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Pacific Life & Annuity Company

700 Newport Center Drive

Newport Beach, CA 92660

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

Pacific Life & Annuity Company has issued this Rider as a part of the annuity Contract to
which it is attached.

All provisions of the Contract that do not conflict with this Rider apply to this Rider. In the
event of any conflict between the provisions of this Rider and the provisions of the Contract, the
provisions of this Rider shall prevail over the provisions of the Contract.

This Rider provides a minimum withdrawal benefit that guarantees, upon election, a series of
withdrawals from the contract equal to 5% of the benefit base. The benefit base is established for
the sole purpose of determining the minimum withdrawal benefit and is not used in calculating the
cash surrender benefit or other guaranteed benefits.

By adding this Rider to the Contract, you agreed to certain allocation limitations and investment
alternatives in which you may invest while this Rider is in effect. These requirements may
include, but are not limited to, maximum Purchase Payment allocation limits to certain Variable
Investment Options or on certain allowable fixed-rate General Account Investment Options that are
outside of any asset allocation model, but participate in the asset allocation program; exclusion
of certain Investment Options; required minimum Purchase Payment allocations and restrictions on
transfers to or from certain Investment Options. These restrictions and limitations are summarized
in Appendix A which is a part of this Rider. These requirements apply to the entire Contract
Value.

The numeric examples contained in this Rider are based on certain assumptions. They have been
provided to assist in understanding the benefits provided by this Rider and to demonstrate how
Purchase Payments received and withdrawals made from the Contract prior to the Annuity Date affect
the values and benefits under this Rider over an extended period of time.

TABLE OF CONTENTS

	 	 	 	 	 
	 	 	Page
	Definition of Terms
	 	 	2	 
	5% Guaranteed Withdrawal Benefit
	 	 	2	 
	Annual Charge
	 	 	2	 
	Change in Annual Charge
	 	 	3	 
	Initial Values
	 	 	3	 
	Subsequent Purchase Payments
	 	 	3	 
	Limitation on Subsequent Purchase Payments
	 	 	3	 
	Annual Credit
	 	 	3	 
	Withdrawal of Protected Payment Amount
	 	 	4	 
	Withdrawals Exceeding Protected Payment Amount
	 	 	4	 
	Withdrawals to Satisfy Required Minimum Distribution
	 	 	4	 
	Depletion of Contract Value
	 	 	4	 
	Depletion of Remaining Protected Balance
	 	 	5	 
	Automatic Reset
	 	 	5	 
	Automatic Reset — Opt-Out Election
	 	 	5	 
	Automatic Reset — Future Participation
	 	 	5	 
	Owner-Elected Resets (Non-Automatic)
	 	 	5	 
	Application of Rider Provisions
	 	 	6	 

	 	 	 	 	 
	 	 	Page
	Annuitization
	 	 	6	 
	Continuation of Rider if Surviving Spouse
Continues Contract
	 	 	6	 
	Termination of Rider
	 	 	6	 
	Rider Effective Date
	 	 	7	 
	 
	 	 	 	 
	Sample Calculations
	 	 	8	 
	 
	 	 	 	 
	Appendix A — Summary of Asset Allocation Program
	 	 	 	 
	Asset Allocation Program
	 	 	14	 
	Asset Allocation Models
	 	 	14	 
	Purchase Payment Allocations
	 	 	14	 
	Rebalancing
	 	 	14	 
	Annual Analysis
	 	 	15	 
	Annual Updates
	 	 	15	 
	Notice of Automatic Updates
	 	 	15	 
	Change of Asset Allocation Model
	 	 	15	 
	Termination of Asset Allocation Program
	 	 	15	 

1

 

Definition of Terms — Unless redefined below, the terms defined in the Contract will have the
same meaning when used in this Rider. For purposes of this Rider, the following definitions apply:

Annual RMD Amount — The amount required to be distributed each Calendar Year for purposes of
satisfying the minimum distribution requirements of Internal Revenue Code Section 401(a)(9) and
related Code provisions in effect on the Rider Effective Date.

Protected Payment Amount — The maximum amount that can be withdrawn under this Rider without
reducing the Protected Payment Base. The Protected Payment Amount on any day after the Rider
Effective Date is equal to the lesser of:

	 	(a)	 	5% of the Protected Payment Base as of that day, less cumulative withdrawals
during that Contract Year; or
	 
	 	(b)	 	the Remaining Protected Balance as of that day.

The Protected Payment Amount will never be less than zero.

Protected Payment Base — An amount used to determine the Protected Payment Amount. The
Protected Payment Base will remain unchanged except as otherwise described under the provisions
of this Rider.

Remaining Protected Balance — The amount available for future withdrawals made under this
Rider. The Remaining Protected Balance will never be less than zero.

Reset Date — Any Contract Anniversary beginning with the first (1st) Contract
Anniversary after the Rider Effective Date on which an automatic reset or an Owner-elected reset
occurs.

For purposes of this Rider, the term “withdrawal” includes any applicable withdrawal charges and
charges for premium taxes and/or other taxes, if applicable. Amounts withdrawn under this Rider
will reduce the Contract Value by the amount withdrawn and will be subject to the same conditions,
limitations, restrictions and all other fees, charges and deductions, if applicable, as withdrawals
otherwise made under the provisions of the Contract.

5% Guaranteed Withdrawal Benefit — You have purchased a 5% Guaranteed Withdrawal Benefit Rider.
Subject to the terms and conditions described herein, this Rider:

	 	(a)	 	allows for withdrawals up to the Protected Payment Amount without any adjustment to the
Protected Payment Base, regardless of market performance, until the Remaining Protected
Balance equals zero;
	 
	 	(b)	 	provides for an annual credit to be applied to the Protected Payment Base and Remaining
Protected Balance as described under the Annual Credit provision of this Rider;
	 
	 	(c)	 	allows for withdrawals for purposes of satisfying the minimum distribution requirements
of Internal Revenue Code Section 401(a)(9) and related Code provisions in effect on the
Rider Effective Date, regardless of the amount, without any adjustment to the Protected
Payment Base, subject to certain conditions as described herein;
	 
	 	(d)	 	provides for automatic annual resets or Owner-elected resets of the Protected Payment
Base and Remaining Protected Balance to an amount equal to 100% of the Contract Value as of
a Reset Date.

This Rider may be purchased and added to the Contract, provided that on the Rider Effective Date:
(a) the age of each Annuitant is 85 years or younger; and (b) the entire Contract Value is invested
according to an asset allocation program established and maintained by us for this Rider.

Annual Charge — An annual charge for expenses related to this Rider will be deducted from the
Investment Options on a proportionate basis relative to the Account Value in each such Investment
Option.

The annual charge is deducted, in arrears, on each Contract Anniversary that this Rider remains in
effect. The annual charge is equal to 0.65% (not to exceed a maximum annual charge percentage of
1.20%) multiplied by the Protected Payment Base on the day the charge is deducted.

2

 

The annual charge percentage established on the Rider Effective Date will not change, except as
otherwise described in the provisions of this Rider.

If this Rider terminates on a Contract Anniversary, the entire annual charge for the prior Contract
Year will be deducted from the Contract Value on that Contract Anniversary.

If the Rider terminates prior to a Contract Anniversary, we will prorate the annual charge. The
prorated amount will be based on the Protected Payment Base as of the day the Rider terminates.
Such prorated amount will be deducted from the Contract Value on the earlier of the day the
Contract terminates or the Contract Anniversary immediately following the day the Rider terminates.

We will waive the annual charge if the Rider terminates as a result of the death of an Owner or
sole surviving Annuitant, or upon full annuitization of the Contract.

Any portion of the annual charge we deduct from any of our fixed-rate General Account Investment
Options (if available under the Contract) will not be greater than the annual interest credited in
excess of that option’s minimum guaranteed interest rate.

Change in Annual Charge — The annual charge percentage may change as a result of any automatic
reset or Owner-elected reset. The annual charge percentage will never exceed the annual charge
percentage then in effect for new issues of this same rider. If we are no longer issuing this
rider, any change in the annual charge percentage will not result in an annual charge percentage
that exceeds the maximum annual charge percentage specified in the Annual Charge provision.

If the Protected Payment Base and Remaining Protected Balance are never reset, the annual charge
percentage established on the Rider Effective Date is guaranteed not to change.

Initial Values — The Protected Payment Base, Remaining Protected Balance and Protected
Payment Amount are initially determined on the Rider Effective Date. On the Rider Effective Date,
the Protected Payment Base and Remaining Protected Balance are equal to the Initial Purchase
Payment or, if available on a Contract Anniversary, the Contract Value on that Contract
Anniversary. The Protected Payment Amount is equal to 5% of the Protected Payment Base.

Subsequent Purchase Payments — Purchase Payments received after the Rider Effective Date will
result in an increase in the Protected Payment Base and Remaining Protected Balance equal to the
amount of the Purchase Payment.

Limitation on Subsequent Purchase Payments — For purposes of this Rider, in no event may any
Purchase Payment received on and after the first (1st) Contract Anniversary, measured from the
Rider Effective Date or the most recent Reset Date, whichever is later, result in the total of all
Purchase Payments received since that Contract Anniversary to exceed $100,000, without our prior
approval.

This provision only applies if the Contract permits Purchase Payments after the first (1st)
Contract Anniversary, measured from the Contract Date.

Annual Credit — On each Contract Anniversary after the Rider Effective Date, an annual credit will
be applied to the Protected Payment Base and Remaining Protected Balance if, as of that Contract
Anniversary:

	 	(a)	 	no withdrawals have occurred after the Rider Effective Date or the most recent Reset
Date, whichever is later; and
	 
	 	(b)	 	that Contract Anniversary is within the first ten (10) Contract Anniversaries, measured
from the Rider Effective Date or the most recent Reset Date, whichever is later.

The annual credit is equal to 6% of the sum of (A) and (B) as of the Contract Anniversary on which
the credit is added, where:

	 	(A)	 	is the Remaining Protected Balance on the Rider Effective Date or the most recent Reset
Date, whichever is later.
	 
	 	(B)	 	is cumulative Purchase Payments received after the Rider Effective Date or the most
recent Reset Date, whichever is later.

3

 

Once a withdrawal has occurred, no annual credit will be applied to the Protected Payment Base and
Remaining Protected Balance on any Contract Anniversary following the withdrawal, unless an
automatic reset or an Owner-elected reset occurs, in which case eligibility for the annual credit
will begin as of the Reset Date of that automatic reset or Owner-elected reset. (See Application
of Rider Provisions).

Withdrawal of Protected Payment Amount — While this Rider is in effect, you may withdraw up to the
Protected Payment Amount without any adjustment to the Protected Payment Base, regardless of market
performance, until the Remaining Protected Balance equals zero.

If a withdrawal does not exceed the Protected Payment Amount immediately prior to that withdrawal,
the Protected Payment Base will remain unchanged. The Remaining Protected Balance will decrease by
the withdrawal amount immediately following the withdrawal.

Withdrawals Exceeding Protected Payment Amount — Except as otherwise provided under the
Withdrawals to Satisfy Required Minimum Distribution provision of this Rider, if a withdrawal
exceeds the Protected Payment Amount immediately prior to that withdrawal, we will adjust the
Protected Payment Base and Remaining Protected Balance immediately following the withdrawal to the
lesser of:

	 	(a)	 	the Contract Value immediately after the withdrawal; or
	 
	 	(b)	 	the Remaining Protected Balance immediately prior to the withdrawal, less the
withdrawal amount.

The amount available for withdrawal under the Contract must be sufficient to support any withdrawal
that would otherwise exceed the Protected Payment Amount.

Withdrawals to Satisfy Required Minimum Distribution — No adjustment will be made to the Protected
Payment Base if a withdrawal made under this Rider exceeds the Protected Payment Amount immediately
prior to the withdrawal, provided that such withdrawal (herein referred to as an “RMD withdrawal”)
is for purposes of satisfying the minimum distribution requirements of Internal Revenue Code
Section 401(a)(9) and related Code provisions in effect on the Rider Effective Date, and further
subject to the following:

	 	(a)	 	you have authorized us to calculate and make periodic distribution of the Annual RMD
Amount for the Calendar Year required based on the payment frequency you have chosen;
	 
	 	(b)	 	the Annual RMD Amount is based on this Contract only; and
	 
	 	(c)	 	no withdrawals (other than RMD withdrawals) are made from the Contract during the
Contract Year.

Each RMD withdrawal will decrease the Remaining Protected Balance by the amount withdrawn
immediately following the RMD withdrawal.

Depletion of Contract Value — If a withdrawal (including an RMD withdrawal) does not exceed the
Protected Payment Amount and reduces the Contract Value to zero, the following will apply:

	 	(a)	 	if the oldest Owner (or youngest Annuitant, in the case of an Owner who is a
Non-Natural Owner):

	 	(i)	 	was younger than age 591/2 when the first withdrawal was taken under this
Rider after the Rider Effective Date or the most recent Reset Date, whichever is
later, 5% of the Protected Payment Base will be paid each year until the Remaining
Protected Balance is reduced to zero; or
	 
	 	(ii)	 	was age 591/2 or older when the first withdrawal was taken under this Rider
after the Rider Effective Date or the most recent Reset Date, whichever is later, 5%
of the Protected Payment Base will be paid each year until the day of the first
death of an Owner or the date of death of the sole surviving Annuitant.

The payments under subparagraphs (a)(i) and (a)(ii) above will be made under a series of
pre-authorized withdrawals under a payment frequency, as elected by the Owner, but no less
frequently than annually;

	 	(b)	 	no additional Purchase Payments will be accepted under the Contract;
	 
	 	(c)	 	any Remaining Protected Balance will not be available for payment in a lump sum and
will not be applied to provide payments under an Annuity Option; and
	 
	 	(d)	 	the Contract will cease to provide any death benefit.

4

 

If the Owner or sole surviving Annuitant dies and the Contract Value is zero as of the date of
death, any Remaining Protected Balance will be paid to the Beneficiary under the series of
pre-authorized withdrawals and payment frequency then in effect at the time of the Owner’s or sole
surviving Annuitant’s death.

Depletion of Remaining Protected Balance — If a withdrawal reduces the Remaining Protected Balance
to zero and Contract Value remains, the following will apply:

If the oldest Owner (or youngest Annuitant, in the case of an Owner who is a Non-Natural Owner):

	 	(a)	 	was younger than age 591/2 when the first withdrawal was taken under this Rider after the
Rider Effective Date or the most recent Reset Date, whichever is later, this Rider will
terminate; or
	 
	 	(b)	 	was age 591/2 or older when the first withdrawal was taken under this Rider after the
Rider Effective Date or the most recent Reset Date, whichever is later, you may elect to
withdraw up to 5% of the Protected Payment Base each year until the day of the first death
of an Owner or the date of death of the sole surviving Annuitant.

If a withdrawal made under subparagraph (b) (except an RMD withdrawal) taken from the Contract
exceeds the Protected Payment Amount, this Rider will terminate.

Any death benefit proceeds to be paid to the Beneficiary from remaining Contract Value will be paid
as described under the Death Benefit provisions of the Contract.

Automatic Reset — On each Contract Anniversary while this rider is in effect and before the
Annuity Date and after any annual credit is applied, we will automatically reset the Protected
Payment Base and Remaining Protected Balance to an amount equal to 100% of the Contract Value, if
the Protected Payment Base is less than the Contract Value on that Contract Anniversary. The
annual charge percentage may change as a result of any automatic reset. (See Change in Annual
Charge provision). We will provide you with written confirmation of each automatic reset.

Automatic Reset — Opt-Out Election — If you are within thirty (30) days after a Contract
Anniversary on which an automatic reset is effective, you have the option to reinstate the
Protected Payment Base, Remaining Protected Balance and any change in the annual charge percentage
to their respective amounts immediately before the automatic reset.

If you elect this option, your opt-out election must be received, in a form satisfactory to us, at
our Service Office within the same thirty (30) day period after the Contract Anniversary on which
the reset is effective.

Any future automatic resets will continue in effect in accordance with the Automatic Reset
provision of this Rider.

Automatic Reset — Future Participation — You may elect not to participate in future automatic
resets at any time. Your election must be received, in a form satisfactory to us, at our Service
Center, while this rider is in effect and before the Annuity Date. Such election will be effective
for future Contract Anniversaries.

If you previously elected not to participate in automatic resets, you may re-elect to participate
in future automatic resets at any time. Your election to resume participation must be received, in
a form satisfactory to us, at our Service Office while this Rider is in effect and before the
Annuity Date. Such election will be effective for future Contract Anniversaries as described in
the Automatic Reset provision.

Owner-Elected Resets (Non-Automatic) — You may, on any Contract Anniversary beginning with the
first (1st) Contract Anniversary, measured from the Rider Effective Date or the most
recent Reset Date, whichever is later, elect to reset the Remaining Protected Balance and Protected
Payment Base to an amount equal to 100% of the Contract Value as of that Contract Anniversary. The
annual charge percentage may change if you elect this reset option. (See Change in Annual Charge
provision).

On each Reset Date and after any annual credit is applied, we will set the Remaining Protected
Balance and Protected Payment Base to an amount equal to 100% of the Contract Value as of that
Reset Date.

5

 

If you elect this option, your election must be received, in a form satisfactory to us, at our
Service Center within thirty (30) days after the Contract Anniversary on which the reset is
effective. Your election of this option may result in a reduction in the Protected Payment Base,
Remaining Protected Balance, Protected Payment Amount and any annual credit that may be applied.
We will provide you with written confirmation of your election.

Application of Rider Provisions — On and after each Reset Date, the provisions of this Rider shall
apply in the same manner as they applied when the Rider was originally issued. Eligibility for the
annual credit, the limitations and restrictions on Purchase Payments and withdrawals, the deduction
of annual charges and any future reset options available on and after each Reset Date, will again
apply and will be measured from that Reset Date.

Annuitization — If you annuitize the Contract at the maximum Annuity Date specified in the
Contract and this Rider is still in effect at the time of your election and a Life Only annuity
option is chosen, the annuity payments will be equal to the greater of:

        .

	 	(a)	 	the Life Only payment amount calculated based on the Net Contract Value at the maximum
Annuity Date, less any charges for premium taxes and/or other taxes, and the Life Only
annuity rates based on the greater of our current income factors in effect for the Contract
on the maximum Annuity Date; or our guaranteed income factors; or
	 
	 	(b)	 	the Protected Payment Amount in effect at the maximum Annuity Date divided by the
number of months in the payment frequency elected for the Life Only annuity option.

If you annuitize the Contract at any time prior to the maximum Annuity Date specified in the
Contract, your annuity payments will be determined in accordance with the terms of the Contract.
The Protected Payment Base, Remaining Protected Balance and Protected Payment Amount under this
Rider will not be used in determining any annuity payments.

Continuation of Rider if Surviving Spouse Continues Contract — If the Owner dies while this Rider
is in effect and if the surviving spouse of the deceased Owner elects to continue the Contract in
accordance with its terms, the surviving spouse may continue to take withdrawals of the Protected
Payment Amount under this Rider, until the Remaining Protected Balance is reduced to zero.

The surviving spouse may elect any of the reset options available under this Rider for subsequent
Contract Anniversaries. If an election to reset is made, whether by an automatic reset or an
Owner-elected reset, then the provisions of this Rider will continue in full force and in effect
for the surviving spouse.

Termination of Rider — Except as otherwise provided under the Continuation of Rider if Surviving
Spouse Continues Contract provision of this Rider, this Rider will automatically terminate upon the
earliest to occur of one of the following events:

	 	(a)	 	the day following the end of our thirty (30) day advance written notice to the Owner of
a transaction resulting in any portion of the Contract Value to be allocated outside of the
asset allocation program and no instructions to remedy are received by us at our Service
Office within such thirty (30) day period (see Termination of Asset Allocation Program
provision in Appendix A);
	 
	 	(b)	 	the day the Remaining Protected Balance is reduced to zero;
	 
	 	(c)	 	the day of the first death of an Owner or the date of death of the sole surviving
Annuitant;
	 
	 	(d)	 	the day the Contract is terminated in accordance with the provisions of the Contract;
	 
	 	(e)	 	the day we are notified of a change in ownership of the Contract; or
	 
	 	(f)	 	the Annuity Date.

This Rider will not terminate under subparagraph (b) above if the oldest Owner (or youngest
Annuitant, in the case of an Owner who is a Non-Natural Owner) was age 591/2 or older when the first
withdrawal was taken under this Rider after the Rider Effective Date or the most recent Reset Date,
whichever is later. In this case the Rider will terminate under subparagraph (c).

6

 

This Rider and the Contract will not terminate under subparagraph (d) above if at the time of this
event, the Contract Value is zero and we are making pre-authorized withdrawals of 5% of the
Protected Payment Base. In this case, the Rider and Contract will terminate under:

	 	(i)	 	subparagraph (b) if the oldest Owner (or youngest Annuitant, in the case of an Owner
who is a Non-Natural Owner) was younger than age 591/2 when the first withdrawal was taken
under this Rider after the Rider Effective Date or the most recent Reset Date, whichever is
later: or
	 
	 	(ii)	 	subparagraph (c) if the oldest Owner (or youngest Annuitant, in the case of an Owner
who is a Non-Natural Owner) was age 591/2 or older when the first withdrawal was taken under
this Rider after the Rider Effective Date or the most recent Reset Date, whichever is
later.

Rider Effective Date — This Rider is effective on the Contract Date, unless a later date is shown
below

Rider Effective Date: [Date]

All other terms and conditions of the Contract remain unchanged by this Rider.

PACIFIC LIFE & ANNUITY COMPANY

	 	 	 
	

	 	
	Chairman and Chief Executive Officer
	 	Secretary

7

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

The numeric examples shown in this section are based on certain assumptions. They have been
provided to assist in understanding the benefits provided by this Rider and to demonstrate how
Purchase Payments received and withdrawals made from the Contract prior to the Annuity Date affect
the values and benefits under this Rider over an extended period of time. These examples are not
intended to serve as projections of future investment returns.

Example #1 — Setting of Initial Values.

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Beginning	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Protected	 	Protected	 	Remaining
	of Contract	 	Purchase	 	 	 	 	 	Contract Value	 	Annual	 	Payment	 	Payment	 	Protected
	Year	 	Payment	 	Withdrawal	 	after Activity	 	Credit	 	Base	 	Amount	 	Balance
	 1 
	 	$	100,000	 	 	 	 	 	 	$	100,000	 	 	$	0.00	 	 	$	100,000	 	 	$	5,000	 	 	$	100,000	 

On the Rider Effective Date, the initial values are set as follows:

	 	•	 	Protected Payment Base = Initial Purchase Payment = $100,000
	 
	 	•	 	Remaining Protected Balance = Initial Purchase Payment = $100,000
	 
	 	•	 	Protected Payment Amount = 5% of Protected Payment Base = $5,000

Example #2 — Subsequent Purchase Payments.

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date
	 
	 	•	 	A subsequent Purchase Payment of $100,000 is received during Contract Year 1.
	 
	 	•	 	No withdrawals taken.
	 
	 	•	 	No automatic resets or Owner-elected resets.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Beginning	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Protected	 	Protected	 	Remaining
	of Contract	 	Purchase	 	 	 	 	 	Contract Value	 	Annual	 	Payment	 	Payment	 	Protected
	Year	 	Payment	 	Withdrawal	 	after Activity	 	Credit	 	Base	 	Amount	 	Balance
	 1 
	 	$	100,000	 	 	 	 	 	 	$	100,000	 	 	$	0.00	 	 	$	100,000	 	 	$	5,000	 	 	$	100,000	 
	Activity
	 	$	100,000	 	 	 	 	 	 	$	200,000	 	 	 	 	 	 	$	200,000	 	 	$	10,000	 	 	$	200,000	 
	 2 
	 	 	 	 	 	 	 	 	 	$	207,000	 	 	$	12,000	 	 	$	212,000	 	 	$	10,600	 	 	$	212,000	 

Immediately after the $100,000 subsequent Purchase Payment during Contract Year 1, the Protected
Payment Base and Remaining Protected Balance are increased by the Purchase Payment amount to
$200,000 ($100,000 + $100,000). The Protected Payment Amount after the Purchase Payment is equal
to $10,000 (5% of the Protected Payment Base after the Purchase Payment since there were no
withdrawals during that Contract Year).

Since no withdrawal occurred prior to the Contract Anniversary at the Beginning of Contract Year 2,
an annual credit of $12,000 (6% of the initial Remaining Protected Balance plus cumulative Purchase
Payments received after the Rider Effective Date) is applied to the Protected Payment Base and
Remaining Protected Balance on that Contract Anniversary, increasing both to $212,000. As a
result, the Protected Payment Amount on that Contract Anniversary is equal to $10,600 (5% of the
Protected Payment Base on that Contract Anniversary).

In addition to Purchase Payments, the Contract Value is further subject to increases and/or
decreases during each Contract Year as a result of additional amounts credited, charges, fees and
other deductions, and increases and/or decreases in the investment performance of the Variable
Account.

8

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #3 — Withdrawals Not Exceeding Protected Payment Amount.

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date
	 
	 	•	 	A subsequent Purchase Payment of $100,000 is received during Contract Year 1.
	 
	 	•	 	A withdrawal equal to or less than the Protected Payment Amount is taken during Contract Years 2, 3 and 4.
	 
	 	•	 	Automatic resets at Beginning of Contract Years 4 and 5.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Beginning	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Protected	 	Protected	 	Remaining
	of Contract	 	Purchase	 	 	 	 	 	Contract Value	 	Annual	 	Payment	 	Payment	 	Protected
	Year	 	Payment	 	Withdrawal	 	after Activity	 	Credit	 	Base	 	Amount	 	Balance
	 1 
	 	$	100,000	 	 	 	 	 	 	$	100,000	 	 	$	0.00	 	 	$	100,000	 	 	$	5,000	 	 	$	100,000	 
	Activity
	 	$	100,000	 	 	 	 	 	 	$	200,000	 	 	 	 	 	 	$	200,000	 	 	$	10,000	 	 	$	200,000	 
	 2 
	 	 	 	 	 	 	 	 	 	$	207,000	 	 	$	12,000	 	 	$	212,000	 	 	$	10,600	 	 	$	212,000	 
	Activity
	 	 	 	 	 	$	10,600	 	 	$	210,890	 	 	 	 	 	 	$	212,000	 	 	 	 	 	 	$	201,400	 
	 3 
	 	 	 	 	 	 	 	 	 	$	210,890	 	 	$	0.00	 	 	$	212,000	 	 	$	10,600	 	 	$	201,400	 
	Activity
	 	 	 	 	 	$	10,600	 	 	$	215,052	 	 	 	 	 	 	$	212,000	 	 	 	 	 	 	$	190,800	 
	4
	 	(Prior to Automatic Reset)	 	 		 	 	$	215,052	 	 	$	0.00	 	 	$	212,000	 	 	$	10,600	 	 	$	190,800	 
	4
	 	(After Automatic Reset)	 	 		 	 	$	215,052	 	 	$	0.00	 	 	$	215,052	 	 	$	10,752	 	 	$	215,052	 
	Activity
	 	 	 	 	 	$	10,600	 	 	$	219,506	 	 	 	 	 	 	$	215,052	 	 	 	 	 	 	$	204,452	 
	5
	 	 (Prior to Automatic
Reset)	 	 		 	 	$	219,506	 	 	$	0.00	 	 	$	215,506	 	 	$	10,752	 	 	$	204,506	 
	5
	 	(After Automatic
Reset)	 	 		 	 	$	219,506	 	 	$	0.00	 	 	$	219,506	 	 	$	10,975	 	 	$	219,506	 

For an explanation of the values and activities at the start of and during Contract Year 1, refer
to Examples #1 and #2.

As the withdrawal during Contract Year 2 did not exceed the Protected Payment Amount immediately
prior to the withdrawal ($10,600):

	 	(a)	 	the Protected Payment Base remains unchanged; and
	 
	 	(b)	 	the Remaining Protected Balance is reduced by the amount of the withdrawal to $201,400
($212,000 — $10,600).

As the withdrawal during Contract Year 3 did not exceed the Protected Payment Amount immediately
prior to the withdrawal ($10,600):

	 	(c)	 	the Protected Payment Base remains unchanged; and
	 
	 	(d)	 	the Remaining Protected Balance is reduced by the amount of the withdrawal to $190,800
($201,400 — $10,600).

Because at the Beginning of Contract Year 4, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 4 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 4 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,752 (5% of the reset Protected Payment Base).

As the withdrawal during Contract Year 4 did not exceed the Protected Payment Amount immediately
prior to the withdrawal ($10,600):

	 	(e)	 	the Protected Payment Base remains unchanged; and
	 
	 	(f)	 	the Remaining Protected Balance is reduced by the amount of the withdrawal to $204,452
($215,452 — $10,600).

Because at the Beginning of Contract Year 5, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 5 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 5 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,975 (5% of the reset Protected Payment Base).

Since withdrawals occurred during Contract Years 2, 3 and 4, no annual credit will be applied to
the Protected Payment Base and Remaining Protected Balance on any Contract Anniversary following
the withdrawal.

9

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #4 — Withdrawals Exceeding Protected Payment Amount.

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date
	 
	 	•	 	A subsequent Purchase Payment of $100,000 is received during Contract Year 1.
	 
	 	•	 	A withdrawal greater than the Protected Payment Amount is taken during Contract Years 2, 3 and 4.
	 
	 	•	 	Automatic resets at Beginning of Contract Years 3, 4 and 5.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Beginning	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Protected	 	Protected	 	Remaining
	of Contract	 	Purchase	 	 	 	 	 	Contract Value	 	Annual	 	Payment	 	Payment	 	Protected
	Year	 	Payment	 	Withdrawal	 	after Activity	 	Credit	 	Base	 	Amount	 	Balance
	 1 
	 	$	100,000	 	 	 	 	 	 	$	100,000	 	 	$	0.00	 	 	$	100,000	 	 	$	5,000	 	 	$	100,000	 
	Activity
	 	$	100,000	 	 	 	 	 	 	$	200,000	 	 	 	 	 	 	$	200,000	 	 	$	10,000	 	 	$	200,000	 
	 2 
	 	 	 	 	 	 	 	 	 	$	207,000	 	 	$	12,000	 	 	$	212,000	 	 	$	10,600	 	 	$	212,000	 
	Activity
	 	 	 	 	 	$	15,000	 	 	$	206,490	 	 	 	 	 	 	$	197,000	 	 	$	0.00	 	 	$	197,000	 
	3
	 	(Prior to Automatic Reset) 	 	 		 	 	$	206,490	 	 	$	0.00	 	 	$	197,000	 	 	$	9,850	 	 	$	197,000	 
	3
	 	(After Automatic
Reset)	 	 		 	 	$	206,490	 	 	$	0.00	 	 	$	206,490	 	 	$	10,325	 	 	$	206,490	 
	Activity
	 	 	 	 	 	$	15,000	 	 	$	205,944	 	 	 	 	 	 	$	191,490	 	 	$	0.00	 	 	$	191,490	 
	4
	 	(Prior to Automatic
Reset)	 	 		 	 	$	205,944	 	 	$	0.00	 	 	$	191,490	 	 	$	9,575	 	 	$	191,490	 
	4
	 	(After Automatic
Reset)	 	 		 	 	$	205,944	 	 	$	0.00	 	 	$	205,944	 	 	$	10,297	 	 	$	205,944	 
	Activity
	 	 	 	 	 	$	15,000	 	 	$	205,360	 	 	 	 	 	 	$	190,944	 	 	$	0.00	 	 	$	190,944	 
	5
	 	(Prior to Automatic
Reset)	 	 		 	 	$	205,360	 	 	$	0.00	 	 	$	190,944	 	 	$	9,547	 	 	$	190,944	 
	5
	 	(After Automatic
Reset)	 	 		 	 	$	205,360	 	 	$	0.00	 	 	$	205,360	 	 	$	10,268	 	 	$	205,360	 

For an explanation of the values and activities at the start of and during Contract Year 1, refer
to Examples #1 and #2.

Because the $15,000 withdrawal during Contract Year 2 exceeds the Protected Payment Amount
immediately prior to the withdrawal ($15,000 > $10,600), the Protected Payment Base and
Remaining Protected Balance immediately after the withdrawal are adjusted to the lesser of:

	 	(a)	 	the Contract Value immediately after the withdrawal ($206,490); or
	 
	 	(b)	 	the Remaining Protected Balance immediately prior to the withdrawal, less the
withdrawal amount ($212,000 — $15,000 = $197,000).

The Protected Payment Amount immediately after the withdrawal is equal to $0 (5% of the Protected
Payment Base after the withdrawal (5% of $197,000 = $9,850), less cumulative withdrawals during
that Contract Year ($15,000), but not less than zero).

Because at the Beginning of Contract Year 3, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 3 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 3 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,325 (5% of the reset Protected Payment Base).

Because the $15,000 withdrawal during Contract Year 3 exceeds the Protected Payment Amount
immediately prior to the withdrawal ($15,000 > $10,325), the Protected Payment Base and
Remaining Protected Balance immediately after the withdrawal are adjusted to the lesser of:

	 	(c)	 	the Contract Value immediately after the withdrawal ($205,944); or
	 
	 	(d)	 	the Remaining Protected Balance immediately prior to the withdrawal, less the
withdrawal amount ($206,490 — $15,000 = $191,490).

The Protected Payment Amount immediately after the withdrawal is equal to $0 (5% of the Protected
Payment Base after the withdrawal (5% of $191,490 = $9,575), less cumulative withdrawals during
that Contract Year ($15,000), but not less than zero).

Because at the Beginning of Contract Year 4, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 4 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 4 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,297 (5% of the reset Protected Payment Base).

10

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #4 — Withdrawals Exceeding Protected Payment Amount (continued)

Because the $15,000 withdrawal during Contract Year 4 exceeds the Protected Payment Amount
immediately prior to the withdrawal ($15,000 > $10,297), the Protected Payment Base and
Remaining Protected Balance immediately after the withdrawal are adjusted to the lesser of:

	 	(e)	 	the Contract Value immediately after the withdrawal ($205,360); or
	 
	 	(f)	 	the Remaining Protected Balance immediately prior to the withdrawal, less the
withdrawal amount ($205,944 — $15,000 = $190,944).

The Protected Payment Amount immediately after the withdrawal is equal to $0 (5% of the Protected
Payment Base after the withdrawal (5% of $191,490 = $9,547), less cumulative withdrawals during
that Contract Year ($15,000), but not less than zero).

Because at the Beginning of Contract Year 5, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 5 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 5 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,268 (5% of the reset Protected Payment Base).

Since withdrawals occurred during Contract Years 2, 3 and 4, no annual credit will be applied to
the Protected Payment Base and Remaining Protected Balance on any Contract Anniversary following
the withdrawal.

11

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #5 — Lifetime Income

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date
	 
	 	•	 	No subsequent Purchase Payments are received.
	 
	 	•	 	Owner is age 591/2 or older when the first withdrawal was taken
	 
	 	•	 	Withdrawals, each equal to 5% of the Protected Payment Base are taken each Contract Year.
	 
	 	•	 	No automatic reset or Owner-elected reset is assumed during the life of the Rider.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Contract	 	 	 	 	 	End of Year	 	Annual	 	Protected	 	Protected	 	Remaining
	Year	 	Withdrawal	 	Contract Value	 	Credit	 	Payment Base	 	Payment Amount	 	Protected Balance
	 1 
	 	$	5,000	 	 	$	96,489	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	95,000	 
	 2 
	 	$	5,000	 	 	$	94,384	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	90,000	 
	 3 
	 	$	5,000	 	 	$	92,215	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	85,000	 
	 4 
	 	$	5,000	 	 	$	89,982	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	80,000	 
	 5 
	 	$	5,000	 	 	$	87,681	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	75,000	 
	 6 
	 	$	5,000	 	 	$	85,311	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	70,000	 
	 7 
	 	$	5,000	 	 	$	82,871	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	65,000	 
	 8 
	 	$	5,000	 	 	$	80,357	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	60,000	 
	 9 
	 	$	5,000	 	 	$	77,768	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	55,000	 
	 10 
	 	$	5,000	 	 	$	75,101	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	50,000	 
	 11 
	 	$	5,000	 	 	$	72,354	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	45,000	 
	 12 
	 	$	5,000	 	 	$	69,524	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	40,000	 
	 13 
	 	$	5,000	 	 	$	66,610	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	35,000	 
	 14 
	 	$	5,000	 	 	$	63,608	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	30,000	 
	 15 
	 	$	5,000	 	 	$	60,517	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	25,000	 
	 16 
	 	$	5,000	 	 	$	57,332	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	20,000	 
	 17 
	 	$	5,000	 	 	$	54,052	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	15,000	 
	 18 
	 	$	5,000	 	 	$	50,674	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	10,000	 
	 19 
	 	$	5,000	 	 	$	47,194	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	5,000	 
	 20 
	 	$	5,000	 	 	$	43,610	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 21 
	 	$	5,000	 	 	$	39,918	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 22 
	 	$	5,000	 	 	$	36,115	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 23 
	 	$	5,000	 	 	$	32,199	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 24 
	 	$	5,000	 	 	$	28,165	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 25 
	 	$	5,000	 	 	$	24,010	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 26 
	 	$	5,000	 	 	$	19,730	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 27 
	 	$	5,000	 	 	$	15,322	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 28 
	 	$	5,000	 	 	$	10,782	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 29 
	 	$	5,000	 	 	$	6,105	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 30 
	 	$	5,000	 	 	$	1,288	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 31 
	 	$	5,000	 	 	$	0	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 32 
	 	$	5,000	 	 	$	0	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 33 
	 	$	5,000	 	 	$	0	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 34 
	 	$	5,000	 	 	$	0	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 

On the Rider Effective Date, the initial values are set as follows:

	 	•	 	Protected Payment Base = Initial Purchase Payment = $100,000
	 
	 	•	 	Remaining Protected Balance = Initial Purchase Payment = $100,000
	 
	 	•	 	Protected Payment Amount = 5% of Protected Payment Base = $5,000

12

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #5 — Lifetime Income (continued)

Because the amount of each withdrawal does not exceed the Protected Payment Amount immediately
prior to the withdrawal ($5,000): (a) the Protected Payment Base remains unchanged; and (b) the
Remaining Protected Balance is reduced by the amount of each withdrawal.

Since a withdrawal occurred during Contract Year 1, no annual credit will be applied to the
Protected Payment Base and Remaining Protected Balance on any Contract Anniversary following the
withdrawal.

Since it was assumed that the Owner was age 591/2 or older when the first withdrawal was taken,
withdrawals of 5% of the Protected Payment Base will continue to be paid each year (even after the
Contract Value and Remaining Protected Balance have been reduced to zero) until the day of the
first death of an Owner or the date of death of the sole surviving Annuitant, whichever occurs
first.

13

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

APPENDIX A — SUMMARY OF ASSET ALLOCATION PROGRAM

This summary outlines the general features of the asset allocation program established and
maintained by us and which operates in combination with optional riders requiring your
participation in an asset allocation program.

Asset Allocation Program — The asset allocation program is a service we offer and maintain for use
in combination with certain optional riders that are available with our variable annuity contracts.
Asset allocation is the allocation of Purchase Payments among asset classes and involves decisions
about which asset classes should be selected and how much of the total Contract Value should be
allocated to each asset class. The theory of asset allocation is that diversification among asset
classes can help reduce volatility over the long-term.

Asset Allocation Models — Currently, there are five (5) asset allocation models, each comprised of
a selected combination of Investment Options. Asset allocation is a two-step process. First, an
analysis is prepared to determine the break down of asset classes. Next, after the asset class
exposures are known, a determination of how each Investment Option can be used to implement the
asset class level allocations. The Investment Options are selected by evaluating the asset classes
represented by that Investment Option and combining Investment Options to arrive at the desired
asset class exposure. Based on this analysis, the Investment Options are selected in a manner
intended to optimize returns for each model, given a particular level of risk tolerance. The
current models and their asset class exposure are set out below.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Asset Class Exposure
	Model A	 	Model B	 	Model C	 	Model D	 	Model E
	Cash

	 	[10%]
	 	Cash
	 	[6%]
	 	Cash
	 	[1%]
	 	Cash
	 	[2%]
	 	Cash
	 	[2%]
	Bonds

	 	[67%]
	 	Bonds
	 	[50%]
	 	Bonds
	 	[39%]
	 	Bonds
	 	[18%]
	 	Bonds
	 	[6%]
	Domestic Stocks

	 	[17%]
	 	Domestic Stocks
	 	[32%]
	 	Domestic Stocks
	 	[42%]
	 	Domestic Stocks
	 	[56%]
	 	Domestic Stocks
	 	[61%]
	International Stocks

	 	[6%]
	 	International Stocks
	 	[12%]
	 	International Stocks
	 	[18%]
	 	International Stocks
	 	[24%]
	 	International Stocks
	 	[31%]
	Shorter Investment Horizon	 	 	 	 	 	 	 	 	 	Longer Investment Horizon

	Lower Risk	 	
	 	Higher Risk

	Less Volatile	 	 	 	 	 	 	 	 	 	 	 	 	 	More Volatile

Purchase Payment Allocations — Your Initial Purchase Payment (in the case of a new
application) or Contract Value, as applicable, will be allocated to the Investment Options
according to the asset allocation model you select. Subsequent Purchase Payments, if allowed under
the Contract, will also be allocated accordingly, unless you instruct us otherwise in writing.

You may also allocate Purchase Payments to any allowable fixed-rate General Account Investment
Option (if available under the Contract) only for purposes of dollar cost averaging (the periodic
transfer of amounts) to the Investment Options within your asset allocation model. However,
amounts transferred from any such allowable fixed-rate General Account Investment Option must be
made over a period not to exceed twelve (12) months.

To maintain the Rider in full force and in effect during the Rider’s required holding period, the
entire Contract Value must remain invested according to the asset allocation program. Any portion
of a Purchase Payment or Contract Value allocated outside of your asset allocation model to an
Investment Option that is not an allowable option under the program, may terminate the Rider in
addition to your participation in the program (see Termination of Asset Allocation Program
provision of this Appendix A).

Rebalancing — If you choose, you can rebalance your Contract Value quarterly, semi-annually, or
annually, to maintain the current allocations of your model, since changes in the net asset values
of the underlying portfolios in each model will alter your asset allocation over time. This
rebalancing option is independent of any other automatic rebalancing as a result of an annual
analysis. If you also allocate part of your Purchase Payment or Contract Value to any allowable
fixed-rate General Account Investment Option and you elect periodic rebalancing, such amounts will
not be considered when rebalancing. Only the Investment Options within your model will be
rebalanced.

14

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

APPENDIX A — SUMMARY OF ASSET ALLOCATION PROGRAM

Annual Analysis — Each of the asset allocation models are evaluated annually to assess whether
the combination of Investment Options within each model should be changed to better seek to
optimize the potential return for the level of risk tolerance intended for the model. As a result
of the periodic analysis, each model may change and Investment Options may be added to a model
(including Investment Options not currently available), or Investment Options may be deleted from a
model.

Annual Updates — When your asset allocation model is updated, we will reallocate your Contract
Value (and subsequent Purchase Payments, if applicable) in accordance with any changes to the model
you have selected. This means the allocation of your Contract Value, and potentially the Investment
Options in which you are invested, will automatically change and your Contract Value (and
subsequent Purchase Payments, if applicable) will be automatically reallocated among the Investment
Options in your updated model (independently of any automatic rebalancing you may have selected).
We require that you grant us discretionary investment authority to periodically reallocate your
Contract Value (and subsequent Purchase Payments, if applicable) in accordance with the updated
version of the asset allocation model you have selected.

Notice of Automatic Updates — We will send you written notice of the updated asset allocation
models at least thirty (30) days in advance of the date we intend the updated version of the model
to be effective. You should carefully review these notices. If you wish to accept the changes in
your selected model, you will not need to take any action, as your Contract Value (or subsequent
Purchase Payments, if applicable) will be reallocated in accordance with the updated model
automatically, provided you have granted us discretionary investment authority (see Annual Updates
provision of this Appendix A).

If you do not wish to accept the changes to your selected model, you can change to a different
model (see Change in Asset Allocation Model provision of this Appendix A) or withdraw from the
asset allocation program (see Termination of Asset Allocation Program provision of this Appendix
A).

Change of Asset Allocation Model — You may change your asset allocation model selection at any time
with a proper written request or by electronic instructions provided a valid electronic
authorization is on file with us. You should consult with your registered representative to assist
you in determining which model is best suited to your financial needs, investment time horizon, and
is consistent with your risk comfort level. You should periodically review those factors to
determine if you need to change models to reflect such changes.

Termination of Asset Allocation Program — You may terminate your Rider and/or your participation
in the asset allocation program at any time with a proper written request or by electronic
instructions, provided a valid electronic authorization is on file with us. If you terminate the
Rider only, you may choose to continue your participation in the asset allocation program without
the benefits of the Rider. If you terminate participation in the program, your Rider will also
terminate.

You may cause an involuntary termination of both the Rider and your participation in the asset
allocation program upon the occurrence of any one of the following events:

	 	(a)	 	you allocate any portion of your Purchase Payments or transfer any portion of the
Contract Value to an Investment Option that is not currently included in your model or that
is not an allowable transfer under the program;
	 
	 	(b)	 	you allocate any portion of your Purchase Payments or transfer any portion of the
Contract Value to any fixed-rate General Account Investment Option (if available under the
Contract) that is not an allowable option or an allowable transfer under the program; or
	 
	 	(c)	 	you change the allocation percentages of your current asset allocation model.

We will send you written notice in the event any transaction described in subparagraphs (a) through
(c) above occur. You may, within thirty (30) days after the date of our notice, direct us to take
appropriate corrective action necessary to continue the Rider in effect and your participation in
the asset allocation program. If no instructions to remedy are received by us at our Service
Center within the thirty (30) day period from the date of our written notice, we will terminate the
Rider and your participation in the program effective on the day following the end of the thirty
(30) day period.

15exv4wxky

 

Pacific Life & Annuity Company

700 Newport Center Drive

Newport Beach, CA 92660

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

Pacific Life & Annuity Company has issued this Rider as a part of the annuity Contract to
which it is attached.

All provisions of the Contract that do not conflict with this Rider apply to this Rider. In the
event of any conflict between the provisions of this Rider and the provisions of the Contract, the
provisions of this Rider shall prevail over the provisions of the Contract.

This Rider provides a minimum withdrawal benefit that guarantees, upon election, a series of
withdrawals from the contract equal to 5% of the benefit base. The benefit base is established for
the sole purpose of determining the minimum withdrawal benefit and is not used in calculating the
cash surrender benefit or other guaranteed benefits.

By adding this Rider to the Contract, you agreed to certain allocation limitations and investment
alternatives in which you may invest while this Rider is in effect. These requirements may
include, but are not limited to, maximum Purchase Payment allocation limits to certain Variable
Investment Options or on certain allowable fixed-rate General Account Investment Options that are
outside of any asset allocation model, but participate in the asset allocation program; exclusion
of certain Investment Options; required minimum Purchase Payment allocations and restrictions on
transfers to or from certain Investment Options. These restrictions and limitations are summarized
in Appendix A which is a part of this Rider. These requirements apply to the entire Contract
Value.

The numeric examples contained in this Rider are based on certain assumptions. They have been
provided to assist in understanding the benefits provided by this Rider and to demonstrate how
Purchase Payments received and withdrawals made from the Contract prior to the Annuity Date affect
the values and benefits under this Rider over an extended period of time.

TABLE OF CONTENTS

	 	 	 	 	 
	 	 	Page
	Definition of Terms
	 	 	2	 
	5% Guaranteed Withdrawal Benefit
	 	 	2	 
	Annual Charge
	 	 	2	 
	Change in Annual Charge
	 	 	3	 
	Initial Values
	 	 	3	 
	Subsequent Purchase Payments
	 	 	3	 
	Limitation on Subsequent Purchase Payments
	 	 	3	 
	Annual Credit
	 	 	3	 
	Withdrawal of Protected Payment Amount
	 	 	4	 
	Withdrawals Exceeding Protected Payment Amount
	 	 	4	 
	Withdrawals to Satisfy Required Minimum Distribution
	 	 	4	 
	Depletion of Contract Value
	 	 	4	 
	Depletion of Remaining Protected Balance
	 	 	5	 
	Automatic Reset
	 	 	5	 
	Automatic Reset — Opt-Out Election
	 	 	5	 
	Automatic Reset — Future Participation
	 	 	5	 
	Owner-Elected Resets (Non-Automatic)
	 	 	5	 
	Application of Rider Provisions
	 	 	6	 

	 	 	 	 	 
	 	 	Page
	Annuitization
	 	 	6	 
	Continuation of Rider if Surviving Spouse
Continues Contract
	 	 	6	 
	Termination of Rider
	 	 	6	 
	Rider Effective Date
	 	 	7	 
	 
	 	 	 	 
	Sample Calculations
	 	 	8	 
	 
	 	 	 	 
	Appendix A — Summary of Asset Allocation Program
	 	 	 	 
	Asset Allocation Program
	 	 	14	 
	Asset Allocation Models
	 	 	14	 
	Purchase Payment Allocations
	 	 	14	 
	Rebalancing
	 	 	14	 
	Annual Analysis
	 	 	15	 
	Annual Updates
	 	 	15	 
	Notice of Automatic Updates
	 	 	15	 
	Change of Asset Allocation Model
	 	 	15	 
	Termination of Asset Allocation Program
	 	 	15	 

1

 

Definition of Terms — Unless redefined below, the terms defined in the Contract will have the
same meaning when used in this Rider. For purposes of this Rider, the following definitions apply:

Annual RMD Amount — The amount required to be distributed each Calendar Year for purposes of
satisfying the minimum distribution requirements of Internal Revenue Code Section 401(a)(9) and
related Code provisions in effect on the Rider Effective Date.

Protected Payment Amount — The maximum amount that can be withdrawn under this Rider without
reducing the Protected Payment Base. The Protected Payment Amount on any day after the Rider
Effective Date is equal to the lesser of:

	 	(a)	 	5% of the Protected Payment Base as of that day, less cumulative withdrawals
during that Contract Year; or
	 
	 	(b)	 	the Remaining Protected Balance as of that day.

The Protected Payment Amount will never be less than zero.

Protected Payment Base — An amount used to determine the Protected Payment Amount. The
Protected Payment Base will remain unchanged except as otherwise described under the provisions
of this Rider.

Remaining Protected Balance — The amount available for future withdrawals made under this
Rider. The Remaining Protected Balance will never be less than zero.

Reset Date — Any Contract Anniversary beginning with the first (1st) Contract
Anniversary after the Rider Effective Date on which an automatic reset or an Owner-elected reset
occurs.

For purposes of this Rider, the term “withdrawal” includes any applicable withdrawal charges and
charges for premium taxes and/or other taxes, if applicable. Amounts withdrawn under this Rider
will reduce the Contract Value by the amount withdrawn and will be subject to the same conditions,
limitations, restrictions and all other fees, charges and deductions, if applicable, as withdrawals
otherwise made under the provisions of the Contract.

5% Guaranteed Withdrawal Benefit — You have purchased a 5% Guaranteed Withdrawal Benefit Rider.
Subject to the terms and conditions described herein, this Rider:

	 	(a)	 	allows for withdrawals up to the Protected Payment Amount without any adjustment to the
Protected Payment Base, regardless of market performance, until the Remaining Protected
Balance equals zero;
	 
	 	(b)	 	provides for an annual credit to be applied to the Protected Payment Base and Remaining
Protected Balance as described under the Annual Credit provision of this Rider;
	 
	 	(c)	 	allows for withdrawals for purposes of satisfying the minimum distribution requirements
of Internal Revenue Code Section 401(a)(9) and related Code provisions in effect on the
Rider Effective Date, regardless of the amount, without any adjustment to the Protected
Payment Base, subject to certain conditions as described herein;
	 
	 	(d)	 	provides for automatic annual resets or Owner-elected resets of the Protected Payment
Base and Remaining Protected Balance to an amount equal to 100% of the Contract Value as of
a Reset Date.

This Rider may be purchased and added to the Contract, provided that on the Rider Effective Date:
(a) the age of each Annuitant is 85 years or younger; and (b) the entire Contract Value is invested
according to an asset allocation program established and maintained by us for this Rider.

Annual Charge — An annual charge for expenses related to this Rider will be deducted from the
Investment Options on a proportionate basis relative to the Account Value in each such Investment
Option.

The annual charge is deducted, in arrears, on each Contract Anniversary that this Rider remains in
effect. The annual charge is equal to 0.65% (not to exceed a maximum annual charge percentage of
1.20%) multiplied by the Protected Payment Base on the day the charge is deducted.

2

 

The annual charge percentage established on the Rider Effective Date will not change, except as
otherwise described in the provisions of this Rider.

If this Rider terminates on a Contract Anniversary, the entire annual charge for the prior Contract
Year will be deducted from the Contract Value on that Contract Anniversary.

If the Rider terminates prior to a Contract Anniversary, we will prorate the annual charge. The
prorated amount will be based on the Protected Payment Base as of the day the Rider terminates.
Such prorated amount will be deducted from the Contract Value on the earlier of the day the
Contract terminates or the Contract Anniversary immediately following the day the Rider terminates.

We will waive the annual charge if the Rider terminates as a result of the death of an Owner or
sole surviving Annuitant, or upon full annuitization of the Contract.

Any portion of the annual charge we deduct from any of our fixed-rate General Account Investment
Options (if available under the Contract) will not be greater than the annual interest credited in
excess of that option’s minimum guaranteed interest rate.

Change in Annual Charge — The annual charge percentage may change as a result of any automatic
reset or Owner-elected reset. The annual charge percentage will never exceed the annual charge
percentage then in effect for new issues of this same rider. If we are no longer issuing this
rider, any change in the annual charge percentage will not result in an annual charge percentage
that exceeds the maximum annual charge percentage specified in the Annual Charge provision.

If the Protected Payment Base and Remaining Protected Balance are never reset, the annual charge
percentage established on the Rider Effective Date is guaranteed not to change.

Initial Values — The Protected Payment Base, Remaining Protected Balance and Protected
Payment Amount are initially determined on the Rider Effective Date. On the Rider Effective Date,
the Protected Payment Base and Remaining Protected Balance are equal to the Initial Purchase
Payment or, if available on a Contract Anniversary, the Contract Value on that Contract
Anniversary. The Protected Payment Amount is equal to 5% of the Protected Payment Base.

Subsequent Purchase Payments — Purchase Payments received after the Rider Effective Date will
result in an increase in the Protected Payment Base and Remaining Protected Balance equal to the
amount of the Purchase Payment.

Limitation on Subsequent Purchase Payments — For purposes of this Rider, in no event may any
Purchase Payment received on and after the first (1st) Contract Anniversary, measured from the
Rider Effective Date or the most recent Reset Date, whichever is later, result in the total of all
Purchase Payments received since that Contract Anniversary to exceed $100,000, without our prior
approval.

This provision only applies if the Contract permits Purchase Payments after the first (1st)
Contract Anniversary, measured from the Contract Date.

Annual Credit — On each Contract Anniversary after the Rider Effective Date, an annual credit will
be applied to the Protected Payment Base and Remaining Protected Balance if, as of that Contract
Anniversary:

	 	(a)	 	no withdrawals have occurred after the Rider Effective Date or the most recent Reset
Date, whichever is later; and
	 
	 	(b)	 	that Contract Anniversary is within the first ten (10) Contract Anniversaries, measured
from the Rider Effective Date or the most recent Reset Date, whichever is later.

The annual credit is equal to 6% of the sum of (A) and (B) as of the Contract Anniversary on which
the credit is added, where:

	 	(A)	 	is the Remaining Protected Balance on the Rider Effective Date or the most recent Reset
Date, whichever is later.
	 
	 	(B)	 	is cumulative Purchase Payments received after the Rider Effective Date or the most
recent Reset Date, whichever is later.

3

 

Once a withdrawal has occurred, no annual credit will be applied to the Protected Payment Base and
Remaining Protected Balance on any Contract Anniversary following the withdrawal, unless an
automatic reset or an Owner-elected reset occurs, in which case eligibility for the annual credit
will begin as of the Reset Date of that automatic reset or Owner-elected reset. (See Application
of Rider Provisions).

Withdrawal of Protected Payment Amount — While this Rider is in effect, you may withdraw up to the
Protected Payment Amount without any adjustment to the Protected Payment Base, regardless of market
performance, until the Remaining Protected Balance equals zero.

If a withdrawal does not exceed the Protected Payment Amount immediately prior to that withdrawal,
the Protected Payment Base will remain unchanged. The Remaining Protected Balance will decrease by
the withdrawal amount immediately following the withdrawal.

Withdrawals Exceeding Protected Payment Amount — Except as otherwise provided under the
Withdrawals to Satisfy Required Minimum Distribution provision of this Rider, if a withdrawal
exceeds the Protected Payment Amount immediately prior to that withdrawal, we will adjust the
Protected Payment Base and Remaining Protected Balance immediately following the withdrawal to the
lesser of:

	 	(a)	 	the Contract Value immediately after the withdrawal; or
	 
	 	(b)	 	the Remaining Protected Balance immediately prior to the withdrawal, less the
withdrawal amount.

The amount available for withdrawal under the Contract must be sufficient to support any withdrawal
that would otherwise exceed the Protected Payment Amount.

Withdrawals to Satisfy Required Minimum Distribution — No adjustment will be made to the Protected
Payment Base if a withdrawal made under this Rider exceeds the Protected Payment Amount immediately
prior to the withdrawal, provided that such withdrawal (herein referred to as an “RMD withdrawal”)
is for purposes of satisfying the minimum distribution requirements of Internal Revenue Code
Section 401(a)(9) and related Code provisions in effect on the Rider Effective Date, and further
subject to the following:

	 	(a)	 	you have authorized us to calculate and make periodic distribution of the Annual RMD
Amount for the Calendar Year required based on the payment frequency you have chosen;
	 
	 	(b)	 	the Annual RMD Amount is based on this Contract only; and
	 
	 	(c)	 	no withdrawals (other than RMD withdrawals) are made from the Contract during the
Contract Year.

Each RMD withdrawal will decrease the Remaining Protected Balance by the amount withdrawn
immediately following the RMD withdrawal.

Depletion of Contract Value — If a withdrawal (including an RMD withdrawal) does not exceed the
Protected Payment Amount and reduces the Contract Value to zero, the following will apply:

	 	(a)	 	if the oldest Owner (or youngest Annuitant, in the case of an Owner who is a
Non-Natural Owner):

	 	(i)	 	was younger than age 591/2 when the first withdrawal was taken under this
Rider after the Rider Effective Date or the most recent Reset Date, whichever is
later, 5% of the Protected Payment Base will be paid each year until the Remaining
Protected Balance is reduced to zero; or
	 
	 	(ii)	 	was age 591/2 or older when the first withdrawal was taken under this Rider
after the Rider Effective Date or the most recent Reset Date, whichever is later, 5%
of the Protected Payment Base will be paid each year until the day of the first
death of an Owner or the date of death of the sole surviving Annuitant.

The payments under subparagraphs (a)(i) and (a)(ii) above will be made under a series of
pre-authorized withdrawals under a payment frequency, as elected by the Owner, but no less
frequently than annually;

	 	(b)	 	no additional Purchase Payments will be accepted under the Contract;
	 
	 	(c)	 	any Remaining Protected Balance will not be available for payment in a lump sum and
will not be applied to provide payments under an Annuity Option; and
	 
	 	(d)	 	the Contract will cease to provide any death benefit.

4

 

If the Owner or sole surviving Annuitant dies and the Contract Value is zero as of the date of
death, any Remaining Protected Balance will be paid to the Beneficiary under the series of
pre-authorized withdrawals and payment frequency then in effect at the time of the Owner’s or sole
surviving Annuitant’s death.

Depletion of Remaining Protected Balance — If a withdrawal reduces the Remaining Protected Balance
to zero and Contract Value remains, the following will apply:

If the oldest Owner (or youngest Annuitant, in the case of an Owner who is a Non-Natural Owner):

	 	(a)	 	was younger than age 591/2 when the first withdrawal was taken under this Rider after the
Rider Effective Date or the most recent Reset Date, whichever is later, this Rider will
terminate; or
	 
	 	(b)	 	was age 591/2 or older when the first withdrawal was taken under this Rider after the
Rider Effective Date or the most recent Reset Date, whichever is later, you may elect to
withdraw up to 5% of the Protected Payment Base each year until the day of the first death
of an Owner or the date of death of the sole surviving Annuitant.

If a withdrawal made under subparagraph (b) (except an RMD withdrawal) taken from the Contract
exceeds the Protected Payment Amount, this Rider will terminate.

Any death benefit proceeds to be paid to the Beneficiary from remaining Contract Value will be paid
as described under the Death Benefit provisions of the Contract.

Automatic Reset — On each Contract Anniversary while this rider is in effect and before the
Annuity Date and after any annual credit is applied, we will automatically reset the Protected
Payment Base and Remaining Protected Balance to an amount equal to 100% of the Contract Value, if
the Protected Payment Base is less than the Contract Value on that Contract Anniversary. The
annual charge percentage may change as a result of any automatic reset. (See Change in Annual
Charge provision). We will provide you with written confirmation of each automatic reset.

Automatic Reset — Opt-Out Election — If you are within thirty (30) days after a Contract
Anniversary on which an automatic reset is effective, you have the option to reinstate the
Protected Payment Base, Remaining Protected Balance and any change in the annual charge percentage
to their respective amounts immediately before the automatic reset.

If you elect this option, your opt-out election must be received, in a form satisfactory to us, at
our Service Office within the same thirty (30) day period after the Contract Anniversary on which
the reset is effective.

Any future automatic resets will continue in effect in accordance with the Automatic Reset
provision of this Rider.

Automatic Reset — Future Participation — You may elect not to participate in future automatic
resets at any time. Your election must be received, in a form satisfactory to us, at our Service
Center, while this rider is in effect and before the Annuity Date. Such election will be effective
for future Contract Anniversaries.

If you previously elected not to participate in automatic resets, you may re-elect to participate
in future automatic resets at any time. Your election to resume participation must be received, in
a form satisfactory to us, at our Service Office while this Rider is in effect and before the
Annuity Date. Such election will be effective for future Contract Anniversaries as described in
the Automatic Reset provision.

Owner-Elected Resets (Non-Automatic) — You may, on any Contract Anniversary beginning with the
first (1st) Contract Anniversary, measured from the Rider Effective Date or the most
recent Reset Date, whichever is later, elect to reset the Remaining Protected Balance and Protected
Payment Base to an amount equal to 100% of the Contract Value as of that Contract Anniversary. The
annual charge percentage may change if you elect this reset option. (See Change in Annual Charge
provision).

On each Reset Date and after any annual credit is applied, we will set the Remaining Protected
Balance and Protected Payment Base to an amount equal to 100% of the Contract Value as of that
Reset Date.

5

 

If you elect this option, your election must be received, in a form satisfactory to us, at our
Service Center within thirty (30) days after the Contract Anniversary on which the reset is
effective. Your election of this option may result in a reduction in the Protected Payment Base,
Remaining Protected Balance, Protected Payment Amount and any annual credit that may be applied.
We will provide you with written confirmation of your election.

Application of Rider Provisions — On and after each Reset Date, the provisions of this Rider shall
apply in the same manner as they applied when the Rider was originally issued. Eligibility for the
annual credit, the limitations and restrictions on Purchase Payments and withdrawals, the deduction
of annual charges and any future reset options available on and after each Reset Date, will again
apply and will be measured from that Reset Date.

Annuitization — If you annuitize the Contract at the maximum Annuity Date specified in the
Contract and this Rider is still in effect at the time of your election and a Life Only annuity
option is chosen, the annuity payments will be equal to the greater of:

        .

	 	(a)	 	the Life Only payment amount calculated based on the Net Contract Value at the maximum
Annuity Date, less any charges for premium taxes and/or other taxes, and the Life Only
annuity rates based on the greater of our current income factors in effect for the Contract
on the maximum Annuity Date; or our guaranteed income factors; or
	 
	 	(b)	 	the Protected Payment Amount in effect at the maximum Annuity Date divided by the
number of months in the payment frequency elected for the Life Only annuity option.

If you annuitize the Contract at any time prior to the maximum Annuity Date specified in the
Contract, your annuity payments will be determined in accordance with the terms of the Contract.
The Protected Payment Base, Remaining Protected Balance and Protected Payment Amount under this
Rider will not be used in determining any annuity payments.

Continuation of Rider if Surviving Spouse Continues Contract — If the Owner dies while this Rider
is in effect and if the surviving spouse of the deceased Owner elects to continue the Contract in
accordance with its terms, the surviving spouse may continue to take withdrawals of the Protected
Payment Amount under this Rider, until the Remaining Protected Balance is reduced to zero.

The surviving spouse may elect any of the reset options available under this Rider for subsequent
Contract Anniversaries. If an election to reset is made, whether by an automatic reset or an
Owner-elected reset, then the provisions of this Rider will continue in full force and in effect
for the surviving spouse.

Termination of Rider — Except as otherwise provided under the Continuation of Rider if Surviving
Spouse Continues Contract provision of this Rider, this Rider will automatically terminate upon the
earliest to occur of one of the following events:

	 	(a)	 	the day following the end of our thirty (30) day advance written notice to the Owner of
a transaction resulting in any portion of the Contract Value to be allocated outside of the
asset allocation program and no instructions to remedy are received by us at our Service
Office within such thirty (30) day period (see Termination of Asset Allocation Program
provision in Appendix A);
	 
	 	(b)	 	the day the Remaining Protected Balance is reduced to zero;
	 
	 	(c)	 	the day of the first death of an Owner or the date of death of the sole surviving
Annuitant;
	 
	 	(d)	 	the day the Contract is terminated in accordance with the provisions of the Contract;
	 
	 	(e)	 	the day we are notified of a change in ownership of the Contract; or
	 
	 	(f)	 	the Annuity Date.

This Rider will not terminate under subparagraph (b) above if the oldest Owner (or youngest
Annuitant, in the case of an Owner who is a Non-Natural Owner) was age 591/2 or older when the first
withdrawal was taken under this Rider after the Rider Effective Date or the most recent Reset Date,
whichever is later. In this case the Rider will terminate under subparagraph (c).

6

 

This Rider and the Contract will not terminate under subparagraph (d) above if at the time of this
event, the Contract Value is zero and we are making pre-authorized withdrawals of 5% of the
Protected Payment Base. In this case, the Rider and Contract will terminate under:

	 	(i)	 	subparagraph (b) if the oldest Owner (or youngest Annuitant, in the case of an Owner
who is a Non-Natural Owner) was younger than age 591/2 when the first withdrawal was taken
under this Rider after the Rider Effective Date or the most recent Reset Date, whichever is
later: or
	 
	 	(ii)	 	subparagraph (c) if the oldest Owner (or youngest Annuitant, in the case of an Owner
who is a Non-Natural Owner) was age 591/2 or older when the first withdrawal was taken under
this Rider after the Rider Effective Date or the most recent Reset Date, whichever is
later.

Rider Effective Date — This Rider is effective on the Contract Date, unless a later date is shown
below

Rider Effective Date: [Date]

All other terms and conditions of the Contract remain unchanged by this Rider.

PACIFIC LIFE & ANNUITY COMPANY

	 	 	 
	

	 	
	Chairman and Chief Executive Officer
	 	Secretary

7

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

The numeric examples shown in this section are based on certain assumptions. They have been
provided to assist in understanding the benefits provided by this Rider and to demonstrate how
Purchase Payments received and withdrawals made from the Contract prior to the Annuity Date affect
the values and benefits under this Rider over an extended period of time. These examples are not
intended to serve as projections of future investment returns.

Example #1 — Setting of Initial Values.

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Beginning	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Protected	 	Protected	 	Remaining
	of Contract	 	Purchase	 	 	 	 	 	Contract Value	 	Annual	 	Payment	 	Payment	 	Protected
	Year	 	Payment	 	Withdrawal	 	after Activity	 	Credit	 	Base	 	Amount	 	Balance
	 1 
	 	$	100,000	 	 	 	 	 	 	$	100,000	 	 	$	0.00	 	 	$	100,000	 	 	$	5,000	 	 	$	100,000	 

On the Rider Effective Date, the initial values are set as follows:

	 	•	 	Protected Payment Base = Initial Purchase Payment = $100,000
	 
	 	•	 	Remaining Protected Balance = Initial Purchase Payment = $100,000
	 
	 	•	 	Protected Payment Amount = 5% of Protected Payment Base = $5,000

Example #2 — Subsequent Purchase Payments.

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date
	 
	 	•	 	A subsequent Purchase Payment of $100,000 is received during Contract Year 1.
	 
	 	•	 	No withdrawals taken.
	 
	 	•	 	No automatic resets or Owner-elected resets.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Beginning	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Protected	 	Protected	 	Remaining
	of Contract	 	Purchase	 	 	 	 	 	Contract Value	 	Annual	 	Payment	 	Payment	 	Protected
	Year	 	Payment	 	Withdrawal	 	after Activity	 	Credit	 	Base	 	Amount	 	Balance
	 1 
	 	$	100,000	 	 	 	 	 	 	$	100,000	 	 	$	0.00	 	 	$	100,000	 	 	$	5,000	 	 	$	100,000	 
	Activity
	 	$	100,000	 	 	 	 	 	 	$	200,000	 	 	 	 	 	 	$	200,000	 	 	$	10,000	 	 	$	200,000	 
	 2 
	 	 	 	 	 	 	 	 	 	$	207,000	 	 	$	12,000	 	 	$	212,000	 	 	$	10,600	 	 	$	212,000	 

Immediately after the $100,000 subsequent Purchase Payment during Contract Year 1, the Protected
Payment Base and Remaining Protected Balance are increased by the Purchase Payment amount to
$200,000 ($100,000 + $100,000). The Protected Payment Amount after the Purchase Payment is equal
to $10,000 (5% of the Protected Payment Base after the Purchase Payment since there were no
withdrawals during that Contract Year).

Since no withdrawal occurred prior to the Contract Anniversary at the Beginning of Contract Year 2,
an annual credit of $12,000 (6% of the initial Remaining Protected Balance plus cumulative Purchase
Payments received after the Rider Effective Date) is applied to the Protected Payment Base and
Remaining Protected Balance on that Contract Anniversary, increasing both to $212,000. As a
result, the Protected Payment Amount on that Contract Anniversary is equal to $10,600 (5% of the
Protected Payment Base on that Contract Anniversary).

In addition to Purchase Payments, the Contract Value is further subject to increases and/or
decreases during each Contract Year as a result of additional amounts credited, charges, fees and
other deductions, and increases and/or decreases in the investment performance of the Variable
Account.

8

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #3 — Withdrawals Not Exceeding Protected Payment Amount.

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date
	 
	 	•	 	A subsequent Purchase Payment of $100,000 is received during Contract Year 1.
	 
	 	•	 	A withdrawal equal to or less than the Protected Payment Amount is taken during Contract Years 2, 3 and 4.
	 
	 	•	 	Automatic resets at Beginning of Contract Years 4 and 5.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Beginning	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Protected	 	Protected	 	Remaining
	of Contract	 	Purchase	 	 	 	 	 	Contract Value	 	Annual	 	Payment	 	Payment	 	Protected
	Year	 	Payment	 	Withdrawal	 	after Activity	 	Credit	 	Base	 	Amount	 	Balance
	 1 
	 	$	100,000	 	 	 	 	 	 	$	100,000	 	 	$	0.00	 	 	$	100,000	 	 	$	5,000	 	 	$	100,000	 
	Activity
	 	$	100,000	 	 	 	 	 	 	$	200,000	 	 	 	 	 	 	$	200,000	 	 	$	10,000	 	 	$	200,000	 
	 2 
	 	 	 	 	 	 	 	 	 	$	207,000	 	 	$	12,000	 	 	$	212,000	 	 	$	10,600	 	 	$	212,000	 
	Activity
	 	 	 	 	 	$	10,600	 	 	$	210,890	 	 	 	 	 	 	$	212,000	 	 	 	 	 	 	$	201,400	 
	 3 
	 	 	 	 	 	 	 	 	 	$	210,890	 	 	$	0.00	 	 	$	212,000	 	 	$	10,600	 	 	$	201,400	 
	Activity
	 	 	 	 	 	$	10,600	 	 	$	215,052	 	 	 	 	 	 	$	212,000	 	 	 	 	 	 	$	190,800	 
	4
	 	(Prior to Automatic Reset)	 	 		 	 	$	215,052	 	 	$	0.00	 	 	$	212,000	 	 	$	10,600	 	 	$	190,800	 
	4
	 	(After Automatic Reset)	 	 		 	 	$	215,052	 	 	$	0.00	 	 	$	215,052	 	 	$	10,752	 	 	$	215,052	 
	Activity
	 	 	 	 	 	$	10,600	 	 	$	219,506	 	 	 	 	 	 	$	215,052	 	 	 	 	 	 	$	204,452	 
	5
	 	 (Prior to Automatic
Reset)	 	 		 	 	$	219,506	 	 	$	0.00	 	 	$	215,506	 	 	$	10,752	 	 	$	204,506	 
	5
	 	(After Automatic
Reset)	 	 		 	 	$	219,506	 	 	$	0.00	 	 	$	219,506	 	 	$	10,975	 	 	$	219,506	 

For an explanation of the values and activities at the start of and during Contract Year 1, refer
to Examples #1 and #2.

As the withdrawal during Contract Year 2 did not exceed the Protected Payment Amount immediately
prior to the withdrawal ($10,600):

	 	(a)	 	the Protected Payment Base remains unchanged; and
	 
	 	(b)	 	the Remaining Protected Balance is reduced by the amount of the withdrawal to $201,400
($212,000 — $10,600).

As the withdrawal during Contract Year 3 did not exceed the Protected Payment Amount immediately
prior to the withdrawal ($10,600):

	 	(c)	 	the Protected Payment Base remains unchanged; and
	 
	 	(d)	 	the Remaining Protected Balance is reduced by the amount of the withdrawal to $190,800
($201,400 — $10,600).

Because at the Beginning of Contract Year 4, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 4 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 4 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,752 (5% of the reset Protected Payment Base).

As the withdrawal during Contract Year 4 did not exceed the Protected Payment Amount immediately
prior to the withdrawal ($10,600):

	 	(e)	 	the Protected Payment Base remains unchanged; and
	 
	 	(f)	 	the Remaining Protected Balance is reduced by the amount of the withdrawal to $204,452
($215,452 — $10,600).

Because at the Beginning of Contract Year 5, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 5 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 5 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,975 (5% of the reset Protected Payment Base).

Since withdrawals occurred during Contract Years 2, 3 and 4, no annual credit will be applied to
the Protected Payment Base and Remaining Protected Balance on any Contract Anniversary following
the withdrawal.

9

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #4 — Withdrawals Exceeding Protected Payment Amount.

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date
	 
	 	•	 	A subsequent Purchase Payment of $100,000 is received during Contract Year 1.
	 
	 	•	 	A withdrawal greater than the Protected Payment Amount is taken during Contract Years 2, 3 and 4.
	 
	 	•	 	Automatic resets at Beginning of Contract Years 3, 4 and 5.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Beginning	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Protected	 	Protected	 	Remaining
	of Contract	 	Purchase	 	 	 	 	 	Contract Value	 	Annual	 	Payment	 	Payment	 	Protected
	Year	 	Payment	 	Withdrawal	 	after Activity	 	Credit	 	Base	 	Amount	 	Balance
	 1 
	 	$	100,000	 	 	 	 	 	 	$	100,000	 	 	$	0.00	 	 	$	100,000	 	 	$	5,000	 	 	$	100,000	 
	Activity
	 	$	100,000	 	 	 	 	 	 	$	200,000	 	 	 	 	 	 	$	200,000	 	 	$	10,000	 	 	$	200,000	 
	 2 
	 	 	 	 	 	 	 	 	 	$	207,000	 	 	$	12,000	 	 	$	212,000	 	 	$	10,600	 	 	$	212,000	 
	Activity
	 	 	 	 	 	$	15,000	 	 	$	206,490	 	 	 	 	 	 	$	197,000	 	 	$	0.00	 	 	$	197,000	 
	3
	 	(Prior to Automatic Reset) 	 	 		 	 	$	206,490	 	 	$	0.00	 	 	$	197,000	 	 	$	9,850	 	 	$	197,000	 
	3
	 	(After Automatic
Reset)	 	 		 	 	$	206,490	 	 	$	0.00	 	 	$	206,490	 	 	$	10,325	 	 	$	206,490	 
	Activity
	 	 	 	 	 	$	15,000	 	 	$	205,944	 	 	 	 	 	 	$	191,490	 	 	$	0.00	 	 	$	191,490	 
	4
	 	(Prior to Automatic
Reset)	 	 		 	 	$	205,944	 	 	$	0.00	 	 	$	191,490	 	 	$	9,575	 	 	$	191,490	 
	4
	 	(After Automatic
Reset)	 	 		 	 	$	205,944	 	 	$	0.00	 	 	$	205,944	 	 	$	10,297	 	 	$	205,944	 
	Activity
	 	 	 	 	 	$	15,000	 	 	$	205,360	 	 	 	 	 	 	$	190,944	 	 	$	0.00	 	 	$	190,944	 
	5
	 	(Prior to Automatic
Reset)	 	 		 	 	$	205,360	 	 	$	0.00	 	 	$	190,944	 	 	$	9,547	 	 	$	190,944	 
	5
	 	(After Automatic
Reset)	 	 		 	 	$	205,360	 	 	$	0.00	 	 	$	205,360	 	 	$	10,268	 	 	$	205,360	 

For an explanation of the values and activities at the start of and during Contract Year 1, refer
to Examples #1 and #2.

Because the $15,000 withdrawal during Contract Year 2 exceeds the Protected Payment Amount
immediately prior to the withdrawal ($15,000 > $10,600), the Protected Payment Base and
Remaining Protected Balance immediately after the withdrawal are adjusted to the lesser of:

	 	(a)	 	the Contract Value immediately after the withdrawal ($206,490); or
	 
	 	(b)	 	the Remaining Protected Balance immediately prior to the withdrawal, less the
withdrawal amount ($212,000 — $15,000 = $197,000).

The Protected Payment Amount immediately after the withdrawal is equal to $0 (5% of the Protected
Payment Base after the withdrawal (5% of $197,000 = $9,850), less cumulative withdrawals during
that Contract Year ($15,000), but not less than zero).

Because at the Beginning of Contract Year 3, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 3 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 3 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,325 (5% of the reset Protected Payment Base).

Because the $15,000 withdrawal during Contract Year 3 exceeds the Protected Payment Amount
immediately prior to the withdrawal ($15,000 > $10,325), the Protected Payment Base and
Remaining Protected Balance immediately after the withdrawal are adjusted to the lesser of:

	 	(c)	 	the Contract Value immediately after the withdrawal ($205,944); or
	 
	 	(d)	 	the Remaining Protected Balance immediately prior to the withdrawal, less the
withdrawal amount ($206,490 — $15,000 = $191,490).

The Protected Payment Amount immediately after the withdrawal is equal to $0 (5% of the Protected
Payment Base after the withdrawal (5% of $191,490 = $9,575), less cumulative withdrawals during
that Contract Year ($15,000), but not less than zero).

Because at the Beginning of Contract Year 4, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 4 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 4 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,297 (5% of the reset Protected Payment Base).

10

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #4 — Withdrawals Exceeding Protected Payment Amount (continued)

Because the $15,000 withdrawal during Contract Year 4 exceeds the Protected Payment Amount
immediately prior to the withdrawal ($15,000 > $10,297), the Protected Payment Base and
Remaining Protected Balance immediately after the withdrawal are adjusted to the lesser of:

	 	(e)	 	the Contract Value immediately after the withdrawal ($205,360); or
	 
	 	(f)	 	the Remaining Protected Balance immediately prior to the withdrawal, less the
withdrawal amount ($205,944 — $15,000 = $190,944).

The Protected Payment Amount immediately after the withdrawal is equal to $0 (5% of the Protected
Payment Base after the withdrawal (5% of $191,490 = $9,547), less cumulative withdrawals during
that Contract Year ($15,000), but not less than zero).

Because at the Beginning of Contract Year 5, the Protected Payment Base was less than the Contract
Value on that Contract Anniversary (see balances at Beginning of Contract Year 5 — Prior to
Automatic Reset), an automatic reset occurred which resets the Protected Payment Base and Remaining
Protected Balance to an amount equal to 100% of the Contract Value (see balances at Beginning of
Contract Year 5 — After Automatic Reset). As a result, the Protected Payment Amount is equal to
$10,268 (5% of the reset Protected Payment Base).

Since withdrawals occurred during Contract Years 2, 3 and 4, no annual credit will be applied to
the Protected Payment Base and Remaining Protected Balance on any Contract Anniversary following
the withdrawal.

11

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #5 — Lifetime Income

The values shown below are based on the following assumptions:

	 	•	 	Initial Purchase Payment = $100,000
	 
	 	•	 	Rider Effective Date = Contract Date
	 
	 	•	 	No subsequent Purchase Payments are received.
	 
	 	•	 	Owner is age 591/2 or older when the first withdrawal was taken
	 
	 	•	 	Withdrawals, each equal to 5% of the Protected Payment Base are taken each Contract Year.
	 
	 	•	 	No automatic reset or Owner-elected reset is assumed during the life of the Rider.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Contract	 	 	 	 	 	End of Year	 	Annual	 	Protected	 	Protected	 	Remaining
	Year	 	Withdrawal	 	Contract Value	 	Credit	 	Payment Base	 	Payment Amount	 	Protected Balance
	 1 
	 	$	5,000	 	 	$	96,489	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	95,000	 
	 2 
	 	$	5,000	 	 	$	94,384	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	90,000	 
	 3 
	 	$	5,000	 	 	$	92,215	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	85,000	 
	 4 
	 	$	5,000	 	 	$	89,982	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	80,000	 
	 5 
	 	$	5,000	 	 	$	87,681	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	75,000	 
	 6 
	 	$	5,000	 	 	$	85,311	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	70,000	 
	 7 
	 	$	5,000	 	 	$	82,871	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	65,000	 
	 8 
	 	$	5,000	 	 	$	80,357	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	60,000	 
	 9 
	 	$	5,000	 	 	$	77,768	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	55,000	 
	 10 
	 	$	5,000	 	 	$	75,101	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	50,000	 
	 11 
	 	$	5,000	 	 	$	72,354	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	45,000	 
	 12 
	 	$	5,000	 	 	$	69,524	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	40,000	 
	 13 
	 	$	5,000	 	 	$	66,610	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	35,000	 
	 14 
	 	$	5,000	 	 	$	63,608	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	30,000	 
	 15 
	 	$	5,000	 	 	$	60,517	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	25,000	 
	 16 
	 	$	5,000	 	 	$	57,332	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	20,000	 
	 17 
	 	$	5,000	 	 	$	54,052	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	15,000	 
	 18 
	 	$	5,000	 	 	$	50,674	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	10,000	 
	 19 
	 	$	5,000	 	 	$	47,194	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	5,000	 
	 20 
	 	$	5,000	 	 	$	43,610	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 21 
	 	$	5,000	 	 	$	39,918	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 22 
	 	$	5,000	 	 	$	36,115	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 23 
	 	$	5,000	 	 	$	32,199	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 24 
	 	$	5,000	 	 	$	28,165	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 25 
	 	$	5,000	 	 	$	24,010	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 26 
	 	$	5,000	 	 	$	19,730	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 27 
	 	$	5,000	 	 	$	15,322	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 28 
	 	$	5,000	 	 	$	10,782	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 29 
	 	$	5,000	 	 	$	6,105	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 30 
	 	$	5,000	 	 	$	1,288	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 31 
	 	$	5,000	 	 	$	0	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 32 
	 	$	5,000	 	 	$	0	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 33 
	 	$	5,000	 	 	$	0	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 
	 34 
	 	$	5,000	 	 	$	0	 	 	$	0	 	 	$	100,000	 	 	$	5,000	 	 	$	0	 

On the Rider Effective Date, the initial values are set as follows:

	 	•	 	Protected Payment Base = Initial Purchase Payment = $100,000
	 
	 	•	 	Remaining Protected Balance = Initial Purchase Payment = $100,000
	 
	 	•	 	Protected Payment Amount = 5% of Protected Payment Base = $5,000

12

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

SAMPLE CALCULATIONS

Example #5 — Lifetime Income (continued)

Because the amount of each withdrawal does not exceed the Protected Payment Amount immediately
prior to the withdrawal ($5,000): (a) the Protected Payment Base remains unchanged; and (b) the
Remaining Protected Balance is reduced by the amount of each withdrawal.

Since a withdrawal occurred during Contract Year 1, no annual credit will be applied to the
Protected Payment Base and Remaining Protected Balance on any Contract Anniversary following the
withdrawal.

Since it was assumed that the Owner was age 591/2 or older when the first withdrawal was taken,
withdrawals of 5% of the Protected Payment Base will continue to be paid each year (even after the
Contract Value and Remaining Protected Balance have been reduced to zero) until the day of the
first death of an Owner or the date of death of the sole surviving Annuitant, whichever occurs
first.

13

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

APPENDIX A — SUMMARY OF ASSET ALLOCATION PROGRAM

This summary outlines the general features of the asset allocation program established and
maintained by us and which operates in combination with optional riders requiring your
participation in an asset allocation program.

Asset Allocation Program — The asset allocation program is a service we offer and maintain for use
in combination with certain optional riders that are available with our variable annuity contracts.
Asset allocation is the allocation of Purchase Payments among asset classes and involves decisions
about which asset classes should be selected and how much of the total Contract Value should be
allocated to each asset class. The theory of asset allocation is that diversification among asset
classes can help reduce volatility over the long-term.

Asset Allocation Models — Currently, there are five (5) asset allocation models, each comprised of
a selected combination of Investment Options. Asset allocation is a two-step process. First, an
analysis is prepared to determine the break down of asset classes. Next, after the asset class
exposures are known, a determination of how each Investment Option can be used to implement the
asset class level allocations. The Investment Options are selected by evaluating the asset classes
represented by that Investment Option and combining Investment Options to arrive at the desired
asset class exposure. Based on this analysis, the Investment Options are selected in a manner
intended to optimize returns for each model, given a particular level of risk tolerance. The
current models and their asset class exposure are set out below.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Asset Class Exposure
	Model A	 	Model B	 	Model C	 	Model D	 	Model E
	Cash

	 	[10%]
	 	Cash
	 	[6%]
	 	Cash
	 	[1%]
	 	Cash
	 	[2%]
	 	Cash
	 	[2%]
	Bonds

	 	[67%]
	 	Bonds
	 	[50%]
	 	Bonds
	 	[39%]
	 	Bonds
	 	[18%]
	 	Bonds
	 	[6%]
	Domestic Stocks

	 	[17%]
	 	Domestic Stocks
	 	[32%]
	 	Domestic Stocks
	 	[42%]
	 	Domestic Stocks
	 	[56%]
	 	Domestic Stocks
	 	[61%]
	International Stocks

	 	[6%]
	 	International Stocks
	 	[12%]
	 	International Stocks
	 	[18%]
	 	International Stocks
	 	[24%]
	 	International Stocks
	 	[31%]
	Shorter Investment Horizon	 	 	 	 	 	 	 	 	 	Longer Investment Horizon

	Lower Risk	 	
	 	Higher Risk

	Less Volatile	 	 	 	 	 	 	 	 	 	 	 	 	 	More Volatile

Purchase Payment Allocations — Your Initial Purchase Payment (in the case of a new
application) or Contract Value, as applicable, will be allocated to the Investment Options
according to the asset allocation model you select. Subsequent Purchase Payments, if allowed under
the Contract, will also be allocated accordingly, unless you instruct us otherwise in writing.

You may also allocate Purchase Payments to any allowable fixed-rate General Account Investment
Option (if available under the Contract) only for purposes of dollar cost averaging (the periodic
transfer of amounts) to the Investment Options within your asset allocation model. However,
amounts transferred from any such allowable fixed-rate General Account Investment Option must be
made over a period not to exceed twelve (12) months.

To maintain the Rider in full force and in effect during the Rider’s required holding period, the
entire Contract Value must remain invested according to the asset allocation program. Any portion
of a Purchase Payment or Contract Value allocated outside of your asset allocation model to an
Investment Option that is not an allowable option under the program, may terminate the Rider in
addition to your participation in the program (see Termination of Asset Allocation Program
provision of this Appendix A).

Rebalancing — If you choose, you can rebalance your Contract Value quarterly, semi-annually, or
annually, to maintain the current allocations of your model, since changes in the net asset values
of the underlying portfolios in each model will alter your asset allocation over time. This
rebalancing option is independent of any other automatic rebalancing as a result of an annual
analysis. If you also allocate part of your Purchase Payment or Contract Value to any allowable
fixed-rate General Account Investment Option and you elect periodic rebalancing, such amounts will
not be considered when rebalancing. Only the Investment Options within your model will be
rebalanced.

14

 

5% GUARANTEED WITHDRAWAL BENEFIT RIDER

APPENDIX A — SUMMARY OF ASSET ALLOCATION PROGRAM

Annual Analysis — Each of the asset allocation models are evaluated annually to assess whether
the combination of Investment Options within each model should be changed to better seek to
optimize the potential return for the level of risk tolerance intended for the model. As a result
of the periodic analysis, each model may change and Investment Options may be added to a model
(including Investment Options not currently available), or Investment Options may be deleted from a
model.

Annual Updates — When your asset allocation model is updated, we will reallocate your Contract
Value (and subsequent Purchase Payments, if applicable) in accordance with any changes to the model
you have selected. This means the allocation of your Contract Value, and potentially the Investment
Options in which you are invested, will automatically change and your Contract Value (and
subsequent Purchase Payments, if applicable) will be automatically reallocated among the Investment
Options in your updated model (independently of any automatic rebalancing you may have selected).
We require that you grant us discretionary investment authority to periodically reallocate your
Contract Value (and subsequent Purchase Payments, if applicable) in accordance with the updated
version of the asset allocation model you have selected.

Notice of Automatic Updates — We will send you written notice of the updated asset allocation
models at least thirty (30) days in advance of the date we intend the updated version of the model
to be effective. You should carefully review these notices. If you wish to accept the changes in
your selected model, you will not need to take any action, as your Contract Value (or subsequent
Purchase Payments, if applicable) will be reallocated in accordance with the updated model
automatically, provided you have granted us discretionary investment authority (see Annual Updates
provision of this Appendix A).

If you do not wish to accept the changes to your selected model, you can change to a different
model (see Change in Asset Allocation Model provision of this Appendix A) or withdraw from the
asset allocation program (see Termination of Asset Allocation Program provision of this Appendix
A).

Change of Asset Allocation Model — You may change your asset allocation model selection at any time
with a proper written request or by electronic instructions provided a valid electronic
authorization is on file with us. You should consult with your registered representative to assist
you in determining which model is best suited to your financial needs, investment time horizon, and
is consistent with your risk comfort level. You should periodically review those factors to
determine if you need to change models to reflect such changes.

Termination of Asset Allocation Program — You may terminate your Rider and/or your participation
in the asset allocation program at any time with a proper written request or by electronic
instructions, provided a valid electronic authorization is on file with us. If you terminate the
Rider only, you may choose to continue your participation in the asset allocation program without
the benefits of the Rider. If you terminate participation in the program, your Rider will also
terminate.

You may cause an involuntary termination of both the Rider and your participation in the asset
allocation program upon the occurrence of any one of the following events:

	 	(a)	 	you allocate any portion of your Purchase Payments or transfer any portion of the
Contract Value to an Investment Option that is not currently included in your model or that
is not an allowable transfer under the program;
	 
	 	(b)	 	you allocate any portion of your Purchase Payments or transfer any portion of the
Contract Value to any fixed-rate General Account Investment Option (if available under the
Contract) that is not an allowable option or an allowable transfer under the program; or
	 
	 	(c)	 	you change the allocation percentages of your current asset allocation model.

We will send you written notice in the event any transaction described in subparagraphs (a) through
(c) above occur. You may, within thirty (30) days after the date of our notice, direct us to take
appropriate corrective action necessary to continue the Rider in effect and your participation in
the asset allocation program. If no instructions to remedy are received by us at our Service
Center within the thirty (30) day period from the date of our written notice, we will terminate the
Rider and your participation in the program effective on the day following the end of the thirty
(30) day period.

15

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