Document:

achv-ex102_45.htm

EXHIBIT 10.2

FIRST Amendment

to 

2021 CONTINGENT CONVERTIBLE DEBT AGREEMENT

 

This First Amendment to 2021 Contingent Convertible Debt Agreement (this “Amendment”) is entered into this 26th day of April, 2022, by and among (a) SILICON VALLEY BANK, a California corporation (“SVB”), in its capacity as administrative agent and collateral agent (“Agent”), (b) SILICON VALLEY BANK, a California corporation, as a lender, (c) SVB Innovation Credit Fund VIII, L.P., a Delaware limited partnership (“SVB Innovation Fund”), as a lender (SVB and SVB Innovation Fund and each of the other “ Lenders”  from time to time a party hereto are referred to herein collectively as the “Lenders” and each individually as a “Lender”), and (d) ACHIEVE LIFE SCIENCES, INC., a Delaware corporation (“Borrower”).

Recitals

A.Borrower, Agent and the Lenders have entered into that certain 2021 Contingent Convertible Debt Agreement dated as of December 22, 2021 (as the same may from time to time be amended, modified, supplemented or restated, the “Loan Agreement”).  

B.The Lenders have extended credit to Borrower for the purposes permitted in the Loan Agreement.  

C.Borrower has requested that the Lenders amend the Loan Agreement to make certain revisions to the Loan Agreement as more fully set forth herein.

D.The Lenders have agreed to so amend certain provisions of the Loan Agreement, but only to the extent, in accordance with the terms, subject to the conditions and in reliance upon the representations and warranties set forth below.

Agreement

Now, Therefore, in consideration of the foregoing recitals and other good and valuable consideration, the receipt and adequacy of which is hereby acknowledged, and intending to be legally bound, the parties hereto agree as follows:

1.Definitions.  Capitalized terms used but not defined in this Amendment shall have the meanings given to them in the Loan Agreement.

2.Amendments to Loan Agreement.

2.1Section 3.3 (Termination).  Section 3.3 is amended by inserting the following to appear as the final sentence thereof:

“Agent’s Lien in the assets of Borrower securing the Obligations of Borrower to Lenders under this Agreement shall be junior and subordinated to SVB’s security interest in the assets of Borrower securing the Obligations of Borrower to SVB under the Senior Loan Agreement.”

 

 

2.2Section 5.15 (Financial Covenants).  The Loan Agreement is amended by inserting the following new Section 5.15 to appear immediately following Section 5.14 thereof:

“5.15Financial Covenants.

 

(a)Upon and after Bank (as such term is defined in the Senior Loan Agreement) making a Term Loan Advance (as such term is defined in the Senior Loan Agreement) under the Senior Loan Agreement (but prior to the Alternate Testing Period), Borrower shall maintain at all times, to be tested as of the last day of each month, a Liquidity Ratio of at least 1.25:1.0.

 

(b)During the Alternate Testing Period, Borrower shall maintain at all times, to be tested as of the last day of each month, either (i) a Liquidity Ratio of at least 1.25:1.0 or (ii) a minimum market capitalization of at least $250,000,000.00, determined based upon the daily closing price for each trading day in Agent’s and each Lender’s sole and absolute discretion.”

 

2.3Section 7.15 (Senior Loan Agreement).  The Loan Agreement is amended by inserting the following new Section 7.15 to appear immediately following Section 7.14 thereof:

“7.15Senior Loan Agreement. The occurrence of an Event of Default (as defined in the Senior Loan Agreement) under the Senior Loan Agreement.”

 

2.4Section 13.2 (Definitions).  The following term and its respective definition set forth in Section 13.2 is amended in its entirety and replaced with the following:

““Loan Documents” are, collectively, this Agreement and any schedules, exhibits, certificates, notices, and any other documents related to this Agreement, the Senior Loan Documents, the Perfection Certificate, Control Agreements, each Disbursement Letter, the Registration Rights Agreement, the Subordination Agreement, the Lender Intercreditor Agreement, any Bank Services Agreement, any subordination agreement, any note, or notes or guaranties executed by Borrower or any Guarantor, landlord waivers and consents, bailee waivers and consents, and any other present or future agreement by Borrower and/or any Guarantor with or for the benefit of Agent and the Lenders in connection with this Agreement or Bank Services, all as amended, restated, or otherwise modified in accordance with the terms thereof and the Lender Intercreditor Agreement.”

 

2.5Section 13.2 (Definitions).  The definition of “Permitted Indebtedness” appear in Section 13.2 thereof is amended by (i) deleting the “and” at the end of clause (j) thereof, (ii) deleting the “.” at the end of clause (k) thereof and replacing it with “; and”, and (iii) inserting the following new clause (l) thereof:

“(l)Indebtedness in connection with the Senior Loan Agreement.”

 

 

2.6Section 13.2 (Definitions).  The definition of “Permitted Indebtedness” appear in Section 13.2 thereof is amended by (i) deleting the “and” at the end of clause (o) thereof, (ii) deleting the “.” at the end of clause (p) thereof and replacing it with “; and”, and (iii) inserting the following new clause (q) thereof:

“(q)Liens in connection with the Senior Loan Agreement.”

 

2.7Section 13.2 (Definitions).  The following new terms and their respective definitions are hereby inserted to appear alphabetically in Section 13.2 thereof:

““Alternate Testing Period” means the period of time commencing upon the occurrence of each of the following: (i) Bank (as such term is defined in the Senior Loan Agreement) making the initial Term Loan Advance (as such term is defined in the Senior Loan Agreement) under the Senior Loan Agreement, (ii) the occurrence of the Equity Event, and (iii) Borrower’s request in writing to Agent to opt into the market capitalization financial covenant in Section 5.15(b)(ii).”

 

““Equity Event” means Borrower has provided Agent with evidence satisfactory to Agent and each Lender in their sole and absolute discretion, that Borrower has received, after the First Amendment Effective Date, unrestricted and unencumbered net cash proceeds from the issuance and sale of its equity securities to investors satisfactory to Agent and each Lender in an aggregate amount of at least $30,000,000.00.”

 

““First Amendment Effective Date” is April 26, 2022.”

 

““Liquidity Ratio” means the ratio of (a) Borrower’s unrestricted and unencumbered cash and Cash Equivalents maintained at SVB or SVB’s Affiliates to (b) all outstanding Obligations under this Agreement and the Senior Loan Agreement.”

 

““Senior Loan Agreement” means that certain Loan and Security Agreement by and between Borrower and SVB dated as of April 26, 2022 (as the same may be amended, modified, supplemented and/or restated from time to time).”

 

““Senior Loan Documents” are, collectively, the Senior Loan Agreement and the Loan Documents as defined therein, all as amended, extended or restated from time to time.”

 

““Subordination Agreement” means that certain Subordination Agreement by and among SVB, Bank (as such term is defined in the Senior Loan Agreement), and the Lenders dated as the Effective Date (as the same may from time to time be amended, modified, supplemented and/or restated).”

 

2.8Exhibit A (Compliance Statement).  The Compliance Statement appearing as Exhibit A to the Loan Agreement is amended in its entirety and replaced with the 

Compliance Statement on Schedule 1 attached hereto.  

 

3.Limitation of Amendments.

3.1The amendments set forth in Section 2 above are effective for the purposes set forth herein and shall be limited precisely as written and shall not be deemed to (a) be a consent to any amendment, waiver or modification of any other term or condition of any Loan Document, or (b) otherwise prejudice any right or remedy which Agent or the Lenders may now have or may have in the future under or in connection with any Loan Document.

3.2This Amendment shall be construed in connection with and as part of the Loan Documents and all terms, conditions, representations, warranties, covenants and agreements set forth in the Loan Documents, except as herein amended, are hereby ratified and confirmed and shall remain in full force and effect.

4.Representations and Warranties.  To induce Agent and the Lenders to enter into this Amendment, Borrower hereby represents and warrants to Agent and the Lenders as follows:

4.1Immediately after giving effect to this Amendment (a) the representations and warranties contained in the Loan Documents are true, accurate and complete in all material respects as of the date hereof (except to the extent such representations and warranties relate to an earlier date, in which case they are true and correct as of such date), and (b) no Event of Default has occurred and is continuing;

4.2Borrower has the power and authority to execute and deliver this Amendment and to perform its obligations under the Loan Agreement, as amended by this Amendment;

4.3The organizational documents of Borrower delivered to Agent on the Effective Date remain true, accurate and complete and have not been amended, supplemented or restated and are and continue to be in full force and effect;

4.4The execution and delivery by Borrower of this Amendment and the performance by Borrower of its obligations under the Loan Agreement, as amended by this Amendment, have been duly authorized; 

4.5The execution and delivery by Borrower of this Amendment and the performance by Borrower of its obligations under the Loan Agreement, as amended by this Amendment, do not and will not contravene (a) any law or regulation binding on or affecting Borrower, (b) any contractual restriction with a Person binding on Borrower, (c) any order, judgment or decree of any court or other governmental or public body or authority, or subdivision thereof, binding on Borrower, or (d) the organizational documents of Borrower; 

4.6The execution and delivery by Borrower of this Amendment and the performance by Borrower of its obligations under the Loan Agreement, as amended by this Amendment, do not require any order, consent, approval, license, authorization or validation of, or filing, recording or registration with, or exemption by any governmental or public body or authority, or subdivision thereof, binding on Borrower, except as already has been obtained or made; and

4.7This Amendment has been duly executed and delivered by Borrower and is the binding obligation of Borrower, enforceable against Borrower in accordance with its terms, except as such enforceability may be limited by bankruptcy, insolvency, reorganization, liquidation, moratorium or other similar laws of general application and equitable principles relating to or affecting creditors’ rights.

5.Updated Perfection Certificate.  Borrower has delivered an updated Perfection Certificate in connection with this Amendment (the “Updated Perfection Certificate”) dated as of the date hereof, which such Updated Perfection Certificate shall supersede in all respects that certain Perfection Certificate of Borrower dated as of December 22, 2021.  Borrower agrees that all references in the Loan Agreement to “Perfection Certificate” with respect to shall hereinafter be deemed to be a reference to the Updated Perfection Certificate.

6.Integration.  This Amendment and the Loan Documents represent the entire agreement about this subject matter and supersede prior negotiations or agreements.  All prior agreements, understandings, representations, warranties, and negotiations between the parties about the subject matter of this Amendment and the Loan Documents merge into this Amendment and the Loan Documents.

7.Counterparts.  This Amendment may be executed in any number of counterparts and all of such counterparts taken together shall be deemed to constitute one and the same instrument.

8.Effectiveness.  This Amendment shall be deemed effective upon (a) the due execution and delivery to Agent of this Amendment by each party hereto and (b) Borrower’s payment to Agent of Agent’s and the Lenders’ legal fees and expenses incurred in connection with this Amendment.

[Signature page follows.]

 

 

In Witness Whereof, the parties hereto have caused this Amendment to be duly executed and delivered as of the date first written above.

 

	
	
BORROWER:

 

ACHIEVE LIFE SCIENCES, INC.

 

 

By:  /s/ John Bencich

 

Name: John Bencich

 

Title: Chief Executive Officer

 

 

	
 

AGENT:

 

SILICON VALLEY BANK, as Agent

 

 

By:  /s/ Peter Sletteland

 

Name: Peter Sletteland

 

Title:  Director

 

	
 

LENDERS:

 

SILICON VALLEY BANK

 

 

By:  /s/ Peter Sletteland

 

Name: Peter Sletteland

 

Title:  Director

 

	
SVB INNOVATION CREDIT FUND VIII, L.P.

 

By:   SVB Innovation Credit Partners VIII, LLC, a

Delaware limited liability company, its General Partner

 

 

By:  /s/ Ryan Grammer

 

 

Name: Ryan Grammer

 

Title:  Senior Managing DirectorEX-4.i

 Exhibit (4)(i) 

EXHIBIT (4)(i) 

INDIVIDUAL FLEXIBLE PREMIUM DEFERRED INDEX-LINKED ANNUITY CONTRACT 

 Transamerica Life Insurance Company 

Cedar Rapids, IA 
 Contact us at
6400 C Street SW, Cedar Rapids, IA 52499 
 (800) 525-6205 

www.transamerica.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. This policy includes provisions which may waive surrender
charges under certain circumstances. The value held in the Index Account(s) of Your policy may increase or decrease in value. Policy Value and benefits based on Index Account(s) allocations are not guaranteed and will increase or decrease in part
due to the performance of the Index Account(s). While the Policy Value may be affected by an external index, the policy does not directly participate in any investments, securities or other instruments that comprise the index. 

We agree to provide annuity payments, to pay withdrawal benefits, to pay Surrender benefits, and to pay death proceeds in accordance with this policy, as
applicable. 
 This policy will be terminated upon Surrender, Involuntary Cashout and upon the payment of death proceeds. 

This policy may be applied for and issued to qualify as a tax-qualified annuity under applicable sections of the
Internal Revenue Code (IRC). 
 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 Policy Value plus any fees or charges deducted under the policy 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. 

 

			
	 

	 	 

		
	 Blake Bostwick

President
	 	 Karyn S.W. Polak

Secretary

 Individual Flexible Premium Deferred Annuity 

With Waiver of Surrender Charge Benefit 

And Any Applicable Index-Linked Interest Option(s) 

Income Payable At Annuity Commencement Date 

Non-Participating 

  
 1 

 TABLE OF CONTENTS 

 

					
		
	 Definitions
	  	 	3	 
		
	 Policy Data Pages
	  			
		
	 General Provisions
	  	 	6	 
		
	 Premium Payments
	  	 	8	 
		
	 Cash Value and Withdrawals
	  	 	9	 
		
	 Policy Value
	  	 	12	 
		
	 Accounts
	  	 	12	 
		
	 Transfers
	  	 	13	 
		
	 Death Proceeds
	  	 	13	 
		
	 Income Options
	  	 	16	 
		
	 Income Option Tables
	  	 	18	 

  
 2 

 SECTION 1 – DEFINITIONS 

Account(s) – The Allocation Account(s) and the Fixed Holding Account. 

Advisory Fee Withdrawal – If you have an advisor, asset manager or broker/dealer who manages Your policy for a fee, You may elect to have that fee
deducted from Your Policy Value and paid directly to Your advisor, asset manager or broker/dealer. 
 Allocation Account(s) – The Fixed Account,
if offered for new allocations, and the Index Account(s) to which You may allocate Premium or transfer Policy Value. 
 Allocation Date – On the
Allocation Date, the premiums held in the Fixed Holding Account will be allocated among the Allocation Account(s) according to Your instructions. 

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 Policy Anniversary on or following the day 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. 

Business Day – Any day when the New York Stock Exchange is open for regular trading. 

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

Commissioner – The primary insurance regulator for the state in which this policy has been issued. 

Company (we, us, our) – Transamerica Life Insurance Company. 

Crediting Period – The period of time following an allocation to the Allocation Account(s) in which the current rates associated with the
allocation will not change. For the Index Account(s), the period of time is also used to determine the change in the index value and the corresponding interest to be credited. 

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. 
 Decedent – The deceased Annuitant or Owner. 

Designated Beneficiary – An individual who is the surviving Owner, if any, and any individual designated as beneficiary by the Owner. 

Earnings – An amount equal to the Policy Value at the time of withdrawal or Surrender, minus the sum of all Premium Payments reduced by all prior
withdrawals deemed to have been from premium, if any. 
 Fixed Account – The account, if offered for new allocations, in which some or
all of Your Premium Payments may be allocated and any portion of Your Policy Value may be transferred. Interest on the Fixed Account will be credited daily and compounded annually, based on a fixed rate declared by us. 

Fixed Holding Account – The account in which Your Premium Payments are held until the Allocation Date. Interest on the Fixed Holding Account will
be credited daily and compounded annually, based on a rate declared by us. 
 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 to issue the policy or execute any transaction pursuant to the terms of the policy. 

  
 3 

 Guaranteed Minimum Effective Annual Interest Rate – The lowest possible credited rate the
Company may use to determine the Fixed Account and Fixed Holding Account portions of Your Policy Value prior to the Annuity Commencement Date. This rate will not change for the life of the policy and is shown in Section 2 - Policy Data. 

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. 

Index Account(s) – The account in which some or all of Your Premium Payments may be allocated and any portion of Your Policy Value
may be transferred. The Index Account value can be either increased or decreased by the performance of an Index You select. We may make one or more Index Account(s) available. The Index Account rider(s) set forth the terms of the Index Account
Option(s) including the Index Credit Rates and Index Account value calculation, and termination provisions of the Index Account rider. The Index Account(s) are a part of the Separate Account. 

Index Account Option(s) - An Index Account Option is composed of an Index, Crediting Period, Growth Opportunity and Downside Protection features. The
Index Account Option(s) You elected will be shown in Section 2-Policy Data. We may offer any combination of Index Account Option(s). We reserve the right to add or remove any index and/or Index Account
Option(s). 
 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. 

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 equal to 87.5% of premiums and transfers to the Fixed Account and Fixed Holding Account, less prior
requested withdrawals (including Advisory Fee Withdrawals) and transfers from the Fixed Account and Fixed Holding 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 equal to the Index Account portion of the Policy Value less the surrender charge attributable to the Index
Account(s). 

 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(s) or
entity who may exercise and receive all rights, privileges and benefits under the policy. 
 Payee – The person to whom annuity payments will be
made. 
 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. 

  
 4 

 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 Account(s). 

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 Policy Anniversary. 
 Premium Payment – An amount paid
to us by or on behalf of an Owner, as consideration for the benefits provided under this policy. 
 Surrender – A full withdrawal of Cash Value
and termination of this policy. 
 Separate Account – The separate investment account(s) established by us to which all or a portion of Your
Premium Payments and Policy Value may be allocated. 
 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. 
 You, Your – The Owner of
this policy. If a joint Owner is named, reference to “You” or “Your” in this policy will apply to both the Owner and any joint Owner. 

  
 5 

 SECTION 3 – GENERAL PROVISIONS 

The Contract 
 The entire contract consists of this policy
and any applications, endorsements or riders. If any portion of this contract is 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 Contract 

No change in this contract is valid unless made in writing by us and approved by one of our authorized officers and given to You for attachment to the policy.

 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 changes 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. Any such amendment will be filed with and approved by the appropriate regulatory authorities prior to use. 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, including any riders or endorsements, 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. 
 Misstatements;
Age or Sex Corrections 
 All statements made in any application for the policy or policy benefits, in the absence of fraud, are deemed representations
and not warranties. 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 11. 
 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 
 Subject to
Misstatements; Age or Sex Corrections above, this policy shall be incontestable from two years from the Policy Date. 
 Involuntary Cashout 

If, at anytime, Your 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: 
  

	 	1.	 The Fixed Account and Fixed Holding Account portions of the Minimum Required Cash Value plus the Index
Account(s) portion of the Policy Value; or 

  

	 	2.	 The Policy Value. 

Evidence of Survival 
 We have the right to reasonably
require satisfactory evidence that a person is alive if a payment is based on that person being alive. 

  
 6 

 Rights of Owner 

The Owner may, while the Annuitant is living: 
  

	 	1.	 Assign this policy with our consent; 

 

	 	2.	 Change the Owner with our consent; 

 

	 	3.	 Surrender the policy to us; 

 

	 	4.	 Amend or modify the policy with our consent; 

 

	 	5.	 Receive annuity payments or name a Payee to receive the payments; and 

 

	 	6.	 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. 

We reserve the right to refuse our consent on a non-discriminatory basis with respect to any action under the policy
that requires our consent. 
 Change of Ownership 
 You
can change the Owner of this policy from Yourself to a new Owner with our prior approval. 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 and subject to our prior
approval. 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. 

Change of Annuitant 
 Once this policy is issued,
generally, the Annuitant cannot be changed. In certain circumstances the Annuitant can be changed, such as when the policy is transferred pursuant to a divorce or when a policy is continued as permitted in Section 9. 

Assignment 
 This policy may be assigned with our prior
approval. You must send written requests, 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 and subject to our prior approval. 

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 of this policy may result in adverse tax consequences. 

Deferment 
 We may defer payments or transfers from the
policy if: 
  

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

  

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

  

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

  
 7 

 When permitted by law, we may defer (with prior authorization from the Commissioner) payment of any
withdrawals or Surrender proceeds from the policy 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 may be paid on any amount deferred for 30 days or more, based on the Index Account Option(s) selected. For amounts allocated to the Fixed Account and Fixed Holding Account, the interest rate will be the
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. 

Reports to Owner 
 We will give You a report at least once
each Policy Year. This report will show any information required by law or regulation and will be mailed to Your last known address as shown in our records or otherwise provided to You according to Your preferences. 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. 

Time Limits on Legal Actions 
 No action at law or in
equity may be brought until 60 days after we receive proof of entitlement to policy benefits. No such action may be brought more than three years after: 
  

	 	1.	 The date we receive proof of entitlement to policy benefits; or 

 

	 	2.	 The time within which proof of entitlement is required to be given; 

whichever is earlier. 
 Conformity With State
Laws 
 Any provision of the policy that, on the Policy Date, conflicts with the laws of the state in which the policy is issued, is amended to meet the
minimum requirements of such laws. 
 SECTION 4 – PREMIUM PAYMENTS 

Payment of Premiums 
 Premium Payments may be made at 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. The Company may decline any additional Premium Payments on a non-discriminatory basis. 
 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
Business Days after the Business Day we receive it and Your complete policy information in Good Order. Subsequent Premium Payments will be credited to the policy within two Business Days after the Business Day we receive the Premium Payment and
required information in Good Order. 
 Allocation of Premium Payments 

Premium Payments will be allocated from the Fixed Holding Account to the available Allocation Account(s). For any Premium Payment, You must indicate what
percentage to allocate to the Allocation Account(s). 
 Each percentage may be either zero or any whole number; however, the allocation among the Allocation
Account(s) must total 100%. 
 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 under an income option, You Surrender the policy, or death proceeds are paid. 

  
 8 

 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 Policy Value less any
surrender charges, if applicable. 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. 

There is no Cash Value once an income option (as set forth in Section 10) has been selected, all necessary instructions are received in Good Order, and
the Company has issued a supplementary contract. 
  

	B.	 WITHDRAWALS AND SURRENDERS 

You may, on or before the Annuity Commencement 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 specific Index Account Option(s) and/or the Fixed Account. If You do not specify where the withdrawal shall
be taken, the withdrawal will be taken pro rata from all Allocation Account(s) in which You are invested, excluding the Fixed Holding Account until all other Allocation Account(s) have been depleted. 

Withdrawals will reduce the amount of the death proceeds. Withdrawals and Surrenders will normally be effective as of the end of the Business Day the request
is received in Good Order. 
 You may request withdrawals in either a gross or a net amount. The gross withdrawal is the total amount which will be deducted
from Your Policy Value as a result of each withdrawal, while the net withdrawal is the amount You actually receive. The gross withdrawal may be more than Your requested withdrawal amount, if requested on a net basis, depending on whether surrender
charges apply at the time of the withdrawal. Premium taxes may also apply upon a Surrender. 
 The gross withdrawal equals the net withdrawal plus the
surrender charge on the excess withdrawal amount. 
 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 that
is subject to surrender charge would be $800. 
 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. 

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 the greater of (1) and (2), where: 
  

	 	1.	 The percentage of total Premium payments as shown in
Section 2-Policy Data, less any withdrawals taken during the current Policy Year; and 

  

	 	2.	 Earnings, plus premiums no longer subject to surrender charges. 

  
 9 

 The surrender charge-free amount available will be determined at the time of any withdrawal in each Policy
Year. Any withdrawals in that Policy Year will reduce the amount available free of surrender charges. Withdrawals taken per (1) and (2) above will reduce Your surrender charge-free amount. Surrender charges will not be assessed against Earnings
withdrawn from Your policy. Any unused portion of Your surrender charge-free amount cannot be carried forward to subsequent Policy Years. 
 Any amounts
withdrawn under Required Minimum Distribution, Nursing Care and Terminal Condition Waiver and Unemployment Waiver will reduce the amount available free of surrender charges. Surrender charges may be waived as described below. A withdrawal or
Surrender shall not prejudice the waiver of any surrender charge. 
 Required Minimum Distribution 

For tax-qualified plans and policies, withdrawals taken to satisfy required minimum distribution
requirements under Section 401(a)(9) of the IRC are available with no surrender charges. 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 applied, unless the excess
distribution qualifies as surrender charge-free under any additional options provided. 
 Advisory Fee Withdrawals cannot be used to satisfy
Your required minimum distribution requirements. 
 Nursing Care and Terminal Condition Waiver 

This benefit is not intended to provide long-term care or nursing home insurance. This benefit is not available if the Owner or Owner’s
spouse (Annuitant or Annuitant’s spouse, if the Owner is a non-natural person) has been admitted to a Hospital on the Policy Date or already resides in a Nursing Facility on the Policy Date. 

Beginning in the first Policy Year, You may elect to Surrender or withdraw a portion of the Policy Value without surrender charges 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 when other withdrawal options are
exercised. 
 For a waiver related to confinement in a Hospital or Nursing Facility, we must receive each withdrawal request (and proof of
eligibility with each request) no later than 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. 

  
 10 

 Unemployment Waiver 

Beginning in the first Policy Year, You may elect to Surrender or withdraw a portion of the Policy Value without surrender charges 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 (or Your spouse): 

 

	 	1.	 Must have been employed full-time for at least two consecutive 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. 

The minimum withdrawal under this waiver is $1,000. This option is available even during Policy Years when other withdrawal options are
exercised. 
 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 Premium Payments withdrawn from the Policy Value. 

For the purposes of calculating the surrender charge, 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).

 Minimum Values 
 Benefits available under this
policy, including any paid up annuity values, Cash Values, nonforfeiture values and death benefits, will not be less than the minimum benefits required by applicable state law. 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 applicable state 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. 

Advisory Fee Withdrawal 
 If You have an advisor, asset
manager or broker/dealer who manages Your policy for a fee, You may elect to have that Advisory Fee deducted from Your Policy Value and paid directly to Your advisor, asset manager or broker/dealer. 

An Advisory Fee Withdrawal is the Advisory Fee amount You have authorized Us to deduct from Your Policy Value and pay directly to Your advisor, asset manager
or broker/dealer on Your behalf. Advisory Fee deductions may begin after the policy’s Right to Cancel Period. 
 Any amount of Advisory Fee in excess
of the Advisory Fee Withdrawal Maximum Percentage shown in Section 2 – Policy Data is treated as a withdrawal under this Policy and is subject to all withdrawal provisions. 

  
 11 

 SECTION 6 – POLICY VALUE 

Policy Value 
 On or before the Annuity Commencement Date,
the Policy Value is equal to Your: 
  

	 	1.	 Premium Payment(s); minus 

 

	 	2.	 Gross withdrawals (withdrawal plus the surrender charge on the portion of the requested withdrawal that is
subject to the surrender charge); plus 

  

	 	3.	 Accumulated gains in the Index Account(s); minus 

 

	 	4.	 Accumulated losses in the Index Account(s); plus 

 

	 	5.	 Interest credited to the Fixed Account (if any) and Fixed Holding Account; minus 

 

	 	6.	 Service Charge, Rider fees, Advisory Fee Withdrawals and premium taxes 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 Account in proportion to the portion of Policy Value (prior to
such charge) in each Account, excluding the Fixed Holding Account until all other Accounts have been depleted. 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 – ACCOUNTS 

Separate Account 
 Premium Payments made to this contract
that are not allocated to the Fixed Account or Fixed Holding Account are invested in the Separate Account. We have exclusive and absolute ownership and control of the assets of the Separate Account and the assets of the Separate Account are subject
to liabilities arising out of other business the company may conduct. It is a non-unitized separate account. You do not share in the investment performance of assets allocated to the Separate Account. All
investment income, gains, and losses, whether or not realized, from assets allocated to the Separate Account are owned by the Company. The obligations under this Contract are independent of the investment performance of the Separate Account and are
the obligations of the Company. 
 We will maintain in the Separate Account assets with an aggregate value at least equal to the reserves and other contract
liabilities of the Separate Account. If the aggregate value of Separate Account assets should fall below such amount, the Company will transfer assets into the Separate Account so that the value of the Separate Account’s assets is at least
equal to such amount. Assets supporting reserves for annuity benefits under such contracts, in the course of payment, shall not be maintained in the Separate Account. 

Fixed Holding Account 
 Premium Payments will be held in
the Fixed Holding Account until the Allocation Date. Interest will be credited daily and compounded annually, based on a fixed rate, until the Allocation Date shown in Section 2- Policy Data. The interest
rates we declare are subject to change, but will never be less than the Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 – Policy Data. Interest will only be credited to the Fixed Holding Account up until the last
available Annuity Commencement Date shown in Section 2 - Policy Data. 
 Allocation Account(s) 

Initial or subsequent Premium Payments may be allocated to one or more of the available Allocation Account(s) noted below. Also, a portion of Your Policy Value
may be transferred to one or more of the available Allocation Account(s) noted below, subject to the transfer restrictions in section 8. An Allocation Account becomes effective on the date You initially allocate Premium Payments or transfer Policy
Value to it. 

  
 12 

	 	1.	 Fixed Account 

Interest on Premium Payments allocated to and any portion of Your Policy Value transferred to the Fixed Account will be credited daily and
compounded annually, based on a fixed rate. The interest rates we declare will be credited for a Crediting Period as shown in Section 2-Policy Data, measured from the date each Premium Payment or transfer
is allocated to the Fixed Account and will not change during that Crediting Period . Interest will only be credited to the Fixed Account up until the last available Annuity Commencement Date shown in Section 2 - Policy Data. These rates will
never be less than the Guaranteed Minimum Effective Annual Interest Rate shown in Section 2 – Policy Data. 
  

	 	2.	 Index Account(s) 

We will issue one or more riders to this Policy which make Index Account(s) available. The rider(s) set forth the terms of the Index Account
Option(s) including applicable fees, the Index Credit Rates and Index Account value computation. 
 SECTION 8 – TRANSFERS 

Transfers before the Annuity Commencement Date 
 Transfers
of Policy Value are not permitted other than at the end of a Crediting Period. At such time, Policy Value may be transferred among the Allocation Account(s). We will provide You notice prior to reaching the end of a Crediting Period. You may choose
the Allocation Account(s) You want the values transferred into by giving us instructions no later than one Business Day before the end of the Crediting Period. Your instructions must indicate the percentage to allocate to various Allocation
Account(s). Each percentage may be either zero or any whole number; however, the allocation among all Allocation Account(s) must total 100%. 
 In the
absence of such instructions, the values will be transferred into the same Index Account Option and Crediting Period as the expiring Index Account Option, unless that option is not available, in which case, the values will be transferred into the
Fixed Account. Any Index Account Option may not have a Crediting Period that extends beyond the last available Annuity Commencement Date shown in Section 2 - Policy Data, in which case the value would be transferred into the Fixed Account. 

However, if the Fixed Account is not being offered, the values will transfer into the Index Account Option with, in order of priority, the shortest Crediting
Period, the highest Downside Protection Rate and the highest Cap Rate from the Index Account Options available at the end of the Crediting Period. We will mail You a notice of completion of the transfer and will deem You to have accepted the new
option if we have not received written rejection from You within 30 days from the postmark date of the completion notice. We reserve the right, at our sole discretion, for new Premium Payments or transfers, to offer new or discontinue previously
offered Allocation Account(s), however no less than one Account will be made available. 
 SECTION 9 - DEATH PROCEEDS 

 

	A.	 BENEFICIARIES 

You may designate, or later change, a beneficiary or beneficiaries to receive amounts payable upon Your death. You must notify us of Your beneficiary
designation (or beneficiary change) in writing, on a form acceptable to us. The beneficiary designation (or beneficiary 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. Beneficiary consent to a designation or change is not required unless the beneficiary was
irrevocably designated or consent is otherwise required by law. If an irrevocable beneficiary dies, You may designate a new 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. 

  
 13 

 General Distribution Rules 

Amounts payable upon death will be paid as follows: 
  

	 	1.	 If an individual Owner is alive at the time of Decedent’s death, payment will be made to that surviving
Owner; otherwise 

  

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

  

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

  

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

  

	 	5.	 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; otherwise 

  

	 	6.	 In the event no primary or contingent beneficiaries have been named and/or all have died before the Decedent,
payment will be made to the Owner’s estate. 

 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. 
 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 Distribution Rules above. 

Protection of Proceeds 
 Unless You otherwise direct by
providing written notice to us, and subject to our consent, 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. 
  

	B.	 REQUIRED DISTRIBUTIONS WHERE OWNER DIES BEFORE THE ENTIRE DEATH PROCEEDS ARE DISTRIBUTED

 Upon the death of an Owner, any remaining death proceeds shall be distributed in accordance with IRC Section 72(s) and
underlying regulations. 
 Death before Annuity Commencement Date 

Except to the extent that an exception applies, if any Owner dies before the Annuity Commencement Date, the entire interest in the policy will be distributed
within 5 years after the death of such Owner, with the exception of: 
  

	 	1.	 Certain Amounts Payable Over Life Of Beneficiary 

If any portion of the Owner’s interest is payable to (or for the benefit of) a Designated Beneficiary, such portion will be distributed
(in accordance with IRC Section 72(s) and underlying regulations) over the life of such Designated Beneficiary (or over a period not extending beyond the life expectancy of such Designated Beneficiary), and such distributions must begin no
later than 1 year after the date of the Owner’s death. 
  

	 	2.	 Surviving Spouse who is the Designated Beneficiary 

If the Designated Beneficiary is the surviving spouse of the deceased Owner, then such spouse may elect to continue the policy as the new
Owner. The spousal continuation election is only available once per policy. 
  

	 	3.	 Owner-elected Method of Payment 

Prior to death, the Owner may elect the method of payment for a Designated Beneficiary, subject to any applicable restrictions in the Code and
subject to applicable administrative rules. 

  
 14 

 Death on or after Annuity Commencement Date 

If any Owner dies on or after the Annuity Commencement Date and before the entire interest in the policy has been distributed, the remaining portion of such
interest will be distributed at least as rapidly as under the method of distributions being used as of the Owner’s date of death. 
 Special Rule
Where Owner Is A Trust, Corporation Or Other Non-Individual 
 For purposes of this section, if the Owner is not
an individual, then 
  

	 	1.	 The death of an Annuitant shall be treated as the death of the Owner; and 

 

	 	2.	 If there is a change of Annuitant, such change shall be treated as the death of the Owner.

 Exception For Certain Annuity Contracts 

Section B. shall not apply to any annuity contract which is provided under a plan described in IRC Sections 401(a), 403(a), 403(b), 408 or 408A, an annuity
that is a qualified funding asset (as defined in Code Section 130(d), but without regard to whether there is a qualified assignment), or a trust that is exempt from tax under Code Section 501. 

 

	C.	 AMOUNT 

The amount payable upon death will be determined and made payable upon receipt, in Good Order, of satisfactory proof of death, and written directions from each
eligible recipient regarding how they wish to receive the amount payable. We reserve the right to independently verify the status of any life relevant to the policy, including verifying when or if the Owner(s) or Annuitant has died. 

Prior to Annuity Commencement Date: Death of Owner who was also the Annuitant 

Upon the death of the Owner who was also the Annuitant, 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 Fixed Account and Fixed Holding Account portions of the Minimum Required Cash Value plus the Index
Account(s) portion of the Policy Value, on the date we receive due proof and an election of method of settlement; or 

  

	 	3.	 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. 

 If elected, the Guaranteed
Minimum Death Benefit (GMDB) will establish a minimum death benefit payable under the policy. Your election, if any, is shown in Section 2 - Policy Data. 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. 

If a death benefit is payable and the policy is continued, all current surrender charges at the time of continuation will be waived. Any premium received
after the time of continuation will be subject to any applicable surrender charges. 
 In the event of simultaneous deaths of both the Owner and the
Annuitant, the death proceeds will be calculated as shown above. 
 Prior to Annuity Commencement Date: Death of Owner who was not also the
Annuitant 
 Upon the death of the Owner who was not also the Annuitant, the amount of the death benefit payable will be the Cash Value. 

 

	D.	 DEATH OF ANNUITANT WHO WAS NOT ALSO AN OWNER PRIOR TO THE ANNUITY COMMENCEMENT DATE

 Upon the death of the Annuitant who was not an Owner, and the Owner is a natural person (not a trust, corporation, or other non-individual), the Owner shall become the Annuitant. In the case of joint Owners (who are natural persons) where neither is the deceased Annuitant, the youngest Owner shall become the Annuitant. The Policy Value
will be adjusted to 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 Fixed Account and Fixed Holding Account portions of the Minimum Required Cash Value plus the Index
Account(s) portion of the Policy Value, on the date we receive due proof and an election of method of settlement; or 

  
 15 

	 	3.	 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. 

 This is a one-time only Policy Value adjustment applied at the time the Owner becomes the Annuitant. 
 DEATH ON OR AFTER THE
ANNUITY COMMENCEMENT DATE 
 In the event of a death, on or 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. 
 SECTION 10 – INCOME OPTIONS 

 

	A.	 GENERAL PAYMENT PROVISIONS 

Payment 
 You may use the Policy Value or the Fixed Account
and Fixed Holding Account portions of the Minimum Required Cash Value plus the Index Account(s) portion of the Policy Value, if greater, on the Annuity Commencement Date to purchase one or more fixed income options. 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), Life 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. 

Subject to the limitations in Section 9, 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 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

 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 and 4 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. 

  
 16 

	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 11 for the option You select. Options 1 and 3 are based on a minimum guaranteed interest rate shown in Section 11.
Options 2 and 4 are based on a minimum guaranteed interest rate shown in Section 11 and the mortality table shown in Section 11. The 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 must not be for less than 120 months and 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 must not be for less than 120 months and 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. 

Current Income Options 
 The amounts shown in the tables
in Section 11 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. 

  
 17 

 SECTION 11 - GUARANTEED FIXED INCOME OPTION TABLES* 

The amounts shown in these tables are the guaranteed amounts for each $1,000 of the policy proceeds. 

Higher current amounts may be available at the time of settlement. 
  

																							
	Option 1	  	 	  	Option 2(a)	  	Option 2(b)	  	Option 2(c)
	Number
of Years
Payable	  	Amount of
Monthly
Installment	  	 	  	Monthly Installment For
Life No Period Certain	  	Monthly Installment For
Life 10 Years Certain	  	Monthly Installment For
Life Guaranteed Return of
Policy Proceeds
	 	  	 	  	Age**	  	Male	  	Female	  	Unisex	  	Male	  	Female	  	Unisex	  	Male	  	Female	  	Unisex
		  		  	50	  	$2.22	  	$2.00	  	$2.07	  	$2.21	  	$2.00	  	$2.06	  	$1.85	  	$1.74	  	$1.78
		  		  	51	  	2.27	  	2.05	  	2.12	  	2.26	  	2.05	  	2.11	  	1.89	  	1.78	  	1.80
		  		  	52	  	2.33	  	2.10	  	2.17	  	2.32	  	2.10	  	2.17	  	1.91	  	1.80	  	1.84
		  		  	53	  	2.40	  	2.15	  	2.23	  	2.39	  	2.15	  	2.22	  	1.95	  	1.84	  	1.88
		  		  	54	  	2.46	  	2.21	  	2.29	  	2.45	  	2.21	  	2.28	  	1.99	  	1.88	  	1.91
		  		  	55	  	2.54	  	2.27	  	2.35	  	2.52	  	2.26	  	2.34	  	2.03	  	1.91	  	1.95
		  		  	56	  	2.61	  	2.33	  	2.42	  	2.59	  	2.33	  	2.41	  	2.07	  	1.95	  	1.99
		  		  	57	  	2.69	  	2.40	  	2.49	  	2.67	  	2.39	  	2.48	  	2.13	  	1.99	  	2.03
		  		  	58	  	2.77	  	2.47	  	2.56	  	2.75	  	2.46	  	2.55	  	2.17	  	2.03	  	2.07
	10	  	8.44	  	59	  	2.86	  	2.54	  	2.64	  	2.83	  	2.53	  	2.62	  	2.21	  	2.07	  	2.13
	11	  	7.68	  	60	  	2.95	  	2.62	  	2.72	  	2.92	  	2.61	  	2.70	  	2.26	  	2.13	  	2.17
	12	  	7.05	  	61	  	3.05	  	2.70	  	2.81	  	3.02	  	2.69	  	2.79	  	2.32	  	2.17	  	2.21
	13	  	6.51	  	62	  	3.16	  	2.79	  	2.90	  	3.11	  	2.77	  	2.88	  	2.38	  	2.22	  	2.26
	14	  	6.06	  	63	  	3.27	  	2.88	  	3.00	  	3.22	  	2.86	  	2.97	  	2.44	  	2.28	  	2.33
	15	  	5.66	  	64	  	3.39	  	2.98	  	3.10	  	3.33	  	2.95	  	3.07	  	2.49	  	2.34	  	2.39
	16	  	5.31	  	65	  	3.51	  	3.09	  	3.21	  	3.45	  	3.05	  	3.17	  	2.55	  	2.39	  	2.43
	17	  	5.01	  	66	  	3.65	  	3.20	  	3.33	  	3.57	  	3.16	  	3.28	  	2.61	  	2.44	  	2.49
	18	  	4.73	  	67	  	3.79	  	3.32	  	3.46	  	3.70	  	3.27	  	3.40	  	2.69	  	2.50	  	2.55
	19	  	4.49	  	68	  	3.95	  	3.44	  	3.59	  	3.83	  	3.39	  	3.53	  	2.75	  	2.57	  	2.64
	20	  	4.27	  	69	  	4.11	  	3.58	  	3.74	  	3.97	  	3.52	  	3.66	  	2.82	  	2.64	  	2.69
		  		  	70	  	4.29	  	3.73	  	3.89	  	4.12	  	3.65	  	3.79	  	2.90	  	2.72	  	2.77
		  		  	71	  	4.47	  	3.89	  	4.06	  	4.27	  	3.80	  	3.94	  	3.00	  	2.79	  	2.84
		  		  	72	  	4.67	  	4.06	  	4.24	  	4.43	  	3.95	  	4.09	  	3.08	  	2.86	  	2.93
		  		  	73	  	4.88	  	4.24	  	4.43	  	4.59	  	4.11	  	4.25	  	3.15	  	2.94	  	3.02
		  		  	74	  	5.10	  	4.44	  	4.64	  	4.76	  	4.27	  	4.42	  	3.25	  	3.06	  	3.12
		  		  	75	  	5.34	  	4.65	  	4.86	  	4.94	  	4.45	  	4.60	  	3.35	  	3.13	  	3.20
		  		  	76	  	5.60	  	4.88	  	5.09	  	5.12	  	4.63	  	4.78	  	3.46	  	3.21	  	3.30
		  		  	77	  	5.88	  	5.13	  	5.35	  	5.31	  	4.82	  	4.97	  	3.60	  	3.35	  	3.41
		  		  	78	  	6.17	  	5.40	  	5.63	  	5.50	  	5.02	  	5.17	  	3.66	  	3.44	  	3.51
		  		  	79	  	6.49	  	5.69	  	5.92	  	5.69	  	5.22	  	5.37	  	3.81	  	3.53	  	3.62
		  		  	80	  	6.82	  	6.00	  	6.24	  	5.88	  	5.43	  	5.57	  	3.89	  	3.68	  	3.74
		  		  	81	  	7.19	  	6.34	  	6.59	  	6.08	  	5.65	  	5.78	  	4.06	  	3.81	  	3.87
		  		  	82	  	7.58	  	6.70	  	6.96	  	6.27	  	5.86	  	5.99	  	4.20	  	3.89	  	4.00
		  		  	83	  	7.99	  	7.10	  	7.36	  	6.46	  	6.08	  	6.20	  	4.34	  	4.09	  	4.16
		  		  	84	  	8.44	  	7.53	  	7.80	  	6.65	  	6.29	  	6.40	  	4.50	  	4.23	  	4.32
		  		  	85	  	8.92	  	7.99	  	8.27	  	6.83	  	6.49	  	6.60	  	4.70	  	4.40	  	4.49
		  		  	86	  		  		  		  	7.00	  	6.69	  	6.79	  	4.89	  	4.54	  	4.74
		  		  	87	  		  		  		  	7.17	  	6.88	  	6.97	  	5.11	  	4.71	  	4.84
		  		  	88	  		  		  		  	7.32	  	7.06	  	7.14	  	5.28	  	4.90	  	5.08
		  		  	89	  		  		  		  	7.47	  	7.23	  	7.31	  	5.53	  	5.19	  	5.27
		  		  	90	  		  		  		  	7.60	  	7.39	  	7.46	  	5.73	  	5.39	  	5.48
		  		  	91	  		  		  		  	7.73	  	7.53	  	7.59	  	5.88	  	5.63	  	5.79
		  		  	92	  		  		  		  	7.84	  	7.66	  	7.72	  	6.17	  	5.78	  	5.97
		  		  	93	  		  		  		  	7.95	  	7.79	  	7.84	  	6.44	  	6.02	  	6.17
		  		  	94	  		  		  		  	8.04	  	7.90	  	7.94	  	6.79	  	6.46	  	6.52
		  		  	95	  		  		  		  	8.12	  	8.00	  	8.04	  	7.13	  	6.73	  	6.83
		  		  	96	  		  		  		  	8.20	  	8.09	  	8.13	  	7.40	  	6.89	  	7.17
		  		  	97	  		  		  		  	8.26	  	8.17	  	8.20	  	7.91	  	7.53	  	7.66
		  		  	98	  		  		  		  	8.31	  	8.24	  	8.27	  	8.19	  	7.84	  	7.75
		  		  	99	  		  		  		  	8.35	  	8.30	  	8.32	  	8.82	  	8.18	  	8.57

  

	*	 Guaranteed fixed income options 1 and 3 are based on the minimum guaranteed interest rate of 0.25%. Guaranteed
fixed income options 2 and 4 are based on the minimum 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. 

	**	 Adjusted Age as defined in Section 10.A. 

Dollar amounts of monthly, quarterly, semi-annual and annual installments not shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company (if the option is available based on Adjusted Age as described in Section 10). 

  
 18 

 Option 4(a) 

Monthly Installment For Joint and Survivor* 
  

															
	 Adjusted Age
of

Male
Annuitant**
	 	 Adjusted Age of Female Annuitant**

	 	 15 Years
Less Than
Male
	 	 12 Years
Less Than
Male
	  	 9 Years
Less Than
Male
	  	 6 Years
Less Than
Male
	  	 3 Years
Less Than
Male
	  	 Same As
Male
	  	 3 Years
More Than
Male

	 50
	 	 $1.45
	 	 $1.51
	  	 $1.58
	  	$1.66	  	$1.73	  	$1.80	  	$1.87
	 55
	 	 1.58
	 	 1.66
	  	 1.75
	  	1.84	  	1.93	  	2.02	  	2.10
	 60
	 	 1.75
	 	 1.85
	  	 1.95
	  	2.07	  	2.18	  	2.29	  	2.41
	 65
	 	 1.95
	 	 2.08
	  	 2.21
	  	2.36	  	2.51	  	2.66	  	2.81
	 70
	 	 2.21
	 	 2.37
	  	 2.55
	  	2.74	  	2.94	  	3.15	  	3.35
	 75
	 	 2.54
	 	 2.76
	  	 3.00
	  	3.26	  	3.54	  	3.83	  	4.11
	 80
	 	 2.99
	 	 3.29
	  	 3.62
	  	3.99	  	4.39	  	4.79	  	5.18
	 85
	 	 3.60
	 	 4.02
	  	 4.50
	  	5.03	  	5.59	  	6.17	  	6.71

 Monthly Installment For Unisex Joint and Survivor* 

 

															
	 Adjusted Age
of

First
Annuitant**
	 	 Adjusted Age of Joint Annuitant**

	 	 15 Years
Less Than
First
	  	 12 Years
Less Than
First
	  	 9 Years
Less Than
First
	  	 6 Years
Less Than
First
	  	 3 Years
Less Than
First
	  	 Same As
First
	  	 3 Years
More Than
First

	 50
	 	 $1.47
	  	$1.53	  	$1.60	  	$1.66	  	$1.72	  	$1.78	  	$1.84
	 55
	 	 1.61
	  	1.68	  	1.76	  	1.84	  	1.92	  	2.00	  	2.06
	 60
	 	 1.78
	  	1.87	  	1.97	  	2.07	  	2.17	  	2.27	  	2.36
	 65
	 	 1.99
	  	2.11	  	2.24	  	2.37	  	2.50	  	2.62	  	2.74
	 70
	 	 2.26
	  	2.41	  	2.58	  	2.76	  	2.93	  	3.11	  	3.27
	 75
	 	 2.60
	  	2.81	  	3.04	  	3.28	  	3.53	  	3.77	  	4.00
	 80
	 	 3.07
	  	3.36	  	3.68	  	4.02	  	4.37	  	4.71	  	5.04
	 85
	 	 3.71
	  	4.12	  	4.58	  	5.07	  	5.57	  	6.07	  	6.54

  

	*	 Guaranteed fixed income options 1 and 3 are based on the minimum guaranteed interest rate of 0.25%. Guaranteed
fixed income options 2 and 4 are based on the minimum 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. 

	**	 Adjusted Age as defined in Section 10.A. 

Dollar amounts of monthly, quarterly, semi-annual and annual installments for gender combinations not shown in the above tables will be calculated on the same
basis as those shown and may be obtained from the Company (if the option is available based on Adjusted Age as described in Section 10). 

  
 19 

 Option 4(b) 

Monthly Installment For Joint and Survivor (Life with 10 year Certain)* 

 

															
	 Adjusted Age
of

Male
Annuitant**
	 	 Adjusted Age of Female Annuitant**

	 	 15 Years
Less Than
Male
	  	 12 Years
Less Than
Male
	  	 9 Years
Less Than
Male
	  	 6 Years
Less Than
Male
	  	 3 Years
Less Than
Male
	  	 Same As
Male
	  	 3 Years
More Than
Male

	 50
	 	 $1.45
	  	$1.51	  	$1.58	  	$1.66	  	$1.73	  	$1.80	  	$1.87
	 55
	 	 1.58
	  	1.66	  	1.75	  	1.84	  	1.93	  	2.02	  	2.10
	 60
	 	 1.75
	  	1.85	  	1.95	  	2.07	  	2.18	  	2.29	  	2.41
	 65
	 	 1.95
	  	2.08	  	2.21	  	2.36	  	2.51	  	2.66	  	2.80
	 70
	 	 2.21
	  	2.37	  	2.55	  	2.74	  	2.94	  	3.14	  	3.34
	 75
	 	 2.54
	  	2.76	  	3.00	  	3.25	  	3.53	  	3.80	  	4.07
	 80
	 	 2.98
	  	3.27	  	3.60	  	3.95	  	4.32	  	4.68	  	5.02
	 85
	 	 3.58
	  	3.97	  	4.41	  	4.88	  	5.34	  	5.76	  	6.11

 Monthly Installment For Unisex Joint and Survivor (Life with 10 year Certain)* 

 

															
	 Adjusted Age
of

First
Annuitant**
	 	 Adjusted Age of Joint Annuitant**

	 	 15 Years
Less Than
First
	 	 12 Years
Less Than
First
	  	 9 Years
Less Than
First
	  	 6 Years
Less Than
First
	  	 3 Years
Less Than
First
	  	 Same As
First
	  	 3 Years
More Than
First

	 50
	 	 $1.47
	 	 $1.53
	  	$1.60	  	$1.66	  	$1.72	  	$1.78	  	$1.84
	 55
	 	 1.61
	 	 1.68
	  	1.76	  	1.84	  	1.92	  	2.00	  	2.06
	 60
	 	 1.78
	 	 1.87
	  	1.97	  	2.07	  	2.17	  	2.27	  	2.36
	 65
	 	 1.99
	 	 2.11
	  	2.24	  	2.37	  	2.50	  	2.62	  	2.74
	 70
	 	 2.25
	 	 2.41
	  	2.58	  	2.75	  	2.93	  	3.10	  	3.26
	 75
	 	 2.60
	 	 2.81
	  	3.04	  	3.27	  	3.52	  	3.75	  	3.96
	 80
	 	 3.06
	 	 3.35
	  	3.66	  	3.98	  	4.31	  	4.62	  	4.90
	 85
	 	 3.68
	 	 4.06
	  	4.48	  	4.91	  	5.33	  	5.70	  	6.00

  

	*	 Guaranteed fixed income options 1 and 3 are based on the minimum guaranteed interest rate of 0.25%. Guaranteed
fixed income options 2 and 4 are based on the minimum 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. 

	**	 Adjusted Age as defined in Section 10.A. 

Dollar amounts of monthly, quarterly, semi-annual and annual installments not shown in the above tables will be calculated on the same basis as those shown
and may be obtained from the Company (if the option is available based on Adjusted Age as described in Section 10). 

  
 20 

 Transamerica Life Insurance Company 

Cedar Rapids, IA 
 Contact us at
6400 C Street SW, Cedar Rapids, IA 52499 
 (800) 525-6205 

www.transamerica.com 

  
 21

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