Document:

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                                   [FORM OF]
                  GENWORTH LIFE INSURANCE COMPANY OF NEW YORK
             GUARANTEED MINIMUM WITHDRAWAL BENEFIT FOR LIFE RIDER

General Features

This rider provides for a guaranteed minimum withdrawal benefit for the life of
the Annuitant(s). This rider is only available for Annuitant(s) [age 50 through
age 85] at the time the Contract is issued. The Withdrawal Base is not the
Contract Value. There is no impact to the Withdrawal Base if no excess
withdrawals are taken. Withdrawals taken under this rider reduce the Contract
Value by the amount of the Gross Withdrawal. The Rider Death Benefit on the
Contract Date is equal to the initial Purchase Payment. There is no annuity
value associated with this rider. There is a rider charge, which is a daily
asset charge that is applied against all amounts in the Subaccounts. Once
elected this rider may not be terminated except as stated below (see When this
Rider is Effective on page [8]).

To receive the full benefit of this rider you must allocate all Contract Value
to the prescribed Investment Strategy and limit total Gross Withdrawals in a
Benefit Year to an amount no greater than the Withdrawal Limit. If you do not
follow the Investment Strategy, there will be a reduction in the Withdrawal
Factor and Rider Death Benefit by the percentage shown on the Contract Data
Pages (see Investment Strategy on page [3]). Even if your benefit is reduced,
you will continue to pay the full amount charged for this rider.

The Withdrawal Base on the Contract Date is equal to the initial Purchase
Payment. The Withdrawal Base and the Withdrawal Factor are used to determine
the Withdrawal Limit. Any additional Purchase Payment will be applied to the
Withdrawal Base on the Valuation Day the additional Purchase Payment is
received. If you do not exceed the Withdrawal Limit, the Withdrawal Base will
never be reduced. You may reset your Withdrawal Base to the Contract Value
subject to the terms and requirements described below (see Restoration or Reset
of the Benefit on page [5]).

The Withdrawal Limit is the total amount that you may withdraw in a Benefit
Year without reducing the benefits provided under this rider. The Withdrawal
Limit is equal to the Withdrawal Factor multiplied by the greater of the
Contract Value on the prior Contract anniversary and the Withdrawal Base (see
Guaranteed Minimum Withdrawal Benefit on page [4]). The Withdrawal Factor is
based on the attained age of the Annuitant for a single Annuitant Contract or
the attained age for the younger living Annuitant for a Joint Annuitant
Contract on the earlier of the Valuation Day of the first Gross Withdrawal and
the Valuation Day when the Contract Value is reduced to zero. If a Gross
Withdrawal plus all prior Gross Withdrawals in a Benefit Year is in excess of
the Withdrawal Limit, your Withdrawal Base and Rider Death Benefit are reduced
(see Excess Withdrawals on page [6]).

Subsequent Purchase Payment(s) applied to your Contract generally will adjust
your Withdrawal Base and Rider Death Benefit. We reserve the right not to
adjust the Withdrawal Base and/or the Rider Death Benefit for any additional
Purchase Payment(s) in order to control future risks under this rider. If we
decide not to adjust the Withdrawal Base and/or the Rider Death Benefit for any
additional Purchase Payments, we will notify you [45] days prior to enacting
this restriction.

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If all of the Annuitants are ages 50 through 59, you may choose to reset your
Withdrawal Base on an annual anniversary of the Contract Date that is at least
12 months after the later of the Contract Date and the last reset date. If the
older of the Annuitants is age 60 through 85, you may choose to reset your
Withdrawal Base on an annual anniversary of the Contract Date that is at least
12 months after the later of the Contract Date and the last reset date (see
Restoration or Reset of the Benefit on page [5]). Reset allocations must follow
the Investment Strategy in effect at that time. The feature may trigger a new
rider charge when used, subject to change but limited to a maximum annual
charge of [2.00%].

This rider also allows you a one-time opportunity to restore your Withdrawal
Factor and Rider Death Benefit if benefits have been reduced due to violation
of the Investment Strategy (see Restoration or Reset of the Benefit on page
[5]).

Prior to the Annuity Commencement Date, at the death of the last Annuitant, a
Death Benefit may be payable under this Contract and rider. The amount of any
Death Benefit payable will be the greatest of (a), (b) and (c), where:

    (a)   is the Death Benefit as calculated under the base Contract;

    (b)   is the Rider Death Benefit; and

    (c)   is any amount payable by any other optional death benefit rider.

The Death Benefit payable will be paid according to the distribution rules
under the Contract. The Death Benefit will be reduced by the sum of any
payments, less charges, made after the death of an Annuitant. We may recover
from you or your estate any payments made after the death of an Annuitant (see
Death Provisions on page [7]).

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

Terms and Procedures

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

Benefit Date - The date that will be the later of:

    (1)   the Contract Date; and

    (2)   the Valuation Day of the most recent reset of the Withdrawal Base.

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

Death Benefit Reduction Percentage - The percentage shown on the Contract Data
Pages. On the first Valuation Day after you choose not to follow the Investment
Strategy, your Rider Death Benefit will be reduced by the Death Benefit
Reduction Percentage.

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

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

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

Rider Death Benefit - The death benefit payable under this rider. The Rider
Death Benefit on the Contract Date is equal to the initial Purchase Payment.

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Withdrawal Base - An amount used to establish the Withdrawal Limit. The
Withdrawal Base on the Contract Date is equal to the initial Purchase Payment.
The Withdrawal Base is used to determine benefits under the rider. The
Withdrawal Base is not the Contract Value.

Withdrawal Factor - The percentage used to establish the Withdrawal Limit. The
Withdrawal Factor is based on the attained age of the Annuitant for a single
Annuitant Contract or the attained age for the younger living Annuitant for a
Joint Annuitant Contract on the earlier of the Valuation Day of the first Gross
Withdrawal and the Valuation Day when the Contract Value is reduced to zero.
The percentage is shown on the Contract Data Pages.

Withdrawal Limit - The total amount that you may withdraw in a Benefit Year
without reducing the benefits provided under this rider. The Withdrawal Limit
is calculated on each Valuation Day. The Withdrawal Limit is (a) multiplied by
(b), where:

    (a)   is the greater of the Contract Value on the prior Contract
          anniversary and the Withdrawal Base; and

    (b)   is the Withdrawal Factor.

Withdrawal Factor Reduction Percentage - The percentage shown on the Contract
Data Pages. On the first Valuation Day after you choose not to follow the
Investment Strategy, your Withdrawal Factor will be reduced by the Withdrawal
Factor Reduction Percentage.

Investment Strategy

To obtain the full benefits provided under this rider, you must allocate all
Contract Value to an Investment Strategy, which will be provided to you.
Benefits may be reduced as described below if you do not invest in the
Investment Strategy. You must allocate your Contract Value among the following
Investment Strategy options shown on the Contract Data Pages for this rider:

  .   the Designated Subaccounts or,

  .   an Asset Allocation Model

You must allocate all Contract Value between the Investment Strategy options.
If you use the Designated Subaccounts option, you must specify the percentage
to invest in each Designated Subaccount. Under the Asset Allocation Model
option, any percentage of Contract Value invested must first be divided into
categories in accordance with the percentages shown on the Contract Data Pages.
Within each category you must then specify the percentage to invest in each
available Subaccount.

Reallocations

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

On a monthly basis, we will rebalance Contract Value to the Subaccounts in
accordance with the percentages that you have chosen. In addition, on any
Valuation Day after any transaction involving a withdrawal, receipt of a
Purchase Payment or a transfer of Contract Value, we will rebalance Contract
Value to the Subaccounts in accordance with the percentages that you have
chosen, unless you instruct us otherwise.

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Allocations Outside of the Investment Strategy

Beginning on the first Valuation Day after you choose not to follow the
Investment Strategy, your Withdrawal Factor and Rider Death Benefit will be
reduced as follows:

The Withdrawal Factor will be (a) minus (b), where:

    (a)   is the Withdrawal Factor; and

    (b)   is the Withdrawal Factor multiplied by the Withdrawal Factor
          Reduction Percentage.

The Rider Death Benefit will be (a) minus (b), where:

    (a)   is the Rider Death Benefit; and

    (b)   is the Rider Death Benefit multiplied by the Death Benefit Reduction
          Percentage.

You may elect to resume participation in the Investment Strategy, as described
in the Restoration or Reset of the Benefit provision, provided we receive
notice of your election in a form acceptable to us.

We will not reduce your Withdrawal Factor or Rider Death Benefit if you are not
following the Investment Strategy due to a portfolio liquidation or a portfolio
dissolution and the assets are transferred from the liquidated or dissolved
portfolio to another portfolio.

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

Notification

Transfer requests must be submitted in a form acceptable to us and must be
submitted in accordance with the terms of the Contract. If your transfer
request is received in good order, we will process your transfer request as of
the Valuation Day your transfer request is received. If your benefit is not
already currently reduced, your transfer request is in good order, and you have
not taken a withdrawal subsequent to this transfer request, but such transfer
causes your Contract Value to not be allocated in accordance with the
Investment Strategy, you will have [1] opportunity, within [5] business days
from the date the confirmation statement is sent to you, to make another
transfer request to the prescribed Investment Strategy without a reduction to
your benefit. Such a transfer request will be considered a transfer for
purposes of counting the number of transfers allowed in a calendar year. Your
Withdrawal Base will not be affected in such circumstance.

This benefit is not available to you if your benefit is: (1) currently reduced
due to not allocating assets according to the prescribed Investment Strategy;
(2) you have already exercised this benefit; or (3) you request a transfer
after [5] business days from the date the confirmation statement is sent to you.

Exercise of this benefit does not preclude you from exercising the restoration
or reset provision.

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Guaranteed Minimum Withdrawal Benefit

If you:

  .   allocate all Contract Value to the Investment Strategy; and

  .   limit total Gross Withdrawals in a Benefit Year to an amount no greater
      than the Withdrawal Limit;

then you will be eligible to receive total Gross Withdrawals in each Benefit
Year equal to the Withdrawal Limit until the last death of an Annuitant.

The Withdrawal Limit is calculated on each Valuation Day. The Withdrawal Limit
is (a) multiplied by (b), where:

    (a)   is the greater of the Contract Value on the prior Contract
          anniversary and the Withdrawal Base; and

    (b)   is the Withdrawal Factor.

The Withdrawal Factor is established based on the attained age of the younger
Annuitant on the earlier of the Valuation Day of the first Gross Withdrawal and
the Valuation Day when the Contract Value is reduced to zero. The Withdrawal
Factor percentage is shown on the Contract Data Pages.

Purchase Payments

Any Purchase Payment applied to your Contract will adjust your Withdrawal Base
and Rider Death Benefit. In order to obtain the full benefit provided by this
rider, you must allocate all assets to the prescribed Investment Strategy from
the Benefit Date. If you have allocated all assets to the Investment Strategy
since the Benefit Date, any subsequent Purchase Payment will be added to the
Withdrawal Base and the Rider Death Beneft. Otherwise, the Purchase Payment
will be added to the Withdrawal Base, and the Rider Death Benefit will be
increased by (a) minus (b), where:

    (a)   is the Purchase Payment; and

    (b)   is the Purchase Payment multiplied by the Death Benefit Reduction
          Percentage.

We reserve the right to not adjust the Withdrawal Base and/or the Rider Death
Benefit for any additional Purchase Payments.

Restoration or Reset of the Benefit

Restoration: If your Withdrawal Factor and Rider Death Benefit have been
reduced because you have not allocated all assets to the prescribed Investment
Strategy, you will have a one-time opportunity to restore your Withdrawal
Factor and Rider Death Benefit.

Reset: If all of the Annuitants are ages 50 through 59, you may choose to reset
your Withdrawal Base on an annual anniversary of the Contract Date that is at
least 12 months after the later of (a) and (b). If the older of the Annuitants
is age 60 through 85, you may choose to reset your Withdrawal Base on an annual
anniversary of the Contract Date that is at least 12 months after the later of
(a) and (b), where:

    (a)   is the Contract Date; and

    (b)   is the last reset date.

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If you do reset your Withdrawal Base, as of that date, we will:

  .   reset the Withdrawal Base to your Contract Value;

  .   reset the charge for this rider. The new charge, which may be higher than
      your previous charge, will never exceed [2.00%] annually; and

  .   reset the Investment Strategy to the current Investment Strategy.

There are similarities as well as distinct differences between restoring your
Withdrawal Factor and resetting your Withdrawal Base and Withdrawal Factor. The
similarities and differences are:

 Restore Provision                      Reset Provision
 -----------------                      -------------------------------------
 You may restore on a Contract          You may reset on a Contract
 anniversary once during the life of    anniversary periodically after your
 this rider.                            Benefit Date.

 You must allocate all assets to the    You must allocate all assets to the
 Investment Strategy in effect as of    Investment Strategy offered as of the
 the last Benefit Date prior to the     date of the reset.
 reduction in benefits.

 Your rider charge assessed will        Your rider charge may increase, not
 remain the same as the charge that     to exceed an annualized rate of
 was in effect as of your last Benefit  [2.00%], calculated on a daily basis.
 Date prior to the reduction in
 benefits.

 Your Withdrawal Base will be the       Your Withdrawal Base will be reset to
 lesser of the current Contract Value   equal your Contract Value as of the
 and your prior Withdrawal Base.        date of your reset.

 The Withdrawal Factor will be          The Withdrawal Factor will be reset
 restored to 100% of the original age   to 100% of the original age
 Withdrawal Factor.                     Withdrawal Factor.

 The Rider Death Benefit will be the    The Rider Death Benefit will be the
 lesser of Contract Value and total     lesser of Contract Value and total
 Purchase Payments less Gross           Purchase Payments less Gross
 Withdrawals.                           Withdrawals.

For either a restoration of your Withdrawal Factor, or a reset of your
Withdrawal Base, we must receive notice of your election in a form acceptable
to us at least [15] days prior to your next Contract anniversary. You may
restore your Withdrawal Factor and Rider Death Benefit once during the life of
this rider.

You may not use the restore or reset provision if any Annuitant is older than
age [85] on the Contract anniversary. We reserve the right to limit the
restoration date to a Contract anniversary on or after [three] complete year[s]
from the Benefit Date.

Excess Withdrawals

If a Gross Withdrawal plus all prior Gross Withdrawals in a Benefit Year is in
excess of the Withdrawal Limit, your Withdrawal Base and Rider Death Benefit
are reduced. The new Withdrawal Base equals the lesser of (a) and (b), where:

    (a)   is the Contract Value on the Valuation Day after the Gross
          Withdrawal; and

    (b)   is the prior Withdrawal Base minus the Gross Withdrawal.

The new Rider Death Benefit equals the lesser of (a) and (b), where:

    (a)   is the Contract Value on the Valuation Day after the Gross
          Withdrawal; and

    (b)   is the prior Rider Death Benefit minus the Gross Withdrawal.

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

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Required Minimum Distributions

If all Contract Value is allocated to the Investment Strategy, the Withdrawal
Limit will be increased for any Benefit Year to the extent necessary to meet
any minimum distribution requirements under federal tax law. This increase
applies only to the required minimum distribution based on the value of the
Contract.

Reduction in Contract Value

Your Contract Value after taking a withdrawal may be less than the amount
required to keep your Contract in effect. In this event or if your Contract
Value becomes zero, your Contract, this rider and any other riders and
endorsements will terminate and the following will occur:

  .   If the Withdrawal Limit is less than $100, we will pay you the greatest
      of the Rider Death Benefit, Contract Value and the present value of the
      Withdrawal Limit in a lump sum calculated using the Annuity 2000
      Mortality Table and an interest rate of 3%.

  .   If the Withdrawal Limit is greater than $100, we will issue you a
      supplemental contract. We will continue to pay you the Withdrawal Limit
      until the death of the last Annuitant. We will make payments no less
      frequent than annually, unless agreed otherwise. If the monthly amount is
      less than $100, we will reduce the frequency so that the payment will be
      at least $100. The Rider Death Benefit will continue under the
      supplemental contract. The Rider Death Benefit will be reduced by each
      payment made under the supplemental contract. The Rider Death Benefit, if
      any, will be payable on the last death of an Annuitant.

Rider Death Benefit

The Rider Death Benefit on the Contract Date is equal to the initial Purchase
Payment.

Purchase Payments in a Benefit Year increase the Rider Death Benefit. If you
have allocated all assets to the Investment Strategy since the Benefit Date,
any subsequent Purchase Payment will be added to the Rider Death Benefit.
Otherwise, the Rider Death Benefit will be increased by (a) minus (b), where:

    (a)   is the Purchase Payment; and

    (b)   is the Purchase Payment multiplied by the Death Benefit Reduction
          Percentage.

Gross Withdrawals in a Benefit Year decrease the Rider Death Benefit. If a
Gross Withdrawal plus all prior Gross Withdrawals in a Benefit Year is less
than or equal to the Withdrawal Limit, the Rider Death Benefit will be reduced
by the Gross Withdrawal. If a Gross Withdrawal plus all prior Gross Withdrawals
in a Benefit Year is in excess of the Withdrawal Limit, your Rider Death
Benefit will equal the lesser of (a) and (b), where:

    (a)   is the Contract Value on the Valuation Day after the Gross
          Withdrawal; and

    (b)   is the prior Rider Death Benefit minus the Gross Withdrawal.

If you choose not to follow the Investment Strategy, your Rider Death Benefit
will be reduced as described in the Investment Strategy provision.

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Death Provisions

At the death of the last Annuitant, a Death Benefit may be payable under this
Contract and rider. The amount of any Death Benefit payable will be the
greatest of (a), (b) and (c), where:

    (a)   is the Death Benefit as calculated under the base Contract;

    (b)   is the Rider Death Benefit; and

    (c)   is any amount payable by any other optional death benefit rider.

The Death Benefit payable will be paid according to the distribution rules
under the Contract. We may recover from you or your estate any payments made
after the death of an Annuitant. All other Death Provisions under the Contract
and in any optional death benefit riders, including distribution rules, apply.

If the designated beneficiary is a surviving spouse who is not an Annuitant,
whose age is [50] through [85], and who elects to continue the Contract as the
new Owner, this rider will continue. The Withdrawal Base for the new Owner will
be the Death Benefit determined as of the first Valuation Day we have receipt
of due proof of death and all required forms at our Service Center. The
Withdrawal Factor for the new Owner will be based on the age of that Owner on
the date of the first Gross Withdrawal for that Owner.

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

If the surviving spouse cannot continue the rider, the rider and the rider
charge will terminate on the next Contract anniversary.

Rider Charge

There will be a daily asset charge for this rider. This charge is added to the
Contract's daily asset charge and applied against all amounts allocated to the
Subaccounts. The charge for this rider will depend upon whether the Contract is
a single Annuitant or Joint Annuitant Contract. This charge is shown on the
Contract Data Pages. Once applied, the Joint Annuitant charge will continue
while the rider is in effect. The charge for this rider will be reset if you
choose to reset your Withdrawal Base and Rider Death Benefit. The new charge,
which may be higher than your previous charge, will never exceed [2.00%]
annually.

When this Rider is Effective

The rider becomes effective on the Contract Date. It will remain in effect
while this Contract is in force and before the Annuity Commencement Date. This
rider may not be terminated prior to the Annuity Commencement Date. On the
Annuity Commencement Date, this rider will terminate.

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Change of Ownership

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

If you marry after issue, you may add your spouse as a Joint Owner and Joint
Annuitant or as a Joint Annuitant only, subject to our approval.

General Provisions

For purposes of this rider:

  .   A non-natural entity Owner must name an Annuitant and may name the
      Annuitant's spouse as a Joint Annuitant.

  .   An individual Owner must also be an Annuitant.

  .   You may name only your spouse as a Joint Owner.

  .   If there is only one Owner, that Owner may name only his or her spouse as
      a Joint Annuitant at issue.

  .   If you marry after issue, you may add your spouse as a Joint Owner and
      Joint Annuitant or as a Joint Annuitant only, subject to our approval.

For Genworth Life Insurance Company of New York,

                            [GRAPHIC APPEARS HERE]

                                David J. Sloane
                                   President

                                      9<PAGE>

                                   [FORM OF]
                  GENWORTH LIFE AND ANNUITY INSURANCE COMPANY
                      PAYMENT PROTECTION WITH COMMUTATION
                 IMMEDIATE AND DEFERRED VARIABLE ANNUITY RIDER

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This rider is added to the Policy. It provides for Monthly Income with a
Guaranteed Payment Floor. The Guaranteed Payment Floor is based on the attained
age of the younger Annuitant on the Maturity Date. This rider may provide
Additional Death Proceeds. To maximize the Additional Death Proceeds and the
Guaranteed Payment Floor, you must allocate Account Value and the value of
Annuity Units to the Investment Strategy. You may not terminate this rider
apart from the Policy.

All rider terms will have the same meaning as under the Policy, unless
otherwise provided.

Additional Death Proceeds - The benefit, if any, we will pay to the Designated
Beneficiary if the last Annuitant dies after the Maturity Date.

Adjustment Account - The account that is established when Monthly Income is
calculated on the Maturity Date.

Annual Income Amount - The sum of Annual Income Amounts determined for each
Investment Subdivision. The Annual Income Amount for an Investment Subdivision
is equal to the number of Annuity Units of that Investment Subdivision
multiplied by the Annuity Unit value for that Investment Subdivision on the
first Valuation Day of each Annuity Year.

Annuity Year - Each one-year period beginning on the Maturity Date or the
annual anniversary of the Maturity Date.

Asset Allocation Model - The Asset Allocation Model shown on the Policy Data
Pages.

Benefit Base - The amount used to calculate the available Income Base.

Commutation Base - The sum of the Commutation Base amounts determined for each
Investment Subdivision. The Commutation Base for an Investment Subdivision is
equal to the number of Commutation Units of that Investment Subdivision
multiplied by the Commutation Unit value for that Investment Subdivision on any
Valuation Day.

Commutation Unit - A unit of measure used in calculating the Commutation Base
in each Investment Subdivision after the Maturity Date.

Commutation Value - A lump sum payment you receive if you terminate the Policy
and rider after the Maturity Date.

Designated Investment Subdivisions - The Designated Investment Subdivisions
shown on the Policy Data Pages.

Guaranteed Payment Floor - The guaranteed amount of Monthly Income as of the
Maturity Date.

Income Base - The value used to calculate the Guaranteed Payment Floor.

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Investment Strategy - The Asset Allocation Model and/or Designated Investment
Subdivisions for this rider.

Joint Annuitant - The additional life on which the Monthly Income may be based.

Level Income Amount - The amount that would result from applying the Annual
Income Amount to a 12-month, period certain, fixed single payment immediate
annuity made available to this rider. We will declare the interest rate at the
start of each Annuity Year.

Monthly Income - The amount paid each month to you on and after the Maturity
Date. The amount remains constant throughout an Annuity Year. The amount may
increase or decrease each Annuity Year.

Investment Strategy

To maximize the Guaranteed Payment Floor, you must allocate all Account Value
to the Investment Strategy. We or our affiliates will provide the Investment
Strategy. You must allocate your Account Value among the following Investment
Strategy options shown on the Policy Data Pages:

     .   the Designated Investment Subdivisions; and/or

     .   the Asset Allocation Model.

You must allocate all Account Value between the Investment Strategy options. If
you use the Designated Investment Subdivisions option, you must specify the
percentage to invest in each Designated Investment Subdivision. Under the Asset
Allocation Model option, any percentage of Account Value invested must first be
divided into categories in accordance with the percentages shown on the Policy
Data Pages. Within each category you must then specify the percentage to invest
in each available Investment Subdivision.

On a monthly basis, we will rebalance Account Value to the Investment
Subdivisions in accordance with the percentages that you have chosen. In
addition, on any Valuation Day after any transaction involving a partial
surrender, receipt of a Purchase Payment or a transfer of Account Value, we
will rebalance Account Value to the Investment Subdivisions in accordance with
the percentages that you have chosen, unless you instruct us otherwise.

If you choose to allocate Account Value without following the Investment
Strategy, your Benefit Base will be reduced by the percentage shown on the
Policy Data Pages. You may elect to resume participation in the Investment
Strategy at your next available reset date, as described in the Benefit Base
provision, provided we receive notice of your election in a form acceptable to
us.

If on the Maturity Date, you are following the Investment Strategy and you
later choose to allocate the value of Annuity Units without following the
Investment Strategy, your Income Base will be reduced by the percentage shown
on the Policy Data Pages. A reduction of Income Base after the Maturity Date
will result in reduction of the Guaranteed Payment Floor and the Additional
Death Proceeds. However, if your Benefit Base was reduced due to not following
the Investment Strategy and then not reset before your Maturity Date, this
adjustment does not apply. On a monthly basis, we will rebalance the value of
Annuity Units to the Investment Subdivisions in accordance with the percentages
that you have chosen.

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We will not reduce your Benefit Base or Income Base if you are not following
the Investment Strategy due to a portfolio liquidation or a portfolio
dissolution and the assets are transferred from the liquidated or dissolved
portfolio to another portfolio.

If this rider is added to the Policy at issue, the Guarantee Account available
as an Investment Option under the Policy, if any, will not be available as an
Investment Option under this rider for as long as this rider is in effect.

Benefit Base

The initial Benefit Base is equal to the sum of the Purchase Payments applied
on the Policy Date. The Benefit Base is constant and remains in effect until
adjusted as described below.

If you have followed the Investment Strategy from the later of the Policy Date
and the date on which the Benefit Base was reset (as described below), any
additional Purchase Payments applied will be added to the Benefit Base as of
the prior Valuation Day. We reserve the right to exclude additional Purchase
Payments from being applied to the Benefit Base.

If your Benefit Base was reduced due to not following the Investment Strategy
and then not reset, any additional Purchase Payments applied will increase the
Benefit Base by (a) minus (b), where:

     (a) is the Purchase Payment; and

     (b) is the Purchase Payment multiplied by the Benefit Base reduction
         percentage, shown on the Policy Data Pages.

We reserve the right to exclude additional Purchase Payments from being applied
to the Benefit Base.

All partial surrenders, including any surrender charges, reduce the Benefit
Base. The new Benefit Base is equal to (a) multiplied by (b) divided by (c),
where:

     (a) is the Benefit Base as of the prior Valuation Day, adjusted for any
         additional Purchase Payments;

     (b) is the Account Value following the partial surrender; and

     (c) is the Account Value before the partial surrender.

On the Maturity Date, the Income Base is set equal to the Benefit Base. Any
partial surrender that occurs on the Maturity Date will be processed before
Benefit Base is converted to Income Base.

If all of the Annuitants are ages 50 through 59, you may choose to reset your
Benefit Base on an annual anniversary of the Policy Date that is at least 12
months after the later of (a) and (b). If the older of the Annuitants is age 60
through 85, you may choose to reset your Benefit Base on an annual anniversary
of the Policy Date that is at least 12 months after the later of (a) and (b),
where:

     (a) is the Policy Date; and

     (b) is the last reset date.

                                      3

<PAGE>

If you do reset your Benefit Base, as of that date, we will:

     .   reset the Benefit Base to your Account Value;

     .   reset the charge for this rider. The new charge, which may be higher
         than your previous charge, will never exceed 1.25% annually; and

     .   reset the Investment Strategy to the current Investment Strategy.

You may not reset your Benefit Base after the Maturity Date. If on any rider
anniversary any Annuitant is older than the maximum reset age, you may not
reset your Benefit Base. The maximum reset age is shown on the Policy Data
Pages.

Monthly Income

The Maturity Date under this rider may be any Valuation Day after the first
Valuation Day under the Policy. Prior to the date that Monthly Income begins,
the Maturity Date may be changed to any Valuation Day after the first Valuation
Day under the Policy. On the Maturity Date, we will begin the payment process
for your Monthly Income. Monthly Income will be paid during the life of the
Annuitant(s). Beginning on the Maturity Date, Monthly Income will be calculated
annually as of the first Valuation Day of each Annuity Year. If the first day
of an Annuity Year does not begin on a Valuation Day, the next Valuation Day
will be used in calculating the Monthly Income for that Annuity Year. Monthly
Income will not vary during an Annuity Year.

How Monthly Income Is Determined

Guaranteed Payment Floor: The Guaranteed Payment Floor is equal to
(a) multiplied by (b) divided by (c), where:

     (a) is the Income Base;

     (b) is the Guaranteed Payment Floor percentage shown on the Policy Data
         Pages for the attained age of the Annuitant for a single Annuitant
         Policy or the attained age for the younger living Annuitant for a
         Joint Annuitant Policy on the Maturity Date; and

     (c) is twelve.

Once a Policy is a Joint Annuitant Policy, it will remain a Joint Annuitant
Policy while the Policy and rider are in effect.

Initial Monthly Income: The initial Monthly Income is the greater of the Level
Income Amount and the Guaranteed Payment Floor. The Annual Income Amount is
used to determine the Level Income Amount. The Level Income Amount is the
monthly amount that would result from applying the Annual Income Amount to a
twelve month, period certain, fixed single payment immediate annuity made
available to this Policy.

The initial Annual Income Amount is equal to (a) multiplied by (b), where:

     (a) is the payment rate based upon the gender(s), when applicable, and
         settlement age(s) of the Annuitant(s), the Account Value on the
         Valuation Day prior to the Maturity Date and the Income Base as of the
         Maturity Date; and

     (b) is the Account Value on the Valuation Day prior to the Maturity Date
         less any premium tax.

For purposes of this rider only, the payment rates are based on the [Annuity
2000 Mortality Table], using an Assumed Interest Rate of [4%].

                                      4

<PAGE>

                            Maximum Age Adjustment

The settlement age(s) is the Annuitant(s)'s age last birthday on the date
Monthly Income begins, minus an age adjustment from the table below. The actual
age adjustment may be less than the numbers shown.

                Year Payments Begin
 ---------------------------------------------------         Maximum Age
          After                     Prior To                  Adjustment
 ------------------------   ------------------------   ------------------------
           2005                       2011                        5
           2010                       2026                        10
           2025                        --                         15

On the Maturity Date, if any Monthly Income would be $100 or less, we reserve
the right to reduce the frequency of payments to an interval that would result
in each amount being at least $100. If the annual payment would be less than
$100, we will pay the Account Value on the Valuation Day prior to the Maturity
Date and the Policy will terminate on the Maturity Date.

Subsequent Monthly Income: Monthly Income in subsequent Annuity Years will be
calculated annually as of the first Valuation Day of each Annuity Year. Monthly
Income in subsequent Annuity Years is the greater of (a) and (b), where:

     (a) is the subsequent Level Income Amount, minus any value in the
         Adjustment Account as of the date the last Monthly Income was paid
         divided by twelve; and

     (b) is the Guaranteed Payment Floor.

The Annual Income Amount is used to determine the Level Income Amount. The
Annual Income Amount in subsequent Annuity Years is determined by means of
Annuity Units. The number of Annuity Units will be determined on the Maturity
Date. The number will not change unless a transfer is made. The number of
Annuity Units for an Investment Subdivision is (a) divided by (b), where:

     (a) is the initial Annual Income Amount from that Investment Subdivision;
         and

     (b) is the Annuity Unit value for that Investment Subdivision as of the
         Maturity Date.

The Annual Income Amount for an Investment Subdivision in each subsequent
Annuity Year is the number of Annuity Units for that Investment Subdivision
multiplied by the Annuity Unit value for that Investment Subdivision on the
first Valuation Day of each Annuity Year. The Annual Income Amount in each
subsequent Annuity Year is equal to the sum of Annual Income Amounts for each
Investment Subdivision.

The Annual Income Amount may be greater or less than the Annual Income Amount
in the first Annuity Year. We guarantee that Annual Income Amount in subsequent
Annuity Years will not be affected by variations in mortality experience from
the mortality assumptions on which the Annual Income Amount in the first
Annuity Year is based.

Determination of Annuity Unit Value: The Annuity Unit value of each Investment
Subdivision for any Valuation Period is equal to the Annuity Unit value for
that Investment Subdivision for the preceding Valuation Period multiplied by
the product of (a) and (b), where:

     (a) is the net investment factor for the Valuation Period for which the
         Annuity Unit value is being calculated; and

     (b) is an Assumed Interest Rate factor equal to [.99989255] raised to a
         power equal to the number of days in the Valuation Period.

                                      5

<PAGE>

The Assumed Interest Rate factor in (b) is the daily equivalent of dividing
(i) one by (ii) one plus the Assumed Interest Rate of [4%]. If a plan with a
different Assumed Interest Rate is used to determine the initial payment, a
different Assumed Interest Rate factor will be used to determine subsequent
payments.

Adjustment Account: An Adjustment Account is established on the Maturity Date.
The value of the Adjustment Account at this time is the greater of (a) and (b),
where:

     (a) is zero; and

     (b) is twelve multiplied by the Guaranteed Payment Floor, minus twelve
         multiplied by the initial Level Income Amount.

The value of the Adjustment Account in subsequent Annuity Years is the greater
of (a) and (b), where:

     (a) is zero; and

     (b) is the value of the Adjustment Account as of the prior Annuity Year,
         plus twelve multiplied by the Monthly Income for the current Annuity
         Year, minus twelve multiplied by the Level Income Amount for the
         current Annuity Year.

Commutation Provision

After the Maturity Date, you may request to terminate your Policy and this
rider. If the right to cancel period as defined under the Policy has ended, you
will receive the Commutation Value in a lump sum. After this payment, Monthly
Income will end.

The Commutation Value will be the lesser of (a) and (b) but not less than zero,
where:

     (a) is (i) minus (ii) minus (iii), where:

         (i)    is the Income Base less any premium tax;

         (ii)   is the commutation charge; and

         (iii)  is the sum of all Monthly Income paid;

     (b) is (i) minus (ii) minus (iii) plus (iv), where:

         (i)    is the Commutation Base less any premium tax;

         (ii)   is the commutation charge;

         (iii)  is the Adjustment Account value; and

         (iv)   is the Level Income Amount multiplied by the number of months
                remaining in the current Annuity Year.

The amount of the commutation charge will be the surrender charge that would
otherwise apply under the contract, in accordance with surrender charge
schedule, if applicable. The free withdrawal amount will not apply to the
commutation value.

On any day that is a Valuation Day, the Commutation Base in an Investment
Subdivision is determined by multiplying the number of Commutation Units in
that Investment Subdivision by the value of the Commutation Unit for that
Investment Subdivision. The Commutation Base is equal to the sum of the
Commutation Base amounts for each Investment Subdivision.

Commutation Units

On the Valuation Day prior to the Maturity Date, the Commutation Units in an
Investment Subdivision will be equal to the number of Accumulation Units for
that Investment Subdivision.

The number of Commutation Units is reduced at the beginning of each Annuity
Year. The reduction for each Investment Subdivision equals (a) divided by (b),
where:

     (a) is the Annual Income Amount for the Investment Subdivision; and

     (b) is the value of the Commutation Unit for the Investment Subdivision on
         the first Valuation Day of the Annuity Year.

                                      6

<PAGE>

Other events that will reduce the number of Commutation Units of an Investment
Subdivision are as follows:

     (1) transfers out of the Investment Subdivision;

     (2) payment of commutation proceeds;

     (3) payment of death proceeds; and

     (4) deduction of applicable Policy charges.

Commutation Units are canceled as of the end of the Valuation Period in which
we receive notice in a form acceptable to us regarding an event that reduces
Commutation Units.

Transfers

When we perform Investment Subdivision transfers after the Maturity Date, we
will redeem the Commutation Units from the current Investment Subdivision and
purchase Commutation Units from the new Investment Subdivision. The Commutation
Base on the date of the transfer will not be affected by the transfer. The
number of Commutation Units added to the new Investment Subdivision is
(a) multiplied by (b), divided by (c), where:

     (a) is the number of Commutation Units transferred out of the current
         Investment Subdivision;

     (b) is the value of a Commutation Unit of the current Investment
         Subdivision; and

     (c) is the value of a Commutation Unit of the new Investment Subdivision.

Value of Commutation Units

The initial value of a Commutation Unit for each Investment Subdivision is the
initial value of the Accumulation Unit for that Investment Subdivision.
Thereafter, the value of a Commutation Unit at the end of every Valuation Day
is the value of the Commutation Unit at the end of the previous Valuation Day
multiplied by the net investment factor, as described in the Policy. The value
of a Commutation Unit may change from one Valuation Period to the next.

Death Provisions

Special Distribution Rules when Death Occurs Before Monthly Income Starts

If the designated beneficiary is a surviving spouse who elects to continue the
Policy as the new Owner, this rider will continue.

Special Distribution Rules when Death of the Last Annuitant Occurs on or After
  Monthly Income Starts

If the last Annuitant dies after the Maturity Date, there may be Additional
Death Proceeds paid under this rider to the designated beneficiary in a lump
sum. The amount of any Additional Death Proceeds will be the greater of (a) and
(b), where:

     (a) is (i) minus (ii), where:

         (i)    is the Income Base;

         (ii)   is the sum of all Monthly Income paid; and

     (b) is zero.

                                      7

<PAGE>

Rider Charge

There will be a daily asset charge made for this rider. This charge is added to
the Policy's mortality and expense charge and applied against all amounts in
the Investment Subdivisions. The charge for this rider will depend upon whether
the Policy is a single Annuitant or Joint Annuitant Policy. This charge is
shown on the Policy Data Pages. Once applied, the Joint Annuitant charge will
continue while the Policy and rider are in effect. The charge for this rider
may be reset if you choose to reset your Benefit Base. The new charge, which
may be higher than your previous charge, will never exceed 1.25% annually.

When this Rider is Effective

The rider becomes effective on the Policy Date. This rider may be terminated
only when the Policy is terminated.

Change of Ownership

We must approve any assignment or sale of this Policy unless under a court
ordered assignment.

General Provisions

For purposes of this rider:

     .   A non-natural entity Owner must name an Annuitant and may name the
         Annuitant's spouse as a Joint Annuitant.

     .   An individual Owner must also be an Annuitant.

     .   An Owner may name only his or her spouse as a Joint Owner.

     .   If there is only one Owner, that Owner may name only his or her spouse
         as a Joint Annuitant at issue.

     .   If you marry after issue but prior to the Maturity Date, you may add
         your spouse as a Joint Owner and Joint Annuitant or as a Joint
         Annuitant only, subject to our approval.

For Genworth Life and Annuity Insurance Company,

                                                    [SIGNATURE APPEARS HERE]

                                                            President

                                      8

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