	 	1.	 The Annuitant’s lifetime; or 

	 	2.	 Until the total dollar amount of payments made to You equals the amount applied to this option. 

*Option 2(a) is not available for adjusted ages greater than 85. 

Option 3 – Income of a Specified Amount 
 Payments are made for any specified amount until the amount applied to this option, with interest, is exhausted. Payments should not exceed the Annuitant’s life expectancy. This will be a series of
level payments followed by a smaller final payment. In the event of the death of the person receiving payments prior to the time policy proceeds with interest are exhausted, payments will be continued to that person’s beneficiary. 

Option 4 – Joint and Survivor Annuity 
 You may choose between: 

	 	a.	 Life Only – We will make level payments only during the Annuitants’ lifetimes;** or 

	 	b.	 Life and 10 Years Period Certain – We will make level payments for the longer of: 

	 	1.	 The Annuitant’s lifetime and a joint Annuitant of Your selection; or 

	 	2.	 10 years, whichever is longer. 

 **Option 4(a) is not available for adjusted ages greater than 85. 

  

			
	ICC12 VA(2)0513	  	Page 19

 Current Income Options 
 The amounts shown in the tables in Section 12 are the guaranteed amounts. Payments at the time of their commencement will not be less than those that would be provided by the application of the
policy proceeds to purchase a single premium immediate annuity policy at purchase rates offered by the Company at the time to the same class of Annuitants. 
 C. VARIABLE INCOME OPTIONS 
 Variable Annuity Units 

The policy proceeds You tell us to apply to a variable income option will be used to purchase variable annuity units in Your chosen
Subaccounts. The dollar value of variable annuity units in Your chosen Subaccounts will increase or decrease reflecting the investment experience of Your chosen Subaccounts. The value of a variable annuity unit in a particular Subaccount on any
Market Day is equal to “a” x “b” x “c”, where: 

	 	“a”	 Is the variable annuity unit value for that Subaccount on the immediately preceding Market Day; 

	 	“b”	 Is the net investment factor for that Subaccount for the Valuation Period; and 

	 	“c”	 Is the Assumed Investment Return adjustment factor for the Valuation Period. 

The net investment factor used to calculate the value of an accumulation unit in each Subaccount for the Valuation Period is determined
by dividing “a” by “b” and subtracting “c” from the result, where: 

	 	“a”	 Is the result of: 

	 	1.	 The net asset value of a fund share held in that Subaccount determined as of the end of the current Valuation Period; plus

	 	2.	 The per share amount of any dividend or capital gain distributions made by the fund for shares held in that Subaccount if the ex-dividend date
occurs during the Valuation Period; plus or minus 

	 	3.	 A per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of that Subaccount.

	 	“b”	 Is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding Valuation Period.

	 	“c”	 Is a factor representing the mortality and expense risk fee and administrative charge after the Annuity Commencement Date. This factor is less than
or equal to, on an annual basis, the percentage shown in Section 2 - Policy Data, of the daily net asset value of a fund share held in that Subaccount. 

 Determination of the First Variable Payment 
 The amount of the first
variable payment is determined by multiplying $1,000 of policy proceeds allocated to a variable income option by the amounts shown in Section 13 for the variable option You select. The tables are based on a 3% Effective Annual Assumed
Investment Return and the “Annuity 2000” (male, female and unisex if required by law) mortality table projected for improvement using projection scale G. The rates were projected dynamically using an assumed Annuity Commencement Date of
2020. The “Annuity 2000” mortality rates are adjusted based on improvements in mortality to more appropriately reflect increased longevity. 
 Option 2-V – Life Income 
 You may choose between: 

	 	a.	 Life Only – Payments will be made during the lifetime of the Annuitant;* or 

	 	b.	 Life and 10 Years Period Certain – Payments will be made for the longer of the Annuitant’s lifetime or ten years. In the event of the
death of the person receiving payments prior to the end of the guarantee period for which the election was made, payments will be continued to that person’s beneficiary. 

*Option 2-V(a) is not available for adjusted age(s) greater than 85. 

Option 4-V – Joint and Survivor Annuity 
 Life Only - Payments are made during the joint lifetime of the Annuitant and a joint Annuitant of Your selection. Payments will be made as long as either person is living. Option 4-V is not available for
adjusted ages greater than 85. 

  

			
	ICC12 VA(2)0513	  	Page 20

 Determination of Subsequent Variable Payments 

The amount of each variable annuity payment after the first will increase or decrease according to the value of the variable annuity units
which reflect the investment experience of the selected Subaccounts. Each variable annuity payment after the first will be equal to the number of variable annuity units in the selected Subaccounts multiplied by the variable annuity unit value on the
date the payment is made. The number of variable annuity units in each selected Subaccount is determined by dividing the first variable annuity payment allocated to the Subaccount by the variable annuity unit value of such Subaccount on the Annuity
Commencement Date. 
 The smallest annual rate of investment return that would have to be earned on the assets of the Separate
Account so that the dollar amount of variable income payments will not decrease is 5.50%. 
 SECTION 11 – FIXED ACCOUNT

 We may make available a Fixed Account as an Investment Option. The Fixed Account, if offered, may be comprised of one or
more options shown below. Premium Payments applied to and any amount transferred to the Fixed Account will be credited interest based on a fixed rate. The interest rates we set will be credited for increments of at least one year measured from each
Premium Payment or transfer date. If the Fixed Account is available, these rates will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 – Policy Data. We reserve the right at our sole
discretion, to limit or refuse Premium Payments and/or transfers allocated to any of the Fixed Account options, if we are crediting an interest rate equal to or less than the Minimum Nonforfeiture Annual Interest Rate. 

Guaranteed Period Options 

We may offer optional Guaranteed Period Options, into which Premium Payments may be paid or amounts transferred. The current interest rate
we set for Policy Value allocated to each Guaranteed Period Option (GPO) is guaranteed until the end of that guaranteed period. 

We will notify You before the end of the GPO. You may elect to have the Policy Value in the GPO transferred to any Investment Option,
including any GPO we then make available. However, any GPO elected may not extend beyond the last available Annuity Commencement Date. If we do not receive instructions from You in Good Order before the end of the GPO regarding how the Policy Value
in that GPO is to be allocated, we will allocate the Policy Value in that GPO to the Money Market Subaccount available in Your policy. No Excess Interest Adjustment (EIA) applies at the end of a GPO. 

When funds are withdrawn or transferred from a GPO, the Policy Value associated with the oldest Premium Payment is considered to be
withdrawn or transferred first. If the amount withdrawn or transferred exceeds the Policy Value associated with the oldest premium, the Policy Value associated with the next oldest Premium Payment is considered to be withdrawn or transferred next,
and so on until the Policy Value associated with the most recent premium is considered to be withdrawn or transferred (this is a First-In, First-Out, or FIFO, basis). 
 Withdrawals, Surrenders, transfers and amounts applied to an income option from the GPO(s) may be subject to an EIA. Amounts received during the right to cancel period are not subject to an EIA.

 Dollar Cost Averaging Fixed Account Option 
 We may offer a Dollar Cost Averaging (DCA) Fixed Account Option (a “DCA Source Account”) separate from the Guaranteed Period Options. This option will have a one-year interest rate guarantee.
The current interest rate we credit may vary on different portions of the DCA Fixed Account. The credited interest rate will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 - Policy
Data. The DCA Fixed Account Option will only be available under a Dollar Cost Averaging program as described in Section 8. 

  

			
	ICC12 VA(2)0513	  	Page 21

 APPENDIX 
 SECTION 12 – GUARANTEED FIXED INCOME OPTION TABLES 
 The amounts shown
in these tables are the guaranteed amounts for each $1,000 of the policy proceeds. 
 Higher current amounts may be available at
the time of settlement. 
  

																							
	Option 1	  	  	  	Option 2(a)	  	Option 2(b)	  	Option
2(c)
	  
 Number
of Years
Payable
	  	  

Amount of
Monthly
    Installment    
	  	  	  	  
 Monthly Installment For
Life No Period Certain
	  	  
 Monthly Installment For
Life 10 Years Certain
	  	  
 Monthly Installment For
Life Guaranteed Return of
Policy Proceeds

	  	  	  	  	Age*	  	Male	  	Female	  	Unisex	  	Male	  	Female	  	Unisex	  	Male	  	Female	  	Unisex
	 	  		  	50	  	$2.22	  	$2.00	  	$2.07	  	$2.21	  	$2.00	  	$2.06	  	$1.85	  	$1.74	  	$1.78
	 	  		  	51	  	2.27	  	2.05	  	2.12	  	2.26	  	2.05	  	2.11	  	1.89	  	1.78	  	1.80
	 	  		  	52	  	2.33	  	2.10	  	2.17	  	2.32	  	2.10	  	2.17	  	1.91	  	1.80	  	1.84
	 	  		  	53	  	2.40	  	2.15	  	2.23	  	2.39	  	2.15	  	2.22	  	1.95	  	1.84	  	1.88
	 	  		  	54	  	2.46	  	2.21	  	2.29	  	2.45	  	2.21	  	2.28	  	1.99	  	1.88	  	1.91
	 	  		  	55	  	2.54	  	2.27	  	2.35	  	2.52	  	2.26	  	2.34	  	2.03	  	1.91	  	1.95
	 	  		  	56	  	2.61	  	2.33	  	2.42	  	2.59	  	2.33	  	2.41	  	2.07	  	1.95	  	1.99
	 	  		  	57	  	2.69	  	2.40	  	2.49	  	2.67	  	2.39	  	2.48	  	2.13	  	1.99	  	2.03
	 	  		  	58	  	2.77	  	2.47	  	2.56	  	2.75	  	2.46	  	2.55	  	2.17	  	2.03	  	2.07
	
10
	  	8.44	  	59	  	2.86	  	2.54	  	2.64	  	2.83	  	2.53	  	2.62	  	2.21	  	2.07	  	2.13
	
11
	  	7.68	  	60	  	2.95	  	2.62	  	2.72	  	2.92	  	2.61	  	2.70	  	2.26	  	2.13	  	2.17
	
12
	  	7.05	  	61	  	3.05	  	2.70	  	2.81	  	3.02	  	2.69	  	2.79	  	2.32	  	2.17	  	2.21
	
13
	  	6.51	  	62	  	3.16	  	2.79	  	2.90	  	3.11	  	2.77	  	2.88	  	2.38	  	2.22	  	2.26
	
14
	  	6.06	  	63	  	3.27	  	2.88	  	3.00	  	3.22	  	2.86	  	2.97	  	2.44	  	2.28	  	2.33
	
15
	  	5.66	  	64	  	3.39	  	2.98	  	3.10	  	3.33	  	2.95	  	3.07	  	2.49	  	2.34	  	2.39
	
16
	  	5.31	  	65	  	3.51	  	3.09	  	3.21	  	3.45	  	3.05	  	3.17	  	2.55	  	2.39	  	2.43
	
17
	  	5.01	  	66	  	3.65	  	3.20	  	3.33	  	3.57	  	3.16	  	3.28	  	2.61	  	2.44	  	2.49
	
18
	  	4.73	  	67	  	3.79	  	3.32	  	3.46	  	3.70	  	3.27	  	3.40	  	2.69	  	2.50	  	2.55
	
19
	  	4.49	  	68	  	3.95	  	3.44	  	3.59	  	3.83	  	3.39	  	3.53	  	2.75	  	2.57	  	2.64
	
20
	  	4.27	  	69	  	4.11	  	3.58	  	3.74	  	3.97	  	3.52	  	3.66	  	2.82	  	2.64	  	2.69
	 	  		  	70	  	4.29	  	3.73	  	3.89	  	4.12	  	3.65	  	3.79	  	2.90	  	2.72	  	2.77
	 	  		  	71	  	4.47	  	3.89	  	4.06	  	4.27	  	3.80	  	3.94	  	3.00	  	2.79	  	2.84
	 	  		  	72	  	4.67	  	4.06	  	4.24	  	4.43	  	3.95	  	4.09	  	3.08	  	2.86	  	2.93
	 	  		  	73	  	4.88	  	4.24	  	4.43	  	4.59	  	4.11	  	4.25	  	3.15	  	2.94	  	3.02
	 	  		  	74	  	5.10	  	4.44	  	4.64	  	4.76	  	4.27	  	4.42	  	3.25	  	3.06	  	3.12
	 	  		  	75	  	5.34	  	4.65	  	4.86	  	4.94	  	4.45	  	4.60	  	3.35	  	3.13	  	3.20
	 	  		  	76	  	5.60	  	4.88	  	5.09	  	5.12	  	4.63	  	4.78	  	3.46	  	3.21	  	3.30
	 	  		  	77	  	5.88	  	5.13	  	5.35	  	5.31	  	4.82	  	4.97	  	3.60	  	3.35	  	3.41
	 	  		  	78	  	6.17	  	5.40	  	5.63	  	5.50	  	5.02	  	5.17	  	3.66	  	3.44	  	3.51
	 	  		  	79	  	6.49	  	5.69	  	5.92	  	5.69	  	5.22	  	5.37	  	3.81	  	3.53	  	3.62
	 	  		  	80	  	6.82	  	6.00	  	6.24	  	5.88	  	5.43	  	5.57	  	3.89	  	3.68	  	3.74
	 	  		  	81	  	7.19	  	6.34	  	6.59	  	6.08	  	5.65	  	5.78	  	4.06	  	3.81	  	3.87
	 	  		  	82	  	7.58	  	6.70	  	6.96	  	6.27	  	5.86	  	5.99	  	4.20	  	3.89	  	4.00
	 	  		  	83	  	7.99	  	7.10	  	7.36	  	6.46	  	6.08	  	6.20	  	4.34	  	4.09	  	4.16
	 	  		  	84	  	8.44	  	7.53	  	7.80	  	6.65	  	6.29	  	6.40	  	4.50	  	4.23	  	4.32
	 	  		  	85	  	8.92	  	7.99	  	8.27	  	6.83	  	6.49	  	6.60	  	4.70	  	4.40	  	4.49
	 	  		  	86	  		  		  	 	  	7.00	  	6.69	  	6.79	  	4.89	  	4.54	  	4.74
	 	  		  	87	  		  		  	 	  	7.17	  	6.88	  	6.97	  	5.11	  	4.71	  	4.84
	 	  		  	88	  		  		  	 	  	7.32	  	7.06	  	7.14	  	5.28	  	4.90	  	5.08
	 	  		  	89	  		  		  	 	  	7.47	  	7.23	  	7.31	  	5.53	  	5.19	  	5.27
	 	  		  	90	  		  		  	 	  	7.60	  	7.39	  	7.46	  	5.73	  	5.39	  	5.48
	 	  		  	91	  		  		  	 	  	7.73	  	7.53	  	7.59	  	5.88	  	5.63	  	5.79
	 	  		  	92	  		  		  	 	  	7.84	  	7.66	  	7.72	  	6.17	  	5.78	  	5.97
	 	  		  	93	  		  		  	 	  	7.95	  	7.79	  	7.84	  	6.44	  	6.02	  	6.17
	 	  		  	94	  		  		  	 	  	8.04	  	7.90	  	7.94	  	6.79	  	6.46	  	6.52
	 	  		  	95	  		  		  	 	  	8.12	  	8.00	  	8.04	  	7.13	  	6.73	  	6.83
	 	  		  	96	  		  		  	 	  	8.20	  	8.09	  	8.13	  	7.40	  	6.89	  	7.17
	 	  		  	97	  		  		  	 	  	8.26	  	8.17	  	8.20	  	7.91	  	7.53	  	7.66
	 	  		  	98	  		  		  	 	  	8.31	  	8.24	  	8.27	  	8.19	  	7.84	  	7.75
	 	  	 	  	99	  	 	  	 	  	 	  	8.35	  	8.30	  	8.32	  	8.82	  	8.18	  	8.57

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

  

			
	ICC12 AP(2)0513	  	Page 22(a)

 APPENDIX (continued) 

Option 4(a) 

Monthly Installment For Joint and Survivor 
  

															
	 Adjusted Age
 of

Male
Annuitant*
	  	Adjusted Age of Female
Annuitant*
	  	15 Years
Less Than
Male	  	12 Years
Less Than
Male	  	9 Years
Less Than
Male	  	6 Years
Less Than
Male	  	3 Years
Less Than
Male	  	Same As
Male	  	3 Years
More Than
Male
	 50
	  	$1.45	  	$1.51	  	$1.58	  	$1.66	  	$1.73	  	$1.80	  	$1.87
	
55
	  	1.58	  	1.66	  	1.75	  	1.84	  	1.93	  	2.02	  	2.10
	
60
	  	1.75	  	1.85	  	1.95	  	2.07	  	2.18	  	2.29	  	2.41
	
65
	  	1.95	  	2.08	  	2.21	  	2.36	  	2.51	  	2.66	  	2.81
	
70
	  	2.21	  	2.37	  	2.55	  	2.74	  	2.94	  	3.15	  	3.35
	
75
	  	2.54	  	2.76	  	3.00	  	3.26	  	3.54	  	3.83	  	4.11
	
80
	  	2.99	  	3.29	  	3.62	  	3.99	  	4.39	  	4.79	  	5.18
	 85
	  	3.60	  	4.02	  	4.50	  	5.03	  	5.59	  	6.17	  	6.71

 Monthly Installment For Unisex Joint and Survivor 

															
	 Adjusted Age

of

First

Annuitant*
	  	Adjusted Age of Joint
Annuitant*
	  	15 Years
Less Than
First	  	12 Years
Less Than
First	  	9 Years
Less Than
First	  	6 Years
Less Than
First	  	3 Years
Less Than
First	  	 Same As

First
	  	3 Years
More Than
First
	
50
	  	$1.47	  	$1.53	  	$1.60	  	$1.66	  	$1.72	  	$1.78	  	$1.84
	
55
	  	1.61	  	1.68	  	1.76	  	1.84	  	1.92	  	2.00	  	2.06
	
60
	  	1.78	  	1.87	  	1.97	  	2.07	  	2.17	  	2.27	  	2.36
	
65
	  	1.99	  	2.11	  	2.24	  	2.37	  	2.50	  	2.62	  	2.74
	
70
	  	2.26	  	2.41	  	2.58	  	2.76	  	2.93	  	3.11	  	3.27
	
75
	  	2.60	  	2.81	  	3.04	  	3.28	  	3.53	  	3.77	  	4.00
	
80
	  	3.07	  	3.36	  	3.68	  	4.02	  	4.37	  	4.71	  	5.04
	 85
	  	3.71	  	4.12	  	4.58	  	5.07	  	5.57	  	6.07	  	6.54

 Option 4(b) 
 Monthly Installment For Joint and Survivor (Life with 10 year Certain) 
  

															
	 Adjusted Age

of
 Male

Annuitant*
	  	Adjusted Age of Female
Annuitant*
	  	15 Years
Less Than
Male	  	12 Years
Less Than
Male	  	9 Years
Less Than
Male	  	6 Years
Less Than
Male	  	3 Years
Less Than
Male	  	Same As
Male	  	3 Years
More Than
Male
	
50
	  	$1.45	  	$1.51	  	$1.58	  	$1.66	  	$1.73	  	$1.80	  	$1.87
	
55
	  	1.58	  	1.66	  	1.75	  	1.84	  	1.93	  	2.02	  	2.10
	
60
	  	1.75	  	1.85	  	1.95	  	2.07	  	2.18	  	2.29	  	2.41
	
65
	  	1.95	  	2.08	  	2.21	  	2.36	  	2.51	  	2.66	  	2.80
	
70
	  	2.21	  	2.37	  	2.55	  	2.74	  	2.94	  	3.14	  	3.34
	
75
	  	2.54	  	2.76	  	3.00	  	3.25	  	3.53	  	3.80	  	4.07
	
80
	  	2.98	  	3.27	  	3.60	  	3.95	  	4.32	  	4.68	  	5.02
	 85
	  	3.58	  	3.97	  	4.41	  	4.88	  	5.34	  	5.76	  	6.11

 Monthly Installment For Unisex Joint and Survivor (Life with 10 year Certain) 

 

															
	 Adjusted Age
 of

First

Annuitant*
	  	Adjusted Age of Joint
Annuitant*
	  	 15 Years

Less Than

First
	  	 12 Years

Less Than

First
	  	 9 Years

Less Than

First
	  	 6 Years

Less Than

First
	  	 3 Years

Less Than

First
	  	 Same As

First
	  	 3 Years

More Than

First

	 50
	  	$1.47	  	$1.53	  	$1.60	  	$1.66	  	$1.72	  	$1.78	  	$1.84
	
55
	  	1.61	  	1.68	  	1.76	  	1.84	  	1.92	  	2.00	  	2.06
	
60
	  	1.78	  	1.87	  	1.97	  	2.07	  	2.17	  	2.27	  	2.36
	
65
	  	1.99	  	2.11	  	2.24	  	2.37	  	2.50	  	2.62	  	2.74
	
70
	  	2.25	  	2.41	  	2.58	  	2.75	  	2.93	  	3.10	  	3.26
	
75
	  	2.60	  	2.81	  	3.04	  	3.27	  	3.52	  	3.75	  	3.96
	
80
	  	3.06	  	3.35	  	3.66	  	3.98	  	4.31	  	4.62	  	4.90
	 85
	  	3.68	  	4.06	  	4.48	  	4.91	  	5.33	  	5.70	  	6.00

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

  

			
	ICC12 AP(2)0513	  	Page 22(b)

 APPENDIX (continued) 

SECTION 13 - VARIABLE INCOME OPTION TABLES 
 BASED ON ASSUMED INVESTMENT RETURN 
 The amounts shown in these tables are
the initial payment amounts based on a 3.0% Assumed Investment Return for each $1,000 of the policy proceeds. 
  

													
	  	  	Option 2-V(a)	  	Option
2-V(b)
	  	  	 Monthly Installment For

Life No Period Certain
	  	 Monthly Installment
For
 Life 10 Years Certain

	Age*	  	Male	  	Female	  	Unisex	  	Male	  	Female	  	Unisex
	
50
	  	$3.70	  	$3.47	  	$3.54	  	$3.68	  	$3.47	  	$3.53
	
51
	  	  3.76	  	  3.52	  	  3.59	  	  3.74	  	  3.51	  	  3.58
	
52
	  	  3.82	  	  3.57	  	  3.65	  	  3.80	  	  3.56	  	  3.63
	
53
	  	  3.88	  	  3.62	  	  3.70	  	  3.86	  	  3.61	  	  3.69
	
54
	  	  3.95	  	  3.68	  	  3.76	  	  3.92	  	  3.66	  	  3.74
	
55
	  	  4.02	  	  3.73	  	  3.82	  	  3.99	  	  3.72	  	  3.80
	
56
	  	  4.09	  	  3.80	  	  3.89	  	  4.06	  	  3.78	  	  3.87
	
57
	  	  4.17	  	  3.86	  	  3.96	  	  4.13	  	  3.84	  	  3.93
	
58
	  	  4.25	  	  3.93	  	  4.03	  	  4.21	  	  3.91	  	  4.00
	
59
	  	  4.34	  	  4.00	  	  4.11	  	  4.30	  	  3.98	  	  4.08
	
60
	  	  4.44	  	  4.08	  	  4.19	  	  4.38	  	  4.05	  	  4.15
	
61
	  	  4.54	  	  4.16	  	  4.28	  	  4.48	  	  4.13	  	  4.24
	
62
	  	  4.65	  	  4.25	  	  4.37	  	  4.57	  	  4.21	  	  4.32
	
63
	  	  4.76	  	  4.34	  	  4.47	  	  4.68	  	  4.30	  	  4.42
	
64
	  	  4.89	  	  4.44	  	  4.58	  	  4.79	  	  4.39	  	  4.51
	
65
	  	  5.02	  	  4.55	  	  4.69	  	  4.90	  	  4.49	  	  4.62
	
66
	  	  5.16	  	  4.66	  	  4.81	  	  5.02	  	  4.60	  	  4.73
	
67
	  	  5.31	  	  4.78	  	  4.94	  	  5.15	  	  4.71	  	  4.84
	
68
	  	  5.47	  	  4.91	  	  5.08	  	  5.28	  	  4.83	  	  4.97
	
69
	  	  5.64	  	  5.05	  	  5.23	  	  5.42	  	  4.95	  	  5.10
	
70
	  	  5.82	  	  5.21	  	  5.39	  	  5.56	  	  5.09	  	  5.23
	
71
	  	  6.01	  	  5.37	  	  5.56	  	  5.71	  	  5.23	  	  5.38
	
72
	  	  6.22	  	  5.55	  	  5.75	  	  5.86	  	  5.37	  	  5.53
	
73
	  	  6.44	  	  5.74	  	  5.95	  	  6.02	  	  5.53	  	  5.68
	
74
	  	  6.67	  	  5.94	  	  6.16	  	  6.19	  	  5.70	  	  5.85
	
75
	  	  6.92	  	  6.17	  	  6.39	  	  6.36	  	  5.87	  	  6.02
	
76
	  	  7.18	  	  6.40	  	  6.64	  	  6.53	  	  6.05	  	  6.20
	
77
	  	  7.47	  	  6.66	  	  6.90	  	  6.71	  	  6.23	  	  6.38
	
78
	  	  7.77	  	  6.94	  	  7.19	  	  6.89	  	  6.42	  	  6.57
	
79
	  	  8.10	  	  7.24	  	  7.49	  	  7.07	  	  6.62	  	  6.76
	
80
	  	  8.45	  	  7.56	  	  7.83	  	  7.25	  	  6.82	  	  6.96
	
81
	  	  8.82	  	  7.92	  	  8.19	  	  7.44	  	  7.02	  	  7.15
	
82
	  	  9.23	  	  8.30	  	  8.57	  	  7.62	  	  7.23	  	  7.35
	
83
	  	  9.66	  	  8.71	  	  8.99	  	  7.79	  	  7.43	  	  7.54
	
84
	  	10.12	  	  9.16	  	  9.44	  	  7.96	  	  7.63	  	  7.73
	
85
	  	10.61	  	  9.64	  	  9.93	  	  8.13	  	  7.82	  	  7.92
	
86
	  		  		  	 	  	  8.29	  	  8.00	  	  8.09
	
87
	  		  		  	 	  	  8.44	  	  8.18	  	  8.26
	
88
	  		  		  	 	  	  8.58	  	  8.34	  	  8.42
	
89
	  		  		  	 	  	  8.71	  	  8.50	  	  8.57
	
90
	  		  		  	 	  	  8.84	  	  8.64	  	  8.70
	
91
	  		  		  	 	  	  8.95	  	  8.77	  	  8.83
	
92
	  		  		  	 	  	  9.06	  	  8.89	  	  8.95
	
93
	  		  		  	 	  	  9.15	  	  9.01	  	  9.06
	
94
	  		  		  	 	  	  9.24	  	  9.11	  	  9.15
	
95
	  		  		  	 	  	  9.32	  	  9.20	  	  9.24
	
96
	  		  		  	 	  	  9.39	  	  9.29	  	  9.32
	
97
	  		  		  	 	  	  9.45	  	  9.36	  	  9.39
	
98
	  		  		  	 	  	  9.49	  	  9.43	  	  9.45
	 99
	  	 	  	 	  	 	  	  9.53	  	  9.48	  	  9.50

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

  

			
	ICC12 AP(2)0513	  	Page 22(c)

 APPENDIX (continued) 

Option 4-V 

Monthly Installment For Joint and Survivor 
  

															
	 Adjusted Age

of
 Male

Annuitant*
	  	Adjusted Age of Female Annuitant*
	  	15 Years
Less Than
Male	  	12 Years
Less Than
Male	  	 9 Years

Less Than
Male
	  	 6 Years

Less Than
Male
	  	 3 Years

Less Than
Male
	  	Same As
Male	  	3 Years
More Than
Male
	  

50
	  	$2.96	  	$3.01	  	$3.06	  	$3.12	  	$3.18	  	$3.24	  	$3.31
	
55
	  	  3.07	  	  3.14	  	  3.21	  	  3.28	  	  3.36	  	  3.44	  	  3.52
	
60
	  	  3.21	  	  3.30	  	  3.39	  	  3.49	  	  3.59	  	  3.70	  	  3.81
	
65
	  	  3.40	  	  3.51	  	  3.64	  	  3.77	  	  3.91	  	  4.05	  	  4.20
	
70
	  	  3.64	  	  3.79	  	  3.96	  	  4.14	  	  4.34	  	  4.54	  	  4.74
	
75
	  	  3.97	  	  4.17	  	  4.41	  	  4.66	  	  4.93	  	  5.22	  	  5.50
	
80
	  	  4.41	  	  4.70	  	  5.03	  	  5.39	  	  5.79	  	  6.19	  	  6.60
	 85
  
	  	   5.03

 
	  	   5.45

 
	  	   5.92

 
	  	   6.45

 
	  	   7.02

 
	  	   7.59

 
	  	   8.15

 

 Monthly Installment For Unisex Joint and Survivor 

 

															
	 Adjusted Age

of

First

Annuitant*
	  	Adjusted Age of Joint
Annuitant*
	  	 15 Years

Less Than

First
	  	 12 Years

Less Than

First
	  	 9 Years

Less Than

First
	  	 6 Years

Less Than

First
	  	 3 Years

Less Than

First
	  	 Same As

First
	  	 3
Years
 More Than
 First

	  

50
	  	$2.97	  	$3.02	  	$3.07	  	$3.12	  	$3.18	  	$3.23	  	$3.28
	
55
	  	  3.09	  	  3.15	  	  3.22	  	  3.29	  	  3.35	  	  3.42	  	  3.48
	
60
	  	  3.24	  	  3.32	  	  3.41	  	  3.49	  	  3.58	  	  3.67	  	  3.76
	
65
	  	  3.43	  	  3.54	  	  3.65	  	  3.77	  	  3.89	  	  4.02	  	  4.13
	
70
	  	  3.68	  	  3.83	  	  3.98	  	  4.15	  	  4.32	  	  4.49	  	  4.65
	
75
	  	  4.02	  	  4.22	  	  4.44	  	  4.67	  	  4.92	  	  5.16	  	  5.39
	
80
	  	  4.49	  	  4.77	  	  5.08	  	  5.42	  	  5.76	  	  6.11	  	  6.45
	 85
  
	  	   5.14

 
	  	   5.54

 
	  	   6.00

 
	  	   6.48

 
	  	   6.99

 
	  	   7.50

 
	  	   7.97

 

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

  

			
	ICC12 AP(2)0513	  	Page 22(d)

  
  

 
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	  	 Administrative and Home Office:
 4333 Edgewood Road N.E.
 Cedar Rapids, Iowa 52499

(319) 355-8511

www.transamericaannuities.com

	  
	  
	 A Stock Company (Hereafter called the Company, we, our or us)
	  
		  

  

			
	ICC12 VA(2)0513	  	Page 23

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00215-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00215-of-00352.parquet"}]]