Document:

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                                                                   Exhibit 10.37

          STATEMENT UNDER SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

         The undersigned officers of Provant, Inc. (the "Company") hereby
certify that, as of the date of this statement, the Company's annual report on
Form 10-K for the year ended June 30, 2002 (the "Report") fully complies with
the requirements of section 13(a) of the Securities Exchange Act of 1934 and
that information contained in the Report fairly presents, in all material
respects, the financial condition and results of operations of the Company as of
and for the year ended June 30, 2002.

         The purpose of this statement is solely to comply with Title 18,
Chapter 63, Section 1350 of the United States Code, as amended by Section 906 of
the Sarbanes-Oxley Act of 2002. This statement is not "filed" for the purposes
of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the
liabilities of that Act or any other federal or state law or regulation.

         Date:  October 15, 2002                  /s/ John H. Zenger
                                                  -----------------------
                                                  Name: John H. Zenger
                                                  Title: Chief Executive Officer

         Date:  October 15, 2002                  /s/ Janet Hoey
                                                  ------------------------
                                                  Name: Janet Hoey
                                                  Title: Chief Financial Officer<PAGE>

                                 EXHIBIT (4)(e)

                                 FORM OF POLICY

<PAGE>

<TABLE>
<S>                                                                                               <C>
    AUSA LIFE INSURANCE COMPANY, INC.
    A Stock Company         Home Office located at:  4 Manhattanville Road, Purchase, New York
    Adm. Office located at: 4333 Edgewood Road N.E. Cedar Rapids, Iowa  52499                     (800) 553-5957
    (Hereafter called the Company, we, our or us)
</TABLE>

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                           POLICY NUMBER:  07 - 12345

This is a legal contract between the Owner and AUSA Life Insurance Company,
Inc., a Stock Company (Hereafter called the Company, we, our or us). The Company
will provide annuities and other benefits as set out in this annuity policy,
subject to its provisions. This annuity policy is delivered in, and is governed
by, the laws of the State of New York.

                                    WE AGREE

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

o   Or to pay Withdrawal benefits in accordance with Section 5 of this policy,

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

This policy permits the accumulation of funds on a tax-deferred basis and
provides a periodic annuity payment for the life of the Annuitant or for a
certain period of time. Payments start 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 Annuity
Payments will not decrease is 6.25%

Prior to the Annuity Commencement Date, a daily charge corresponding to an
annual charge of 1.45% for the Annual Step-Up death benefit option, (1.30% for
the Return of Premium death benefit option), is applied by the Company to the
assets of the Separate Account. The corresponding charge after the Annuity
Commencement Date is 1.25%, regardless of death benefit option elected prior to
the Annuity Commencement Date. In addition, a maximum annual Service Charge of
$30 is assessed (prior to the Annuity Commencement Date only) on each Policy
Anniversary if either the sum of premiums less Withdrawals is less than $50,000
(or the Policy Value is less than $50,000) on the Policy Anniversary. See the
"Service Charge" provision in Section 4 and the "Charges and Deductions"
provision in section 6 of this policy for more details.

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

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

                             20 DAY RIGHT TO CANCEL

You may cancel this policy by delivering or mailing a written notice to us or
your agent. You must return the policy before midnight of the twentieth day
after the day You receive it. Notice given by mail and return of the policy by
mail are effective upon being mailed, properly addressed and postage prepaid. We
must return the Policy Value within 10 days after we receive notice of
cancellation and the returned policy.

If this policy is a replacement of another policy, the Right to Cancel period is
extended to 60 days and we will return the Policy Value for this policy within
10 days after we receive notice of cancellation and the returned policy.

The value of the Subaccount(s) is based on the value of the Separate Account
assets which are not guaranteed as to fixed dollar amounts and will increase or
decrease in value based on investment results.

                        Signed for us at our home office.

    /s/ Craig D. Vermie                          /s/ Tom Schlossberg

         SECRETARY                                     PRESIDENT

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

                   Flexible Premium Deferred Variable Annuity
                   Income Payable At Annuity Commencement Date
          Benefits Based On The Performance Of The Separate Account Are
  Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C)
                                Non-Participating

AV806 101 158 102

<PAGE>

                             SECTION 1 - DEFINITIONS

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

ANNUITY COMMENCEMENT DATE - The Date the Annuitant will begin receiving payments
from this policy. This date may be changed by the Owner as described in Section
3. In no event can this date be later than the last day of the month following
the month in which the Annuitant attains age 90 or 10 years from the Policy Date
if later.

CASH VALUE - Amount, defined in Section 5 that is available for partial or full
Surrenders.

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

DISTRIBUTION - A Withdrawal or disbursement of funds from the Policy Value or
Cash Value. Policy Value and Cash Value will be reduced by any Distribution.

EARNINGS - The gains, if any, in the Policy Value.

GAINS - Cumulative Earnings, if any, in the Policy Value.

INVESTMENT OPTIONS - Any of the Guaranteed Period Options of the Fixed Account,
the Dollar Cost Averaging Fixed Account Option, and any of the Subaccounts of
the Separate Account.

MONTHIVERSARY - The same date each month as
the Policy Date. If there is no day in the calendar month, which coincides with
the Policy Date, the Monthiversary will be the next business day on which the
New York Stock Exchange is open for trading.

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

PAYMENT OPTIONS - Options through which the distribution of the Policy Value can
be directed.

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

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

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

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

SEPARATE ACCOUNT - The separate investment account(s) established by us, as
described in Section 6. The investment performance of the Separate Account is
independent of the performance of the general assets of the Company.

SUBACCOUNT - A division of the Separate Account which invests in shares of one
Portfolio. The investment performance of each Subaccount is directly linked to
the investment performance of the corresponding Portfolio, as described in
Section 6.

SURRENDER - A partial or full Withdrawal of funds from the Policy Value or Cash
Value.

WITHDRAWAL - A distribution of funds from the Policy Value or Cash Value.

YOU, YOUR - The owner of this policy. Unless otherwise specified on the Policy
Data page, the Annuitant and the owner shall be one and the same person. If the
owner is a trust and the trust allows any person(s) other than the trustee to
exercise ownership rights under the policy, then such person(s) must be named as
the Annuitant, as applicable. The Owner while living, controls all rights and
benefits under the policy. The right of survivorship means that if a Joint Owner
dies, his or her interest in the policy will pass to the surviving Joint Owner
in accordance with the Death Provisions (see Section 9). If a joint owner is
named, reference to "You" or "Your" in this policy will apply to both the owner
and the joint owner.

This policy may not have Joint Owners if it is issued in connection with a tax
qualified retirement plan or program.

AVB806                               Page 2

<PAGE>

                             SECTION 2 - POLICY DATA

POLICY NUMBER:       [NY - 01234]                 ANNUITANT:    [John Doe]

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

POLICY DATE:         [August 1, 2002]              OWNER(S):    [John Doe]

ANNUITY
COMMENCEMENT                                      GUARANTEED
DATE:                [August 10, 2051]               MINIMUM
                                               DEATH BENEFIT
                                                     OPTION:    [P]
BENEFICIARY:         [Jane Doe]

Initial Effective Annual Interest Rate Credited to Fixed Account:        [3.50%]

Fixed Account Guaranteed Minimum Effective Annual Interest Rate:          3.00%

Before the Annuity Commencement Date:

    SERVICE CHARGE:  Annual charge equal to the lesser of 2% of the Policy
         Value or $30.

    Death Benefit Option P - Return of Premium
         Mortality and Expense Risk Fee and Administrative Charge:         1.30%

    Death Benefit Option C - Annual Step-up to age 81
         Mortality and Expense Risk Fee and Administrative Charge:         1.45%

After the Annuity Commencement Date:

         Mortality and Expense Risk Fee and Administrative Charge:         1.25%

         The minimum initial premium payment is $5,000 for nonqualified and
         $1,000 for qualified.

         The maximum total premium payments, which we will accept without prior
         Approval is $1,000,000.

SURRENDER CHARGES:

           Number of Years                               Percentage of
      Since Premium Payment Date                       Premium Withdrawn

              0-1                                            8%
              1-2                                            8%
              2-3                                            7%
              3-4                                            6%
              4-5                                            5%
              5-6                                            4%
              6-7                                            3%
              7 or more                                      0%

AV806 101 158 102SP                       Page 3

<PAGE>

                          SECTION 3 - PREMIUM PAYMENTS

PAYMENT OF PREMIUMS
Premium payments may be made any time while this policy is in force before the
Annuity Commencement Date. You may start or stop, increase or decrease, or skip
any Premium Payments. We reserve the right to prohibit premium payments to the
Fixed Account if we are crediting an interest rate equal to the Fixed Account
Guaranteed Minimum Effective Annual Interest Rate of 3%.

MAXIMUM AND MINIMUM PREMIUM PAYMENT
The premium payments may not be more than the amount permitted by law if this is
a tax-qualified annuity. The minimum initial premium payment is $5,000. If this
policy is being used as a tax-qualified annuity, the minimum initial premium is
$1,000, except that no minimum initial premium payment will be required for
403(b) annuities. The minimum subsequent premium payment we will accept is $50.
The maximum total premium payments which we will accept without prior Company
approval is $1,000,000.

If premium payments are discontinued, the Policy Value at the cessation of
premium payments will be held by us and the Fixed Account portion of the policy
will continue to be credited with at least the guaranteed interest rate provided
in this policy. We may delcare a higher rate in advance. On the Annuity
Commencement Date we will distribute the Policy Value under one of the Annuity
Payment Options.

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

ALLOCATION OF PREMIUM PAYMENTS
Premium payments may be applied to various Investment Options, which we make
available. For each premium payment, You must indicate what percentage to
allocate to various Investment Options. Each percent may be either zero or any
whole number; however, the allocation among all accounts must total 100%.

CHANGE OF ALLOCATION
You may change the allocation of premium payments to various Investment Options
by providing us notice containing the facts that we need. Premium payments
received after the date on which we receive Your notice will be applied on the
basis of the new allocation.

PREMIUM TAXES
The insurance laws of the State of New York currently do not allow the
imposition of premium taxes on annuity considerations. Therefore, wherever
reference is made in this annuity policy to the deduction of premium taxes, such
deductions will not be made while the Owner is a resident of the State of New
York, unless subsequent changes in New York's insurance laws provide otherwise.
The amount of any applicable premium tax imposed on amounts relating to this
annuity policy may be withdrawn from this annuity policy. For purposes of this
annuity policy, premium taxes include retaliatory taxes or similar taxes.

M1381                               Page 4

<PAGE>

                            SECTION 4 - POLICY VALUE

POLICY VALUE
On or before the Annuity Commencement Date, the Policy Value is equal to Your:

(a) premium payments; minus
(b) Gross Partial Withdrawals (as defined in Section 5); plus
(c) interest credited to the Fixed Account (see Section 7); plus
(d) accumulated gains in the Separate Account (see Section 6); minus
(e) accumulated losses in the Separate Account (see Section 6); minus
(f) service charges, premium taxes, rider fees and transfer fees, if any.

You may use the Policy Value on the Annuity Commencement Date to provide
lifetime income or income for a period of no less than 60 months under the
General Payment Provisions in Section 10.

SERVICE CHARGE
On each Policy Anniversary during any Policy Year before the Annuity
Commencement Date, we reserve the right to assess a Service Charge up to $30 for
policy administration expenses. The Service Charge will be deducted from each
Investment Option in proportion to the portion of Policy Value (prior to such
charge) in each Investment Option. In no event will the Service Charge exceed 2%
of the Policy Value on the Policy Anniversary.

The Service Charge will not be deducted on a Policy Anniversary if, (1) the sum
of all premium payments less the sum of all Withdrawals taken equals or exceeds
$50,000; or (2) the Policy Value equals or exceeds $50,000.

                 SECTION 5 - CASH VALUE AND PARTIAL WITHDRAWALS

CASH VALUE
On or before the Annuity Commencement Date, the Cash Value is equal to the
Policy Value less any surrender charges. Information on the current amount of
Your policy's Cash Value is available upon request. The Cash Value may be
partially withdrawn or will be paid in the event of a full Surrender of the
policy. We must receive Your written partial Withdrawal or Surrender request
before the Annuity Commencement Date.

There is no Cash Value once an Annuity Payment Option has been selected.

U1381                               Page 5

<PAGE>

                              SECTION 5 - CONTINUED

PARTIAL WITHDRAWALS
We will pay You a portion of the Cash Value as a Partial Withdrawal provided we
receive Your written request while the policy is in effect and before the
Annuity Commencement Date. When You request a Partial Withdrawal You must tell
us how it is to be allocated from among the Investment Options. If Your request
for a Partial Withdrawal from any Investment Option is less than or equal to the
Cash Value in that option, we will pay the amount of Your request. However, if
Your request for a Partial Withdrawal from any Investment Option is greater than
the Cash Value in that option, we will pay You the Cash Value of that Investment
Option.

The Gross Partial Withdrawal is the total amount which will be deducted from
Your Policy Value as a result of each Partial Withdrawal. The Gross Partial
Withdrawal may be more or less than Your requested Partial Withdrawal amount,
depending on whether surrender charges apply at the time You request the Partial
Withdrawal.

The Excess Partial Withdrawal amount is the portion of the requested Partial
Withdrawal that is subject to surrender charge (that is, the portion which is in
excess of the surrender charge-free portion). For example, if the requested
Withdrawal amount is $1,000, and the surrender charge-free amount is $200, then
the Excess Partial Withdrawal would be $800. Excess Partial Withdrawals will
reduce the Policy Value by an amount equal to (X+Z) where:

X = Excess Partial Withdrawal
Z = surrender charge on X.

The formula for determining the Gross Partial Withdrawal is as follows:

Gross Partial Withdrawal = R + SC, where:

R      is the requested Partial Withdrawal;
       and

SC     is the surrender charge on EPW; where

EPW    is the Excess Partial Withdrawal Amount (the portion of the requested
       Partial Withdrawal that is subject to surrender charge).

If no premium payments have been made for three years and any Partial Withdrawal
reduces the Cash Value below $500, we reserve the right to pay the full Cash
Value and terminate the policy.

We may delay payment of the Cash Value from the Fixed Account for up to 6 months
after we receive the request. If payment of the Partial Withdrawal or full
Surrender is not made within 10 business days of our receipt of the request, We
will pay interest on that amount from the date of receipt to the date of
payment. The interest rate will be the rate that is currently paid on Guaranteed
Payment Option 1, Interest Payments. If the owner dies after we receive the
request, but before the request is processed, the request will be processed
before the death proceeds are determined.

For interest crediting purposes only, the oldest premium payment is considered
to be withdrawn first, then the interest associated with that premium payment.
If the amount withdrawn exceeds this amount, the next oldest premium payment,
and its associated interest is considered to be withdrawn, and so on until the
most recent premium payment and its associated interest is considered to be
withdrawn (i.e. Partial Withdrawals are made on a First-In, First-Out or "FIFO"
basis).

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

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

LUMP SUM
Beginning in the second Policy Year, You may withdraw, free from surrender
charges, a lump sum amount equal to the maximum of A and B where:

A     is the Cumulative Earnings, if any, in the Policy Value and

B     is an amount equal to 10% of the premium payments immediately prior to
      the partial Withdrawal.

The minimum partial Withdrawal under this option is $500. This Partial
Withdrawal option is available once per Policy Year.

P1360                              Page 6

<PAGE>

                              SECTION 5 - CONTINUED

SYSTEMATIC PAYOUT OPTION
Beginning in the first Policy Year, a Systematic Payout Option (SPO) is
available on a monthly, quarterly, semi-annual or annual basis. At the time a
SPO payout is made, such payout must be at least $50 and may not exceed the
maximum of A and B, divided by the number of payouts made per year (e.g. 12 for
monthly).

A     is the Cumulative Earnings, if any, in the Policy Value and

B     is an amount equal to 10% of the premium payments immediately prior to
      the partial Withdrawal.

No surrender charges will apply to the SPO payout. Monthly and quarterly payouts
must be sent through electronic funds transfer directly to a checking or savings
account. You may start or stop SPO payouts at any time; however, 30 days'
written notice is required to stop SPO payouts.

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

MINIMUM REQUIRED DISTRIBUTION
Notwithstanding any other provision of the policy and to the extent required by
Internal Revenue Code Section 408(b)(3) and the rules and regulations issued
thereunder, distribution must be made from the policy in a manner which
satisfies the requirements of Internal Revenue Code Section 401(1)(9) and the
rules and regulations issued thereunder, as follows:

The entire Policy Value must be distributed, or must commence to be distributed,
no later than the Required Beginning Date, in equal or substantially equal
amounts over: (a) the life of the Owner or over the lives of the Owner and the
Beneficiary; or (b) a period certain not extending beyond the life expectancy of
the Owner or over the lives of the Owner, or the joint and last survivor
expectancy of such Owner and Beneficiary. Such amount must be distributed
periodically at intervals of no longer than one year and must be either
non-increasing or increasing only as provided in Proposed Income Tax Regulation
Section 1.401(a)(9)-1.

All distribution must be made in accordance with the requirements of Internal
Revenue Code Section 401(a)(9), including the incidental death benefit
requirements of Internal Revenue Code Section 402(1)(9)(G), and the regulations
issued thereunder, including the minimum distribution incidental benefit
requirement of Proposed Income Tax Regulation Section 1.401(a)(9)-2.

The amount to be distributed each year, beginning  with  the  first Calendar
Year for which distributions are required to begin and then for each year
thereafter, shall not be less than the quotient obtained by dividing the entire
Policy Value by the lesser of: (a) the life expectancy of the Owner, or the
joint life expectancy of such Owner and the Beneficiary, whichever is
applicable; or (b) if the Owner's spouse is not the Beneficiary, the applicable
divisor determined from the table set forth in Proposed Income Tax Regulation
Section 1.401(a)(9)-2. Distribution after the death of the Owner will be
calculated using the applicable life expectancy as the relevant divisor without
regard to Proposed Income Tax Regulation Section 1.401(a)(9)-2.

Life expectancy of the Owner and the joint life expectancy of the Owner and the
Beneficiary are computed by use of the return multiples contained in Tables V
and VI of Income Tax Regulation Section 1.72-9. Unless otherwise elected by the
Owner by the time distributions are required to begin, life expectancies will be
recalculated annually. Such election will be irrevocable as to the Owner and
will apply to all subsequent years. The life expectancy of a non-spouse
Beneficiary may not be recalculated. Instead, the life expectancy of such
non-spouse Beneficiary will be calculated using the attained age of such
non-spouse Beneficiary during the Calendar Year in which such non-spouse
Beneficiary attains age 70 1/2 , and payments for subsequent years will be based
on such life expectancy reduced by one year for each Calendar Year which has
elapsed since the Calendar Year in which the life expectancy of such non-spouse
Beneficiary was first calculated.

For tax-qualified plans, partial Withdrawals taken to satisfy minimum
distribution requirements under Section 401(a)(9) of the Internal Revenue Code
(IRC) are available with no surrender charges. The amount available from this
policy with respect to the minimum distribution requirement is based solely on
this policy.

The owner must be at least 70 1/2 years old in the calendar year of
distribution, must submit a written request to us and must take the distribution
before year-end. If the owner attains age 70 1/2 in the calendar year of
distribution, a written request, which is postmarked no later than the end of
the current calendar year, must be submitted to us.

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

Any amount requested in excess of the IRC minimum required distribution will
have the appropriate surrender charges applied, unless the excess Distribution
qualifies as surrender charge-free under any additional options provided.

PB1360                               Page 7

<PAGE>

                              SECTION 5 - CONTINUED

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

Number of Years            Percentage of
 Since Premium           Premium Withdrawn
 Payment Date

    0-1                          8%
    1-2                          8%
    2-3                          7%
    3-4                          6%
    4-5                          5%
    5-6                          4%
    6-7                          3%
    7 or more                    0%

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

GUARANTEED RETURN OF FIXED ACCOUNT PREMIUM PAYMENTS
Upon full Surrender of the policy, You will always receive at least the premium
payments made to, less prior Withdrawals and transfers from, the Fixed Account.

MINIMUM VALUES
Benefits available under this policy, including any paid up annuity Cash Value
or death benefits that may be available, are not less than those required by the
insurance laws of the State of New York. Such benefits will be increased as
interest is credited to the policy (and decreased by any Withdrawals).

                          SECTION 6 - SEPARATE ACCOUNT

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

The Separate Account is divided into Subaccounts. Each Subaccount invests
exclusively in shares of one of the portfolios of an underlying fund. We reserve
the right to add or remove any Subaccount of the Separate Account.

The Separate Account meets the definition of a "Separate Account": under rule
0-1(e)(1) of the Investment Company Act of 1940 (the "1940 Act"). The assets of
the Separate Account are our property. These assets will equal or exceed the
reserves and other contract liabilities of the Separate Account. These assets
will not be chargeable with liabilities arising out of any other business we
conduct. We reserve the right, subject to regulations governing the Separate
Account, to transfer assets of a Subaccount, in excess of the reserves and other
contract liabilities with respect to that Subaccount, to another Subaccount or
to our General Account.

We will determine the fair market value of the assets of the Separate Account in
accordance with a method of valuation, which we establish in good faith.
Valuation Period means the period of time from one determination of the value of
each Subaccount to the next. Such determinations are made when the value of the
assets and liabilities of each Subaccount is calculated. This is generally the
close of business on each day on which the New York Stock Exchange is open. In
order to determine the value of an asset on a day that is not a Business Day,
the Company will use the value of that asset as of the end of the next Business
Day on which trading takes place.

The Company will determine the value of the reserves for assets in the Separate
Account at the end of each Business Day. In order to determine the value of
reserves for assets on a day that is not a Business Day, the Company will use
the value of that asset as of the end of the prior Business Day on which trading
took place.

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

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

(a)  deregister the Separate Account under the 1940 Act;
(b)  manage the Separate Account under the direction of a committee at any time;

V1348                                 Page 8

<PAGE>

                              SECTION 6 - CONTINUED

(c)   restrict or eliminate any voting rights of policy owners or other persons
      who have voting rights as to the Separate Account;
(d)   combine the Separate Account with one or more other Separate Accounts;
(e)   create new Separate Accounts;
(f)   add new Subaccounts to or remove existing Subaccounts from the Separate
      Account, or combine Subaccounts; and
(g)   add new underlying mutual funds, remove existing mutual funds, or
      substitute a new fund for an existing fund.

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 New York or deemed approved in accordance with such law or regulation.
If so required, the process for obtaining such approval is filed with the
insurance official of the state or district in which this policy is delivered.

CHARGES AND DEDUCTIONS
The Mortality and Expense Risk Fee and the Administrative Charge are each
deducted both before and after the Annuity Commencement Date to compensate for
changes in mortality and expenses not anticipated by the mortality and
administration charges guaranteed in the policy.

The Service Charge is deducted prior to the Annuity Commencement Date only.

If the Mortality and Expense Risk Fee is more than sufficient, the Company will
retain the balance as profit or may reduce this fee in the future.

ACCUMULATION UNITS
The Policy Value in the Separate Account before the Annuity Commencement Date is
represented by accumulation units. The dollar value of accumulation units for
each Subaccount will change from business day to business day reflecting the
investment experience of the Subaccount.

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 business 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.

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

(a)   is the result of:

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

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

(c)   is a factor representing the Mortality and Expense Risk Fee and
      Administrative Charge before the Annuity Commencement Date. This factor
      is less than or equal to, on an annual basis, the percentage shown on the
      Policy Data Page of the daily net asset value of a fund share held in
      that Subaccount.

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

VB1348                               Page 9

<PAGE>

                            SECTION 7 - FIXED ACCOUNT

FIXED ACCOUNT
Premium payments applied to and any amounts transferred to the Fixed Account
will reflect a fixed interest rate. The interest rates we set will be credited
for increments of at least one year measured from each premium payment or
transfer date. These rates will never be less than the Fixed Account Guaranteed
Minimum Effective Annual Interest Rate of 3%.

GUARANTEED PERIODS
We may offer optional Guaranteed Period Options, into which premium payments may
be paid or amounts transferred. The current interest rate we set for funds
entering each Guaranteed Period Option (GPO) is guaranteed until the end of that
option's Guaranteed Period. At that time, the premium payment made or amount
transferred into the GPO, less any Withdrawals or transfers from that GPO, plus
accrued interest, will be rolled into a new GPO or may be transferred to any
Subaccount(s) within the Separate Account(s).

You may choose the Investment Option(s) You want the funds rolled into by giving
us a written notice within 30 days before the end of the expiring option's
Guaranteed Period. However, any Guaranteed Period elected may not extend beyond
the maximum Annuity Commencement Date defined in Section 11. In the absence of
such election, the funds will be rolled into a new GPO which is the same as the
expiring GPO unless that GPO is no longer offered, in which case, the next
shorter GPO offered will be used. You will be mailed a notice of completion of
the rollover with the new interest rate applicable. The new GPO will be deemed
as accepted if we do not receive a written rejection within 30 days from the
postmark date of the completion notice. We reserve the right for new premium
payments, transfers, or rollovers to offer or not to offer any GPO, except that
we will always offer a GPO with a minimum one-year duration.

When funds are withdrawn or transferred from a GPO, the Policy Value associated
with the oldest premium payment or rollover is considered to be
withdrawn/transferred first. If the amount withdrawn/transferred exceeds the
Policy Value associated with the oldest premium, the Policy Value associated
with the next oldest premium payment or rollover is considered to be
withdrawn/transferred next, and so on until the Policy Value associated with the
most recent premium payment or rollover is considered to be
withdrawn/transferred (this is a "First-In, First-Out" or FIFO basis).

DOLLAR COST AVERAGING FIXED ACCOUNT OPTION
We may offer a Dollar Cost Averaging (DCA) Fixed Account Option separate from
the Guaranteed Period Options. This option will have a one-year interest rate
guarantee. The current interest rate we set for the DCA Fixed Account may differ
from the rates credited on the one-year GPO in the Fixed Account. In addition,
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 on Page 3. The
DCA Fixed Account Option will only be available under a Dollar Cost Averaging
program as described in Section 8.

The DCA Fixed Account Option includes an "enhanced" rate option (either 6 month
or 12 month), and a "regular" (that is, non-enhanced) rate option, where
transfers can be made over periods ranging from six months to twenty four
months. The "enhanced" rate option has a higher interest credited rate than the
"regular" rate option. The enhanced rate will be in excess of the gross
investment earnings rate (less appropriate expense and risk charges). The
enhanced rate applies to all new premiums allocated to the enhanced rate option.

                              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 by providing us notice
containing the facts that we need.

Transfers of interest credited in the GPOs to other Investment Options are
allowed on a "First-In, First-Out" basis. Such transfers may be made monthly,
quarterly, semi-annually, or annually. Each such transfer must be at least $50.

Transfers of Policy Value from the Separate Account are subject to a minimum of
$500 or the entire Subaccount Policy Value, if less. However, if the remaining
Subaccount Policy Value is less than $500, we reserve the right to include that
amount as part of the transfer.

L1044                               Page 10

<PAGE>

                              SECTION 8 - CONTINUED

You may choose which GPO to transfer to or from, however, any GPO elected may
not extend beyond the maximum Annuity Commencement Date defined in Section 11.

We reserve the right to limit transfers to no more than 12 in any one Policy
Year. Any transfers in excess of 12 per Policy Year may be charged a $10 per
transfer fee. Transfers among multiple Investment Options will be treated as one
transfer in determining the number of transfers that have occurred. We also
reserve the right to prohibit transfers to the Fixed Account if we are crediting
an interest rate equal to the Fixed Account Guaranteed Minimum Effective Annual
Interest Rate of 3%.

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

DOLLAR COST AVERAGING OPTION
Prior to the Annuity Commencement Date, You may instruct us to automatically
transfer a specified amount from the Money Market Subaccount, U.S. Government
Securities Subaccount, or out of the Dollar Cost Averaging (DCA) Fixed Account
Option to any other Subaccount(s) of the Separate Account. The automatic
transfers can occur monthly or quarterly.

Transfers will continue until the elected Subaccount or DCA Fixed Account value
is depleted. The amount transferred each time must be at least $500. All
transfers from the DCA account will be the same amount as the initial transfer.
Changes to the Subaccounts to which these transfers are allocated are not
restricted. Transfers must be scheduled for at least 6, but not more than
24 months or for at least 4, but not more than 8 quarters each time the Dollar
Cost Averaging program is started or restarted following termination of the
program for any reason.

Dollar Cost Averaging results in the purchase of more accumulation units when
the value of the accumulation unit is low, and fewer accumulation units when the
value of the accumulation unit is high. However, there is no guarantee that the
Dollar Cost Averaging program will result in higher Policy Values or will
otherwise be successful.

Dollar Cost Averaging may be discontinued after satisfying the minimum number of
required transfers by sending written notice to us. While Dollar Cost Averaging
is in effect, Asset Rebalancing is not available.

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 quarterly, semi-annual or
annual basis, beginning on a date selected by You. You must select the
percentage of the Policy Value desired in each of the various Subaccounts
offered (totaling 100%). Any amounts in the Fixed Account are ignored for the
purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at
any time. Asset Rebalancing is not available while Dollar Cost Averaging is in
effect. Rebalancing will cease as soon as we receive a request for any other
transfer.

B.    TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE
After the Annuity Commencement Date, You may transfer the value of the variable
annuity units from one Subaccount to another within the Separate Account or to
the Fixed Account. If You want to transfer the value of the variable annuity
units, You must provide a signed notice, containing the facts that we need. We
reserve the right to limit transfers between the Subaccounts or to the Fixed
Accounts to once per Policy Year.

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

After the Annuity Commencement Date, no transfers may be made from the Fixed
Account to any other Investment Options.

LB1044                              Page 11

<PAGE>

                           SECTION 9 - DEATH PROCEEDS

A.   DEATH PROCEEDS PRIOR TO ANNUITY COMMENCEMENT DATE
The amount of death proceeds will be the greatest of (a), (b) or (c) where:

(a)   is the Policy Value on the date we receive due proof of death and an
      election of a method of settlement;
(b)   is the Cash Value on the date we receive due proof of death and an
      election of a method of settlement, and;
(c)   is the Guaranteed Minimum Death Benefit (GMDB), if any, plus any
      additional premium payments received, less any Gross Partial Withdrawals
      from the date of death to the date of payment of death proceeds.

If You have not selected a payment option by the date of death, the beneficiary
may make such election within one year of the date we receive due proof of the
owner's or Annuitant's death as described in C below. The beneficiary may elect
to receive the death proceeds as a lump sum payment or may use the death
proceeds to provide any of the annuity Payment Options described in Section 10.
Interest on death proceeds will be paid as required by law.

B.   GUARANTEED MINIMUM DEATH BENEFIT
The amount of the Guaranteed Minimum Death Benefit (GMDB) is based on the death
benefit option shown on the Policy Data Page. You may not change the GMDB option
after the policy is issued.

Option C:  Annual Step-Up Death Benefit

      This GMDB is equal to:

      (1)  the largest Policy Value on the Policy Date or on any Policy
           Anniversary prior to the earlier of the date of death or the
           Annuitant's 81st birthday; plus
      (2)  any premium payments subsequent to the date of the Policy Anniversary
           with the largest Policy Value; minus
      (3)  any Adjusted Partial Withdrawals (as described below), subsequent to
           the date of the Policy Anniversary with the largest Policy Value.

Option P:  Return of Premium Death Benefit

      This GMDB is equal to the total premiums paid for this policy, less
      any Adjusted Partial Withdrawals (as described below), as of the date
      of death.

A partial Withdrawal taken as provided in Section 5 will reduce the Guaranteed
Minimum Death Benefit by an amount referred to as the "Adjusted Partial
Withdrawal". The Adjusted Partial Withdrawal may be a different amount than the
Gross Partial Withdrawal described in Section 5. If at the time of the partial
Withdrawal, the Policy Value is greater than the GMDB, OR the Gross Partial
Withdrawal is less than a maximum annual amount, the Adjusted Partial Withdrawal
will equal the Gross Partial Withdrawal.

D457                                Page 12

<PAGE>

                              SECTION 9 - CONTINUED

If the Gross Partial Withdrawal is greater than the maximum annual amount,
the excess amount will be adjusted based on the percentage of Policy Value
withdrawn. The Adjusted Partial Withdrawal may be greater than the Gross
Partial Withdrawal. The Adjusted Partial Withdrawal is equal to: (a) divided
by (b) multiplied by (c) where:

      (a)  is the amount of the Gross Partial Withdrawal;

      (b)  is the Policy Value prior to the Withdrawal; and

      (c)  is the Death Proceeds prior to the Withdrawal.

C.    DEATH PRIOR TO ANNUITY
      COMMENCEMENT DATE
Death proceeds are payable contingent upon the relationships between the owner,
Annuitant, and beneficiary as outlined below. The policy must be Surrendered
upon settlement or on proof of death.

If there is a surviving owner(s), the surviving owner(s) automatically takes the
place of any Beneficiary designation.

I.    Annuitant Death

      When we have due proof that the Annuitant died before the Annuity
      Commencement Date, we will provide the death proceeds to the Beneficiary.
      Interest upon the death proceeds paid will be computed daily at the rate
      of interest currently paid by us on proceeds left under the Guaranteed
      Payment Option 1, from the date of death, in connection with the death
      claim of this policy to the date of payment and will be considered a
      part of the total sum paid. If no Beneficiary is designated, the owner
      or owner's estate will become the Beneficiary.

      a)   Beneficiary is the deceased Annuitant's surviving spouse. The
           beneficiary may elect to continue this policy as owner and Annuitant
           rather than receiving the death proceeds. If the policy is continued,
           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, and the Guaranteed Minimum Death
           Benefit will continue on as applicable. If the policy is continued,
           all current surrender charges will be waived.

           If this Beneficiary elects to have the death proceeds paid, the death
           proceeds must be distributed:

      (1)  by the end of 5 years after the date of the deceased Annuitant's
           death, or
      (2)  payments must begin no later than one year after the deceased
           Annuitant's death and must be made for a period certain or for this
           Beneficiary's lifetime, so long as any period certain does not exceed
           this Beneficiary's life expectancy.

      In 1035 exchanges where there are joint Annuitants, the death proceeds
      will only be payable upon the death of the surviving Annuitant.

II.   Owner or Joint Owner dies.

      If an owner or joint owner who is also an Annuitant dies, death proceeds
      will be payable according to section I above.

      If an owner or joint owner who is not an Annuitant dies prior to the
      Annuity Commencement Date and before the entire interest in the policy
      is distributed, the successor owner as defined below will become the new
      owner. The person or entity first listed below who is alive or in
      existence on the date of that death will become the successor owner:

      a)   owner or joint owners;
      b)   primary Beneficiary;
      c)   contingent Beneficiary; or
      d)   owner's estate.

DB457                               Page 13

<PAGE>

                              SECTION 9 - CONTINUED

If the sole successor owner is the deceased owner's surviving spouse, the
successor owner may elect to continue this policy rather than receiving the
Policy Value. If the policy is continued, all current surrender charges will be
waived.

If the successor owner is a natural person but is not the sole surviving spouse,
OR if the successor owner is the sole surviving spouse but elects to have the
Policy Value paid, the Policy Value must be distributed by either a) or b)
below:

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

      b)   payments must begin no later than one year after the deceased
           owner's death and must be made for a period certain or for the
           successor owner's lifetime, so long as any period certain does
           not exceed the successor owner's life expectancy.

D.    DEATH ON OR AFTER THE ANNUITY COMMENCEMENT DATE
The death proceeds on or after the Annuity Commencement Date depend on the
payment option selected. If any owner dies on or after the Annuity Commencement
Date, but before the entire interest in the policy is distributed, the remaining
portion of such interest in the policy will be distributed to the owner's
beneficiary at least as rapidly as under the method of distribution being used
as of the date of that owner's death.

E.    AN OWNER IS NOT AN INDIVIDUAL
In the case of a non tax-qualified annuity, if any owner or beneficial owner is
not an individual, then for purposes of Section 72(s) of the Internal Revenue
Code's mandatory distribution provisions in subsection C or D above, (1) the
primary Annuitant will be treated as the owner of the policy, and (2) if there
is any change in the primary Annuitant, such a change will be treated as the
death of the owner.

                          SECTION 10 - ANNUITY PAYMENTS

A.    GENERAL PAYMENT PROVISIONS
Payment
If this policy is in force on the Annuity Commencement Date, we will use the
Fixed Account portion and/or the Separate Account portion of the Policy Value to
make annuity payments to the Payee under Option 3 and/or 3-V, respectively, with
10 years certain, or if elected, under one or more of the other options
described in this section. However, the option(s) elected must provide for
lifetime income or income for a period of at least 60 months. You will become
the Annuitant at the Annuity Commencement Date. Payments will be made at 1, 3, 6
or 12-month intervals. We reserve the right to change the frequency of payments
to avoid making payments of less than $50.00.

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. If we agree, the proceeds may be placed under some
other method of payment instead.

Betterment of Rates
The amounts shown in the tables on page 18 are the guaranteed amounts. Current
amounts offered to individuals of the same class may be obtained from us. Fixed
annuity payments at the time of their commencement will not be less than those
which would be provided by the application of the Policy Value to purchase any
single consideration immediate annuity contract (as described in Section 4223
(a)(1)(E) of New York Insurance Law) offered by the Company at the time to the
same class of Annuitant.

Adjusted Age
Payments under Options 3 and 5 and the first payment under Options 3-V and 5-V
are determined based on the adjusted age of the Annuitant. The adjusted age is
the Annuitant's actual age on the Annuitant's nearest birthday, at the Annuity
Commencement Date, adjusted as follows:

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

S1151                               Page 14

<PAGE>

                             SECTION 10 - CONTINUED

Election of Optional Method of Payment
Before the Annuity Commencement Date You can elect or change a Payment Option.
You may elect, in a notice You sign which gives us the facts that we need,
annuity payments 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 are to be applied to provide each type
of payment. (You must also specify which Subaccounts.) The amount of a combined
payment will be the sum of the variable and fixed payments. Payments under a
variable Payment Option will reflect the investment performance of the selected
Subaccount of the Separate Account.

Payee
Unless You specify otherwise, the Payee shall be the Annuitant, or the
beneficiary as defined in the Beneficiary provision in Section 11.

Proof of Age
We may require proof of the age of any person who has an annuity purchased under
Options 3, 3-V, 5 and 5 -V of this section before we make the first payment.

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

Premium Tax
The Insurance laws of the State of New York currently do not allow the
imposition of premium taxes on the amount applied to a settlement option.
Therefore, such deductions will not be made while the Owner is a resident of the
State of New York, unless subsequent changes in New York's insurance laws
provide otherwise. However, if the Owner becomes a non-resident of New York or
if New York changes its insurance laws to allow the imposition of premium taxes
on the amount applied to a settlement option, we will deduct the applicable
premium tax before applying the proceeds.

Supplementary Contract
Once proceeds become payable and a payment 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 ACCOUNT PAYMENTS
Commutation of Payments after the Annuity Commencement Date

For Options 2,3, and 4, if the present value is paid in a single sum, the
interest rate used for commutation is the interest rate that equated the amount
applied at annuitization to the present value of annuity payments.

Guaranteed Payment Options
The fixed account payment is determined by multiplying each $1,000 of policy
proceeds allocated to a fixed payment option by the amounts shown on page 18 for
the option You select. Options 1, 2 and 4 are based on a guaranteed interest
rate of 3%. Options 3 and 5 are based on a guaranteed interest rate of 3% and
the "Annuity 2000" (male, female, and unisex if required by law) mortality table
projected for improvement using projection scale G (50% of the female scale G
factors were used, while 100% of the male scale factors were used). The rates
were projected dynamically using an assumed Annuity Commencement date of 2005.
The "Annuity 2000" mortality rates are adjusted based on improvements in
mortality since 2000 to more appropriately reflect increased longevity. This
is accomplished using a set of improvement factors referred to as projection
scale G.

Option 1 - Interest Payments
We will pay the interest on the amount we use to provide annuity payments in
equal payments or this amount may be left to accumulate for a period of time we
and You agree to. We and You will agree on Withdrawal rights when You elect this
option. The interest rate we declare for this option may be different than the
interest rate(s) credited prior to the Annuity Commencement Date.

Option 2 - Income for a Specified Period
We will make level payments only for the fixed period You choose. 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 or their
present value may be paid in a single sum. No funds will remain at the end.

Option 3 - Life Income - You may choose between:
1.   No Period Certain - We will make level payments only during the Annuitant's
     lifetime.
2.   10 Years Certain - We will make level payments for the longer of the
     Annuitant's lifetime or ten years.
3.   Guaranteed Return of Policy Proceeds - We will make level payments for the
     longer of the Annuitant's lifetime or until the total dollar amount of
     payments we made to You equals the amount applied to this option.

Option 4 - Income of a Specified Amount
Payments are made for any specified amount until the amount applied to this
option, with interest, is exhausted. 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 proceeds with interest are exhausted,
payments will be continued to that person's beneficiary or their
present value may be paid in a single sum.

SB1151                              Page 15

<PAGE>

                             SECTION 10 - CONTINUED

Option 5 - Joint and Survivor Annuity

1.   Payments are made during the joint lifetime of the Payee and a joint Payee
     of Your selection. Payments will be made as long as either person is
     living.

Current Payment Options
The amounts shown in the tables on page 18 are the guaranteed amounts. Current
amounts offered to individuals of the same class may be obtained from us. Any
rates not shown in the Tables contained in this annuity policy will be provided
by the Company upon request.

C.  VARIABLE ACCOUNT PAYMENT OPTIONS
Variable Annuity Units
The policy proceeds You tell us to apply to a variable payment 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 business day
is equal to (a) multiplied by (b) multiplied by (c), where:

(a)  is the variable annuity unit value for that Subaccount on the immediately
     preceding business day;
(b)  is the net investment factor for that Subaccount for the Valuation Period;
     and
(c)  is the Assumed Investment Return adjustment factor for the Valuation
     Period.

The Assumed Investment Return adjustment factor for the valuation period is the
product of discount factors of .99986634 per day to recognize the 5.0% effective
annual Assumed Investment Return.

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

(a)  is the net result of:

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

(b)  is the net asset value of a fund share held in that Subaccount determined
     as of the end of the immediately preceding Valuation Period.

(c)  is a factor representing the Mortality and Expense Risk Fee and
     Administrative Charge applicable after the Annuity Commencement Date. This
     factor is less than or equal to, on an annual basis, the percentage shown
     on the Policy Data Page of the daily net asset value of a fund share held
     in the Separate Account for that Subaccount.

Determination of the First Variable Payment
The amount of the first variable payment is determined by multiplying each
$1,000 of policy proceeds allocated to a variable payment option by the amounts
shown on page 20 for the variable option You select. The tables are based on a
5% 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 (50% of the female scale G factors were used, while
100% of the male scale factors were used). The rates were projected dynamically
using an assumed Annuity Commencement date of 2005. The "Annuity 2000" mortality
rates are adjusted based on improvements in mortality since 2000 to more
appropriately reflect increased longevity. This is accomplished using a set of
improvement factors referred to as projection scale G.

C885                                Page 16

<PAGE>

                             SECTION 10 - CONTINUED

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

1.   No Period Certain - Payments will be made during the lifetime of the
     Annuitant.
2.   10 Years 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 or their
     present value may be paid in a single sum.

Option 5-V - Joint and Survivor Annuity

Payments are made as long as either the Annuitant or the joint Annuitant is
living.

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 that
Subaccount on the Annuity Commencement Date.

Once Annuity Payments begin, neither expenses actually incurred other than taxes
on the investment return, nor mortality actually experienced by the Company,
shall adversely affect the dollar amount of Variable Annuity Payments to any
Annuitant for whom such payments have commenced.

CB885                               Page 17

<PAGE>

                    GUARANTEED FIXED ACCOUNT PAYMENT OPTIONS

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

<TABLE>
<CAPTION>
----------------------------------------------------------------------------------------------------------------
Option 2, Table I                  Option 3, Table II        Option 3, Table III         Option 3, Table IV
----------------------------------------------------------------------------------------------------------------
Number of    Amount of                                     Monthly Installment For     Monthly Installment For
  Years       Monthly            Monthly Installment For             Life             Life Guaranteed Return Of
 Payable    Installment          Life No Period Certain        10 Years Certain                Proceeds
----------- ----------- ------ -------------------------- -------------------------- ---------------------------
                         Age*    Male    Female   Unisex     Male    Female   Unisex   Male     Female   Unisex
----------- ----------- ------ ------- --------- -------- --------- -------- ------- -------- --------- --------
<S>         <C>         <C>     <C>      <C>     <C>       <C>      <C>      <C>      <C>     <C>       <C>
                         50      $3.82    $3.70   $3.74     $3.80    $3.69    $3.72    $3.70   $3.62     $3.65
                         51       3.89     3.76    3.80      3.86     3.74     3.78     3.75    3.67      3.70
                         52       3.95     3.81    3.86      3.92     3.80     3.84     3.81    3.72      3.75
                         53       4.02     3.88    3.92      3.99     3.86     3.90     3.87    3.78      3.80
    5         17.91      54       4.10     3.94    3.99      4.06     3.92     3.96     3.93    3.83      3.86
    6         15.14      55       4.18     4.01    4.06      4.13     3.99     4.03     3.99    3.89      3.92
    7         13.16      56       4.26     4.08    4.14      4.21     4.06     4.10     4.06    3.95      3.98
    8         11.68      57       4.35     4.16    4.22      4.29     4.13     4.18     4.13    4.02      4.05
    9         10.53      58       4.44     4.24    4.30      4.38     4.21     4.26     4.20    4.08      4.12
    10         9.61      59       4.54     4.33    4.39      4.47     4.29     4.35     4.27    4.16      4.19
    11         8.86      60       4.64     4.42    4.49      4.57     4.38     4.44     4.36    4.23      4.27
    12         8.24      61       4.76     4.52    4.59      4.67     4.47     4.53     4.44    4.31      4.35
    13         7.71      62       4.88     4.63    4.70      4.78     4.57     4.63     4.53    4.39      4.43
    14         7.26      63       5.01     4.74    4.82      4.89     4.67     4.74     4.62    4.48      4.52
    15         6.87      64       5.15     4.86    4.94      5.01     4.78     4.85     4.72    4.57      4.62
    16         6.53      65       5.30     4.98    5.08      5.14     4.89     4.97     4.83    4.67      4.72
    17         6.23      66       5.46     5.12    5.22      5.27     5.02     5.09     4.94    4.78      4.82
    18         5.96      67       5.63     5.27    5.37      5.41     5.14     5.22     5.05    4.89      4.94
    19         5.73      68       5.81     5.42    5.54      5.55     5.28     5.36     5.17    5.00      5.05
    20         5.51      69       6.00     5.59    5.71      5.70     5.42     5.51     5.30    5.13      5.18
                         70       6.21     5.78    5.90      5.86     5.58     5.66     5.43    5.26      5.31
                         71       6.43     5.97    6.11      6.02     5.74     5.82     5.58    5.39      5.45
                         72       6.66     6.19    6.33      6.18     5.90     5.99     5.72    5.54      5.59
                         73       6.91     6.42    6.56      6.35     6.08     6.16     5.88    5.70      5.75
                         74       7.18     6.67    6.82      6.53     6.26     6.34     6.05    5.86      5.92
                         75       7.46     6.94    7.09      6.70     6.45     6.53     6.22    6.04      6.09
                         76       7.77     7.23    7.39      6.88     6.65     6.72     6.40    6.22      6.27
                         77       8.10     7.55    7.71      7.07     6.85     6.91     6.60    6.42      6.47
                         78       8.45     7.89    8.05      7.25     7.05     7.11     6.80    6.63      6.68
                         79       8.83     8.26    8.43      7.43     7.26     7.31     7.01    6.85      6.90
                         80       9.23     8.66    8.83      7.61     7.46     7.51     7.24    7.08      7.13
                         81       9.66     9.10    9.27      7.79     7.66     7.70     7.47    7.33      7.37
                         82      10.13     9.57    9.74      7.97     7.86     7.89     7.72    7.59      7.63
                         83      10.62    10.09   10.24      8.13     8.05     8.07     7.98    7.86      7.90
                         84      11.15    10.64   10.79      8.29     8.23     8.25     8.26    8.15      8.18
                         85      11.72    11.24   11.38      8.44     8.40     8.41     8.55    8.45      8.48
                         86      12.32    11.89   12.02      8.59     8.56     8.56     8.85    8.77      8.80
                         87      12.97    12.59   12.70      8.72     8.70     8.71     9.17    9.11      9.12
                         88      13.65    13.33   13.42      8.84     8.83     8.83     9.50    9.45      9.47
                         89      14.38    14.11   14.19      8.95     8.95     8.95     9.85    9.82      9.83
                         90      15.16    14.94   15.00      9.06     9.05     9.05    10.22   10.19     10.20
                         91      15.97    15.80   15.85      9.15     9.15     9.15    10.61   10.59     10.59
                         92      16.84    16.70   16.74      9.23     9.23     9.23    11.01   11.00     11.00
                         93      17.75    17.63   17.67      9.31     9.31     9.31    11.45   11.42     11.43
                         94      18.72    18.60   18.64      9.37     9.37     9.37    11.92   11.88     11.89
                         95      19.77    19.62   19.66      9.43     9.43     9.43    12.42   12.36     12.38
----------------------------------------------------------------------------------------------------------------
</TABLE>
*Adjusted Age as defined in Section 10.A.

Dollar amounts of monthly, quarterly, semi-annual, and annual
installments not shown in the above tables will be calculated
on the same basis as those shown and may be obtained from the
Company.

T933                                Page 18

<PAGE>
                               Option 5, Table VI

                 Monthly Installment For Joint and Full Survivor

<TABLE>
<CAPTION>
-------------------------------------------------------------------------------------------------------------------------------
                                                 Age of Female Annuitant*
                   ------------------------------------------------------------------------------------------------------------
     Age of           15 Years         12 Years      9 Years         6 Years           3 Years         Same         3 Years
      Male           Less Than        Less Than     Less Than       Less Than         Less Than         As         More Than
   Annuitant*           Male            Male           Male            Male             Male           Male           Male
------------------ --------------- --------------- -------------- ---------------- -------------- --------------- -------------
<S>                   <C>             <C>             <C>            <C>              <C>            <C>            <C>
       50              $3.06           $3.12           $3.19          $3.25            $3.31          $3.38          $3.44
       55               3.20            3.27            3.35           3.44             3.52           3.61           3.69
       60               3.37            3.47            3.57           3.68             3.79           3.91           4.02
       65               3.59            3.72            3.86           4.01             4.16           4.32           4.47
       70               3.88            4.06            4.25           4.45             4.67           4.89           5.11
-------------------------------------------------------------------------------------------------------------------------------
                                    Monthly Installment For Unisex Joint and Full Survivor
-------------------------------------------------------------------------------------------------------------------------------
                                                 Age of Joint Annuitant*
                   ------------------------------------------------------------------------------------------------------------
     Age of           15 Years         12 Years      9 Years         6 Years           3 Years         Same         3 Years
      First          Less Than        Less Than     Less Than       Less Than         Less Than         As         More Than
   Annuitant*          First            First         First           First             First          First         First
------------------ --------------- --------------- -------------- ---------------- -------------- --------------- -------------
       50              $3.07           $3.13           $3.19          $3.25            $3.31          $3.37          $3.43
       55               3.20            3.28            3.36           3.44             3.52           3.60           3.67
       60               3.38            3.48            3.58           3.68             3.79           3.89           4.00
       65               3.61            3.73            3.87           4.01             4.16           4.30           4.44
       70               3.90            4.07            4.26           4.46             4.66           4.86           5.05
-------------------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A.
-------------------------------------------------------------------------------------------------------------------------------
</TABLE>

Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.

TB933
                                     Page 19

<PAGE>

                            VARIABLE PAYMENT OPTIONS
                       BASED ON ASSUMED INVESTMENT RETURN

The amounts shown in these tables are the initial payment amounts based on a
5.0% Assumed Investment Return for each $1,000 of the proceeds.

                Option 3-V, Table II                   Option 3-V, Table III
      --------------------------------------------------------------------------
             Monthly Installment for Life           Monthly Installment for Life
                 No Period Certain                         10 Years Certain
      --------------------------------------------------------------------------
       Age*      Male      Female     Unisex         Male      Female    Unisex
        50      $5.07      $4.93      $4.98         $5.04      $4.92     $4.95
        51       5.13       4.99       5.03          5.09       4.96      5.00
        52       5.19       5.04       5.08          5.15       5.01      5.05
        53       5.26       5.10       5.14          5.21       5.07      5.11
        54       5.33       5.16       5.21          5.27       5.12      5.17
        55       5.40       5.22       5.27          5.34       5.18      5.23
        56       5.48       5.29       5.35          5.41       5.25      5.30
        57       5.57       5.36       5.42          5.49       5.32      5.37
        58       5.66       5.44       5.50          5.57       5.39      5.44
        59       5.75       5.52       5.59          5.66       5.47      5.52
        60       5.85       5.61       5.68          5.75       5.55      5.61
        61       5.97       5.70       5.78          5.85       5.63      5.70
        62       6.09       5.81       5.89          5.95       5.72      5.79
        63       6.21       5.91       6.00          6.06       5.82      5.89
        64       6.35       6.03       6.13          6.17       5.92      6.00
        65       6.50       6.16       6.26          6.29       6.03      6.11
        66       6.66       6.29       6.40          6.42       6.15      6.23
        67       6.83       6.43       6.55          6.55       6.27      6.36
        68       7.01       6.59       6.71          6.69       6.40      6.49
        69       7.21       6.76       6.89          6.83       6.54      6.63
        70       7.41       6.94       7.08          6.98       6.69      6.77
        71       7.63       7.14       7.28          7.13       6.84      6.93
        72       7.87       7.35       7.50          7.28       7.00      7.09
        73       8.12       7.58       7.74          7.45       7.17      7.25
        74       8.39       7.83       8.00          7.61       7.34      7.42
        75       8.68       8.11       8.28          7.78       7.52      7.60
        76       8.99       8.40       8.58          7.95       7.71      7.78
        77       9.32       8.72       8.90          8.12       7.90      7.97
        78       9.68       9.07       9.25          8.29       8.09      8.16
        79      10.06       9.45       9.63          8.47       8.29      8.34
        80      10.47       9.85      10.04          8.64       8.48      8.53
        81      10.91      10.30      10.48          8.80       8.67      8.71
        82      11.38      10.78      10.96          8.97       8.86      8.89
        83      11.88      11.30      11.47          9.12       9.04      9.06
        84      12.42      11.87      12.03          9.27       9.21      9.23
        85      12.99      12.48      12.63          9.41       9.37      9.38
        86      13.60      13.13      13.27          9.54       9.51      9.52
        87      14.26      13.84      13.96          9.67       9.65      9.65
        88      14.95      14.59      14.70          9.78       9.77      9.77
        89      15.69      15.39      15.48          9.89       9.88      9.88
        90      16.47      16.23      16.30          9.98       9.98      9.98
        91      17.29      17.10      17.16         10.07      10.07     10.07
        92      18.16      18.01      18.05         10.15      10.15     10.15
        93      19.07      18.95      18.98         10.22      10.22     10.22
        94      20.05      19.92      19.96         10.28      10.28     10.28
        95      21.09      20.94      20.99         10.34      10.33     10.33
      --------------------------------------------------------------------------
      *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.

H1108                               Page 20

<PAGE>

                               Option 5V, Table V

                 Monthly Installment For Joint and Full Survivor

<TABLE>
<CAPTION>

---------------------------------------------------------------------------------------------------------------------
   Age of                                      Age of Female Annuitant*

    Male       15 Years      12 Years        9 Years         6 Years         3 Years                        3 Years
              Less Than     Less Than       Less Than       Less Than       Less Than        Same As       More Than
 Annuitant*      Male          Male            Male            Male            Male            Male          First
---------------------------------------------------------------------------------------------------------------------
<S>             <C>           <C>             <C>             <C>             <C>             <C>            <C>
    50          $4.37         $4.42           $4.46           $4.51           $4.56           $4.62          $4.67
    55           4.48          4.54            4.60            4.67            4.74            4.81           4.88
    60           4.62          4.70            4.79            4.88            4.98            5.08           5.18
    65           4.81          4.92            5.04            5.17            5.31            5.46           5.61
    70           5.07          5.23            5.40            5.59            5.79            6.00           6.22
---------------------------------------------------------------------------------------------------------------------
                                  Monthly Installment For Unisex Joint and Full Survivor
<CAPTION>
---------------------------------------------------------------------------------------------------------------------
   Age of                                       Age of Joint Annuitant*

    First       15 Years      12 Years       9 Years         6 Years         3 Years                        3 Years
               Less Than     Less Than      Less Than       Less Than       Less Than        Same As       More Than
 Annuitant*      First         First          First           First           First           First          First
---------------------------------------------------------------------------------------------------------------------
<S>             <C>           <C>             <C>             <C>             <C>             <C>            <C>
    50          $4.38         $4.42           $4.47           $4.51           $4.56           $4.61          $4.66
    55           4.48          4.54            4.60            4.67            4.73            4.80           4.87
    60           4.63          4.70            4.79            4.88            4.97            5.07           5.16
    65           4.82          4.93            5.05            5.17            5.30            5.44           5.57
    70           5.09          5.24            5.41            5.59            5.78            5.97           6.16
---------------------------------------------------------------------------------------------------------------------
*Adjusted Age as defined in Section 10.A

-------------------------------------------------- ------------------------------------------------------------------
</TABLE>

Dollar amounts of monthly, quarterly, semi-annual, and annual installments not
shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company.

J1108                               Page 21

<PAGE>

                         SECTION 11 - GENERAL PROVISIONS

THE ENTIRE CONTRACT
The entire contract consists of this policy, the Policy Data page, endorsements,
and riders, if any and the application signed by you, a copy of which is
attached hereto. No insertion in or other alteration of any written application
can be made by any person other than the Owner without his or her written
consent, except that insertions may be made by the Company for administrative
purposes only in such manner as to clearly indicate that the insertions are not
to be ascribed to the Owner. All statements in the application are
representations and not warranties. Nothing is incorporated by reference, unless
a copy is endorsed upon or attached to the Policy. Nothing in the policy or any
attached endorsements or riders thereto invalidates or impairs any right granted
to the Owner by New York law or this policy.

MODIFICATION OF POLICY
No change in this policy is valid unless made in writing by us and approved by
one of our officers. No Registered Representative has authority to change or
waive any provision of Your policy.

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

NON-PARTICIPATING
This policy will not share in our surplus earnings.

AGE OR SEX CORRECTIONS
If the age or sex of the Annuitant has been misstated, the benefits will be
those, which the premiums paid, would have purchased for the correct age and
sex. 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.

Any underpayment made by us will be paid with the next payment. Any overpayment
made by us will be deducted from future payments. Any underpayment or
overpayment, will include interest at 5% per year, from the date of the wrong
payment to the date of the adjustment.

INCONTESTABILITY
This policy shall be incontestable from the Policy Date.

EVIDENCE OF SURVIVAL
We have the right to require satisfactory evidence
that a person was alive if a payment is based on that person being alive. No
payment will be made until we receive the evidence.

SETTLEMENT
Any payment by us under this policy is payable by our Home Office.

RIGHTS OF OWNER

The owner may, while the Annuitant is living:
  1.    Assign this policy.
  2.    Surrender the policy to us.
  3.    Amend or modify the policy with our consent.
  4.    Receive annuity payments or name a Payee to receive the payments.
  5.    Exercise, receive and enjoy every other right and benefit contained
        in the policy.

The use of these rights may be subject to the consent of any assignee 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.

SUCCESSOR OWNER
A successor owner will be the new owner as described in Section 9, C, II.

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, in a notice You sign which gives us the
facts that we need. When this change takes effect, all rights of ownership in
this policy will pass to the new owner.

A change of owner will not be effective until it is received by us. After it has
been received, the change will take effect as of the date You signed the notice.
However, if the Annuitant dies before the notice has been received, it will not
be effective as to those proceeds we have paid before the change was received by
us.

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.

ANNUITY COMMENCEMENT DATE
The Annuity Commencement Date is the date annuity payments begin. This date is
generally no later than the last day of the policy month starting after the
Annuitant attains age 85. In no event can this date be later than the last day
of the month following the month in which the Annuitant attains age 90 or 10
years from the Policy Date, if later. You may change the Annuity Commencement
Date at any time before the Annuity Commencement date by giving us 30 days'
written notice. The revised Annuity Commencement Date may not be earlier than
the first day of the calendar month coinciding with or next following the first
Policy Anniversary.

R199                                Page 22

<PAGE>
                             SECTION 11 - CONTINUED

ASSIGNMENT
(a)  In the case of a non tax-qualified annuity, this Policy may be assigned.
     The assignment must be in writing and filed with us.

(b)  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.

(c)  This policy may be applied for and issued to qualify as a tax-qualified
     annuity under certain sections of the Internal Revenue Code. Ownership of
     this policy is then restricted so that it will comply with provisions of
     the Internal Revenue Code.

Assignment of this policy may result in adverse tax consequences.

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

You may direct that the beneficiary shall not have the right to withdraw, assign
or commute any sum payable under an option. In the absence of such election or
direction, the beneficiary may change the manner of payment or make an election
of any option.

If any primary or contingent beneficiary dies before the Annuitant, that
beneficiary's interest in this policy ends with that beneficiary's death. Only
those beneficiaries living at the time of the Annuitant's death will be eligible
to receive their share of the death proceeds. In the event no primary or
contingent beneficiaries have been named and all primary beneficiaries have died
before the death proceeds become payable, the owner(s) will become the
beneficiary(ies) unless elected otherwise in accordance with Section 9. If both
primary and contingent beneficiaries have been named, payment will be made to
the named primary beneficiaries living at the time the death proceeds become
payable. If there is more than one beneficiary and You failed to specify their
interest, they will share equally. Payment will be made to the named contingent
beneficiary(ies) only, if all primary beneficiaries have died before the death
proceeds become payable. If any primary beneficiary is alive at the time the
death proceeds become payable, but dies before receiving their payment, their
share will be paid to their estate.

PROTECTION OF PROCEEDS
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
We will pay any partial Withdrawals or Surrender proceeds from the Separate
Account within 7 days after we receive all requirements that we need. However,
it may happen that the New York Stock Exchange is closed for trading (other than
the usual weekend or holiday closings), or the Securities and Exchange
Commission restricts trading or determines that an emergency exists. If so, it
may not be practical for us to determine the investment experience of the
Separate Account. In that case, we may defer transfers among the Subaccounts and
to the Fixed Account, and determination or payment of partial Withdrawals or
Surrender proceeds.

When permitted by law, we may defer paying any partial Withdrawals or Surrender
proceeds from the Fixed Account for up to 6 months from the date we receive Your
request. If the owner dies after the request is received, but before the request
is processed, the request will be processed before the death proceeds are
determined. The interest rate will be the rate that is currently paid on
Guaranteed Payment Option1, Interest Payments.

REPORTS TO OWNER
We will give You an annual report at least once each Policy Year. This report
will show the number and value of the accumulation units held in each of the
Subaccounts as well as the value of the Fixed Account. It will also give You the
Surrender Charges, Death Benefit and method of determining the Cash Value, and
any other facts required by law or regulation

RB199                               Page 23

<PAGE>

<TABLE>
<S>                                                                                               <C>
    AUSA LIFE INSURANCE COMPANY, INC.
    A Stock Company         Home Office located at:  4 Manhattanville Road, Purchase, New York
    Adm. Office located at: 4333 Edgewood Road N.E. Cedar Rapids, Iowa  52499                     (800) 553-5957
    (Hereafter called the Company, we, our or us)
</TABLE>

                                      INDEX

                                                                          Page

Accumulation Units .......................................................   9
Age or Sex Corrections ...................................................  22
Annuity Commencement Date ................................................  22
Annuity Payments .........................................................  14
Assignment ...............................................................  23
Beneficiary ..............................................................  23
Cash Value ...............................................................   5
Contract .................................................................  22
Death Proceeds ...................................................  12, 13, 14
Definitions ..............................................................   2
Dollar Cost Averaging Option .............................................  11
Evidence of Survival .....................................................  22
Fixed Account ............................................................  10
Guaranteed Minimum Death Benefit .........................................  12
Guaranteed Return of Fixed Account Premium Payments ......................   8
Guaranteed Periods .......................................................  10

                                                                           Page

Incontestability .........................................................  22
Modification of Policy ...................................................  22
Non-participating ........................................................  22
Option to Change Annuity Commencement Date ...............................  22
Partial Withdrawals ......................................................   6
Payee ....................................................................  15
Payment of Premiums ......................................................   4
Payment Option Tables ........................................  18, 19, 20, 21
Policy Data Page .........................................................   3
Policy Value .............................................................   5
Proof of Age .............................................................  15
Protection of Proceeds ...................................................  23
Right to Cancel ..........................................................   1
Rights of Owner ..........................................................  22
Separate Account .......................................................  8, 9
Service Charge ...........................................................   5
Settlement ...............................................................  22
Surrender Charges ........................................................   8
Transfers ............................................................  10, 11

                   Flexible Premium Deferred Variable Annuity
                   Income Payable At Annuity Commencement Date
            Benefits Based On The Performance Of The Separate Account
Are Variable And Are Not Guaranteed As To Dollar Amount (See Sections 6 and 10C)
                                Non-Participating

Y836

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00043-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00043-of-00352.parquet"}]]