Document:

Form of Consultant Stock Option Agreement

 EXHIBIT 10.3 
 FORM OF 
 CONSULTANT STOCK OPTION AGREEMENT 
 This Non-Qualified Stock Option Agreement (this “Agreement”) is made and entered into as of January 10, 2008 (the “Grant Date”)
by and between BioLargo, Inc., a Delaware corporation (the “Company”), whose address is 2603 Main Street, Suite 1155, Irvine, California 92614, and ________________________________, an individual (“Optionee”). Capitalized terms
used herein without definition shall have the meanings given to them in Appendix “A” attached hereto and incorporated herein by this reference). 
 RECITALS 
 A. The Board of Directors of the Company (the “Board”) has authorized granting
to Optionee, effective as of the date of this Agreement, a non-qualified stock option under such terms and conditions as are hereinafter set forth. 
 NOW, THEREFORE, in consideration of the mutual covenants, agreements, representations and warranties herein set forth and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties
hereto, intending to be legally bound hereby, agree as follows: 
 1. Grant of Stock Option. The Company hereby grants to Optionee a
Non-Qualified Stock Option (the “Option”) to purchase, upon and subject to the terms and conditions of this Agreement, all or any part of One Million Two Hundred Thousand (1,200,000) shares of Stock at a per share exercise price of
$0.99 (the “Per Share Exercise Price”). 
 2. Vesting. Subject to Sections 4.2 and 6 hereof, the Option shall become
exercisable with respect to the following percentages of the number of shares subject to the Option on the following dates (each, a “Vesting Date”) and at any time thereafter until such Option shall terminate in accordance with the terms
of this Agreement: 
  

			
	Vesting Date	  	Percentage Vested
	January 10, 2008	  	25%
	December 31, 2008	  	25%
	December 31, 2009	  	25%
	December 31, 2010	  	25%

 Notwithstanding the foregoing, no portion of this Option shall vest if the Optionee is not, on a Vesting Date,
providing services to the Company pursuant to his related consulting agreement. 
  

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 3. Manner of Exercise and Payment. Optionee shall exercise the Option by giving (a) written
notice of such exercise to the Board (or, if so authorized by the Board, to the Compensation Committee of the Board (the “Committee”), specifying the number of shares of Stock with respect to which such Option is being exercised, together
with (b) payment of the full purchase price for such shares, by wire transfer to a Company account designated by the Board (or the Committee) or by unendorsed certified or cashier’s check, equal to the number of shares to be purchased
multiplied by the Per Share Exercise Price. 
 3.1. Effective Date of Exercise. The date upon which such written
notice is given and payment of the full purchase price is received by the Company shall be the exercise date for the Option. From such exercise date, Optionee shall be entitled to the issuance of a stock certificate evidencing Optionee’s
ownership of the shares of Stock acquired pursuant to such exercise (but subject to Section 8 hereof). Optionee shall not have any of the rights or privileges of a stockholder of the Company (including, without limitation, rights to
distributions, voting rights, inspection rights, dissenter’s rights, rights to bring a derivative action, or other rights of a shareholder under applicable corporate law) in respect of any shares of Stock issuable upon exercise of such Option
until and only to the extent such Option is exercised and certificates representing such shares shall have been issued and delivered. 
 3.2. No Fractional Shares. No installment of such Stock Option shall be exercisable except with respect to whole shares. 
 4. Termination. 
 4.1. In General. The Option granted under Section 1
hereof, to the extent unexercised, shall terminate at the close of business on the fifth (5th ) anniversary of the Grant Date, subject to Section 6 or Section 7 hereof (as applicable). 
 4.2. Change of Control. If, in connection with the Change of Control, this Option is not assumed, or if a substitute Option is not
issued, or if the assumed or substituted awards fail to contain similar terms and conditions as the Option prior to the Change of Control or fail to preserve, to the extent applicable, the benefit to be provided to the Optionee as of the date of the
Change of Control, including but not limited to the right of the Optionee to receive shares upon exercise of the Option that are registered for sale to the public pursuant to an effective registration statement filed with the U.S. Securities and
Exchange Commission, then each holder of an Option that is outstanding as of the date of the Change of Control shall have the right, exercisable by written notice to the Company (or its successor in the Change of Control transaction) within 30 days
after the Change of Control (but not beyond the Option’s expiration date), to receive, in exchange for the surrender of the Option, an amount of cash equal to the excess of the greater of the Fair Market Value of the Shares determined on the
Change of Control date or the Fair Market Value of the Shares on the date of surrender covered by the Option (to the extent vested and not yet exercised) that is so surrendered over the purchase or grant price of such Shares under the Award. If the
Board (or the Committee) so determines prior to the Change of Control, any such Option that is not exercised or surrendered prior to the end of such 30-day period will be cancelled. 
  

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 5. Non-Transferability. Neither Optionee nor any successor or assignee thereof shall have any
power or right to transfer, assign, anticipate, hypothecate or otherwise encumber any part or all of the Option granted under Section 1 hereof, other than by will or by the laws of descent and distribution, and such Option shall be exercisable
during Optionee’s lifetime only by Optionee; nor shall all or any part of such Option be subject to seizure by any creditor of any such person, by a proceeding at law or in equity, and no such benefit shall be transferable by operation of law
in the event of the bankruptcy or insolvency of Optionee or any successor or assignee thereof. Any such attempted assignment or transfer shall be void and shall terminate this Agreement, and the Company shall thereupon have no further liability
hereunder. 
 6. Cessation of Employment. 
 6.1. In General. Subject to Sections 6.2 and 7 hereof, if Optionee ceases to be employed by the Company or any of Subsidiary,
Optionee may, subject to the time limitations of Section 4 hereof, exercise the Option granted under Section 1 hereof to the extent that Optionee was entitled to exercise it under Section 2 hereof on the date of such cessation at any
time (a) within one (1) year after such cessation if such cessation results from the Disability of Optionee, or (b) otherwise within ninety (90) days after such cessation. 
 6.2. Termination for Cause. If Optionee is terminated as an employee of the Company or any Subsidiary for Cause, the right to
exercise any unexercised portion of the Option granted under Section 1 hereof shall terminate immediately. For the purposes of this Agreement “Cause” with respect to an Optionee means (a) a material breach by Optionee of any
employment agreement between such Optionee on the one hand and the Company or Subsidiary on the other hand, together with failure to correct such breach within thirty (30) days after notice of such breach is given to such Optionee by the
employer; (b) gross malfeasance by Optionee in the performance of Optionee’s duties on behalf of the Company or Subsidiary; or (c) the conviction of or plea of guilty or nolo contendere by Optionee with respect to any misdemeanor or
felony arising from or related to the conduct of the affairs of the Company or Subsidiary. 
 7. Death of Optionee. If Optionee dies
while employed by the Company or Subsidiary, or during the period described in clause (a) or clause (b) of Section 6.1 hereof as applicable, then, subject to the time limitations of Section 4 hereof, the Option granted under
Section 1 hereof shall expire within one (1) year after the date of death; and the executor or administrator of Optionee’s estate, or the person or persons to whom Optionee’s rights under such Option shall have passed by will or
by the applicable laws of descent and distribution, shall have the right to exercise the Option to the extent that Optionee was entitled to exercise the Option under Section 2 hereof on the date of death. 
  

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 8. Compliance With Securities and Tax Laws. No shares of Stock shall be issued pursuant to the
exercise of the Option except in compliance with all applicable federal and state securities and tax laws and regulations and in compliance with rules of stock exchanges on which the Stock may be listed. In furtherance of the foregoing and not in
order to limit the generality of the foregoing in any way: 
 8.1. Representation. The Company, as a condition to the
issuance of such shares, may require the person exercising Option to represent and warrant at the time of such exercise that any shares of Stock acquired upon exercise are being acquired only for investment and without any present intention to sell
or distribute such shares if, in the opinion of counsel for the Company, such a representation is required under any applicable law, regulation or rule of any governmental agency. 
 8.2. Notice of Sale. The person acquiring such shares shall give the Company notice of any sale or other disposition of any such
shares not less than ten (10) days after such sale or other disposition. 
 8.3. Withholding. Optionee
acknowledges and agrees that the Company, in order to fulfill its withholding obligations under any federal, state or local tax law upon exercise of the Stock Option, may (a) withhold such sums from other compensation due Optionee,
(b) require Optionee to pay to the Company such amounts as a condition to the delivery of shares pursuant to such exercise, or (c) sell shares that would otherwise be delivered to Optionee upon exercise of the Option in order to raise cash
in the necessary amount. 
 9. Miscellaneous. 
 9.1. Complete Agreement. This Agreement, and any appendices, schedules, exhibits or documents referred to herein or executed
contemporaneously herewith, constitute the entire agreement among the parties hereto with respect to the subject matter hereof, and supersede all prior written, and all prior and contemporaneous oral, agreements, representations, warranties,
statements, promises and understandings with respect to the subject matter hereof; whether express or implied. All schedules, appendices and exhibits attached hereto are hereby incorporated in and made a part of this Agreement as if fully set forth
herein. 
 9.2. Payments Subject to Creditors. Payments to Optionee hereunder shall be made from assets which shall
continue, for all purposes, to be a part of the general assets of the Company; and no person, other than the Company, shall have, by virtue of the grant of the Option hereunder, any interest in such assets. To the extent that any person acquires a
right to receive payments from the Company under the provisions hereof; such right shall be no greater than the right of any unsecured general creditor of the Company. 
 9.3. No Contract of Employment. It is expressly understood by the parties hereto that this Agreement are not intended to be an
employment contract. Nothing contained in this Agreement and no action taken pursuant to its provisions by either party hereto shall create, or be construed to create, (a) a trust of any kind, or a fiduciary relationship between the Company and
Optionee; or (b) a contract of employment for any term of years, or a right of Optionee to continue in the employ of the Company in any capacity. 
  

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 9.4. Binding Effect. This Agreement shall be binding upon and inure to the benefit
of the Company and its successors and assigns, and Optionee and Optionee’s successors, assigns, heirs, executors, administrators and beneficiaries. Nothing in this Section 9.4 shall be deemed to modify or waive in any manner whatsoever
such prohibitions on transfer or assignment of Optionee’s rights hereunder as are contained elsewhere in this Agreement. 
 9.5. Amendment. Except as provided herein, this Agreement may not be amended, altered, modified or terminated except by a written instrument signed by the parties hereto, or their respective successors or assigns. 
 9.6. Notice. Whenever this Agreement requires that notice be given by or to the Company or Optionee, such notice shall be given to
the Company at the address first set forth above (or to such other address as the Company may communicate to Optionee under this Section 9.6) and to Optionee at such address as is set forth on the books and records of the Company for the
mailing of any documents with respect to Optionee as follows: (a) by personal delivery, in which case notice shall be deemed to have been given on the date of delivery; (b) by certified United States mail, in which case notice shall be
deemed to have been given two (2) days after deposit of such notice with the United States Postal Service; or (c) by DHL, Federal Express, United Parcel Service, or similar internationally-recognized overnight delivery service, in which
case notice shall be deemed to have been given one (I) day after deposit of such notice or instrument with such service. 
 9.7. Governing Law, Jurisdiction. This Agreement shall be construed in accordance with and governed by the laws of the State of Delaware, without reference to any conflict of law principles. The parties agree that the exclusive venue
for any legal action or proceeding with respect to this Agreement or for recognition and enforcement of any judgment in respect of this Agreement, shall be a court sitting in the County of Los Angeles, or the Federal District Court for the Central
District of California sitting in the County of Los Angeles, in the State of California, and further agree that any such action may be heard only in a “bench” trial, and any party to such action or proceeding shall agree to waive its right
to assert a jury trial. 
 9.8. Headings. The headings in this Agreement are inserted only as a matter of convenience,
and in no way define, limit, or interpret the scope of this Agreement or of any particular section hereof. 
 9.9. Waivers
Strictly Construed. With regard to any power, remedy or right provided herein or otherwise available to any party hereunder, (a) no waiver or extension of time shall be effective unless expressly contained in a writing signed by the waiving
party, and (b) no alteration, modification or impairment shall be implied by reason of any previous waiver, extension of time, delay or omission in exercise, or by any other indulgence. 
  

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 9.10. Severability. The validity, legality or enforceability of the remainder of
this Agreement shall not be affected even if one or more of the provisions of this Agreement shall be held to be invalid, illegal or unenforceable in any respect. 
 9.11. Counterparts. This Agreement may be executed simultaneously in two or more counterparts, each of which shall be deemed an
original, but all of which together shall constitute one and the same instrument. 
 IN WITNESS WHEREOF, the parties hereto have executed
this Agreement as of the date first set forth above. 
 BIOLARGO, INC. 
 By:__________________________________ 
 Name:_______________________________ 
 Title:________________________________ 
 Optionee: 
 By:__________________________________ 
 Name:_______________________________ 
 Title:________________________________ 
  

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 ATTACHMENT “A” 
 DEFINITIONS 
 For purposes of this Agreement, the following terms shall have the respective
meanings ascribed to them: 
 (a) “Award” means a grant of Options under this Agreement. 
 (b) “Change of Control” means the occurrence of any one of the following events: 
 (i) the consummation of a merger or consolidation of the Company with or into another entity or any other corporate reorganization,
if more than fifty percent (50%) of the combined voting power of the continuing or surviving entity’s securities outstanding immediately after such merger, consolidation or other reorganization is owned by Persons who were not stockholders
of the Company immediately prior to such merger, consolidation or other reorganization; 
 (ii) the sale, transfer or
other disposition of all or substantially all of the Company’s assets; 
 (iii) a change in the composition of the
Board, as a result of which fewer than fifty percent (50%) of the incumbent directors are directors who either (A) had been directors of the Company on the date twenty-four (24) months prior to the date of the event that may
constitute a Change of Control (the “original directors”) or (B) were elected, or nominated for election, to the Board with the affirmative votes of at least a majority of the aggregate of the original directors who were still in
office at the time of the election or nomination and the directors whose election or nomination was previously so approved; or 
 (iv) any transaction as a result of which any Person is the “beneficial owner” (as defined in Rule 13d-3 under the Exchange Act), directly or indirectly, of securities of the Company representing at least fifty percent
(50%) of the total voting power represented by the Company’s then outstanding voting securities. For purposes of this paragraph (iv), the term “Person” shall exclude (A) a trustee or other fiduciary holding securities under
an employee benefit plan of the Company or a Subsidiary and (B) a corporation owned directly or indirectly by the stockholders of the Company in substantially the same proportions as their ownership of the common stock of the Company.

 A transaction shall not constitute a Change of Control if its sole purpose is to change the state of the Company’s
incorporation or to create a holding company that will be owned in substantially the same proportions by the persons who held the Company’s securities immediately before such transaction. 
  

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 (c) “Fair Market Value” means, per Share on a particular date, (i) if the Stock is listed
for trading on the New York Stock Exchange, the last reported sales price on the date in question as reported in The Wall Street Journal, or if no sales of Stock occur on the date in question, on the last preceding date on which there was a sale on
such exchange; or (ii) if the Stock is not listed or admitted to trading on the New York Stock Exchange, the last reported sales price on the date in question on the principal national securities exchange on which the Stock is listed or
admitted to trading, or if no sales of Stock occur on the date in question, on the last preceding date on which there was a sale on such exchange; or (iii) if the Stock is not listed or admitted to trading on any national securities exchange,
the last reported sales price on the date in question in the over-the-counter market, as reported by the National Association of Securities Dealers, Inc. Automated Quotations System (“NASDAQ”) or such other system then in use, or if no
sales of Stock occur on the date in question, on the last preceding date on which there was a sale; or (iv) if on any such date the Stock is not quoted by any such organization, the last sales price on the date in question as furnished by a
professional market making a market in the Stock selected by the Board for the date in question, or if no sales of Stock occur on the date in question, on the last preceding date on which there was a sale; or (v) if on any such date no market
maker is making a market in the Stock, the price as determined in good faith by the Board (or the Committee); provided, however, that if the Fair Market Value as determined in accordance with the foregoing shall be different from such value as
determined by Statement of Financial Accounting Standards No. 123R (or any successor or amended Statement adopted by the Financial Accounting Standards Board or its successor), then the Fair Market Value shall be determined according to the
latter method. 
 (d) “Person” or “Persons” has the meaning given in Section 3(a)(9) of the Securities Exchange Act
of 1934, as amended, and used in Sections 14(d) and 15(d) thereof. 
 (e) “Share” or “Shares” means a share or shares, as
the case may be, of Stock. 
 (f) “Stock” means the common stock of the Company 
 (g) “Subsidiary” means any corporation (other than the Company) in an unbroken chain of corporations beginning with the Company if each such
corporation owns stock possessing fifty percent (50%) or more of the total combined voting power in one of the other corporations in the chain. 
  

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 SPOUSAL CONSENT 
 I certify that: 
 1.    I am the spouse of __________________who signed the foregoing
Incentive Option Agreement dated as of ___________, 20___(the “Agreement”) by and between ____________________as the “Optionee” thereunder and BioLargo, Inc. as the “Company” thereunder. 
 2.    I have read and approve the provisions of the Agreement, including, but not limited to, those relating to the exercise,
transfer and disposition of the Option described therein. 
 3.    I agree to be bound by and accept those provisions of
that Agreement in lieu of all other interests I may have in the Options thereby granted, whether that interest may be community property or otherwise. 
 4.    Optionee shall have full power of management of Optionee’s interests in the Options, including any portion of those interests that may be community property, and Optionee has the full
right, without my further approval, to exercise Optionee’s rights with respect to such Options, to execute any amendments to the Agreement, and to exercise and otherwise deal in any manner with such Options, including any portion of such
interests that may be community property. 
 Date:________________________________ 
 By:_________________________________ 
 Name:_______________________________ 
  

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                  GENWORTH LIFE INSURANCE COMPANY OF NEW YORK

             GUARANTEED MINIMUM WITHDRAWAL BENEFIT FOR LIFE RIDER
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General Features

This rider provides for a guaranteed minimum withdrawal benefit for the life of
the Annuitant(s). The Purchase Payment Benefit Amount, Roll-Up Value and
Maximum Anniversary Value on the Contract Date are equal to the initial
Purchase Payment. The Benefit Base is used to calculate the guaranteed minimum
withdrawal benefit. The Benefit Base does not impact the Contract Value,
Surrender Value, Death Benefit or Income Payment under the Contract. Gross
Withdrawals taken under this rider reduce the Contract Value by the amount of
the Gross Withdrawal. Under this rider, at the time the Contract is issued or
when an Annuitant is added to the Contract, Annuitant(s) must be age [45]
through age [85]. There is a charge for this rider that is calculated
[quarterly] as a percentage of the Benefit Base and deducted [quarterly] from
the Contract Value.

In order to obtain the full benefit described in this rider, your withdrawals
must be limited. You must allocate all Purchase Payments and Contract Value to
the Investment Strategy at all times. You may terminate this rider apart from
the Contract on any Contract anniversary on or after the [5/th/] Contract
anniversary (see When this Rider is Effective on page 7).

The Benefit Base and the Withdrawal Factor are used to determine the Withdrawal
Limit. Any additional Purchase Payment will be applied to the Purchase Payment
Benefit Amount and may be applied to the Roll-Up Value on the Valuation Day the
additional Purchase Payment is received (see Purchase Payments and Roll-Up
Value on page 4). You may reset your Maximum Anniversary Value to the Contract
Value subject to the terms and requirements described below (see Maximum
Anniversary Value and Reset on page 5).

The Withdrawal Limit is the total amount that you may withdraw in a Benefit
Year without reducing the guaranteed minimum withdrawal benefit provided under
this rider. The Withdrawal Limit equals the Benefit Base multiplied by the
Withdrawal Factor (see Guaranteed Minimum Withdrawal Benefit on page 3). The
Withdrawal Factor is established based on the age of the younger Annuitant on
the earlier of the Valuation Day of the first Gross Withdrawal and the
Valuation Day when the Contract Value is reduced to [$100].

If a Gross Withdrawal plus all prior Gross Withdrawals in a Benefit Year is in
excess of the Withdrawal Limit, your Purchase Payment Benefit Amount, Roll-Up
Value and Maximum Anniversary Value are reduced (see Excess Withdrawals on page
6). The Roll-Up Value will not increase after this date.

The Purchase Payment Benefit Amount is an amount used to calculate the Benefit
Base. Generally, the Purchase Payment Benefit Amount will equal your Purchase
Payment(s). If no withdrawals are taken prior to the later of the [10/th/]
anniversary of the Contract Date and the date the older Annuitant turns age
[65] your Purchase Payment Benefit Amount will equal the sum of (a) plus (b),
where:
   (a) is [200%] of Purchase Payments made in the [first] Contract year; and
   (b) Purchase Payments received after the [first] Contract year.

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The Roll-Up Value is an amount used to calculate the Benefit Base. The Roll-Up
Value may be adjusted based on the daily roll-up factor. On each Contract
anniversary, if the Maximum Anniversary Value is greater than the current
Roll-Up Value, the Roll-Up Value will be increased to the Maximum Anniversary
Value. The Roll-Up Value will continue to increase until the date of the first
withdrawal or the later of the [10/th/] anniversary of the Contract Date and
the date the older Annuitant turns age [65]. The Roll-Up Value will not
increase after this date.

Subsequent Purchase Payment(s) applied to your Contract generally will adjust
your Purchase Payment Benefit Amount and may adjust your Roll-Up Value as
described in the Roll-Up Value section. We reserve the right not to adjust the
Purchase Payment Benefit Amount and/or the Roll-Up Value for any additional
Purchase Payment(s) in order to control future risks under this rider. If we
decide not to make adjustments, we will notify you [45] days prior to enacting
this restriction.

The Maximum Anniversary Value is an amount used to calculate the Benefit Base.
The Maximum Anniversary Value on the Contract Date is equal to the initial
Purchase Payment. On each Contract anniversary, if the Contract Value is
greater than the current Maximum Anniversary Value, the Maximum Anniversary
Value will be increased to the Contract Value. If this day is not a Valuation
Day, this reset will occur on the next Valuation Day. On the Valuation Day we
reset your Maximum Anniversary Value, we will reset the Investment Strategy to
the current Investment Strategy and reset the charges for this rider. The new
charges, which may be higher than your previous charges, will never exceed the
maximum rider charge of 2.00%. Resets will occur automatically unless such
automatic resets are or have been terminated.

Prior to the Annuity Commencement Date, at the death of any Annuitant, a Death
Benefit may be payable under this Contract. The amount of any Death Benefit
payable will be the greater of (a) and (b), where:
   (a) is the Death Benefit as calculated under the base Contract; and
   (b) is any amount payable by any other optional death benefit rider, if
       applicable.

The Death Benefit payable will be paid according to the distribution rules
under the Contract. All other Death Provisions under the Contract and any
optional death benefit riders, including distribution rules, apply.

Terms and Procedures

All rider terms will have the same meaning as under the Contract, unless
otherwise stated.

Asset Allocation Model(s) -- The Asset Allocation Model(s) shown on the
Contract Data Pages.

Benefit Base -- The amount used to calculate the Withdrawal Limit. The Benefit
Base is only used to determine benefits under this rider. The Benefit Base is
not the Contract Value.

Benefit Year -- Each one-year period following the Contract Date and each
anniversary of that date.

Designated Subaccounts -- The Designated Subaccounts shown on the Contract Data
Pages.

Gross Withdrawal -- An amount withdrawn from Contract Value including any
surrender charge, any taxes withheld and any applicable premium taxes.

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Investment Strategy -- The Asset Allocation Model(s) and/or Designated
Subaccounts for this rider.

Maximum Anniversary Value -- An amount used to calculate the Benefit Base.

Purchase Payment Benefit Amount -- An amount used to calculate the Benefit Base.

Roll-Up Value -- An amount used to calculate the Benefit Base. The Roll-Up
Value on the Contract Date is equal to the initial Purchase Payment. The
Roll-Up Value is only used to determine benefits under this rider. The Roll-Up
Value is not the Contract Value.

Withdrawal Factor -- The percentage shown on the Contract Data Pages used to
establish the Withdrawal Limit.

Withdrawal Limit -- The total amount you may withdraw in a Benefit Year without
reducing the guaranteed minimum withdrawal benefit provided under this rider.
The Withdrawal Limit equals the Benefit Base multiplied by the Withdrawal
Factor.

Investment Strategy

You must allocate all Purchase Payments and Contract Value to the Investment
Strategy at all times. The Investment Strategy options are shown on the
Contract Data Pages and may include Designated Subaccounts and/or Asset
Allocation Models.

Reallocations

You may reallocate Contract Value within the Investment Strategy by submitting
a transfer request. We reserve the right to assess a charge for transfers in
accordance with the terms of the Contract to which this rider is attached. The
maximum transfer charge is shown on the Contract Data Pages.

On a monthly basis, we will rebalance Contract Value to the Subaccounts in
accordance with the percentages allocated. In addition, on any Valuation Day
after any transaction involving a withdrawal, receipt of a Purchase Payment or
a transfer of Contract Value, we will rebalance Contract Value to the
Subaccounts in accordance with the percentages allocated, unless you instruct
us otherwise. Your allocation instructions must always comply with the
Investment Strategy.

Allocations outside of the Investment Strategy are not allowed.

The Guarantee Account, if any, under the Contract will not be available as an
Investment Option under this rider for as long as this rider is in effect.

Guaranteed Minimum Withdrawal Benefit

If you limit total Gross Withdrawals in a Benefit Year to an amount no greater
than the Withdrawal Limit, then you will be eligible to receive total Gross
Withdrawals in each Benefit Year equal to the Withdrawal Limit until the last
death of an Annuitant.

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Withdrawal Limit
The Withdrawal Limit is calculated on each Valuation Day. The Withdrawal Limit
equals the Benefit Base multiplied by the Withdrawal Factor. The Withdrawal
Factor percentages are shown on the Contract Data Pages.

The Withdrawal Factor is based on the age of the younger Annuitant. The
Withdrawal Factor will be fixed on the earlier of the Valuation Day of the
first withdrawal and the Valuation Day when the Contract Value is reduced to
[$100].

Benefit Base
The Benefit Base is an amount used to establish the Withdrawal Limit. The
Benefit Base on the Contract Date is equal to the initial Purchase Payment. On
each Valuation Day, the Benefit Base is the greatest of the Purchase Payment
Benefit Amount, the Roll-Up Value and the Maximum Anniversary Value. The
Benefit Base may change as a result of a Purchase Payment, withdrawal, or reset
as described below.

Purchase Payments
Any Purchase Payment applied to your Contract will adjust your Purchase Payment
Benefit Amount and may adjust your Roll-Up Value as described in the Roll-Up
Value section below. You must allocate all Purchase Payments and Contract Value
to the Investment Strategy at all times.

We reserve the right to not adjust the Purchase Payment Benefit Amount and/or
the Roll-Up Value for any additional Purchase Payments.

Purchase Payment Benefit Amount
The Purchase Payment Benefit Amount will equal your Purchase Payment(s) unless
adjusted as described in this provision.

If no withdrawals are taken prior to the later of the [10/th/] anniversary of
the Contract Date and the date the older Annuitant turns age [65], your
Purchase Payment Benefit Amount will equal the sum of (a) plus (b), where:
   (a) is [200%] of Purchase Payments made in the [first] Contract year; and
   (b) Purchase Payments received after the [first Contract year].

On any Valuation Day you make a Gross Withdrawal, if that Gross Withdrawal plus
all prior Gross Withdrawals within that Benefit Year is in excess of the
Withdrawal Limit, your Purchase Payments Benefit Amount will be reduced on a
pro-rata basis by the excess amount as described in the Excess Withdrawals
section below.

Roll-Up Value
The Roll-Up Value on the Contract Date is equal to the initial Purchase
Payment. We will increase your Roll-Up Value on each day. The new Roll-Up Value
is equal to the sum of (a) and (b), multiplied by (c), where:
   (a) is the Roll-Up Value on the prior day;
   (b) is any Purchase Payment(s) made on the prior Valuation Day; and
   (c) is the daily roll-up factor shown on the Contract Data Pages.

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On each Contract anniversary, if the Maximum Anniversary Value is greater than
the current Roll-Up Value, the Roll-Up Value will be increased to the Maximum
Anniversary Value. If this day is not a Valuation Day, this adjustment will
occur on the next Valuation Day. The Roll-Up Value will continue to increase
until the date of the first withdrawal or the later of the [10/th/] anniversary
of the Contract Date and the date the older Annuitant turns age [65]. The
Roll-Up Value will not increase after this date.

On any Valuation Day you make a Gross Withdrawal, if that Gross Withdrawal plus
all prior Gross Withdrawals within that Benefit Year is in excess of the
Withdrawal Limit, your Roll-Up Value will be reduced on a pro-rata basis by the
excess amount as described in the Excess Withdrawals section below. The Roll-Up
Value will not increase after this date.

Maximum Anniversary Value and Reset
The Maximum Anniversary Value on the Contract Date is equal to the initial
Purchase Payment. On each Contract anniversary, if the Contract Value is
greater than the current Maximum Anniversary Value, the Maximum Anniversary
Value will be increased to the Contract Value. If this day is not a Valuation
Day, this reset will occur on the next Valuation Day.

On any Valuation Day you make a Gross Withdrawal, if that Gross Withdrawal plus
all prior Gross Withdrawals within that Benefit Year is in excess of the
Withdrawal Limit, your Maximum Anniversary Value will be reduced on a pro-rata
basis by the excess amount as described in the Excess Withdrawals section below.

On the Valuation Day we reset your Maximum Anniversary Value, we will reset the
Investment Strategy to the current Investment Strategy and reset the charges
for this rider. The new charges, which may be higher than your previous
charges, will never exceed the maximum rider charge of 2.00%.

Resets will occur automatically unless such automatic resets are or have been
terminated as described below.

Automatic resets will continue until and unless:
   (a) you submit a written request to terminate automatic resets (such request
       must be received at least [15 days] prior to the Contract anniversary
       date);
   (b) the Investment Strategy changes, allocations are affected, and we do not
       receive confirmation of new allocations;
   (c) the Annuity Commencement Date is reached; or
   (d) there is a change in ownership of the Contract.

If automatic resets have terminated, you may later reinstate automatic resets
for any future Contract anniversary by submitting a written request to do so;
provided you are following the Investment Strategy and you have not reached the
Annuity Commencement Date.

Any change to the charges or to the required Investment Strategy for this rider
will be communicated to you in writing prior to the Contract anniversary date.
Upon reset, these changes will apply. The reset provision will end if, on the
Contract anniversary, any Annuitant is older than the maximum reset age as
shown on the Contract Data Pages.

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Excess Withdrawals

If a Gross Withdrawal plus all prior Gross Withdrawals within a Benefit Year is
in excess of the Withdrawal Limit, your Purchase Payment Benefit Amount,
Roll-Up Value and Maximum Anniversary Value will be recalculated to reflect a
pro-rata reduction for each dollar that is in excess of your Withdrawal Limit.
Your new Purchase Payment Benefit Amount, Roll-Up Value and Maximum Anniversary
Value after such a withdrawal will be calculated by multiplying each of (a) by
(b), divided by (c), where:
   (a) is the Purchase Payment Benefit Amount, Roll-Up Value and Maximum
       Anniversary Value before the Gross Withdrawal;
   (b) is the Contract Value after the Gross Withdrawal; and
   (c) is the Contract Value before the Gross Withdrawal reduced by any
       remaining Withdrawal Limit.

For purposes of (c) above, "any remaining Withdrawal Limit" is the Gross
Withdrawal that could have been taken without exceeding the Withdrawal Limit.

If the total Gross Withdrawals in a Benefit Year are less than or equal to the
Withdrawal Limit, we will waive any surrender charge on the Gross Withdrawals.

Required Minimum Distributions
The Withdrawal Limit will be increased for any Benefit Year to the extent
necessary to meet any minimum distribution requirements (before death) under
federal tax law. This increase applies only to the required minimum
distribution based on the value of the Contract.

Reduction in Contract Value

After taking a withdrawal, your Contract Value may be less than the amount
required to keep your Contract in effect. In this event, or if your Contract
Value is less than or equal to [$100], the following will occur:
  .  If the Withdrawal Limit is less than [$100], we will pay you the greater
     of the following:
      (a) the Contract Value; and
      (b) a lump sum equal to the present value of future lifetime payments in
          the amount of the Withdrawal Limit calculated using the [2000 Annuity
          Mortality Table] and an interest rate of [3%].
  .  If the Withdrawal Limit is greater than [$100], we will begin Income
     Payments. We will make payments of a fixed amount for the life of the
     Annuitant or, if there are Joint Annuitants, the last surviving Annuitant.
     The fixed amount payable annually will equal the most recently calculated
     Withdrawal Limit. We will make payments monthly unless agreed otherwise.
     If the monthly amount is less than [$100], we will reduce the frequency,
     to no less than annual, so that the payment will be at least [$100].

Death Provisions

At the death of any Annuitant, a Death Benefit may be payable under the
Contract. The Death Benefit, if any, will be paid according to the distribution
rules under the Contract. All other Death Provisions under the Contract and any
optional death benefit riders, including distribution rules, apply.

If the designated beneficiary is a surviving spouse who is not an Annuitant,
whose age is [45] through [85], and who elects to continue the Contract as the
new Owner, this rider will continue.

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The Purchase Payment Benefit Amount, Roll-Up Value and Maximum Anniversary
Value for the new Owner will be the Death Benefit determined as of the first
Valuation Day we receive at our [Service Center] due proof of death and all
required forms. The Withdrawal Factor for the new Owner will be based on the
age of that Owner on the date of the first Gross Withdrawal for that Owner.

If the designated beneficiary is a surviving spouse who is an Annuitant and who
elects to continue the Contract as the Owner, this rider will continue. The
Purchase Payment Benefit Amount, Roll-Up Value and Maximum Anniversary Value
will be the same as it was under the Contract for the deceased Owner. If no
withdrawals were taken prior to the first Valuation Day we receive due proof of
death and all required forms at our [Service Center], the Withdrawal Factor for
the surviving spouse will be established based on the age of the surviving
spouse on the date of the first Gross Withdrawal for the surviving spouse.
Otherwise, the Withdrawal Factor will continue as it was under the Contract for
the deceased Owner.

If the surviving spouse cannot continue the rider, the rider and the rider
charge will terminate.

Rider Charge

A charge will be assessed for the guaranteed minimum withdrawal benefit. The
charge for the guaranteed minimum withdrawal benefit is calculated [quarterly]
as a percentage of the Benefit Base and deducted [quarterly] from the Contract
Value. The charges are shown on the Contract Data Pages. We may apply different
charges for the rider for a Contract that is a single Annuitant contract and a
Contract that is a Joint Annuitant contract. Once a Contract is a Joint
Annuitant contract and the Joint Annuitant rider charge is applied, the Joint
Annuitant rider charge will continue while the rider is in effect. If a spouse
is added as Joint Annuitant after the Contract is issued, new charges may
apply. These new charges may be higher than the charges previously applied to
your Contract. The charges for this rider will never exceed the maximum charge
of 2.00%. On the day the rider and/or the Contract terminates, the charges for
this rider will be calculated, prorata, and deducted.

When this Rider is Effective

The rider becomes effective on the Contract Date. It will remain in effect
while this Contract is in force and before the Annuity Commencement Date. You
may terminate this rider apart from the Contract on any Contract anniversary on
or after the [5/th/] Contract anniversary. Otherwise this rider and the
corresponding charges will terminate on the Annuity Commencement Date.

Change of Ownership

You may assign the benefits provided under this rider. The Annuitant(s) will
not change if you assign benefits. We must be notified in writing if you assign
the benefits of this rider.

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General Provisions

For purposes of this rider:
  .  A non-natural entity Owner must name an Annuitant and may name the
     Annuitant's spouse as a Joint Annuitant.
  .  An individual Owner must also be an Annuitant and may name his/her spouse
     as Joint Annuitant at issue.
  .  A Joint Owner must be the Owner's spouse.
  .  If you marry after issue, you may add your spouse as a Joint Owner and
     Joint Annuitant or as a Joint Annuitant only, subject to our approval.

For Genworth Life Insurance Company of New York,

                                          /s/ David J. Sloane
                                          [David J. Sloane]
                                          [President]

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                  GENWORTH LIFE INSURANCE COMPANY OF NEW YORK

             GUARANTEED MINIMUM WITHDRAWAL BENEFIT FOR LIFE RIDER
--------------------------------------------------------------------------------

General Features

This rider provides for a guaranteed minimum withdrawal benefit for the life of
the Annuitant(s) and an additional death benefit. The Purchase Payment Benefit
Amount, Roll-Up Value, Maximum Anniversary Value and Principal Protection Death
Benefit on the Contract Date are equal to the initial Purchase Payment. The
Benefit Base is used to calculate the guaranteed minimum withdrawal benefit.
The Benefit Base does not impact the Contract Value, Surrender Value, Death
Benefit or Income Payment under the Contract. Gross Withdrawals taken under
this rider reduce the Contract Value by the amount of the Gross Withdrawal.
Under this rider, at the time the Contract is issued or when an Annuitant is
added to the Contract, Annuitant(s) must be age [45] through age [85]. There
are two charges for this rider. One charge is calculated [quarterly] as a
percentage of the Benefit Base and deducted [quarterly] from the Contract
Value. Another charge is calculated [quarterly] as a percentage of the value of
the Principal Protection Death Benefit and deducted [quarterly] from the
Contract Value.

In order to obtain the full benefit described in this rider, your withdrawals
must be limited. You must allocate all Purchase Payments and Contract Value to
the Investment Strategy at all times. You may terminate this rider apart from
the Contract on any Contract anniversary on or after the [5/th/] Contract
anniversary (see When this Rider is Effective on page 8).

The Benefit Base and the Withdrawal Factor are used to determine the Withdrawal
Limit. Any additional Purchase Payment will be applied to the Purchase Payment
Benefit Amount and may be applied to the Roll-Up Value on the Valuation Day the
additional Purchase Payment is received (see Purchase Payments and Roll-Up
Value on page 4). You may reset your Maximum Anniversary Value to the Contract
Value subject to the terms and requirements described below (see Maximum
Anniversary Value and Reset on page 5).

The Withdrawal Limit is the total amount that you may withdraw in a Benefit
Year without reducing the guaranteed minimum withdrawal benefit provided under
this rider. The Withdrawal Limit equals the Benefit Base multiplied by the
Withdrawal Factor (see Guaranteed Minimum Withdrawal Benefit on page 4). The
Withdrawal Factor is established based on the age of the younger Annuitant on
the earlier of the Valuation Day of the first Gross Withdrawal and the
Valuation Day when the Contract Value is reduced to [$100].

If a Gross Withdrawal plus all prior Gross Withdrawals in a Benefit Year is in
excess of the Withdrawal Limit, your Purchase Payment Benefit Amount, Roll-Up
Value, Maximum Anniversary Value and Principal Protection Death Benefit are
reduced (see Excess Withdrawals on page 6). The Roll-Up Value will not increase
after this date.

The Purchase Payment Benefit Amount is an amount used to calculate the Benefit
Base. Generally, the Purchase Payment Benefit Amount will equal your Purchase
Payment(s). If no withdrawals are taken prior to the later of the [10/th/]
anniversary of the Contract Date and the date the older Annuitant turns age
[65] your Purchase Payment Benefit Amount will equal the sum of (a) plus (b),
where:
   (a) is [200%] of Purchase Payments made in the [first] Contract year; and
   (b) Purchase Payments received after the [first] Contract year.

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The Roll-Up Value is an amount used to calculate the Benefit Base. The Roll-Up
Value may be adjusted based on the daily roll-up factor. On each Contract
anniversary, if the Maximum Anniversary Value is greater than the current
Roll-Up Value, the Roll-Up Value will be increased to the Maximum Anniversary
Value. The Roll-Up Value will continue to increase until the date of the first
withdrawal or the later of the [10/th/] anniversary of the Contract Date and
the date the older Annuitant turns age [65]. The Roll-Up Value will not
increase after this date.

Subsequent Purchase Payment(s) applied to your Contract generally will adjust
your Purchase Payment Benefit Amount and Principal Protection Death Benefit,
and may adjust your Roll-Up Value as described in the Roll-Up Value section. We
reserve the right not to adjust the Purchase Payment Benefit Amount, the
Principal Protection Death Benefit and/or the Roll-Up Value for any additional
Purchase Payment(s) in order to control future risks under this rider. If we
decide not to make adjustments, we will notify you [45] days prior to enacting
this restriction.

The Maximum Anniversary Value is an amount used to calculate the Benefit Base.
The Maximum Anniversary Value on the Contract Date is equal to the initial
Purchase Payment. On each Contract anniversary, if the Contract Value is
greater than the current Maximum Anniversary Value, the Maximum Anniversary
Value will be increased to the Contract Value. If this day is not a Valuation
Day, this reset will occur on the next Valuation Day. On the Valuation Day we
reset your Maximum Anniversary Value, we will reset the Investment Strategy to
the current Investment Strategy and reset the charges for this rider. The new
charges, which may be higher than your previous charges, will never exceed the
maximum annual charge of 2.00% of the Benefit Base plus the maximum annual
charge of 0.50% of the value of the Principal Protection Death Benefit. Resets
will occur automatically unless such automatic resets are or have been
terminated.

Prior to the Annuity Commencement Date, at the death of any Annuitant, a Death
Benefit may be payable under this Contract and rider. The amount of any Death
Benefit payable will be the greater of (a), (b) and (c), where:
   (a) is the Death Benefit as calculated under the base Contract;
   (b) is the Principal Protection Death Benefit; and
   (c) is any amount payable by any other optional death benefit rider, if
       applicable.

The Death Benefit payable will be paid according to the distribution rules
under the Contract. All other Death Provisions under the Contract and any
optional death benefit riders, including distribution rules, apply.

Terms and Procedures

All rider terms will have the same meaning as under the Contract, unless
otherwise stated.

Asset Allocation Model(s) -- The Asset Allocation Model(s) shown on the
Contract Data Pages.

Benefit Base -- The amount used to calculate the Withdrawal Limit. The Benefit
Base is only used to determine benefits under this rider. The Benefit Base is
not the Contract Value.

Benefit Year -- Each one-year period following the Contract Date and each
anniversary of that date.

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Designated Subaccounts -- The Designated Subaccounts shown on the Contract Data
Pages.

Gross Withdrawal -- An amount withdrawn from Contract Value including any
surrender charge, any taxes withheld and any applicable premium taxes.

Investment Strategy -- The Asset Allocation Model(s) and/or Designated
Subaccounts for this rider.

Maximum Anniversary Value -- An amount used to calculate the Benefit Base.

Principal Protection Death Benefit -- The death benefit provided under this
rider for an additional charge.

Purchase Payment Benefit Amount -- An amount used to calculate the Benefit Base.

Roll-Up Value -- An amount used to calculate the Benefit Base. The Roll-Up
Value on the Contract Date is equal to the initial Purchase Payment. The
Roll-Up Value is only used to determine benefits under this rider. The Roll-Up
Value is not the Contract Value.

Withdrawal Factor -- The percentage shown on the Contract Data Pages used to
establish the Withdrawal Limit.

Withdrawal Limit -- The total amount you may withdraw in a Benefit Year without
reducing the guaranteed minimum withdrawal benefit provided under this rider.
The Withdrawal Limit equals the Benefit Base multiplied by the Withdrawal
Factor.

Investment Strategy

You must allocate all Purchase Payments and Contract Value to the Investment
Strategy at all times. The Investment Strategy options are shown on the
Contract Data Pages and may include Designated Subaccounts and/or Asset
Allocation Models.

Reallocations

You may reallocate Contract Value within the Investment Strategy by submitting
a transfer request. We reserve the right to assess a charge for transfers in
accordance with the terms of the Contract to which this rider is attached. The
maximum transfer charge is shown on the Contract Data Pages.

On a monthly basis, we will rebalance Contract Value to the Subaccounts in
accordance with the percentages allocated. In addition, on any Valuation Day
after any transaction involving a withdrawal, receipt of a Purchase Payment or
a transfer of Contract Value, we will rebalance Contract Value to the
Subaccounts in accordance with the percentages allocated, unless you instruct
us otherwise. Your allocation instructions must always comply with the
Investment Strategy.

Allocations outside of the Investment Strategy are not allowed.

The Guarantee Account, if any, under the Contract will not be available as an
Investment Option under this rider for as long as this rider is in effect.

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Guaranteed Minimum Withdrawal Benefit

If you limit total Gross Withdrawals in a Benefit Year to an amount no greater
than the Withdrawal Limit, then you will be eligible to receive total Gross
Withdrawals in each Benefit Year equal to the Withdrawal Limit until the last
death of an Annuitant.

Withdrawal Limit
The Withdrawal Limit is calculated on each Valuation Day. The Withdrawal Limit
equals the Benefit Base multiplied by the Withdrawal Factor. The Withdrawal
Factor percentages are shown on the Contract Data Pages.

The Withdrawal Factor is based on the age of the younger Annuitant. The
Withdrawal Factor will be fixed on the earlier of the Valuation Day of the
first withdrawal and the Valuation Day when the Contract Value is reduced to
[$100].

Benefit Base
The Benefit Base is an amount used to establish the Withdrawal Limit. The
Benefit Base on the Contract Date is equal to the initial Purchase Payment. On
each Valuation Day, the Benefit Base is the greatest of the Purchase Payment
Benefit Amount, the Roll-Up Value and the Maximum Anniversary Value. The
Benefit Base may change as a result of a Purchase Payment, withdrawal, or reset
as described below.

Purchase Payments
Any Purchase Payment applied to your Contract will adjust your Purchase Payment
Benefit Amount and Principal Protection Death Benefit, and may adjust your
Roll-Up Value as described in the Roll-Up Value section below. You must
allocate all Purchase Payments and Contract Value to the Investment Strategy at
all times.

We reserve the right to not adjust the Purchase Payment Benefit Amount,
Principal Protection Death Benefit, and/or the Roll-Up Value for any additional
Purchase Payments.

Purchase Payment Benefit Amount
The Purchase Payment Benefit Amount will equal your Purchase Payment(s) unless
adjusted as described in this provision.

If no withdrawals are taken prior to the later of the [10/th/] anniversary of
the Contract Date and the date the older Annuitant turns age [65], your
Purchase Payment Benefit Amount will equal the sum of (a) plus (b), where:
   (a) is [200%] of Purchase Payments made in the [first] Contract year; and
   (b) Purchase Payments received after the [first] Contract year.

On any Valuation Day you make a Gross Withdrawal, if that Gross Withdrawal plus
all prior Gross Withdrawals within that Benefit Year is in excess of the
Withdrawal Limit, your Purchase Payments Benefit Amount will be reduced on a
pro-rata basis by the excess amount as described in the Excess Withdrawals
section below.

Roll-Up Value
The Roll-Up Value on the Contract Date is equal to the initial Purchase
Payment. We will increase your Roll-Up Value on each day. The new Roll-Up Value
is equal to the sum of (a) and (b), multiplied by (c), where:
   (a) is the Roll-Up Value on the prior day;

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   (b) is any Purchase Payment(s) made on the prior Valuation Day; and
   (c) is the daily roll-up factor shown on the Contract Data Pages.

On each Contract anniversary, if the Maximum Anniversary Value is greater than
the current Roll-Up Value, the Roll-Up Value will be increased to the Maximum
Anniversary Value. If this day is not a Valuation Day, this adjustment will
occur on the next Valuation Day. The Roll-Up Value will continue to increase
until the date of the first withdrawal or the later of the [10/th/] anniversary
of the Contract Date and the date the older Annuitant turns age [65]. The
Roll-Up Value will not increase after this date.

On any Valuation Day you make a Gross Withdrawal, if that Gross Withdrawal plus
all prior Gross Withdrawals within that Benefit Year is in excess of the
Withdrawal Limit, your Roll-Up Value will be reduced on a pro-rata basis by the
excess amount as described in the Excess Withdrawals section below. The Roll-Up
Value will not increase after this date.

Maximum Anniversary Value and Reset
The Maximum Anniversary Value on the Contract Date is equal to the initial
Purchase Payment. On each Contract anniversary, if the Contract Value is
greater than the current Maximum Anniversary Value, the Maximum Anniversary
Value will be increased to the Contract Value. If this day is not a Valuation
Day, this reset will occur on the next Valuation Day.

On any Valuation Day you make a Gross Withdrawal, if that Gross Withdrawal plus
all prior Gross Withdrawals within that Benefit Year is in excess of the
Withdrawal Limit, your Maximum Anniversary Value will be reduced on a pro-rata
basis by the excess amount as described in the Excess Withdrawals section below.

On the Valuation Day we reset your Maximum Anniversary Value, we will reset the
Investment Strategy to the current Investment Strategy and reset the charges
for this rider. The new charges, which may be higher than your previous
charges, will never exceed the maximum annual charge of 2.00% of the Benefit
Base plus the maximum annual charge of 0.50% of the value of the Principal
Protection Death Benefit.

Resets will occur automatically unless such automatic resets are or have been
terminated as described below.

Automatic resets will continue until and unless:
   (a) you submit a written request to terminate automatic resets (such request
       must be received at least [15 days] prior to the Contract anniversary
       date);
   (b) the Investment Strategy changes, allocations are affected, and we do not
       receive confirmation of new allocations;
   (c) the Annuity Commencement Date is reached; or
   (d) there is a change in ownership of the Contract.

If automatic resets have terminated, you may later reinstate automatic resets
for any future Contract anniversary by submitting a written request to do so;
provided you are following the Investment Strategy and you have not reached the
Annuity Commencement Date.

Any change to the charges or to the required Investment Strategy for this rider
will be communicated to you in writing prior to the Contract anniversary date.
Upon reset, these changes will apply. The reset provision will end if, on the
Contract anniversary, any Annuitant is older than the maximum reset age as
shown on the Contract Data Pages.

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Excess Withdrawals

If a Gross Withdrawal plus all prior Gross Withdrawals within a Benefit Year is
in excess of the Withdrawal Limit, your Purchase Payment Benefit Amount,
Principal Protection Death Benefit, Roll-Up Value and Maximum Anniversary Value
will be recalculated to reflect a pro-rata reduction for each dollar that is in
excess of your Withdrawal Limit. Your new Purchase Payment Benefit Amount,
Principal Protection Death Benefit, Roll-Up Value and Maximum Anniversary Value
after such a withdrawal will be calculated by multiplying each of (a) by (b),
divided by (c), where:
   (a) is the Purchase Payment Benefit Amount, Principal Protection Death
       Benefit, Roll-Up Value and Maximum Anniversary Value before the Gross
       Withdrawal;
   (b) is the Contract Value after the Gross Withdrawal; and
   (c) is the Contract Value before the Gross Withdrawal reduced by any
       remaining Withdrawal Limit.

For purposes of (c) above, "any remaining Withdrawal Limit" is the Gross
Withdrawal that could have been taken without exceeding the Withdrawal Limit.

If the total Gross Withdrawals in a Benefit Year are less than or equal to the
Withdrawal Limit, we will waive any surrender charge on the Gross Withdrawals.

Required Minimum Distributions
The Withdrawal Limit will be increased for any Benefit Year to the extent
necessary to meet any minimum distribution requirements (before death) under
federal tax law. This increase applies only to the required minimum
distribution based on the value of the Contract.

Reduction in Contract Value

After taking a withdrawal, your Contract Value may be less than the amount
required to keep your Contract in effect. In this event, or if your Contract
Value is less than or equal to [$100], the following will occur:
  .  If the Withdrawal Limit is less than [$100], we will pay you the greatest
     of the following:
      (a) the Contract Value;
      (b) a lump sum equal to the present value of future lifetime payments in
          the amount of the Withdrawal Limit calculated using the [2000 Annuity
          Mortality Table] and an interest rate of [3%]; and
      (c) the Principal Protection Death Benefit.
  .  If the Withdrawal Limit is greater than [$100], we will begin Income
     Payments. We will make payments of a fixed amount for the life of the
     Annuitant or, if there are Joint Annuitants, the last surviving Annuitant.
     The fixed amount payable annually will equal the most recently calculated
     Withdrawal Limit. We will make payments monthly unless agreed otherwise.
     If the monthly amount is less than [$100], we will reduce the frequency,
     to no less than annual, so that the payment will be at least [$100]. The
     Principal Protection Death Benefit will continue under this provision. The
     Principal Protection Death Benefit will be reduced by each payment. The
     Principal Protection Death Benefit, if any, will be payable on the last
     death of an Annuitant.

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Principal Protection Death Benefit

The Principal Protection Death Benefit is used to determine the death benefit
at the death of last Annuitant, if any, payable under this Contract and rider
as described in the Death Provisions section below.

The Principal Protection Death Benefit on the Contract Date is equal to the
initial Purchase Payment. Purchase Payments in a Benefit Year increase the
Principal Protection Death Benefit.

Gross Withdrawals in a Benefit Year decrease the Principal Protection Death
Benefit. If a Gross Withdrawal plus all prior Gross Withdrawals within that
Benefit Year is less than or equal to the Withdrawal Limit, the Principal
Protection Death Benefit will be reduced by the Gross Withdrawal. If a Gross
Withdrawal plus all prior Gross Withdrawals within that Benefit Year is in
excess of the Withdrawal Limit, your Principal Protection Death Benefit will be
reduced on a pro-rata basis for each dollar that is in excess of your
Withdrawal Limit, as described in the Excess Withdrawals section above.

At the death of the last Annuitant, a Death Benefit may be payable under this
Contract and rider. The amount of any Death Benefit payable will be the
greatest of (a), (b) and (c), where:
   (a) is the Death Benefit as calculated under the base Contract;
   (b) is the Principal Protection Death Benefit; and
   (c) is any amount payable by any other optional death benefit rider, if
       applicable.

Death Provisions

At the death of any Annuitant, a Death Benefit may be payable under the
Contract. The Death Benefit, if any, will be paid according to the distribution
rules under the Contract. All other Death Provisions under the Contract and any
optional death benefit riders, including distribution rules, apply.

If the designated beneficiary is a surviving spouse who is not an Annuitant,
whose age is [45] through [85], and who elects to continue the Contract as the
new Owner, this rider will continue. The Purchase Payment Benefit Amount,
Principal Protection Death Benefit, Roll-Up Value and Maximum Anniversary Value
for the new Owner will be the Death Benefit determined as of the first
Valuation Day we receive at our [Service Center] due proof of death and all
required forms. The Withdrawal Factor for the new Owner will be based on the
age of that Owner on the date of the first Gross Withdrawal for that Owner.

If the designated beneficiary is a surviving spouse who is an Annuitant and who
elects to continue the Contract as the Owner, this rider will continue. The
Purchase Payment Benefit Amount, Principal Protection Death Benefit, Roll-Up
Value and Maximum Anniversary Value will be the same as it was under the
Contract for the deceased Owner. If no withdrawals were taken prior to the
first Valuation Day we receive due proof of death and all required forms at our
[Service Center], the Withdrawal Factor for the surviving spouse will be
established based on the age of the surviving spouse on the date of the first
Gross Withdrawal for the surviving spouse. Otherwise, the Withdrawal Factor
will continue as it was under the Contract for the deceased Owner.

If the surviving spouse cannot continue the rider, the rider and the rider
charges will terminate.

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Rider Charge

A charge will be assessed for the guaranteed minimum withdrawal benefit.
Another charge will be assessed for the Principal Protection Death Benefit. The
charge for the guaranteed minimum withdrawal benefit is calculated [quarterly]
as a percentage of the Benefit Base and deducted [quarterly] from the Contract
Value. The charge for the Principal Protection Death Benefit is calculated
[quarterly] as a percentage of the value of the Principal Protection Death
Benefit and deducted [quarterly] from the Contract Value. The charges are shown
on the Contract Data Pages. We may apply different charges for the rider for a
Contract that is a single Annuitant contract and a Contract that is a Joint
Annuitant contract. Once a Contract is a Joint Annuitant contract and the Joint
Annuitant rider charge is applied, the Joint Annuitant rider charge will
continue while the rider is in effect. If a spouse is added as Joint Annuitant
after the Contract is issued, new charges may apply. These new charges may be
higher than the charges previously applied to your Contract. The new charges,
which may be higher than your previous charges, will never exceed the maximum
annual charge of 2.00% of the Benefit Base plus the maximum annual charge of
0.50% of the value of the Principal Protection Death Benefit. On the day the
rider and/or the Contract terminates, the charges for this rider will be
calculated, prorata, and deducted.

When this Rider is Effective

The rider becomes effective on the Contract Date. It will remain in effect
while this Contract is in force and before the Annuity Commencement Date. You
may terminate this rider apart from the Contract on any Contract anniversary on
or after the [5/th/] Contract anniversary. Otherwise this rider and the
corresponding charges will terminate on the Annuity Commencement Date.

Change of Ownership

You may assign the benefits provided under this rider. The Annuitant(s) will
not change if you assign benefits. We must be notified in writing if you assign
the benefits of this rider.

General Provisions

For purposes of this rider:
  .  A non-natural entity Owner must name an Annuitant and may name the
     Annuitant's spouse as a Joint Annuitant.
  .  An individual Owner must also be an Annuitant and may name his/her spouse
     as Joint Annuitant at issue.
  .  A Joint Owner must be the Owner's spouse.
  .  If you marry after issue, you may add your spouse as a Joint Owner and
     Joint Annuitant or as a Joint Annuitant only, subject to our approval.

For Genworth Life Insurance Company of New York,

                                          /s/ David J. Sloane

                                          [David J. Sloane]
                                          [President]

NY5409DB 07/08

                                       8

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