Document:

icc19va710jacksonadvanta

   Home  Office:              Service Center:  1 Corporate Way            P.O. Box 24068  Lansing,  Michigan 48951   Lansing, MI 48909-4068                             1-800-644-4565                             www.jackson.com                               Jackson National Life Insurance Company®      Thank you for choosing Jackson National Life Insurance Company, also referred to as "the Company" or   "Jackson®."                                  READ YOUR CONTRACT CAREFULLY.    This annuity contract is issued by the Company and is a legal agreement between the Owner ("You") and  Jackson.    AMOUNTS YOU ALLOCATE TO THE INVESTMENT DIVISIONS ARE NOT GUARANTEED AND MAY  INCREASE OR DECREASE IN VALUE BASED UPON THE PERFORMANCE OF THE UNDERLYING MUTUAL  FUNDS.    THE COMPANY WILL RE-DETERMINE THE CONTRACT'S FIXED ACCOUNT MINIMUM INTEREST RATE  EACH JANUARY ON THE REDETERMINATION DATE.    THE FIXED ACCOUNT OPTIONS ARE SUBJECT TO A MARKET VALUE ADJUSTMENT WHICH MAY  INCREASE OR DECREASE THE VALUE OF AMOUNTS TRANSFERRED, WITHDRAWN OR ANNUITIZED  FROM THE FIXED ACCOUNT OPTIONS, BUT THE FIXED ACCOUNT CONTRACT VALUE WILL NEVER  DECREASE TO LESS THAN THE FIXED ACCOUNT MINIMUM VALUE.    THE COMPANY MAY RESTRICT FUTURE PREMIUM PAYMENTS, WHICH WOULD LIMIT YOUR ABILITY TO  INVEST IN THE CONTRACT AND COULD AFFECT THE VALUE OF YOUR CONTRACT AND ITS BENEFITS.    NOTICE OF RIGHT TO EXAMINE CONTRACT  YOU MAY RETURN THIS CONTRACT TO THE FINANCIAL PROFESSIONAL WHO SOLD YOU THE  CONTRACT OR THE COMPANY NO LATER THAN 10 DAYS AFTER YOU RECEIVE IT (30 DAYS AFTER YOU  RECEIVE IT IF YOU PURCHASED THE CONTRACT AS A REPLACEMENT CONTRACT). THE COMPANY  WILL REFUND THE FULL PREMIUM ALLOCATED TO THE FIXED ACCOUNT OPTIONS LESS ANY  WITHDRAWALS FROM THE FIXED ACCOUNT OPTIONS, PLUS THE SEPARATE ACCOUNT CONTRACT  VALUE, WITHOUT DEDUCTION FOR ANY FEES AND CHARGES, CALCULATED ON THE BUSINESS DAY  ON WHICH THE COMPANY RECEIVES THE CONTRACT AT ITS SERVICE CENTER. RETURNED  CONTRACTS ARE VOID.    Please Note: The Company reserves the right to allocate all Premium received during the "Notice of Right to  Examine Contract" period to a money market Investment Division or the Fixed Account. After the "Notice of Right  to Examine Contract" period expires, the Company will allocate the Contract Value to the Contract Options You  have specified.    The Telephone Number for the Michigan Department of Insurance is 877-999-6442.                                                              This Contract is signed by the Company INDIVIDUAL DEFERRED VARIABLE AND FIXED  ANNUITY CONTRACT WITH MARKET VALUE                                           ADJUSTMENT. (FLEXIBLE PREMIUM).  GUARANTEED MINIMUM DEATH BENEFIT AVAILABLE.   INCOME OPTIONS AVAILABLE.  NONPARTICIPATING.                                                                                         President  CONTAINS PROVISIONS THAT   WAIVE WITHDRAWAL CHARGES.                                                                                           Secretary      ICC19 VA710  

 

                                  TABLE OF CONTENTS                        Provision                                 Page Number                   Contract Data Pages                                          3a                   Definitions 4                   General Provisions                                             8                   Accumulation Provisions                                      13                   Withdrawal Provisions                                        15                   Death Benefit Provisions                                     21                   Income Provisions                                            24                   Termination Provision                                        28    If You have questions about this Contract or require information about coverage or complaint  resolutions, You may contact the Company's Service Center identified on the Contract's cover  page.    ICC19 VA710                                2 

 

                               CONTRACT DATA PAGES     Contract Number:                       1234567890       Owner: John Doe       Owner Issue Age:                       35       Joint Owner:                           Jane Doe       Joint Owner Issue Age:                 35       Annuitant: John Doe       Annuitant Issue Age:                   35       Joint Annuitant:                       Jane Doe       Joint Annuitant Issue Age:             35       Initial Premium:                       $50,000       Issue Date:                            May 1, 2020       Issue State:                           MI       Income Date:                           May 1, 2080       Primary Beneficiary(ies):              Brian Doe       Contingent Beneficiary(ies):           Mary Doe                                          ICC19 VA710-CB1                           3a 

 

                         CONTRACT DATA PAGES (CONT'D)    FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION:    Initial Fixed Account Minimum Interest Rate: 1.00%  The Company will re-determine the Fixed Account Minimum Interest Rate each January on the  Redetermination Date. The Fixed Account Minimum Interest Rate is the guaranteed minimum  interest rate under the Contract and may change each year on the Redetermination Date.    Initial Base Interest Rate:           1.00% for the 1-Year Fixed Account Option Period                                        1.00% for the 3-Year Fixed Account Option Period                                        1.00% for the 5-Year Fixed Account Option Period                                        1.00% for the 7-Year Fixed Account Option Period    Fixed Account Minimum Value Percentage: 87.5%    Fixed Account Minimum Value Annual Expense Allowance: $50    Interest Rate for Adjustments Due to Misstatement of Age or Sex: 1.00%    Annual Contract Maintenance Charge: $35  The Company will deduct the Annual Contract Maintenance Charge from the Contract Value  (but not the Remaining Premium) on each Contract Anniversary that occurs on or before the  Income Date or when You withdraw the Contract Value in full on a date other than a Contract  Anniversary. The Company will only deduct the Annual Contract Maintenance Charge from  Contracts with a Contract Value less than $50,000.    Core Contract Charge: 1.0500%  The Core Contract Charge is expressed as an annual percentage and is deducted daily from  the Separate Account Contract Value (but not the Remaining Premium). The Company will  reduce the Core Contract Charge to 0.9500% if the Contract Value on the later of the Issue  Date or the most recent Contract Quarterly Anniversary is greater than or equal to $1,000,000. If  the Contract Value subsequently falls below $1,000,000 on any Contract Quarterly Anniversary,  the Company will reinstate the charge of 1.0500% for the following Contract Quarter.    Total Asset-Based Charges: 1.0500%  The Total Asset-Based Charges are expressed as an annual percentage and are deducted daily  from the Separate Account Contract Value (but not the Remaining Premium). The Company will  deduct asset-based charges daily as part of the Accumulation Unit Value calculation. Total  Asset-Based Charges include the Core Contract Charge and asset-based charges for add-on  benefits.    Transfer Charge: $25  The Company allows 25 free transfers between Contract Options in a Contract Year. The  Company charges a fee for each transfer You make in excess of the 25 free transfers in any  Contract Year. The Company deducts Transfer Charges from the amount You seek to transfer  before allocation to the new Contract Option. The Company does not assess Transfer Charges  on transfers under any of the Company's systematic investment programs, and the Company  does not count those transfers against the 25 free transfers allowed in a Contract Year. Free  transfers not utilized during a given Contract Year cannot be carried forward to subsequent  Contract Years.   ICC19 VA710-CB1                           3b  

 

                         CONTRACT DATA PAGES (CONT'D)    FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION (continued):    Add-on Benefit Charges:  If applicable, refer to the supplemental contract data pages of any attached add-on benefits for  additional charges and fees associated with Your Contract.    WITHDRAWALS:    Withdrawal Charge Schedule:              Completed Years Since                         Withdrawal Charge              Receipt of Premium                             Percentage                       0 8.50%                       1 7.50%                       2 6.50%                       3 5.50%                       4 5.00%                       5 4.00%                       6 2.00%                      7+ 0.00%    For Owners age 86 or older, upon a partial or total withdrawal, the Withdrawal Charge  Percentage will be the lesser of the Withdrawal Charge Percentage indicated above or the  Maximum Withdrawal Charge Percentage listed below. In either case, the Withdrawal Charge  Percentage will decrease with each year until it no longer applies.          Contract Anniversary on or after                Maximum Withdrawal           Owner Attains the Age of:                     Charge Percentage                      86 7.25%                      87 6.50%                      88 5.50%                      89 4.50%                      90 3.75%                      91 2.75%                      92 1.75%                      93 0.75%                      94+ 0.00%    Please see Withdrawal Provisions for a complete explanation of the determination of Withdrawal  Charges.    Minimum partial withdrawal amount unless as a scheduled part of an automatic  withdrawal program: $500    Minimum partial withdrawal amount as a scheduled part of an automatic withdrawal  program: $50    Minimum Contract Value remaining after a partial withdrawal: $2,000    Free Withdrawal Percentage: 10%   ICC19 VA710-CB1                           3c 

 

                         CONTRACT DATA PAGES (CONT'D)    WITHDRAWALS (continued):    Waiver of Withdrawal Charge Due to Terminal Illness  Eligibility Date:                                                  May 1, 2021    Waiver of Withdrawal Charge Due to Terminal Illness Maximum Amount: 100% of the  Contract Value, not to exceed $250,000    Waiver of Withdrawal Charge for Extended Care  Eligibility Date:                                                  May 1, 2021    Waiver of Withdrawal Charge for Extended Care Maximum Amount: 100% of the Contract  Value, not to exceed $250,000    MARKET VALUE ADJUSTMENT (MVA):    An MVA is a positive or negative adjustment the Company applies to amounts You remove from  a Fixed Account Option due to withdrawals, transfers or annuitizations.    The MVA reflects the movement in the Base Interest Rate since the date of Your allocation to  the Fixed Account Option from which You remove Fixed Account Contract Value, which is  valued over the number of months remaining in the Fixed Account Option period.    The MVA may:  1.  reduce the value of the amount paid, transferred or annuitized if the Base Interest Rate on     the date You remove Fixed Account Contract Value from a Fixed Account Option is greater     than the Base Interest Rate on the date of Your allocation to that Fixed Account Option; or  2.  increase the value of the amount paid, transferred or annuitized if the Base Interest Rate on     the date You remove Fixed Account Contract Value from a Fixed Account Option is less     than the Base Interest Rate on the date of Your allocation to that Fixed Account Option.    The Company applies the same MVA formula regardless of whether the formula results in an  increase or decrease to amounts You remove from a Fixed Account Option.    The Company applies the MVA formula to the amount You remove less any applicable charges.    ICC19 VA710-CB1                           3d 

 

                         CONTRACT DATA PAGES (CONT'D)    MVA (continued):    MVA formula. The Company calculates the MVA by multiplying the amount You remove from a  Fixed Account Option by the result of the formula below:                                            (m/12)                                       [1+I ]                                                        -1                                              (m/12)                                  [1+J  +.0025]             where:    I  is  the Base Interest Rate the Company credits to the Fixed Account Option from which You         are removing Fixed Account Contract Value.  J  is  the Base Interest Rate the Company credits on new allocations to Fixed Account         Options of the same period on the date You remove Fixed Account Contract Value from         a Fixed Account Option. If the Company does not offer such a Fixed Account Option on         the date of the removal, the Company will establish "J" by straight-line interpolation         between the two (2) Fixed Account Options with durations closest to the duration of the         Fixed Account Option from which You are removing Fixed Account Contract Value.  m  is  the number of complete months remaining from the date of the removal to the end of the         period of the Fixed Account Option from which You are removing Fixed Account         Contract Value.    The Company makes no MVA when J is less than I by 0.0025 or less.    In no event will a total withdrawal from a Fixed Account Option be less than the Fixed Account  Minimum Value.    Amounts You remove from a Fixed Account Option no more than thirty (30) days following the  end of the Fixed Account Option period are not subject to an MVA. The Company will mail You  Written Notice at least fifteen (15) but not more than forty-five (45) days before the end of any  Fixed Account Option period to which You have allocated Contract Value.     The Company will not apply an MVA to:  1.  death benefit proceeds;  2.  payment of charges or fees;  3.  amounts You allocate to an Income Option that is life contingent or results in payments     spread over at least five (5) years;  4.  exercise of Your Notice of Right to Examine Contract provision;  5.  withdrawals taken under the Free Withdrawal provision;  6.  amounts You remove from the 1-Year Fixed Account Option;  7.  amounts You remove from any Fixed Account Option on the Latest Income Date; or  8.  amounts You remove from any Fixed Account Option in the 30-day period following the end     of a Fixed Account Option.     Unavailability of Base Interest Rate. In the event that the Base Interest Rate cannot be  determined on the date You remove Fixed Account Contract Value from a Fixed Account  Option, the Company may substitute a comparable index subject to approval by the Interstate  Insurance Product Regulation Commission (IIPRC). In this case, the Company will base the  values of I and J on the substitute index. The Company will notify You and any assignee before  using a substitute rate or index to calculate the MVA. If an index is substituted for the Base  Interest Rate a 0.0025 adjustment to J in the MVA formula will not be applied.  ICC19 VA710-CB1                           3e 

 

                         CONTRACT DATA PAGES (CONT'D)    TRANSFERS:    Transfer among Investment Divisions. At any time, You may transfer all or a portion of Your  Contract Value in any Investment Division to any available Investment Division(s).    Transfer from an Investment Division to a Fixed Account Option. Before the Income Date,  You may transfer all or a portion of Your Contract Value in an Investment Division to any  available Fixed Account Option(s) unless the Company has restricted this type of transfer.    Transfer from a Fixed Account Option to an Investment Division or to a Fixed Account  Option. Before the Income Date, You may transfer all or a portion of Your Contract Value in a  Fixed Account Option, subject to any applicable MVA, to any available Investment Division(s) or  any available Fixed Account Option(s) unless the Company has restricted this type of transfer.    Transfer Effective Date: Transfers You request will be effective as of the end of the Business  Day upon which the Company receives Your transfer request in Good Order at the Company's  Service Center.    Additional details on transfer restrictions are outlined in the Transfer of Funds Restrictions  section of the General Provisions.    PREMIUM(S):   This is a flexible Premium Contract. You may change the amount, frequency and timing of  Premium payments, subject to the minimum and maximum Premium payment amounts and the  Company's reserved rights specified below. The Company may waive the minimums or  maximums at any time.    Minimum Initial Premium for Non-Qualified Plan Contract: $50,000    Minimum Initial Premium for Qualified Plan Contract: $50,000    Minimum Subsequent Premium: $500 ($50 if made as a scheduled part of an automatic  payment plan)    Maximum Total Premium under a Contract: $2,500,000    Minimum Amount Allocated to an Investment Division or Fixed Account Option: $100    The Company reserves the right to limit, restrict, suspend or reject any or all subsequent  Premium payments. The Company will send You Written Notice at least thirty (30) days in  advance of any such limitation, restriction, suspension or rejection.    The Company reserves the right to restrict or reject any allocation of Premium to a Fixed  Account Option(s) at any time. The Company will allocate any Premium payment subsequent to  issue according to Your most recent instructions on file with the Company, provided that each  allocation complies with the Company's then current minimum amounts and restrictions.    ICC19 VA710-CB1                           3f 

 

                         CONTRACT DATA PAGES (CONT'D)    PREMIUM(S) (continued):    The Company reserves the right to require that amounts You allocate to the 1-Year Fixed   Account Option be automatically transferred to the Investment Division(s) of Your choice, in  scheduled installments over a period that the Company shall specify. The scheduled transfers  will continue until such time that all amounts in the 1-Year Fixed Account Option have been  transferred out. These automatic transfers will not count against the 25 free transfers the  Company allows in a Contract Year. You may change the Investment Division(s) You select at  any time.    Minimum Contract Value to Participate in the Enhanced Interest Rate Dollar Cost  Averaging Program: $15,000    Minimum Investment Return to Avoid Decrease in Variable Annuity Payments: The  minimum investment return which the Investment Division(s) must earn so that the dollar  amount of Variable Annuity Payments will not decrease is 2.05%. This quantity is equal to the  assumed net investment rate specified in the Basis of Computation section of the Contract Data  Pages plus the Core Contract Charge shown on the Contract Data Pages. Variable Annuity  Payments are further described under the Income Provisions.    CONTRACT OPTIONS:    Investment Divisions: Available Investment Division(s) are identified in the current prospectus  and any supplements. The Company may offer new Investment Divisions, or eliminate,  substitute, or combine Investment Divisions.    Separate Account: Jackson National Separate Account - I    Fixed Account Options: 1-Year Period; 3-Year Period; 5-Year Period; and 7-Year Period; the  availability of each option will be determined by the Company.    Available Fixed Account Options are identified in the current prospectus and any supplements.    Maximum Contract Option Allocations Allowed: The number of allocations to the Contract  Options may not exceed 99 at any one time.    The Company will identify the Contract Options You select in a confirmation the Company  sends You on or after the Issue Date.    ICC19 VA710-CB1                           3g 

 

                                                                     CONTRACT DATA PAGES (CONT'D)                                                                     TABLE OF INCOME OPTIONS                          The following table shows income values for each $1,000 of net proceeds applied to the Income             Option.                UNDER OPTION 4                                               MONTHLY INSTALLMENTS UNDER OPTIONS 1 OR 3                                                                                                                                                                   Age of                         Age of                            Age of                          Age of                   No. of   Monthly   Annui-       No. of Mos.       Annui-        No. of Mos.         Annui-        No. of Mos.       Annui-           No. of Mos.  Monthly    Install-  tant          Certain          tant           Certain            tant           Certain          tant             Certain   Install-  ments   ments                       Male Life 120 240 Male                  Life    120 240 Female Life 120 240 Female Life                             120      240     60 17.09 40 2.33 2.32 2.31 68 4.72 4.57 4.02                                       40      2.22 2.22 2.21           68      4.36     4.26      3.86     72 14.31 41 2.37 2.36 2.35 69 4.90 4.72 4.09                                       41      2.26 2.26 2.25           69      4.52     4.40      3.94     84 12.33 42 2.41 2.41 2.39 70 5.09 4.89 4.16                                       42      2.30 2.30 2.29           70      4.69     4.55      4.02     96 10.84 43 2.45 2.45 2.43 71 5.31 5.06 4.23                                       43      2.34 2.34 2.32           71      4.87     4.70      4.09    108 9.68 44 2.50 2.50 2.47 72 5.54 5.24 4.29                                        44      2.38 2.38 2.36           72      5.06     4.87      4.16    120 8.76 45 2.55 2.54 2.52 73 5.79 5.43 4.34                                        45      2.42 2.42 2.40           73      5.28     5.04      4.22    132 8.00 46 2.60 2.59 2.56 74 6.06 5.63 4.39                                        46      2.47 2.47 2.45           74      5.51     5.23      4.28    144 7.37 47 2.65 2.64 2.61 75 6.35 5.83 4.43                                        47      2.52 2.51 2.49           75      5.76     5.42      4.34    156 6.84 48 2.71 2.70 2.66 76 6.67 6.04 4.47                                        48      2.57 2.56 2.54           76      6.03     5.62      4.38    168 6.38 49 2.77 2.76 2.71 77 7.02 6.26 4.50                                        49      2.62 2.61 2.59           77      6.33     5.83      4.43    180 5.98 50 2.83 2.82 2.76 78 7.40 6.48 4.52                                        50      2.67 2.67 2.64           78      6.65     6.04      4.46    192 5.64 51 2.89 2.88 2.82 79 7.81 6.70 4.54                                        51      2.73 2.72 2.69           79      7.01     6.26      4.49    204 5.33 52 2.96 2.94 2.88 80 8.27 6.92 4.56                                        52      2.79 2.78 2.74           80      7.40     6.48      4.52    216 5.06 53 3.03 3.01 2.94 81 8.76 7.13 4.57                                        53      2.85 2.84 2.80           81      7.83     6.70      4.54    228 4.82 54 3.10 3.08 3.00 82 9.30 7.34 4.58                                        54      2.92 2.91 2.85           82      8.29     6.92      4.56    240 4.60 55 3.18 3.16 3.06 83 9.89 7.53 4.58                                        55      2.99 2.98 2.91           83      8.80     7.13      4.57    252 4.40 56 3.26 3.23 3.13 84 10.54 7.72 4.59                                       56      3.07 3.05 2.98           84      9.35     7.33      4.58    264 4.22 57 3.35 3.32 3.19 85 11.26 7.88 4.59                                       57      3.14 3.12 3.04           85      9.95     7.52      4.58    276 4.06 58 3.44 3.40 3.26 86 12.05 8.03 4.59                                       58      3.23 3.20 3.11           86      10.59    7.70      4.59    288 3.90 59 3.54 3.49 3.34 87 12.91 8.17 4.59                                       59      3.31 3.29 3.18           87      11.28    7.87      4.59    300 3.77 60 3.64 3.59 3.41 88 13.86 8.28 4.60                                       60      3.40 3.37 3.25           88      12.03    8.02      4.59    312 3.64 61 3.74 3.69 3.48 89 14.88 8.38 4.60                                       61      3.50 3.46 3.32           89      12.84    8.15      4.59    324 3.52 62 3.86 3.79 3.56 90 15.99 8.46 4.60                                       62      3.60 3.56 3.40           90      13.71    8.27      4.60    336 3.41 63 3.98 3.91 3.64 91 17.17 8.53 4.60                                       63      3.71 3.66 3.47           91      14.66    8.37      4.60    348 3.31 64 4.11 4.02 3.71 92 18.43 8.58 4.60                                       64      3.82 3.77 3.55           92      15.70    8.45      4.60    360 3.21 65 4.24 4.15 3.79 93 19.78 8.63 4.60                                       65      3.95 3.88 3.63           93      16.86    8.53      4.60                        66 4.39 4.28 3.87 94 21.20 8.66 4.60                            66      4.07 4.00 3.71           94      18.13    8.58      4.60                        67 4.55 4.42 3.95 95 22.67 8.68 4.60                            67      4.21 4.12 3.79           95      19.53    8.63      4.60                          Note: Due to the volume of relevant information, the Table does not provide income values for             Option 2 described in the Income Provisions. Those values are available from the Company's             Service Center upon request. You may contact the Company's Service Center as shown on the             cover page of the Contract.                          BASIS OF COMPUTATION. The 2012 Individual Annuity Mortality Period Table, with an             assumed net investment rate of 1.00% and a 0% expense load, provides the actuarial basis for             the Table of Income Options. The Table of Income Options does not include any applicable tax.               ICC19 VA710-CB1                                                3h 

 

                                       DEFINITIONS    ACCUMULATION UNIT. A unit of measure the Company uses to calculate the value of  amounts allocated to an Investment Division before the Income Date.    ANNUITANT. The natural person(s) so designated on the Contract Data Pages, or by  subsequent designation, on whose life the Company determines the amount of Income  Payments provided by the Contract. References to the Annuitant include all Joint Annuitants, if  applicable.    ANNUITIZE. When You elect to convert the Contract Value into Income Payments.    ANNUITY UNIT. A unit of measure the Company uses to calculate each Variable Annuity  Payment.    BASE INTEREST RATE. The annual percentage, declared by the Company, at which Your  money grows for a specified Fixed Account Option period.    BENEFICIARY(IES). The natural person(s) or legal entity(ies) You designate as Primary or  Contingent Beneficiary(ies) to receive any death benefit provided by the Contract. The initial  designated Beneficiary(ies) are shown on the Contract Data Pages.    BUSINESS DAY. Any day that the New York Stock Exchange (NYSE) is open for business. The  Business Day ends when the NYSE closes for the day.    CONTRACT. The Individual Deferred Variable and Fixed Annuity Contract described herein.    CONTRACT ANNIVERSARY. Each one-year anniversary of the Issue Date.    CONTRACT OPTION(S). The Investment Divisions and Fixed Account Options the Contract  offers, as shown on the Contract Data Pages. Each Contract Option is explained in the  Accumulation Provisions.    CONTRACT QUARTERLY ANNIVERSARY. Each three-month anniversary of the Issue Date.    CONTRACT VALUE. The current value of the amounts under this Contract allocated to the  Investment Divisions and Fixed Account Options.    CONTRACT YEAR. The twelve-month period beginning on the Issue Date and on any Contract  Anniversary thereafter while the Contract remains in force.    CURRENT INTEREST RATE. The Base Interest Rate plus any additional interest rate the  Company credits. The Current Interest Rate will never be less than the Fixed Account Minimum  Interest Rate.    DESIGNATED OPTION(S). The Investment Division(s) and/or Fixed Account Option(s) You  select, to which amounts will be transferred from a Source Option pursuant to one of the  Company's systematic investment programs.    ICC19 VA710                                4 

 

                                 DEFINITIONS (CONT'D)    DUE PROOF. Evidence of death, including but not limited to, a certified death certificate issued  by the governmental authority for the location of the death, or other lawful evidence the  Company requires.    FIXED ACCOUNT. The Fixed Account is part of the Company's general account. A Fixed  Account earns a specified interest rate, not less than the guaranteed minimum interest rate, to  which You may allocate Premium and Contract Value unless the Company has restricted such  allocations.    FIXED ACCOUNT CONTRACT VALUE. The larger of the Fixed Account Minimum Value or the  sum of all amounts allocated to the Fixed Account Options, reduced by the gross amount of  withdrawals and transfers from the Fixed Account Options, and applicable charges and taxes,  plus all interest credited to the Fixed Account Options.    FIXED ACCOUNT MINIMUM INTEREST RATE. The Fixed Account Minimum Interest Rate is  the minimum annual percentage at which Your money allocated to the Fixed Account will grow.  The Company uses this rate to determine the Fixed Account Minimum Value. The Initial Fixed  Account Minimum Interest Rate is shown on the Contract Data Pages.    FIXED ACCOUNT MINIMUM VALUE. The Fixed Account Minimum Value is equal to all  amounts allocated to the Fixed Account Options, net of applicable taxes, multiplied by the Fixed  Account Minimum Value Percentage, and;  1.  reduced by partial withdrawals and transfers from the Fixed Account Options, (after being     reduced for any applicable Withdrawal Charges and then adjusted for any applicable MVA),     and the Fixed Account Minimum Value Annual Expense Allowance; then  2.  accumulated at the Fixed Account Minimum Interest Rate.    FIXED ACCOUNT MINIMUM VALUE ANNUAL EXPENSE ALLOWANCE. An annual  deduction from the Fixed Account Minimum Value. On each Contract Anniversary, the Company  will deduct the Fixed Account Minimum Value Annual Expense Allowance from the Fixed  Account Minimum Value. The Fixed Account Minimum Value Annual Expense Allowance is  shown on the Contract Data Pages.    FIXED ACCOUNT MINIMUM VALUE PERCENTAGE. The Fixed Account Minimum Value  Percentage is multiplied by Premiums and transfers allocated to the Fixed Account in the  determination of the Fixed Account Minimum Value. The Fixed Account Minimum Value  Percentage is shown on the Contract Data Pages.    FIXED ACCOUNT OPTION. A Contract Option within the Fixed Account that specifies a fixed  period for which the Company credits the Current Interest Rate.    GOOD ORDER. The Company's receipt of all information, documentation, instructions and/or  Premium the Company requires before it will issue the Contract or execute any transaction.    INCOME DATE. The date, not less than one (1) year after the Contract's Issue Date, on which  Income Payments are to begin as described in the Income Provisions.    INCOME OPTION. One of the payment options provided under the Income Provisions.    ICC19 VA710                                5 

 

                                 DEFINITIONS (CONT'D)    INCOME PAYMENTS. Fixed Annuity Payments and Variable Annuity Payments offered by the  Company at the Income Date.    INVESTMENT DIVISIONS. Separate and distinct divisions of the Separate Account, each of  which invests in a specific Underlying Mutual Fund, and for which Accumulation Units and  Annuity Units are separately maintained. The Separate Account Contract Value in the  Investment Divisions will increase or decrease depending on the performance of the Underlying  Mutual Funds.    ISSUE DATE. The date the Company issued the Contract. The Issue Date is shown on the  Contract Data Pages.    JOINT OWNER. Each of multiple Contract Owners.    LATEST INCOME DATE. The Contract Anniversary on which You will be 95 years old, or such  earlier date required by a Qualified Plan, law or regulation.    NON-QUALIFIED PLAN. A retirement plan which does not qualify for favorable tax treatment  under Sections 401, 403, 408, 408A or 457 of the Internal Revenue Code, as amended.    OWNER ("YOU," "YOUR"). The natural person(s) or legal entity(ies) shown on the Contract  Data Pages, or by subsequent designation. In this Contract, "You" and "Your" also mean the  Owner. References to the Owner include all Joint Owners, if applicable.    PREMIUM(S). Money paid into this Contract for allocation to a Contract Option.    QUALIFIED PLAN. A retirement plan which qualifies for favorable tax treatment under Sections  401, 403, 408, 408A or 457 of the Internal Revenue Code, as amended.    REDETERMINATION DATE. The date the Fixed Account Minimum Interest Rate is reset as  described in the Fixed Account Minimum Interest Rate provision. It is the date each January that  coincides with the Issue Date. For example, if Your Contract's Issue Date is May 23, the  Redetermination Date will be January 23 each year following the Issue Date.    REDETERMINATION PERIOD. The twelve-month period that begins on each Redetermination  Date.    REMAINING PREMIUM. Total Premium paid into the Contract, reduced by withdrawals of  Premium, including the Withdrawal Charges, before withdrawals are adjusted for any applicable  MVA or charges.    REQUIRED MINIMUM DISTRIBUTION (RMD). For certain Qualified Plan contracts, the  RMD is the amount defined by the Internal Revenue Code and the implementing regulations  as the minimum distribution requirement that applies to this Contract only.    ICC19 VA710                                6 

 

                                 DEFINITIONS (CONT'D)    SEPARATE ACCOUNT. An asset account the Company has established and maintains in  accordance with Michigan law. The Company has allocated a portion of its assets to this  account for this Contract and certain other contracts. The name of the Separate Account is  shown on the Contract Data Pages.    SEPARATE ACCOUNT CONTRACT VALUE. The current value of the amounts under this  Contract allocated to the Separate Account's Investment Divisions.    SERVICE CENTER. The Company's administrative address and telephone number as identified  on the Contract's cover page or as the Company may designate from time to time.    SOURCE OPTION. The Investment Division or Fixed Account Option You select from those the  Company makes available, from which amounts will be transferred to a Designated Option(s)  pursuant to one of the Company's systematic investment programs.    UNDERLYING MUTUAL FUNDS. The registered management investment companies in which  the assets of the Investment Divisions will be invested.    WITHDRAWAL CHARGE. A charge assessed against certain withdrawals. The Withdrawal  Charge Schedule is shown on the Contract Data Pages.    WITHDRAWAL VALUE. The Contract Value, less any tax payable, applicable Withdrawal  Charges, Annual Contract Maintenance Charge, and charges due under any add-on benefit,  adjusted for any applicable MVA.    ICC19 VA710                                7 

 

                                 GENERAL PROVISIONS    ANNUITANT. You may change the Annuitant at any time before the Income Date, unless the  Contract is owned by a legal entity. If the Contract is owned by a legal entity, the Company will  use the oldest Annuitant's age for all Contract purposes unless otherwise specified in the  Contract. The Company reserves the right to limit the number of Joint Annuitants to two (2).  When the Owner is a legal entity, the Annuitant(s) shall be entitled to the benefits of the Waiver  of Withdrawal Charge Due to Terminal Illness and the Waiver of Withdrawal Charge for  Extended Care.    ASSIGNMENT. You may assign ownership of this Contract subject to the interests of assignees  and irrevocable Beneficiaries. The Company will only be bound by an assignment if a request is  submitted in a form acceptable to the Company, received in Good Order at the Company's  Service Center and recorded. Unless You specify otherwise, an assignment will take effect on  the date the request is signed by You, subject to any payments the Company has made or other  actions the Company has taken before the Company receives and records Your request. The  Company may refuse assignments if necessary to comply with applicable laws or regulations.    The Company assumes no responsibility for the validity or tax consequences of any  assignment. If You make an assignment, You may have to pay taxes. The Company  encourages You to seek legal and/or tax advice.    BENEFICIARY. You may change the Beneficiaries, subject to the interest of assignees and  irrevocable Beneficiaries. The Company will only be bound by a change in Beneficiary if a  request is submitted in a form acceptable to the Company, received in Good Order at the  Company's Service Center and recorded. Any previously designated irrevocable Beneficiary  must consent in writing to any change in Beneficiary. Unless You specify otherwise, a change in  Beneficiary will take effect on the date the request is signed by You, subject to any payments  the Company has made or other actions the Company has taken before the Company receives  and records Your request, and while You are alive.    CHARGES AND FEES. The Contract permits the Company to assess certain charges and fees.  Charges and fees associated with Your Contract are listed on the Contract Data Pages.    CONFORMITY WITH INTERSTATE INSURANCE PRODUCT REGULATION COMMISSION  (IIPRC) STANDARDS. This Contract is approved under the authority of the IIPRC and is issued  under the IIPRC standards. Any provision of this Contract that, on the provision's effective date,  is in conflict with the applicable IIPRC standards for this product type is hereby amended to  conform to the IIPRC standards in effect as of the provision's effective date.    DEFERRAL OF FIXED ACCOUNT PAYMENTS. If approved in writing by the chief insurance  regulator of the Company's state of domicile, the Company may defer payment of Your request  for a partial and/or total withdrawal from a Fixed Account Option for a period not exceeding six  (6) months. The Company will credit interest on deferred amounts as required by law. The  Company will not defer payment of death benefits from a Fixed Account Option.    ENTIRE CONTRACT. The Contract, application, if any, and any attached endorsements, add- on benefits and amendments together make up the entire Contract between You and the  Company. All statements made by the applicant to procure the Contract will, in the absence of  fraud, be deemed representations and not warranties.    ICC19 VA710                                8 

 

                          GENERAL PROVISIONS (CONT'D)    INCONTESTABILITY. The Company may only contest this Contract when an applicant has  procured the Contract by fraud, and only if permitted by law in the state in which the Company  delivered the Contract or issued the Contract for delivery.    MINIMUM BENEFITS. No Withdrawal Values or death benefits provided by this Contract shall  be less than the minimum benefits required by Section 7 of the Variable Annuity Model  Regulation, Model 250, Standard Nonforfeiture Law for Individual Deferred Annuities, Model  805, or applicable successor provision, as amended.    MISSTATEMENT OF AGE AND/OR SEX. If Your or the Annuitant's age and/or sex is misstated  at the time the Contract's Income Payments become payable, the Company will adjust the  payments to reflect income consistent with the correct age and/or sex. Immediately upon  discovery, the Company will adjust the next payment due as a credit or charge, as appropriate,  for any underpayments or overpayments using the Interest Rate for Adjustments Due to  Misstatement of Age or Sex shown on the Contract Data Pages.    MODIFICATION OF CONTRACT. No financial professional has authority to change or waive  any of this Contract's provisions. No change to or waiver of this Contract's terms is valid unless  in writing and signed by the Company's President, Vice President, Secretary or Assistant  Secretary; provided, however, that the Company may amend any Contract term, and administer  the Contract to conform to the Internal Revenue Code.    NONPARTICIPATING. This Contract is nonparticipating and does not share in the Company's  surplus or earnings.    OWNER. You may change the Owner or any Joint Owner. The Company will only be bound by  a change of ownership if submitted in a form acceptable to the Company, received in Good  Order at the Company's Service Center and recorded. No person whose age exceeds the  maximum issue age the Company had set as of the Issue Date may become a new Owner.  Unless You specify otherwise, a change of ownership will take effect on the date the request is  signed by You, subject to any payments the Company has made or other actions the Company  has taken before the Company receives and records Your request. Joint Owners have equal  ownership rights; therefore, each Owner must authorize any exercise of Contract rights unless  the Joint Owners instruct the Company in writing to act upon authorization of an individual Joint  Owner. The Company reserves the right to limit the number of Joint Owners to two (2).    The Company assumes no responsibility for the validity or tax consequences of any  ownership change. If You make an ownership change, You may have to pay taxes. The  Company encourages You to seek legal and/or tax advice.    PROOF OF AGE, SEX AND/OR SURVIVAL. The Company may require proof of age and/or  sex satisfactory to the Company at any time. If any payment required by this Contract depends  on a living Annuitant, Owner, or Beneficiary, the Company may require proof of that person's  survival satisfactory to the Company.    PROTECTION OF PROCEEDS. A Beneficiary may not assign Contract proceeds before the  proceeds are payable. Contract proceeds are not subject to the claims of creditors or to legal  process unless required by applicable law.    ICC19 VA710                                9 

 

                          GENERAL PROVISIONS (CONT'D)    REPORTS. The Company will send a report to Your last address in the Company's records at  least annually before the Income Date. In the case of Joint Owners, the Company will send  reports only to the primary Owner's address. Each report will provide at least the following  information:  1.  the dates that begin and end the reporting period;  2.  the Contract Value at the beginning and at the end of the current reporting period prior to the     application of any MVA;  3.  the Withdrawal Charge and MVA amount the Company used to determine the Withdrawal     Value;  4.  the amounts the Company has credited to and deducted from the Contract Value during the     reporting period;  5.  the Withdrawal Value at the end of the reporting period;  6.  the death benefit at the end of the reporting period; and  7.  any other information state and federal law require.    You may receive copies of reports the Company provides upon request at no additional charge.    SUBSTITUTION OF UNDERLYING MUTUAL FUND(S). If the Company determines that an  Underlying Mutual Fund is no longer available or appropriate for Contract purposes, the  Company may replace that Underlying Mutual Fund with another Underlying Mutual Fund  without Your consent but upon notice to You. Changes of the Underlying Mutual Fund(s) are  subject to federal securities laws and the laws of the state where the Company issued the  Contract for delivery. In the event the Company replaces an Underlying Mutual Fund, You are  permitted to transfer Your Contract Value and allocate future Premiums among the available  Investment Divisions, consistent with Your rights under the Contract.    SUSPENSION OF SEPARATE ACCOUNT PAYMENTS. The Company may suspend or delay  withdrawals of Separate Account Contract Value or transfers to or from an Investment Division  for any period when:  1.  the NYSE is closed (other than customary weekend and holiday closings);  2.  under applicable Securities and Exchange Commission (SEC) rules, trading on the NYSE is     restricted;  3.  under applicable SEC rules, an emergency exists such that it is not reasonably practicable     to dispose of securities in the Separate Account or to determine the value of its assets; or  4.  the SEC, by order, so permits.    TAXES. The Company will deduct any taxes attributed to the Contract and payable to a  government entity from the Contract Value. The Company reserves the right to deduct any  amounts the Company might advance to pay taxes from the Contract Value. The Company will  withhold taxes required by law from any amounts payable from this Contract.    ICC19 VA710                               10 

 

                           GENERAL PROVISIONS (CONT'D)    TRANSFER OF FUNDS. The Contract Data Pages describe the conditions for transfers of  funds between Contract Options.    Transfer of Funds Restrictions. The Company may restrict the number and frequency of  transfers into and between Contract Options in certain circumstances. This includes, but is not  limited to, circumstances in which the Company determines, at its sole discretion, that a  reasonably designed restriction is required to prevent transfers that would disadvantage an  Owner. The Company may impose a restriction including, but not limited to:  1.  a minimum time between transfers;  2.  a limitation on transfer requests of an agent acting for one or more Owners; and  3.  a limitation on the dollar amount of any transfer.    The Company may also impose restrictions on Your ability to make transfers to or from the 1- Year Fixed Account Option. This includes a restriction that transfers from the 1-Year Fixed  Account Option in any Contract Year may not exceed the maximum amount, as defined below:  1.  in the first Contract Year that transfer restrictions are in effect, or if in the prior Contract Year     the maximum amount was not transferred out of the 1-Year Fixed Account Option, the     maximum amount that You may transfer out of the 1-Year Fixed Account Option is equal to     1/3 of the Contract Value in the 1-Year Fixed Account Option at the beginning of the current     Contract Year;  2.  if the maximum amount (1/3 of the value of the 1-Year Fixed Account Option at the     beginning of the prior Contract Year) was transferred from the 1-Year Fixed Account Option     in the prior Contract Year, the maximum amount that You may transfer out of the 1-Year     Fixed Account Option in the current Contract Year is equal to 1/2 of the Contract Value in     the 1-Year Fixed Account Option at the beginning of the current Contract Year. Any     transfers out of the 1-Year Fixed Account Option cannot begin until twelve (12) calendar     months after the last transfer out of the 1-Year Fixed Account Option in the prior Contract     Year;  3.  if the maximum amount (1/3 and then 1/2 of the value of the 1-Year Fixed Account Option at     the beginning of each of the two (2) prior Contract Years, respectively) was transferred from     the 1-Year Fixed Account Option in each of the two (2) prior Contract Years, You may     transfer the remaining Contract Value in the 1-Year Fixed Account Option. Any transfers out     of the 1-Year Fixed Account Option cannot begin until twelve (12) calendar months after the     last transfer out of the 1-Year Fixed Account Option in the prior Contract Year.    If the 1-Year Fixed Account Option restriction is imposed, the Company may:  1.  limit Your ability to transfer into or allocate new Premium to the 1-Year Fixed Account Option     in any Contract Year in which You make a transfer from the 1-Year Fixed Account Option.  2.  limit Your ability to transfer from the 1-Year Fixed Account Option in any Contract Year in     which You make a transfer into or allocate new Premium to the 1-Year Fixed Account     Option.  3.  offer an optional automated systematic transfer program to allow for systematic transfers out     of the 1-Year Fixed Account Option.    If the 1-Year Fixed Account Option restriction is imposed transfers under systematic investment  programs do not count against the maximum amount, and the Contract Value under such  programs is excluded from the determination of the maximum amount.    ICC19 VA710                               11 

 

                           GENERAL PROVISIONS (CONT'D)    Systematic Investment Programs. The Company may provide systematic investment  programs that allow You to systematically transfer funds between the Contract Options. These  programs may include dollar cost averaging, portfolio rebalancing, and the automatic monthly  transfer of earnings from the 1-Year Fixed Account Option and/or money market Investment  Division to the Designated Option(s). You may contact the Company's Service Center to obtain  materials and forms that describe, and are required to participate in, these programs. The  Company makes no guarantee that these programs will result in a profit or protect against loss.    The Company's dollar cost averaging program permits You to authorize the automatic monthly,  quarterly, semiannual, or annual transfer of a fixed dollar amount or selected percentage of the  value of a Source Option, to one (1) or more Designated Option(s).    The Company may offer an enhanced interest rate on Premium which an Owner that selects  dollar cost averaging allocates to the 1-Year Fixed Account Option (as the Source Option). You  may participate in the enhanced interest rate dollar cost averaging program only if Your  Contract Value is at least equal to the minimum shown on the Contract Data Pages. Under an  enhanced interest rate dollar cost averaging program, amounts You allocate to the Source  Option are automatically transferred to the Designated Option(s) of Your choice in scheduled  installments over a period prescribed by the Company until all amounts in the Source Option  have been transferred. You may contact the Company's Service Center to request the interest  rates and the specified periods applicable to the enhanced interest rate dollar cost averaging  program. In the event You cancel participation in the enhanced interest rate dollar cost  averaging program, the Company will transfer the Source Option balance, including any  interest, into the Designated Option(s) You selected.    WRITTEN NOTICE. Written information or instructions You intend to give to the Company must  be in Good Order and delivered to the Company's Service Center, unless the Company advises  You otherwise. Instructions included in the Written Notice will take effect on the date the  Company receives the notice in Good Order at the Company's Service Center, unless otherwise  provided in the notice or in this Contract, or unless the Company advises You otherwise.    The Company will deliver any notice or communication to Your last address in the Company's  records unless You request otherwise in writing. You are responsible for promptly notifying the  Company of any address change or any error in a Company notice sent to You. In the case of  Joint Owners, the Company will send notices and other communications to the primary Owner's  address.    ICC19 VA710                               12 

 

                            ACCUMULATION PROVISIONS    You may not allocate funds to more than the maximum number of Contract Options, shown on  the Contract Data Pages, at any one time. The Company may waive this maximum.    SEPARATE ACCOUNT. The Separate Account is an asset account shown on the Contract  Data Pages. The Separate Account consists of assets the Company has set aside and has kept  separate from the Company's general account assets and other separate accounts. The  Separate Account assets will not be charged with liabilities arising out of any other Company  business. The Company credits or charges all the income, gains, and losses resulting from the  Separate Account assets exclusively to the contracts supported by the Separate Account. The  Separate Account assets will be available to cover the liabilities of the Company's general  account only to the extent that they exceed the Separate Account liabilities arising from the  Contracts supported by the Separate Account. The Separate Account is divided into several  Investment Divisions. The Company will value the Separate Account assets at their fair market  value at least monthly.    Accumulation Units. The Separate Account Contract Value may increase or decrease  depending on the performance of the Investment Divisions. The Company uses a unit of  measure called an Accumulation Unit to measure the Separate Account Contract Value before  the Income Date. The value of an Accumulation Unit may increase or decrease from Business  Day to Business Day. Transactions affecting the Separate Account Contract Value, such as  withdrawals, transfers, and certain charges, result in the redemption of Accumulation Units but  do not change the value of Accumulation Units.    When You make an allocation to the Investment Divisions, the Company credits Your Contract  with Accumulation Units. The Company determines the number of Accumulation Units credited  to Your Contract by dividing the amount You allocate to each Investment Division by its  Accumulation Unit Value at the close of the Business Day on which You make the allocation.    Accumulation Unit Value. The Company determines the Accumulation Unit Value for each of  the Investment Divisions by:  1.  determining the total amount of money allocated to that particular Investment Division;  2.  subtracting from that amount any applicable Core Contract Charge and taxes; and  3.  dividing the result by the number of outstanding Accumulation Units.    FIXED ACCOUNT. Allocations You make to Fixed Account Options are included in the  Company's general account. The Company's general account consists of all the Company's  assets, other than those in the Separate Account and other asset accounts.    You may select from the Fixed Account Options made available by the Company. Amounts in  the Fixed Account Option You select will earn interest at that option's Current Interest Rate  during the Fixed Account Option period. The Company may declare Base Interest Rates higher  or lower than any Base Interest Rates the Company previously declared but the interest rate  credited to the Fixed Account Option will never be less than the Fixed Account Minimum Interest  Rate.    ICC19 VA710                               13 

 

                       ACCUMULATION PROVISIONS (CONT'D)    You may allocate Premium, or make transfers from the Investment Divisions and/or Fixed  Account Options, to the Fixed Account Options at any time before the Income Date, subject to  the provisions of this Contract. You may not select any Fixed Account Option, other than the 1- Year Fixed Account Option, that extends beyond the Income Date.    When the period of a Fixed Account Option ends:  1.  If the option ends within one (1) year of the Income Date, the Company will renew You into     the 1-Year Fixed Account Option;   2.  If the option ends more than one (1) year before the Income Date, You may select a new     Fixed Account Option that does not extend beyond the Income Date within thirty (30) days     of the end of the expired Fixed Account Option;   3.  If You do not select a Fixed Account Option within thirty (30) days of the end of the expired     Fixed Account Option:     a.  if the same option is available at the time and does not extend beyond the Income Date,        the Company will renew You into the same Fixed Account Option.     b.  if the same option is available at the time but extends beyond the Income Date, the        Company will select the available Fixed Account Option that ends closest to but before        the Income Date.     c.  if the same option is not available at the time but would not extend beyond the Income        Date were it available, the Company will select the available Fixed Account Option with        the period closest to but less than the Fixed Account Option that just ended.           Fixed Account Minimum Interest Rate. The Initial Fixed Account Minimum Interest Rate  established on the Issue Date is shown on the Contract Data Pages. The Company will re- determine the Fixed Account Minimum Interest Rate on each Redetermination Date for that  Redetermination Period.    The Fixed Account Minimum Interest Rate on each Redetermination Date will be equal to:  1.  the average of all the daily reported five-year Constant Maturity Treasury Rates during     October of the year then ended, rounded to the nearest 1/20th of one (1) percent;  2.  less 1.25 percentage points;  3.  but never less than 1.00% or greater than 3.00%.    The Fixed Account Minimum Interest Rate is the guaranteed minimum interest rate under the  Contract and may change each year on the Redetermination Date. The Company will send You  notice of the re-determined Fixed Account Minimum Interest Rate annually.    ICC19 VA710                               14 

 

                               WITHDRAWAL PROVISIONS    On or before the Income Date You may request a total or partial withdrawal of the Contract  Value by submitting a request to the Company's Service Center in a form acceptable to the  Company.     Amounts You withdraw from the Contract Value may be subject to Withdrawal Charges. In  addition to Withdrawal Charges, amounts You withdraw from a Fixed Account Option may also  incur an MVA. The Company will adjust the amount You request for withdrawal for any  applicable taxes, charges, including Withdrawal Charges, and MVA.     TOTAL WITHDRAWAL. Upon a total withdrawal, You will receive the Withdrawal Value. The  Withdrawal Value will be determined at the end of the Business Day on which the Company  receives Your withdrawal request in Good Order at the Company's Service Center. If a total  withdrawal is requested, You must submit the Contract to the Company's Service Center. A total  withdrawal terminates Your Contract.    No withdrawal may exceed the Withdrawal Value.    PARTIAL WITHDRAWAL. Any partial withdrawal must be either:  1.  an amount not less than the Minimum partial withdrawal amount shown on the Contract     Data Pages; or  2.  an amount equal to Your entire interest in an Investment Division or a Fixed Account Option.    The amount payable as a result of the partial withdrawal will be determined at the end of the  Business Day on which the Company receives Your request for withdrawal in Good Order at the  Company's Service Center.    Your Contract Value will be reduced by the gross withdrawal amount requested. Unless You  request otherwise, a partial withdrawal will be deducted from each Contract Option in proportion  to its current value. The partial withdrawal will be reduced for any applicable taxes and charges,  including Withdrawal Charges, and then adjusted for any applicable MVA.    At least the Minimum Contract Value remaining after a partial withdrawal, as shown on the  Contract Data Pages, must remain after any partial withdrawal. If the partial withdrawal would  reduce the Contract Value below the Minimum Contract Value remaining after a partial  withdrawal, as shown on the Contract Data Pages, the Company will treat the withdrawal  request as a total withdrawal and the Withdrawal Value will be paid.    QUALIFIED PLAN CONTRACT REQUIRED MINIMUM DISTRIBUTIONS. Qualified Plan  Contract Required Minimum Distributions are based upon Your Contract Value, the value of  any add-on benefits as calculated by the Company, and applicable federal tax law  requirements. You may request a withdrawal for an RMD by submitting a written request to  the Service Center on a Company-provided form.    The Company will waive the Withdrawal Charges if the amount withdrawn does not exceed  the Contract's RMD. However, if a withdrawal amount is greater than the Contract's RMD,  the excess of the partial withdrawal over the Contract's RMD may be subject to Withdrawal  Charges.    ICC19 VA710                               15 

 

                         WITHDRAWAL PROVISIONS (CONT'D)    AUTOMATIC WITHDRAWAL. You may elect to take an automatic withdrawal by withdrawing a  specific sum or a certain percentage of the Contract Value on a monthly, quarterly, semiannual  or annual basis, subject to the Minimum partial withdrawal amount made as a scheduled part of  an automatic withdrawal program, as shown on the Contract Data Pages. Automatic  withdrawals are treated as a partial withdrawal and will be counted in determining the amount  taken as a Free Withdrawal in any Contract Year. Automatic withdrawals in excess of the Free  Withdrawal amount may be subject to Withdrawal Charges and/or MVA. If an automatic  withdrawal causes the Withdrawal Value to fall to zero, future automatic withdrawals will  terminate. If the automatic withdrawal would reduce the Contract Value below the Minimum  Contract Value remaining after a partial withdrawal, as shown on the Contract Data Pages,  the Company will treat the withdrawal request as a total withdrawal and the Withdrawal  Value will be paid.    WITHDRAWAL CHARGE. For purposes of determining the Withdrawal Charge, the Contract  Value is divided into earnings and Remaining Premium, as defined in the Contract. Earnings are  not subject to a Withdrawal Charge. For the sole purposes of determining the amount of the  Withdrawal Charge, earnings are defined as any excess of the Contract Value over Remaining  Premium.     A Withdrawal Charge will be imposed upon certain withdrawals of Remaining Premium. The  Withdrawal Charge will be calculated in accordance with the Withdrawal Charge Schedule  shown on the Contract Data Pages. The Withdrawal Charge is equal to the applicable  Withdrawal Charge Percentage applied to the gross amount of Remaining Premium withdrawn  (not the net amount of Remaining Premium received by You), excluding any amount for which  the Contract expressly provides for waived, or no, Withdrawal Charge. In the event of a total  withdrawal, the applicable Withdrawal Charge Percentage(s) is/are applied to the full value of  Remaining Premium immediately prior to the withdrawal, less any Free Withdrawal available at  the time of the total withdrawal. The Withdrawal Charge reduces Remaining Premium and  Contract Value. The Withdrawal Charge will be taken from the Contract Options in the same  proportion as the requested withdrawal.    Withdrawals will be allocated first to earnings (which may be withdrawn free of any Withdrawal  Charge), if any, and second to Remaining Premium on a first-in, first-out basis so that all  withdrawals will be allocated to Remaining Premium to which the lowest (if any) Withdrawal  Charges apply.    Any portion of the Withdrawal Charge that would reduce the Fixed Account Contract Value  below the Fixed Account Minimum Value will be waived.    FREE WITHDRAWAL. During a Contract Year, You may make partial withdrawals from the  Contract without incurring a Withdrawal Charge or MVA. The amount of Free Withdrawal  available in any Contract Year is equal to:  1.  the Free Withdrawal Percentage, as shown on the Contract Data Pages, multiplied by the     Remaining Premium at the beginning of the Contract Year, that is subject to a Withdrawal     Charge according to the Withdrawal Charge Schedule shown on the Contract Data Pages;     plus  2.  the Free Withdrawal Percentage, as shown on the Contract Data Pages, multiplied by     Premium received during the Contract Year; less  3.  earnings, as defined in the Withdrawal Charge provision of this Contract.   ICC19 VA710                               16 

 

                         WITHDRAWAL PROVISIONS (CONT'D)    The amount of Free Withdrawal is subject to a minimum of zero. The Free Withdrawal can be  taken as a single withdrawal or multiple withdrawals throughout the Contract Year. The amount  of Your Free Withdrawal available will vary throughout the Contract Year depending on previous  withdrawals of Your Free Withdrawal amount, previous withdrawals of earnings, and the amount  of earnings present at the time of the withdrawal. The amount of Your Free Withdrawal available  will reduce due to withdrawals during the Contract Year.    Any amount withdrawn to satisfy an RMD may reduce the amount of Your Free Withdrawal  available.    No Free Withdrawal may exceed the Withdrawal Value.    Amounts withdrawn under the Free Withdrawal provision reduce both the Contract Value and  Remaining Premium. Withdrawals during the Contract Year in excess of the amount of Free  Withdrawal may be subject to any applicable Withdrawal Charges and applicable MVAs.    WAIVER OF WITHDRAWAL CHARGE DUE TO TERMINAL ILLNESS.    If You are diagnosed with a terminal illness on or after the Issue Date shown on the Contract  Data Pages, the Company will waive the Withdrawal Charge on the amount You withdraw from  the Contract, up to the maximum amount shown on the Contract Data Pages. Upon Your  compliance with the Claim Requirements described below, You will be eligible for this waiver on  or after the Eligibility Date shown on the Contract Data Pages.     The Company will allocate the withdrawal amount to each Contract Option according to the  method described in the Withdrawal Provisions. The Company will determine values at the end  of the Business Day on which the Company receives the request for withdrawal in Good Order  at the Company's Service Center. A withdrawal from the Fixed Account Option(s) is subject to  any applicable MVA. Withdrawals under this provision reduce Remaining Premium.    This Waiver of Withdrawal Charge Due to Terminal Illness is available only once, no matter the  amount withdrawn or in the circumstances of multiple medical conditions and/or Joint Owners.    For the purpose of this waiver, the following definitions apply:      Immediate Family - means the individual's spouse/domestic partner, child, brother, sister,     parent or grandparent.         Physician - means an individual who is licensed to practice medicine and treat illness or     injury in the state where treatment is received and who is acting within the scope of his or     her license. The term Physician only refers to a Physician licensed and currently practicing     in the United States or its territories. The term Physician does not include a person who is:     1.  an Annuitant or Joint Annuitant;     2.  an Owner or Joint Owner;     3. a Beneficiary;     4.  a member of the Annuitant's, Joint Annuitant's, Owner's or Joint Owner's Immediate        Family.    ICC19 VA710                               17 

 

                         WITHDRAWAL PROVISIONS (CONT'D)      Physician's Statement - means a written statement signed by a Physician, which:     1.  provides the Physician's diagnosis of Your medical condition; and     2.  declares with reasonable medical certainty and to the Company's reasonable        satisfaction that notwithstanding ordinary and reasonable medical care, advice and        treatment, Your medical condition will result in Your death within twelve (12) months        from the date of the Physician's statement.    Claim Requirements. Your request to the Company must include (1) a completed claim form,  (2) Your signed release for records of all Physicians and institutions that have treated You for  the medical condition You claim, and (3) a Physician's Statement to the Company's Service  Center in Good Order. The Company reserves the right to request additional releases for the  records of any Physician and institution that have provided treatment to You.    The Company will send You a form to claim the Waiver of Withdrawal Charge Due to Terminal  Illness within ten (10) Business Days of the Company's receipt of Your request. If the Company  fails to send the claim form within ten (10) Business Days, You will be deemed to have complied  with the above claim requirements.    Claim Determination. The Company reserves the right to deny Your claim if You do not satisfy  the Claim Requirements. The Company will notify You if the Company denies Your waiver of  Withdrawal Charge for a terminal illness claim, and You will then have the opportunity to submit  a standard withdrawal request subject to any applicable Withdrawal Charges and any applicable  MVA. Termination of the Contract will not prejudice any payment made under the terminal  illness waiver that occurred while this Contract was in force.    YOU MAY OWE TAX ON WITHDRAWALS FOR TERMINAL ILLNESS. THE COMPANY  ENCOURAGES YOU TO SEEK LEGAL AND/OR TAX ADVICE.    WAIVER OF WITHDRAWAL CHARGE FOR EXTENDED CARE.    If You are confined as an inpatient in a Nursing Home or Hospital for ninety (90) consecutive  days starting after the Issue Date shown on the Contract Data Pages, the Company will waive  the Withdrawal Charge on the amount You withdraw from the Contract, up to the maximum  amount shown on the Contract Data Pages. Upon Your compliance with the Claim  Requirements described below, You will be eligible for this waiver on the Eligibility Date shown  on the Contract Data Pages.    The availability of access to guarantees or values is not intended to provide long-term care or  nursing home insurance.    The Company will allocate the withdrawal amount to each Contract Option according to the  method described in the Withdrawal Provisions. The Company will determine values at the end  of the Business Day on which the Company receives the request for withdrawal in Good Order  at the Company's Service Center. A withdrawal from the Fixed Account Option(s) is subject to  any applicable MVA. Withdrawals under this provision reduce Remaining Premium.    This Waiver of Withdrawal Charge for Extended Care is available only once, no matter the  amount withdrawn or in the circumstances of multiple confinements for the same or a different  medical condition and/or Joint Owners.    ICC19 VA710                               18 

 

                         WITHDRAWAL PROVISIONS (CONT'D)    For the purpose of this waiver, the following definitions apply:      Hospital. A facility that:     1.  is located within the United States or its territories;     2.  is operated pursuant to the law;     3.  operates primarily for the inpatient care and treatment of sick and injured persons;     4.  provides continuous twenty-four (24) hour a day nursing service by or under the         supervision of a registered nurse (R.N.);     5.  is supervised by a staff of licensed physicians; and     6.  has its own medical and diagnostic facilities or has access to such facilities on a         prearranged basis.         Immediate Family - means the individual's spouse/domestic partner, child, brother, sister,     parent or grandparent.      Medically Necessary - means consistent with Your diagnosis, in accordance with accepted     standards of medical practice and without which Your medical condition would be adversely     affected.      Nursing Home. A facility that:     1.  is licensed by the appropriate governmental licensing agency as a Nursing Home in the         state in which it maintains such facilities;     2.  is operated pursuant to the law;     3.  charges patients a fee for the care provided;     4.  is primarily engaged in providing nursing care (skilled, intermediate or custodial) by or         under the supervision of a licensed Physician and room and board accommodations;     5.  provides continuous twenty-four (24) hour a day nursing services by or under the         supervision of a registered nurse (R.N.);     6.  has a licensed Physician on premises available to furnish emergency medical care;     7.  maintains a daily medical record of each patient; and     8.  maintains control and records of dispensed medications.      Physician - means an individual who is licensed to practice medicine and treat illness or     injury in the state where treatment is received and who is acting within the scope of his or     her license. The term Physician only refers to a Physician licensed and currently practicing     in the United States or its territories. The term Physician does not include a person who is:     1.  an Annuitant or Joint Annuitant;     2.  an Owner or Joint Owner;     3. a Beneficiary;     4.  a member of the Annuitant's, Joint Annuitant's, Owner's or Joint Owner's Immediate         Family.      Physician's Statement - means a written statement signed by a Physician which provides     the Physician's diagnosis of Your medical condition.    You will be considered confined to a Nursing Home or Hospital only if Your confinement is  prescribed by a Physician and Medically Necessary.    ICC19 VA710                               19 

 

                         WITHDRAWAL PROVISIONS (CONT'D)    Claim Requirements. Ninety (90) days after the date You become confined, Your request to  the Company must include (1) a completed claim form, (2) Your signed release for records of all  Physicians and institutions that have treated You for the medical condition You claim, and (3) a  Physician's Statement to the Company's Service Center in Good Order. The Company reserves  the right to request additional releases for the records of any Physician, Hospital and Nursing  Home that have provided treatment to You.    The Company will send You a form to claim the Waiver of Withdrawal Charge for Extended  Care within ten (10) Business Days of the Company's receipt of Your request. If the Company  fails to send the claim form within ten (10) Business Days, You will be deemed to have complied  with the above claim requirements.    Claim Determination. The Company reserves the right to deny Your claim if You do not satisfy  the Claim Requirements. The Company will notify You if the Company denies Your waiver of  Withdrawal Charge for an extended care claim, and You will then have the opportunity to submit  a standard withdrawal request subject to any applicable Withdrawal Charges and any applicable  MVA. Termination of the Contract will not prejudice any payment made under the extended care  waiver that occurred while this Contract was in force.    YOU MAY OWE TAX ON WITHDRAWALS FOR EXTENDED CARE. THE COMPANY  ENCOURAGES YOU TO SEEK LEGAL AND/OR TAX ADVICE.      ICC19 VA710                               20 

 

                             DEATH BENEFIT PROVISIONS    NATURAL OWNER'S DEATH BEFORE THE INCOME DATE. Upon Your death or the death of  any Joint Owner before the Income Date, the Company will pay the death benefit to the  Beneficiary(ies) designated by You. In the event of the death of a Joint Owner, the surviving  Joint Owner, if any, will be the Primary Beneficiary. Any other Beneficiary designation on record  at the Company's Service Center at the time of death will be treated as a Contingent  Beneficiary.    DEATH BENEFIT AMOUNT BEFORE THE INCOME DATE. The guaranteed minimum death  benefit amount before the Income Date is equal to the greater of:    1.  the current Contract Value; or  2.  all Premiums (net of any applicable tax) paid into the Contract, reduced for any withdrawals     (including any applicable charges and adjustments for such withdrawals). All adjustments for     amounts withdrawn will reduce the death benefit in the same proportion that the Contract     Value was reduced on the date of the withdrawal.    DEATH BENEFIT PAYMENT OPTIONS BEFORE THE INCOME DATE. Unless You  designated a Pre-selected Death Benefit Option, a Beneficiary entitled to the death benefit  before the Income Date must request that the Company pay the death benefit according to one  of the death benefit payment options below:    Option 1 - single lump-sum payment;  Option 2 - payment of the entire death benefit distributed within five (5) years of the date of the            relevant death; or  Option 3 - Income Payments of the death benefit (i) over the lifetime of the Beneficiary, or (ii)           over a period not extending beyond the life expectancy of the Beneficiary, with           distribution beginning within one (1) year of the date of the relevant death.    The Company may make available other death benefit payment options.    A Beneficiary that wishes to elect payment under the life income option (Option 3) must do so  no later than sixty (60) days from the date the Company receives Due Proof of death in Good  Order at the Company's Service Center.    Any portion of the death benefit not applied under the life income option (Option 3) must be paid  within five (5) years from Your death. The death benefit will remain invested in accordance with  the allocation selected by You until a payout option is selected or the Beneficiary specifies  otherwise.    ANNUITANT'S DEATH BEFORE THE INCOME DATE. Upon the death of an Annuitant who is  not an Owner before the Income Date, the Contract remains in force and the Owner becomes  the Annuitant. The Owner may designate a new Annuitant, subject to the Company's  administrative rules then in effect. However, if the Contract is owned by a legal entity, upon the  death of any Annuitant, the Company will pay the death benefit to the Beneficiary(ies)  designated by the Owner, or, if no Beneficiary(ies) survive the applicable death, to the Owner.      ICC19 VA710                               21 

 

                       DEATH BENEFIT PROVISIONS (CONT'D)    BENEFICIARY'S ENTITLEMENT TO DEATH BENEFIT BEFORE THE INCOME DATE. The  Company will pay the death benefit to Primary Beneficiaries or, if none exist, to Contingent  Beneficiaries, in equal shares (the "default allocation") unless You have designated otherwise  (the "designated allocation"). A Beneficiary that dies before or within ten (10) days (or different  period as prescribed by applicable law) of Your death is not entitled to any death benefit. In that  circumstance, the Company will pay the deceased Beneficiary's benefit to surviving  Beneficiaries in the same proportion as the designated allocation or, if applicable, the default  allocation. If no Beneficiary survives You, the Company will pay the death benefit to Your estate.    PAYMENT OF DEATH BENEFIT PROCEEDS. The Company will pay the death benefit  proceeds to the Beneficiary upon receipt of a request for payment with Due Proof of death in  Good Order at the Company's Service Center. If the Company has received Due Proof of death,  the Company will calculate the share of the death benefit due to a Beneficiary using Contract  values established at the end of the Business Day on the date the Company receives from that  Beneficiary a claim form with a payment option elected. If the Company has not received Due  Proof of death or any other required documentation, the Company will calculate the share of the  death benefit due to a Beneficiary using Contract values established at the end of the Business  Day on the date the Company receives any remaining required documentation. As a result,  market fluctuation may cause the calculation of a Beneficiary's death benefit share to differ from  the calculation of another Beneficiary's death benefit share. We will pay interest on a  Beneficiary's death benefit share as required by law.    Each Beneficiary entitled to the death benefit bears the investment risk associated with amounts  allocated to any Investment Division until the Company calculates their share of the death  benefit.    If any death benefit proceed is due to an Owner's estate, the Company will pay it in a single  lump-sum payment.    With the exception of death benefit Option 3 above, the Company will pay a Beneficiary that  elects a death benefit option within seven (7) calendar days of the date the Company receives  request for payment, provided the Company has received Due Proof of death in Good Order at  the Company's Service Center, unless the Suspension of Separate Account Payments provision  is in effect.    If the Company does not distribute death benefit proceeds within seven (7) calendar days, the  death benefit proceeds will include interest accrued and payable from the eighth day following  the date that Due Proof of death was received in Good Order at the Company's Service Center  until the death benefit is paid. The rate of interest will equal the rate of interest applicable to  death benefit proceeds left on deposit with the Company on the date of Your death.    If the Company does not distribute the death benefit payment within thirty (30) calendar days of  the latest of the dates specified in items 1, 2, and 3 below, then beginning on the thirty-first  calendar day from the latest of the dates specified in items 1, 2, and 3 below until the date the  claim is paid, the death benefit will accrue additional interest at a rate of 10% annually.    ICC19 VA710                               22 

 

                       DEATH BENEFIT PROVISIONS (CONT'D)    1.  The date the Company receives Due Proof of death;  2.  the date the Company receives sufficient information to determine liability, the extent of the     liability, and the appropriate payee legally entitled to the proceeds; and  3.  the date that legal impediments to payment of proceeds that depend on the action of parties     other than the Company are resolved and sufficient evidence of the same is provided to the     Company. Legal impediments to payment include, but are not limited to, (a) the     establishment of guardianships and conservatorships; (b) appointment and qualification of     trustees, executors and administrators; and (c) submission of information required to satisfy     state and federal reporting requirements.    Spousal Continuation Option Instead of Death Benefit. Unless the Contract is subject to a  Pre-selected Death Benefit Option, a spouse who is a Joint Owner or Beneficiary of the  deceased Owner, may elect to continue the Contract in his or her own name and exercise the  Owner's rights under the Contract instead of taking the standard death benefit.    For purposes of the Spousal Continuation Option, the "continuation date" is the date on which  the Company receives the spouse's written request to elect the Spousal Continuation Option  and Due Proof of the relevant death in Good Order at the Company's Service Center.    If the Contract Value on the continuation date is less than the death benefit, an amount will be  added to the Contract Value to make up the difference. This amount is referred to as the  continuation adjustment. The Company will allocate the continuation adjustment to the Contract  Options based on the current allocation rules for the Contract. The continuation adjustment will  have no effect on the Fixed Account Minimum Value. Withdrawal Charges will continue with the  same schedule as prior to the original Owner's death. However, no Withdrawal Charge will  apply to the continuation adjustment.    For purposes of determining the future death benefits for the surviving spouse under the  continuing Contract, the Contract Value following the application of any continuation adjustment  will be considered the initial Premium of the continuing Contract.    The Spousal Continuation Option is void in the event the original Contract Owner is no longer  the Contract Owner or in the event the Contract has been assigned. This Spousal Continuation  Option may be exercised only once, and may not be available if You designated a Pre-selected  Death Benefit Option.    Pre-selected Death Benefit Option. Before the Income Date, You may designate the option  according to which the Company will pay the death benefit from the death benefit payment  options described in the Contract, or other death benefit payment options made available by the  Company. You may do so by submitting a designation in a form acceptable to the Company in  Good Order to the Company's Service Center. Pre-selected Death Benefit Options are effective  only after being recorded by the Company. The Company will pay the death benefit consistent  with Your Pre-selected Death Benefit Option unless the Internal Revenue Code requires  otherwise, or Your election requires payment over a period that exceeds the Beneficiary's life  expectancy.    Only You may revoke or change a Pre-selected Death Benefit Option. To do so, You must  submit a request in a form acceptable to the Company to the Company's Service Center.  Revocations of and changes to a Pre-selected Death Benefit Option are effective only after  being recorded by the Company.   ICC19 VA710                               23 

 

                                   INCOME PROVISIONS    INCOME DATE. The Income Date is the date, not less than one (1) year after the Contract's  Issue Date, on which Income Payments will begin. If You do not select an Income Date, the  Income Date is the Latest Income Date. You may change the Income Date to any date that is  not later than the Latest Income Date by submitting Written Notice in Good Order to the  Company's Service Center at least seven (7) days before the Income Date.    INCOME PAYMENT. On or before the Income Date, You can elect payment in a single lump- sum. A single lump-sum payment is considered a total withdrawal and terminates the Contract.  The Company will make payment to You or another payee You specify. Alternatively, You may  elect an Income Option. The Company will apply the Contract Value, less any applicable taxes,  MVA, and other Contract charges, to provide You Fixed Annuity Payments or Variable Annuity  Payments according to Your selected Income Option. If You do not choose how to receive Your  Income Payments, Your Income Payments will be Variable Annuity Payments.    Income Options. You may elect payment as provided in Options 1, 2, 3 or 4 below. You may  elect an Income Option at any time before the Income Date and You can change an Income  Option up to seven (7) days before the Income Date by submitting Written Notice in Good Order  to the Company's Service Center.    If You do not select an Income Option, the Company will make payments as provided in Option  3 below, with 120 months certain. The Company will make payments monthly, quarterly,  semiannually or annually as You elect. However, if the Contract Value on the Income Date is  less than $2,000, the Company may pay out the Contract Value in one (1) lump-sum payment  instead of providing Income Payments according to the Income Option You elect. If the first  monthly payment provided would be less than $20, the Company may make payments  quarterly, semiannually or annually to achieve an initial payment of at least $20, or the  Company may pay out the Contract Value in one (1) single lump-sum payment.    At the time of their commencement, Income Payments will not be less than those that would be  provided by the application of an equivalent amount to purchase a single premium immediate  annuity contract from the Company at purchase rates the Company offered on the Income Date  to annuitants in the same class as the Annuitant.    YOU MAY NOT TAKE WITHDRAWALS DURING ANY PERIOD THE COMPANY IS MAKING  PAYMENTS FOR AN ANNUITANT'S LIFETIME.    OPTION 1 - LIFE INCOME. A monthly payment for the Annuitant's lifetime. All payments end  upon the Annuitant's death. However, in the event of the Annuitant's death before the first  monthly payment, the Company will pay the amount allocated to this Income Option to You or, if  You are deceased, to Your Beneficiary. No MVA applies to Contract Value applied to Option 1.    ICC19 VA710                               24 

 

                            INCOME PROVISIONS (CONT'D)    OPTION 2 - JOINT AND SURVIVOR INCOME. A monthly payment for the longer of the  Annuitant's lifetime or that of a second person You designate. Upon the occasion of the first  person to die, monthly payments continue during the survivor's lifetime at either the full amount  previously payable or as a percentage (either one-half or two-thirds) of the full amount, as You  select at the time You elect the Income Option. If reduced Income Payments to the survivor are  desired, the Company will calculate Variable Annuity Payments using either one-half or two- thirds of the number of Annuity Units for each Investment Division comprising the Variable  Annuity Payments payable during the joint life of the Annuitant and the designated second  person. The Company will calculate Fixed Annuity Payments equal to either one-half or two- thirds of the Fixed Annuity Payment payable during the joint life of the Annuitant and the  designated second person.    All payments end upon the death of the last surviving Annuitant. However, in the event of the  deaths of the Annuitant and the designated second person before the first monthly payment, the  Company will pay the amount allocated to this Income Option to You or, if You are deceased,  Your Beneficiary. No MVA applies to Contract Value applied to Option 2.      OPTION 3 - LIFE INCOME WITH 120 OR 240 MONTHLY PAYMENTS GUARANTEED. A  monthly payment for the Annuitant's lifetime with the guarantee that the Company will make no  fewer than 120 or 240 monthly payments to You. If the Owner is an entity, at the Annuitant's  death, if fewer than the guaranteed number of payments have been made, the remaining  guaranteed payments will be made to the Owner as previously scheduled. If the Owner is the  Annuitant, in the event You die before the Company makes the specified number of guaranteed  payments, Your Beneficiary may elect to continue to receive the Income Payments according to  the terms of this Contract, or alternatively may elect to receive the present value of any  remaining guaranteed payments in a single lump-sum payment. The present value of any  remaining guaranteed payments will be based on the total Income Payments as of the date of  the calculation. The Company will determine the interest rate used in this present value  calculation, but in no instance will it be greater than (one) 1 percentage point higher than the  rate used to calculate the initial Income Payment. No MVA applies to Contract Value applied to  Option 3.    OPTION 4 - INCOME FOR A SPECIFIED PERIOD. A monthly payment for any whole number  of years ranging from 5 to 30. In the event You die before the Company makes the specified  number of payments, Your Beneficiary may elect to continue to receive the Income Payments  according to the terms of this Contract, or alternatively may elect to receive the present value of  any remaining guaranteed payments in a single lump-sum payment. The present value of any  remaining guaranteed payments will be based on the total Income Payments as of the date of  the calculation. The Company will determine the interest rate used in this present value  calculation, but in no instance will it be greater than (one) 1 percentage point higher than the  rate used to calculate the initial Income Payment. No MVA applies to Contract Value applied to  payments spread over five (5) years or more under Option 4.    ADDITIONAL INCOME OPTIONS. The Company may make available other Income Options.    ICC19 VA710                               25 

 

                            INCOME PROVISIONS (CONT'D)    FIXED ANNUITY PAYMENTS. The Company will determine Fixed Annuity Payments by  applying annuity rates consistent with the age and sex (unless unisex rates apply) of the  Annuitant and, if applicable, the designated second person, to the portion of the Contract Value  allocated to the Fixed Annuity Payment options, less any applicable taxes and other Contract  charges. Annuity rates applied will not be less than the rates provided in the Contract's Table of  Income Options.    Once begun, the Company will not change the amount of the Fixed Annuity Payments, except  upon the first death between the Annuitant and the designated second person under Option 2.    VARIABLE ANNUITY PAYMENTS. The Company will determine the initial Variable Annuity  Payment by applying annuity rates consistent with the age and sex (unless unisex rates apply)  of the Annuitant and, if applicable, the designated second person, to the portion of the Contract  Value allocated to the Variable Annuity Payment options, less any applicable taxes and other  Contract charges. Annuity rates applied will not be less than the rates provided in the Contract's  Table of Income Options.    The Company will determine the second and subsequent Variable Annuity Payments in two (2)  steps. First, the Company will divide the initial Variable Annuity Payment by the Annuity Unit  Value calculated on the Income Date to establish a number of Annuity Units. Second, the  Company will multiply that number of Annuity Units by the Annuity Unit Value determined on the  Business Day next preceding the date on which each payment is due. The result of each  calculation determines the Variable Annuity Payment due.    Once Variable Annuity Payments have begun, the number of Annuity Units remains constant  absent a reallocation between the Investment Divisions. Variable Annuity Payments are not  affected by expenses other than taxes.    The Contract Data Pages specify the minimum investment return Your Investment Division(s)  must earn to avoid a decrease in the dollar amount of Variable Annuity Payments.    Annuity Unit Value. The Company sets the initial value of an Annuity Unit of each Investment  Division when the Company establishes the Investment Division. The Annuity Unit Value  reflects the investment performance of an Investment Division and may increase or decrease  from one Business Day to the next. The Contract's Table of Income Options assumes the net  investment rates described in the Contract's Basis of Computation provision. Therefore, if an  Investment Division's actual net investment rate is greater than or less than the assumed net  investment rate, Variable Annuity Payments will increase or decrease accordingly over time.    The Company calculates each Investment Division's Annuity Unit Value for any Business Day in  two (2) steps:    First, the Company multiplies the immediately preceding Business Day's Annuity Unit Value by  the Business Day's "net investment factor" determined on the day of the calculation. The  Company determines the "net investment factor," which reflects changes in the Investment  Division's net asset value, by dividing the value established at (1) below by the value  established at (2) below, and then subtracting the value established at (3) below, where:    ICC19 VA710                               26 

 

                            INCOME PROVISIONS (CONT'D)    (1)  Is the net result of:      a.  the Investment Division's net asset value at the end of the Business Day; plus      b.  the per share amount of any dividend or other distribution declared by the Investment         Division if the "ex-dividend" date occurs on the Business Day; plus or minus      c.  a per share credit or charge with respect to any taxes paid or reserved for by the         Company which are determined by the Company to be attributable to the operation of         the Investment Division (no federal income taxes are applicable under present law); and  (2)  Is the Investment Division's net asset value at the end of the preceding Business Day; and  (3)  Is the asset charge factor the Company determines for the Business Day to reflect the      applicable Core Contract Charge.    Second, the Company multiplies the result from the first step above by a factor equal to the ratio  of one over one plus the assumed net investment rate, raised to the number of calendar days  between the previous Business Day and the current Business Day over the number of calendar  days in the current year. The factor is expressed formulaically as follows:                                                   &#0;                                           1    &#0;                                       &#0;       &#0;                                          1 &#0;   where:    AIR  is   the assumed net investment rate.  t     is  the number of calendar days between the previous Business Day and the current            Business Day.  y     is  the number of calendar days in the current year.    NATURAL OWNER'S DEATH AFTER THE INCOME DATE. Upon Your death or the death of  any Joint Owner, who is not also an Annuitant, after the Income Date, remaining Income  Payments due continue as before. Upon Your death after the Income Date, the Beneficiary  becomes the Owner.    ANNUITANT'S DEATH AFTER THE INCOME DATE. Upon the death of the Annuitant after the  Income Date, the death benefit, if any, will be as specified in the Income Option elected. Death  benefits will be paid at least as rapidly as under the method of distribution in effect at the  Annuitant's death.    BENEFICIARY'S ENTITLEMENT TO INCOME PAYMENTS AFTER THE INCOME DATE.  Upon Your death or the death of any Joint Owner, the Company will pay remaining Income  Payments due to Primary Beneficiaries or, if none exist, to the Contingent Beneficiaries, in equal  shares (the "default allocation") unless You have designated otherwise (the "designated  allocation"). A Beneficiary that dies before or within ten (10) days (or different period as  prescribed by applicable law) of Your death is not entitled to any remaining Income Payments  due; in that circumstance, the Company will pay remaining Income Payments due the deceased  Beneficiary to surviving Beneficiaries in the same proportion as the designated allocation or, if  applicable, the default allocation. If no Beneficiary survives You, the Company will pay  remaining Income Payments to Your estate.    ICC19 VA710                               27 

 

                                TERMINATION PROVISION    This Contract terminates and all Contract benefits, including those provided by any add-on  benefits unless otherwise specified in the add-on benefits, will end on the earlier of:  1.  the date You take a total withdrawal;  2.  the date the Contract Value is reduced to zero for any reason or insufficient to pay Contract     charges; or  3.  the date upon which the Company receives Due Proof of Your (or any Joint Owner's) death     and receives all Beneficiaries' elections of death benefit payment options in Good Order at     the Company's Service Center, unless the Contract is continued by the spouse under the     Spousal Continuation Option.    ICC19 VA710                               28icc19va720jacksonadvanta

   Home  Office:              Service Center:  1 Corporate Way            P.O. Box 24068  Lansing,  Michigan 48951   Lansing, MI 48909-4068                             1-800-644-4565                             www.jackson.com                               Jackson National Life Insurance Company®      Thank you for choosing Jackson National Life Insurance Company, also referred to as "the Company" or   "Jackson®."                                  READ YOUR CONTRACT CAREFULLY.    This annuity contract is issued by the Company and is a legal agreement between the Owner ("You") and  Jackson.    AMOUNTS YOU ALLOCATE TO THE INVESTMENT DIVISIONS ARE NOT GUARANTEED AND MAY  INCREASE OR DECREASE IN VALUE BASED UPON THE PERFORMANCE OF THE UNDERLYING MUTUAL  FUNDS.    THE COMPANY WILL RE-DETERMINE THE CONTRACT'S FIXED ACCOUNT MINIMUM INTEREST RATE  EACH JANUARY ON THE REDETERMINATION DATE.    THE FIXED ACCOUNT OPTIONS ARE SUBJECT TO A MARKET VALUE ADJUSTMENT WHICH MAY  INCREASE OR DECREASE THE VALUE OF AMOUNTS TRANSFERRED, WITHDRAWN OR ANNUITIZED  FROM THE FIXED ACCOUNT OPTIONS, BUT THE FIXED ACCOUNT CONTRACT VALUE WILL NEVER  DECREASE TO LESS THAN THE FIXED ACCOUNT MINIMUM VALUE.    THE COMPANY MAY RESTRICT FUTURE PREMIUM PAYMENTS, WHICH WOULD LIMIT YOUR ABILITY TO  INVEST IN THE CONTRACT AND COULD AFFECT THE VALUE OF YOUR CONTRACT AND ITS BENEFITS.    NOTICE OF RIGHT TO EXAMINE CONTRACT  YOU MAY RETURN THIS CONTRACT TO THE FINANCIAL PROFESSIONAL WHO SOLD YOU THE  CONTRACT OR THE COMPANY NO LATER THAN 10 DAYS AFTER YOU RECEIVE IT (30 DAYS AFTER YOU  RECEIVE IT IF YOU PURCHASED THE CONTRACT AS A REPLACEMENT CONTRACT). THE COMPANY  WILL REFUND THE FULL PREMIUM ALLOCATED TO THE FIXED ACCOUNT OPTIONS LESS ANY  WITHDRAWALS FROM THE FIXED ACCOUNT OPTIONS, PLUS THE SEPARATE ACCOUNT CONTRACT  VALUE, WITHOUT DEDUCTION FOR ANY FEES AND CHARGES, CALCULATED ON THE BUSINESS DAY  ON WHICH THE COMPANY RECEIVES THE CONTRACT AT ITS SERVICE CENTER. RETURNED  CONTRACTS ARE VOID.    Please Note: The Company reserves the right to allocate all Premium received during the "Notice of Right to  Examine Contract" period to a money market Investment Division or the Fixed Account. After the "Notice of Right  to Examine Contract" period expires, the Company will allocate the Contract Value to the Contract Options You  have specified.    The Telephone Number for the Michigan Department of Insurance is 877-999-6442.                                                              This Contract is signed by the Company INDIVIDUAL DEFERRED VARIABLE AND FIXED  ANNUITY CONTRACT WITH MARKET VALUE                                           ADJUSTMENT. (FLEXIBLE PREMIUM).  DEATH BENEFIT AVAILABLE.  INCOME OPTIONS AVAILABLE.  NONPARTICIPATING.                                                                                         President  CONTAINS PROVISIONS THAT   WAIVE WITHDRAWAL CHARGES.                                                                                           Secretary      ICC19 VA720  

 

                                  TABLE OF CONTENTS                        Provision                                 Page Number                   Contract Data Pages                                          3a                   Definitions 4                   General Provisions                                             8                   Accumulation Provisions                                      13                   Withdrawal Provisions                                        15                   Death Benefit Provisions                                     21                   Income Provisions                                            24                   Termination Provision                                        28    If You have questions about this Contract or require information about coverage or complaint  resolutions, You may contact the Company's Service Center identified on the Contract's cover  page.      ICC19 VA720                                2 

 

                               CONTRACT DATA PAGES     Contract Number:                       1234567890       Owner: John Doe       Owner Issue Age:                       35       Joint Owner:                           Jane Doe       Joint Owner Issue Age:                 35       Annuitant: John Doe       Annuitant Issue Age:                   35       Joint Annuitant:                       Jane Doe       Joint Annuitant Issue Age:             35       Initial Premium:                       $50,000       Issue Date:                            May 1, 2020       Issue State:                           MI       Income Date:                           May 1, 2080       Primary Beneficiary(ies):              Brian Doe       Contingent Beneficiary(ies):           Mary Doe                                          ICC19 VA720-CB1                           3a 

 

                         CONTRACT DATA PAGES (CONT'D)    FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION:    Initial Fixed Account Minimum Interest Rate: 1.00%  The Company will re-determine the Fixed Account Minimum Interest Rate each January on the  Redetermination Date. The Fixed Account Minimum Interest Rate is the guaranteed minimum  interest rate under the Contract and may change each year on the Redetermination Date.    Initial Base Interest Rate:           1.00% for the 1-Year Fixed Account Option Period                                        1.00% for the 3-Year Fixed Account Option Period                                        1.00% for the 5-Year Fixed Account Option Period                                        1.00% for the 7-Year Fixed Account Option Period    Fixed Account Minimum Value Percentage: 87.5%    Fixed Account Minimum Value Annual Expense Allowance: $50    Interest Rate for Adjustments Due to Misstatement of Age or Sex: 1.00%    Annual Contract Maintenance Charge: $35  The Company will deduct the Annual Contract Maintenance Charge from the Contract Value  (but not the Remaining Premium) on each Contract Anniversary that occurs on or before the  Income Date or when You withdraw the Contract Value in full on a date other than a Contract  Anniversary. The Company will only deduct the Annual Contract Maintenance Charge from  Contracts with a Contract Value less than $50,000.    Core Contract Charge: 0.9500%  The Core Contract Charge is expressed as an annual percentage and is deducted daily from  the Separate Account Contract Value (but not the Remaining Premium). The Company will  reduce the Core Contract Charge to 0.8500% if the Contract Value on the later of the Issue  Date or the most recent Contract Quarterly Anniversary is greater than or equal to $1,000,000. If  the Contract Value subsequently falls below $1,000,000 on any Contract Quarterly Anniversary,  the Company will reinstate the charge of 0.9500% for the following Contract Quarter.    Total Asset-Based Charges: 0.9500%  The Total Asset-Based Charges are expressed as an annual percentage and are deducted daily  from the Separate Account Contract Value (but not the Remaining Premium). The Company will  deduct asset-based charges daily as part of the Accumulation Unit Value calculation. Total  Asset-Based Charges include the Core Contract Charge and asset-based charges for add-on  benefits.    Transfer Charge: $25  The Company allows 25 free transfers between Contract Options in a Contract Year. The  Company charges a fee for each transfer You make in excess of the 25 free transfers in any  Contract Year. The Company deducts Transfer Charges from the amount You seek to transfer  before allocation to the new Contract Option. The Company does not assess Transfer Charges  on transfers under any of the Company's systematic investment programs, and the Company  does not count those transfers against the 25 free transfers allowed in a Contract Year. Free  transfers not utilized during a given Contract Year cannot be carried forward to subsequent  Contract Years.   ICC19 VA720-CB1                           3b  

 

                         CONTRACT DATA PAGES (CONT'D)    FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION (continued):    Add-on Benefit Charges:  If applicable, refer to the supplemental contract data pages of any attached add-on benefits for  additional charges and fees associated with Your Contract.    WITHDRAWALS:    Withdrawal Charge Schedule:              Completed Years Since                         Withdrawal Charge              Receipt of Premium                             Percentage                       0 8.50%                       1 7.50%                       2 6.50%                       3 5.50%                       4 5.00%                       5 4.00%                       6 2.00%                      7+ 0.00%    For Owners age 86 or older, upon a partial or total withdrawal, the Withdrawal Charge  Percentage will be the lesser of the Withdrawal Charge Percentage indicated above or the  Maximum Withdrawal Charge Percentage listed below. In either case, the Withdrawal Charge  Percentage will decrease with each year until it no longer applies.          Contract Anniversary on or after                Maximum Withdrawal           Owner Attains the Age of:                     Charge Percentage                      86 7.25%                      87 6.50%                      88 5.50%                      89 4.50%                      90 3.75%                      91 2.75%                      92 1.75%                      93 0.75%                      94+ 0.00%    Please see Withdrawal Provisions for a complete explanation of the determination of Withdrawal  Charges.    Minimum partial withdrawal amount unless as a scheduled part of an automatic  withdrawal program: $500    Minimum partial withdrawal amount as a scheduled part of an automatic withdrawal  program: $50    Minimum Contract Value remaining after a partial withdrawal: $2,000    Free Withdrawal Percentage: 10%   ICC19 VA720-CB1                           3c 

 

                         CONTRACT DATA PAGES (CONT'D)    WITHDRAWALS (continued):    Waiver of Withdrawal Charge Due to Terminal Illness  Eligibility Date:                                                  May 1, 2021    Waiver of Withdrawal Charge Due to Terminal Illness Maximum Amount: 100% of the  Contract Value, not to exceed $250,000    Waiver of Withdrawal Charge for Extended Care  Eligibility Date:                                                  May 1, 2021    Waiver of Withdrawal Charge for Extended Care Maximum Amount: 100% of the Contract  Value, not to exceed $250,000    MARKET VALUE ADJUSTMENT (MVA):    An MVA is a positive or negative adjustment the Company applies to amounts You remove from  a Fixed Account Option due to withdrawals, transfers or annuitizations.    The MVA reflects the movement in the Base Interest Rate since the date of Your allocation to  the Fixed Account Option from which You remove Fixed Account Contract Value, which is  valued over the number of months remaining in the Fixed Account Option period.    The MVA may:  1.  reduce the value of the amount paid, transferred or annuitized if the Base Interest Rate on     the date You remove Fixed Account Contract Value from a Fixed Account Option is greater     than the Base Interest Rate on the date of Your allocation to that Fixed Account Option; or  2.  increase the value of the amount paid, transferred or annuitized if the Base Interest Rate on     the date You remove Fixed Account Contract Value from a Fixed Account Option is less     than the Base Interest Rate on the date of Your allocation to that Fixed Account Option.    The Company applies the same MVA formula regardless of whether the formula results in an  increase or decrease to amounts You remove from a Fixed Account Option.    The Company applies the MVA formula to the amount You remove less any applicable charges.    ICC19 VA720-CB1                           3d 

 

                         CONTRACT DATA PAGES (CONT'D)    MVA (continued):    MVA formula. The Company calculates the MVA by multiplying the amount You remove from a  Fixed Account Option by the result of the formula below:                                            (m/12)                                       [1+I ]                                                        -1                                              (m/12)                                  [1+J  +.0025]             where:    I  is  the Base Interest Rate the Company credits to the Fixed Account Option from which You         are removing Fixed Account Contract Value.  J  is  the Base Interest Rate the Company credits on new allocations to Fixed Account         Options of the same period on the date You remove Fixed Account Contract Value from         a Fixed Account Option. If the Company does not offer such a Fixed Account Option on         the date of the removal, the Company will establish "J" by straight-line interpolation         between the two (2) Fixed Account Options with durations closest to the duration of the         Fixed Account Option from which You are removing Fixed Account Contract Value.  m  is  the number of complete months remaining from the date of the removal to the end of the         period of the Fixed Account Option from which You are removing Fixed Account         Contract Value.    The Company makes no MVA when J is less than I by 0.0025 or less.    In no event will a total withdrawal from a Fixed Account Option be less than the Fixed Account  Minimum Value.    Amounts You remove from a Fixed Account Option no more than thirty (30) days following the  end of the Fixed Account Option period are not subject to an MVA. The Company will mail You  Written Notice at least fifteen (15) but not more than forty-five (45) days before the end of any  Fixed Account Option period to which You have allocated Contract Value.     The Company will not apply an MVA to:  1.  death benefit proceeds;  2.  payment of charges or fees;  3.  amounts You allocate to an Income Option that is life contingent or results in payments     spread over at least five (5) years;  4.  exercise of Your Notice of Right to Examine Contract provision;  5.  withdrawals taken under the Free Withdrawal provision;  6.  amounts You remove from the 1-Year Fixed Account Option;  7.  amounts You remove from any Fixed Account Option on the Latest Income Date; or  8.  amounts You remove from any Fixed Account Option in the 30-day period following the end     of a Fixed Account Option.     Unavailability of Base Interest Rate. In the event that the Base Interest Rate cannot be  determined on the date You remove Fixed Account Contract Value from a Fixed Account  Option, the Company may substitute a comparable index subject to approval by the Interstate  Insurance Product Regulation Commission (IIPRC). In this case, the Company will base the  values of I and J on the substitute index. The Company will notify You and any assignee before  using a substitute rate or index to calculate the MVA. If an index is substituted for the Base  Interest Rate a 0.0025 adjustment to J in the MVA formula will not be applied. ICC19 VA720-CB1                           3e 

 

                         CONTRACT DATA PAGES (CONT'D)    TRANSFERS:    Transfer among Investment Divisions. At any time, You may transfer all or a portion of Your  Contract Value in any Investment Division to any available Investment Division(s).    Transfer from an Investment Division to a Fixed Account Option. Before the Income Date,  You may transfer all or a portion of Your Contract Value in an Investment Division to any  available Fixed Account Option(s) unless the Company has restricted this type of transfer.    Transfer from a Fixed Account Option to an Investment Division or to a Fixed Account  Option. Before the Income Date, You may transfer all or a portion of Your Contract Value in a  Fixed Account Option, subject to any applicable MVA, to any available Investment Division(s) or  any available Fixed Account Option(s) unless the Company has restricted this type of transfer.    Transfer Effective Date: Transfers You request will be effective as of the end of the Business  Day upon which the Company receives Your transfer request in Good Order at the Company's  Service Center.    Additional details on transfer restrictions are outlined in the Transfer of Funds Restrictions  section of the General Provisions.    PREMIUM(S):   This is a flexible Premium Contract. You may change the amount, frequency and timing of  Premium payments, subject to the minimum and maximum Premium payment amounts and the  Company's reserved rights specified below. The Company may waive the minimums or  maximums at any time.    Minimum Initial Premium for Non-Qualified Plan Contract: $50,000    Minimum Initial Premium for Qualified Plan Contract: $50,000    Minimum Subsequent Premium: $500 ($50 if made as a scheduled part of an automatic  payment plan)    Maximum Total Premium under a Contract: $2,500,000    Minimum Amount Allocated to an Investment Division or Fixed Account Option: $100    The Company reserves the right to limit, restrict, suspend or reject any or all subsequent  Premium payments. The Company will send You Written Notice at least thirty (30) days in  advance of any such limitation, restriction, suspension or rejection.    The Company reserves the right to restrict or reject any allocation of Premium to a Fixed  Account Option(s) at any time. The Company will allocate any Premium payment subsequent to  issue according to Your most recent instructions on file with the Company, provided that each  allocation complies with the Company's then current minimum amounts and restrictions.    ICC19 VA720-CB1                           3f 

 

                         CONTRACT DATA PAGES (CONT'D)    PREMIUM(S) (continued):    The Company reserves the right to require that amounts You allocate to the 1-Year Fixed   Account Option be automatically transferred to the Investment Division(s) of Your choice, in  scheduled installments over a period that the Company shall specify. The scheduled transfers  will continue until such time that all amounts in the 1-Year Fixed Account Option have been  transferred out. These automatic transfers will not count against the 25 free transfers the  Company allows in a Contract Year. You may change the Investment Division(s) You select at  any time.    Minimum Contract Value to Participate in the Enhanced Interest Rate Dollar Cost  Averaging Program: $15,000    Minimum Investment Return to Avoid Decrease in Variable Annuity Payments: The  minimum investment return which the Investment Division(s) must earn so that the dollar  amount of Variable Annuity Payments will not decrease is 1.95%. This quantity is equal to the  assumed net investment rate specified in the Basis of Computation section of the Contract Data  Pages plus the Core Contract Charge shown on the Contract Data Pages. Variable Annuity  Payments are further described under the Income Provisions.    CONTRACT OPTIONS:    Investment Divisions: Available Investment Division(s) are identified in the current prospectus  and any supplements. The Company may offer new Investment Divisions, or eliminate,  substitute, or combine Investment Divisions.    Separate Account: Jackson National Separate Account - I    Fixed Account Options: 1-Year Period; 3-Year Period; 5-Year Period; and 7-Year Period; the  availability of each option will be determined by the Company.    Available Fixed Account Options are identified in the current prospectus and any supplements.    Maximum Contract Option Allocations Allowed: The number of allocations to the Contract  Options may not exceed 99 at any one time.    The Company will identify the Contract Options You select in a confirmation the Company  sends You on or after the Issue Date.    ICC19 VA720-CB1                           3g 

 

                                                                     CONTRACT DATA PAGES (CONT'D)                                                                     TABLE OF INCOME OPTIONS                          The following table shows income values for each $1,000 of net proceeds applied to the Income             Option.                UNDER OPTION 4                                               MONTHLY INSTALLMENTS UNDER OPTIONS 1 OR 3                                                                                                                                                                   Age of                         Age of                            Age of                          Age of                   No. of   Monthly   Annui-       No. of Mos.       Annui-        No. of Mos.         Annui-        No. of Mos.       Annui-           No. of Mos.  Monthly    Install-  tant          Certain          tant           Certain            tant           Certain          tant             Certain   Install-  ments   ments                       Male Life 120 240 Male                  Life    120 240 Female Life 120 240 Female Life                             120      240     60 17.09 40 2.33 2.32 2.31 68 4.72 4.57 4.02                                       40      2.22 2.22 2.21           68      4.36     4.26      3.86     72 14.31 41 2.37 2.36 2.35 69 4.90 4.72 4.09                                       41      2.26 2.26 2.25           69      4.52     4.40      3.94     84 12.33 42 2.41 2.41 2.39 70 5.09 4.89 4.16                                       42      2.30 2.30 2.29           70      4.69     4.55      4.02     96 10.84 43 2.45 2.45 2.43 71 5.31 5.06 4.23                                       43      2.34 2.34 2.32           71      4.87     4.70      4.09    108 9.68 44 2.50 2.50 2.47 72 5.54 5.24 4.29                                        44      2.38 2.38 2.36           72      5.06     4.87      4.16    120 8.76 45 2.55 2.54 2.52 73 5.79 5.43 4.34                                        45      2.42 2.42 2.40           73      5.28     5.04      4.22    132 8.00 46 2.60 2.59 2.56 74 6.06 5.63 4.39                                        46      2.47 2.47 2.45           74      5.51     5.23      4.28    144 7.37 47 2.65 2.64 2.61 75 6.35 5.83 4.43                                        47      2.52 2.51 2.49           75      5.76     5.42      4.34    156 6.84 48 2.71 2.70 2.66 76 6.67 6.04 4.47                                        48      2.57 2.56 2.54           76      6.03     5.62      4.38    168 6.38 49 2.77 2.76 2.71 77 7.02 6.26 4.50                                        49      2.62 2.61 2.59           77      6.33     5.83      4.43    180 5.98 50 2.83 2.82 2.76 78 7.40 6.48 4.52                                        50      2.67 2.67 2.64           78      6.65     6.04      4.46    192 5.64 51 2.89 2.88 2.82 79 7.81 6.70 4.54                                        51      2.73 2.72 2.69           79      7.01     6.26      4.49    204 5.33 52 2.96 2.94 2.88 80 8.27 6.92 4.56                                        52      2.79 2.78 2.74           80      7.40     6.48      4.52    216 5.06 53 3.03 3.01 2.94 81 8.76 7.13 4.57                                        53      2.85 2.84 2.80           81      7.83     6.70      4.54    228 4.82 54 3.10 3.08 3.00 82 9.30 7.34 4.58                                        54      2.92 2.91 2.85           82      8.29     6.92      4.56    240 4.60 55 3.18 3.16 3.06 83 9.89 7.53 4.58                                        55      2.99 2.98 2.91           83      8.80     7.13      4.57    252 4.40 56 3.26 3.23 3.13 84 10.54 7.72 4.59                                       56      3.07 3.05 2.98           84      9.35     7.33      4.58    264 4.22 57 3.35 3.32 3.19 85 11.26 7.88 4.59                                       57      3.14 3.12 3.04           85      9.95     7.52      4.58    276 4.06 58 3.44 3.40 3.26 86 12.05 8.03 4.59                                       58      3.23 3.20 3.11           86      10.59    7.70      4.59    288 3.90 59 3.54 3.49 3.34 87 12.91 8.17 4.59                                       59      3.31 3.29 3.18           87      11.28    7.87      4.59    300 3.77 60 3.64 3.59 3.41 88 13.86 8.28 4.60                                       60      3.40 3.37 3.25           88      12.03    8.02      4.59    312 3.64 61 3.74 3.69 3.48 89 14.88 8.38 4.60                                       61      3.50 3.46 3.32           89      12.84    8.15      4.59    324 3.52 62 3.86 3.79 3.56 90 15.99 8.46 4.60                                       62      3.60 3.56 3.40           90      13.71    8.27      4.60    336 3.41 63 3.98 3.91 3.64 91 17.17 8.53 4.60                                       63      3.71 3.66 3.47           91      14.66    8.37      4.60    348 3.31 64 4.11 4.02 3.71 92 18.43 8.58 4.60                                       64      3.82 3.77 3.55           92      15.70    8.45      4.60    360 3.21 65 4.24 4.15 3.79 93 19.78 8.63 4.60                                       65      3.95 3.88 3.63           93      16.86    8.53      4.60                        66 4.39 4.28 3.87 94 21.20 8.66 4.60                            66      4.07 4.00 3.71           94      18.13    8.58      4.60                        67 4.55 4.42 3.95 95 22.67 8.68 4.60                            67      4.21 4.12 3.79           95      19.53    8.63      4.60                          Note: Due to the volume of relevant information, the Table does not provide income values for             Option 2 described in the Income Provisions. Those values are available from the Company's             Service Center upon request. You may contact the Company's Service Center as shown on the             cover page of the Contract.                          BASIS OF COMPUTATION. The 2012 Individual Annuity Mortality Period Table, with an             assumed net investment rate of 1.00% and a 0% expense load, provides the actuarial basis for             the Table of Income Options. The Table of Income Options does not include any applicable tax.               ICC19 VA720-CB1                                                3h 

 

                                       DEFINITIONS    ACCUMULATION UNIT. A unit of measure the Company uses to calculate the value of  amounts allocated to an Investment Division before the Income Date.    ANNUITANT. The natural person(s) so designated on the Contract Data Pages, or by  subsequent designation, on whose life the Company determines the amount of Income  Payments provided by the Contract. References to the Annuitant include all Joint Annuitants, if  applicable.    ANNUITIZE. When You elect to convert the Contract Value into Income Payments.    ANNUITY UNIT. A unit of measure the Company uses to calculate each Variable Annuity  Payment.    BASE INTEREST RATE. The annual percentage, declared by the Company, at which Your  money grows for a specified Fixed Account Option period.    BENEFICIARY(IES). The natural person(s) or legal entity(ies) You designate as Primary or  Contingent Beneficiary(ies) to receive any death benefit provided by the Contract. The initial  designated Beneficiary(ies) are shown on the Contract Data Pages.    BUSINESS DAY. Any day that the New York Stock Exchange (NYSE) is open for business. The  Business Day ends when the NYSE closes for the day.    CONTRACT. The Individual Deferred Variable and Fixed Annuity Contract described herein.    CONTRACT ANNIVERSARY. Each one-year anniversary of the Issue Date.    CONTRACT OPTION(S). The Investment Divisions and Fixed Account Options the Contract  offers, as shown on the Contract Data Pages. Each Contract Option is explained in the  Accumulation Provisions.    CONTRACT QUARTERLY ANNIVERSARY. Each three-month anniversary of the Issue Date.    CONTRACT VALUE. The current value of the amounts under this Contract allocated to the  Investment Divisions and Fixed Account Options.    CONTRACT YEAR. The twelve-month period beginning on the Issue Date and on any Contract  Anniversary thereafter while the Contract remains in force.    CURRENT INTEREST RATE. The Base Interest Rate plus any additional interest rate the  Company credits. The Current Interest Rate will never be less than the Fixed Account Minimum  Interest Rate.    DESIGNATED OPTION(S). The Investment Division(s) and/or Fixed Account Option(s) You  select, to which amounts will be transferred from a Source Option pursuant to one of the  Company's systematic investment programs.    ICC19 VA720                                4 

 

                                 DEFINITIONS (CONT'D)    DUE PROOF. Evidence of death, including but not limited to, a certified death certificate issued  by the governmental authority for the location of the death, or other lawful evidence the  Company requires.    FIXED ACCOUNT. The Fixed Account is part of the Company's general account. A Fixed  Account earns a specified interest rate, not less than the guaranteed minimum interest rate, to  which You may allocate Premium and Contract Value unless the Company has restricted such  allocations.    FIXED ACCOUNT CONTRACT VALUE. The larger of the Fixed Account Minimum Value or the  sum of all amounts allocated to the Fixed Account Options, reduced by the gross amount of  withdrawals and transfers from the Fixed Account Options, and applicable charges and taxes,  plus all interest credited to the Fixed Account Options.    FIXED ACCOUNT MINIMUM INTEREST RATE. The Fixed Account Minimum Interest Rate is  the minimum annual percentage at which Your money allocated to the Fixed Account will grow.  The Company uses this rate to determine the Fixed Account Minimum Value. The Initial Fixed  Account Minimum Interest Rate is shown on the Contract Data Pages.    FIXED ACCOUNT MINIMUM VALUE. The Fixed Account Minimum Value is equal to all  amounts allocated to the Fixed Account Options, net of applicable taxes, multiplied by the Fixed  Account Minimum Value Percentage, and;  1.  reduced by partial withdrawals and transfers from the Fixed Account Options, (after being     reduced for any applicable Withdrawal Charges and then adjusted for any applicable MVA),     and the Fixed Account Minimum Value Annual Expense Allowance; then  2.  accumulated at the Fixed Account Minimum Interest Rate.    FIXED ACCOUNT MINIMUM VALUE ANNUAL EXPENSE ALLOWANCE. An annual  deduction from the Fixed Account Minimum Value. On each Contract Anniversary, the Company  will deduct the Fixed Account Minimum Value Annual Expense Allowance from the Fixed  Account Minimum Value. The Fixed Account Minimum Value Annual Expense Allowance is  shown on the Contract Data Pages.    FIXED ACCOUNT MINIMUM VALUE PERCENTAGE. The Fixed Account Minimum Value  Percentage is multiplied by Premiums and transfers allocated to the Fixed Account in the  determination of the Fixed Account Minimum Value. The Fixed Account Minimum Value  Percentage is shown on the Contract Data Pages.    FIXED ACCOUNT OPTION. A Contract Option within the Fixed Account that specifies a fixed  period for which the Company credits the Current Interest Rate.    GOOD ORDER. The Company's receipt of all information, documentation, instructions and/or  Premium the Company requires before it will issue the Contract or execute any transaction.    INCOME DATE. The date, not less than one (1) year after the Contract's Issue Date, on which  Income Payments are to begin as described in the Income Provisions.    INCOME OPTION. One of the payment options provided under the Income Provisions.    ICC19 VA720                                5 

 

                                 DEFINITIONS (CONT'D)    INCOME PAYMENTS. Fixed Annuity Payments and Variable Annuity Payments offered by the  Company at the Income Date.    INVESTMENT DIVISIONS. Separate and distinct divisions of the Separate Account, each of  which invests in a specific Underlying Mutual Fund, and for which Accumulation Units and  Annuity Units are separately maintained. The Separate Account Contract Value in the  Investment Divisions will increase or decrease depending on the performance of the Underlying  Mutual Funds.    ISSUE DATE. The date the Company issued the Contract. The Issue Date is shown on the  Contract Data Pages.    JOINT OWNER. Each of multiple Contract Owners.    LATEST INCOME DATE. The Contract Anniversary on which You will be 95 years old, or such  earlier date required by a Qualified Plan, law or regulation.    NON-QUALIFIED PLAN. A retirement plan which does not qualify for favorable tax treatment  under Sections 401, 403, 408, 408A or 457 of the Internal Revenue Code, as amended.    OWNER ("YOU," "YOUR"). The natural person(s) or legal entity(ies) shown on the Contract  Data Pages, or by subsequent designation. In this Contract, "You" and "Your" also mean the  Owner. References to the Owner include all Joint Owners, if applicable.    PREMIUM(S). Money paid into this Contract for allocation to a Contract Option.    QUALIFIED PLAN. A retirement plan which qualifies for favorable tax treatment under Sections  401, 403, 408, 408A or 457 of the Internal Revenue Code, as amended.    REDETERMINATION DATE. The date the Fixed Account Minimum Interest Rate is reset as  described in the Fixed Account Minimum Interest Rate provision. It is the date each January that  coincides with the Issue Date. For example, if Your Contract's Issue Date is May 23, the  Redetermination Date will be January 23 each year following the Issue Date.    REDETERMINATION PERIOD. The twelve-month period that begins on each Redetermination  Date.    REMAINING PREMIUM. Total Premium paid into the Contract, reduced by withdrawals of  Premium, including the Withdrawal Charges, before withdrawals are adjusted for any applicable  MVA or charges.    REQUIRED MINIMUM DISTRIBUTION (RMD). For certain Qualified Plan contracts, the  RMD is the amount defined by the Internal Revenue Code and the implementing regulations  as the minimum distribution requirement that applies to this Contract only.    ICC19 VA720                                6 

 

                                 DEFINITIONS (CONT'D)    SEPARATE ACCOUNT. An asset account the Company has established and maintains in  accordance with Michigan law. The Company has allocated a portion of its assets to this  account for this Contract and certain other contracts. The name of the Separate Account is  shown on the Contract Data Pages.    SEPARATE ACCOUNT CONTRACT VALUE. The current value of the amounts under this  Contract allocated to the Separate Account's Investment Divisions.    SERVICE CENTER. The Company's administrative address and telephone number as identified  on the Contract's cover page or as the Company may designate from time to time.    SOURCE OPTION. The Investment Division or Fixed Account Option You select from those the  Company makes available, from which amounts will be transferred to a Designated Option(s)  pursuant to one of the Company's systematic investment programs.    UNDERLYING MUTUAL FUNDS. The registered management investment companies in which  the assets of the Investment Divisions will be invested.    WITHDRAWAL CHARGE. A charge assessed against certain withdrawals. The Withdrawal  Charge Schedule is shown on the Contract Data Pages.    WITHDRAWAL VALUE. The Contract Value, less any tax payable, applicable Withdrawal  Charges, Annual Contract Maintenance Charge, and charges due under any add-on benefit,  adjusted for any applicable MVA.    ICC19 VA720                                7 

 

                                 GENERAL PROVISIONS    ANNUITANT. You may change the Annuitant at any time before the Income Date, unless the  Contract is owned by a legal entity. If the Contract is owned by a legal entity, the Company will  use the oldest Annuitant's age for all Contract purposes unless otherwise specified in the  Contract. The Company reserves the right to limit the number of Joint Annuitants to two (2).  When the Owner is a legal entity, the Annuitant(s) shall be entitled to the benefits of the Waiver  of Withdrawal Charge Due to Terminal Illness and the Waiver of Withdrawal Charge for  Extended Care.    ASSIGNMENT. You may assign ownership of this Contract subject to the interests of assignees  and irrevocable Beneficiaries. The Company will only be bound by an assignment if a request is  submitted in a form acceptable to the Company, received in Good Order at the Company's  Service Center and recorded. Unless You specify otherwise, an assignment will take effect on  the date the request is signed by You, subject to any payments the Company has made or other  actions the Company has taken before the Company receives and records Your request. The  Company may refuse assignments if necessary to comply with applicable laws or regulations.    The Company assumes no responsibility for the validity or tax consequences of any  assignment. If You make an assignment, You may have to pay taxes. The Company  encourages You to seek legal and/or tax advice.    BENEFICIARY. You may change the Beneficiaries, subject to the interest of assignees and  irrevocable Beneficiaries. The Company will only be bound by a change in Beneficiary if a  request is submitted in a form acceptable to the Company, received in Good Order at the  Company's Service Center and recorded. Any previously designated irrevocable Beneficiary  must consent in writing to any change in Beneficiary. Unless You specify otherwise, a change in  Beneficiary will take effect on the date the request is signed by You, subject to any payments  the Company has made or other actions the Company has taken before the Company receives  and records Your request, and while You are alive.    CHARGES AND FEES. The Contract permits the Company to assess certain charges and fees.  Charges and fees associated with Your Contract are listed on the Contract Data Pages.    CONFORMITY WITH INTERSTATE INSURANCE PRODUCT REGULATION COMMISSION  (IIPRC) STANDARDS. This Contract is approved under the authority of the IIPRC and is issued  under the IIPRC standards. Any provision of this Contract that, on the provision's effective date,  is in conflict with the applicable IIPRC standards for this product type is hereby amended to  conform to the IIPRC standards in effect as of the provision's effective date.    DEFERRAL OF FIXED ACCOUNT PAYMENTS. If approved in writing by the chief insurance  regulator of the Company's state of domicile, the Company may defer payment of Your request  for a partial and/or total withdrawal from a Fixed Account Option for a period not exceeding six  (6) months. The Company will credit interest on deferred amounts as required by law. The  Company will not defer payment of death benefits from a Fixed Account Option.    ENTIRE CONTRACT. The Contract, application, if any, and any attached endorsements, add- on benefits and amendments together make up the entire Contract between You and the  Company. All statements made by the applicant to procure the Contract will, in the absence of  fraud, be deemed representations and not warranties.    ICC19 VA720                                8 

 

                          GENERAL PROVISIONS (CONT'D)    INCONTESTABILITY. The Company may only contest this Contract when an applicant has  procured the Contract by fraud, and only if permitted by law in the state in which the Company  delivered the Contract or issued the Contract for delivery.    MINIMUM BENEFITS. No Withdrawal Values or death benefits provided by this Contract shall  be less than the minimum benefits required by Section 7 of the Variable Annuity Model  Regulation, Model 250, Standard Nonforfeiture Law for Individual Deferred Annuities, Model  805, or applicable successor provision, as amended.    MISSTATEMENT OF AGE AND/OR SEX. If Your or the Annuitant's age and/or sex is misstated  at the time the Contract's Income Payments become payable, the Company will adjust the  payments to reflect income consistent with the correct age and/or sex. Immediately upon  discovery, the Company will adjust the next payment due as a credit or charge, as appropriate,  for any underpayments or overpayments using the Interest Rate for Adjustments Due to  Misstatement of Age or Sex shown on the Contract Data Pages.    MODIFICATION OF CONTRACT. No financial professional has authority to change or waive  any of this Contract's provisions. No change to or waiver of this Contract's terms is valid unless  in writing and signed by the Company's President, Vice President, Secretary or Assistant  Secretary; provided, however, that the Company may amend any Contract term, and administer  the Contract to conform to the Internal Revenue Code.    NONPARTICIPATING. This Contract is nonparticipating and does not share in the Company's  surplus or earnings.    OWNER. You may change the Owner or any Joint Owner. The Company will only be bound by  a change of ownership if submitted in a form acceptable to the Company, received in Good  Order at the Company's Service Center and recorded. No person whose age exceeds the  maximum issue age the Company had set as of the Issue Date may become a new Owner.  Unless You specify otherwise, a change of ownership will take effect on the date the request is  signed by You, subject to any payments the Company has made or other actions the Company  has taken before the Company receives and records Your request. Joint Owners have equal  ownership rights; therefore, each Owner must authorize any exercise of Contract rights unless  the Joint Owners instruct the Company in writing to act upon authorization of an individual Joint  Owner. The Company reserves the right to limit the number of Joint Owners to two (2).    The Company assumes no responsibility for the validity or tax consequences of any  ownership change. If You make an ownership change, You may have to pay taxes. The  Company encourages You to seek legal and/or tax advice.    PROOF OF AGE, SEX AND/OR SURVIVAL. The Company may require proof of age and/or  sex satisfactory to the Company at any time. If any payment required by this Contract depends  on a living Annuitant, Owner, or Beneficiary, the Company may require proof of that person's  survival satisfactory to the Company.    PROTECTION OF PROCEEDS. A Beneficiary may not assign Contract proceeds before the  proceeds are payable. Contract proceeds are not subject to the claims of creditors or to legal  process unless required by applicable law.    ICC19 VA720                                9 

 

                          GENERAL PROVISIONS (CONT'D)    REPORTS. The Company will send a report to Your last address in the Company's records at  least annually before the Income Date. In the case of Joint Owners, the Company will send  reports only to the primary Owner's address. Each report will provide at least the following  information:  1.  the dates that begin and end the reporting period;  2.  the Contract Value at the beginning and at the end of the current reporting period prior to the     application of any MVA;  3.  the Withdrawal Charge and MVA amount the Company used to determine the Withdrawal     Value;  4.  the amounts the Company has credited to and deducted from the Contract Value during the     reporting period;  5.  the Withdrawal Value at the end of the reporting period;  6.  the death benefit at the end of the reporting period; and  7.  any other information state and federal law require.    You may receive copies of reports the Company provides upon request at no additional charge.    SUBSTITUTION OF UNDERLYING MUTUAL FUND(S). If the Company determines that an  Underlying Mutual Fund is no longer available or appropriate for Contract purposes, the  Company may replace that Underlying Mutual Fund with another Underlying Mutual Fund  without Your consent but upon notice to You. Changes of the Underlying Mutual Fund(s) are  subject to federal securities laws and the laws of the state where the Company issued the  Contract for delivery. In the event the Company replaces an Underlying Mutual Fund, You are  permitted to transfer Your Contract Value and allocate future Premiums among the available  Investment Divisions, consistent with Your rights under the Contract.    SUSPENSION OF SEPARATE ACCOUNT PAYMENTS. The Company may suspend or delay  withdrawals of Separate Account Contract Value or transfers to or from an Investment Division  for any period when:  1.  the NYSE is closed (other than customary weekend and holiday closings);  2.  under applicable Securities and Exchange Commission (SEC) rules, trading on the NYSE is     restricted;  3.  under applicable SEC rules, an emergency exists such that it is not reasonably practicable     to dispose of securities in the Separate Account or to determine the value of its assets; or  4.  the SEC, by order, so permits.    TAXES. The Company will deduct any taxes attributed to the Contract and payable to a  government entity from the Contract Value. The Company reserves the right to deduct any  amounts the Company might advance to pay taxes from the Contract Value. The Company will  withhold taxes required by law from any amounts payable from this Contract.    ICC19 VA720                               10 

 

                           GENERAL PROVISIONS (CONT'D)    TRANSFER OF FUNDS. The Contract Data Pages describe the conditions for transfers of  funds between Contract Options.    Transfer of Funds Restrictions. The Company may restrict the number and frequency of  transfers into and between Contract Options in certain circumstances. This includes, but is not  limited to, circumstances in which the Company determines, at its sole discretion, that a  reasonably designed restriction is required to prevent transfers that would disadvantage an  Owner. The Company may impose a restriction including, but not limited to:  1.  a minimum time between transfers;  2.  a limitation on transfer requests of an agent acting for one or more Owners; and  3.  a limitation on the dollar amount of any transfer.    The Company may also impose restrictions on Your ability to make transfers to or from the 1- Year Fixed Account Option. This includes a restriction that transfers from the 1-Year Fixed  Account Option in any Contract Year may not exceed the maximum amount, as defined below:  1.  in the first Contract Year that transfer restrictions are in effect, or if in the prior Contract Year     the maximum amount was not transferred out of the 1-Year Fixed Account Option, the     maximum amount that You may transfer out of the 1-Year Fixed Account Option is equal to     1/3 of the Contract Value in the 1-Year Fixed Account Option at the beginning of the current     Contract Year;  2.  if the maximum amount (1/3 of the value of the 1-Year Fixed Account Option at the     beginning of the prior Contract Year) was transferred from the 1-Year Fixed Account Option     in the prior Contract Year, the maximum amount that You may transfer out of the 1-Year     Fixed Account Option in the current Contract Year is equal to 1/2 of the Contract Value in     the 1-Year Fixed Account Option at the beginning of the current Contract Year. Any     transfers out of the 1-Year Fixed Account Option cannot begin until twelve (12) calendar     months after the last transfer out of the 1-Year Fixed Account Option in the prior Contract     Year;  3.  if the maximum amount (1/3 and then 1/2 of the value of the 1-Year Fixed Account Option at     the beginning of each of the two (2) prior Contract Years, respectively) was transferred from     the 1-Year Fixed Account Option in each of the two (2) prior Contract Years, You may     transfer the remaining Contract Value in the 1-Year Fixed Account Option. Any transfers out     of the 1-Year Fixed Account Option cannot begin until twelve (12) calendar months after the     last transfer out of the 1-Year Fixed Account Option in the prior Contract Year.    If the 1-Year Fixed Account Option restriction is imposed, the Company may:  1.  limit Your ability to transfer into or allocate new Premium to the 1-Year Fixed Account Option     in any Contract Year in which You make a transfer from the 1-Year Fixed Account Option.  2.  limit Your ability to transfer from the 1-Year Fixed Account Option in any Contract Year in     which You make a transfer into or allocate new Premium to the 1-Year Fixed Account     Option.  3.  offer an optional automated systematic transfer program to allow for systematic transfers out     of the 1-Year Fixed Account Option.    If the 1-Year Fixed Account Option restriction is imposed transfers under systematic investment  programs do not count against the maximum amount, and the Contract Value under such  programs is excluded from the determination of the maximum amount.    ICC19 VA720                               11 

 

                           GENERAL PROVISIONS (CONT'D)    Systematic Investment Programs. The Company may provide systematic investment  programs that allow You to systematically transfer funds between the Contract Options. These  programs may include dollar cost averaging, portfolio rebalancing, and the automatic monthly  transfer of earnings from the 1-Year Fixed Account Option and/or money market Investment  Division to the Designated Option(s). You may contact the Company's Service Center to obtain  materials and forms that describe, and are required to participate in, these programs. The  Company makes no guarantee that these programs will result in a profit or protect against loss.    The Company's dollar cost averaging program permits You to authorize the automatic monthly,  quarterly, semiannual, or annual transfer of a fixed dollar amount or selected percentage of the  value of a Source Option, to one (1) or more Designated Option(s).    The Company may offer an enhanced interest rate on Premium which an Owner that selects  dollar cost averaging allocates to the 1-Year Fixed Account Option (as the Source Option). You  may participate in the enhanced interest rate dollar cost averaging program only if Your  Contract Value is at least equal to the minimum shown on the Contract Data Pages. Under an  enhanced interest rate dollar cost averaging program, amounts You allocate to the Source  Option are automatically transferred to the Designated Option(s) of Your choice in scheduled  installments over a period prescribed by the Company until all amounts in the Source Option  have been transferred. You may contact the Company's Service Center to request the interest  rates and the specified periods applicable to the enhanced interest rate dollar cost averaging  program. In the event You cancel participation in the enhanced interest rate dollar cost  averaging program, the Company will transfer the Source Option balance, including any  interest, into the Designated Option(s) You selected.    WRITTEN NOTICE. Written information or instructions You intend to give to the Company must  be in Good Order and delivered to the Company's Service Center, unless the Company advises  You otherwise. Instructions included in the Written Notice will take effect on the date the  Company receives the notice in Good Order at the Company's Service Center, unless otherwise  provided in the notice or in this Contract, or unless the Company advises You otherwise.    The Company will deliver any notice or communication to Your last address in the Company's  records unless You request otherwise in writing. You are responsible for promptly notifying the  Company of any address change or any error in a Company notice sent to You. In the case of  Joint Owners, the Company will send notices and other communications to the primary Owner's  address.    ICC19 VA720                               12 

 

                            ACCUMULATION PROVISIONS    You may not allocate funds to more than the maximum number of Contract Options, shown on  the Contract Data Pages, at any one time. The Company may waive this maximum.    SEPARATE ACCOUNT. The Separate Account is an asset account shown on the Contract  Data Pages. The Separate Account consists of assets the Company has set aside and has kept  separate from the Company's general account assets and other separate accounts. The  Separate Account assets will not be charged with liabilities arising out of any other Company  business. The Company credits or charges all the income, gains, and losses resulting from the  Separate Account assets exclusively to the contracts supported by the Separate Account. The  Separate Account assets will be available to cover the liabilities of the Company's general  account only to the extent that they exceed the Separate Account liabilities arising from the  Contracts supported by the Separate Account. The Separate Account is divided into several  Investment Divisions. The Company will value the Separate Account assets at their fair market  value at least monthly.    Accumulation Units. The Separate Account Contract Value may increase or decrease  depending on the performance of the Investment Divisions. The Company uses a unit of  measure called an Accumulation Unit to measure the Separate Account Contract Value before  the Income Date. The value of an Accumulation Unit may increase or decrease from Business  Day to Business Day. Transactions affecting the Separate Account Contract Value, such as  withdrawals, transfers, and certain charges, result in the redemption of Accumulation Units but  do not change the value of Accumulation Units.    When You make an allocation to the Investment Divisions, the Company credits Your Contract  with Accumulation Units. The Company determines the number of Accumulation Units credited  to Your Contract by dividing the amount You allocate to each Investment Division by its  Accumulation Unit Value at the close of the Business Day on which You make the allocation.    Accumulation Unit Value. The Company determines the Accumulation Unit Value for each of  the Investment Divisions by:  1.  determining the total amount of money allocated to that particular Investment Division;  2.  subtracting from that amount any applicable Core Contract Charge and taxes; and  3.  dividing the result by the number of outstanding Accumulation Units.    FIXED ACCOUNT. Allocations You make to Fixed Account Options are included in the  Company's general account. The Company's general account consists of all the Company's  assets, other than those in the Separate Account and other asset accounts.    You may select from the Fixed Account Options made available by the Company. Amounts in  the Fixed Account Option You select will earn interest at that option's Current Interest Rate  during the Fixed Account Option period. The Company may declare Base Interest Rates higher  or lower than any Base Interest Rates the Company previously declared but the interest rate  credited to the Fixed Account Option will never be less than the Fixed Account Minimum Interest  Rate.    ICC19 VA720                               13 

 

                       ACCUMULATION PROVISIONS (CONT'D)    You may allocate Premium, or make transfers from the Investment Divisions and/or Fixed  Account Options, to the Fixed Account Options at any time before the Income Date, subject to  the provisions of this Contract. You may not select any Fixed Account Option, other than the 1- Year Fixed Account Option, that extends beyond the Income Date.    When the period of a Fixed Account Option ends:  1.  If the option ends within one (1) year of the Income Date, the Company will renew You into     the 1-Year Fixed Account Option;   2.  If the option ends more than one (1) year before the Income Date, You may select a new     Fixed Account Option that does not extend beyond the Income Date within thirty (30) days     of the end of the expired Fixed Account Option;   3.  If You do not select a Fixed Account Option within thirty (30) days of the end of the expired     Fixed Account Option:     a.  if the same option is available at the time and does not extend beyond the Income Date,        the Company will renew You into the same Fixed Account Option.     b.  if the same option is available at the time but extends beyond the Income Date, the        Company will select the available Fixed Account Option that ends closest to but before        the Income Date.     c.  if the same option is not available at the time but would not extend beyond the Income        Date were it available, the Company will select the available Fixed Account Option with        the period closest to but less than the Fixed Account Option that just ended.           Fixed Account Minimum Interest Rate. The Initial Fixed Account Minimum Interest Rate  established on the Issue Date is shown on the Contract Data Pages. The Company will re- determine the Fixed Account Minimum Interest Rate on each Redetermination Date for that  Redetermination Period.    The Fixed Account Minimum Interest Rate on each Redetermination Date will be equal to:  1.  the average of all the daily reported five-year Constant Maturity Treasury Rates during     October of the year then ended, rounded to the nearest 1/20th of one (1) percent;  2.  less 1.25 percentage points;  3.  but never less than 1.00% or greater than 3.00%.    The Fixed Account Minimum Interest Rate is the guaranteed minimum interest rate under the  Contract and may change each year on the Redetermination Date. The Company will send You  notice of the re-determined Fixed Account Minimum Interest Rate annually.    ICC19 VA720                               14 

 

                               WITHDRAWAL PROVISIONS    On or before the Income Date You may request a total or partial withdrawal of the Contract  Value by submitting a request to the Company's Service Center in a form acceptable to the  Company.     Amounts You withdraw from the Contract Value may be subject to Withdrawal Charges. In  addition to Withdrawal Charges, amounts You withdraw from a Fixed Account Option may also  incur an MVA. The Company will adjust the amount You request for withdrawal for any  applicable taxes, charges, including Withdrawal Charges, and MVA.     TOTAL WITHDRAWAL. Upon a total withdrawal, You will receive the Withdrawal Value. The  Withdrawal Value will be determined at the end of the Business Day on which the Company  receives Your withdrawal request in Good Order at the Company's Service Center. If a total  withdrawal is requested, You must submit the Contract to the Company's Service Center. A total  withdrawal terminates Your Contract.    No withdrawal may exceed the Withdrawal Value.    PARTIAL WITHDRAWAL. Any partial withdrawal must be either:  1.  an amount not less than the Minimum partial withdrawal amount shown on the Contract     Data Pages; or  2.  an amount equal to Your entire interest in an Investment Division or a Fixed Account Option.    The amount payable as a result of the partial withdrawal will be determined at the end of the  Business Day on which the Company receives Your request for withdrawal in Good Order at the  Company's Service Center.    Your Contract Value will be reduced by the gross withdrawal amount requested. Unless You  request otherwise, a partial withdrawal will be deducted from each Contract Option in proportion  to its current value. The partial withdrawal will be reduced for any applicable taxes and charges,  including Withdrawal Charges, and then adjusted for any applicable MVA.    At least the Minimum Contract Value remaining after a partial withdrawal, as shown on the  Contract Data Pages, must remain after any partial withdrawal. If the partial withdrawal would  reduce the Contract Value below the Minimum Contract Value remaining after a partial  withdrawal, as shown on the Contract Data Pages, the Company will treat the withdrawal  request as a total withdrawal and the Withdrawal Value will be paid.    QUALIFIED PLAN CONTRACT REQUIRED MINIMUM DISTRIBUTIONS. Qualified Plan  Contract Required Minimum Distributions are based upon Your Contract Value, the value of  any add-on benefits as calculated by the Company, and applicable federal tax law  requirements. You may request a withdrawal for an RMD by submitting a written request to  the Service Center on a Company-provided form.    The Company will waive the Withdrawal Charges if the amount withdrawn does not exceed  the Contract's RMD. However, if a withdrawal amount is greater than the Contract's RMD,  the excess of the partial withdrawal over the Contract's RMD may be subject to Withdrawal  Charges.    ICC19 VA720                               15 

 

                         WITHDRAWAL PROVISIONS (CONT'D)    AUTOMATIC WITHDRAWAL. You may elect to take an automatic withdrawal by withdrawing a  specific sum or a certain percentage of the Contract Value on a monthly, quarterly, semiannual  or annual basis, subject to the Minimum partial withdrawal amount made as a scheduled part of  an automatic withdrawal program, as shown on the Contract Data Pages. Automatic  withdrawals are treated as a partial withdrawal and will be counted in determining the amount  taken as a Free Withdrawal in any Contract Year. Automatic withdrawals in excess of the Free  Withdrawal amount may be subject to Withdrawal Charges and/or MVA. If an automatic  withdrawal causes the Withdrawal Value to fall to zero, future automatic withdrawals will  terminate. If the automatic withdrawal would reduce the Contract Value below the Minimum  Contract Value remaining after a partial withdrawal, as shown on the Contract Data Pages,  the Company will treat the withdrawal request as a total withdrawal and the Withdrawal  Value will be paid.    WITHDRAWAL CHARGE. For purposes of determining the Withdrawal Charge, the Contract  Value is divided into earnings and Remaining Premium, as defined in the Contract. Earnings are  not subject to a Withdrawal Charge. For the sole purposes of determining the amount of the  Withdrawal Charge, earnings are defined as any excess of the Contract Value over Remaining  Premium.     A Withdrawal Charge will be imposed upon certain withdrawals of Remaining Premium. The  Withdrawal Charge will be calculated in accordance with the Withdrawal Charge Schedule  shown on the Contract Data Pages. The Withdrawal Charge is equal to the applicable  Withdrawal Charge Percentage applied to the gross amount of Remaining Premium withdrawn  (not the net amount of Remaining Premium received by You), excluding any amount for which  the Contract expressly provides for waived, or no, Withdrawal Charge. In the event of a total  withdrawal, the applicable Withdrawal Charge Percentage(s) is/are applied to the full value of  Remaining Premium immediately prior to the withdrawal, less any Free Withdrawal available at  the time of the total withdrawal. The Withdrawal Charge reduces Remaining Premium and  Contract Value. The Withdrawal Charge will be taken from the Contract Options in the same  proportion as the requested withdrawal.    Withdrawals will be allocated first to earnings (which may be withdrawn free of any Withdrawal  Charge), if any, and second to Remaining Premium on a first-in, first-out basis so that all  withdrawals will be allocated to Remaining Premium to which the lowest (if any) Withdrawal  Charges apply.    Any portion of the Withdrawal Charge that would reduce the Fixed Account Contract Value  below the Fixed Account Minimum Value will be waived.    FREE WITHDRAWAL. During a Contract Year, You may make partial withdrawals from the  Contract without incurring a Withdrawal Charge or MVA. The amount of Free Withdrawal  available in any Contract Year is equal to:  1.  the Free Withdrawal Percentage, as shown on the Contract Data Pages, multiplied by the     Remaining Premium at the beginning of the Contract Year, that is subject to a Withdrawal     Charge according to the Withdrawal Charge Schedule shown on the Contract Data Pages;     plus  2.  the Free Withdrawal Percentage, as shown on the Contract Data Pages, multiplied by     Premium received during the Contract Year; less  3.  earnings, as defined in the Withdrawal Charge provision of this Contract.   ICC19 VA720                               16 

 

                         WITHDRAWAL PROVISIONS (CONT'D)    The amount of Free Withdrawal is subject to a minimum of zero. The Free Withdrawal can be  taken as a single withdrawal or multiple withdrawals throughout the Contract Year. The amount  of Your Free Withdrawal available will vary throughout the Contract Year depending on previous  withdrawals of Your Free Withdrawal amount, previous withdrawals of earnings, and the amount  of earnings present at the time of the withdrawal. The amount of Your Free Withdrawal available  will reduce due to withdrawals during the Contract Year.    Any amount withdrawn to satisfy an RMD may reduce the amount of Your Free Withdrawal  available.    No Free Withdrawal may exceed the Withdrawal Value.    Amounts withdrawn under the Free Withdrawal provision reduce both the Contract Value and  Remaining Premium. Withdrawals during the Contract Year in excess of the amount of Free  Withdrawal may be subject to any applicable Withdrawal Charges and applicable MVAs.    WAIVER OF WITHDRAWAL CHARGE DUE TO TERMINAL ILLNESS.    If You are diagnosed with a terminal illness on or after the Issue Date shown on the Contract  Data Pages, the Company will waive the Withdrawal Charge on the amount You withdraw from  the Contract, up to the maximum amount shown on the Contract Data Pages. Upon Your  compliance with the Claim Requirements described below, You will be eligible for this waiver on  or after the Eligibility Date shown on the Contract Data Pages.     The Company will allocate the withdrawal amount to each Contract Option according to the  method described in the Withdrawal Provisions. The Company will determine values at the end  of the Business Day on which the Company receives the request for withdrawal in Good Order  at the Company's Service Center. A withdrawal from the Fixed Account Option(s) is subject to  any applicable MVA. Withdrawals under this provision reduce Remaining Premium.    This Waiver of Withdrawal Charge Due to Terminal Illness is available only once, no matter the  amount withdrawn or in the circumstances of multiple medical conditions and/or Joint Owners.    For the purpose of this waiver, the following definitions apply:      Immediate Family - means the individual's spouse/domestic partner, child, brother, sister,     parent or grandparent.         Physician - means an individual who is licensed to practice medicine and treat illness or     injury in the state where treatment is received and who is acting within the scope of his or     her license. The term Physician only refers to a Physician licensed and currently practicing     in the United States or its territories. The term Physician does not include a person who is:     1.  an Annuitant or Joint Annuitant;     2.  an Owner or Joint Owner;     3. a Beneficiary;     4.  a member of the Annuitant's, Joint Annuitant's, Owner's or Joint Owner's Immediate        Family.    ICC19 VA720                               17 

 

                         WITHDRAWAL PROVISIONS (CONT'D)      Physician's Statement - means a written statement signed by a Physician, which:     1.  provides the Physician's diagnosis of Your medical condition; and     2.  declares with reasonable medical certainty and to the Company's reasonable        satisfaction that notwithstanding ordinary and reasonable medical care, advice and        treatment, Your medical condition will result in Your death within twelve (12) months        from the date of the Physician's statement.    Claim Requirements. Your request to the Company must include (1) a completed claim form,  (2) Your signed release for records of all Physicians and institutions that have treated You for  the medical condition You claim, and (3) a Physician's Statement to the Company's Service  Center in Good Order. The Company reserves the right to request additional releases for the  records of any Physician and institution that have provided treatment to You.    The Company will send You a form to claim the Waiver of Withdrawal Charge Due to Terminal  Illness within ten (10) Business Days of the Company's receipt of Your request. If the Company  fails to send the claim form within ten (10) Business Days, You will be deemed to have complied  with the above claim requirements.    Claim Determination. The Company reserves the right to deny Your claim if You do not satisfy  the Claim Requirements. The Company will notify You if the Company denies Your waiver of  Withdrawal Charge for a terminal illness claim, and You will then have the opportunity to submit  a standard withdrawal request subject to any applicable Withdrawal Charges and any applicable  MVA. Termination of the Contract will not prejudice any payment made under the terminal  illness waiver that occurred while this Contract was in force.    YOU MAY OWE TAX ON WITHDRAWALS FOR TERMINAL ILLNESS. THE COMPANY  ENCOURAGES YOU TO SEEK LEGAL AND/OR TAX ADVICE.    WAIVER OF WITHDRAWAL CHARGE FOR EXTENDED CARE.    If You are confined as an inpatient in a Nursing Home or Hospital for ninety (90) consecutive  days starting after the Issue Date shown on the Contract Data Pages, the Company will waive  the Withdrawal Charge on the amount You withdraw from the Contract, up to the maximum  amount shown on the Contract Data Pages. Upon Your compliance with the Claim  Requirements described below, You will be eligible for this waiver on the Eligibility Date shown  on the Contract Data Pages.    The availability of access to guarantees or values is not intended to provide long-term care or  nursing home insurance.    The Company will allocate the withdrawal amount to each Contract Option according to the  method described in the Withdrawal Provisions. The Company will determine values at the end  of the Business Day on which the Company receives the request for withdrawal in Good Order  at the Company's Service Center. A withdrawal from the Fixed Account Option(s) is subject to  any applicable MVA. Withdrawals under this provision reduce Remaining Premium.    This Waiver of Withdrawal Charge for Extended Care is available only once, no matter the  amount withdrawn or in the circumstances of multiple confinements for the same or a different  medical condition and/or Joint Owners.    ICC19 VA720                               18 

 

                         WITHDRAWAL PROVISIONS (CONT'D)    For the purpose of this waiver, the following definitions apply:      Hospital. A facility that:     1.  is located within the United States or its territories;     2.  is operated pursuant to the law;     3.  operates primarily for the inpatient care and treatment of sick and injured persons;     4.  provides continuous twenty-four (24) hour a day nursing service by or under the         supervision of a registered nurse (R.N.);     5.  is supervised by a staff of licensed physicians; and     6.  has its own medical and diagnostic facilities or has access to such facilities on a         prearranged basis.         Immediate Family - means the individual's spouse/domestic partner, child, brother, sister,     parent or grandparent.      Medically Necessary - means consistent with Your diagnosis, in accordance with accepted     standards of medical practice and without which Your medical condition would be adversely     affected.      Nursing Home. A facility that:     1.  is licensed by the appropriate governmental licensing agency as a Nursing Home in the         state in which it maintains such facilities;     2.  is operated pursuant to the law;     3.  charges patients a fee for the care provided;     4.  is primarily engaged in providing nursing care (skilled, intermediate or custodial) by or         under the supervision of a licensed Physician and room and board accommodations;     5.  provides continuous twenty-four (24) hour a day nursing services by or under the         supervision of a registered nurse (R.N.);     6.  has a licensed Physician on premises available to furnish emergency medical care;     7.  maintains a daily medical record of each patient; and     8.  maintains control and records of dispensed medications.      Physician - means an individual who is licensed to practice medicine and treat illness or     injury in the state where treatment is received and who is acting within the scope of his or     her license. The term Physician only refers to a Physician licensed and currently practicing     in the United States or its territories. The term Physician does not include a person who is:     1.  an Annuitant or Joint Annuitant;     2.  an Owner or Joint Owner;     3. a Beneficiary;     4.  a member of the Annuitant's, Joint Annuitant's, Owner's or Joint Owner's Immediate         Family.      Physician's Statement - means a written statement signed by a Physician which provides     the Physician's diagnosis of Your medical condition.    You will be considered confined to a Nursing Home or Hospital only if Your confinement is  prescribed by a Physician and Medically Necessary.    ICC19 VA720                               19 

 

                         WITHDRAWAL PROVISIONS (CONT'D)    Claim Requirements. Ninety (90) days after the date You become confined, Your request to  the Company must include (1) a completed claim form, (2) Your signed release for records of all  Physicians and institutions that have treated You for the medical condition You claim, and (3) a  Physician's Statement to the Company's Service Center in Good Order. The Company reserves  the right to request additional releases for the records of any Physician, Hospital and Nursing  Home that have provided treatment to You.    The Company will send You a form to claim the Waiver of Withdrawal Charge for Extended  Care within ten (10) Business Days of the Company's receipt of Your request. If the Company  fails to send the claim form within ten (10) Business Days, You will be deemed to have complied  with the above claim requirements.    Claim Determination. The Company reserves the right to deny Your claim if You do not satisfy  the Claim Requirements. The Company will notify You if the Company denies Your waiver of  Withdrawal Charge for an extended care claim, and You will then have the opportunity to submit  a standard withdrawal request subject to any applicable Withdrawal Charges and any applicable  MVA. Termination of the Contract will not prejudice any payment made under the extended care  waiver that occurred while this Contract was in force.    YOU MAY OWE TAX ON WITHDRAWALS FOR EXTENDED CARE. THE COMPANY  ENCOURAGES YOU TO SEEK LEGAL AND/OR TAX ADVICE.    ICC19 VA720                               20 

 

                             DEATH BENEFIT PROVISIONS    NATURAL OWNER'S DEATH BEFORE THE INCOME DATE. Upon Your death or the death of  any Joint Owner before the Income Date, the Company will pay the death benefit to the  Beneficiary(ies) designated by You. In the event of the death of a Joint Owner, the surviving  Joint Owner, if any, will be the Primary Beneficiary. Any other Beneficiary designation on record  at the Company's Service Center at the time of death will be treated as a Contingent  Beneficiary.    DEATH BENEFIT AMOUNT BEFORE THE INCOME DATE. The death benefit amount before  the Income Date is equal to the Contract Value.    DEATH BENEFIT PAYMENT OPTIONS BEFORE THE INCOME DATE. Unless You  designated a Pre-selected Death Benefit Option, a Beneficiary entitled to the death benefit  before the Income Date must request that the Company pay the death benefit according to one  of the death benefit payment options below:    Option 1 - single lump-sum payment;  Option 2 - payment of the entire death benefit distributed within five (5) years of the date of the            relevant death; or  Option 3 - Income Payments of the death benefit (i) over the lifetime of the Beneficiary, or (ii)           over a period not extending beyond the life expectancy of the Beneficiary, with           distribution beginning within one (1) year of the date of the relevant death.    The Company may make available other death benefit payment options.    A Beneficiary that wishes to elect payment under the life income option (Option 3) must do so  no later than sixty (60) days from the date the Company receives Due Proof of death in Good  Order at the Company's Service Center.    Any portion of the death benefit not applied under the life income option (Option 3) must be paid  within five (5) years from Your death. The death benefit will remain invested in accordance with  the allocation selected by You until a payout option is selected or the Beneficiary specifies  otherwise.    ANNUITANT'S DEATH BEFORE THE INCOME DATE. Upon the death of an Annuitant who is  not an Owner before the Income Date, the Contract remains in force and the Owner becomes  the Annuitant. The Owner may designate a new Annuitant, subject to the Company's  administrative rules then in effect. However, if the Contract is owned by a legal entity, upon the  death of any Annuitant, the Company will pay the death benefit to the Beneficiary(ies)  designated by the Owner, or, if no Beneficiary(ies) survive the applicable death, to the Owner.    BENEFICIARY'S ENTITLEMENT TO DEATH BENEFIT BEFORE THE INCOME DATE. The  Company will pay the death benefit to Primary Beneficiaries or, if none exist, to Contingent  Beneficiaries, in equal shares (the "default allocation") unless You have designated otherwise  (the "designated allocation"). A Beneficiary that dies before or within ten (10) days (or different  period as prescribed by applicable law) of Your death is not entitled to any death benefit. In that  circumstance, the Company will pay the deceased Beneficiary's benefit to surviving  Beneficiaries in the same proportion as the designated allocation or, if applicable, the default  allocation. If no Beneficiary survives You, the Company will pay the death benefit to Your estate.      ICC19 VA720                               21 

 

                       DEATH BENEFIT PROVISIONS (CONT'D)    PAYMENT OF DEATH BENEFIT PROCEEDS. The Company will pay the death benefit  proceeds to the Beneficiary upon receipt of a request for payment with Due Proof of death in  Good Order at the Company's Service Center. If the Company has received Due Proof of death,  the Company will calculate the share of the death benefit due to a Beneficiary using Contract  values established at the end of the Business Day on the date the Company receives from that  Beneficiary a claim form with a payment option elected. If the Company has not received Due  Proof of death or any other required documentation, the Company will calculate the share of the  death benefit due to a Beneficiary using Contract values established at the end of the Business  Day on the date the Company receives any remaining required documentation. As a result,  market fluctuation may cause the calculation of a Beneficiary's death benefit share to differ from  the calculation of another Beneficiary's death benefit share. We will pay interest on a  Beneficiary's death benefit share as required by law.    Each Beneficiary entitled to the death benefit bears the investment risk associated with amounts  allocated to any Investment Division until the Company calculates their share of the death  benefit.    If any death benefit proceed is due to an Owner's estate, the Company will pay it in a single  lump-sum payment.    With the exception of death benefit Option 3 above, the Company will pay a Beneficiary that  elects a death benefit option within seven (7) calendar days of the date the Company receives  request for payment, provided the Company has received Due Proof of death in Good Order at  the Company's Service Center, unless the Suspension of Separate Account Payments provision  is in effect.    If the Company does not distribute death benefit proceeds within seven (7) calendar days, the  death benefit proceeds will include interest accrued and payable from the eighth day following  the date that Due Proof of death was received in Good Order at the Company's Service Center  until the death benefit is paid. The rate of interest will equal the rate of interest applicable to  death benefit proceeds left on deposit with the Company on the date of Your death.    If the Company does not distribute the death benefit payment within thirty (30) calendar days of  the latest of the dates specified in items 1, 2, and 3 below, then beginning on the thirty-first  calendar day from the latest of the dates specified in items 1, 2, and 3 below until the date the  claim is paid, the death benefit will accrue additional interest at a rate of 10% annually.     1.  The date the Company receives Due Proof of death;  2.  the date the Company receives sufficient information to determine liability, the extent of the     liability, and the appropriate payee legally entitled to the proceeds; and  3.  the date that legal impediments to payment of proceeds that depend on the action of parties     other than the Company are resolved and sufficient evidence of the same is provided to the     Company. Legal impediments to payment include, but are not limited to, (a) the     establishment of guardianships and conservatorships; (b) appointment and qualification of     trustees, executors and administrators; and (c) submission of information required to satisfy     state and federal reporting requirements.    ICC19 VA720                               22 

 

                       DEATH BENEFIT PROVISIONS (CONT'D)    Spousal Continuation Option Instead of Death Benefit. Unless the Contract is subject to a  Pre-selected Death Benefit Option, a spouse who is a Joint Owner or Beneficiary of the  deceased Owner, may elect to continue the Contract in his or her own name and exercise the  Owner's rights under the Contract instead of taking the standard death benefit.    For purposes of the Spousal Continuation Option, the "continuation date" is the date on which  the Company receives the spouse's written request to elect the Spousal Continuation Option  and Due Proof of the relevant death in Good Order at the Company's Service Center.    The Spousal Continuation Option is void in the event the original Contract Owner is no longer  the Contract Owner or in the event the Contract has been assigned. This Spousal Continuation  Option may be exercised only once, and may not be available if You designated a Pre-selected  Death Benefit Option.    Pre-selected Death Benefit Option. Before the Income Date, You may designate the option  according to which the Company will pay the death benefit from the death benefit payment  options described in the Contract, or other death benefit payment options made available by the  Company. You may do so by submitting a designation in a form acceptable to the Company in  Good Order to the Company's Service Center. Pre-selected Death Benefit Options are effective  only after being recorded by the Company. The Company will pay the death benefit consistent  with Your Pre-selected Death Benefit Option unless the Internal Revenue Code requires  otherwise, or Your election requires payment over a period that exceeds the Beneficiary's life  expectancy.    Only You may revoke or change a Pre-selected Death Benefit Option. To do so, You must  submit a request in a form acceptable to the Company to the Company's Service Center.  Revocations of and changes to a Pre-selected Death Benefit Option are effective only after  being recorded by the Company.    ICC19 VA720                               23 

 

                                   INCOME PROVISIONS    INCOME DATE. The Income Date is the date, not less than one (1) year after the Contract's  Issue Date, on which Income Payments will begin. If You do not select an Income Date, the  Income Date is the Latest Income Date. You may change the Income Date to any date that is  not later than the Latest Income Date by submitting Written Notice in Good Order to the  Company's Service Center at least seven (7) days before the Income Date.    INCOME PAYMENT. On or before the Income Date, You can elect payment in a single lump- sum. A single lump-sum payment is considered a total withdrawal and terminates the Contract.  The Company will make payment to You or another payee You specify. Alternatively, You may  elect an Income Option. The Company will apply the Contract Value, less any applicable taxes,  MVA, and other Contract charges, to provide You Fixed Annuity Payments or Variable Annuity  Payments according to Your selected Income Option. If You do not choose how to receive Your  Income Payments, Your Income Payments will be Variable Annuity Payments.    Income Options. You may elect payment as provided in Options 1, 2, 3 or 4 below. You may  elect an Income Option at any time before the Income Date and You can change an Income  Option up to seven (7) days before the Income Date by submitting Written Notice in Good Order  to the Company's Service Center.    If You do not select an Income Option, the Company will make payments as provided in Option  3 below, with 120 months certain. The Company will make payments monthly, quarterly,  semiannually or annually as You elect. However, if the Contract Value on the Income Date is  less than $2,000, the Company may pay out the Contract Value in one (1) lump-sum payment  instead of providing Income Payments according to the Income Option You elect. If the first  monthly payment provided would be less than $20, the Company may make payments  quarterly, semiannually or annually to achieve an initial payment of at least $20, or the  Company may pay out the Contract Value in one (1) single lump-sum payment.    At the time of their commencement, Income Payments will not be less than those that would be  provided by the application of an equivalent amount to purchase a single premium immediate  annuity contract from the Company at purchase rates the Company offered on the Income Date  to annuitants in the same class as the Annuitant.    YOU MAY NOT TAKE WITHDRAWALS DURING ANY PERIOD THE COMPANY IS MAKING  PAYMENTS FOR AN ANNUITANT'S LIFETIME.    OPTION 1 - LIFE INCOME. A monthly payment for the Annuitant's lifetime. All payments end  upon the Annuitant's death. However, in the event of the Annuitant's death before the first  monthly payment, the Company will pay the amount allocated to this Income Option to You or, if  You are deceased, to Your Beneficiary. No MVA applies to Contract Value applied to Option 1.    ICC19 VA720                               24 

 

                            INCOME PROVISIONS (CONT'D)    OPTION 2 - JOINT AND SURVIVOR INCOME. A monthly payment for the longer of the  Annuitant's lifetime or that of a second person You designate. Upon the occasion of the first  person to die, monthly payments continue during the survivor's lifetime at either the full amount  previously payable or as a percentage (either one-half or two-thirds) of the full amount, as You  select at the time You elect the Income Option. If reduced Income Payments to the survivor are  desired, the Company will calculate Variable Annuity Payments using either one-half or two- thirds of the number of Annuity Units for each Investment Division comprising the Variable  Annuity Payments payable during the joint life of the Annuitant and the designated second  person. The Company will calculate Fixed Annuity Payments equal to either one-half or two- thirds of the Fixed Annuity Payment payable during the joint life of the Annuitant and the  designated second person.    All payments end upon the death of the last surviving Annuitant. However, in the event of the  deaths of the Annuitant and the designated second person before the first monthly payment, the  Company will pay the amount allocated to this Income Option to You or, if You are deceased,  Your Beneficiary. No MVA applies to Contract Value applied to Option 2.    OPTION 3 - LIFE INCOME WITH 120 OR 240 MONTHLY PAYMENTS GUARANTEED. A  monthly payment for the Annuitant's lifetime with the guarantee that the Company will make no  fewer than 120 or 240 monthly payments to You. If the Owner is an entity, at the Annuitant's  death, if fewer than the guaranteed number of payments have been made, the remaining  guaranteed payments will be made to the Owner as previously scheduled. If the Owner is the  Annuitant, in the event You die before the Company makes the specified number of guaranteed  payments, Your Beneficiary may elect to continue to receive the Income Payments according to  the terms of this Contract, or alternatively may elect to receive the present value of any  remaining guaranteed payments in a single lump-sum payment. The present value of any  remaining guaranteed payments will be based on the total Income Payments as of the date of  the calculation. The Company will determine the interest rate used in this present value  calculation, but in no instance will it be greater than (one) 1 percentage point higher than the  rate used to calculate the initial Income Payment. No MVA applies to Contract Value applied to  Option 3.    OPTION 4 - INCOME FOR A SPECIFIED PERIOD. A monthly payment for any whole number  of years ranging from 5 to 30. In the event You die before the Company makes the specified  number of payments, Your Beneficiary may elect to continue to receive the Income Payments  according to the terms of this Contract, or alternatively may elect to receive the present value of  any remaining guaranteed payments in a single lump-sum payment. The present value of any  remaining guaranteed payments will be based on the total Income Payments as of the date of  the calculation. The Company will determine the interest rate used in this present value  calculation, but in no instance will it be greater than (one) 1 percentage point higher than the  rate used to calculate the initial Income Payment. No MVA applies to Contract Value applied to  payments spread over five (5) years or more under Option 4.    ADDITIONAL INCOME OPTIONS. The Company may make available other Income Options.    ICC19 VA720                               25 

 

                            INCOME PROVISIONS (CONT'D)    FIXED ANNUITY PAYMENTS. The Company will determine Fixed Annuity Payments by  applying annuity rates consistent with the age and sex (unless unisex rates apply) of the  Annuitant and, if applicable, the designated second person, to the portion of the Contract Value  allocated to the Fixed Annuity Payment options, less any applicable taxes and other Contract  charges. Annuity rates applied will not be less than the rates provided in the Contract's Table of  Income Options.    Once begun, the Company will not change the amount of the Fixed Annuity Payments, except  upon the first death between the Annuitant and the designated second person under Option 2.    VARIABLE ANNUITY PAYMENTS. The Company will determine the initial Variable Annuity  Payment by applying annuity rates consistent with the age and sex (unless unisex rates apply)  of the Annuitant and, if applicable, the designated second person, to the portion of the Contract  Value allocated to the Variable Annuity Payment options, less any applicable taxes and other  Contract charges. Annuity rates applied will not be less than the rates provided in the Contract's  Table of Income Options.    The Company will determine the second and subsequent Variable Annuity Payments in two (2)  steps. First, the Company will divide the initial Variable Annuity Payment by the Annuity Unit  Value calculated on the Income Date to establish a number of Annuity Units. Second, the  Company will multiply that number of Annuity Units by the Annuity Unit Value determined on the  Business Day next preceding the date on which each payment is due. The result of each  calculation determines the Variable Annuity Payment due.    Once Variable Annuity Payments have begun, the number of Annuity Units remains constant  absent a reallocation between the Investment Divisions. Variable Annuity Payments are not  affected by expenses other than taxes.    The Contract Data Pages specify the minimum investment return Your Investment Division(s)  must earn to avoid a decrease in the dollar amount of Variable Annuity Payments.    Annuity Unit Value. The Company sets the initial value of an Annuity Unit of each Investment  Division when the Company establishes the Investment Division. The Annuity Unit Value  reflects the investment performance of an Investment Division and may increase or decrease  from one Business Day to the next. The Contract's Table of Income Options assumes the net  investment rates described in the Contract's Basis of Computation provision. Therefore, if an  Investment Division's actual net investment rate is greater than or less than the assumed net  investment rate, Variable Annuity Payments will increase or decrease accordingly over time.    The Company calculates each Investment Division's Annuity Unit Value for any Business Day in  two (2) steps:    First, the Company multiplies the immediately preceding Business Day's Annuity Unit Value by  the Business Day's "net investment factor" determined on the day of the calculation. The  Company determines the "net investment factor," which reflects changes in the Investment  Division's net asset value, by dividing the value established at (1) below by the value  established at (2) below, and then subtracting the value established at (3) below, where:    ICC19 VA720                               26 

 

                            INCOME PROVISIONS (CONT'D)    (1)  Is the net result of:      a.  the Investment Division's net asset value at the end of the Business Day; plus      b.  the per share amount of any dividend or other distribution declared by the Investment         Division if the "ex-dividend" date occurs on the Business Day; plus or minus      c.  a per share credit or charge with respect to any taxes paid or reserved for by the         Company which are determined by the Company to be attributable to the operation of         the Investment Division (no federal income taxes are applicable under present law); and  (2)  Is the Investment Division's net asset value at the end of the preceding Business Day; and  (3)  Is the asset charge factor the Company determines for the Business Day to reflect the      applicable Core Contract Charge.    Second, the Company multiplies the result from the first step above by a factor equal to the ratio  of one over one plus the assumed net investment rate, raised to the number of calendar days  between the previous Business Day and the current Business Day over the number of calendar  days in the current year. The factor is expressed formulaically as follows:                                                   &#0;                                           1    &#0;                                       &#0;       &#0;                                          1 &#0;   where:    AIR  is   the assumed net investment rate.  t     is  the number of calendar days between the previous Business Day and the current            Business Day.  y     is  the number of calendar days in the current year.    NATURAL OWNER'S DEATH AFTER THE INCOME DATE. Upon Your death or the death of  any Joint Owner, who is not also an Annuitant, after the Income Date, remaining Income  Payments due continue as before. Upon Your death after the Income Date, the Beneficiary  becomes the Owner.    ANNUITANT'S DEATH AFTER THE INCOME DATE. Upon the death of the Annuitant after the  Income Date, the death benefit, if any, will be as specified in the Income Option elected. Death  benefits will be paid at least as rapidly as under the method of distribution in effect at the  Annuitant's death.    BENEFICIARY'S ENTITLEMENT TO INCOME PAYMENTS AFTER THE INCOME DATE.  Upon Your death or the death of any Joint Owner, the Company will pay remaining Income  Payments due to Primary Beneficiaries or, if none exist, to the Contingent Beneficiaries, in equal  shares (the "default allocation") unless You have designated otherwise (the "designated  allocation"). A Beneficiary that dies before or within ten (10) days (or different period as  prescribed by applicable law) of Your death is not entitled to any remaining Income Payments  due; in that circumstance, the Company will pay remaining Income Payments due the deceased  Beneficiary to surviving Beneficiaries in the same proportion as the designated allocation or, if  applicable, the default allocation. If no Beneficiary survives You, the Company will pay  remaining Income Payments to Your estate.    ICC19 VA720                               27 

 

                                TERMINATION PROVISION    This Contract terminates and all Contract benefits, including those provided by any add-on  benefits unless otherwise specified in the add-on benefits, will end on the earlier of:  1.  the date You take a total withdrawal;  2.  the date the Contract Value is reduced to zero for any reason or insufficient to pay Contract     charges; or  3.  the date upon which the Company receives Due Proof of Your (or any Joint Owner's) death     and receives all Beneficiaries' elections of death benefit payment options in Good Order at     the Company's Service Center, unless the Contract is continued by the spouse under the     Spousal Continuation Option.    ICC19 VA720                               28

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