Document:

Exhibit 4(h)

 EXHIBIT 4(h) 
 FORM OF POLICY RIDER 
 (RIM) 

					
	 

             A Stock
Company (Hereafter called the Company, we, our or us)
	  	 Home Office:
 4333 Edgewood
Road N.E.
 Cedar Rapids, Iowa 52499

(319)355-8511

 RETIREMENT INCOME
MAXSM RIDER 

GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 This rider is issued as a part of the policy to which it is attached. All provisions of the policy that do not conflict with this rider apply to this rider. In the event of any conflict between the
provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 
 The purpose of the guaranteed living benefit provided under this rider is to provide security through a stream of income payments to the Owner. This rider will terminate upon assignment or change in
ownership of the policy unless the new assignee or Owner meets the qualifications specified in the Termination provision on page 5 of this rider. 
 You may cancel this rider before midnight of the thirtieth calendar day after You receive it and no Rider Fees will be assessed. 

Rider Data Specification 
  

			
	 Policy Number:
	  	12345
	 Rider Date:
	  	05/01/2013
	 Growth Rate Percentage:
	  	5.00%
	 Initial Rider Fee Percentage*:
	  	1.25%
	 Annuitant:
	  	John Doe
		
	 Annuitant’s Issue Age/Sex:
	  	35 / Male

 *The initial rider fee percentage is also the maximum rider fee percentage for the life of the policy,
provided there are no automatic step-ups. When an automatic step-up is utilized, the maximum rider fee percentage will be 0.75% greater than the initial rider fee percentage shown above. 

Designated Allocations: If You elect this rider, 100% of Your Policy Value must be in one or more of the Designated Investment
Options. 
 You can generally transfer between the Designated Investment Options as permitted under Your policy; however, You
cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If You wish to make a transfer to a non-designated investment option, this rider must be terminated, as described in Article IV,
prior to making the transfer. You will be notified if there are any changes to the Designated Allocations. 
 Guaranteed
Lifetime Withdrawal Benefit: The withdrawal percentage is determined by the attained age and is used to determine the Rider Withdrawal Amount as described in Article III of this rider. The withdrawal percentages are shown in the table below:

  

			
	 Attained Age
	  	 Withdrawal

Percentage

	 0 - 58
	  	0.0%
	 59 - 64
	  	4.3%
	 65 - 79
	  	5.3%
	 80 +
	  	6.3%

  

					
	ICC12 RGMB410513(IS)	 	(1)	  	(Income-Single)

 ARTICLE I 

DEFINITIONS: 
 Terms used that are not defined in this rider shall have the same meaning as those in Your policy. 
 Designated Investment Options 
 Investment Options authorized for use with
this rider and identified by us as Designated Investment Options. 
 Excess Withdrawal 

The excess of a Gross Partial Withdrawal over the Rider Withdrawal Amount remaining prior to the withdrawal, if any. 

Gross Partial Withdrawal 
 The amount which will be deducted from Your Policy Value as a result of each partial withdrawal. 
 Rider Anniversary 
 The anniversary of the rider date. 

Rider Fee 

The fees charged for the benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 

Rider Monthiversary 
 The same day of the month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. If a certain date does not exist in a given month, the first
day of the following month will be used. 
 Rider Quarter 

Each three-month period beginning on the rider date. 
 Rider Withdrawal Amount 
 The maximum amount that can be withdrawn from the
policy each Rider Year without causing an Excess Withdrawal under the terms of this rider and thus reducing the Withdrawal Base. This amount will change if the Withdrawal Base changes. 

Rider Year 
 Each twelve-month period following the rider date. 
 Withdrawal Base

 The amount used to calculate the Rider Withdrawal Amount and the Rider Fee. This amount cannot be taken as a
surrender and is not payable as a death benefit. 
 ARTICLE II 

RIDER FEE 
 The Rider Fee is deducted on each Rider Quarter in arrears. The fee is calculated and stored at issue and at each subsequent Rider Quarter for the upcoming quarter. It will be deducted automatically from
each Investment Option on a pro rata basis at the end of each Rider Quarter. The initial rider fee percentage and the maximum rider fee percentage are described on page 1, in the Rider Data Specification section. The rider fee percentage will not
change during the first Rider Year, and will only change thereafter due to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the
number of days that have elapsed since the previous Rider Quarter. 
 The stored fee will be adjusted if the Withdrawal Base is
adjusted during the Rider Quarter. 
 The quarterly fee is calculated as follows: 

Multiply (1) by (2) by (3). 
  

	1)	Withdrawal Base; 

	2)	Rider fee percentage; 

	3)	Number of days remaining in the Rider Quarter divided by the number of days within the applicable Rider Year. 

  

					
	ICC12 RGMB410513(IS)	 	(2)	  	(Income-Single)

 ARTICLE III 

GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that You can receive up to the Rider Withdrawal Amount each Rider Year, regardless of the Policy Value, (first as withdrawals from Your Policy Value and, if necessary, as
payments from us) until the Annuitant’s death. 
 The withdrawal percentage is determined by the attained age (age at last
birthday) of the Annuitant at the time of the first withdrawal of any amount from the Policy Value taken on or after the Rider Anniversary following the Annuitant’s 59th birthday. Once the withdrawal percentage is established, it may only be
changed by an automatic step-up. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age at the time of the automatic step-up. The withdrawal percentages are shown in the table in the Rider Data Specification
section. 
 If the Annuitant is not yet [59] on the rider date, the withdrawal percentage will be zero until the Rider
Anniversary following the Annuitant’s [59]th birthday. Withdrawals prior to age 59 1/2 will be subject to the IRS 10% early withdrawal penalty. 
 Withdrawals will reduce the Policy Value and death benefit of the policy to which this rider is attached. If the Policy Value equals zero, You cannot make subsequent Premium Payments and all other policy
features, benefits and guarantees are no longer available. Also, if the Policy Value equals zero, You will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this rider attaches, equal to
the Rider Withdrawal Amount. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be allowed. 
 ISSUE AGE AND SURVIVAL 
 The benefits under this rider depend on the
Annuitant being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the Annuitant. Proof of survival and the issue ages may be required by the Company. 

If the Annuitant’s age has been misstated, this rider’s fees and benefits will be adjusted to the amounts which would have been
calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the rider is treated as if it never existed, and any fees charged for this rider would be returned. If withdrawals under the provisions
of the rider have already commenced and the misstatement caused the Rider Withdrawal Amount to be overstated, any withdrawal in excess of the correct Rider Withdrawal Amount will be considered an Excess Withdrawal and will impact the Withdrawal Base
and Rider Withdrawal Amount. If overpayments occurred when the sum of the accumulated values in all the Investment Options was zero, the amount of that overpayment will be deducted from one or more future payments until this amount is paid in full.

 RIDER WITHDRAWAL AMOUNT 
 The Rider Withdrawal Amount will be equal to the greater of 1) and 2), where: 
  

	1)	 is the withdrawal percentage multiplied by the Withdrawal Base; 

	2)	 is an amount equal to the minimum required distribution amount, if any. Prior to the 1st Rider Anniversary, this amount is based on the initial
Policy Value on the rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true:

	 	A)	 the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required,

	 	B)	 the minimum required distributions do not start prior to the Annuitant’s attained age 70 1/2, 

	 	C)	 the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table,

	 	D)	 the minimum required distributions are based on age of the living Annuitant. The minimum required distributions can not be based on the age of
someone who is deceased, 

	 	E)	 the minimum required distributions are based only on the policy to which this rider is attached, and 

	 	F)	 the minimum required distributions are only for the current Rider Year. Amounts carried over from past Rider Years are not considered.

  

					
	ICC12 RGMB410513(IS)	 	(3)	  	(Income-Single)

 ARTICLE III CONTINUED 

If any of the above are not true, then 2) is equal to zero and it is not available as a Rider Withdrawal Amount. 

If You withdraw less than the Rider Withdrawal Amount in a Rider Year, the unused portion cannot be carried over to the next Rider Year.

 Surrender charges may apply if Your Rider Withdrawal Amount exceeds your surrender charge-free amount. 

WITHDRAWAL BASE 
 The Withdrawal Base is used to calculate the Rider Withdrawal Amount. On the rider date, the initial Withdrawal Base is equal to the Policy Value (less any applicable premium enhancements if the rider is
added in the first Policy Year). During any Rider Year, the Withdrawal Base is increased by subsequent Premium Payments (not including premium enhancements, if any), and is reduced for Excess Withdrawals. 

On each Rider Anniversary, the Withdrawal Base will be set to the greatest of: 

 

	 	1)	 The current Withdrawal Base; 

	 	2)	 The Policy Value on the Rider Anniversary; 

	 	3)	 The highest Policy Value on a Rider Monthiversary for the current Rider Year; and 

	 	4)	 The current Withdrawal Base immediately prior to Rider Anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any Excess Withdrawals in the current Rider Year. Item 4) above will be zero
after the 10th Rider Anniversary or if there have been any withdrawals in the current Rider Year. 
 AUTOMATIC STEP-UP
FEATURE 
 The rider receives an automatic step-up on the Rider Anniversary if the Withdrawal Base is set equal to the
Policy Value or the highest Policy Value on a Rider Monthiversary. This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The Rider Fee and withdrawal percentages may be
changed due to an automatic step-up. Beginning with the first Rider Anniversary, the rider fee percentage may be increased if there is an automatic step-up, but will not exceed the maximum rider fee percentage described in the Rider Data
Specification section. 
 You have the right to reject an automatic step-up within 30 days following a Rider Anniversary, if the
rider fee percentage increases. If You reject an automatic step-up, You must notify us in a manner which is acceptable to us, however You are eligible for future automatic step-ups. Changes as a result of the automatic step-up feature will be
reversed. Any increase in the Rider Fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross Partial Withdrawals, taken in a Rider Year, less than or equal to the Rider Withdrawal Amount will not reduce the
Withdrawal Base. Excess Withdrawals will reduce the Withdrawal Base by the withdrawal base adjustment which may be more than the dollar amount of the Excess Withdrawal. The withdrawal base adjustment is the greater of 1) and 2), where:

  

	1)	 is the Excess Withdrawal amount; and 

	2)	 is the result of A) multiplied by B), divided by C, where: 

 

	 	A)	 is the Excess Withdrawal; 

	 	B)	 is the Withdrawal Base prior to the Excess Withdrawal amount; and 

	 	C)	 is the Policy Value after the Rider Withdrawal Amount has been withdrawn, but prior to the withdrawal of the Excess Withdrawal amount.

  

					
	ICC12 RGMB410513(IS)	 	(4)	  	(Income-Single)

 ARTICLE IV 

CONTINUATION 
 In the case of spousal joint Owners where one spouse is the Annuitant, if the spouse who is not the Annuitant dies and the surviving spouse is the sole beneficiary, the rider continues with the same rider
values. In the case of spousal joint Owners where one spouse is the Annuitant, if the spouse who is the Annuitant dies, this rider will terminate. 
 In the case of non-spousal joint Owners where an Owner who is not the Annuitant dies, the surviving Owner (who is also the sole designated beneficiary) may elect to receive lifetime income payments under
this rider instead of receiving any benefits applicable to the policy. The lifetime income payments must begin no later than 1 year after the Owner’s death and will be equal to the Rider Withdrawal Amount divided by the number of payments made
per year. Once the payments begin, no additional Premium Payments will be accepted and no additional withdrawals will be paid. 

ANNUITIZATION 
 On the maximum Annuity Commencement Date, as described in Your policy, You will have the option to receive lifetime income payments that are no less than Your Rider Withdrawal Amount each year.

 TERMINATION 
 This rider will terminate upon the earliest of: 
  

	1)	 the date the policy to which this rider is attached terminates; 

	2)	 the date the policy to which this rider is attached is assigned or if the Owner is changed without our approval; 

	3)	 the date of the Annuitant’s death; 

	4)	 the date You elect to receive annuity payments under Your policy; and 

	5)	 the date You notify us in writing of Your intention to terminate this rider (this date must be within 30 days after the fifth Rider Anniversary and
every fifth Rider Anniversary thereafter). 

	6)	 the date any of Your Policy Value is not invested in one of the Designated Investment Options. 

Termination of the rider will result in the loss of all benefits provided by the rider. After termination, rider fees will no longer be
assessed. 
 REPORTS TO OWNER 
 We will give You a report at least once each Policy Year. Before You are eligible to receive the Rider Withdrawal Amount, the report will direct You to contact the Company for information regarding Your
Rider Withdrawal Amount. After You are eligible for Your Rider Withdrawal Amount, this amount will be included in the report. 

Signed for us at our home office. 
  

			
	 

 SECRETARY
	  	 

 PRESIDENT

  

					
	ICC12 RGMB410513(IS)	 	(5)	  	(Income-Single)

					
	 

             A Stock
Company (Hereafter called the Company, we , our or us)
	  	 Home Office:
 4333 Edgewood
Road N.E.
 Cedar Rapids, Iowa 52499

(319)355-8511

 RETIREMENT INCOME MAXSM RIDER 
 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 

This rider is issued as a part of the policy to which it is attached. All provisions of the policy that do not conflict with this rider
apply to this rider. In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

The purpose of the guaranteed living benefit provided under this rider is to provide security through a stream of income payments to
the Owner. This rider will terminate upon assignment or change in ownership of the policy unless the new assignee or Owner meets the qualifications specified in the Termination provision on page 5 of this rider. 

You may cancel this rider before midnight of the thirtieth calendar day after You receive it and no Rider Fees will be assessed.

 Rider Data Specification 
  

			
	 Policy Number:
	  	12345
	 Rider Date:
	  	05/01/2013
	 Growth Rate Percentage:
	  	5.00%
	 Initial Rider Fee Percentage*:
	  	1.25%
	 Annuitant:
	  	John Doe
		
	 Annuitant’s Issue Age/Sex:
	  	35 / Male
	 Annuitant’s Spouse:
	  	Jane Doe
	 Annuitant’s Spouse’s Issue Age/Sex:
	  	35 / Female

 *The initial rider fee percentage is also the maximum rider fee percentage for the life of the policy,
provided there are no automatic step-ups. When an automatic step-up is utilized, the maximum rider fee percentage will be 0.75% greater than the initial rider fee percentage shown above. 

Designated Allocations: If You elect this rider, 100% of Your Policy Value must be in one or more of the Designated Investment
Options. 
 You can generally transfer between the Designated Investment Options as permitted under Your policy; however, You
cannot make transfers as provided for in the policy to a non-designated investment option while this rider is in force. If You wish to make a transfer to a non-designated investment option, this rider must be terminated, as described in Article IV,
prior to making the transfer. You will be notified if there are any changes to the Designated Allocations. 
 Guaranteed
Lifetime Withdrawal Benefit: The withdrawal percentage is determined by the attained age and is used to determine the Rider Withdrawal Amount as described in Article III of this rider. The withdrawal percentages are shown in the table below:

  

			
	 Attained Age
	  	 Withdrawal

Percentage

	 0 - 58
	  	0.0%
	 59 - 64
	  	3.8%
	 65 - 79
	  	4.8%
	 80 +
	  	5.8%

  

					
	ICC12 RGMB410513(IJ)	 	(1)	  	(Income-Joint)

 ARTICLE I 
 The Annuitant’s spouse as of the rider date is hereafter referred to as the Annuitant’s spouse. As it pertains to the benefits of this rider, the Annuitant’s spouse cannot be changed. The
Annuitant’s spouse must be the sole primary beneficiary and/or a joint Owner. The only living Owners allowed on the policy to which this rider is attached are the Annuitant and the Annuitant’s spouse. 

DEFINITIONS: 
 Terms used that are not defined in this rider shall have the same meaning as those in Your policy. 
 Designated Investment Options 
 Investment Options authorized for use with
this rider and identified by us as Designated Investment Options. 
 Excess Withdrawal 

The excess of a Gross Partial Withdrawal over the Rider Withdrawal Amount remaining prior to the withdrawal, if any. 

Gross Partial Withdrawal 
 The amount which will be deducted from Your Policy Value as a result of each partial withdrawal. 
 Rider Anniversary 
 The anniversary of the rider date. 

Rider Fee 

The fees charged for the benefits under this rider. The fees will be charged on a rider quarterly basis by the Company. 

Rider Monthiversary 
 The same day of the month as the rider date, or the next business day if our Administrative Office or the New York Stock Exchange are closed. If a certain date does not exist in a given month, the first
day of the following month will be used. 
 Rider Quarter 

Each three-month period beginning on the rider date. 
 Rider Withdrawal Amount 
 The maximum amount that can be withdrawn from the
policy each Rider Year without causing an Excess Withdrawal under the terms of this rider and thus reducing the Withdrawal Base. This amount will change if the Withdrawal Base changes. 

Rider Year 
 Each twelve-month period following the rider date. 
 Withdrawal Base

 The amount used to calculate the Rider Withdrawal Amount and the Rider Fee. This amount cannot be taken as a
surrender and is not payable as a death benefit. 
 ARTICLE II 

RIDER FEE 
 The Rider Fee is deducted on each Rider Quarter in arrears. The fee is calculated and stored at issue and at each subsequent Rider Quarter for the upcoming quarter. It will be deducted automatically from
each Investment Option on a pro rata basis at the end of each Rider Quarter. The initial rider fee percentage and the maximum rider fee percentage are described on page 1, in the Rider Data Specification section. The rider fee percentage will not
change during the first Rider Year, and will only change thereafter due to an automatic step-up. You will be notified of any increase in the rider fee percentage. A portion of this fee will also be deducted when the rider is terminated based on the
number of days that have elapsed since the previous Rider Quarter. 
 The stored fee will be adjusted if the Withdrawal Base is
adjusted during the Rider Quarter. 
 The quarterly fee is calculated as follows: 
 Multiply (1) by (2) by (3). 
  

	1)	Withdrawal Base; 

	2)	Rider fee percentage; 

	3)	Number of days remaining in the Rider Quarter divided by the number of days within the applicable Rider Year. 

  

					
	ICC12 RGMB410513(IJ)	 	(2)	  	(Income-Joint)

 ARTICLE III 

GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 Under this rider, we guarantee that You can receive up to the Rider Withdrawal Amount each Rider Year, regardless of the Policy Value, (first as withdrawals from Your Policy Value and, if necessary, as
payments from us) until the Annuitant’s or the Annuitant’s spouse’s death, whichever is later. 
 The withdrawal
percentage is determined by the attained age (age at last birthday) of the younger of the living spouses at the time of the first withdrawal of any amount from the Policy Value taken on or after the Rider Anniversary following the younger of the
living spouse’s 59th birthday. Once the withdrawal percentage is established, it may only be changed by an automatic step-up. Upon automatic step-up, the withdrawal percentage will be reset based on the attained age of the younger of the living
spouses at the time of the automatic step-up. The withdrawal percentages are shown in the table in the Rider Data Specification section. 
 If the younger of the Annuitant and the Annuitant’s spouse is not yet 59 on the rider date, the withdrawal percentage will be zero until the Rider Anniversary following the younger of the living
spouse’s 59th birthday. Withdrawals prior to age 59 1/2 will be subject to the IRS 10% early withdrawal penalty. 

Withdrawals will reduce the Policy Value and death benefit of the policy to which this rider is attached. If the Policy Value equals
zero, You cannot make subsequent Premium Payments and all other policy features, benefits and guarantees are no longer available. Also, if the Policy Value equals zero, You will need to request payments by selecting the amount and frequency in
accordance with the policy provisions to which this rider attaches, equal to the Rider Withdrawal Amount. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be allowed. 

ISSUE AGE AND SURVIVAL 
 The benefits under this rider depend on the Annuitant or Annuitant’s spouse being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the Annuitant and
Annuitant’s spouse. Proof of survival and the issue ages may be required by the Company. 
 If the younger of the
spouses’ ages has been misstated, this rider’s fees and benefits will be adjusted to the amounts which would have been calculated for the correct age. However, if this rider would not have been issued had the age not been misstated, the
rider is treated as if it never existed, and any fees charged for this rider would be returned. If withdrawals under the provisions of the rider have already commenced and the misstatement caused the Rider Withdrawal Amount to be overstated, any
withdrawal in excess of the correct Rider Withdrawal Amount will be considered an Excess Withdrawal and will impact the Withdrawal Base and Rider Withdrawal Amount. If overpayments occurred when the sum of the accumulated values in all the
Investment Options was zero, the amount of that overpayment will be deducted from one or more future payments until this amount is paid in full. 
 RIDER WITHDRAWAL AMOUNT 
 The Rider Withdrawal Amount will be equal to the
greater of 1) and 2), where: 
  

	1)	 is the withdrawal percentage multiplied by the Withdrawal Base; 

	2)	 is an amount equal to the minimum required distribution amount, if any. Prior to the 1st Rider Anniversary, this amount is based on the initial
Policy Value on the rider date. After this time, the minimum required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true:

	 	A)	 the policy to which this rider is attached is a tax-qualified policy for which IRS minimum required distributions are required,

	 	B)	 the minimum required distributions do not start prior to the Annuitant’s attained age 70 1/2, 

	 	C)	 the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table,

  

					
	ICC12 RGMB410513(IJ)	 	(3)	  	(Income-Joint)

 ARTICLE III CONTINUED 

 

	 	D)	 the minimum required distributions are based on age of the living Annuitant or the Annuitant’s spouse if the Annuitant is deceased. The minimum
required distributions can not be based on the age of someone who is deceased, 

	 	E)	 the minimum required distributions are based only on the policy to which this rider is attached, and 

	 	F)	 the minimum required distributions are only for the current Rider Year. Amounts carried over from past Rider Years are not considered.

 If any of the above are not true, then 2) is equal to zero and it is not available as a Rider Withdrawal
Amount. 
 If You withdraw less than the Rider Withdrawal Amount in a Rider Year, the unused portion cannot be carried over to
the next Rider Year. 
 Surrender charges may apply if Your Rider Withdrawal Amount exceeds Your surrender charge-free amount.

 WITHDRAWAL BASE 
 The Withdrawal Base is used to calculate the Rider Withdrawal Amount. On the rider date, the initial Withdrawal Base is equal to the Policy Value (less any applicable premium enhancements if the rider is
added in the first Policy Year). During any Rider Year, the Withdrawal Base is increased by subsequent Premium Payments (not including premium enhancements, if any), and is reduced for Excess Withdrawals. 

On each Rider Anniversary, the Withdrawal Base will be set to the greatest of: 

 

	 	1)	 The current Withdrawal Base; 

	 	2)	 The Policy Value on the Rider Anniversary; 

	 	3)	 The highest Policy Value on a Rider Monthiversary for the current Rider Year; and 

	 	4)	 The current Withdrawal Base immediately prior to Rider Anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any Excess Withdrawals in the current Rider Year. Item 4) above will be zero
after the 10th Rider Anniversary or if there have been any withdrawals in the current Rider Year. 
 AUTOMATIC STEP-UP
FEATURE 
 The rider receives an automatic step-up on the Rider Anniversary if the Withdrawal Base is set equal to the
Policy Value or the highest Policy Value on a Rider Monthiversary. This feature does not require the termination of the existing rider. This rider will continue with the same rider date and features. The Rider Fee and withdrawal percentages may be
changed due to an automatic step-up. Beginning with the first Rider Anniversary, the rider fee percentage may be increased if there is an automatic step-up, but will not exceed the maximum rider fee percentage described in the Rider Data
Specification section. 
 You have the right to reject an automatic step-up within 30 days following a Rider Anniversary, if the
rider fee percentage increases. If You reject an automatic step-up, You must notify us in a manner which is acceptable to us, however You are eligible for future automatic step-ups. Changes as a result of the automatic step-up feature will be
reversed. Any increase in the Rider Fee or withdrawal percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS

 Gross Partial Withdrawals, taken in a Rider Year, less than or equal to the Rider Withdrawal Amount will not reduce the
Withdrawal Base. Excess Withdrawals will reduce the Withdrawal Base by the withdrawal base adjustment which may be more than the dollar amount of the Excess Withdrawal. The withdrawal base adjustment is the greater of 1) and 2), where:

  

	1)	 is the Excess Withdrawal amount; and 

	2)	 is the result of (A multiplied by B), divided by C, where: 

 

	 	A)	 is the Excess Withdrawal; 

	 	B)	 is the Withdrawal Base prior to the Excess Withdrawal amount; and 

	 	C)	 is the Policy Value after the Rider Withdrawal Amount has been withdrawn, but prior to the withdrawal of the Excess Withdrawal amount.

  

					
	ICC12 RGMB410513(IJ)	 	(4)	  	(Income-Joint)

 ARTICLE IV 

CONTINUATION 
 In the case of spousal joint Owners where one spouse is the Annuitant, if the spouse who is not the Annuitant dies and the surviving spouse is the sole beneficiary, the rider continues with the same rider
values. In the case of spousal joint Owners where one spouse is the Annuitant, if the spouse who is the Annuitant dies and the surviving spouse is the sole beneficiary, the rider continues with the same rider values if the policy to which this rider
is attached is continued until the death of the surviving spouse. 
 ANNUITIZATION 

On the maximum Annuity Commencement Date, as described in Your policy, You will have the option to receive lifetime income payments that
are no less than Your Rider Withdrawal Amount each year. 
 TERMINATION 

This rider will terminate upon the earliest of: 
  

	1)	 the date the policy to which this rider is attached terminates; 

	2)	 the date the policy to which this rider is attached is assigned or if the Owner is changed without our approval; 

	3)	 the later of the Annuitant’s or Annuitant’s spouse’s death; 

	4)	 the date You elect to receive annuity payments under Your policy; and 

	5)	 the date You notify us in writing of Your intention to terminate this rider (this date must be within 30 days after the fifth Rider Anniversary and
every fifth Rider Anniversary thereafter). 

	6)	 the date any of Your Policy Value is not invested in one of the Designated Investment Options. 

Termination of the rider will result in the loss of all benefits provided by the rider. After termination, rider fees will no longer be
assessed. 
 REPORTS TO OWNER 
 We will give You a report at least once each Policy Year. Before You are eligible to receive the Rider Withdrawal Amount, the report will direct You to contact the Company for information regarding Your
Rider Withdrawal Amount. After You are eligible for Your Rider Withdrawal Amount, this amount will be included in the report. 

Signed for us at our home office. 
  

			
	 

 SECRETARY
	  	 

 PRESIDENT

  

					
	ICC12 RGMB410513(IJ)	 	(5)	  	(Income-Joint)Exhibit 4(a)

 EXHIBIT 4(a) 
 FORM OF POLICY 

			
	

	  	 Administrative and Home Office:
 4333
Edgewood Road N.E.
 Cedar Rapids, Iowa 52499
 (319)
355-8511
 www.transamericaannuities.com

 READ YOUR POLICY CAREFULLY 

This policy is a legal contract between the Owner and Transamerica Life Insurance Company issued in consideration of the payment of an initial premium. 

Amounts withdrawn or Surrendered may be subject to surrender charges and/or an excess interest adjustment reflecting changes in interest rates. The excess
interest adjustment may result in both upward and downward adjustments in partial withdrawals, Surrender benefits or amounts available for annuitizations, as applicable. This policy includes provisions which may waive surrender charges under certain
circumstances. The value held in the Separate Account may increase or decrease in value. Policy Value and benefits based on Separate Account assets are not guaranteed and will decrease and increase with investment experience. 

We agree to provide annuity payments, to pay withdrawal or Surrender benefits, or to pay death proceeds in accordance with this policy, as applicable. 

This policy may be applied for and issued to qualify as a tax-qualified annuity under applicable sections of the Internal Revenue Code. 

RIGHT TO CANCEL 
 You may cancel this
policy by delivering or mailing a written notice in Good Order to us or Your registered representative. You must return the policy to us before close of business on the 10th day after the day You receive it. Notice given by mail and return of the
policy by mail are effective on being postmarked, properly addressed and postage prepaid. 
 We will pay You an amount equal to the sum of the Premium
Payments paid less prior withdrawals, if any, plus or minus the accumulated gains or losses, if any, in the Separate Account on the date of the cancellation, unless otherwise required by law. 

If this policy is a replacement of another annuity or life insurance policy, the Right to Cancel period is extended to 30 days. 

Any questions or complaints pertaining to this policy may be directed to our Administrative Office. You may contact the State Department of Insurance at
XXX-XXX-XXXX. 
 Signed for us at our home office. 
  

 
 Flexible Premium Deferred Variable Annuity 

With Excess Interest Adjustment 

And Waiver of Surrender Charge Benefit 

Income Payable At Annuity Commencement Date 

Benefits Based On The Performance Of The Separate Account Are Variable 

And Are Not Guaranteed As To Dollar Amount (See Sections 7 and 10) 

Non-Participating 

  

			
	ICC12 VA0513	 	Page 1

 TABLE OF CONTENTS 

 

					
	 Definitions
	  	 	3	  
		
	 Policy Data Pages
	  	 	5	  
		
	 General Provisions
	  	 	6	  
		
	 Premium Payments
	  	 	9	  
		
	 Cash Value and Withdrawals
	  	 	9	  
		
	 Policy Value
	  	 	13	  
		
	 Separate Account
	  	 	13	  
		
	 Transfers
	  	 	15	  
		
	 Death Proceeds
	  	 	17	  
		
	 Income Options
	  	 	19	  
		
	 Fixed Account
	  	 	22	  
		
	 Income Option Tables
	  	 	23	  

  

			
	ICC12 VA0513	 	Page 2

 SECTION 1 – DEFINITIONS 

Adjusted Policy Value – The Policy Value increased or decreased by any applicable excess interest adjustment. This value may be used to fund one
of the income options. 
 Annuitant – The person on whose life any annuity payments involving life contingencies will be based. 

Annuity Commencement Date – The date an income option has been selected, all necessary paperwork is in Good Order, and the Company has issued a
supplementary contract. In no event can this date be earlier than the third Policy Anniversary, or later than the last day of the month following the month in which the Annuitant attains age 99. You may elect an Annuity Commencement Date at any time
by giving the Company 30 days written notice. If You do not elect an Annuity Commencement Date prior to the last available Annuity Commencement Date, annuity payments will begin as outlined in Section 10. 

Cash Value – The amount as defined in Section 5 that is available for Surrender. 

Commissioner – The primary Insurance Regulator for the State in which this policy has been issued. 

Custodial Care – Care designed primarily to help a person with the activities of daily living which does not require continuous attention of
trained medical or paramedical personnel. 
 DCA Source Account – The Money Market Subaccount and/or other Subaccount(s) as identified by the
Company and the DCA Fixed Account Option, if offered, which are permitted to be used in conjunction with Dollar Cost Averaging. 
 Decedent –
The deceased Annuitant or Owner. 
 Earnings – An amount equal to the Policy Value at the time a withdrawal or Surrender is made, minus the
sum of all Premium Payments, reduced by all prior withdrawals deemed to have been from premium, if any. 
 Fixed Account Guaranteed Minimum Effective
Annual Interest Rate – If the Fixed Account is offered, the minimum guaranteed credited rate used to determine the Fixed Account portion of Your Policy Value prior to the Annuity Commencement Date. This rate will apply for the life
of the policy and is shown in Section 2 - Policy Data. 
 Good Order – The receipt by the Company, at our Administrative Office, of all
information, documentation, instructions and/or Premium Payment deemed necessary by the Company, in its sole discretion, to issue the policy or execute any transaction pursuant to the terms of the policy. 

Guaranteed Period Option or GPO – An Investment Option offered within the Fixed Account which credits a guaranteed interest rate for a specified
period of time. 
 Hospital – An institution which: 
  

	 	1.	Is operated pursuant to the laws of the jurisdiction in which it is located; 

  

	 	2.	Operates primarily for the care and treatment of sick and injured persons on an inpatient basis; 

  

	 	3.	Provides 24-hour nursing service by or under the supervision of registered graduate nurses; 

  

	 	4.	Is supervised by a staff of one or more licensed Physicians; and 

  

	 	5.	Has medical, surgical and diagnostic facilities or access to such facilities. 

 Investment Options –
Any of the Subaccounts of the Separate Account and any of the options of the Fixed Account, if offered. 
 IIPRC – The Interstate Insurance
Product Regulation Commission. 
 Market Day – Any day and for so long as the New York Stock Exchange is open for business. 

Minimum Nonforfeiture Interest Rate – The interest rate shown in Section 2 - Policy Data which is used to determine the Minimum Required Cash
Value as defined in the nonforfeiture law. This rate is not the credited rate used to determine Your policy’s Cash Value. 

  

			
	ICC12 VA0513	 	Page 3

 Minimum Required Cash Value – The minimum amount we will pay You on Surrender, which is equal to the
sum of (1) and (2), where: 
  

	 	(1)	Is the Fixed Account portion of the Minimum Required Cash Value, equal to 87.5% of premiums and transfers to the Fixed Account, less prior requested withdrawals and transfers from the Fixed Account, less a $50 deduction
at the beginning of each Policy Year, all accumulated at the Minimum Nonforfeiture Interest Rate shown in Section 2 - Policy Data; and 

  

	 	(2)	Is the Separate Account portion of the Cash Value, equal to the Separate Account portion of the Policy Value less the surrender charge attributable to the Separate Account. 

Nursing Care – Care prescribed by a Physician and performed or supervised by a registered graduate nurse. Such care includes nursing and
rehabilitation services available 24 hours a day. 
 Nursing Facility – A facility which: 

 

	 	1.	Is operated under the laws of the jurisdiction in which it is located; 

  

	 	2.	Provides Nursing Care or Custodial Care; 

  

	 	3.	Primarily provides Nursing Care under the direction of a licensed Physician, registered graduate nurse, or licensed vocational nurse, except when receiving Custodial Care; and 

 

	 	4.	Is not other than incidentally a Hospital, a home for the aged, a retirement home, a rest home, a community living center or a place mainly for the treatment of alcoholism, mental illness or drug abuse.

 Owner – The person who may exercise all rights and privileges under the policy. 

Physician – A Doctor of Medicine or Doctor of Osteopathy who is licensed as such and operating within the scope of such license. 

Policy Anniversary – The anniversary of the Policy Date for each year the policy remains in force. If a certain date does not exist in a given
month, the first day of the following month will be used. 
 Policy Date – The date, shown in Section 2 - Policy Data, on which this policy
becomes effective. 
 Policy Value – The amount described in Section 6, which represents the value of Your Investment Options. 

Policy Year – The 12-month period following the Policy Date shown in Section 2 - Policy Data. The first Policy Year starts on the Policy
Date. Each subsequent Policy Year starts on the anniversary of the Policy Date. 
 Premium Payment – An amount paid to us by or on behalf of an
Owner, as consideration for the benefits provided under this policy. 
 Separate Account – The separate investment account(s) established by us,
under the Investment Company Act of 1940, as amended (the “1940 Act”), to which Premium Payments under the policy may be allocated. 

Subaccount – A division within the Separate Account, the assets of which are invested in a specified underlying fund portfolio. 

Surrender – A full withdrawal of Cash Value and termination of this policy. 

Terminal Condition – A condition resulting from an accident or illness which, as determined by a Physician, has reduced life expectancy to not
more than 12 months, despite appropriate medical care. 
 Valuation Period – The period of time from one determination of the value of each
Subaccount to the next. Such determinations are made when the values of the assets and liabilities of each Subaccount are calculated. This is generally the close of business on each Market Day. 

You, Your – The Owner of this policy. Unless otherwise specified, the Annuitant and the Owner shall be the same person. If a joint Owner is named,
reference to “You” or “Your” in this policy will apply to both the Owner and any joint Owner. 

  

			
	ICC12 VA0513	 	Page 4

 SECTION 2 – POLICY DATA 

Policy Information 
  

			
	 	 
	 Policy
Number:
  
	  	 
	 	 
	 Policy
Date:
  
	  	 
	 	 
	 Income Tax Status
of the Policy:
  
	  	 
	 	 
	 Initial Premium
Payment:
  
	  	 
	 	 
	 Last Available
Annuity
 Commencement Date:
  
	  	 
	 	 
	 Death Benefit
Option:
  
	  	 
	
	 Annuitant(s) Information

 

	 	 
	
Annuitant(s):
  
	  	 
	 	 
	 Primary
Annuitant’s Issue Age/Sex:
  
	  	/
	
	 Owner(s) Information

 

	 	 
	 Owner(s):

 
	  	 
	 	 
	 Primary
Owner’s Issue Age/Sex:
  
	  	/
	
	 Rate Information for Fixed Account, if offered

 

	 	 
	 Fixed Account
Guaranteed Minimum Effective Annual Interest Rate:*
  
	  	 
	 	 
	 Minimum
Nonforfeiture Interest Rate:**
  
	  	 

  

	*	This rate applies for the life of the policy. 

	**	This rate applies for the life of the policy. This rate is used in the calculation of Your Minimum Required Cash Value. Your Minimum Required Cash Value reflects a 12.50% reduction in premiums and transfers to the Fixed
Account and a $50 annual expense allowance. See the definition of Minimum Required Cash Value for the details of this calculation. 

Regarding the Excess Interest Adjustment (EIA) feature: 
  

	 	a.	The guaranteed elements used to determine any EIA are the minimum guaranteed and current declared interest rates applicable to the Fixed Account; 

 

	 	b.	Declared interest rates used in computing any EIA may change from time to time (subject to Fixed Account Guaranteed Minimum Effective Annual Interest Rate), which may affect the benefits available under Your policy; and

  

	 	c.	The U.S. Treasury rate may be used as a substitute for the current declared interest rate in the EIA formula as specified in Your policy. 

  

			
	ICC12 PDB0513	 	Page 5(a)

 SECTION 2 – POLICY DATA (continued) 

Minimum Premium Payments 
  

			
	 	 
	 Minimum Initial
Premium
 Payment:
  
	  	 Non-Qualified - $ 5,000

Qualified - $ 1,000

	 	 
	 Minimum
Subsequent Premium
 Payment:
  
	  	$50

 Maximum Premium Payments (without prior Company Approval) 

 

					
	 	  	 Issue Age
0-80*
  
	  	Issue Age 81+*
	 	 	 
	 Total during the
1st Policy Year:
  
	  	$1,000,000	  	$500,000
	 	 	 
	 Total during each
Policy Year
 After 1st Policy Anniversary:
	  	 Non-qualified - $25,000

Qualified - Lesser of $60,000 or IRS Contribution limit
  
	  	 Non-qualified - $25,000

Qualified - Lesser of $60,000 or IRS Contribution limit
  

	 	 	 
	 Cumulative
Maximum Premiums -
 Life of Policy:
  
	  	$1,000,000	  	$500,000

  

	*	Issue Age is the greater of the Owner(s)’ or Annuitant(s)’ age. 

 Mortality and
Expense Risk Fee and Administrative Charge 
  

			
	 	 
	 Before the
Annuity
 Commencement Date:
  
	  	 
	 	 
	 After the
Annuity
 Commencement Date:
  
	  	 

 Withdrawal/Surrender Charges 
  

																	
	Number of Years Since Premium Payment Date:	  	0-1	  	1-2	  	2-3	  	3-4	  	4-5	  	5-6	  	6-7	  	7 or more
	Charge (% of Premium Withdrawn or Surrendered):	  	8%	  	8%	  	7%	  	6%	  	5%	  	4%	  	3%	  	0%

 The amount paid on Surrender will never be less than the greater of the following amounts: 

 

	 	a.	Cash Value described in Section 5; and 

  

	 	b.	Minimum Required Cash Value. 

  

			
	ICC12 PDB0513	 	Page 5(b)

 SECTION 2 – POLICY DATA (continued) 

Service Charge 
  

			
	 	 
	 Service Charge at
the Time of Issue:
  
	  	$35
	 	 
	 Maximum Annual
Service Charge:
  
	  	$50

 The Company may waive some or all of Your service charge each year based on Your Policy Value, Premium Payments made or active
participation in specific online or e-delivery service programs at the time a service charge is assessed. 
  

	1.	If Your Policy Value or sum of Premium Payments minus all withdrawals equals or exceeds: 

$50,000 = up to a $35 fee waiver 

$250,000 = up to a $50 fee waiver 
  

	2.	Enrollment in specific online or e-delivery service programs may result in up to a $15 fee waiver. 

Transfer Minimums and Charges Before the Annuity Commencement Date 

 

			
	 Transfers Allowed Without

Charges in any One Policy Year:
  
	  	12
	 Charges After Allowable

Transfers in any One Policy Year:
  
	  	$10
	 Minimum Transfer

Amount from a Subaccount:
  
	  	$500 or the entire Subaccount Policy Value, if
less
	 Minimum Transfer

Amount from a GPO:
  
	  	$50

 Fixed Account Transfer Maximum Before the Annuity Commencement Date 

 

			
	 	 
	 Maximum Transfer
from the GPO
 when EIA has no Impact or a Positive Impact:
  
	  	100% of the GPO’s Value
	 	 
	 Maximum Transfer
from the GPO
 when EIA has a Negative Impact:
  
	  	25% of the GPO’s Value

 Dollar Cost Averaging (DCA) 
  

			
	 	 
	 DCA Source
Account Minimum:
  
	  	$3,000
	 	 
	 Minimum Amount of
each Transfer:
  
	  	$500
	 	 
	 Minimum Time DCA
can be Scheduled:
  
	  	6 months
	 	 
	 Maximum Time DCA
can be Scheduled:
  
	  	24 months

  

			
	ICC12 PDB0513	 	Page 5(c)

 SECTION 2 – POLICY DATA (continued) 

Fund Facilitation Fee 
 A Fund Facilitation Fee may be
charged in addition to any policy fees and charges, and will be used in the calculation of net investment factor as described in Section 7 of the policy. The Fund Facilitation Fee will only be charged when money is allocated to one of the
Subaccounts listed with a Fund Facilitation Fee. The Fund Facilitation Fee is an annualized percentage taken from the daily net asset values of a fund share held in that Subaccount. 

We may update Fund Facilitation Fee funds and charge up to the maximum of 0.30% for Subaccounts made available subsequent to the Policy Date. The
Subaccount(s) as of Your Policy Date which include this fee are listed below with the current fee noted after the Subaccount name. 

Initial Investment Options: 
  

			
	Fixed Account(s) :	 	
	 	
	1 Year Fixed Guaranteed Period	 	
	3 Year Fixed Guaranteed Period	 	
	5 Year Fixed Guaranteed Period	 	
	7 Year Fixed Guaranteed Period	 	
	 	
	Subaccount:	 	
	 	
	TA AEGON Money Market	 	
	TA AEGON Tactical Vanguard ETF - Balanced	 	
	TA AEGON Tactical Vanguard ETF - Conservative	 	
	TA AEGON U.S. Government Securities	 	
	TA Asset Allocation - Conservative	 	
	TA PIMCO Total Return	 	

  

			
	ICC12 PDB0513	 	Page 5(d)

 SECTION 3 – GENERAL PROVISIONS 

The Contract 
 The entire contract consists of this policy
and any applications, endorsements or riders. If any portion of this policy or rider attached hereto shall be found to be invalid, unenforceable or illegal, the remainder shall not in any way be affected or impaired thereby, but shall have the same
force and effect as if the invalid, unenforceable or illegal portion had not been inserted. 
 Modification of Policy 

No change in this policy is valid unless made in writing by us and approved by one of our authorized officers. We may pay You more than Your then current
Policy Value for Your voluntary participation in certain promotional offerings. We will notify You of the terms of any such programs. 
 Tax
Qualification and Change of Law 
 This policy is intended to qualify as an annuity contract for federal income tax purposes. The provisions of this
policy are to be interpreted to maintain such qualification, notwithstanding any other provisions to the contrary. To maintain such tax qualification, we reserve the right to amend this policy, retroactively or prospectively, to reflect any
amendment or clarifications that may be needed or are appropriate to maintain such tax qualification or to conform this policy to any applicable changes in the tax qualification requirements. We will send You a copy in the event of any such
amendment. If You refuse such an amendment, You must provide written notice to us, and Your refusal may result in adverse tax consequences. We reserve the right to amend this policy or riders attached to, as necessary to comply with specific
direction provided by our state or federal regulators, through change of law, rule, regulation, bulletin, regulatory directives or agreements. 

Non-Participating 
 This policy will not share in our
profits. 
 Form Approval 
 This policy is approved
under the authority of the IIPRC and issued under the IIPRC standards. Any provision of this policy that on the provision’s effective date is in conflict with IIPRC standards for this product type is hereby amended to conform to the IIPRC
standards for this product type as of the provision’s effective date. 
 Age or Sex Corrections 

We may require proof of the Annuitant’s or Owner’s age and/or sex before any payments associated with the death benefit or any rider(s) attached to
this policy are made. If the age and/or sex of the Annuitant or Owner is incorrectly stated, we will base any such payment associated with the death benefit and/or rider benefit proceeds on the Annuitant’s or Owner’s correct age and/or
sex. If required by law to ignore differences in the sex of the Annuitant, the annuity payments will be determined using the unisex factors in Section 10. 

We may require proof of the Annuitant’s age and/or sex before starting annuity payments. If the age and/or sex (or both) of the Annuitant is incorrectly
stated, we will correct the amount payable based upon the Annuitant’s correct age and/or sex, if applicable. Any underpayment made by us will be paid with the next payment. Any overpayment by us will be deducted from future payments. Any
underpayment or overpayment will include annual interest at a rate of 1% per year, from the date of the underpayment or overpayment to the date of the adjustment. 

Incontestability 
 This policy shall be incontestable from
the Policy Date, except in instances involving fraud. 
 Involuntary Cashout 

If, at anytime, Your Adjusted Policy Value is below $2,000, and there have been no Premium Payments made to the policy within the last two Policy Years, we
reserve the right to terminate the policy and pay the greater of: 
  

	 	a.	The Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of the Policy Value; or 

  

	 	b.	The Adjusted Policy Value. 

  

			
	ICC12 VA0513	 	Page 6

 Evidence of Survival 

We have the right to require satisfactory evidence that a person was alive if a payment is based on that person being alive. 

Rights of Owner 
 The Owner may, while the Annuitant is
living: 
  

	 	a.	Assign this policy; 

  

	 	b.	Surrender the policy to us; 

  

	 	c.	Amend or modify the policy with our consent; 

  

	 	d.	Receive annuity payments or name a payee to receive the payments; and 

  

	 	e.	Exercise, receive and enjoy every other right and benefit contained in the policy. 

 The use of these rights
may be subject to the consent of any assignee or irrevocable beneficiary, and of the spouse in a community or marital property state. Unless we have been notified of a community or marital property interest in this policy, we will rely on our good
faith belief that no such interest exists and will assume no responsibility for inquiry. 
 Change of Ownership 

In the case of a non-tax-qualified annuity, You can change the Owner of this policy from Yourself to a new Owner. You must send written notification, to our
Administrative Office, which contains all necessary information to make the change. Any Owner change made, unless otherwise specified by the Owner, shall take effect on the date the notification is signed by the Owner, when received in Good Order,
subject to any payments made or actions taken by us prior to receipt of the notification. No change will apply to any payment we made before the written notice was received. 

We may require that the change be endorsed in the policy. Changing the Owner does not change the beneficiary or the Annuitant. A change of Ownership may
result in adverse tax consequences. A change in Ownership due to death is outlined further in Section 9. 
 Assignment 

In the case of a non-tax-qualified annuity, this policy may be assigned. You must send written notification, to our Administrative Office, which contains all
necessary information to make the change. Any assignment made, unless otherwise specified by the Owner, shall take effect on the date the notification is signed by the Owner, when received in Good Order, subject to any payments made or actions taken
by us prior to receipt of the notification. 
 We assume no responsibility for the validity of any assignment. Any claim made under an assignment shall be
subject to proof of interest and the extent of the assignment. Assignment does not change the benefit or amount of the policy. 
 This policy may be applied
for and issued to qualify as a tax-qualified annuity under certain sections of the Internal Revenue Code (IRC). Ownership of this policy is then restricted so it will comply with provisions of the IRC. 

Assignment of this policy may result in adverse tax consequences. 

Beneficiary 
 Amounts payable upon death in accordance
with Section 9, may be payable to the designated beneficiary or beneficiaries. Such beneficiary(ies) must be named and may be changed without beneficiary consent (unless irrevocably designated or required by law) by notifying us in writing, on
a form acceptable to us. Unless otherwise specified by You, the change will take effect upon the date You sign it, whether or not You are living when we receive it, subject to any payments made or actions taken by the Company prior to receipt of
this notice. The notice must have been postmarked (or show other evidence of delivery that is acceptable to us) on or before the Decedent’s date of death. Your most recent beneficiary change notice will replace any prior beneficiary
designations. No change will apply to any payment we made before the written notice was received by us. If an irrevocable beneficiary dies, You may designate a new beneficiary. 

You may elect the method of payment for each named beneficiary, subject to our then current rules, prior to the date of death of the Decedent. When no such
election is made as to a specific beneficiary, such beneficiary must elect the method of payment within 60 days of the date we receive all required documentation, in Good Order, to pay the amount payable to that beneficiary. 

If there is more than one beneficiary at any level (primary or contingent), and You failed to specify their interest, they will share equally. 

  

			
	ICC12 VA0513	 	Page 7

	 	a.	General Distribution Rules 

 Unless You have provided other specific instructions to us,
amounts payable upon death will be paid in accordance with Section 9 and as outlined below: 
  

	 	1.	If a primary beneficiary is alive at the time of Decedent’s death, payment will be made to the primary beneficiary; 

  

	 	2.	If a primary beneficiary dies before the Decedent and there are additional living primary beneficiaries, the deceased primary beneficiary’s interest will be shared proportionately with all living primary
beneficiaries; 

  

	 	3.	When all primary beneficiaries die before the Decedent’s death, payment will be made to the living contingent beneficiary(ies), if any; 

 

	 	4.	If a contingent beneficiary dies before the Decedent and there are additional living contingent beneficiaries, the deceased contingent beneficiary’s interest will be shared proportionately with all living
contingent beneficiaries; 

  

	 	5.	In the event no primary or contingent beneficiaries have been named and/or all have died before the Decedent, the Owner’s estate will become the beneficiary; 

 

	 	6.	If a primary or contingent beneficiary dies after the Decedent’s death, but prior to death proceeds being payable to the beneficiary, payment will be made to the beneficiary’s estate. 

 

	 	b.	Other Specific Instructions 

 You may provide specific instructions to the Company which
direct that upon the death of a beneficiary, that their interest pass to a specific contingent beneficiary(ies) or per stirpes. 
  

	 	1.	Per Stirpes: If You provide instructions that a specific primary or contingent beneficiary’s share be passed per stirpes, we will pay that beneficiary’s share to their identifiable lineal descendants who are
living at the time of Decedent’s death. 

  

	 	2.	Specific Contingent: If You provide instructions that a specific primary or contingent beneficiary’s share be passed to a specified contingent beneficiary(ies), we will pay that specific beneficiary’s share to
those identifiable specific contingent beneficiaries who are living (or in existence) at the time of Decedent’s death. 

A deceased beneficiary share will be distributed as outlined under General Distributions Rules above. 

Protection of Proceeds 
 Unless You so direct by filing
written notice with us, no beneficiary may assign any payments under this policy before the same are due. To the extent permitted by law, no payments under this policy will be subject to the claims of creditors of any beneficiary. 

Deferment 
 Payment of any amount due from the Separate
Account for a Surrender, withdrawal or death proceeds will generally occur within seven days from the date we receive in Good Order all required information. We may defer payments or transfers from the Separate Account if: 

 

	 	a.	The New York Stock Exchange is closed other than for usual weekends or holidays or trading on the Exchange is otherwise restricted; 

  

	 	b.	An emergency exists as defined by the Securities and Exchange Commission (SEC) or the SEC requires that trading be restricted; or 

  

	 	c.	The SEC permits a delay for the protection of Owners. 

 When permitted by law, we may defer (with prior
authorization from the Commissioner) payment of any transfers, withdrawals or Surrender proceeds from the Fixed Account, if offered, for up to 6 months from the date we receive Your request. If the Owner or Annuitant dies after the request is
received, but before the request is processed, the request will be processed before the death proceeds are determined. Interest will be paid on any amount deferred for 30 days or more. This interest rate will be the Fixed Account Guaranteed Minimum
Effective Annual Interest Rate shown in Section 2 - Policy Data, unless otherwise required by law. 
 If we delay payment of any transactions as noted
above, we will disclose to You the specified date on which the above transactions will be effective and the reason for the delay. 

  

			
	ICC12 VA0513	 	Page 8

 Reports to Owner 

We will give You a report at least once each Policy Year, and may provide it more often. This report will show the start date and end date for the current
period and include the following information: 
  

	 	a.	The amounts credited or debited to the Policy Value during the current report period; 

  

	 	b.	The Policy Value at start and end date of the current report period; 

  

	 	c.	The number and value of the accumulation units held in each Separate Account; 

  

	 	d.	The Cash Value, which is after the application of any Excess Interest Adjustment (EIA), at start and end date of the current report period; 

 

	 	e.	The death benefit at the end of the current report period; 

  

	 	f.	The dollar amount in the Fixed Account, if any; and 

  

	 	g.	The EIA formula used to determine the Cash Value. 

 A report as described above will be mailed to Your last
known address as shown in our records. The information provided will be as of a date not more than four months prior to the date of the mailing. We will provide copies of the report available to You upon request at no additional cost. 

SECTION 4 – PREMIUM PAYMENTS 

Payment of Premiums 
 Premium Payments may be made any
time while this policy is in force and prior to the Annuity Commencement Date, subject to the minimums and maximums as specified in Section 2 – Policy Data. 

Premium Payment Date 
 The Premium Payment date is the
date the Premium Payment is credited to the policy. The initial Premium Payment will be credited to the policy within two Market Days after the Market Day we receive it and Your complete policy information in Good Order. Subsequent Premium Payments
will be credited to the policy as of the Market Day the Premium Payment and required information are received in Good Order. 
 Allocation of Premium
Payments 
 Premium Payments may be applied to various Investment Options, which we make available. For the initial Premium Payment, You must indicate
what percentage to allocate to various Investment Options. For additional Premium Payments, allocations will be what is currently indicated by You. Each percentage may be either zero or any whole number; however, the allocation among all Investment
Options must total 100%. 
 Change of Allocation 
 You
may change allocations for additional Premium Payments by providing us instructions. The allocation change will apply to Premium Payments received on or after the date we receive the allocation change in Good Order. We will allocate subsequent
Premium Payments the same way, unless You request a different allocation. 
 Premium Taxes 

Your state may impose premium taxes on the Premium Payments You make. We currently do not deduct for these taxes at the time You make a Premium Payment unless
required by the applicable state law. Generally, we will deduct the total amount of premium taxes, if any, from the Policy Value when You begin receiving annuity payments, You Surrender the policy, or death proceeds are paid. 

SECTION 5 – CASH VALUE AND WITHDRAWALS 

A. Cash Value 
 On or before the Annuity Commencement
Date, You may make withdrawals or Surrender the Cash Value. The Cash Value is equal to the Adjusted Policy Value less any surrender charges. Information on the current amount of Your Cash Value is available upon request. We must receive Your
withdrawal or Surrender request, in Good Order, before the Annuity Commencement Date. 

  

			
	ICC12 VA0513	 	Page 9

 There is no Cash Value once an income option has been selected, all necessary instructions are received in Good
Order, and the Company has issued a supplementary contract. 
 Excess Interest Adjustment 

The Excess Interest Adjustment (EIA) is only applied to transactions affecting the Guaranteed Period Options (GPO) of the Fixed Account, if offered, and is
based on any change in interest rates from the time the affected guaranteed period(s) started until the time the EIA occurs. The EIA may be positive or negative. 

An EIA applies in the following situations: 
  

	 	1.	When You withdraw or Surrender Your Cash Value; 

  

	 	2.	When You exercise an income option; 

  

	 	3.	When You transfer out of a GPO; or 

  

	 	4.	When a death benefit is calculated. However, the death benefit will not be reduced if the EIA results in a decrease in the Cash Value available to You. 

The EIA is applied as follows: 
  

	 	1.	The EIA is only applied when the transactions occur prior to the end of the GPO; 

  

	 	2.	Transfers to the GPO of the Fixed Account are considered Premium Payments for purposes of determining the EIA; 

  

	 	3.	The EIA is distinct from, and is applied prior to, the surrender charge; 

  

	 	4.	The EIA may affect the death benefit defined in Section 9; 

  

	 	5.	If interest rates have decreased from the time the affected GPO started until the time the transaction occurs, the EIA will result in additional funds available to You; 

 

	 	6.	If interest rates have increased from the time the affected GPO started until the time the transaction occurs, the EIA will result in a decrease in the funds available to You; 

 

	 	7.	Certain amounts are not subject to the EIA as provided in Sections 5, 8 and 11; and 

  

	 	8.	Upon Surrender, the cumulative interest credited to the GPO of the Fixed Account at the time of Surrender will not be subject to an EIA. 

The formula for determining the amount of the EIA is as follows: 

EIA = S x (G-C) x (M/12) where: 
  

	 	“S”	Is the amount (before surrender charges, premium taxes and the application of any Guaranteed Minimum Death Benefits, if any) being Surrendered, withdrawn, transferred, paid upon death, or applied to an income option
that is subject to EIA; 

  

	 	“G”	Is the guaranteed interest rate for the guaranteed period applicable to “S”; 

  

	 	“C”	Is the current guaranteed interest rate then being offered on new Premium Payments for the next longer guaranteed period than “M”. If this policy form or such a GPO is no longer offered, “C” will be
the U.S. Treasury rate for the next longer maturity (in whole years) than “M” on the 25th day of the previous calendar month; and 

  

	 	“M”	Is the number of months remaining in the guaranteed period for “S”, rounded up to the next higher whole number of months. 

The EIA for each GPO will not reduce the Adjusted Policy Value for that GPO below the amount allocated, less any prior withdrawals and transfers from that
GPO, plus interest at the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 - Policy Data. 
 B. Withdrawals and
Surrenders 
 You may, on or before the Annuity Commmencement Date, withdraw all (Surrender) or a portion (withdrawal) of the amount available under this
policy, provided we receive Your request, in Good Order, while this policy is in effect and before the Annuity Commencement Date. The minimum withdrawal is $500, with the exception of systematic payouts and required minimum distributions. 

You may specify that the withdrawal be taken from one or more specific Investment Options or pro rata from all Investment Options. If You do not specify the
Investment Option from which the withdrawal is to be made, the withdrawal will be taken pro rata from all Investment Options relative to the value in each Investment Option. 

  

			
	ICC12 VA0513	 	Page 10

 Withdrawals will reduce the amount of the death proceeds. Withdrawals and Surrenders will normally be effective
as of the end of the Market Day the request is received in Good Order. 
 The gross withdrawal is the total amount which will be deducted from Your Policy
Value as a result of each withdrawal. The gross withdrawal may be more than Your requested withdrawal amount, depending on whether surrender charges and/or EIA apply at the time of the withdrawal. 

The gross withdrawal = R - E + SC, where: 
  

	 	“R”	Is the requested withdrawal; 

  

	 	“E”	Is the EIA; and 

  

	 	“SC”	Is the surrender charge on the following: excess withdrawal amount minus the EIA. 

 The excess withdrawal
amount is the portion of the requested withdrawal or Surrender that is subject to surrender charges (that is, the portion which is in excess of the surrender charge-free portion). For example, if the requested withdrawal or Surrender amount is
$1,000, and the surrender charge-free amount is $200, then the excess withdrawal would be $800. 
 Excess withdrawals will reduce the Policy Value by an
amount equal to X - Y + Z; where: 
  

	 	“X”	Is the excess withdrawal; and 

  

	 	“A”	Is the amount of withdrawal or Surrender subject to EIA; and 

  

	 	“Y”	Is EIA = A x (G-C) x (M/12) where G, C and M are defined in the EIA provision above, with “A” substituted for “S” in the definitions of “G” and “M”; and 

 

	 	“Z”	Is surrender charge on X minus Y. 

 Each withdrawal or Surrender consists of a portion which may be subject to
a surrender charge (that is, the excess withdrawal) and a remaining portion that is free from surrender charge (that is, the surrender charge-free amount). Either portion may be zero (0) depending on the withdrawal or Surrender requested and
prior amounts withdrawn. 
 Withdrawals in the amount of the cumulative interest in the GPO(s) of the Fixed Account, at the time of withdrawal, may be
withdrawn from the GPO(s) of the Fixed Account free of any EIA. 
 Systematic Payout Option 

A Systematic Payout Option (SPO) is a series of pre-scheduled withdrawals. Beginning in the first Policy Year, a SPO is available on a monthly, quarterly,
semi-annual or annual basis. At the time a SPO is made, each such payout must be at least $50. Monthly and quarterly SPO’s must be sent through electronic funds transfer directly to a checking, savings or other similar financial account. You
may stop SPO payouts at any time with a 30 day written notice sent to our Administrative Office. 
 Surrender Charge-Free Amount 

Each Policy Year, You may withdraw or Surrender a portion of Your Policy Value free from any surrender charge. The surrender charge-free amount each Policy
Year is equal to 10% of the total Premium Payments, less the total surrender charge-free amount or Earnings previously withdrawn in the same Policy Year. Any unused portion of Your surrender charge-free amount cannot be carried forward to subsequent
Policy Years. 
 A surrender charge will not be assessed against Earnings withdrawn from Your policy. Withdrawals of Your Earnings will reduce Your annual
surrender charge-free amount on a dollar for dollar basis. 
 Amounts withdrawn under one of the options below may reduce the amount available free of
surrender charges under another option. Surrender charges and/or EIA may be waived as described below. A withdrawal or Surrender shall not prejudice the waiver of any surrender charge while any of the options described below are in force. 

Required Minimum Distribution 
 For tax-qualified plans
and policies, withdrawals taken to satisfy required minimum distribution requirements under Section 401(a)(9) of the Internal Revenue Code (IRC) are available with no surrender charges and no EIA. The amount available from this policy with
respect to the required minimum distribution is based solely on this policy. 
 Any amount requested in excess of the IRC required minimum distribution will
have the appropriate surrender charges and EIA applied, unless the excess distribution qualifies as surrender charge-free or EIA-free under any additional options provided. 

  

			
	ICC12 VA0513	 	Page 11

 Nursing Care and Terminal Condition Waiver 

This benefit is not intended to provide long-term care or nursing home insurance. 

Beginning in the first Policy Year, You may elect to Surrender or withdraw a portion of the Policy Value without surrender charges and without an EIA if the
Owner or Owner’s spouse (Annuitant or Annuitant’s spouse, if the Owner is a non-natural person) has been: 
  

	 	1.	Confined in a Hospital or Nursing Facility for 30 consecutive days; or 

  

	 	2.	Diagnosed as having a Terminal Condition. 

 The minimum withdrawal under this waiver is $1,000. This option is
available even during Policy Years other withdrawal options were exercised prior to Nursing Care. 
 For a waiver of confinement in a Hospital or Nursing
Facility, we must receive each withdrawal request (and proof of eligibility with each request) no later then 90 days following the date that confinement has ceased, unless it can be shown that it was not reasonably possible to provide the notice and
proof within the above time period and that the notice and proof were given as soon as reasonably possible. However, in no event shall the notice and proof be provided later than one year following the date that confinement has ceased. Proof of
confinement may be a Physician’s statement or a statement from a Hospital or Nursing Facility administrator. 
 For a waiver related to a Terminal
Condition, proof of eligibility is required only with the initial withdrawal request and must be furnished by the Owner’s, Owner’s spouse’s, Annuitant’s, or Annuitant’s spouse’s Physician. We must receive a new request
for each withdrawal under this waiver. Each withdrawal request must be received no later than one year following diagnosis of the Terminal Condition. 
 If
a request for this waiver is denied, the Owner will be notified of the denial. The Owner will be provided an opportunity to instruct the Company of their desire to either proceed with or cancel their withdrawal or Surrender, including any surrender
charges, if a waiver request is denied. 
 Unemployment Waiver 

Beginning in the first Policy Year, You may elect to Surrender or withdraw a portion of the Policy Value without surrender charges and without an EIA if the
Owner or Owner’s spouse (Annuitant or Annuitant’s spouse, if the Owner is a non-natural person) becomes unemployed. In order to qualify, You: 
  

	 	1.	Must have been employed full-time for at least two years prior to Your becoming unemployed; 

  

	 	2.	Must have been employed full-time on Your Policy Date; 

  

	 	3.	Must have been unemployed for at least 60 consecutive days at the time of withdrawal; and 

  

	 	4.	Must have a minimum Cash Value of $5,000 at the time of withdrawal. 

 Proof of unemployment will consist of
providing us with a determination letter from the applicable state’s Department of Labor, which verifies that You or Your spouse qualify for and are receiving unemployment benefits at the time of withdrawal. The determination letter must be
received by us no later than 90 days following the date of the withdrawal request. 
 If a request for this waiver is denied, the Owner will be notified of
the denial. The Owner will be provided an opportunity to instruct the Company of their desire to either proceed with or cancel their withdrawal or Surrender, including any surrender charges, if a waiver request is denied. 

Surrender Charges 
 Withdrawals or Surrenders in excess of
the surrender charge-free amount are subject to a surrender charge. The amount of this charge, if any, will be a percentage, as shown in the table in Section 2 - Policy Data, of the amount withdrawn. 

All Earnings are considered to be withdrawn first and will reduce Your annual surrender charge-free amount. After all Earnings are withdrawn the oldest
Premium Payment is the first Premium Payment considered to be withdrawn. If the amount withdrawn exceeds this, the next oldest Premium Payment is considered to be withdrawn, and so on until the most recent Premium Payments are deemed to be withdrawn
(the procedure being applied to withdrawals of premium is “First-In, First-Out” or FIFO procedure). 

  

			
	ICC12 VA0513	 	Page 12

 Minimum Values 

Benefits available under this policy, including any paid up annuity values, Cash Values, or death benefits, are not less than the minimum benefits required by
section 7B and 7G of the Model Variable Annuity Regulation, model # 250 or successor models. Minimum benefits will be increased to reflect any guaranteed additional amounts credited to the policy and will be decreased by prior withdrawals. 

Minimum Required Cash Value 
 The Minimum Required Cash
Value is the amount prescribed by the nonforfeiture law, and is the minimum amount required to be paid to You on Surrender. 
 The minimum amount is
determined differently than Your policy’s Cash Value, and is described in Section 2 - Policy Data. The minimum amount for the Fixed Account, if offered, is calculated according to a procedure specified in the law using a prescribed Minimum
Nonforfeiture Interest Rate, which will be fixed at issue and determined as follows: 
 On the Policy Date, the Minimum Nonforfeiture Interest Rate is equal
to an “average Five Year Constant Maturity Treasury rate”, less 1.25%, but such rate will not be less than 1% nor more than 3%. The averaged rate is determined by averaging the daily Treasury rates for the first 10 Market Days of the month
immediately preceding the calendar quarter in which Your policy is issued. The average of these ten Treasury rates is rounded to the nearest 0.05% before the deduction of 1.25%. For example, if Your policy was issued on any Market Day during the
third calendar quarter, Your Minimum Nonforfeiture Interest Rate would be determined by averaging the first ten Market Days’ Five Year Constant Maturity Treasury rates for the month of June during the same calendar year, rounding that result to
the nearest 0.05%, then deducting 1.25% (with the resulting rate not being less than 1% nor more than 3%). 
 SECTION 6 – POLICY
VALUE 
 Policy Value 
 On or before the Annuity
Commencement Date, the Policy Value is equal to Your: 
  

	 	a.	Premium Payment(s); minus 

  

	 	b.	Gross withdrawals (withdrawals plus the surrender charge on the portion of the requested withdrawal that is subject to the surrender charge plus or minus any EIA); plus 

 

	 	c.	Interest credited to the Fixed Account (if any); plus 

  

	 	d.	Accumulated gains in the Separate Account; minus 

  

	 	e.	Accumulated losses in the Separate Account; minus 

  

	 	f.	Service charges, rider fees, premium taxes, and transfer fees if any. 

 Service Charge 

On each Policy Anniversary prior to the Annuity Commencement Date and at the time of Surrender, we may deduct an annual service charge as set forth in
Section 2 - Policy Data. The service charge will be deducted from each Investment Option in proportion to the portion of Policy Value (prior to such charge) in each Investment Option. In no event will the service charge exceed 2% of the Policy
Value or the maximum, as shown in Section 2 - Policy Data, on the Policy Anniversary or at the time of Surrender. 
 SECTION 7 –
SEPARATE ACCOUNT 
 Separate Account 
 We have
established and will maintain one or more Separate Account(s), under the laws of the state of Iowa. Any realized or unrealized income, net gains and losses from the assets of the Separate Account are credited to or charged against it without regard
to our other income, gains or losses. Assets are put in the Separate Account for this policy, as well as for other variable annuity policies. Any Separate Account may invest assets in shares of one or more mutual fund portfolio(s), or in the case of
a managed Separate Account, direct investments in stocks or other securities as permitted by law. Fund shares refer to shares of underlying mutual funds or pro-rata ownership of the assets held in a Subaccount of a managed Separate Account. Fund
shares are purchased, redeemed and valued on behalf of the Separate Account. 

  

			
	ICC12 VA0513	 	Page 13

 The Separate Account is divided into Subaccounts. Each Subaccount invests exclusively in shares of one of the
portfolios of an underlying fund. We reserve the right to add or remove any Subaccount of the Separate Account. 
 The assets of the Separate Account are
our property. These assets will equal or exceed the reserves and other contract liabilities of the Separate Account. These assets will not be chargeable with liabilities arising out of any other business we conduct. We reserve the right, subject to
regulations governing the Separate Account, to transfer assets of a Subaccount, in excess of the reserves and other contract liabilities with respect to that Subaccount, to another Subaccount or to our General Account. 

We will determine the fair market value of the assets of the Separate Account in accordance with the Valuation Period, which we establish in good faith. 

We also reserve the right to transfer assets of the Separate Account, which we determine to be associated with the class of policies to which this policy
belongs, to another Separate Account. If this type of transfer is made, the term “Separate Account”, as used in the policy shall then mean the Separate Account to which the assets are transferred. 

We also reserve the right, when permitted by law to: 
  

	 	a.	Deregister the Separate Account under the Investment Company Act of 1940; 

  

	 	b.	Manage the Separate Account under the direction of a committee at any time; 

  

	 	c.	Restrict or eliminate any voting rights of policy Owners or other persons who have voting rights as to the Separate Account; 

  

	 	d.	Combine the Separate Account with one or more Separate Accounts; 

  

	 	e.	Create new Separate Accounts; 

  

	 	f.	Add new Separate Accounts to or remove existing Subaccounts from the Separate Account, or combine Subaccounts; and 

  

	 	g.	Add new underlying mutual funds, remove existing mutual funds, or substitute a new fund for an existing mutual fund. 

The net asset value of a fund share is the per-share value calculated by the mutual fund or, in the case of a managed Separate Account, by the Company. The
net asset value is computed by adding the value of the Subaccount’s investments, cash and other assets, subtracting its liabilities, and then dividing by the number of shares outstanding. Net asset values of fund shares reflect investment
advisory fees and other expenses incurred in managing a mutual fund or a managed Separate Account. 
 Change in Investment Objective or Policy of a
Mutual Fund 
 If required by law or regulation, an investment policy of the Separate Account will only be changed if approved by the appropriate
insurance official of the state of Iowa or deemed approved in accordance with such law or regulation. If so required, the process for obtaining such approval is filed with the insurance official of the state or district in which this policy is
delivered. 
 Charges and Deductions 
 The mortality and
expense risk fee and the administrative charge are each deducted, both before and after the Annuity Commencement Date, to compensate for changes in mortality and expenses not anticipated by the mortality and administration charges guaranteed in the
policy. Expenses and mortality results will not adversely affect the dollar amounts of variable benefits or other variable contractual payments or values. The mortality and expense risk fee and the administrative charge is specified in
Section 2 - Policy Data. 
 Accumulation Units 

The Policy Value in the Separate Account before the Annuity Commencement Date is represented by accumulation units. The dollar value of accumulation units for
each Subaccount will change from Market Day to Market Day reflecting the investment experience of the Subaccount. 
 Premium Payments allocated to and any
amounts transferred to the Subaccounts will be applied to provide accumulation units in those Subaccounts. The number of accumulation units purchased in a Subaccount will be determined by dividing the amount allocated to or transferred to that
Subaccount by the value of an accumulation unit for that Subaccount on the Premium Payment or transfer date. 

  

			
	ICC12 VA0513	 	Page 14

 The number of accumulation units withdrawn or transferred from the Subaccounts will be determined by dividing the
amount withdrawn or transferred by the value of an accumulation unit for that Subaccount on the withdrawal or transfer date. 
 The value of an accumulation
unit on any Market Day is determined by multiplying the value of that unit at the end of the immediately preceding Valuation Period by the net investment factor for the Valuation Period. 

The net investment factor used to calculate the value of an accumulation unit in each Subaccount for the Valuation Period is determined by dividing
(a) by (b) and subtracting (c) from the result, where: 
  

	 	(a)	Is the result of: 

  

	 	1.	The net asset value of a fund share held in that Subaccount determined as of the end of the current Valuation Period; plus 

  

	 	2.	The per share amount of any dividend or capital gain distributions made by the fund for shares held in that Subaccount if the ex-dividend date occurs during the Valuation Period; plus or minus 

 

	 	3.	A per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of that Subaccount. 

 

	 	(b)	Is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding Valuation Period. 

 

	 	(c)	Is a factor representing the mortality and expense risk fee and administrative charge before the Annuity Commencement Date. This factor is less than or equal to, on an annual basis, the percentage shown in
Section 2 - Policy Data, of the daily net asset value of a fund share held in that Subaccount. 

 Since the net investment factor may be
greater or less than one, the accumulation unit value may increase or decrease. 
 SECTION 8 – TRANSFERS 

A. TRANSFERS BEFORE THE ANNUITY COMMENCEMENT DATE 
 Prior
to the Annuity Commencement Date, You may transfer the value of the accumulation units from one Investment Option to another within certain limitations. 

Transfers of Policy Value from the Guaranteed Period Options (GPO) of the Fixed Account, if offered, prior to the end of that GPO are subject to an EIA. Such
transfers are limited to the maximum Fixed Account transfer limits shown in Section 2 - Policy Data, less values previously transferred out of that GPO during the current Policy Year. Transfer minimums and charges shown in Section 2 -
Policy Data, may also apply to transfers out of the GPO. 
 Transfers of interest credited in the GPO’s to other Investment Options are allowed on a
“First-In, First-Out” basis. Such transfers may be made monthly, quarterly, semi-annually, or annually. Each such transfer is subject to transfer minimums and charges as set forth in Section 2 - Policy Data and will not be subject to
an EIA. 
 You may choose which GPO to transfer to or from; however, any GPO elected may not extend beyond the last available Annuity Commencement Date
shown in Section 2 - Policy Data. 
 Transfers of Policy Value from the Separate Account are subject to a minimum and charges as set forth in
Section 2 - Policy Data. If the remaining Subaccount Policy Value is less than the minimum transfer amount, as shown in Section 2 - Policy Data, we reserve the right to include that amount as part of the transfer. Transfers among multiple
Investment Options will be treated as one transfer in determining the number of transfers that have occurred. 
 If You want to transfer the value of the
variable units You must provide written notification with the following information provided: 
  

	 	1.	The Investment Option from which the transfer is to be made; 

  

	 	2.	The amount of the transfer; and 

  

	 	3.	The Investment Option(s) to receive the transferred amount. 

  

			
	ICC12 VA0513	 	Page 15

 The policy was not designed for the use of market timers or frequent or disruptive traders. Such transfers may be
harmful to the underlying fund portfolios and increase transaction costs. We have developed policies and procedures with respect to market timing and disruptive trading (which vary for certain Subaccounts at the request of the corresponding
underlying fund portfolios). 
 We employ various means in an attempt to detect market timing and disruptive trading. However, despite our monitoring, we
may not be able to detect nor halt all harmful trading. If we determine You are engaged in market timing or disruptive trading, we may take one or more actions in an attempt to halt such trading. Your ability to make transfers is subject to
modification or restriction if we determine, in our sole discretion, that Your exercise of the transfer privilege may disadvantage or potentially harm the rights or interests of other Owners (or others having an interest in the variable insurance
products). Transfer restrictions may take the form of loss of expedited transfer privilege. We consider transfers by telephone, fax, overnight mail, or the Internet to be “expedited” transfers. This means that we would accept only an
original signature transmitted to us only by U.S. mail. We may also restrict the transfer privileges of others acting on Your behalf, including Your registered representative or an asset allocation or investment advisory service. 

We reserve the right to reject any Premium Payments or transfer requests from any person without prior notice, if, in our judgment: 

 

	 	1.	The payment or transfer, or series of transfers, would have a negative impact on an underlying fund portfolio’s operations; or 

  

	 	2.	If an underlying fund portfolio would reject or has rejected our purchase order or has instructed us not to allow that purchase or transfer; or 

 

	 	3.	Because of a history of market timing or disruptive trading. 

 Dollar Cost Averaging 

Prior to the Annuity Commencement Date, You may enroll in Dollar Cost Averaging (DCA) by instructing us to automatically make periodic transfers of Policy
Value from a DCA Source Account without waiting for further instructions from You. A DCA program will begin once we have received, in Good Order, all necessary information and the minimum required amount. 

You must provide us with the following information to initiate DCA: 
  

	 	1.	The date on which the transfers are to begin. Your request will normally be effective the day after the effective date of the policy. If a certain date does not exist in a given month, the first day of the following
month will be used; 

  

	 	2.	The DCA Source Account from which the transfers are to be made. To begin dollar cost averaging, the value of the DCA Source Account is subject to minimums as described in Section 2 - Policy Data; 

 

	 	3.	The amount and frequency of the transfers. You may choose monthly or quarterly transfers. The amount of each transfer is subject to minimums as described in Section 2 - Policy Data; and 

 

	 	4.	The Investment Option(s) to receive the transferred amounts. You may choose one or more Investment Options. If You select more than one Investment Option, Your request must specify how the transferred amounts are to be
allocated among these Investments Options and cannot include Your DCA Source Account. 

 Transfers must be scheduled for a minimum or maximum
length of time as specified in Section 2 - Policy Data. DCA results in the purchase of more accumulation units when the value of the accumulation unit is low, and fewer accumulation units when the value of the accumulation unit is high.
However, there is no guarantee that the DCA program will result in higher Policy Values or will otherwise be successful. 
 Asset Rebalancing 

Prior to the Annuity Commencement Date, You may instruct us to automatically transfer amounts among the Subaccounts of the Separate Account on a regular basis
to maintain a desired allocation of the Policy Value among the various Subaccounts offered. Rebalancing will occur on a monthly, quarterly, semi-annual, or annual basis, beginning on a date selected by You. You must select the percentage of the
Policy Value desired in each of the various Subaccounts offered. Any amounts in the DCA Source Account or Fixed Account, if offered, are ignored for the purposes of Asset Rebalancing. Rebalancing can be started, stopped or changed at any time.
Rebalancing will cease as soon as we receive a request for any transfer. 

  

			
	ICC12 VA0513	 	Page 16

 B. TRANSFERS AFTER THE ANNUITY COMMENCEMENT DATE 

After the Annuity Commencement Date, You may transfer the value of the variable annuity units from one Subaccount to another within the Separate Account or to
the Fixed Account, if offered. If You want to transfer the value of the variable units You must provide written notification with the following information provided: 
  

	 	1.	The Investment Option from which the transfer is to be made; 

  

	 	2.	The amount of the transfer; and 

  

	 	3.	The Investment Option(s) to receive the transferred amount. 

 The minimum amount which may be transferred is
the lesser of $10 monthly income or the entire monthly income of the variable annuity units in the Subaccount from which the transfer is being made. If the monthly income of the remaining units in a Subaccount is less than $10, we have the right to
include the value of those variable annuity units as part of the transfer. We reserve the right to limit transfers between the Subaccounts or to the Fixed Accounts to once per Policy Year. 

After the Annuity Commencement Date, no transfers may be made from the Fixed Account, if offered, to any other Investment Option. 

SECTION 9 - DEATH PROCEEDS 
 A. DEATH
PRIOR TO THE ANNUITY COMMENCEMENT DATE 
 The amount payable upon death will be determined and made payable upon receipt, in Good Order, of satisfactory
proof of death, written directions from each eligible recipient regarding how they wish to receive the amount payable, and any other documents, forms and information that we need (collectively referred to as “due proof of death”). Not
withstanding the foregoing, we may confer with a variety of resources and/or other affiliates in order to ascertain or verify whether the Annuitant or any other relevant life in being is or may have become deceased during the term of this policy.
Any such activities or efforts by us in no manner abrogate, waive or otherwise diminish Your continued obligation to provide us with timely notice in writing of due proof of death in Good Order. 

The amount of the death benefit payable will be the greatest of: 
  

	 	1.	The Policy Value on the date we receive due proof of death and an election of method of settlement; 

  

	 	2.	The Cash Value on the date we receive due proof of death and an election of method of settlement; 

  

	 	3.	The Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of the Policy Value, on the date we receive due proof and an election of method of settlement; or 

 

	 	4.	The Guaranteed Minimum Death Benefit (GMDB), if any, on the date of death, plus any additional Premium Payments received, less any gross withdrawals from the date of death to the date of payment of death proceeds.

 The Owner(s) may elect the method of payment of death proceeds for each named beneficiary, subject to our then current rules, prior to the
date of the applicable Decedent’s death. When no such election is made as to a specific beneficiary, such beneficiary must elect the method of payment within 60 days of the date we receive all required documentation, in Good Order, to pay the
death proceeds to that beneficiary. 
 Guaranteed Minimum Death Benefit 

If elected, the GMDB will establish a minimum death benefit payable under the policy. Your election, if any, is shown in Section 2 - Policy Data. You may
not change Your election after the policy is issued. 
 Death of Annuitant Prior To The Annuity Commencement Date 

A death benefit will be payable if the Annuitant dies prior to the Annuity Commencement Date. 

 

	 	1.	Non-Natural Owner(s) 

 For purposes of determining who receives the death benefit for a
policy owned by a non-natural Owner, we will apply the rules for Individual Owner(s) as provided below in 2(a) or (b). 

  

			
	ICC12 VA0513	 	Page 17

	 	2.	Individual Owner(s) 

  

	 	(a)	Surviving Owner 

 If there is a surviving Owner(s) when the Annuitant dies, the surviving
Owner(s) will receive the death benefit (i.e., the surviving Owner(s) takes the place of any beneficiary designation). 
  

	 	(b)	No surviving Owner 

 If there is no surviving Owner, the death benefit is payable to the named
beneficiary(ies). If no beneficiary(ies) are named, the death benefit will be payable to the Owner’s estate. 
 Death of Owner Prior To The Annuity
Commencement Date 
 If the Owner is not the Annuitant and the Owner dies before the Annuitant, under certain circumstances, an amount equal to the Cash
Value, as of the date we receive due proof of death, will be paid. 
 If You are not also the Annuitant and in the event of simultaneous deaths of both You
and the Annuitant, the death proceeds will be calculated under the Death of Annuitant provisions. 
  

	 	1.	Non-Natural Owner(s) 

 If the policy is owned by a trust using the grantor’s social
security number as its taxpayer identification number, the death of the grantor will be treated as the death of the Owner. 
 If there is a
change in the Annuitant, such change will be treated as the death of the non-natural Owner and we will pay an amount equal to the Cash Value as of the day we receive, in Good Order, the request to change the Annuitant. 

 

	 	2.	Individual Owner(s) 

 If You die while the Annuitant is living, the Cash Value
will be paid to the first among the following who is living or in existence: 
  

	 	a.	The surviving Owner(s); 

  

	 	b.	Primary beneficiary(ies); 

  

	 	c.	Contingent beneficiary(ies); or 

  

	 	d.	Deceased Owner’s estate. 

  

	 	3.	Joint Owner(s) 

 If there is a joint Owner, the Cash Value will be payable upon the death
of the first Owner, unless the surviving joint Owner is the spouse. 
 Non-Spouse Individual Beneficiary: 

If the beneficiary is an individual who is not eligible to continue the contract as noted below, the amount payable must be distributed by the end of 5 years
after the date of Decedent’s death, or payments must begin no later than one year after the date of Decedent’s death and must be made for a period certain or for the beneficiary’s lifetime, so long as the period certain does not
exceed the beneficiary’s life expectancy. 
 If the beneficiary is not a natural person, the death proceeds must be distributed by the end of 5 years
after the date of Decedent’s death. 
 Spousal Beneficiary 

A spousal beneficiary, who is the sole beneficiary, may elect to continue this policy as Owner rather than receiving the amount payable when they are the
deceased Owner’s surviving spouse. 
 If the surviving spouse does not elect to continue the contract, the amount payable must be distributed by the
end of 5 years after the date of the Decedent’s death, or payments must begin no later than one year after the Decedent’s death and must be made for a period certain or for the beneficiary’s lifetime, so long as the period certain
does not exceed the beneficiary’s life expectancy. 
 If a death benefit is payable and the policy is continued, an amount equal to the excess, if any,
of the Guaranteed Minimum Death Benefit over the Policy Value will then be added to the Policy Value. This is a one-time only Policy Value adjustment applied at the time the policy is continued. The spousal continuation election is only available
once per policy. 

  

			
	ICC12 VA0513	 	Page 18

 If a death benefit is payable and the policy is continued, all current surrender charges will be waived; however,
any premium received after the Decedent’s death will be subject to any applicable surrender charges. 
 B. DEATH ON OR AFTER THE ANNUITY
COMMENCEMENT DATE 
 In the event of a death after the Annuity Commencement Date, the amount payable will depend on the income option selected. If any
Owner dies on or after the Annuity Commencement Date, but before the entire interest in the policy is distributed, the remaining portion of such interest in the policy will be distributed to the beneficiary(ies) at least as rapidly as under the
method of distribution being used as of the date of that death. 
 C. ADDITIONAL TAX INFORMATION 

In any event, the death proceeds will be paid in accordance with Section 72(s) of the IRC. For purposes of applying the non-natural Owner death rules of
Section 72(s)(6), we will apply the Annuitant death rules set forth earlier in this section. 
 These distribution rules do not apply to an annuity
provided under a plan described in Section 401(a), 403(a), 403(b), 408 or 408A of the IRC or to an annuity that is a qualified funding asset as defined in Code Section 130(d) of the IRC. 

SECTION 10 – INCOME OPTIONS 
 A.
GENERAL PAYMENT PROVISIONS 
 Payment 
 You may use
the Adjusted Policy Value or the Fixed Account portion of the Minimum Required Cash Value plus the Separate Account portion of the Policy Value, if greater, on the Annuity Commencement Date. If the policy is in force on the last available Annuity
Commencement Date, we will make annuity payments to the payee under Option 2(b), with 10 years certain, or if elected, under one or more of the other options described in this section, or any other method of payment if we agree. However, the
option(s) elected must provide for lifetime income or income for a period of at least 120 months. Payments will be made at 1, 3, 6 or 12 month intervals. We reserve the right to avoid making payments of less than $20.00. 

Before the Annuity Commencement Date, if the death proceeds become payable or if You Surrender this policy, we will pay any proceeds in one sum, or if
elected, all or part of these proceeds may be placed under one or more of the options described in this section. 
 Adjusted Age 

Payments under Options 2 and 4 and the first payment under Options 2-V and 4-V are determined based on the adjusted age of the Annuitant. The adjusted age is
the Annuitant’s actual age on the Annuitant’s nearest birthday, at the Annuity Commencement Date, adjusted as follows: 
  

			
	 Annuity

Commencement Date
	  	Adjusted Age
	Before 2025	  	Actual Age
	2025 - 2032	  	Actual Age minus 1
	2033 - 2040	  	Actual Age minus 2
	2041 - 2048	  	Actual Age minus 3
	2049 - 2055	  	Actual Age minus 4
	After 2055	  	Determined by us

 Election of Optional Method of Payment 

You may elect, in a manner acceptable to us, income options that may be either variable, fixed, or a combination of both. If You elect a combination, You must
also tell us what part of the policy proceeds on the Annuity Commencement Date is to be applied to provide each type of payment. You must also specify which Subaccounts to allocate policy proceeds. The amount of a combined payment will be the sum of
the variable and fixed payments. Payments under a variable income option will reflect the investment performance of the selected Subaccount of the Separate Account. 

  

			
	ICC12 VA0513	 	Page 19

 Qualified Plans and Policies 

Certain income options may not be available or may be limited for qualified plans and qualified policies in order to ensure compliance with the IRC. 

Proof of Age 
 We may require proof of the age of any
person who has an annuity purchased under Options 2, 2-V, 4 and 4-V of this section before we make the first payment. 
 Minimum Proceeds 

If the proceeds are less than $2,000, we reserve the right to pay them out as a lump sum instead of applying them to an income option. 

Supplementary Contract 
 Once proceeds become payable and
an income option has been selected, we will issue a supplementary contract to reflect the terms of the selected option. The contract will name the payee(s) and will describe the payment schedule. 

B. FIXED INCOME OPTIONS 
 Guaranteed Income Options

 The fixed income option is determined by multiplying each $1,000 of policy proceeds allocated to a fixed income option by the amounts shown in
Section 12 for the option You select. Options 1 and 3 are based on a guaranteed interest rate of 0.25%. Options 2 and 4 are based on a guaranteed interest rate of 0.25% and the “Annuity 2000” (male, female and unisex if required by
law) mortality table projected for improvement using projection scale G. The rates were projected dynamically using an assumed Annuity Commencement Date of 2020. The “Annuity 2000” mortality rates are adjusted based on improvements in
mortality to more appropriately reflect increased longevity. 
 Option 1 – Income for a Specified Period 

We will make level payments only for the fixed period You choose. Payments should not exceed the Annuitant’s life expectancy. In the event of the death of
the person receiving payments prior to the end of the fixed period elected, payments will be continued to that person’s beneficiary. No funds will remain at the end of the specified period. 

Option 2 – Life Income 
 You may choose between: 

 

	 	a.	Life Only – We will make level payments only during the Annuitant’s lifetime;* or 

  

	 	b.	Life 10 Years Period Certain – We will make level payments for the longer of: 

  

	 	1.	The Annuitant’s lifetime; or 

  

	 	2.	10 years, whichever is longer; or 

  

	 	c.	Guaranteed Return of policy proceeds – We will make level payments for the longer of: 

  

	 	1.	The Annuitant’s lifetime; or 

  

	 	2.	Until the total dollar amount of payments made to You equals the amount applied to this option. 

  

	*	Option 2(a) is not available for adjusted ages greater than 85. 

 Option 3 – Income of a Specified
Amount 
 Payments are made for any specified amount until the amount applied to this option, with interest, is exhausted. Payments should not exceed the
Annuitant’s life expectancy. This will be a series of level payments followed by a smaller final payment. In the event of the death of the person receiving payments prior to the time policy proceeds with interest are exhausted, payments will be
continued to that person’s beneficiary. 
 Option 4 – Joint and Survivor Annuity 

You may choose between: 
  

	 	a.	Life Only – We will make level payments only during the Annuitants’ lifetimes;** or 

  

	 	b.	Life and 10 Years Period Certain – We will make level payments for the longer of: 

  

	 	1.	The Annuitant’s lifetime and a joint Annuitant of Your selection; or 

  

	 	2.	10 years, whichever is longer. 

  

	**	Option 4(a) is not available for adjusted ages greater than 85. 

  

			
	ICC12 VA0513	 	Page 20

 Current Income Options 

The amounts shown in the tables in Section 12 are the guaranteed amounts. Payments at the time of their commencement will not be less than those that
would be provided by the application of the policy proceeds to purchase a single premium immediate annuity policy at purchase rates offered by the Company at the time to the same class of Annuitants. 

C. VARIABLE INCOME OPTIONS 
 Variable Annuity Units

 The policy proceeds You tell us to apply to a variable income option will be used to purchase variable annuity units in Your chosen Subaccounts. The
dollar value of variable annuity units in Your chosen Subaccounts will increase or decrease reflecting the investment experience of Your chosen Subaccounts. The value of a variable annuity unit in a particular Subaccount on any Market Day is equal
to “a” x “b” x “c”, where: 
  

	 	“a”	Is the variable annuity unit value for that Subaccount on the immediately preceding Market Day; 

  

	 	“b”	Is the net investment factor for that Subaccount for the Valuation Period; and 

  

	 	“c”	Is the Assumed Investment Return adjustment factor for the Valuation Period. 

 The net investment factor used
to calculate the value of an accumulation unit in each Subaccount for the Valuation Period is determined by dividing “a” by “b” and subtracting “c” from the result, where: 

 

	 	“a”	Is the result of: 

  

	 	1.	The net asset value of a fund share held in that Subaccount determined as of the end of the current Valuation Period; plus 

  

	 	2.	The per share amount of any dividend or capital gain distributions made by the fund for shares held in that Subaccount if the ex-dividend date occurs during the Valuation Period; plus or minus 

 

	 	3.	A per share credit or charge for any taxes reserved for, which we determine to have resulted from the investment operations of that Subaccount. 

 

	 	“b”	Is the net asset value of a fund share held in that Subaccount determined as of the end of the immediately preceding Valuation Period. 

 

	 	“c”	Is a factor representing the mortality and expense risk fee and administrative charge after the Annuity Commencement Date. This factor is less than or equal to, on an annual basis, the percentage shown in Section 2
-Policy Data, of the daily net asset value of a fund share held in that Subaccount. 

 Determination of the First Variable Payment 

The amount of the first variable payment is determined by multiplying $1,000 of policy proceeds allocated to a variable income option by the amounts shown in
Section 13 for the variable option You select. The tables are based on a 3% Effective Annual Assumed Investment Return and the “Annuity 2000” (male, female and unisex if required by law) mortality table projected for improvement using
projection scale G. The rates were projected dynamically using an assumed Annuity Commencement Date of 2020. The “Annuity 2000” mortality rates are adjusted based on improvements in mortality to more appropriately reflect increased
longevity. 
 Option 2-V – Life Income 
 You may
choose between: 
  

	 	a.	Life Only – Payments will be made during the lifetime of the Annuitant;* or 

  

	 	b.	Life and 10 Years Period Certain – Payments will be made for the longer of the Annuitant’s lifetime or ten years. In the event of the death of the person receiving payments prior to the end of the guarantee
period for which the election was made, payments will be continued to that person’s beneficiary. 

  

	*	Option 2-V(a) is not available for adjusted age(s) greater than 85. 

 Option 4-V – Joint and Survivor
Annuity 
 Life Only - Payments are made during the joint lifetime of the Annuitant and a joint Annuitant of Your selection. Payments
will be made as long as either person is living. Option 4-V is not available for adjusted ages greater than 85. 

  

			
	ICC12 VA0513	 	Page 21

 Determination of Subsequent Variable Payments 

The amount of each variable annuity payment after the first will increase or decrease according to the value of the variable annuity units which reflect the
investment experience of the selected Subaccounts. Each variable annuity payment after the first will be equal to the number of variable annuity units in the selected Subaccounts multiplied by the variable annuity unit value on the date the payment
is made. The number of variable annuity units in each selected Subaccount is determined by dividing the first variable annuity payment allocated to the Subaccount by the variable annuity unit value of such Subaccount on the Annuity Commencement
Date. 
 The smallest annual rate of investment return that would have to be earned on the assets of the Separate Account so that the dollar amount of
variable income payments will not decrease is 5.50%. 
 SECTION 11 – FIXED ACCOUNT 

We may make available a Fixed Account as an Investment Option. The Fixed Account, if offered, may be comprised of one or more options shown below. Premium
Payments applied to and any amount transferred to the Fixed Account will be credited interest based on a fixed rate. The interest rates we set will be credited for increments of at least one year measured from each Premium Payment or transfer date.
If the Fixed Account is available, these rates will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 – Policy Data. We reserve the right at our sole discretion, to limit or refuse
Premium Payments and/or transfers allocated to any of the Fixed Account options, if we are crediting an interest rate equal to or less than the Minimum Nonforfeiture Annual Interest Rate. 

Guaranteed Period Options 
 We may offer optional
Guaranteed Period Options, into which Premium Payments may be paid or amounts transferred. The current interest rate we set for Policy Value allocated to each Guaranteed Period Option (GPO) is guaranteed until the end of that guaranteed period. 

We will notify You before the end of the GPO. You may elect to have the Policy Value in the GPO transferred to any Investment Option, including any GPO we
then make available. However, any GPO elected may not extend beyond the last available Annuity Commencement Date. If we do not receive instructions from You in Good Order before the end of the GPO regarding how the Policy Value in that GPO is to be
allocated, we will allocate the Policy Value in that GPO to the Money Market Subaccount available in Your policy. No Excess Interest Adjustment (EIA) applies at the end of a GPO. 

When funds are withdrawn or transferred from a GPO, the Policy Value associated with the oldest Premium Payment is considered to be withdrawn or transferred
first. If the amount withdrawn or transferred exceeds the Policy Value associated with the oldest premium, the Policy Value associated with the next oldest Premium Payment is considered to be withdrawn or transferred next, and so on until the Policy
Value associated with the most recent premium is considered to be withdrawn or transferred (this is a First-In, First-Out, or FIFO, basis). 
 Withdrawals,
Surrenders, transfers and amounts applied to an income option from the GPO(s) may be subject to an EIA. Amounts received during the right to cancel period are not subject to an EIA. 

Dollar Cost Averaging Fixed Account Option 
 We may offer
a Dollar Cost Averaging (DCA) Fixed Account Option (a “DCA Source Account”) separate from the Guaranteed Period Options. This option will have a one-year interest rate guarantee. The current interest rate we credit may vary on different
portions of the DCA Fixed Account. The credited interest rate will never be less than the Fixed Account Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 - Policy Data. The DCA Fixed Account Option will only be available
under a Dollar Cost Averaging program as described in Section 8. 

  

			
	ICC12 VA0513	 	Page 22

							
	

	  		 	  
 Home Office:

4333 Edgewood Road N.E.
 Cedar Rapids, Iowa
52499
 (319)398-8511 
	 	
	  	    {	 	 	}
	  	 	 
	  	 	 
	  	 		 

 DEATH BENEFIT RIDER 

The Guaranteed Minimum Death Benefit provision in the Death Proceeds Section of the policy to which this Rider is attached, is amended to include the addition
of the following language: 
 The amount of this Guaranteed Minimum Death Benefit is equal to [100%] of the total premiums paid for this policy, less any
Adjusted Partial Withdrawals (as described below), as of the date of death. 
 A partial withdrawal will reduce the Guaranteed Minimum Death Benefit by an
amount referred to as the “Adjusted Partial Withdrawal”. The Adjusted Partial Withdrawal may be a different amount than the Gross Partial Withdrawal. If at the time of the partial withdrawal, the Policy Value is greater than or equal to
the Death Proceeds, the Adjusted Partial Withdrawal will equal the Gross Partial Withdrawal. If at the time of the partial withdrawal, the Policy Value is less than the Death Proceeds, the Adjusted Partial Withdrawal will be greater than the Gross
Partial Withdrawal. 
 The Adjusted Partial Withdrawal is equal to the Gross Partial Withdrawal multiplied by the Death Proceeds immediately prior to the
partial withdrawal divided by the Policy Value immediately prior to the partial withdrawal. The formula is APW = GPW x (DP/PV) where: 
  

	GPW	= Gross Partial Withdrawal 

  

	DP	= Death Proceeds prior to the partial withdrawal = greatest of (PV, CV, or GMDB) 

  

	PV	= Policy Value prior to the partial withdrawal 

  

	GMDB	= Guaranteed Minimum Death Benefit prior to the partial withdrawal 

  

	CV	= Cash Value prior to the partial withdrawal 

 This Rider is effective on the Policy Date and can only be
terminated when the policy to which this Rider is attached terminates. This Rider is subject to all the terms and conditions of the policy not inconsistent herewith. 

Signed for us at our home office. 
  

 

  
 RGMD 8 0603 

			
	

	  	 Home Office:
 4333 Edgewood Road N.E.

Cedar Rapids, Iowa 52499
 (319)355-8511

 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 

This rider is issued as a part of the policy to which it is attached. All provisions of the policy that do not conflict with this rider apply to this rider.
In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

This rider is effective on the Policy Date. This rider is subject to all the terms and conditions of the policy not inconsistent herewith. 

Data Specification 
  

			
	 Policy Number:
	  	12345
	 Benefit Issue Date:
	  	05-01-2013
	 Growth Rate Percentage:
	  	5.00%
	 Initial Benefit Fee Percentage*:
	  	1.25%
	 Annuitant:
	  	John Doe
	 Annuitant’s Issue Age/Sex:
	  	35 / Male

  

	*	The initial benefit fee percentage is also the maximum benefit fee percentage for the life of the policy, provided there are no automatic step-ups. When an automatic step-up is utilized, the maximum benefit fee
percentage will be 0.75% greater than the initial benefit fee percentage shown above. 

 Guaranteed Lifetime Withdrawal Benefit: The
withdrawal percentage is determined by the attained age and is used to determine the Benefit Withdrawal Amount as described in Article III. The withdrawal percentages are shown in the table below. 

 

					
	 Attained Age
	  	Withdrawal
Percentage	 
	 0 - 58
	  	 	0.0	% 
	 59 - 64
	  	 	4.5	% 
	 65 - 79
	  	 	5.5	% 
	 80 +
	  	 	6.5	% 

 ARTICLE I 

DEFINITIONS: 
 Terms used that are not defined herein shall
have the same meaning as those in Your policy. 
 Benefit Anniversary 

The anniversary of the benefit issue date. 
 Benefit Fee

 The fees charged for this benefit. The fees will be charged by the Company at the end of each Benefit Quarter. 

 

  

					
	ICC13 RGMB460513(IS)	 	(1)	 	(Income-Single)

 ARTICLE I CONTINUED 

Benefit Monthiversary 
 The same day of the month as the
benefit issue date, or the next Market Day if our Administrative Office or the New York Stock Exchange are closed. If a certain date does not exist in a given month, the first day of the following month will be used. 

Benefit Quarter 
 Each three-month period beginning on the
benefit issue date. 
 Benefit Withdrawal Amount 
 The
maximum amount that can be withdrawn from the policy each Benefit Year without causing an Excess Withdrawal under the terms of this Guaranteed Lifetime Withdrawal Benefit and thus reducing the Withdrawal Base. This amount will change if the
Withdrawal Base changes. 
 Benefit Year 
 The
twelve-month period following the benefit issue date shown on page 1, in the Data Specification section. 
 Excess Withdrawal 

As used to determine benefits under this Guaranteed Lifetime Withdrawal Benefit, the excess of a Gross Partial Withdrawal over the Benefit Withdrawal Amount
remaining prior to the withdrawal, if any. 
 Gross Partial Withdrawal 

The amount which will be deducted from Your Policy Value as a result of each partial withdrawal. 

Withdrawal Base 
 The amount used to calculate the
Benefit Withdrawal Amount and the Benefit Fee. This amount is not payable upon Surrender or as a death benefit. 
 ARTICLE II 

BENEFIT FEE 
 The Benefit Fee is deducted on each Benefit
Quarter in arrears. The Benefit Fee is calculated and stored at issue and at each subsequent Benefit Quarter for the upcoming quarter. It will be deducted automatically from each Investment Option on a pro rata basis at the end of each Benefit
Quarter. The initial benefit fee percentage and maximum benefit fee percentage are described on page 1, in the Data Specification section. The benefit fee percentage will not change during the first Benefit Year, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the benefit fee percentage. A portion of this fee will also be deducted when the benefit is terminated based on the number of days that have elapsed since the previous Benefit Quarter.

 The stored fee will be adjusted if the Withdrawal Base is adjusted during the Benefit Quarter. 

The quarterly fee is calculated as follows: 
 Multiply
(1) by (2) by (3). 
  

	1)	Withdrawal Base; 

  

	2)	Benefit fee percentage; 

  

	3)	Number of days remaining in the Benefit Quarter divided by the number of days within the applicable Benefit Year. 

  

					
	ICC13 RGMB460513(IS)	 	(2)	 	(Income-Single)

 ARTICLE III 

GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 We guarantee that
You can receive up to the Benefit Withdrawal Amount each Benefit Year, regardless of the Policy Value, (first as withdrawals from Your Policy Value and, if necessary, as payments from us) until the Annuitant’s death. 

The withdrawal percentage is determined by the attained age (age at last birthday) of the Annuitant at the time of the first withdrawal of any amount from the
Policy Value taken on or after the Benefit Anniversary following the Annuitant’s 59th birthday. Once the withdrawal percentage is established, it may only be changed by an automatic step-up. Upon an automatic step-up, the withdrawal percentage
will be reset based on the attained age at the time of the automatic step-up. The withdrawal percentages are shown in the table in the Data Specification section. 

If the Annuitant is not yet 59 on the benefit issue date, the withdrawal percentage will be zero until the Benefit Anniversary following the Annuitant’s
59th birthday. 
 Withdrawals prior to age 59 1/2 may be subject to the IRS 10% early withdrawal penalty. Withdrawals will reduce the Policy Value and death
benefit of the policy to which this benefit is attached. If the Policy Value equals zero, You cannot make subsequent Premium Payments and all other policy features, benefits and guarantees are no longer available. Also, if the Policy Value equals
zero, You will need to request payments by selecting the amount and frequency in accordance with the policy provisions to which this benefit attaches, equal to the Benefit Withdrawal Amount. Once the payment amount and frequency are established,
they cannot be changed and no additional withdrawals will be allowed. 
 ISSUE AGE AND SURVIVAL 

The benefits require the Annuitant being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the Annuitant. Proof of
survival and the issue ages may be required by the Company. 
 If the Annuitant’s age has been misstated, this benefit’s fees and benefits will be
adjusted to the amounts which would have been calculated for the correct age. However, if this benefit and policy would not have been issued had the age not been misstated, the benefit and policy is treated as if it never existed, and any fees
charged for this benefit would be returned. If withdrawals under the provisions of the benefit have already commenced and the misstatement caused the Benefit Withdrawal Amount to be overstated, any withdrawal in excess of the correct Benefit
Withdrawal Amount will be considered an Excess Withdrawal and will impact the Withdrawal Base and Benefit Withdrawal Amount. If overpayments occurred when the sum of the accumulated values in all the Investment Options was zero, the amount of that
overpayment will be deducted from one or more future payments until this amount is paid in full. 
 BENEFIT WITHDRAWAL AMOUNT 

The Benefit Withdrawal Amount will be equal to the greater of 1) and 2), where: 
  

	1)	is the withdrawal percentage multiplied by the Withdrawal Base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st Benefit Anniversary, this amount is based on the initial Policy Value on the benefit issue date. After this time, the minimum
required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this benefit is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

  

	 	B)	the minimum required distributions do not start prior to the Annuitant’s attained age 70 1/2, 

  

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living Annuitant. The minimum required distributions can not be based on the age of someone who is deceased, 

 

	 	E)	the minimum required distributions are based only on the policy to which this benefit is attached, and 

  

	 	F)	the minimum required distributions are only for the current Benefit Year. Amounts carried over from past Benefit Years are not considered. 

  

					
	ICC13 RGMB460513(IS)	 	(3)	 	(Income-Single)

 ARTICLE III CONTINUED 

If any of the above are not true, then 2) is equal to zero and it is not available as a Benefit Withdrawal Amount. 

If You withdraw less than the Benefit Withdrawal Amount in a Benefit Year, the unused portion cannot be carried over to the next Benefit Year. 

Surrender charges may apply if Your Benefit Withdrawal Amount exceeds Your surrender charge-free amount. 

WITHDRAWAL BASE 
 The Withdrawal Base is used to calculate
the Benefit Withdrawal Amount. On the benefit issue date, the initial Withdrawal Base is equal to the Policy Value. During any Benefit Year, the Withdrawal Base is increased by subsequent Premium Payments, and is reduced for Excess Withdrawals. 

On each Benefit Anniversary, the Withdrawal Base will be set to the greatest of: 
  

	 	1)	The current Withdrawal Base; 

  

	 	2)	The Policy Value on the Benefit Anniversary; 

  

	 	3)	The highest Policy Value on a Benefit Monthiversary for the current Benefit Year; or 

  

	 	4)	The current Withdrawal Base immediately prior to Benefit Anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any Excess Withdrawals in the current Benefit Year. Item 4) above will be zero after the 10th Benefit
Anniversary or if there have been any withdrawals in the current Benefit Year. 
 AUTOMATIC STEP-UP FEATURE 

The benefit receives an automatic step-up on the Benefit Anniversary if the Withdrawal Base is set equal to the Policy Value or the highest Policy Value on a
Benefit Monthiversary. This benefit will continue with the same benefit issue date and features. The Benefit Fee and withdrawal percentages may be changed due to an automatic step-up. Beginning with the first Benefit Anniversary, the benefit fee
percentage may be increased if there is an automatic step-up, but will not exceed the maximum benefit fee percentage described in the Data Specification section. 

You have the right to reject an automatic step-up within 30 days following a Benefit Anniversary, if the benefit fee percentage increases. If You reject an
automatic step-up, You must notify us in a manner which is acceptable to us, however You are eligible for future automatic step-ups. Changes as a result of the automatic step-up feature will be reversed. Any increase in the Benefit Fee or withdrawal
percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS 

Gross Partial Withdrawals, taken in a Benefit Year, less than or equal to the Benefit Withdrawal Amount will not reduce the Withdrawal Base. Excess
Withdrawals will reduce the Withdrawal Base by the withdrawal base adjustment which may be more than the dollar amount of the Excess Withdrawal. The withdrawal base adjustment is the greater of 1) and 2), where: 

 

	1)	is the Excess Withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the Excess Withdrawal; 

  

	 	B)	is the Withdrawal Base prior to the Excess Withdrawal Amount; and 

  

	 	C)	is the Policy Value after the Benefit Withdrawal Amount has been withdrawn, but prior to the withdrawal of the Excess Withdrawal Amount. 

  

					
	ICC13 RGMB460513(IS)	 	(4)	 	(Income-Single)

 ARTICLE IV 

CONTINUATION 
 In the case of spousal joint Owners where
one spouse is the Annuitant, if the spouse who is not the Annuitant dies and the surviving spouse is the sole beneficiary, the benefit continues with the same values. In the case of spousal joint Owners where one spouse is the Annuitant, if the
spouse who is the Annuitant dies, this benefit will terminate. 
 In the case of non-spousal joint Owners where an Owner who is not the Annuitant dies, the
surviving Owner (who is treated as the designated beneficiary) may elect to receive lifetime income payments under this benefit instead of receiving any benefits applicable to the policy. The lifetime income payments must begin no later than 1 year
after the Owner’s death and will be equal to the Benefit Withdrawal Amount divided by the number of payments made per year. Once the payments begin, no additional Premium Payments will be accepted and no additional withdrawals will be paid.
Regardless if income payments are or are not elected, this benefit will terminate 1 year following the Owner’s death. 
 ANNUITIZATION 

On the last available Annuity Commencement Date, as described in Your policy, You will have the option to receive payments, under the Life Income Option, that
are no less than Your Benefit Withdrawal Amount each year. Upon election of an Income Option, this benefit will terminate. 
 OWNERSHIP AND ASSIGNMENT

 Ownership changes or assignments of any policy to which this benefit is attached must be approved by the Company. We reserve the right to disapprove
ownership changes or assignments in a non-discriminatory manner when involving an institutional investor, a settlement company or another similar organization. 

REPORTS TO OWNER 
 We will give You a report at least once
each Policy Year. Before You are eligible to receive the Benefit Withdrawal Amount, the report will direct You to contact the Company for information regarding Your Benefit Withdrawal Amount. After You are eligible for Your Benefit Withdrawal
Amount, this amount will be included in the report. 
 TERMINATION 

This Guaranteed Lifetime Withdrawal Benefit will be terminated at the earlier of when the policy to which this is attached terminates, election of an Income
Option, upon death of the Annuitant or 1 year after the death of the non-spousal Owner. After termination, Benefit Fees will no longer be assessed. 

Signed for us at our home office. 
  

 

  

					
	ICC13 RGMB460513(IS)	 	(5)	 	(Income-Single)

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	  	 Administrative and Home Office:
 4333
Edgewood Road N.E.
 Cedar Rapids, Iowa 52499
 (319)
355-8511
 www.transamericaannuities.com

  

			
	ICC12 VA0513	 	Page 24

			
	

	  	 Home Office:
 4333 Edgewood Road N.E.

Cedar Rapids, Iowa 52499
 (319)355-8511

 GUARANTEED LIFETIME WITHDRAWAL BENEFIT 

This rider is issued as a part of the policy to which it is attached. All provisions of the policy that do not conflict with this rider apply to this rider.
In the event of any conflict between the provisions of this rider and the provisions of the policy, the provisions of this rider shall prevail over the provisions of the policy. 

This rider is effective on the Policy Date. This rider is subject to all the terms and conditions of the policy not inconsistent herewith. 

Data Specification 
  

			
	Policy Number:	  	12345
	Benefit Issue Date:	  	05-01-2013
	Growth Rate Percentage:	  	5.00%
	Initial Benefit Fee Percentage*:	  	1.25%
	Annuitant:	  	John Doe
	Annuitant’s Issue Age/Sex:	  	35 / Male
	Annuitant’s Spouse:	  	Jane Doe
	Annuitant’s Spouse’s Issue Age/Sex:	  	35 / Female

  

	*	The initial benefit fee percentage is also the maximum benefit fee percentage for the life of the policy, provided there are no automatic step-ups. When an automatic step-up is utilized, the maximum benefit fee
percentage will be 0.75% greater than the initial benefit fee percentage shown above. 

 Guaranteed Lifetime Withdrawal Benefit: The
withdrawal percentage is determined by the attained age and is used to determine the Benefit Withdrawal Amount as described in Article III. The withdrawal percentages are shown in the table below. 

 

					
	 Attained Age
	  	Withdrawal
Percentage	 
	 0 - 58
	  	 	0.0	% 
	 59 - 64
	  	 	4.0	% 
	 65 - 79
	  	 	5.0	% 
	 80 +
	  	 	6.0	% 

 ARTICLE I 

DEFINITIONS: 
 Terms used that are not defined herein shall
have the same meaning as those in Your policy. 
 Benefit Anniversary 

The anniversary of the benefit issue date. 
 Benefit Fee

 The fees charged for this benefit. The fees will be charged by the Company at the end of each Benefit Quarter. 

  

					
	ICC13 RGMB460513(IJ)	 	(1)	 	(Income-Joint)

 ARTICLE I CONTINUED 

Benefit Monthiversary 
 The same day of the month as the
benefit issue date, or the next Market Day if our Administrative Office or the New York Stock Exchange are closed. If a certain date does not exist in a given month, the first day of the following month will be used. 

Benefit Quarter 
 Each three-month period beginning on the
benefit issue date. 
 Benefit Withdrawal Amount 
 The
maximum amount that can be withdrawn from the policy each Benefit Year without causing an Excess Withdrawal under the terms of this Guaranteed Lifetime Withdrawal Benefit and thus reducing the Withdrawal Base. This amount will change if the
Withdrawal Base changes. 
 Benefit Year 
 The
twelve-month period following the benefit issue date shown on page 1, in the Data Specification section. 
 Excess Withdrawal 

As used to determine benefits under this Guaranteed Lifetime Withdrawal Benefit, the excess of a Gross Partial Withdrawal over the Benefit Withdrawal Amount
remaining prior to the withdrawal, if any. 
 Gross Partial Withdrawal 

The amount which will be deducted from Your Policy Value as a result of each partial withdrawal. 

Withdrawal Base 
 The amount used to calculate the
Benefit Withdrawal Amount and the Benefit Fee. This amount is not payable upon Surrender or as a death benefit. 
 ARTICLE II 

BENEFIT FEE 
 The Benefit Fee is deducted on each Benefit
Quarter in arrears. The Benefit Fee is calculated and stored at issue and at each subsequent Benefit Quarter for the upcoming quarter. It will be deducted automatically from each Investment Option on a pro rata basis at the end of each Benefit
Quarter. The initial benefit fee percentage and maximum benefit fee percentage are described on page 1, in the Data Specification section. The benefit fee percentage will not change during the first Benefit Year, and will only change thereafter due
to an automatic step-up. You will be notified of any increase in the benefit fee percentage. A portion of this fee will also be deducted when the benefit is terminated based on the number of days that have elapsed since the previous Benefit Quarter.

 The stored fee will be adjusted if the Withdrawal Base is adjusted during the Benefit Quarter. 

The quarterly fee is calculated as follows: 
 Multiply
(1) by (2) by (3). 
  

	1)	Withdrawal Base; 

  

	2)	Benefit fee percentage; 

  

	3)	Number of days remaining in the Benefit Quarter divided by the number of days within the applicable Benefit Year. 

  

					
	ICC13 RGMB460513(IJ)	 	(2)	 	(Income-Joint)

 ARTICLE III 

GUARANTEED LIFETIME WITHDRAWAL BENEFIT 
 We guarantee that
You can receive up to the Benefit Withdrawal Amount each Benefit Year, regardless of the Policy Value, (first as withdrawals from Your Policy Value and, if necessary, as payments from us) until the Annuitant’s or the Annuitant’s
spouse’s death. 
 The withdrawal percentage is determined by the attained age (age at last birthday) of the younger of the living spouses at the time
of the first withdrawal of any amount from the Policy Value taken on or after the Benefit Anniversary following the younger of the living spouse’s 59th birthday. Once the withdrawal percentage is established, it may only be changed by an
automatic step-up. Upon an automatic step-up, the withdrawal percentage will be reset based on the attained age of the younger of the living spouses at the time of the automatic step-up. The withdrawal percentages are shown in the table in the Data
Specification section. 
 If the younger of the Annuitant and the Annuitant’s spouse is not yet 59 on the benefit issue date, the withdrawal percentage
will be zero until the Benefit Anniversary following the younger of the living spouse’s 59th birthday. Withdrawals prior to age 59 1/2 may be subject to the IRS 10% early withdrawal penalty. 

Withdrawals will reduce the Policy Value and death benefit of the policy to which this benefit is attached. If the Policy Value equals zero, You cannot make
subsequent Premium Payments and all other policy features, benefits and guarantees are no longer available. Also, if the Policy Value equals zero, You will need to request payments by selecting the amount and frequency in accordance with the policy
provisions to which this benefit attaches, equal to the Benefit Withdrawal Amount. Once the payment amount and frequency are established, they cannot be changed and no additional withdrawals will be allowed. 

ISSUE AGE AND SURVIVAL 
 The benefits require the
Annuitant or Annuitant’s spouse being alive at the time of withdrawal and the amount of the benefit depends on the issue age of the Annuitant and Annuitant’s spouse. Proof of survival and the issue ages may be required by the Company. 

If the younger of the spouse’s age has been misstated, this benefit’s fees and benefits will be adjusted to the amounts which would have been
calculated for the correct age. However, if this benefit and policy would not have been issued had the age not been misstated, the benefit and policy is treated as if it never existed, and any fees charged for this benefit would be returned. If
withdrawals under the provisions of the benefit have already commenced and the misstatement caused the Benefit Withdrawal Amount to be overstated, any withdrawal in excess of the correct Benefit Withdrawal Amount will be considered an Excess
Withdrawal and will impact the Withdrawal Base and Benefit Withdrawal Amount. If overpayments occurred when the sum of the accumulated values in all the Investment Options was zero, the amount of that overpayment will be deducted from one or more
future payments until this amount is paid in full. 
 BENEFIT WITHDRAWAL AMOUNT 

The Benefit Withdrawal Amount will be equal to the greater of 1) and 2), where: 
  

	1)	is the withdrawal percentage multiplied by the Withdrawal Base; 

  

	2)	is an amount equal to the minimum required distribution amount, if any. Prior to the 1st Benefit Anniversary, this amount is based on the initial Policy Value on the benefit issue date. After this time, the minimum
required distribution is calculated based on the rules established by the IRS. The minimum required distribution may only be used if all of the following are true: 

 

	 	A)	the policy to which this benefit is attached is a tax-qualified policy for which IRS minimum required distributions are required, 

  

	 	B)	the minimum required distributions do not start prior to the Annuitant’s attained age 70 1/2, 

  

	 	C)	the minimum required distributions are based on either the Uniform Lifetime table or the Joint Life and Last Survivor Expectancy table, 

 

	 	D)	the minimum required distributions are based on age of the living Annuitant or the Annuitant’s spouse. The minimum required distributions can not be based on the age of someone who is deceased, 

 

	 	E)	the minimum required distributions are based only on the policy to which this benefit is attached, and 

  

	 	F)	the minimum required distributions are only for the current Benefit Year. Amounts carried over from past Benefit Years are not considered. 

  

					
	ICC13 RGMB460513(IJ)	 	(3)	 	(Income-Joint)

 ARTICLE III CONTINUED 

If any of the above are not true, then 2) is equal to zero and it is not available as a Benefit Withdrawal Amount. 

If You withdraw less than the Benefit Withdrawal Amount in a Benefit Year, the unused portion cannot be carried over to the next Benefit Year. 

Surrender charges may apply if Your Benefit Withdrawal Amount exceeds Your surrender charge-free amount. 

WITHDRAWAL BASE 
 The Withdrawal Base is used to calculate
the Benefit Withdrawal Amount. On the benefit issue date, the initial Withdrawal Base is equal to the Policy Value. During any Benefit Year, the Withdrawal Base is increased by subsequent Premium Payments, and is reduced for Excess Withdrawals. 

On each Benefit Anniversary, the Withdrawal Base will be set to the greatest of: 
  

	 	1)	The current Withdrawal Base; 

  

	 	2)	The Policy Value on the Benefit Anniversary; 

  

	 	3)	The highest Policy Value on a Benefit Monthiversary for the current Benefit Year; or 

  

	 	4)	The current Withdrawal Base immediately prior to Benefit Anniversary processing increased by the growth rate percentage. 

Item 3) above will be zero if there have been any Excess Withdrawals in the current Benefit Year. Item 4) above will be zero after the 10th Benefit
Anniversary or if there have been any withdrawals in the current Benefit Year. 
 AUTOMATIC STEP-UP FEATURE 

The benefit receives an automatic step-up on the Benefit Anniversary if the Withdrawal Base is set equal to the Policy Value or the highest Policy Value on a
Benefit Monthiversary. This benefit will continue with the same benefit issue date and features. The Benefit Fee and withdrawal percentages may be changed due to an automatic step-up. Beginning with the first Benefit Anniversary, the benefit fee
percentage may be increased if there is an automatic step-up, but will not exceed the maximum benefit fee percentage described in the Data Specification section. 

You have the right to reject an automatic step-up within 30 days following a Benefit Anniversary, if the benefit fee percentage increases. If You reject an
automatic step-up, You must notify us in a manner which is acceptable to us, however You are eligible for future automatic step-ups. Changes as a result of the automatic step-up feature will be reversed. Any increase in the Benefit Fee or withdrawal
percentages will also be reversed. 
 WITHDRAWAL BASE ADJUSTMENTS 

Gross Partial Withdrawals, taken in a Benefit Year, less than or equal to the Benefit Withdrawal Amount will not reduce the Withdrawal Base. Excess
Withdrawals will reduce the Withdrawal Base by the withdrawal base adjustment which may be more than the dollar amount of the Excess Withdrawal. The withdrawal base adjustment is the greater of 1) and 2), where: 

 

	1)	is the Excess Withdrawal amount; and 

  

	2)	is the result of (A multiplied by B), divided by C, where: 

  

	 	A)	is the Excess Withdrawal; 

  

	 	B)	is the Withdrawal Base prior to the Excess Withdrawal amount; and 

  

	 	C)	is the Policy Value after the Benefit Withdrawal Amount has been withdrawn, but prior to the withdrawal of the Excess Withdrawal amount. 

  

					
	ICC13 RGMB460513(IJ)	 	(4)	 	(Income-Joint)

 ARTICLE IV 

CONTINUATION 
 In the case of spousal joint Owners where
one spouse is the Annuitant, if the spouse who is not the Annuitant dies and the surviving spouse is the sole beneficiary or joint Owner, the benefit continues with the same values. In the case of spousal joint Owners where one spouse is the
Annuitant, if the spouse who is the Annuitant dies and the surviving spouse is the sole beneficiary or joint Owner, the benefit continues with the same values if the policy is continued until the death of the surviving spouse. 

ANNUITIZATION 
 On the last available Annuity Commencement
Date, as described in Your policy, You will have the option to receive payments, under the Life Income Option, that are no less than Your Benefit Withdrawal Amount each year. Upon election of an Income Option, this benefit will terminate. 

OWNERSHIP AND ASSIGNMENT 
 Ownership changes or
assignments of any policy to which this benefit is attached must be approved by the Company. We reserve the right to disapprove ownership changes or assignments in a non-discriminatory manner when involving an institutional investor, a settlement
company or another similar organization. 
 REPORTS TO OWNER 

We will give You a report at least once each Policy Year. Before You are eligible to receive the Benefit Withdrawal Amount, the report will direct You to
contact the Company for information regarding Your Benefit Withdrawal Amount. After You are eligible for Your Benefit Withdrawal Amount, this amount will be included in the report. 

TERMINATION 
 This Guaranteed Lifetime Withdrawal Benefit
will be terminated at the earlier of when the policy to which this is attached terminates, election of an Income Option, or upon death of the last surviving Annuitant or Annuitant’s spouse. After termination, Benefit Fees will no longer be
assessed. 
 Signed for us at our home office. 
  

 

  

					
	ICC13 RGMB460513(IJ)	 	(5)	 	(Income-Joint)

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