Document:

va680nycontract121719

   Home Office:            Service Center:  [2900 Westchester Avenue  [P.O. Box 24068  Purchase,  New York 10577]  Lansing, MI 48909-4068                          1-800-599-5651                          www.jackson.com]                       Jackson National Life Insurance Company of New York®      Thank you for choosing Jackson National Life Insurance Company of New York, also referred to as "the   Company" or "Jackson of NY®."                               READ YOUR CONTRACT CAREFULLY.      This annuity contract is issued by the Company and is a legal agreement between the Owner ("You")   and Jackson of NY.      AMOUNTS YOU ALLOCATE TO THE INVESTMENT DIVISIONS DURING THE ACCUMULATION   AND ANNUITY PERIODS ARE NOT GUARANTEED AND MAY INCREASE OR DECREASE IN   VALUE BASED UPON THE PERFORMANCE OF THE FUNDS UNDERLYING THE SEPARATE   ACCOUNT.      IF THE ACTUAL INVESTMENT RATES EXPERIENCED BY THE SEPARATE ACCOUNT ASSETS   (PRIOR TO DEDUCTION OF THE ASSET-BASED CHARGES SPECIFIED IN THIS CONTRACT)   ARE LESS THAN [2.00%], VARIABLE ANNUITY PAYMENTS WILL DECREASE OVER TIME.      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 20 DAYS AFTER YOU RECEIVE IT (60 DAYS   AFTER YOU RECEIVE IT IF YOU PURCHASED THE CONTRACT AS A REPLACEMENT   CONTRACT). THE COMPANY WILL REFUND THE CONTRACT VALUE CALCULATED ON THE   BUSINESS DAY ON WHICH THE CONTRACT IS RETURNED TO THE SELLING FINANCIAL   PROFESSIONAL OR THE COMPANY RECEIVES THE CONTRACT AT ITS SERVICE CENTER,   INCLUDING ANY FEES OR OTHER CHARGES DEDUCTED FROM THE PREMIUMS OR IMPOSED   UNDER THE CONTRACT. 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. After the "Notice of Right to   Examine Contract" period expires, the Company will allocate the Contract Value to the Investment   Divisions You have specified.                                                         This Contract is signed by the Company INDIVIDUAL DEFERRED VARIABLE  ANNUITY CONTRACT.  (FLEXIBLE PREMIUM).                                                   DEATH BENEFIT AVAILABLE.  INCOME OPTIONS AVAILABLE.  NONPARTICIPATING.                                                                                President                                                                                  Secretary       VA680NY  

 

                             TABLE OF CONTENTS                      Provision                             Page Number                 Contract Data Pages                                    [3a                 Definitions                                             4                 General Provisions                                      6                 Accumulation Provisions                                10                 Withdrawal Provisions                                  11                 Death Benefit Provisions                               12                 Income Provisions                                      15                 Termination Provision                                  19]    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.      VA680NY                               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:                    [$5,000]                                        Issue Date:                         [May 1, 2020]                                        Issue State:                        NY                                        Income Date:                        [May 1, 2080]     Primary Beneficiary(ies):           [Brian Doe]     Contingent Beneficiary(ies):        [Mary Doe]                                                                                                                                                                                                                                                                                                                                                            VA680NY-CB1                           3a 

 

                      CONTRACT DATA PAGES (CONT'D)    CONTRACT CHARGE INFORMATION:    Annual Contract Maintenance Charge: [$30]  The Company will deduct the Annual Contract Maintenance Charge from the Contract Value 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: [1.0000%]  The Core Contract Charge is expressed as an annual percentage and is deducted daily from  the Contract Value. 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  [1.0000%] for the following Contract Quarter.    Liquidity Option Charge: [0.2500]%  The Liquidity Option is expressed as an annual percentage and is deducted daily from the  Contract Value.     The Liquidity Option allows You to take a partial or total withdrawal without incurring a  withdrawal charge. An Annual Contract Maintenance Charge may be deducted upon a total  withdrawal.     Total Asset-Based Charges: [1.2500%]  The Total Asset-Based Charges are expressed as an annual percentage and are deducted daily  from the Contract Value. 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, Liquidity Option Charge and asset-based charges for add-on benefits.    Interest Rate for Adjustments Due to Misstatement of Age or Sex: [1.00%]    Transfer Charge: [$25]  The Company allows [25] free transfers between Investment Divisions 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 Investment Division. 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.    VA680NY-CB1                           3b  

 

                      CONTRACT DATA PAGES (CONT'D)    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:    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]    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 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 on page 9.    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  specified below. The Company may waive the minimums or maximums at any time.    Minimum Initial Premium for Non-Qualified Plan Contract: [$5,000]    Minimum Initial Premium for Qualified Plan Contract: [$2,000]    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: [$100]    VA680NY-CB1                           3c 

 

                      CONTRACT DATA PAGES (CONT'D)    PREMIUM(S) (continued):    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.    Investment Divisions: Investment Division(s) available at issue are identified in the application,  if attached, current prospectus and any supplements. The Company may offer new Investment  Divisions, or eliminate, substitute, or combine Investment Divisions.    Separate Account: [JNLNY Separate Account I]    Maximum Investment Division Allocations Allowed: The number of allocations to the  Investment Divisions may not exceed [99] at any one time.    The Company will identify the Investment Division(s) You select in a confirmation the Company  sends You on or after the Issue Date and are stated in the application or any supplemental  application attached to this Contract, if any.    VA680NY-CB1                           3d 

 

                                                                  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.                 VA680NY-CB1                                                                 3e 

 

                                  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.    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 Contract described herein.    CONTRACT ANNIVERSARY. Each one-year anniversary of the Issue Date.    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  Separate Account's Investment Divisions.    CONTRACT YEAR. The twelve-month period beginning on the Issue Date and on any Contract  Anniversary thereafter while the Contract remains in force.    DESIGNATED OPTION(S). The Investment Division(s) You select, to which amounts will be  transferred from a Source Option pursuant to one of the Company's systematic investment  programs.    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.    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 on which Income Payments are to begin as described in the Income  Provisions. The Income Date must be at least thirteen (13) months after the Contract Issue  Date.    INCOME OPTION. One of the payment options provided under the Income Provisions.    VA680NY                               4 

 

                             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 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 the 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. The primary Owner is the first Owner specified on the Contract Data Pages. References  to the Owner include the Joint Owner, if applicable.    PREMIUM(S). Money paid into this Contract for allocation to an Investment Division.    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.    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.    SEPARATE ACCOUNT. An asset account the Company has established and maintains in  accordance with applicable 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.    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 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 VALUE. The Contract Value, less any tax payable, the Annual Contract  Maintenance Charge, and any charges due under any add-on benefit.   VA680NY                               5 

 

                            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).     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 and received in Good Order at the Company's  Service Center. 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 Your request.     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 and received in Good Order at the  Company's Service Center. 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 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 LAWS. This Contract will be interpreted under the laws of the state of  New York as of the date issued and any applicable federal laws. Any provision that is in conflict  with New York law or any federal law is amended to conform to the minimum requirements of  such law. Non-conforming provisions may be enforced against the Company to the extent  provided by applicable New York or federal law.    ENTIRE CONTRACT. The Contract, attached application or supplemental 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, or under the authority of, the  applicant for issuance of the Contract, shall be deemed representations and not warranties.    VA680NY                               6  

 

                       GENERAL PROVISIONS (CONT'D)    INCONTESTABILITY. The Company will not contest this Contract from its Issue Date, as  shown on the Contract Data Pages.    MINIMUM BENEFITS. For any paid-up annuity option, cash value or death benefit, the amount  available under this Contract shall not be less than the minimum benefits required by the state  of New York.    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; and approved by the New York Department of Financial Services prior to use. Your  written consent will be obtained prior to changing any terms and conditions of the Contract in a  manner that diminishes Your rights and/or benefits under the Contract.    NONPARTICIPATING. This Contract is nonparticipating and does not share in the Company's  surplus or earnings.    OWNER. You may change the Owner or the Joint Owner. The Company will only be bound by a  change of ownership if submitted in a form acceptable to the Company and received in Good  Order at the Company's Service Center. 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 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  maximum number of Joint Owners allowed is 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 New York law.   VA680NY                               7 

 

                       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;  3.  the amounts the Company has credited to and deducted from the Contract Value during the     reporting period;  4.  the Withdrawal Value at the end of the reporting period;  5.  the death benefit at the end of the reporting period; and  6.  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. No replacement or substitution will be made without notice to You or  without prior approval of the New York Department of Financial Services. Changes of the  Underlying Mutual Fund(s) are subject to federal securities laws and the laws of the state of  New York. 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 PAYMENTS. The Company may suspend or delay withdrawals of 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 Investment Division or to determine the value of its assets; or  4.  the SEC, by order, so permits.    The Company will not suspend death benefit payments, annuity payments, previously  scheduled guaranteed living benefit payments or payments made to comply with the RMD  requirements of the Internal Revenue Code, as applicable.    TAXES. The Company will deduct any taxes attributed to the Contract and payable to the state  of New York or other government entity from the Contract Value as they are incurred.    VA680NY                               8 

 

                       GENERAL PROVISIONS (CONT'D)    TRANSFER OF FUNDS. The Contract Data Pages describe the conditions for transfers of  funds between Investment Divisions.    Transfer of Funds Restrictions. The Company may restrict the number and frequency of  transfers into and between Investment Divisions in certain circumstances. This includes,  circumstances in which the Company determines that a reasonably designed restriction is  required to prevent transfers that would disadvantage an Owner. The Company may impose a  restriction including:  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.    Systematic Investment Programs. The Company may from time to time offer systematic  investment programs that allow You to systematically transfer funds between the Investment  Divisions. These programs may include, but are not limited to, dollar cost averaging, portfolio  rebalancing, and the automatic monthly transfer of earnings from the money market Investment  Division to the Designated Option(s). After issue of Your Contract, You may elect one of the  programs by contacting 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 optional 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).    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. A notice relating to Owner, Beneficiary designation or assignment changes shall  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 the request.  Otherwise, instructions included in a Written Notice will take effect on the date the Company  receives the notice at the Company's Service Center.    The Company will deliver any notice or communication to Your last known 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.    VA680NY                               9 

 

                        ACCUMULATION PROVISIONS    You may not allocate funds to more than the maximum number of Investment Divisions, shown  on the Contract Data Pages, at any one time.     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 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 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 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.    VA680NY                               10 

 

                          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.     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.    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 Investment Division in  proportion to its current value.     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.    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.    VA680NY                               11 

 

                         DEATH BENEFIT PROVISIONS    NATURAL OWNER'S DEATH BEFORE THE INCOME DATE. Upon Your death or the death of  the 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, or, if eligible, has the option to continue the  Contract under the Spousal Continuation Option Instead of Death Benefit provision:    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. 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.    VA680NY                               12 

 

                   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.     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.    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.    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, has the option 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.    VA680NY                               13  

 

                   DEATH BENEFIT PROVISIONS (CONT'D)                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 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 received Your request. 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. Unless  You specify otherwise, revocations of and changes to a Pre-selected Death Benefit Option 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 received Your request   VA680NY                               14  

 

                             INCOME PROVISIONS    INCOME DATE. Income Payments will begin on the Income Date. The Income Date must be at  least thirteen (13) months after the Contract Issue Date. 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 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. The single  lump-sum payment will not be less than the amount which would have been applied under an  Income Option. On the Income Date, 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.    The amount applied to an Income Option will not be less than the greater of the Withdrawal  Value or 95% of the Contract Value.    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.     VA680NY                               15 

 

                        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.     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.     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.     ADDITIONAL INCOME OPTIONS. The Company may make available other Income Options.    VA680NY                               16 

 

                        INCOME PROVISIONS (CONT'D)    You may elect either fixed or variable annuity payments as described below.    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. 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. 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.    Neither expenses actually incurred, other than taxes on the investment return, nor the mortality  actually experienced, shall adversely affect the dollar amount of Variable Annuity Payments  after such payments have commenced.    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:    VA680NY                               17 

 

                        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 (but not the Liquidity Option 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+ 퐴퐼푅   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  the 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 the 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.        VA680NY                               18 

 

                           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 the 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.    VA680NY                               19a7763nyunisexendorsement

   2900 Westchester Avenue  Purchase, New York 10577                                                                                                                                               UNISEX CONTRACT ENDORSEMENT    Thank you for choosing Jackson National Life Insurance Company of New York®, also  referred to as "the Company" or "Jackson of New York®". This endorsement is made a  part of the Contract to which it is attached. Certain provisions of Your Contract are  revised as described below. To the extent any provisions contained in this endorsement  are contrary to or inconsistent with those of the Contract to which it is attached, the  provisions of this endorsement will control. The provisions of Your Contract remain in  effect except where modified by this endorsement.    The Contract is revised as follows:    1) "Interest Rate for Adjustments Due to Misstatement of Age or Sex" on the Contract     Data Page is revised to read:       "Interest Rate for Adjustments Due to Misstatement of Age:"       2)  The MISSTATEMENT OF AGE AND/OR SEX provision is revised to read:       "MISSTATEMENT OF AGE. If Your or the Annuitant's age 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. 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 shown on the Contract Data Pages."    3)  The PROOF OF AGE, SEX AND/OR SURVIVAL provision is revised to read:       "PROOF OF AGE AND/OR SURVIVAL. The Company may require proof of age     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."    4)  The TABLE OF INCOME OPTIONS is deleted in its entirety and replaced by the following:      7763NY  

 

                                                           "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                                       No. of                 Age of                                  Age of                                                 Monthly                      No. of Mos.                            No. of Mos.                                     Monthly                 Annui-                                  Annui-                                                 Install-                       Certain                               Certain                                      Install-                tant                                     tant                                                  ments                                      ments                                                             Unisex      Life     120       240      Unisex      Life    120      240                                        60        17.09        40       2.27      2.26      2.25       68       4.50     4.38    3.93                                        72        14.31        41       2.30      2.30      2.29       69       4.67     4.53    4.01                                        84        12.33        42       2.34      2.34      2.33       70       4.85     4.69    4.08                                        96        10.84        43       2.39      2.38      2.37       71       5.05     4.85    4.15                                       108         9.68        44       2.43      2.43      2.41       72       5.26     5.02    4.21                                       120         8.76        45       2.47      2.47      2.45       73       5.48     5.20    4.27                                       132         8.00        46       2.52      2.52      2.50       74       5.73     5.39    4.33                                       144         7.37        47       2.57      2.57      2.54       75       6.00     5.59    4.38                                       156         6.84        48       2.62      2.62      2.59       76       6.29     5.80    4.42                                       168         6.38        49       2.68      2.67      2.64       77       6.61     6.01    4.46                                       180         5.98        50       2.74      2.73      2.69       78       6.96     6.23    4.49                                       192         5.64        51       2.80      2.79      2.74       79       7.33     6.45    4.52                                       204         5.33        52       2.86      2.85      2.80       80       7.75     6.67    4.54                                       216         5.06        53       2.93      2.91      2.85       81       8.20     6.88    4.55                                       228         4.82        54       3.00      2.98      2.91       82       8.70     7.10    4.57                                       240         4.60        55       3.07      3.05      2.98       83       9.24     7.30    4.58                                       252         4.40        56       3.15      3.13      3.04       84       9.83     7.50    4.58                                       264         4.22        57       3.23      3.20      3.10       85       10.47    7.68    4.59                                       276         4.06        58       3.31      3.29      3.17       86       11.17    7.85    4.59                                       288         3.90        59       3.40      3.37      3.24       87       11.93    8.00    4.59                                       300         3.77        60       3.50      3.46      3.32       88       12.76    8.14    4.59                                       312         3.64        61       3.60      3.56      3.39       89       13.65    8.25    4.60                                       324         3.52        62       3.71      3.66      3.46       90       14.61    8.36    4.60                                       336         3.41        63       3.82      3.76      3.54       91       15.65    8.44    4.60                                       348         3.31        64       3.94      3.87      3.62       92       16.77    8.51    4.60                                       360         3.21        65       4.07      3.99      3.70       93       18.00    8.57    4.60                                                               66       4.20      4.11      3.78       94       19.33    8.62    4.60                                                               67       4.35      4.24      3.85       95       20.76    8.65    4.60                 Note: Due to the volume of relevant information, the Table does not provide income values for Option  2. Those values are available from the Company's Service Center upon request. You may contact the  Company's Service Center as specified on the cover page of the Contract.    BASIS OF COMPUTATION. The 2012 Individual Annuity Mortality Period Table, blended 40% male  and 60% female, 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."                                                                                        Signed for the                                                                                    Jackson National Life Insurance Company                                                                                    of New York                                                                                                                                                                          President   7763NY                                                                       2

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