Document:

EX-4.PP

 

Exhibit 4(pp)

Home Office: Cincinnati, Ohio

Variable Administrative Office: P.O. Box 5423, Cincinnati, Ohio 45201-5423

Group Flexible Premium Deferred Variable Annuity Contract

We have issued this Group Flexible Premium Deferred Variable Annuity Contract (the “Contract”)
in consideration of the payment of Purchase Payments, and of any application and/or participation
enrollment forms. The Contract Owner is set out on the Contract Specifications page. It is
effective as of the Contract Effective Date, which is set out on Contract Specifications page. It
is subject to all of the terms and conditions that are set out on the following pages.

As you read through this Contract, please note that the words “we”, “us”, “our”, and “Company”
refer to Annuity Investors Life Insurance Company. The words “you” and “your” refer to the
Contract Owner. “Administrative Office” means our home office or any other place of business that
we may designate.

	 	 	 
	
	 	
	MARK F. MUETHING
	 	CHARLES R. SCHEPER
	SECRETARY
	 	PRESIDENT

NONPARTICIPATING — NO DIVIDENDS

PAYMENTS AND OTHER VALUES DESCRIBED IN THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF
THE SEPARATE ACCOUNT, MAY INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS.
NO MINIMUM CONTRACT VALUE IS GUARANTEED, EXCEPT FOR AMOUNTS IN THE FIXED ACCOUNT.

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CONTRACT SPECIFICATIONS

CONTRACT OWNER: [ JOHN DOE ]

CONTRACT NUMBER: [ 000000000 ]

CONTRACT EFFECTIVE DATE: [ DECEMBER 01, 2006 ]

SEPARATE ACCOUNT: Annuity Investors Variable Account B

Following is a list of the Funds in which the currently available Sub-Accounts invest:

[ AIM V.I. Capital Development Fund ]

[ AIM V.I. Core Equity Fund ]

[ AIM V.I. Financial Services Fund ]

[ AIM V.I. Global Health Care Fund ]

[ AIM V.I. High Yield Fund ]

[ AIM V.I. Small Cap Equity Fund ]

[ AIM V.I. Small Cap Growth Fund ]

[ American Century VP Large Company Value Fund ]

[ American Century VP Mid Cap Value Fund ]

[ American Century VP
Ultra® Fund ]

[ American Century VP VistaSM Fund ]

[ Dreyfus IP Technology Growth Portfolio ]

[ The Dreyfus Socially Responsible Growth Fund, Inc. ]

[ Dreyfus Stock Index Fund, Inc. ]

[ Dreyfus VIF Appreciation Portfolio ]

[ Dreyfus VIF Developing Leaders Portfolio ]

[ Dreyfus VIF Growth and Income Portfolio ]

[ Dreyfus VIF Money Market Portfolio ]

[ DWS Small Cap Index VIP ]

[ Janus Aspen Series Balanced Portfolio ]

[ Janus Aspen Series Forty Portfolio ]

[ Janus Aspen Series International Growth Portfolio ]

[ Janus Aspen Series Large Cap Growth Portfolio ]

[ Janus Aspen Series Mid Cap Growth Portfolio ]

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[ Oppenheimer Balanced Fund/VA ]

[ Oppenheimer Capital Appreciation Fund/VA ]

[ Oppenheimer Main Street
Fund®/VA ]

[ PIMCO VIT Real Return Portfolio ]

[ PIMCO VIT Total Return Portfolio ]

[ Van Kampen UIF Core Plus Fixed Income Portfolio ]

[ Van Kampen UIF U.S. Mid Cap Value Portfolio ]

[ Van Kampen UIF U.S. Real Estate Portfolio ]

[ Van Kampen UIF Value Portfolio ]

FIXED ACCOUNT:

Following is a list of the currently available Fixed Account options, with guarantee periods as may
be applicable:

Fixed Accumulation Account

[ Fixed Account One-Year Guarantee Period ]

We may add or delete Fixed Account options at any time.

FIXED ACCOUNT GUARANTEED INTEREST RATE: [ 3.00% ]

TRANSFER FEE: [ $25 ] per transfer by a Participant in excess of [ twelve (12) ] in any Certificate Year.

CERTIFICATE MAINTENANCE FEE: [ $40 ] Annually

MORTALITY AND EXPENSE RISK CHARGE: A charge equal to an effective annual rate of
[ 1.25% ] of the daily Net Asset Value of the Sub-Accounts.

ADMINISTRATION CHARGE: A charge equal to an effective annual rate of [ 0.15% ]
of the daily Net Asset Value of the Sub-Accounts.

MINIMUM TERMINATION VALUE: [ $500 ]

	 	 	 
	INQUIRIES:

	 	For information, or to make a complaint, call or write:
	 

	 	Policyowner Service Department

Annuity Investors Life Insurance Company

Post Office Box 5423

Cincinnati, Ohio 45201-5423

1-800-789-6771
	 
	 	 
	 

	 	If you prefer, you may visit us at our website, www.gafri.com.

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	TABLE OF CONTENTS	 	Page	 
	 
	DEFINITIONS
	 	 	6	 
	 
	 	 	 	 
	GENERAL PROVISIONS
	 	 	8	 
	 
	 	 	 	 
	Entire Contract
	 	 	8	 
	Changes — Waivers
	 	 	8	 
	Nonparticipating
	 	 	8	 
	Misstatement
	 	 	8	 
	Required Reports
	 	 	8	 
	Exclusive Benefit
	 	 	9	 
	State Law
	 	 	9	 
	Claims of Creditors
	 	 	9	 
	Company Liability
	 	 	9	 
	Voting Rights
	 	 	9	 
	Incontestability
	 	 	9	 
	Discharge of Liability
	 	 	9	 
	Transfer by the Company
	 	 	9	 
	Termination
	 	 	9	 
	Taxes
	 	 	9	 
	 
	 	 	 	 
	PURCHASE PAYMENTS
	 	 	10	 
	 
	 	 	 	 
	Purchase Payments
	 	 	10	 
	Allocation of Purchase Payments
	 	 	10	 
	 
	 	 	 	 
	FIXED ACCOUNT
	 	 	10	 
	 
	 	 	 	 
	Fixed Account
	 	 	10	 
	Fixed Account Options
	 	 	10	 
	Interest Crediting
	 	 	10	 
	Renewal
	 	 	11	 
	Fixed Account Value
	 	 	11	 
	 
	 	 	 	 
	SEPARATE ACCOUNT
	 	 	12	 
	 
	 	 	 	 
	General Description
	 	 	12	 
	Sub-Accounts of the Separate Account
	 	 	12	 
	Valuation of Assets
	 	 	12	 
	Variable Account Value
	 	 	12	 
	Accumulation Unit Value
	 	 	13	 
	 
	 	 	 	 
	TRANSFERS
	 	 	14	 
	 
	 	 	 	 
	Transfers From a Fixed Account Option
	 	 	14	 
	Transfers From a Sub-Account
	 	 	14	 
	Other Transfer Rules
	 	 	14	 
	 
	 	 	 	 
	FEES AND CHARGES
	 	 	15	 
	 
	 	 	 	 
	Mortality and Expense Risk Charge
	 	 	15	 
	Administration Charge
	 	 	15	 
	Certificate Maintenance Fee
	 	 	15	 

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	TABLE OF CONTENTS	 	Page	 
	 
	SURRENDER AND WITHDRAWALS
	 	 	16	 
	 
	 	 	 	 
	Surrender
	 	 	16	 
	Withdrawals
	 	 	16	 
	Transfers and Rollovers
	 	 	16	 
	Termination
	 	 	16	 
	Deferral of Payment
	 	 	17	 
	 
	 	 	 	 
	OWNERSHIP PROVISIONS
	 	 	17	 
	 
	 	 	 	 
	Ownership of Separate Account
	 	 	17	 
	Ownership of the Contract and Participant Account
	 	 	17	 
	Transfer and Assignment
	 	 	18	 
	Successor Owner
	 	 	18	 
	Community Property
	 	 	18	 
	 
	 	 	 	 
	BENEFICIARY PROVISIONS
	 	 	18	 
	 
	 	 	 	 
	Beneficiary
	 	 	18	 
	Designation of Beneficiary
	 	 	18	 
	 
	 	 	 	 
	ANNUITY BENEFIT
	 	 	19	 
	 
	 	 	 	 
	Annuity Commencement Date
	 	 	19	 
	Annuity Benefit Amount
	 	 	19	 
	Annuity Benefit Payments
	 	 	19	 
	Form of Annuity Benefit
	 	 	19	 
	 
	 	 	 	 
	DEATH BENEFIT
	 	 	20	 
	 
	 	 	 	 
	Death Benefit
	 	 	20	 
	Death Benefit Amount
	 	 	20	 
	Step Up in Account Value for Successor Owner
	 	 	20	 
	Transfers After Death
	 	 	21	 
	Death Benefit Commencement Date
	 	 	21	 
	Death Benefit Payments
	 	 	21	 
	Form of Death Benefit
	 	 	21	 
	 
	 	 	 	 
	SETTLEMENT OPTIONS
	 	 	22	 
	 
	 	 	 	 
	Conditions
	 	 	22	 
	Benefit Payments
	 	 	22	 
	Fixed Dollar Payments
	 	 	23	 
	Variable Dollar Payments
	 	 	23	 
	Limitation on Election of Settlement Option
	 	 	24	 
	Settlement Option Computations
	 	 	24	 
	Available Settlement Options
	 	 	24	 
	Commuted Values
	 	 	25	 
	Settlement Option Tables
	 	 	25	 

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DEFINITIONS

Account(s): The Sub-Accounts and the Fixed Account options.

Account Value: For a Participant, the aggregate value of his or her interest in all of the
Sub-Accounts and the Fixed Account options as of the end of any Valuation Period. The value of his
or her interest in all of the Sub-Accounts is his or her “Variable Account Value”. The value of
his or her interest in all of the Fixed Account options is his or her “Fixed Account Value.”

Accumulation Unit: A unit of measure used to calculate the value of a Sub-Account prior to the
Commencement Date. The value of an Accumulation Unit is referred to as “Accumulation Unit Value”.

Annuity Benefit: The payments that may be made under the ANNUITY BENEFIT section of this Contract.

Annuity Commencement Date: For the interest of a Participant in this Contract, the first day of
the first payment interval for which an Annuity Benefit payment is to be made.

Beneficiary: The person entitled to receive any Death Benefit with respect to the interest of a
Participant in this Contract.

Benefit Unit: A unit of measure used to determine the dollar value of any Variable Dollar
payments. The value of a Benefit Unit is referred to as “Benefit Unit Value”.

Certificate: Evidence that is provided to a Participant of his or her interest in this Contract.

Certificate Anniversary: For a Participant, the date in each year that is the annual anniversary
of his or her Certificate Effective Date.

Certificate Effective Date: For a Participant, the date on which his or her interest in this
Contract took effect. This date is set out on his or her Certificate Specifications page.

Certificate Year: For a Participant, each twelve (12) month period that begins on his or her
Certificate Effective Date or on a Certificate Anniversary.

Code: The Internal Revenue Code of 1986, as amended, and the rules and regulations that are issued
under it.

Commencement Date: For the interest of a Participant in this Contract, the Annuity Commencement
Date if an Annuity Benefit is payable; or the Death Benefit Commencement Date if a Death Benefit is
payable.

Death Benefit: The benefit described in the DEATH BENEFIT section of this Contract.

Death Benefit Commencement Date: For the interest of a Participant in this Contract, the first day
of the first payment interval for a Death Benefit that is paid as periodic payments; or the date of
payment for a Death Benefit that is paid as a lump sum.

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Death Benefit Valuation Date: For the interest of a Participant in this Contract, the earlier of:

	 	1)	 	the date that we have received both Due Proof of Death and a Written Request
with instructions as to the form of Death Benefit; or

	 	2)	 	the date that is the Death Benefit Commencement Date.

Due Proof of Death: One (1) of the following:

	 	1)	 	a certified copy of a death certificate; or

	 	2)	 	a certified copy of a decree that is made by a court of competent jurisdiction
as to the finding of death.

We will also accept other proof that is satisfactory to us.

Fund: A management investment company (or a portfolio of it) that is registered under the
Investment Company Act of 1940, as amended. Each Sub-Account invests in a Fund.

Net Asset Value: The amount computed by an investment company as the price at which its shares or
units may be redeemed. This price is computed in accordance with the rules of the Securities and
Exchange Commission. It is computed no less frequently than each Valuation Period.

Participant: A person who has an interest in this Contract, as evidenced by a Certificate. The
name of each Participant is set out on his or her Certificate Specifications page.

Purchase Payment: An amount paid to us for an interest in this Contract, less any fee charged by
the person remitting payments. It is also after the deduction of premium tax or other taxes that
may apply.

Separate Account: An account that is established and maintained by the Company pursuant to the
laws of the State of Ohio. The Separate Account is registered as a unit investment trust under the
Investment Company Act of 1940, as amended.

Sub-Account: A subdivision of the Separate Account. Each of the Sub-Accounts invests in the
shares of a designated Fund.

Valuation Date: Each day on which the New York Stock Exchange is open for business.

Valuation Period: The period commencing at the close of regular trading on the New York Stock
Exchange on any Valuation Date, and ending at the close of trading on the next succeeding Valuation
Date.

Written Request: Information provided, or a request made, that is:

	 	1)	 	complete and satisfactory to us;

	 	2)	 	on our form or in a manner satisfactory to us, which may, at our discretion, be
by telephone or electronic means; and

	 	3)	 	received by us at our Administrative Office.

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A Written Request is subject to any payment that we make before we acknowledge it. It is also
subject to any action that we take before we acknowledge it. We will deem a Written Request to be
a standing order. It may be modified or revoked only by a subsequent Written Request, when
permitted by the terms of this Contract. A Participant may be required to return his or her
Certificate to us in connection with a Written Request.

GENERAL PROVISIONS

Entire Contract

This Contract is a group flexible premium deferred variable annuity contract. It is restricted as
required to obtain favorable tax treatment under the Code. It is not valid without the requisite
endorsement(s) being attached. This Contract and its endorsements, the application for it, if any,
and any application and enrollment forms of Participants, form the entire contract between you and
us. A Certificate is not a contract and is not a part of this Contract.

Only statements made in consideration for this Contract or an interest in it will be used to void
this Contract or an interest in it, or to defend a claim based on it. Such statements are treated
as representations and not warranties.

Changes — Waivers

No changes or waivers of the terms of this Contract are valid unless made in writing and are signed
by our President, Vice President, or Secretary. No other person or agent has authority to change
or waive any provision of this Contract. We reserve the right both to administer and to change the
terms of this Contract to conform to pertinent laws and governmental regulations and rulings.

Nonparticipating

This Contract does not pay dividends or share in the Company’s divisible surplus.

Misstatement

If the age of a person is misstated, payments shall be adjusted to the amount that would have been
payable based on the correct age. If payments based on the correct age would have been higher, we
will pay the underpaid amount promptly in one (1) sum, with interest. If payments based on the
correct age would have been lower, we may deduct the overpaid amount, with interest, from
succeeding payments. We may also pursue other remedies at law or in equity.

Required Reports

At least once each Certificate Year, we will send the Participant a report of his or her current
values. We will also provide any other information required by law. These reports will stop when
his or her interest in this Contract is fully surrendered, or on a Commencement Date, whichever is
first.

The reports will be mailed to his or her last known address. If permitted by law, in lieu of that
we may deliver these and other required documents in electronic form. The reported values will be
based on the information in our possession at the time that we prepare the report. We may adjust
the reported values at a later date if that information proves to be incorrect or has changed.

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Exclusive Benefit

The rights of a Participant in this Contract are for the exclusive benefit of the Participant and
his or her Beneficiaries. Those rights are nonforfeitable by us.

State Law

All factors, values, benefits, and reserves under this Contract will not be less than those
required by the law of the state in which this Contract is delivered.

Claims of Creditors

To the extent allowed by law, this Contract and all values and benefits under it are not subject to
the claims of creditors or to legal process.

Company Liability

We will not be liable for any loss that is related to a failure by you, by a Participant, or by any
person having rights or benefits under this Contract, to comply with pertinent laws or governmental
regulations or rulings.

Voting Rights

To the extent required by law, we will vote all shares of the Funds held in the Separate Account at
regular and special shareholder meetings of the Funds. We will vote the shares attributable to an
interest in this Contract in accordance with instructions received from the Participant, or if
applicable, from the payee of a settlement option. If there is a change in the law that permits us
to vote the shares of the Funds without such instructions, then we reserve the right to do so.

Incontestability

This Contract, and the interests of Participants in it, shall not be contestable by us.

Discharge of Liability

We shall be discharged from all liability to the extent of each payment that is made for a
withdrawal, surrender, Annuity Benefit, or Death Benefit.

Transfer by the Company

We reserve the right to transfer our obligations under this Contract to another qualified life
insurance company under an assumption reinsurance arrangement. We may make such a transfer without
your consent or the consent of the Participants.

Termination

We may terminate this Contract by giving you sixty (60) days advance notice in writing. You may
terminate this Contract by giving us sixty (60) days advance notice in writing. If this Contract
is terminated, each Participant may continue his or her interest in it, but no more Purchase
Payments will be allowed. Termination of this Contract will not affect payments being made by us.
Termination of this Contract will not affect our right to any fees and charges, loans, or
applicable premium tax or other taxes not previously deducted.

Taxes

Some states impose on the Company a premium tax or other taxes on annuities. If a premium tax or
other tax is charged or due, we reserve the right to deduct this amount from the Purchase Payment
or Account Value of a Participant at the time that it is imposed.

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PURCHASE PAYMENTS

Purchase Payments

One (1) or more Purchase Payments may be paid to us for a Participant at any time before the
Annuity Commencement Date, so long as:

	 	1)	 	he or she is still living; and

	 	2)	 	his or her interest in this Contract has not been surrendered.

The initial Purchase Payment for a Participant must be paid to us on or before his or her
Certificate Effective Date. Each Purchase Payment must be received by us at our Administrative
Office. Each Purchase Payment is subject to any minimums or maximums that we set from time to
time. Upon request, we will provide you with a receipt as proof of payment.

Allocation of Purchase Payments

We will allocate Purchase Payments to the available Sub-Accounts and Fixed Account options
according to instructions from the Participant. Those instructions must be made by Written
Request. Allocations must be made in whole percentages. The minimum amount that can be allocated
to the Fixed Accumulation Account Option or to a Sub-Account is $10.00. The minimum amount that
can be allocated to a Fixed Account option other than the Fixed Accumulation Account is $2,000. We
may, in our sole discretion, restrict or prohibit allocations to Fixed Account options or
Sub-Accounts from time to time on a nondiscriminatory basis.

FIXED ACCOUNT

Fixed Account

The Fixed Account is part of the Company’s general account. The values of the Fixed Account are
not dependent upon the investment performance of the Sub-Accounts.

Fixed Account Options

The Fixed Account options available as of the Contract Effective Date are listed on the Contract
Specifications page. We may add or delete Fixed Account options at any time. A Fixed Account
option will not be available to a Participant if it has a guarantee period that ends after the
Annuity Commencement Date.

Interest Crediting

Amounts held under a Fixed Account option will be credited with interest at an annual effective
rate that is at least equal to the Fixed Account Guaranteed Interest Rate. The Fixed Account
Guaranteed Interest Rate is set out on the Contract Specifications page. We may from time to time
pay a higher current interest rate for any of the Fixed Account options. Such higher rate would be
as declared by our Board of Directors in its discretion. Once declared, such rate will be credited
until changed.

Interest on amounts held under a Fixed Account option is earned daily. We will stop crediting
interest on an amount as of the date that it is transferred, withdrawn, surrendered, or applied to
charges. We will stop crediting interest on an amount that is applied to a settlement option as of
the Commencement Date.

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The interest rate credited to each Purchase Payment allocated to the Fixed Accumulation Account
will not be changed for at least twelve (12) months following the date on which it was received.
Thereafter, the interest rate credited will not be changed more frequently than once per calendar
quarter. In the case of transfers from other Fixed Account options or the Sub-Accounts to the
Fixed Accumulation Account Option, the interest rate will not be changed more frequently than once
per calendar quarter.

The interest rate credited to an amount that is held under a Fixed Account option that has a
guarantee period will not be changed until the end of that period. The guarantee period is
measured from the date that the amount is allocated or transferred to that option.

Renewal

An amount that is allocated or transferred to a Fixed Account option that has a guarantee period
will mature at the end of that period. When an amount matures, a Participant may transfer it to
any of the Fixed Account options or Sub-Accounts that are then available to him or her under this
Contract. To do so, a Written Request must be received within the thirty (30) day period that ends
on the date that the amount matures.

If a Participant does not transfer the amount, then it will be applied to a new guarantee period
under the same Fixed Account option if it is then available to him or her. The interest rate for
the new period will be the then current rate for that option. If that option is not available,
then the amount will be transferred to the Fixed Accumulation Account.

Such a transfer or renewal will be effective on the day after the amount matures.

Fixed Account Value

For a Participant, the Fixed Account Value at any time is equal to:

	 	1)	 	Purchase Payment(s) for his or her interest in this Contract that are allocated
to the Fixed Account options; plus

	 	2)	 	amounts transferred to the Fixed Account for him or her; plus

	 	3)	 	interest credited to the Fixed Account for him or her; less

	 	4)	 	any withdrawals, surrender, deductions, and transfers from the Fixed Account
for him or her; and less
	 
	 	5)	 	other charges and adjustments to his or her interest made as described elsewhere in this
Contract.

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SEPARATE ACCOUNT

General Description

The variable benefits under this Contract are provided through the Separate Account.

The income, if any, and any gains or losses, realized or unrealized, on the Separate Account will
be credited to or charged against the amounts allocated to such account. This credit or charge
will be made without regard to other income, gains, or losses of the Company. The amounts
allocated to the Separate Account and the earnings on those amounts are the property of the
Company. However, the Separate Account is not chargeable with any other liabilities of the Company
to the extent that it is equal to the reserves and other contractual liabilities under all of the
policies, annuities, and other contracts identified with it. The Company is not, and does not hold
itself out to be, a trustee with respect to such amounts.

We have the right to transfer certain assets from the Separate Account to our general account. We
may transfer any assets that are in excess of the required reserves and other contractual
liabilities under all of the policies, annuities, and other contracts identified with the Separate
Account. We may make these transfers in our sole discretion at any time and without prior notice.

We may merge or combine the Separate Account with any other separate account of the Company. We
may transfer the assets of the Separate Account to another life insurance company by means of a
merger or reinsurance. We may convert the Separate Account into a managed separate account. We
may de-register the Separate Account under the Investment Company Act of 1940. Such a change will
be made in accordance with pertinent laws. It will be made only after obtaining any approvals that
may be needed, including those of the Ohio Department of Insurance and the Securities and Exchange
Commission.

Sub-Accounts of the Separate Account

The Separate Account is divided into Sub-Accounts. All of the Sub-Accounts that are available as
of the Contract Effective Date are listed on the Contract Specifications page. Each of the
Sub-Accounts invests exclusively in shares of an underlying Fund. These Funds are shown on the
Contract Specifications page. Any amounts of income on the shares of a Fund will be reinvested in
additional shares of that Fund at its Net Asset Value. Any gains on the shares of a Fund will also
be reinvested.

We may add or delete Sub-Accounts. We may substitute shares of a different Fund or different class
or series of a Fund for shares held in a Sub-Account. We may merge or combine Sub-Accounts. Such
a change will be made in accordance with pertinent laws. It will be made only after obtaining any
approvals that may be needed.

Valuation of Assets

Shares of Funds held by each Sub-Account will be valued at their Net Asset Value at the end of each
Valuation Period, as reported by each such Fund.

Variable Account Value

Purchase Payment(s) that are allocated to a Sub-Account, and amounts that are transferred to a
Sub-Account, are converted into Accumulation Units. The number of Accumulation Units credited is
determined by dividing the dollar amount directed to that Sub-Account by the value of the
Accumulation Unit for that Sub-Account at the end of the Valuation Period during which the amount
is received.

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The following events will result in the cancellation of an appropriate number of Accumulation Units
of a Sub-Account:

	 	1)	 	a transfer from a Sub-Account;

	 	2)	 	the surrender or a withdrawal of the Variable Account Value;

	 	3)	 	the payment of a Death Benefit;

	 	4)	 	the application of the Variable Account Value to a settlement option; or

	 	5)	 	the deduction of the charges, fees, or other adjustments described in this
Contract.

Accumulation Units will be canceled as of:

	 	1)	 	the end of the Valuation Period during which we receive a Written Request that
gives rise to such cancellation;

	 	2)	 	the Commencement Date; or

	 	3)	 	the end of the Valuation Period on which a charge, fee, or other adjustment is
due.

At any time, the Variable Account Value of a Participant is equal to the sum of the values of his
or her interest in each Sub-Account. The value of his or her interest in a Sub-Account is equal to
the number of his or her Accumulation Units for that Sub-Account multiplied by the Accumulation
Unit Value for that Sub-Account. These values are determined as of the end of the preceding
Valuation Period.

Accumulation Unit Value

The initial Accumulation Unit Value for the Money Market Sub-Account was set at $1.00. The initial
Accumulation Unit Value for each of the other Sub-Accounts was set at $10.00. After that, the
Accumulation Unit Value at the end of each Valuation Period is the Accumulation Unit Value as of
the end of the prior Valuation Period multiplied by the Net Investment Factor. The Net Investment
Factor is described below. The Accumulation Unit Values will vary as a result of the varying
investment experience of the Funds.

The Net Investment Factor is a measure of the investment performance of a Sub-Account from one
Valuation Period to the next. Each Sub-Account has a Net Investment Factor for each Valuation
Period. The Net Investment Factor may be greater than one, or it may be less than one. This means
that the Accumulation Unit Value for each Sub-Account may increase or it may decrease. The Net
Investment Factor for any Sub-Account for any Valuation Period is determined by dividing (1) by (2)
and then subtracting (3) from the result, where:

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	 	1)	 	is equal to:

	 	a)	 	the Net Asset Value per share of the Fund held in the Sub-Account,
determined at the end of the applicable Valuation Period; plus

	 	b)	 	the per share amount of any dividend or net capital gain distributions
made by the Fund held in the Sub-Account, if the “ex-dividend” date occurs during
the applicable Valuation Period; plus or minus

	 	c)	 	a per share charge or credit for any taxes reserved for, which is
determined by the Company to have resulted from the investment operations of the
Sub-Account;

	 	2)	 	is the Net Asset Value per share of the Fund held in the Sub-Account,
determined at the end of the preceding Valuation Period; and

	 	3)	 	is the sum of the Mortality and Expense Risk Charge and the Administration
Charge to be deducted from the Sub-Account for the number of days in the applicable
Valuation Period.

TRANSFERS

Prior to a Commencement Date, a Participant may transfer amounts in a Sub-Account or Fixed
Account option as set out below.

Transfers From a Fixed Account Option

If allowed by the Company, in its sole discretion, a Participant may transfer amounts from his or
her interest in a Fixed Account option to another Fixed Account option or to a Sub-Account. No
transfer from a Fixed Account option is allowed during his or her first Certificate Year. If a
transfer is being made from a Fixed Account option pursuant to the Renewal provision of this
Contract, then the entire amount that has matured may be transferred. Other transfers from a Fixed
Account option during a Certificate Year may not exceed the greater of $500 or twenty percent (20%)
of the value of his or her interest in that option as of the most recent Certificate Anniversary.
We may, in our sole discretion, restrict or prohibit this type of transfer or the availability of
any Fixed Account option or Sub-Account from time to time on a nondiscriminatory basis.

Transfers From a Sub-Account

If allowed by the Company, in its sole discretion, a Participant may transfer amounts from his or
her interest in a Sub-Account to another Sub-Account or to a Fixed Account option. Amounts
transferred from a Fixed Account option to the Sub-Accounts may not be transferred back to a Fixed
Account option for a period of six (6) months from the date of transfer. We may, in our sole
discretion, restrict or prohibit this type of transfer or the availability of any Sub-Account or
Fixed Account option from time to time on a nondiscriminatory basis.

Other Transfer Rules

A transfer must be made by Written Request. The minimum transfer amount is $500 or the balance of
the Sub-Account or Fixed Account option, if less.

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We will charge a Transfer Fee on each transfer over a certain number per year. The amount of the
Transfer Fee, and the number of transfers that may be made before it applies, are set out on the
Contract Specifications page.

We may modify our transfer procedures at any time and at our sole discretion. Such modifications
could be applied to transfers to or from some or all of the Sub-Accounts or Fixed Account options,
and may include, but not be limited to, the following:

	 	1)	 	the requirement of a minimum time period between each transfer;

	 	2)	 	the means for submitting a Written Request; or

	 	3)	 	limits on the dollar amount that may be transferred between available
Sub-Accounts or Fixed Account options at any one time.

FEES AND CHARGES

Mortality and Expense Risk Charge

The Mortality and Expense Risk Charge is shown on the Contract Specifications page. It is deducted
daily from each of the Sub-Accounts. This deduction is made to compensate us for assuming the
mortality and expense risks under this Contract.

Administration Charge

The Administration Charge is shown on the Contract Specifications page. It is deducted daily from
each of the Sub-Accounts. This deduction is made to reimburse us for certain expenses that are
incurred in the administration of this Contract and the Separate Account.

Certificate Maintenance Fee

The Certificate Maintenance Fee (“Fee”) is shown on the Contract Specifications page. It is
deducted from the interest of a Participant in this Contract as of the Valuation Date after each
Certificate Anniversary that his or her interest in this Contract is in effect until the
Commencement Date. The full annual Fee will also be deducted at the time of a surrender of his or
her interest in this Contract. The Fee will be deducted pro-rata from each Sub-Account in which he
or she has an interest at that time. The Fee does not apply to the Fixed Account.

After the Commencement Date, if Variable Dollar payments are to be made, the Fee will be deducted
pro-rata from each payment. This deduction will result in a reduction in the amount of such
payment.

We may waive the Fee in whole or in part in our sole discretion.

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SURRENDER AND WITHDRAWALS

Surrender

A Participant may surrender his or her interest in this Contract in full for his or her Account
Value at any time prior to the Annuity Commencement Date. The amount available for surrender will
be his or her Account Value at the end of the Valuation Period in which the Written Request is
received. Any fees and charges, loans or applicable premium tax or other taxes not previously
deducted, will be deducted as part of the calculation of his or her Account Value. A surrender
must be made by Written Request. In the case of a surrender, his or her interest in this Contract
will be terminated.

Withdrawals

A Participant may take withdrawals from his or her interest in this Contract at any time prior to
the Annuity Commencement Date. A withdrawal must be made by Written Request. The amount of any
withdrawal must be at least $500. No withdrawal can be made that would reduce his or her Account
Value to less than the Minimum Termination Value. The Minimum Termination Value is set out on the
Contract Specifications page.

A withdrawal will result in the cancellation of Accumulation Units from each of his or her
applicable Sub-Accounts and/or a reduction of his or her Fixed Account Value. Unless a Participant
states otherwise in his or her request for a withdrawal, the reduction in each Sub-Account and
Fixed Account option will be in the same proportion as the reduction in his or her total Account
Value.

Transfers and Rollovers

An amount paid on a withdrawal or surrender may be paid to or for another annuity or tax-qualified
account in a transfer or rollover to the full extent allowed by federal tax law.

Termination

We reserve the right to terminate the interest of a Participant in this Contract at any time that
his or her Account Value is less than the Minimum Termination Value. The Minimum Termination Value
is set out on the Contract Specifications page. If we terminate his or her interest in this
Contract, we will pay him or her the Account Value less any fees and charges, loans, or applicable
premium tax or other taxes not previously deducted.

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Deferral of Payment

The Company has the right to suspend or delay the date of payment of a withdrawal or surrender of
the Variable Account Value at certain times. We may do this for any period:

	 	1)	 	when the New York Stock Exchange is closed, or when trading on the New York
Stock Exchange is restricted; or

	 	2)	 	when an emergency exists (as determined by the Securities and Exchange
Commission) as a result of which:

	 	a)	 	the disposal of securities in the Separate Account is not reasonably practicable; or
	 
	 	b)	 	it is not reasonably practicable to determine fairly the value of the
net assets in the Separate Account; or

	 	3)	 	when the Securities and Exchange Commission so permits for the protection of
security holders.

The Company further reserves the right to delay payment of a withdrawal or surrender of the Fixed
Account Value. We may delay such payment for up to six (6) months after we receive the Written
Request.

OWNERSHIP PROVISIONS

Ownership of Separate Account

The Company has absolute ownership of the assets in the Separate Account. We are not, and do not
hold ourselves out to be, a trustee in respect of any amounts under the Separate Account.

Ownership of the Contract and Participant Account

The owner of this Contract is shown on the Contract Specifications page and must be an employer or
the trustee of an employer’s retirement plan. You hold this Contract for the benefit of the
Participants and Beneficiaries.

Each person for whom Purchase Payment(s) are made will have an interest in this Contract as a
Participant. An account will be established for each Participant.

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Transfer and Assignment

Neither you nor a Participant may transfer, sell, assign, pledge, charge, encumber, or in any way
alienate an interest in this Contract.

Successor Owner

In some cases, the spouse of a Participant may succeed to the ownership of his or her interest in
this Contract after the death of the Participant. Specifically, if a Participant dies before the
Annuity Commencement Date and his or her spouse is his or her sole surviving Beneficiary, the
spouse will become the successor owner of his or her interest if:

	 	1)	 	the Participant makes that Written Request before his or her death; or

	 	2)	 	after his or her death, the spouse makes that Written Request within one (1)
year of the death of the Participant and before the Death Benefit Commencement Date.

As successor owner, the spouse will then succeed to all the rights of the Participant under this
Contract except the right to name another successor owner.

Community Property

If a Participant lives in a community property state and has a spouse at any time while he or she
has an interest in this Contract, the laws of that state may vary his or her ownership rights.

BENEFICIARY PROVISIONS

Beneficiary

For each Participant, the Beneficiary is the person or persons that he or she designates under the
Designation of Beneficiary provision of his or her Certificate. If there is no designated
Beneficiary that survives the Participant, then his or her estate will be his or her Beneficiary.

A Beneficiary will be deemed not to have survived the Participant if he or she dies within thirty
(30) days after the death of the Participant.

Designation of Beneficiary

Unless a Participant has specified that a prior designation is irrevocable, he or she may make or
change a designation of Beneficiary at any time before the Annuity Commencement Date. A
designation of Beneficiary must be made by Written Request. Except as otherwise elected or as
required by law, it will not cancel a settlement option election.

A Participant may designate two (2) or more persons jointly as the Beneficiary. Unless the
Participant states otherwise, joint Beneficiaries that survive him or her will be entitled to equal
shares. A Participant may also designate one (1) or more persons as contingent Beneficiary.
Unless the Participant states otherwise, a contingent Beneficiary will be entitled to a benefit
only if there is no primary Beneficiary that survives him or her.

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ANNUITY BENEFIT

Annuity Commencement Date

The Annuity Commencement Date for the interest of a Participant in this Contract is set out on his
or her Certificate Specifications page. A Participant may change the Annuity Commencement Date by
Written Request. Such a request must be made at least thirty (30) days prior to the date that
Annuity Benefit payments are to begin.

Generally the Annuity Commencement Date must be no later than the Certificate Anniversary following
his or her 70th birthday. It can be later only if we agree.

Annuity Benefit Amount

The Account Value of the Participant as of the Annuity Commencement Date, reduced by any fees and
charges, loans, or applicable premium tax or other taxes not previously deducted, will be used to
provide Annuity Benefit payments under his or her interest in this Contract.

Annuity Benefit Payments

Annuity Benefit payments will be made to the Participant as payee unless amounts are paid as a
transfer or rollover to an annuity or tax-qualified account as permitted by federal tax law.

Annuity Benefit payments that are still payable after the death of the payee will be made to the
contingent payee that designated by the Participant. If there is no such contingent payee
surviving, then such payments will be made to the person or persons designated as contingent payee
by the last payee who received payments. Failing that, such payments will be made to the estate of
the last payee who received payments.

A designation or change of a payee or contingent payee must be made by Written Request. Unless it
has been specified that a prior designation is irrevocable, a Participant may change the payee or
contingent payee at any time.

The Participant will be the person on whose life Annuity Benefit payments are based. No change of
payee or contingent payee at any time will change this.

Form of Annuity Benefit

Annuity Benefit payments will be made annually under the terms of Option B with a fixed period of
ten (10) years, as described in the SETTLEMENT OPTIONS section of this Contract.

In lieu of that, a Participant may elect to have Annuity Benefit payments made pursuant to any
other available option that is described in the SETTLEMENT OPTIONS section of this Contract. Such
an election must be made before the Annuity Commencement Date. A Participant may change his or her
election so long as we receive the request for a change at least thirty (30) days prior to the date
that Annuity Benefit payments are scheduled to begin.

Any election or change of election must be made by Written Request.

An election of a settlement option may be subject to restrictions stated in the tax qualification
endorsement.

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DEATH BENEFIT

Death Benefit

A Death Benefit will be paid with respect to the interest of a Participant in this Contract if he
or she dies before the Annuity Commencement Date and before his or her interest in this Contract is
surrendered.

If a Death Benefit becomes payable:

	 	1)	 	it will be in lieu of all other benefits with respect to his or her interest in
this Contract; and

	 	2)	 	all other rights with respect to his or her interest in this Contract will be
terminated except for rights related to the Death Benefit.

No Death Benefit will be paid on the death of a Participant if his or her spouse becomes the
successor owner of his or her interest in this Contract. Only one (1) Death Benefit will be paid
with respect to the interest of a Participant in this Contract.

Death Benefit Amount

The amount of the Death Benefit will be based on the greater of:

	 	1)	 	the Account Value of the Participant on the Death Benefit Valuation Date;

	 	2)	 	the total of all Purchase Payments for the interest of the Participant in this
Contract, reduced proportionally for any withdrawals.

The reduction for withdrawals will be in the same proportion that the Account Value of the
Participant was reduced on the date of the withdrawal.

As of the Death Benefit Valuation Date, the amount of the Death Benefit will be allocated among the
Sub-Accounts and Fixed Account options. The allocation will be in the same proportion as each
Account’s value is to the total Account Value of the Participant as of the end of the Valuation
Period that precedes the Death Benefit Valuation Date. After this allocation, the amount of the
Death Benefit to be paid will be based on the Account Value.

The Death Benefit will be reduced by any applicable premium tax or other taxes not previously
deducted. The Death Benefit will also be reduced by any outstanding loans.

Step Up in Account Value for Successor Owner

If a spouse becomes the successor owner of the interest of a Participant in this Contract, his or
her Account Value will be increased to equal the amount of the Death Benefit which would have been
payable if the spouse had not become the successor owner. This increase will occur as of the date
that would have been the Death Benefit Valuation Date. If the Account Value of a Participant is
increased under this provision, we will add the amount of the increase to the Fixed Accumulation
Account.

If the Death Benefit that would have been payable is equal to the Account Value of a Participant as
of the date that would have been the Death Benefit Valuation Date, then there will be no such
change to the Account Value.

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The election to become successor owner will be deemed to be instructions as to the form of Death
Benefit. Therefore, the date that would have been the Death Benefit Valuation Date will be the
later of the date that we receive Due Proof of Death, or the date we receive the successor owner
election. This date will never be later than one (1) year after the date of the death of the
Participant.

Transfers After Death

Between the Death Benefit Valuation Date and the Death Benefit Commencement Date, the Beneficiary
may transfer funds among Sub-Accounts and Fixed Account options. Such transfers are subject to the
limitations set out in the TRANSFERS section of this Contract.

Death Benefit Commencement Date

The Beneficiary of a Participant may designate the Death Benefit Commencement Date by Written
Request. This request must be made within one (1) year of the death of the Participant. If no
designation is made, then the Death Benefit Commencement Date will be one (1) year after the death
of the Participant. No Death Benefit will be paid until we receive Due Proof of Death.

Death Benefit Payments

Death Benefit payments will be made to the Beneficiary as payee unless:

	 	1)	 	amounts are paid as a transfer or rollover to an annuity or tax-qualified
account as permitted by federal tax law; or

	 	2)	 	the Beneficiary is a non-natural person, and elects to have Death Benefit
payments made to a payee to whom the Beneficiary is obligated to make corresponding
payments.

Death Benefit payments that are still payable after the death of the Beneficiary will be made to
the contingent payee designated as part of a Death Benefit settlement option election made by the
Participant. If there is no such contingent payee surviving, then such payments will be made to
the person or persons designated as contingent payee by the Beneficiary. Failing that, such
payments will be made to the estate of the last payee who received payments.

A designation or change of a payee or contingent payee must be made by Written Request. A
Beneficiary may not change a contingent payee designation made as part of a Death Benefit
settlement option election made by the Participant. A Beneficiary may make or change any other
payee or contingent payee designation at any time.

The Beneficiary will be the person on whose life Death Benefit payments under a settlement option
will be based. No change of payee or contingent payee at any time will change this. A Beneficiary
that is a non-natural person may elect to have payments based on the life of a person to whom the
Beneficiary is obligated. Such an election shall be made by Written Request before the Death
Benefit Commencement Date.

Form of Death Benefit

Death Benefit payments will be made annually under the terms of Option A with a period certain of
four (4) years, as described in the SETTLEMENT OPTIONS section of this Contract.

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In lieu of that, a Participant may elect at any time before his or her death to have Death Benefit
payments made in one (1) lump sum or pursuant to any available option described in the SETTLEMENT
OPTIONS section of this Contract. A Participant may change his or her election of a settlement
option at any time before his or her death.

If the Participant does not make any such election, the Beneficiary may make that election at any
time after the death of the Participant and before the Death Benefit Commencement Date. A
Beneficiary may change his or her own election of a settlement option so long as we receive the
request for a change at least thirty (30) days prior to the date that Death Benefit payments are
scheduled to begin.

Any election or change of election must be made by Written Request.

An election of a settlement option is subject to restrictions stated in the tax qualification
endorsement.

SETTLEMENT OPTIONS

Conditions

Payments under a settlement option are subject to any minimum amounts, payment intervals, and other
terms or conditions that we may from time to time require. If we change our minimums, we may
change any current or future payment amounts and/or payment intervals to conform to the change.
More than one (1) settlement option may be elected if the requirements for each settlement option
elected are satisfied. Once payment begins under a settlement option, the settlement option may
not be changed.

All elected settlement options must comply with pertinent laws and governmental regulations and
rulings.

If more than one (1) person is the payee under a settlement option, payments will be made to the
payees jointly. No more than two (2) persons may be initial payees under a joint and survivor
settlement option.

If payment under a settlement option depends on whether a specified person is still alive, we may
at any time require proof that such person is still living. We will require proof of the age of
any person on whose life payments are based.

Benefit Payments

Payments may be calculated and paid:

	 	1)	 	as Fixed Dollar payments;

	 	2)	 	as Variable Dollar payments; or

	 	3)	 	as a combination of both.

The amount to be applied to Variable Dollar payments is the Variable Account Value of the
Participant as of the end of the Valuation Period that precedes the Commencement Date. It will
include the amount of any transfer to Variable Dollar payments that is made from his or her
interest in the Fixed Account as of that same time. It will be reduced by the amount of any
transfer to Fixed Dollar payments that is to be made from his or her interest in the Separate
Account on the Commencement Date. An amount that is transferred from the Fixed Account will be
allocated among the Sub-Accounts by Written Request.

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The amount to be applied to Fixed Dollar payments is the Fixed Account Value of the Participant as
of the Commencement Date. It will include the amount of any transfer to Fixed Dollar payments that
is made from his or her interest in the Separate Account on that date. It will not include the
amount of any transfer to Variable Dollar payments that is made from his or her interest in the
Fixed Account as of the end of the Valuation Period that precedes the Commencement Date.

In each case, the amount to be applied to payments will be reduced by any fees and charges, loans,
or applicable premium tax or other taxes not previously deducted.

No transfers between Fixed Dollar payments and Variable Dollar payments will be allowed after the
Commencement Date. Twelve (12) months or more after the Commencement Date, the payee may transfer
all or part of the Benefit Units upon which Variable Dollar payments are based from the
Sub-Account(s) then held, to Benefit Units in other Sub-Account(s) that are then available. Such
transfers of Benefit Units may not occur more than once in any twelve (12) month period. Such
transfers are subject to the other limitations set out in the TRANSFERS section of this Contract.

Fixed Dollar Payments

Fixed Dollar payments are determined as follows. We start with the amount to be applied to Fixed
Dollar payments, expressed in thousands of dollars. This amount is then multiplied by the amount
of the periodic payment per $1,000 of value. This payment is obtained from the Settlement Option
Table for the option that is elected. Fixed Dollar payments will remain level for the duration of
the payment period.

Variable Dollar Payments

The Variable Dollar base payment is determined as follows. We start with the amount to be applied
to Variable Dollar payments, expressed in thousands of dollars. This amount is then multiplied by
the amount of the periodic payment per $1,000 of value. This payment is obtained from the
Settlement Option Table for the option that is elected.

The number of Benefit Units in each Sub-Account held for Variable Dollar payments is determined as
follows. We divide the dollar amount of the Variable Dollar base payment from each Sub-Account by
the Benefit Unit Value for that Sub-Account as of the Commencement Date. The number of Benefit
Units in each Sub-Account will change if the payee makes transfers among Sub-Accounts. The Benefit
Units in each Sub-Account will change proportionally to a change in the base payment due to any
change in the payment interval or as specified by the settlement option. Otherwise, the number of
Benefit Units remains fixed during the payment period.

The actual amount of each Variable Dollar payment will reflect the investment performance of the
Sub-Account(s) selected. It may vary from payment to payment. The total amount of each Variable
Dollar payment will be equal to the sum of the payments from each Sub-Account. We will deduct a
pro-rata portion of the Certificate Maintenance Fee from this total.

The payment from each Sub-Account is found by multiplying the number of Benefit Units held in that
Sub-Account for such Variable Dollar payments by the Benefit Unit Value for that Sub-Account. We
do this as of the end of the fifth (5th) Valuation Period before the date that the
payment is due.

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The Benefit Unit Value for each Sub-Account is originally established in the same manner as
Accumulation Unit Values. For any date after that, the value of a Benefit Unit for a Sub-Account
is determined by multiplying the Benefit Unit Value as of the end of the preceding Valuation Period
by the Net Investment Factor. This factor is determined as set forth in the Accumulation Unit
Value provision of this Contract. The product is then multiplied by the assumed daily investment
factor for the number of days in the Valuation Period. The factor is based on the assumed net
investment rate for the Settlement Option Table that is used to fix the base payment. This factor
shall be no greater than [ 0.99997236 ] , which is the factor based on a net
investment rate of [ one percent (1%) ] per year, compounded annually, as
reflected in the guaranteed Settlement Option Tables.

Limitation on Election of Settlement Option

Fixed periods shorter than five (5) years are generally not available. A fixed period of less than
five (5) years is available only as a Death Benefit settlement option.

Settlement Option Computations

The Annuity 2000 Mortality Table for blended lives (60% female/40% male) with interest at
[ one percent (1%) ] per year, compounded annually, is used to compute all
guaranteed settlement option factors, values, and benefits under this Contract.

Available Settlement Options

The available settlement options are set out below.

Option A Income for a Fixed Period

We will make periodic payments for a fixed period. The first payment will be paid as of the
last day of the initial payment interval. The maximum time over which we will make payments
or money will be held by us is thirty (30) years. The Option A Table applies to this
Option.

Option B Life Annuity with Payments for at Least a Fixed Period

We will make periodic payments for at least a fixed period. If the person on whose life
payments are based lives longer than the fixed period, then we will make payments until his
or her death. The first payment will be paid as of the last day of the initial payment
interval. The Option B Table applies to this Option.

Option C Joint and One-half Survivor Annuity

We will make periodic payments until the death of the primary person on whose life payments
are based; thereafter, we will make one-half (1/2) of the periodic payment until the death
of the secondary person on whose life payments are based. The first payment will be paid as
of the last day of the initial payment interval. The Option C Table applies to this Option.

We will make periodic payments in any other form of settlement option that is acceptable to us at
the time of an election.

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Commuted Values

Commuted values are not available unless we agree otherwise.

Settlement Option Tables

The Option Tables show the payments that we will make at sample payment intervals for each $1,000
applied based on the guaranteed settlement option factors. Amounts may vary with the payment
interval and the age of the person on whose life payments are based. Upon request, we will provide
information on the payments that we will make for other payment intervals and ages.

OPTION A TABLE — INCOME FOR A FIXED PERIOD

Payments for fixed number of years for each $1,000 applied.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Term of	 	 	 	 	 	Semi-	 	 	 	 
	Payments	 	Annual	 	Annual	 	Quarterly	 	Monthly
	 
	Years
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	1
	 	$	[1,010.00]	 	 	$	[503.74]	 	 	$	[251.55]	 	 	$	[83.78]	 
	2
	 	 	[507.51]	 	 	 	[253.12]	 	 	 	[126.40]	 	 	 	[42.10]	 
	3
	 	 	[340.02]	 	 	 	[169.58]	 	 	 	[84.68]	 	 	 	[28.20]	 
	4
	 	 	[256.28]	 	 	 	[127.82]	 	 	 	[63.83]	 	 	 	[21.25]	 
	5
	 	 	[206.03]	 	 	 	[102.76]	 	 	 	[51.31]	 	 	 	[17.09]	 
	6
	 	 	[172.54]	 	 	 	[86.05]	 	 	 	[42.97]	 	 	 	[14.31]	 
	7
	 	 	[148.62]	 	 	 	[74.12]	 	 	 	[37.01]	 	 	 	[12.32]	 
	8
	 	 	[130.69]	 	 	 	[65.18]	 	 	 	[32.55]	 	 	 	[10.84]	 
	9
	 	 	[116.74]	 	 	 	[58.22]	 	 	 	[29.07]	 	 	 	[9.68]	 
	10
	 	 	[105.58]	 	 	 	[52.65]	 	 	 	[26.29]	 	 	 	[8.75]	 
	11
	 	 	[96.45]	 	 	 	[48.10]	 	 	 	[24.02]	 	 	 	[8.00]	 
	12
	 	 	[88.84]	 	 	 	[44.31]	 	 	 	[22.12]	 	 	 	[7.37]	 
	13
	 	 	[82.41]	 	 	 	[41.10]	 	 	 	[20.52]	 	 	 	[6.83]	 
	14
	 	 	[76.90]	 	 	 	[38.35]	 	 	 	[19.15]	 	 	 	[6.37]	 
	15
	 	 	[72.12]	 	 	 	[35.97]	 	 	 	[17.96]	 	 	 	[5.98]	 
	16
	 	 	[67.94]	 	 	 	[33.88]	 	 	 	[16.92]	 	 	 	[5.63]	 
	17
	 	 	[64.25]	 	 	 	[32.04]	 	 	 	[16.00]	 	 	 	[5.33]	 
	18
	 	 	[60.98]	 	 	 	[30.41]	 	 	 	[15.18]	 	 	 	[5.05]	 
	19
	 	 	[58.05]	 	 	 	[28.95]	 	 	 	[14.45]	 	 	 	[4.81]	 
	20
	 	 	[55.41]	 	 	 	[27.63]	 	 	 	[13.80]	 	 	 	[4.59]	 

The values stated for years 1-4 are available only as a Death Benefit option.

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OPTION B TABLE — LIFE ANNUITY

Monthly payments by age of the person named for each $1,000 applied.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Number of Months Certain
	Age	 	0	 	60	 	120	 	180	 	240
	 
	55
	 	$	[3.25]	 	 	$	[3.24]	 	 	$	[3.22]	 	 	$	[3.18]	 	 	$	[3.12]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	56
	 	 	[3.33]	 	 	 	[3.33]	 	 	 	[3.30]	 	 	 	[3.26]	 	 	 	[3.18]	 
	57
	 	 	[3.42]	 	 	 	[3.42]	 	 	 	[3.39]	 	 	 	[3.34]	 	 	 	[3.25]	 
	58
	 	 	[3.52]	 	 	 	[3.51]	 	 	 	[3.48]	 	 	 	[3.42]	 	 	 	[3.32]	 
	59
	 	 	[3.62]	 	 	 	[3.61]	 	 	 	[3.58]	 	 	 	[3.51]	 	 	 	[3.40]	 
	60
	 	 	[3.73]	 	 	 	[3.72]	 	 	 	[3.68]	 	 	 	[3.60]	 	 	 	[3.47]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	61
	 	 	[3.85]	 	 	 	[3.83]	 	 	 	[3.79]	 	 	 	[3.69]	 	 	 	[3.54]	 
	62
	 	 	[3.97]	 	 	 	[3.95]	 	 	 	[3.90]	 	 	 	[3.79]	 	 	 	[3.62]	 
	63
	 	 	[4.10]	 	 	 	[4.08]	 	 	 	[4.02]	 	 	 	[3.89]	 	 	 	[3.69]	 
	64
	 	 	[4.24]	 	 	 	[4.22]	 	 	 	[4.14]	 	 	 	[4.00]	 	 	 	[3.77]	 
	65
	 	 	[4.39]	 	 	 	[4.36]	 	 	 	[4.27]	 	 	 	[4.10]	 	 	 	[3.84]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	66
	 	 	[4.55]	 	 	 	[4.52]	 	 	 	[4.41]	 	 	 	[4.21]	 	 	 	[3.91]	 
	67
	 	 	[4.72]	 	 	 	[4.68]	 	 	 	[4.56]	 	 	 	[4.33]	 	 	 	[3.99]	 
	68
	 	 	[4.90]	 	 	 	[4.86]	 	 	 	[4.71]	 	 	 	[4.44]	 	 	 	[4.05]	 
	69
	 	 	[5.10]	 	 	 	[5.04]	 	 	 	[4.87]	 	 	 	[4.55]	 	 	 	[4.12]	 
	70
	 	 	[5.30]	 	 	 	[5.24]	 	 	 	[5.03]	 	 	 	[4.67]	 	 	 	[4.18]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	71
	 	 	[5.53]	 	 	 	[5.45]	 	 	 	[5.21]	 	 	 	[4.78]	 	 	 	[4.24]	 
	72
	 	 	[5.77]	 	 	 	[5.68]	 	 	 	[5.39]	 	 	 	[4.89]	 	 	 	[4.29]	 
	73
	 	 	[6.03]	 	 	 	[5.92]	 	 	 	[5.57]	 	 	 	[5.00]	 	 	 	[4.34]	 
	74
	 	 	[6.31]	 	 	 	[6.18]	 	 	 	[5.76]	 	 	 	[5.11]	 	 	 	[4.38]	 
	75
	 	 	[6.61]	 	 	 	[6.45]	 	 	 	[5.95]	 	 	 	[5.21]	 	 	 	[4.42]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	76
	 	 	[6.93]	 	 	 	[6.74]	 	 	 	[6.15]	 	 	 	[5.31]	 	 	 	[4.45]	 
	77
	 	 	[7.28]	 	 	 	[7.04]	 	 	 	[6.35]	 	 	 	[5.40]	 	 	 	[4.48]	 
	78
	 	 	[7.66]	 	 	 	[7.37]	 	 	 	[6.55]	 	 	 	[5.48]	 	 	 	[4.50]	 
	79
	 	 	[8.07]	 	 	 	[7.71]	 	 	 	[6.75]	 	 	 	[5.56]	 	 	 	[4.52]	 
	80
	 	 	[8.51]	 	 	 	[8.07]	 	 	 	[6.94]	 	 	 	[5.63]	 	 	 	[4.54]	 

AILIC

-26-

 

OPTION C TABLE — JOINT AND ONE-HALF SURVIVOR ANNUITY

Monthly payments by ages of the persons named for each $1,000 applied.*

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Primary	 	Secondary Age
	Age	 	60	 	61	 	62	 	63	 	64	 	65	 	66	 	67	 	68	 	69	 	70
	 
	60
	 	$	[3.39]	 	 	$	[3.42]	 	 	$	[3.44]	 	 	$	[3.46]	 	 	$	[3.48]	 	 	$	[3.50]	 	 	$	[3.52]	 	 	$	[3.54]	 	 	$	[3.56]	 	 	$	[3.57]	 	 	$	[3.59]	 
	61
	 	 	[3.47]	 	 	 	[3.49]	 	 	 	[3.52]	 	 	 	[3.54]	 	 	 	[3.56]	 	 	 	[3.59]	 	 	 	[3.61]	 	 	 	[3.63]	 	 	 	[3.65]	 	 	 	[3.66]	 	 	 	[3.68]	 
	62
	 	 	[3.54]	 	 	 	[3.57]	 	 	 	[3.59]	 	 	 	[3.62]	 	 	 	[3.65]	 	 	 	[3.67]	 	 	 	[3.69]	 	 	 	[3.72]	 	 	 	[3.74]	 	 	 	[3.76]	 	 	 	[3.78]	 
	63
	 	 	[3.61]	 	 	 	[3.64]	 	 	 	[3.67]	 	 	 	[3.70]	 	 	 	[3.73]	 	 	 	[3.76]	 	 	 	[3.79]	 	 	 	[3.81]	 	 	 	[3.83]	 	 	 	[3.86]	 	 	 	[3.88]	 
	64
	 	 	[3.69]	 	 	 	[3.72]	 	 	 	[3.76]	 	 	 	[3.79]	 	 	 	[3.82]	 	 	 	[3.85]	 	 	 	[3.88]	 	 	 	[3.91]	 	 	 	[3.93]	 	 	 	[3.96]	 	 	 	[3.98]	 
	65
	 	 	[3.77]	 	 	 	[3.80]	 	 	 	[3.84]	 	 	 	[3.88]	 	 	 	[3.91]	 	 	 	[3.94]	 	 	 	[3.98]	 	 	 	[4.01]	 	 	 	[4.04]	 	 	 	[4.07]	 	 	 	[4.09]	 
	66
	 	 	[3.85]	 	 	 	[3.89]	 	 	 	[3.93]	 	 	 	[3.97]	 	 	 	[4.00]	 	 	 	[4.04]	 	 	 	[4.08]	 	 	 	[4.11]	 	 	 	[4.14]	 	 	 	[4.18]	 	 	 	[4.21]	 
	67
	 	 	[3.93]	 	 	 	[3.97]	 	 	 	[4.02]	 	 	 	[4.06]	 	 	 	[4.10]	 	 	 	[4.14]	 	 	 	[4.18]	 	 	 	[4.22]	 	 	 	[4.25]	 	 	 	[4.29]	 	 	 	[4.32]	 
	68
	 	 	[4.01]	 	 	 	[4.06]	 	 	 	[4.11]	 	 	 	[4.15]	 	 	 	[4.20]	 	 	 	[4.24]	 	 	 	[4.28]	 	 	 	[4.33]	 	 	 	[4.37]	 	 	 	[4.41]	 	 	 	[4.44]	 
	69
	 	 	[4.10]	 	 	 	[4.15]	 	 	 	[4.20]	 	 	 	[4.25]	 	 	 	[4.30]	 	 	 	[4.34]	 	 	 	[4.39]	 	 	 	[4.44]	 	 	 	[4.48]	 	 	 	[4.53]	 	 	 	[4.57]	 
	70
	 	 	[4.18]	 	 	 	[4.24]	 	 	 	[4.29]	 	 	 	[4.34]	 	 	 	[4.40]	 	 	 	[4.45]	 	 	 	[4.50]	 	 	 	[4.55]	 	 	 	[4.60]	 	 	 	[4.65]	 	 	 	[4.70]	 

 

			
	*	 	Payments after the death of the primary payee will be one-half (1/2) of the amount shown.

AILIC

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Group Flexible Premium Deferred Variable Annuity Contract

NONPARTICIPATING — NO DIVIDENDS

AILICEX-4.QQ

 

Exhibit 4(qq)

Home Office: Cincinnati, Ohio

Variable Administrative Office: P.O. Box 5423, Cincinnati, Ohio 45201-5423

Certificate of Participation

Under a Group Flexible Premium Deferred Variable Annuity Contract

This is your Certificate of Participation (“Certificate”). It is evidence of your interest in
the Group Flexible Premium Deferred Variable Annuity Contract (the “Contract”) that is identified
on the Certificate Specifications page. We have issued the Contract to the Contract Owner that is
identified on the Certificate Specifications page.

As you read through this Certificate, please note that the words “we”, “us”, “our”, and “Company”
refer to Annuity Investors Life Insurance Company. The words “you” and “your” refer to the
Participant. “Administrative Office” means our home office or any other place of business that we
may designate.

	 	 	 
	
	 	
	MARK F. MUETHING
	 	CHARLES R. SCHEPER
	SECRETARY
	 	PRESIDENT

NONPARTICIPATING — NO DIVIDENDS

PAYMENTS AND OTHER VALUES DESCRIBED IN THIS CERTIFICATE, WHEN BASED ON THE INVESTMENT EXPERIENCE OF
THE SEPARATE ACCOUNT, MAY INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS.
NO MINIMUM CONTRACT VALUE IS GUARANTEED, EXCEPT FOR AMOUNTS IN THE FIXED ACCOUNT.

AILIC

 

 

CERTIFICATE SPECIFICATIONS

PARTICIPANT: [ JOHN DOE ]

AGE OF PARTICIPANT AS OF CERTIFICATE EFFECTIVE DATE: [ 35 ]

GROUP CONTRACT OWNER: [ JOHN DOE ]

GROUP CONTRACT NUMBER: [ 000000000 ]

CERTIFICATE NUMBER: [ 000000000 ]

CERTIFICATE EFFECTIVE DATE: [ DECEMBER 01, 2006 ]

ANNUITY COMMENCEMENT DATE: [ FEBRUARY 01, 2056 ]

SEPARATE ACCOUNT: Annuity Investors Variable Account B

Following is a list of the Funds in which the currently available Sub-Accounts invest:

[ AIM V.I. Capital Development Fund ]

[ AIM V.I. Core Equity Fund ]

[ AIM V.I. Financial Services Fund ]

[ AIM V.I. Global Health Care Fund ]

[ AIM V.I. High Yield Fund ]

[ AIM V.I. Small Cap Equity Fund ]

[ AIM V.I. Small Cap Growth Fund ]

[ American Century VP Large Company Value Fund ]

[ American Century VP Mid Cap Value Fund ]

[ American Century VP Ultra® Fund ]

[ American Century VP VistaSM Fund ]

[ Dreyfus IP Technology Growth Portfolio ]

[ The Dreyfus Socially Responsible Growth Fund, Inc. ]

[ Dreyfus Stock Index Fund, Inc. ]

[ Dreyfus VIF Appreciation Portfolio ]

[ Dreyfus VIF Developing Leaders Portfolio ]

[ Dreyfus VIF Growth and Income Portfolio ]

[ Dreyfus VIF Money Market Portfolio ]

[ DWS Small Cap Index VIP ]

AILIC

-2-

 

[ Janus Aspen Series Balanced Portfolio ]

[ Janus Aspen Series Forty Portfolio ]

[ Janus Aspen Series International Growth Portfolio ]

[ Janus Aspen Series Large Cap Growth Portfolio ]

[ Janus Aspen Series Mid Cap Growth Portfolio ]

[ Oppenheimer Balanced Fund/VA ]

[ Oppenheimer Capital Appreciation Fund/VA ]

[ Oppenheimer Main Street Fund(R)/VA ]

[ PIMCO VIT Real Return Portfolio ]

[ PIMCO VIT Total Return Portfolio ]

[ Van Kampen UIF Core Plus Fixed Income Portfolio ]

[ Van Kampen UIF U.S. Mid Cap Value Portfolio ]

[ Van Kampen UIF U.S. Real Estate Portfolio ]

[ Van Kampen UIF Value Portfolio ]

FIXED ACCOUNT:

Following is a list of the currently available Fixed Account options, with guarantee periods as may
be applicable:

Fixed Accumulation Account

[ Fixed Account One-Year Guarantee Period ]

We may add or delete Fixed Account options at any time.

FIXED ACCOUNT GUARANTEED INTEREST RATE: [ 3.00% ]

TRANSFER FEE: [ $25 ] per transfer in excess of [ twelve
(12) ] in any Certificate Year.

CERTIFICATE MAINTENANCE FEE: [ $40 ] Annually

MORTALITY AND EXPENSE RISK CHARGE: A charge equal to an effective annual rate of
[ 1.25% ] of the daily Net Asset Value of the Sub-Accounts.

ADMINISTRATION CHARGE: A charge equal to an effective annual rate of [ 0.15% ]
of the daily Net Asset Value of the Sub-Accounts.

MINIMUM TERMINATION VALUE: [ $500 ]

	 	 	 
	INQUIRIES:

	 	For information, or to make a complaint, call or write:
	 

	 	Policyholder Service Department

Annuity Investors Life Insurance Company

Post Office Box 5423

Cincinnati, Ohio 45201-5423

1-800-789-6771
	 
	 	 
	 

	 	If you prefer, you may visit us at our website, www.gafri.com.

AILIC

-3-

 

	 	 	 	 	 
	TABLE OF CONTENTS	 	Page	 
	 
	DEFINITIONS
	 	 	6	 
	 
	 	 	 	 
	GENERAL PROVISIONS
	 	 	8	 
	 
	 	 	 	 
	Entire Contract
	 	 	8	 
	Changes — Waivers
	 	 	8	 
	Nonparticipating
	 	 	8	 
	Misstatement
	 	 	8	 
	Required Reports
	 	 	8	 
	Exclusive Benefit
	 	 	9	 
	State Law
	 	 	9	 
	Claims of Creditors
	 	 	9	 
	Company Liability
	 	 	9	 
	Voting Rights
	 	 	9	 
	Incontestability
	 	 	9	 
	Discharge of Liability
	 	 	9	 
	Transfer by the Company
	 	 	9	 
	Termination
	 	 	9	 
	Taxes
	 	 	10	 
	 
	 	 	 	 
	PURCHASE PAYMENTS
	 	 	10	 
	 
	 	 	 	 
	Purchase Payments
	 	 	10	 
	Allocation of Purchase Payments
	 	 	10	 
	 
	 	 	 	 
	FIXED ACCOUNT
	 	 	10	 
	 
	 	 	 	 
	Fixed Account
	 	 	10	 
	Fixed Account Options
	 	 	10	 
	Interest Crediting
	 	 	10	 
	Renewal
	 	 	11	 
	Fixed Account Value
	 	 	11	 
	 
	 	 	 	 
	SEPARATE ACCOUNT
	 	 	12	 
	 
	 	 	 	 
	General Description
	 	 	12	 
	Sub-Accounts of the Separate Account
	 	 	12	 
	Valuation of Assets
	 	 	12	 
	Variable Account Value
	 	 	12	 
	Accumulation Unit Value
	 	 	13	 
	 
	 	 	 	 
	TRANSFERS
	 	 	14	 
	 
	 	 	 	 
	Transfers From a Fixed Account Option
	 	 	14	 
	Transfers From a Sub-Account
	 	 	14	 
	Other Transfer Rules
	 	 	14	 
	 
	 	 	 	 
	FEES AND CHARGES
	 	 	15	 
	 
	 	 	 	 
	Mortality and Expense Risk Charge
	 	 	15	 
	Administration Charge
	 	 	15	 
	Certificate Maintenance Fee
	 	 	15	 

AILIC

-4-

 

	 	 	 	 	 
	TABLE OF CONTENTS	 	Page	 
	 
	SURRENDER AND WITHDRAWALS
	 	 	15	 
	 
	 	 	 	 
	Surrender
	 	 	15	 
	Withdrawals
	 	 	16	 
	Transfers and Rollovers
	 	 	16	 
	Termination
	 	 	16	 
	Deferral of Payment
	 	 	16	 
	 
	 	 	 	 
	OWNERSHIP PROVISIONS
	 	 	17	 
	 
	 	 	 	 
	Ownership of Separate Account
	 	 	17	 
	Ownership of
the Contract and Participant Account
	 	 	17	 
	Transfer and Assignment
	 	 	17	 
	Successor Owner
	 	 	17	 
	Community Property
	 	 	17	 
	 
	 	 	 	 
	BENEFICIARY PROVISIONS
	 	 	17	 
	 
	 	 	 	 
	Beneficiary
	 	 	17	 
	Designation of Beneficiary
	 	 	18	 
	 
	 	 	 	 
	ANNUITY BENEFIT
	 	 	18	 
	 
	 	 	 	 
	Annuity Commencement Date
	 	 	18	 
	Annuity Benefit Amount
	 	 	18	 
	Annuity Benefit Payments
	 	 	18	 
	Form of Annuity Benefit
	 	 	19	 
	 
	 	 	 	 
	DEATH BENEFIT
	 	 	19	 
	 
	 	 	 	 
	Death Benefit
	 	 	19	 
	Death Benefit Amount
	 	 	19	 
	Step Up in Account Value for Successor Owner
	 	 	20	 
	Transfers After Death
	 	 	20	 
	Death Benefit Commencement Date
	 	 	20	 
	Death Benefit Payments
	 	 	20	 
	Form of Death Benefit
	 	 	21	 
	 
	 	 	 	 
	SETTLEMENT OPTIONS
	 	 	21	 
	 
	 	 	 	 
	Conditions
	 	 	21	 
	Benefit Payments
	 	 	22	 
	Fixed Dollar Payments
	 	 	22	 
	Variable Dollar Payments
	 	 	22	 
	Limitation on Election of Settlement Option
	 	 	23	 
	Settlement Option Computations
	 	 	23	 
	Available Settlement Options
	 	 	24	 
	Commuted Values
	 	 	24	 
	Settlement Option Tables
	 	 	25	 

AILIC

-5-

 

DEFINITIONS

Account(s): The Sub-Accounts and the Fixed Account options.

Account Value: The aggregate value of your interest in all of the Sub-Accounts and the Fixed
Account options as of the end of any Valuation Period. The value of your interest in all of the
Sub-Accounts is your “Variable Account Value”. The value of your interest in all of the Fixed
Account options is your “Fixed Account Value.”

Accumulation Unit: A unit of measure used to calculate the value of a Sub-Account prior to the
Commencement Date. The value of an Accumulation Unit is referred to as “Accumulation Unit Value”.

Annuity Benefit: The payments that may be made under the ANNUITY BENEFIT section of this
Certificate.

Annuity Commencement Date: For your interest in the Contract, the first day of the first payment
interval for which an Annuity Benefit payment is to be made.

Beneficiary: The person entitled to receive any Death Benefit under this Certificate.

Benefit Unit: A unit of measure used to determine the dollar value of any Variable Dollar
payments. The value of a Benefit Unit is referred to as “Benefit Unit Value”.

Certificate Anniversary: The date in each year that is the annual anniversary of your Certificate
Effective Date.

Certificate Effective Date: The date on which your interest in the Contract took effect. This
date is set out on the Certificate Specifications page.

Certificate Year: Each twelve (12) month period that begins on your Certificate Effective Date or
on a Certificate Anniversary.

Code: The Internal Revenue Code of 1986, as amended, and the rules and regulations that are issued
under it.

Commencement Date: For your interest in the Contract, the Annuity Commencement Date if an Annuity
Benefit is payable; or the Death Benefit Commencement Date if a Death Benefit is payable.

Death Benefit: The benefit described in the DEATH BENEFIT section of this Certificate.

Death Benefit Commencement Date: For your interest in the Contract, the first day of the first
payment interval for a Death Benefit that is paid as periodic payments; or the date of payment for
a Death Benefit that is paid as a lump sum.

AILIC

-6-

 

Death Benefit Valuation Date: For your interest in the Contract, the earlier of:

	 	1)	 	the date that we have received both Due Proof of Death and a Written Request
with instructions as to the form of Death Benefit; or

	 	2)	 	the date that is the Death Benefit Commencement Date.

Due Proof of Death: One (1) of the following:

	 	1)	 	a certified copy of a death certificate; or

	 	2)	 	a certified copy of a decree that is made by a court of competent jurisdiction
as to the finding of death.

We will also accept other proof that is satisfactory to us.

Fund: A management investment company (or a portfolio of it) that is registered under the
Investment Company Act of 1940, as amended. Each Sub-Account invests in a Fund.

Net Asset Value: The amount computed by an investment company as the price at which its shares or
units may be redeemed. This price is computed in accordance with the rules of the Securities and
Exchange Commission. It is computed no less frequently than each Valuation Period.

Participant: The person identified on the Certificate Specifications page who has an interest in
the Contract, as evidenced by this Certificate.

Purchase Payment: An amount paid to us for your interest in the Contract, less any fee charged by
the person remitting payments. It is also after the deduction of premium tax or other taxes that
may apply.

Separate Account: An account that is established and maintained by the Company pursuant to the
laws of the State of Ohio. The Separate Account is registered as a unit investment trust under the
Investment Company Act of 1940, as amended.

Sub-Account: A subdivision of the Separate Account. Each of the Sub-Accounts invests in the
shares of a designated Fund.

Valuation Date: Each day on which the New York Stock Exchange is open for business.

Valuation Period: The period commencing at the close of regular trading on the New York Stock
Exchange on any Valuation Date, and ending at the close of trading on the next succeeding Valuation
Date.

AILIC

-7-

 

Written Request: Information provided, or a request made, that is:

	 	1)	 	complete and satisfactory to us;

	 	2)	 	on our form or in a manner satisfactory to us, which may, at our discretion, be
by telephone or electronic means; and

	 	3)	 	received by us at our Administrative Office.

A Written Request is subject to any payment that we make before we acknowledge it. It is also
subject to any action that we take before we acknowledge it. We will deem a Written Request to be
a standing order. It may be modified or revoked only by a subsequent Written Request, when
permitted by the terms of the Contract. You may be required to return this Certificate to us in
connection with a Written Request.

GENERAL PROVISIONS

Entire Contract

The Contract is a group flexible premium deferred variable annuity contract. The Contract and this
Certificate are restricted as required to obtain favorable tax treatment under the Code. Neither
is valid without the requisite endorsement(s) being attached. The Contract and its endorsements,
the application for it, if any, and any application and enrollment forms of participants, form the
entire contract between the Contract Owner and us. This Certificate is not a contract and is not a
part of the Contract.

Only statements made in consideration for the Contract or an interest in it will be used to void
the Contract or an interest in it, or to defend a claim based on it. Such statements are treated
as representations and not warranties.

Changes — Waivers

No changes or waivers of the terms of the Contract or this Certificate are valid unless made in
writing and are signed by our President, Vice President, or Secretary. No other person or agent
has authority to change or waive any provision of the Contract. We reserve the right both to
administer and to change the terms of the Contract to conform to pertinent laws and governmental
regulations and rulings.

Nonparticipating

The Contract does not pay dividends or share in the Company’s divisible surplus.

Misstatement

If the age of a person is misstated, payments shall be adjusted to the amount that would have been
payable based on the correct age. If payments based on the correct age would have been higher, we
will pay the underpaid amount promptly in one (1) sum, with interest. If payments based on the
correct age would have been lower, we may deduct the overpaid amount, with interest, from
succeeding payments. We may also pursue other remedies at law or in equity.

Required Reports

At least once each Certificate Year, we will send you a report of your current values. We will
also provide any other information required by law. These reports will stop when your interest in
the Contract is fully surrendered, or on the Commencement Date, whichever is first.

AILIC

-8-

 

The reports will be mailed to your last known address. If permitted by law, in lieu of that we may
deliver these and other required documents in electronic form. The reported values will be based
on the information in our possession at the time that we prepare the report. We may adjust the
reported values at a later date if that information proves to be incorrect or has changed.

Exclusive Benefit

Your rights as a Participant in the Contract are for the exclusive benefit of you and your
Beneficiaries. Those rights are nonforfeitable by us.

State Law

All factors, values, benefits, and reserves under the Contract will not be less than those required
by the law of the state in which the Contract is delivered.

Claims of Creditors

To the extent allowed by law, the Contract and all values and benefits under it are not subject to
the claims of creditors or to legal process.

Company Liability

We will not be liable for any loss that is related to a failure by the Contract Owner, by you, or
by any person having rights or benefits under the Contract, to comply with pertinent laws or
governmental regulations or rulings.

Voting Rights

To the extent required by law, we will vote all shares of the Funds held in the Separate Account at
regular and special shareholder meetings of the Funds. We will vote the shares attributable to the
Contract in accordance with instructions received from you, or if applicable, from the payee of a
settlement option. If there is a change in the law that permits us to vote the shares of the Funds
without such instructions, then we reserve the right to do so.

Incontestability

The Contract, and your interest in it, shall not be contestable by us.

Discharge of Liability

We shall be discharged from all liability to the extent of each payment that is made for a
withdrawal, surrender, Annuity Benefit, or Death Benefit.

Transfer by the Company

We reserve the right to transfer our obligations under the Contract to another qualified life
insurance company under an assumption reinsurance arrangement. We may make such a transfer without
your consent or the consent of the Contract Owner.

Termination

We may terminate the Contract by giving the Contract Owner sixty (60) days advance notice in
writing. The Contract Owner may terminate the Contract by giving us sixty (60) days advance notice
in writing. If the Contract is terminated, you may continue your interest in it, but no more
Purchase Payments will be allowed. Termination of the Contract will not affect payments being made
by us. Termination of the Contract will not affect our right to any fees and charges, loans, or
applicable premium tax or other taxes not previously deducted.

AILIC

-9-

 

Taxes

Some states impose on the Company a premium tax or other taxes on annuities. If a premium tax or
other tax is charged or due, we reserve the right to deduct this amount from the Purchase Payment
or your Account Value at the time that it is imposed.

PURCHASE PAYMENTS

Purchase Payments

One (1) or more Purchase Payments may be paid to us for you at any time before the Annuity
Commencement Date, so long as:

	 	1)	 	you are still living; and

	 	2)	 	your interest in the Contract has not been surrendered.

The initial Purchase Payment for you must be paid to us on or before your Certificate Effective
Date. Each Purchase Payment must be received by us at our Administrative Office. Each Purchase
Payment is subject to any minimums or maximums that we set from time to time. Upon request, we
will provide the Contract Owner with a receipt as proof of payment.

Allocation of Purchase Payments

We will allocate Purchase Payments to the available Sub-Accounts and Fixed Account options
according to your instructions. Those instructions must be made by Written Request. Allocations
must be made in whole percentages. The minimum amount that can be allocated to the Fixed
Accumulation Account Option or to a Sub-Account is $10.00. The minimum amount that can be
allocated to a Fixed Account option other than the Fixed Accumulation Account is $2,000. We may,
in our sole discretion, restrict or prohibit allocations to Fixed Account options or Sub-Accounts
from time to time on a nondiscriminatory basis.

FIXED ACCOUNT

Fixed Account

The Fixed Account is part of the Company’s general account. The values of the Fixed Account are
not dependent upon the investment performance of the Sub-Accounts.

Fixed Account Options

The Fixed Account options available as of the Certificate Effective Date are listed on the
Certificate Specifications page. We may add or delete Fixed Account options at any time. A Fixed
Account option will not be available to you if it has a guarantee period that ends after the
Annuity Commencement Date.

Interest Crediting

Amounts held under a Fixed Account option will be credited with interest at an annual effective
rate that is at least equal to the Fixed Account Guaranteed Interest Rate. The Fixed Account
Guaranteed Interest Rate is set out on the Certificate Specifications page. We may from time to
time pay a higher current interest rate for any of the Fixed Account options. Such higher rate
would be as declared by our Board of Directors in its discretion. Once declared, such rate will be
credited until changed.

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Interest on amounts held under a Fixed Account option is earned daily. We will stop crediting
interest on an amount as of the date that it is transferred, withdrawn, surrendered, or applied to
charges. We will stop crediting interest on an amount that is applied to a settlement option as of
the Commencement Date.

The interest rate credited to each Purchase Payment allocated to the Fixed Accumulation Account
will not be changed for at least twelve (12) months following the date on which it was received.
Thereafter, the interest rate credited will not be changed more frequently than once per calendar
quarter. In the case of transfers from other Fixed Account options or the Sub-Accounts to the
Fixed Accumulation Account Option, the interest rate will not be changed more frequently than once
per calendar quarter.

The interest rate credited to an amount that is held under a Fixed Account option that has a
guarantee period will not be changed until the end of that period. The guarantee period is
measured from the date that the amount is allocated or transferred to that option.

Renewal

An amount that is allocated or transferred to a Fixed Account option that has a guarantee period
will mature at the end of that period. When an amount matures, you may transfer it to any of the
Fixed Account options or Sub-Accounts that are then available to you under the Contract. To do so,
a Written Request must be received within the thirty (30) day period that ends on the date that the
amount matures.

If you do not transfer the amount, then it will be applied to a new guarantee period under the same
Fixed Account option if it is then available to you. The interest rate for the new period will be
the then current rate for that option. If that option is not available, then the amount will be
transferred to the Fixed Accumulation Account.

Such a transfer or renewal will be effective on the day after the amount matures.

Fixed Account Value

Your Fixed Account Value at any time is equal to:

	 	1)	 	Purchase Payment(s) for your interest in the Contract that are allocated to the
Fixed Account options; plus

	 	2)	 	amounts transferred to the Fixed Account for you; plus

	 	3)	 	interest credited to the Fixed Account for you; less

	 	4)	 	any withdrawals, surrender, deductions, and transfers from the Fixed Account
for you; and less
	 
	 	5)	 	other charges and adjustments to your interest made as described elsewhere in this
Certificate.

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SEPARATE ACCOUNT

General Description

The variable benefits under the Contract are provided through the Separate Account.

The income, if any, and any gains or losses, realized or unrealized, on the Separate Account will
be credited to or charged against the amounts allocated to such account. This credit or charge
will be made without regard to other income, gains, or losses of the Company. The amounts
allocated to the Separate Account and the earnings on those amounts are the property of the
Company. However, the Separate Account is not chargeable with any other liabilities of the Company
to the extent that it is equal to the reserves and other contractual liabilities under all of the
policies, annuities, and other contracts identified with it. The Company is not, and does not hold
itself out to be, a trustee with respect to such amounts.

We have the right to transfer certain assets from the Separate Account to our general account. We
may transfer any assets that are in excess of the required reserves and other contractual
liabilities under all of the policies, annuities, and other contracts identified with the Separate
Account. We may make these transfers in our sole discretion at any time and without prior notice.

We may merge or combine the Separate Account with any other separate account of the Company. We
may transfer the assets of the Separate Account to another life insurance company by means of a
merger or reinsurance. We may convert the Separate Account into a managed separate account. We
may de-register the Separate Account under the Investment Company Act of 1940. Such a change will
be made in accordance with pertinent laws. It will be made only after obtaining any approvals that
may be needed, including those of the Ohio Department of Insurance and the Securities and Exchange
Commission.

Sub-Accounts of the Separate Account

The Separate Account is divided into Sub-Accounts. All of the Sub-Accounts that are available as
of the Certificate Effective Date are listed on the Certificate Specifications page. Each of the
Sub-Accounts invests exclusively in shares of an underlying Fund. These Funds are shown on the
Certificate Specifications page. Any amounts of income on the shares of a Fund will be reinvested
in additional shares of that Fund at its Net Asset Value. Any gains on the shares of a Fund will
also be reinvested.

We may add or delete Sub-Accounts. We may substitute shares of a different Fund or different class
or series of a Fund for shares held in a Sub-Account. We may merge or combine Sub-Accounts. Such
a change will be made in accordance with pertinent laws. It will be made only after obtaining any
approvals that may be needed.

Valuation of Assets

Shares of Funds held by each Sub-Account will be valued at their Net Asset Value at the end of each
Valuation Period, as reported by each such Fund.

Variable Account Value

Purchase Payment(s) that are allocated to a Sub-Account, and amounts that are transferred to a
Sub-Account, are converted into Accumulation Units. The number of Accumulation Units credited is
determined by dividing the dollar amount directed to that Sub-Account by the value of the
Accumulation Unit for that Sub-Account at the end of the Valuation Period during which the amount
is received.

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The following events will result in the cancellation of an appropriate number of Accumulation Units
of a Sub-Account:

	 	1)	 	a transfer from a Sub-Account;

	 	2)	 	the surrender or a withdrawal of the Variable Account Value;

	 	3)	 	the payment of a Death Benefit;

	 	4)	 	the application of the Variable Account Value to a settlement option; or

	 	5)	 	the deduction of the charges, fees, or other adjustments described in this
Certificate.

Accumulation Units will be canceled as of:

	 	1)	 	the end of the Valuation Period during which we receive a Written Request that
gives rise to such cancellation;

	 	2)	 	the Commencement Date; or

	 	3)	 	the end of the Valuation Period on which a charge, fee, or other adjustment is
due.

At any time, your Variable Account Value is equal to the sum of the values of your interest in each
Sub-Account. The value of your interest in a Sub-Account is equal to the number of your
Accumulation Units for that Sub-Account multiplied by the Accumulation Unit Value for that
Sub-Account. These values are determined as of the end of the preceding Valuation Period.

Accumulation Unit Value

The initial Accumulation Unit Value for the Money Market Sub-Account was set at $1.00. The initial
Accumulation Unit Value for each of the other Sub-Accounts was set at $10.00. After that, the
Accumulation Unit Value at the end of each Valuation Period is the Accumulation Unit Value as of
the end of the prior Valuation Period multiplied by the Net Investment Factor. The Net Investment
Factor is described below. The Accumulation Unit Values will vary as a result of the varying
investment experience of the Funds.

The Net Investment Factor is a measure of the investment performance of a Sub-Account from one
Valuation Period to the next. Each Sub-Account has a Net Investment Factor for each Valuation
Period. The Net Investment Factor may be greater than one, or it may be less than one. This means
that the Accumulation Unit Value for each Sub-Account may increase or it may decrease. The Net
Investment Factor for any Sub-Account for any Valuation Period is determined by dividing (1) by (2)
and then subtracting (3) from the result, where:

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	 	1)	 	is equal to:

	 	a)	 	the Net Asset Value per share of the Fund held in the Sub-Account,
determined at the end of the applicable Valuation Period; plus

	 	b)	 	the per share amount of any dividend or net capital gain distributions
made by the Fund held in the Sub-Account, if the “ex-dividend” date occurs during
the applicable Valuation Period; plus or minus

	 	c)	 	a per share charge or credit for any taxes reserved for, which is determined by
the Company to have resulted from the investment operations of the
Sub-Account;

	 	2)	 	is the Net Asset Value per share of the Fund held in the
Sub-Account, determined at the end of the preceding Valuation Period; and
	 
	 	3)	 	is the sum of the Mortality and Expense Risk Charge and the Administration
Charge to be deducted from the Sub-Account for the number of days in the applicable
Valuation Period.

TRANSFERS

Prior to a Commencement Date, you may transfer amounts in a Sub-Account or Fixed Account
option as set out below.

Transfers From a Fixed Account Option

If allowed by the Company, in its sole discretion, you may transfer amounts from your interest in a
Fixed Account option to another Fixed Account option or to a Sub-Account. No transfer from a Fixed
Account option is allowed during your first Certificate Year. If a transfer is being made from a
Fixed Account option pursuant to the Renewal provision of this Certificate, then the entire amount
that has matured may be transferred. Other transfers from a Fixed Account option during a
Certificate Year may not exceed the greater of $500 or twenty percent (20%) of the value of your
interest in that option as of the most recent Certificate Anniversary. We may, in our sole
discretion, restrict or prohibit this type of transfer or the availability of any Fixed Account
option or Sub-Account from time to time on a nondiscriminatory basis.

Transfers From a Sub-Account

If allowed by the Company, in its sole discretion, you may transfer amounts from your interest in a
Sub-Account to another Sub-Account or to a Fixed Account option. Amounts transferred from a Fixed
Account option to the Sub-Accounts may not be transferred back to a Fixed Account option for a
period of six (6) months from the date of transfer. We may, in our sole discretion, restrict or
prohibit this type of transfer or the availability of any Sub-Account or Fixed Account option from
time to time on a nondiscriminatory basis.

Other Transfer Rules

A transfer must be made by Written Request. The minimum transfer amount is $500 or the balance of
the Sub-Account or Fixed Account option, if less.

We will charge a Transfer Fee on each transfer over a certain number per year. The amount of the
Transfer Fee, and the number of transfers that may be made before it applies, are set out on the
Certificate Specifications page.

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We may modify our transfer procedures at any time and at our sole discretion. Such modifications
could be applied to transfers to or from some or all of the Sub-Accounts or Fixed Account options,
and may include, but not be limited to, the following:

	 	1)	 	the requirement of a minimum time period between each transfer;

	 	2)	 	the means for submitting a Written Request; or

	 	3)	 	limits on the dollar amount that may be transferred between available
Sub-Accounts or Fixed Account options at any one time.

FEES AND CHARGES

Mortality and Expense Risk Charge

The Mortality and Expense Risk Charge is shown on the Certificate Specifications page. It is
deducted daily from each of the Sub-Accounts. This deduction is made to compensate us for assuming
the mortality and expense risks under the Contract.

Administration Charge

The Administration Charge is shown on the Certificate Specifications page. It is deducted daily
from each of the Sub-Accounts. This deduction is made to reimburse us for certain expenses that
are incurred in the administration of the Contract and the Separate Account.

Certificate Maintenance Fee

The Certificate Maintenance Fee (“Fee”) is shown on the Certificate Specifications page. It is
deducted as of the Valuation Date after each Certificate Anniversary that your interest in the
Contract is in effect until the Commencement Date. The full annual Fee will also be deducted at
the time of a surrender of your interest in the Contract. The Fee will be deducted pro-rata from
each Sub-Account in which you have an interest at that time. The Fee does not apply to the Fixed
Account.

After the Commencement Date, if Variable Dollar payments are to be made, the Fee will be deducted
pro-rata from each payment. This deduction will result in a reduction in the amount of such
payment.

We may waive the Fee in whole or in part in our sole discretion.

SURRENDER AND WITHDRAWALS

Surrender

You may surrender your interest in the Contract in full for your Account Value at any time prior to
the Annuity Commencement Date. The amount available for surrender will be your Account Value at
the end of the Valuation Period in which the Written Request is received. Any fees and charges,
loans or applicable premium tax or other taxes not previously deducted, will be deducted as part of
the calculation of your Account Value. A surrender must be made by Written Request. In the case
of a surrender, your interest in the Contract will be terminated.

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Withdrawals

You may take withdrawals from your interest in the Contract at any time prior to the Annuity
Commencement Date. A withdrawal must be made by Written Request. The amount of any withdrawal
must be at least $500. No withdrawal can be made that would reduce your Account Value to less than
the Minimum Termination Value. The Minimum Termination Value is set out on the Certificate
Specifications page.

A withdrawal will result in the cancellation of Accumulation Units from each of your applicable
Sub-Accounts and/or a reduction of your Fixed Account Value. Unless you state otherwise in your
request for a withdrawal, the reduction in each Sub-Account and Fixed Account option will be in the
same proportion as the reduction in your total Account Value.

Transfers and Rollovers

An amount paid on a withdrawal or surrender may be paid to or for another annuity or tax-qualified
account in a transfer or rollover to the full extent allowed by federal tax law.

Termination

We reserve the right to terminate your interest in the Contract at any time that your Account Value
is less than the Minimum Termination Value. The Minimum Termination Value is set out on the
Certificate Specifications page. If we terminate your interest in the Contract, we will pay you
the Account Value less any fees and charges, loans, or applicable premium tax or other taxes not
previously deducted.

Deferral of Payment

The Company has the right to suspend or delay the date of payment of a withdrawal or surrender of
the Variable Account Value at certain times. We may do this for any period:

	 	1)	 	when the New York Stock Exchange is closed, or when trading on the New York
Stock Exchange is restricted; or

	 	2)	 	when an emergency exists (as determined by the Securities and Exchange
Commission) as a result of which:

	 	a)	 	the disposal of securities in the Separate Account is not reasonably practicable; or

	 	b)	 	it is not reasonably practicable to determine fairly the value of the
net assets in the Separate Account; or

	 	3)	 	when the Securities and Exchange Commission so permits for the protection of
security holders.

The Company further reserves the right to delay payment of a withdrawal or surrender of your Fixed
Account Value. We may delay such payment for up to six (6) months after we receive your Written
Request.

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OWNERSHIP PROVISIONS

Ownership of Separate Account

The Company has absolute ownership of the assets in the Separate Account. We are not, and do not
hold ourselves out to be, a trustee in respect of any amounts under the Separate Account.

Ownership of the Contract and Participant Account

The owner of the Contract (the “Contract Owner”) is your employer or the trustee of your employer’s
retirement plan. The Contract Owner is shown on the Certificate Specifications page. The Contract
is held by the Contract Owner for the benefit of the participants and Beneficiaries.

Each person for whom Purchase Payment(s) are made will have an interest in the Contract as a
participant. An account will be established for each participant.

Transfer and Assignment

Neither you nor the Contract Owner may transfer, sell, assign, pledge, charge, encumber, or in any
way alienate an interest in the Contract.

Successor Owner

In some cases, your spouse may succeed to the ownership of your interest in the Contract after your
death. Specifically, if you die before the Annuity Commencement Date and your spouse is your sole
surviving Beneficiary, he or she will become the successor owner of your interest if:

	 	1)	 	you make that Written Request before your death; or

	 	2)	 	after your death, your spouse makes that Written Request within one (1) year of
your death and before the Death Benefit Commencement Date.

As successor owner, your spouse will then succeed to all your rights under the Contract except the
right to name another successor owner.

Community Property

If you live in a community property state and have a spouse at any time while you have an interest
in the Contract, the laws of that state may vary your ownership rights.

BENEFICIARY PROVISIONS

Beneficiary

Your Beneficiary is the person or persons that you designate under the Designation of Beneficiary
provision of this Certificate. If there is no designated Beneficiary that survives you, then your
estate will be your Beneficiary.

A Beneficiary will be deemed not to have survived you if he or she dies within thirty (30) days
after your death.

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Designation of Beneficiary

Unless you have specified that a prior designation is irrevocable, you may make or change a
designation of Beneficiary at any time before the Annuity Commencement Date. A designation of
Beneficiary must be made by Written Request. Except as otherwise elected or as required by law, it
will not cancel a settlement option election.

You may designate two (2) or more persons jointly as the Beneficiary. Unless you state otherwise,
joint Beneficiaries that survive you will be entitled to equal shares. You may also designate one
(1) or more persons as contingent Beneficiary. Unless you state otherwise, a contingent
Beneficiary will be entitled to a benefit only if there is no primary Beneficiary that survives
you.

ANNUITY BENEFIT

Annuity Commencement Date

The Annuity Commencement Date for your interest in the Contract is set out on the Certificate
Specifications page. You may change the Annuity Commencement Date by Written Request. Such a
request must be made at least thirty (30) days prior to the date that Annuity Benefit payments are
to begin.

Generally the Annuity Commencement Date must be no later than the Certificate Anniversary following
your 70th birthday. It can be later only if we agree.

Annuity Benefit Amount

Your Account Value as of the Annuity Commencement Date, reduced by any fees and charges, loans, or
applicable premium tax or other taxes not previously deducted, will be used to provide Annuity
Benefit payments under your interest in the Contract.

Annuity Benefit Payments

Annuity Benefit payments will be made to you as payee unless amounts are paid as a transfer or
rollover to an annuity or tax-qualified account as permitted by federal tax law.

Annuity Benefit payments that are still payable after your death will be made to the contingent
payee that you designate. If there is no such contingent payee surviving, then such payments will
be made to the person or persons designated as contingent payee by the last payee who received
payments. Failing that, such payments will be made to the estate of the last payee who received
payments.

A designation or change of a contingent payee must be made by Written Request. Unless you have
specified that a prior designation is irrevocable, you may change the contingent payee at any time.

You will be the person on whose life Annuity Benefit payments are based. No change of payee or
contingent payee at any time will change this.

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Form of Annuity Benefit

Annuity Benefit payments will be made annually under the terms of Option B with a fixed period of
ten (10) years, as described in the SETTLEMENT OPTIONS section of this Certificate.

In lieu of that, you may elect to have Annuity Benefit payments made pursuant to any other
available option that is described in the SETTLEMENT OPTIONS section of this Certificate. Such an
election must be made before the Annuity Commencement Date. You may change your election so long
as we receive your request for a change at least thirty (30) days prior to the date that Annuity
Benefit payments are scheduled to begin.

Any election or change of election must be made by Written Request.

An election of a settlement option may be subject to restrictions stated in the tax qualification
endorsement.

DEATH BENEFIT

Death Benefit

A Death Benefit will be paid with respect to your interest in the Contract if you die before the
Annuity Commencement Date and before your interest in the Contract is surrendered.

If a Death Benefit becomes payable:

	 	1)	 	it will be in lieu of all other benefits with respect to your interest in the
Contract; and

	 	2)	 	all other rights with respect to your interest in the Contract will be
terminated except for rights related to the Death Benefit.

No Death Benefit will be paid on your death if your spouse becomes the successor owner of your
interest in the Contract. Only one (1) Death Benefit will be paid with respect to your interest in
the Contract.

Death Benefit Amount

The amount of the Death Benefit will be based on the greater of:

	 	1)	 	your Account Value on the Death Benefit Valuation Date;

	 	2)	 	the total of all Purchase Payments for your interest in the Contract, reduced
proportionally for any withdrawals.

The reduction for withdrawals will be in the same proportion that your Account Value was reduced on
the date of the withdrawal.

As of the Death Benefit Valuation Date, the amount of the Death Benefit will be allocated among the
Sub-Accounts and Fixed Account options. The allocation will be in the same proportion as each
Account’s value is to your total Account Value as of the end of the Valuation Period that precedes
the Death Benefit Valuation Date. After this allocation, the amount of the Death Benefit to be
paid will be based on the Account Value.

The Death Benefit will be reduced by any applicable premium tax or other taxes not previously
deducted. The Death Benefit will also be reduced by any outstanding loans.

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Step Up in Account Value for Successor Owner

If your spouse becomes the successor owner of your interest in the Contract, your Account Value
will be increased to equal the amount of the Death Benefit which would have been payable if your
spouse had not become the successor owner. This increase will occur as of the date that would have
been the Death Benefit Valuation Date. If your Account Value is increased under this provision, we
will add the amount of the increase to the Fixed Accumulation Account.

If the Death Benefit that would have been payable is equal to your Account Value as of the date
that would have been the Death Benefit Valuation Date, then there will be no such change to your
Account Value.

The election to become successor owner will be deemed to be instructions as to the form of Death
Benefit. Therefore, the date that would have been the Death Benefit Valuation Date will be the
later of the date that we receive Due Proof of Death, or the date we receive the successor owner
election. This date will never be later than one (1) year after the date of your death.

Transfers After Death

Between the Death Benefit Valuation Date and the Death Benefit Commencement Date, the Beneficiary
may transfer funds among Sub-Accounts and Fixed Account options. Such transfers are subject to the
limitations set out in the TRANSFERS section of this Certificate.

Death Benefit Commencement Date

Your Beneficiary may designate the Death Benefit Commencement Date by Written Request. This
request must be made within one (1) year of your death. If no designation is made, then the Death
Benefit Commencement Date will be one (1) year after your death. No Death Benefit will be paid
until we receive Due Proof of Death.

Death Benefit Payments

Death Benefit payments will be made to the Beneficiary as payee unless:

	 	1)	 	amounts are paid as a transfer or rollover to an annuity or tax-qualified
account as permitted by federal tax law; or

	 	2)	 	the Beneficiary is a non-natural person, and elects to have Death Benefit
payments made to a payee to whom the Beneficiary is obligated to make corresponding
payments.

Death Benefit payments that are still payable after the death of the Beneficiary will be made to
the contingent payee designated as part of a Death Benefit settlement option election made by you.
If there is no such contingent payee surviving, then such payments will be made to the person or
persons designated as contingent payee by the Beneficiary. Failing that, such payments will be
made to the estate of the last payee who received payments.

A designation or change of a payee or contingent payee must be made by Written Request. A
Beneficiary may not change a contingent payee designation made as part of a Death Benefit
settlement option election made by you. A Beneficiary may make or change any other payee or
contingent payee designation at any time.

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The Beneficiary will be the person on whose life Death Benefit payments under a settlement option
will be based. No change of payee or contingent payee at any time will change this. A Beneficiary
that is a non-natural person may elect to have payments based on the life of a person to whom the
Beneficiary is obligated. Such an election shall be made by Written Request before the Death
Benefit Commencement Date.

Form of Death Benefit

Death Benefit payments will be made annually under the terms of Option A with a period certain of
four (4) years, as described in the SETTLEMENT OPTIONS section of this Certificate.

In lieu of that, you may elect at any time before your death to have Death Benefit payments made in
one (1) lump sum or pursuant to any available option described in the SETTLEMENT OPTIONS section of
this Certificate. You may change your election of a settlement option at any time before your
death.

If you do not make any such election, the Beneficiary may make that election at any time after your
death and before the Death Benefit Commencement Date. A Beneficiary may change his or her own
election of a settlement option so long as we receive the request for a change at least thirty (30)
days prior to the date that Death Benefit payments are scheduled to begin.

Any election or change of election must be made by Written Request.

An election of a settlement option is subject to restrictions stated in the tax qualification
endorsement.

SETTLEMENT OPTIONS

Conditions

Payments under a settlement option are subject to any minimum amounts, payment intervals, and other
terms or conditions that we may from time to time require. If we change our minimums, we may
change any current or future payment amounts and/or payment intervals to conform to the change.
More than one (1) settlement option may be elected if the requirements for each settlement option
elected are satisfied. Once payment begins under a settlement option, the settlement option may
not be changed.

All elected settlement options must comply with pertinent laws and governmental regulations and
rulings.

If more than one (1) person is the payee under a settlement option, payments will be made to the
payees jointly. No more than two (2) persons may be initial payees under a joint and survivor
settlement option.

If payment under a settlement option depends on whether a specified person is still alive, we may
at any time require proof that such person is still living. We will require proof of the age of
any person on whose life payments are based.

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Benefit Payments

Payments may be calculated and paid:

	 	1)	 	as Fixed Dollar payments;

	 	2)	 	as Variable Dollar payments; or

	 	3)	 	as a combination of both.

The amount to be applied to Variable Dollar payments is your Variable Account Value as of the end
of the Valuation Period that precedes the Commencement Date. It will include the amount of any
transfer to Variable Dollar payments that is made from your interest in the Fixed Account as of
that same time. It will be reduced by the amount of any transfer to Fixed Dollar payments that is
to be made from your interest in the Separate Account on the Commencement Date. An amount that is
transferred from the Fixed Account will be allocated among the Sub-Accounts by Written Request.

The amount to be applied to Fixed Dollar payments is your Fixed Account Value as of the
Commencement Date. It will include the amount of any transfer to Fixed Dollar payments that is
made from your interest in the Separate Account on that date. It will not include the amount of
any transfer to Variable Dollar payments that is made from your interest in the Fixed Account as of
the end of the Valuation Period that precedes the Commencement Date.

In each case, the amount to be applied to payments will be reduced by any fees and charges, loans,
or applicable premium tax or other taxes not previously deducted.

No transfers between Fixed Dollar payments and Variable Dollar payments will be allowed after the
Commencement Date. Twelve (12) months or more after the Commencement Date, the payee may transfer
all or part of the Benefit Units upon which Variable Dollar payments are based from the
Sub-Account(s) then held, to Benefit Units in other Sub-Account(s) that are then available. Such
transfers of Benefit Units may not occur more than once in any twelve (12) month period. Such
transfers are subject to the other limitations set out in the TRANSFERS section of this
Certificate.

Fixed Dollar Payments

Fixed Dollar payments are determined as follows. We start with the amount to be applied to Fixed
Dollar payments, expressed in thousands of dollars. This amount is then multiplied by the amount
of the periodic payment per $1,000 of value. This payment is obtained from the Settlement Option
Table for the option that is elected. Fixed Dollar payments will remain level for the duration of
the payment period.

Variable Dollar Payments

The Variable Dollar base payment is determined as follows. We start with the amount to be applied
to Variable Dollar payments, expressed in thousands of dollars. This amount is then multiplied by
the amount of the periodic payment per $1,000 of value. This payment is obtained from the
Settlement Option Table for the option that is elected.

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The number of Benefit Units in each Sub-Account held for Variable Dollar payments is determined as
follows. We divide the dollar amount of the Variable Dollar base payment from each Sub-Account by
the Benefit Unit Value for that Sub-Account as of the Commencement Date. The number of Benefit
Units in each Sub-Account will change if the payee makes transfers among Sub-Accounts. The Benefit
Units in each Sub-Account will change proportionally to a change in the base payment due to any
change in the payment interval or as specified by the settlement option. Otherwise, the number of
Benefit Units remains fixed during the payment period.

The actual amount of each Variable Dollar payment will reflect the investment performance of the
Sub-Account(s) selected. It may vary from payment to payment. The total amount of each Variable
Dollar payment will be equal to the sum of the payments from each Sub-Account. We will deduct a
pro-rata portion of the Certificate Maintenance Fee from this total.

The payment from each Sub-Account is found by multiplying the number of Benefit Units held in that
Sub-Account for such Variable Dollar payments by the Benefit Unit Value for that Sub-Account. We
do this as of the end of the fifth (5th) Valuation Period before the date that the
payment is due.

The Benefit Unit Value for each Sub-Account is originally established in the same manner as
Accumulation Unit Values. For any date after that, the value of a Benefit Unit for a Sub-Account
is determined by multiplying the Benefit Unit Value as of the end of the preceding Valuation Period
by the Net Investment Factor. This factor is determined as set forth in the Accumulation Unit
Value provision of this Certificate. The product is then multiplied by the assumed daily
investment factor for the number of days in the Valuation Period. The factor is based on the
assumed net investment rate for the Settlement Option Table that is used to fix the base payment.
This factor shall be no greater than [ 0.99997236 ] , which is the factor based on
a net investment rate of [ one percent (1%) ] per year, compounded annually, as
reflected in the guaranteed Settlement Option Tables.

Limitation on Election of Settlement Option

Fixed periods shorter than five (5) years are generally not available. A fixed period of less than
five (5) years is available only as a Death Benefit settlement option.

Settlement Option Computations

The Annuity 2000 Mortality Table for blended lives (60% female/40% male) with interest at
[ one percent (1%) ] per year, compounded annually, is used to compute all
guaranteed settlement option factors, values, and benefits under the Contract.

AILIC

-23-

 

Available Settlement Options

The available settlement options are set out below.

Option A Income for a Fixed Period

We will make periodic payments for a fixed period. The first payment will be paid as of the
last day of the initial payment interval. The maximum time over which we will make payments
or money will be held by us is thirty (30) years. The Option A Table applies to this
Option.

Option B Life Annuity with Payments for at Least a Fixed Period

We will make periodic payments for at least a fixed period. If the person on whose life
payments are based lives longer than the fixed period, then we will make payments until his
or her death. The first payment will be paid as of the last day of the initial payment
interval. The Option B Table applies to this Option.

Option C Joint and One-half Survivor Annuity

We will make periodic payments until the death of the primary person on whose life payments
are based; thereafter, we will make one-half (1/2) of the periodic payment until the death
of the secondary person on whose life payments are based. The first payment will be paid as
of the last day of the initial payment interval. The Option C Table applies to this Option.

We will make periodic payments in any other form of settlement option that is acceptable to us at
the time of an election.

Commuted Values

Commuted values are not available unless we agree otherwise.

AILIC

-24-

 

Settlement Option Tables

The Option Tables show the payments that we will make at sample payment intervals for each $1,000
applied based on the guaranteed settlement option factors. Amounts may vary with the payment
interval and the age of the person on whose life payments are based. Upon request, we will provide
information on the payments that we will make for other payment intervals and ages.

OPTION A TABLE — INCOME FOR A FIXED PERIOD

Payments for fixed number of years for each $1,000 applied.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Term of 	 	 	 	 	 	Semi-	 	 	 	 
	Payments	 	Annual	 	Annual	 	Quarterly	 	Monthly
	 
	Years
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	1
	 	$	[1,010.00]	 	 	$	[503.74]	 	 	$	[251.55]	 	 	$	[83.78]	 
	2
	 	 	[507.51]	 	 	 	[253.12]	 	 	 	[126.40]	 	 	 	[42.10]	 
	3
	 	 	[340.02]	 	 	 	[169.58]	 	 	 	[84.68]	 	 	 	[28.20]	 
	4
	 	 	[256.28]	 	 	 	[127.82]	 	 	 	[63.83]	 	 	 	[21.25]	 
	5
	 	 	[206.03]	 	 	 	[102.76]	 	 	 	[51.31]	 	 	 	[17.09]	 
	6
	 	 	[172.54]	 	 	 	[86.05]	 	 	 	[42.97]	 	 	 	[14.31]	 
	7
	 	 	[148.62]	 	 	 	[74.12]	 	 	 	[37.01]	 	 	 	[12.32]	 
	8
	 	 	[130.69]	 	 	 	[65.18]	 	 	 	[32.55]	 	 	 	[10.84]	 
	9
	 	 	[116.74]	 	 	 	[58.22]	 	 	 	[29.07]	 	 	 	[9.68]	 
	10
	 	 	[105.58]	 	 	 	[52.65]	 	 	 	[26.29]	 	 	 	[8.75]	 
	11
	 	 	[96.45]	 	 	 	[48.10]	 	 	 	[24.02]	 	 	 	[8.00]	 
	12
	 	 	[88.84]	 	 	 	[44.31]	 	 	 	[22.12]	 	 	 	[7.37]	 
	13
	 	 	[82.41]	 	 	 	[41.10]	 	 	 	[20.52]	 	 	 	[6.83]	 
	14
	 	 	[76.90]	 	 	 	[38.35]	 	 	 	[19.15]	 	 	 	[6.37]	 
	15
	 	 	[72.12]	 	 	 	[35.97]	 	 	 	[17.96]	 	 	 	[5.98]	 
	16
	 	 	[67.94]	 	 	 	[33.88]	 	 	 	[16.92]	 	 	 	[5.63]	 
	17
	 	 	[64.25]	 	 	 	[32.04]	 	 	 	[16.00]	 	 	 	[5.33]	 
	18
	 	 	[60.98]	 	 	 	[30.41]	 	 	 	[15.18]	 	 	 	[5.05]	 
	19
	 	 	[58.05]	 	 	 	[28.95]	 	 	 	[14.45]	 	 	 	[4.81]	 
	20
	 	 	[55.41]	 	 	 	[27.63]	 	 	 	[13.80]	 	 	 	[4.59]	 

The values stated for years 1-4 are available only as a Death Benefit option.

AILIC

-25-

 

OPTION B TABLE — LIFE ANNUITY

Monthly payments by age of the person named for each $1,000 applied.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Number of Months Certain
	Age	 	0	 	60	 	120	 	180	 	240
	 
	55
	 	$	[3.25]	 	 	$	[3.24]	 	 	$	[3.22]	 	 	$	[3.18]	 	 	$	[3.12]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	56
	 	 	[3.33]	 	 	 	[3.33]	 	 	 	[3.30]	 	 	 	[3.26]	 	 	 	[3.18]	 
	57
	 	 	[3.42]	 	 	 	[3.42]	 	 	 	[3.39]	 	 	 	[3.34]	 	 	 	[3.25]	 
	58
	 	 	[3.52]	 	 	 	[3.51]	 	 	 	[3.48]	 	 	 	[3.42]	 	 	 	[3.32]	 
	59
	 	 	[3.62]	 	 	 	[3.61]	 	 	 	[3.58]	 	 	 	[3.51]	 	 	 	[3.40]	 
	60
	 	 	[3.73]	 	 	 	[3.72]	 	 	 	[3.68]	 	 	 	[3.60]	 	 	 	[3.47]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	61
	 	 	[3.85]	 	 	 	[3.83]	 	 	 	[3.79]	 	 	 	[3.69]	 	 	 	[3.54]	 
	62
	 	 	[3.97]	 	 	 	[3.95]	 	 	 	[3.90]	 	 	 	[3.79]	 	 	 	[3.62]	 
	63
	 	 	[4.10]	 	 	 	[4.08]	 	 	 	[4.02]	 	 	 	[3.89]	 	 	 	[3.69]	 
	64
	 	 	[4.24]	 	 	 	[4.22]	 	 	 	[4.14]	 	 	 	[4.00]	 	 	 	[3.77]	 
	65
	 	 	[4.39]	 	 	 	[4.36]	 	 	 	[4.27]	 	 	 	[4.10]	 	 	 	[3.84]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	66
	 	 	[4.55]	 	 	 	[4.52]	 	 	 	[4.41]	 	 	 	[4.21]	 	 	 	[3.91]	 
	67
	 	 	[4.72]	 	 	 	[4.68]	 	 	 	[4.56]	 	 	 	[4.33]	 	 	 	[3.99]	 
	68
	 	 	[4.90]	 	 	 	[4.86]	 	 	 	[4.71]	 	 	 	[4.44]	 	 	 	[4.05]	 
	69
	 	 	[5.10]	 	 	 	[5.04]	 	 	 	[4.87]	 	 	 	[4.55]	 	 	 	[4.12]	 
	70
	 	 	[5.30]	 	 	 	[5.24]	 	 	 	[5.03]	 	 	 	[4.67]	 	 	 	[4.18]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	71
	 	 	[5.53]	 	 	 	[5.45]	 	 	 	[5.21]	 	 	 	[4.78]	 	 	 	[4.24]	 
	72
	 	 	[5.77]	 	 	 	[5.68]	 	 	 	[5.39]	 	 	 	[4.89]	 	 	 	[4.29]	 
	73
	 	 	[6.03]	 	 	 	[5.92]	 	 	 	[5.57]	 	 	 	[5.00]	 	 	 	[4.34]	 
	74
	 	 	[6.31]	 	 	 	[6.18]	 	 	 	[5.76]	 	 	 	[5.11]	 	 	 	[4.38]	 
	75
	 	 	[6.61]	 	 	 	[6.45]	 	 	 	[5.95]	 	 	 	[5.21]	 	 	 	[4.42]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	76
	 	 	[6.93]	 	 	 	[6.74]	 	 	 	[6.15]	 	 	 	[5.31]	 	 	 	[4.45]	 
	77
	 	 	[7.28]	 	 	 	[7.04]	 	 	 	[6.35]	 	 	 	[5.40]	 	 	 	[4.48]	 
	78
	 	 	[7.66]	 	 	 	[7.37]	 	 	 	[6.55]	 	 	 	[5.48]	 	 	 	[4.50]	 
	79
	 	 	[8.07]	 	 	 	[7.71]	 	 	 	[6.75]	 	 	 	[5.56]	 	 	 	[4.52]	 
	80
	 	 	[8.51]	 	 	 	[8.07]	 	 	 	[6.94]	 	 	 	[5.63]	 	 	 	[4.54]	 

AILIC

-26-

 

OPTION C TABLE — JOINT AND ONE-HALF SURVIVOR ANNUITY

Monthly payments by ages of the persons named for each $1,000 applied.*

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Primary	 	Secondary Age
	Age	 	60	 	61	 	62	 	63	 	64	 	65	 	66	 	67	 	68	 	69	 	70
	 
	60
	 	$	[3.39]	 	 	$	[3.42]	 	 	$	[3.44]	 	 	$	[3.46]	 	 	$	[3.48]	 	 	$	[3.50]	 	 	$	[3.52]	 	 	$	[3.54]	 	 	$	[3.56]	 	 	$	[3.57]	 	 	$	[3.59]	 
	61
	 	 	[3.47]	 	 	 	[3.49]	 	 	 	[3.52]	 	 	 	[3.54]	 	 	 	[3.56]	 	 	 	[3.59]	 	 	 	[3.61]	 	 	 	[3.63]	 	 	 	[3.65]	 	 	 	[3.66]	 	 	 	[3.68]	 
	62
	 	 	[3.54]	 	 	 	[3.57]	 	 	 	[3.59]	 	 	 	[3.62]	 	 	 	[3.65]	 	 	 	[3.67]	 	 	 	[3.69]	 	 	 	[3.72]	 	 	 	[3.74]	 	 	 	[3.76]	 	 	 	[3.78]	 
	63
	 	 	[3.61]	 	 	 	[3.64]	 	 	 	[3.67]	 	 	 	[3.70]	 	 	 	[3.73]	 	 	 	[3.76]	 	 	 	[3.79]	 	 	 	[3.81]	 	 	 	[3.83]	 	 	 	[3.86]	 	 	 	[3.88]	 
	64
	 	 	[3.69]	 	 	 	[3.72]	 	 	 	[3.76]	 	 	 	[3.79]	 	 	 	[3.82]	 	 	 	[3.85]	 	 	 	[3.88]	 	 	 	[3.91]	 	 	 	[3.93]	 	 	 	[3.96]	 	 	 	[3.98]	 
	65
	 	 	[3.77]	 	 	 	[3.80]	 	 	 	[3.84]	 	 	 	[3.88]	 	 	 	[3.91]	 	 	 	[3.94]	 	 	 	[3.98]	 	 	 	[4.01]	 	 	 	[4.04]	 	 	 	[4.07]	 	 	 	[4.09]	 
	66
	 	 	[3.85]	 	 	 	[3.89]	 	 	 	[3.93]	 	 	 	[3.97]	 	 	 	[4.00]	 	 	 	[4.04]	 	 	 	[4.08]	 	 	 	[4.11]	 	 	 	[4.14]	 	 	 	[4.18]	 	 	 	[4.21]	 
	67
	 	 	[3.93]	 	 	 	[3.97]	 	 	 	[4.02]	 	 	 	[4.06]	 	 	 	[4.10]	 	 	 	[4.14]	 	 	 	[4.18]	 	 	 	[4.22]	 	 	 	[4.25]	 	 	 	[4.29]	 	 	 	[4.32]	 
	68
	 	 	[4.01]	 	 	 	[4.06]	 	 	 	[4.11]	 	 	 	[4.15]	 	 	 	[4.20]	 	 	 	[4.24]	 	 	 	[4.28]	 	 	 	[4.33]	 	 	 	[4.37]	 	 	 	[4.41]	 	 	 	[4.44]	 
	69
	 	 	[4.10]	 	 	 	[4.15]	 	 	 	[4.20]	 	 	 	[4.25]	 	 	 	[4.30]	 	 	 	[4.34]	 	 	 	[4.39]	 	 	 	[4.44]	 	 	 	[4.48]	 	 	 	[4.53]	 	 	 	[4.57]	 
	70
	 	 	[4.18]	 	 	 	[4.24]	 	 	 	[4.29]	 	 	 	[4.34]	 	 	 	[4.40]	 	 	 	[4.45]	 	 	 	[4.50]	 	 	 	[4.55]	 	 	 	[4.60]	 	 	 	[4.65]	 	 	 	[4.70]	 

* Payments after the death of the primary payee will be one-half (1/2) of the amount shown.

AILIC

-27-

 

CERTIFICATE OF PARTICIPATION

UNDER A GROUP FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT

NONPARTICIPATING — NO DIVIDENDS

AILIC

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00118-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00118-of-00352.parquet"}]]