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 BRIGHTHOUSE LIFE INSURANCE COMPANY OF NY 

(A Stock Company) 
 285 Madison Avenue 

New York, NY 10017 
 NOTICE 

To obtain information about your policy or if you need assistance or need help in resolving a complaint, you may call (800)-638-7732. 

Brighthouse Life Insurance Company of NY (referred to as “we”, “us”, “our”, and the “Company”) will make
Income Payments as described in this Contract beginning on the Annuity Date. 
 This Policy is a legal contract between the policyholder and the
Company. 
 FREE LOOK PROVISION - RIGHT TO CANCEL 
 This
Contract may be returned for any reason within 10 days after you receive it by mailing or delivering the Contract to either us or the agent who sold it. Return of this Contract by mail is effective on being postmarked, properly addressed and postage
prepaid. We will promptly refund your Account Value plus the sum of all fees, taxes, and charges deducted from the Purchase Payment as of the effective date of the Free Look on the Business Day we receive your Contract. Your Account Value may be
more or less than your Purchase Payment. 
 Signed for the Company. 
  

			
	

	  	

		
	 Secretary
	  	President

 INDIVIDUAL SINGLE PREMIUM DEFERRED INDEX-LINKED SEPARATE ACCOUNT ANNUITY CONTRACT 

This Contract contains Shield Options and a Fixed Account. The initial interest rate for the Fixed Account is guaranteed for one year. 

NONPARTICIPATING 
 READ YOUR CONTRACT
CAREFULLY. 
 VALUES AND DETERMINATION OF ANNUITY PAYMENTS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE VALUE OF THE SHIELD OPTION(S) SUBJECT
TO THE SHIELD RATE AND THE CAP OR STEP RATE, ARE VARIABLE, MAY INCREASE OR DECREASE, BASED ON WHETHER THE INDEX PERFORMANCE IS POSITIVE, NEGATIVE, OR EQUAL TO ZERO, AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. INVESTMENT IN THE CONTRACT
INVOLVES INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF PRINCIPAL. 
 We reserve the right with 30 days advance written notice to restrict
transfers and allocations into the Fixed Account during the Transfer Period if the declared interest rate that would apply equals the Minimum Guaranteed Interest Rate and the Company is unable to support the Minimum Guaranteed Interest Rate. We will
notify you if these restrictions on transfers and allocations are subsequently lifted. 

  

					
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 TABLE OF CONTENTS 

 

			
	 	  	PAGE
		
	 CONTRACT SCHEDULE
	  	3
		
	 DEFINITIONS
	  	4
		
	 GENERAL PROVISIONS
	  	5
		
	 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
	  	6
		
	 BENEFICIARY PROVISIONS
	  	7
		
	 PURCHASE PAYMENT PROVISIONS
	  	7
		
	 RENEWAL PROVISIONS
	  	8
		
	 ACCOUNT VALUE PROVISIONS
	  	8
		
	 WITHDRAWAL PROVISIONS
	  	10
		
	 DEATH BENEFIT PROVISIONS
	  	11
		
	 ANNUITY PROVISIONS
	  	12

  

					
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 DEFINITIONS 

Account Value 
 Is the total of the value of the Shield
Option(s) under this Contract, adjusted for any amounts that may be included by rider during the Accumulation Period. Also referred to as “Contract Value.” 

Accumulation Period 
 The period prior to the Annuity Date. 

Annuity Service Office 
 The office indicated on the Contract
Schedule to which notices and requests must be sent, or as otherwise changed by notice from us. 
 Annuitant 

The natural person listed on the Contract Schedule on whose life Income Payments are based. Any reference to Annuitant shall also include any Joint
Annuitant under an Annuity Option. 
 Annuity Date 
 A date
on which you choose to begin receiving Income Payments. If we agree, you may change the Annuity Date subject to the requirements shown under the Annuity Option Information section on the Contract Schedule. If you do not choose an Annuity Date, the
Annuity Date will be the Annuity Date described on the Contract Schedule. Also referred to as “Maturity Date.” 
 Attained Age 

The age of any Owner, Beneficiary or Annuitant on his/her last birthday. 

Beneficiary 
 The person(s) or entity(ies) you name to receive
a death benefit payable under this Contract upon the death of the Owner or a Joint Owner, or in certain circumstances, an Annuitant. 
 Business Day 

Any day our Annuity Service Office, shown on the Contract Schedule, is open for business. For purposes of administrative requests and transactions, a
Business Day ends at 4:00PM Eastern Standard Time. 
 Code 
 The Internal
Revenue Code of 1986, as amended. 
 Company 
 Brighthouse Life Insurance
Company of NY. 
 Contract Anniversary 
 An anniversary of the Issue Date of
this Contract. 
 Contract Year 
 A one-year period starting on the Issue
Date and on each Contract Anniversary thereafter. 
 Income Payments 
 A
series of payments made by us during an Income Period, which we guarantee as to dollar amount. 
 Income Period 

A period starting on an Annuity Date during which Income Payments are payable. 

Investment Amount 
 The Investment Amount for each Shield
Option is the amount that is allocated to the Shield Option. The Investment Amount will be reduced for any withdrawal by the same percentage that the withdrawal reduces the Interim Value attributable to that Shield Option. The Investment Amount is
adjusted by the Performance Rate at the end of the Term. 
 Issue Date 
 The
date this Contract was issued. The Issue Date is shown on the Contract Schedule. 

  

					
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 Joint Owner 
 If there is more
than one Owner, each Owner shall be a Joint Owner of the Contract. 
 Notice 

Any form of communication providing information we need, either in a signed writing or another manner that we approve in advance. All Notices to us must
be sent to our Annuity Service Office and received in good order. To be effective for a Business Day, a Notice must be received in good order prior to the end of that Business Day. 

Owner 
 The person(s) entitled to the ownership rights under
this Contract. If Joint Owners are named, all references to Owner shall mean Joint Owners. (Referred to as “you”, “yours” or “policyholder.”) 

Purchase Payment 
 The amount paid to us under this Contract as consideration
for the benefits it provides. 
 Shield Option 
 This is an
investment option offered in this product. The option shields the client from a specified amount of investment losses. Each Shield Option has an associated Index, Term, Shield Rate, and either a Cap Rate or Step Rate. For example, a Shield 10
represents an investment option where if the contract holder holds the investment until the end of the Term, the Company will cover the first 10% of any losses. 

GENERAL PROVISIONS 
 The
Contract 
 The Contract consists of this contract and any attached riders or endorsements. We may require this Contract to be returned to us prior
to the payment of any benefit. It is important to review any riders or endorsements. In case of conflict with any other provision of this Contract, the provisions of the Rider or Endorsement will control. 

Non-Participating 
 This Contract will not share in any distribution by us of
Company dividends. 
 Misstatement of Age or Sex 
 We may
require proof of the age or sex of the Annuitant, Owner and/or Beneficiary before making any payments under this Contract that are measured by the Annuitant’s, Owner’s or Beneficiary’s life. If the age or sex of the Annuitant, Owner
or Beneficiary has been misstated, the amount payable will be the amount that the Account Value would have provided at the correct age and sex. 
 Once
Income Payments have begun, the amount of any overpayments or underpayments, with interest at 6% per annum, will be, as appropriate, deducted from or added to the payment or payments made after the adjustment. 

Reports 
 At least once each calendar year we will furnish you
with a report showing the Account Value and any other information as may be required by law. The Report shall provide current information as of a date not more than four months prior to the date of mailing. We will send you confirmations of certain
transactions, the beginning and end dates of the current Report period, the Account Value, if any, at the beginning of the current Report period and at the end of the current Report period, the Withdrawal Value, if any, at the end of the current
Report period, the amounts that have been credited and debited to the Account Value such as Purchase Payment, partial withdrawals, and any applicable Withdrawal Charges and any additional benefit values, if any at the end of the current Report
period, added by Rider to this Contract. Reports and confirmations will be sent to your last known address on our records. 
 Premium and Other Taxes 

Any taxes paid by us to any governmental entity relating to this Contract will be deducted from the Purchase Payments or Account Value when incurred. We
will, at our sole discretion, determine when taxes relate to the Contract, including when they have resulted from: the investment experience of the Separate Account; receipt by us of the Purchase Payments; or commencement of Annuity Payments. We
may, at our sole discretion, pay taxes when due and deduct that amount from the Account Value at a later date. Payment at an earlier date does not waive any right we may have to deduct amounts at a later date. We will deduct any withholding taxes
required by applicable law. 
 Evidence of Survival 
 We may
require proof that any person(s) on whose life Income Payments are based is alive. We reserve the right to discontinue Income Payments until satisfactory proof is received. 

  

					
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 Modification of Contract 

This Contract may be changed by us in order to maintain compliance with applicable state and federal law. This Contract may be changed or altered only in
writing signed by our President, Vice-President, or Secretary. 
 Notwithstanding any provision of this Contract to the contrary, this Contract will
be construed and administered in accordance with applicable sections of the Code. To preserve this Contract’s status as an annuity and comply with applicable sections of the Code and applicable Treasury Regulations, we may, if necessary amend
this Contract. We will notify you of any amendments and, when required by law, we will obtain your approval and the approval of the New York Department of Financial Services. 

Incontestability 
 We will not contest this contract from the Issue Date. 

Deferral of Payments 
 After receipt of a Notice of withdrawal
from you, we reserve the right to defer payment for a withdrawal for the period permitted by law, but not for more than six (6) months. 
 Interest of Delayed
Payments 
 We will pay interest on any payments of death benefits from the date of death. We will also pay interest on withdrawals paid ten
Business Days or later after receipt by us of any Notice to complete the transactions. Interest, in either instance, will be paid in accordance with laws and regulations in effect in the state of New York. 

Suspension of Payments or Transfers 
 We may be required to
suspend or delay the payment ofwithdrawals, and transfers when we cannot obtain an Index Value under the following circumstances: 
  

	 	•	 	the New York Stock Exchange is closed (other than customary weekend and holiday closings); 

  

	 	•	 	trading on the New York Stock Exchange is restricted; 

  

	 	•	 	an emergency exists such that we cannot value Investment Amounts; or 

  

	 	•	 	during any other period when a regulator by order, so permits. 

ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 

Owner 
 You, as the Owner, have all the interest and rights
under this Contract. The Owner is the person named as such on the Issue Date, unless changed. 
 You may change the Owner at any time. Any change of
Owner request may be refused in a non-discriminatory manner in order to comply with any applicable laws, rules or regulations in effect at the time of the request. A change of Owner will automatically revoke any prior named Owner. A request for
change must be: 
  

	 	1.	by Notice; and 

  

	 	2.	received by us at the Annuity Service Office. 

 The change will become effective as of the date the Notice
is signed by you. Naming a new Owner will not apply to any payment made or action taken by us prior to the time the new naming was received at our Annuity Service Office. 

Joint Owner 
 A Contract may be owned by Joint Owners, both of
whom must be natural persons. Either Joint Owner can exercise all rights under the Contract unless you inform us otherwise or in a Notice to us. Upon the death of either Owner, the surviving Joint Owner will be deemed to be the primary Beneficiary
unless you inform us otherwise. Any other Beneficiary naming will be treated as a contingent Beneficiary unless otherwise indicated on the Contract Schedule or in a Notice to us. 

Annuitant 
 The Annuitant is the person on whose life Annuity
Payments are based. The Annuitant is the person named by you as of the Issue Date, unless changed prior to the Annuity Date. The Annuitant may not be changed in a Contract which is owned by a non-natural person. Any change of Annuitant is subject to
the specified maximum age in effect at the time of the request. 

  

					
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 Assignment 
 You
may assign your rights under this Contract unless restricted by the Internal Revenue Code or other applicable law. For example, in certain tax markets assignment of this Contract is prohibited by the Internal Revenue Code. If your contract is
assigned absolutely, we will treat it as a change of ownership and all rights will be transferred. We are not bound by any assignment unless it is in writing and until it is received at our Annuity Service Office. We are not responsible for the
validity of any assignment. Assignments will be effective as of the date the written notice of assignment was signed subject to all payments made and actions taken by us before a copy of the signed assignment form is received by us at our Annuity
Service Office. 
 BENEFICIARY PROVISIONS 

Beneficiary 
 The Beneficiary is the person(s) outlined on the
Contract Schedule or the surviving Joint Owner, unless changed. Unless you provide otherwise, the death benefit will be paid to or in equal shares as follows: 
  

	 	1.	to the primary Beneficiary(ies) who survive you (or who survive the Annuitant if the Owner is a non-natural person); or if there are none, then 

 

	 	2.	to the contingent Beneficiary(ies) who survive you (or who survive the Annuitant if the Owner is a non-natural person); or if there are none, then 

 

	 	3.	to your estate. 

 Change of Beneficiary 

Subject to the rights, including the written consent, of any irrevocable Beneficiary and any applicable laws or regulations, you may change the primary
Beneficiary or contingent Beneficiary. A change may be made by filing a Notice with us. The change will take effect as of the date the Notice is signed, but we will not be liable for any payment made or action taken before we have received the
Notice. 
 PURCHASE PAYMENT PROVISIONS 

Separate Account 
 The Purchase Payment made to this Contract
is invested in the Separate Account shown on the Contract Schedule. We have exclusive and absolute ownership and control of the assets of the Separate Account. 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 borne 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 for all contracts issued on the Separate Account. 
 If the aggregate value of such 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. 
 Shield Options 

On the Issue Date, you may allocate your Purchase Payment to one or more of the available Shield Options listed on the Contract Schedule. At the end of
each Term, you may transfer the Account Value attributable to the Shield Option(s) to one or more of the available Shield Options subject to the Transfer Requirements and Minimum Allocation shown on the Contract Schedule and the Renewal Provisions.

 Each Shield Option has an associated Index, Term, Shield Rate, and either a Cap Rate or a Step Rate as defined below. 

Term 
 The initial Term(s) begin on the Issue Date. A Term
ends and a subsequent Term begins, on the Contract Anniversary coinciding with the term duration of the then current Term for that Shield Option. 
 Index 

There is a specific Index associated with each Shield Option. The Index is the price index of certain securities, excluding dividends, or commodities.

  

					
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 Index Value 
 The
Index Value of an Index, on a Business Day, is the published closing value of the Index on that Business Day. We will use consistent sources to obtain Index Values. If these sources are no longer available for specific indices, we will select an
alternative published source(s) for these Index Values. The Index Value on any day that is not a Business Day is the value as of the prior Business Day. 
 Index
Performance 
 Index Performance is the percentage change in an Index Value measured from the beginning of a Term to any day, including the last
day, within the Term. Index Performance can be positive, negative, or zero. 
 Shield Rate 

The Shield Rate is the amount of any negative Index Performance that is absorbed by us at the end of the Term. Any negative Index Performance beyond the
Shield Rate will reduce the Investment Amount. For example, a -15% Index Performance with a 10% Shield Rate will result in a -5% Performance Rate; or, a -10% Index Performance with a 25% Shield Rate will result in a 0% Performance Rate. 

The Shield Rate may vary between Shield Options, and it is not an annual rate. 

Cap Rate 
 The Cap Rate is the maximum rate that may be
credited at the end of a Term based on Index Performance. A new Cap Rate is declared for each subsequent Term, and such rate will not be less than the Minimum Guaranteed Cap Rate on the Contract Schedule. 

The Cap Rate may vary between Shield Options, and it is not an annual rate. 
 Step
Rate 
 The Step Rate is the rate credited at the end of a Term if the Index Performance is greater than or equal to zero. A new Step Rate is
declared for each subsequent Term, and such rate will not be less than the Minimum Guaranteed Step Rate on the Contract Schedule. 
 The Step Rate may vary between
Shield Options, and it is not an annual rate. 
 RENEWAL PROVISIONS 

For renewals into the same Shield Option, a new Cap Rate or Step Rate, whichever is applicable, will be declared and will go into effect on the Contract
Anniversary that coincides with the beginning of the new Shield Option. 
 Discontinuation or Substantial Change to an Index 

If any Index is discontinued or, we determine that our use of such Index should be discontinued, or if the calculation of an Index is substantially
changed, we may substitute a comparable index. We will send you 30 days advance written notice if we determine that such Index should be discontinued and reasonable written Notice should the Index be discontinued by the Index provider. Upon
substitution of an Index, we will calculate your Index Performance on the existing Index up until the date of substitution and the new Index from the date of substitution to the end of the Term. A substitute Index will not change the Shield Rate,
Cap Rate or Step Rate for an existing Shield Option. 
 Addition or Discontinuance of a Shield Option 

We can add or discontinue any Shield Option. When a change is made to the Shield Options or Indices referenced on the Contract Schedule or as changed
subsequent to the Issue Date, we will send notification to you which will describe any changes to the Shield Options then available under the Contract as required by law. This change will take effect upon your Contract as of the next Contract
Anniversary for any allowable transfers into the Shield Option(s). If you are currently invested in a Shield Option which is no longer available, you will remain in that Shield Option until the end of the Term, but that Shield Option will not be
available thereafter. At least one Shield Option will be available at all times. 
 ACCOUNT VALUE PROVISIONS 

The Account Value attributable to each Shield Option is as determined below and will be the Interim Value on any day during the Term and the Investment
Amount as adjusted for the Performance Rate at the end of the Term as defined below. 
 Performance Rate 

The Performance Rate is the rate credited at the end of the Term. The Performance Rate at the end of a particular Term is the Index Performance, adjusted
for the applicable Shield Rate, Cap Rate, or Step Rate. The Performance Rate can be positive, negative, or equal to zero. At the end of the Term, any increase or reduction in a particular Shield Option is

  

					
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determined by multiplying the Performance Rate by the Investment Amount of the Shield Option on the last day of the Term. 

The Performance Rate is determined as follows: 
 Shield Options with a Cap Rate:

 If Index Performance is equal to or less than zero, then the Performance Rate will equal the lesser of zero, or the Index Performance increased
by the Shield Rate. (For example: a -15% Index Performance with a 10% Shield Rate will result in a -5% Performance Rate.) The Performance Rate can never be greater than zero if the Index Performance is negative. 

If Index Performance is greater than zero and less than the Cap Rate, then the Performance Rate will equal the Index Performance. 

If Index Performance is greater than zero and equals or exceeds the Cap Rate, then the Performance Rate will equal the Cap Rate. 

Shield Options with a Step Rate: 
 If Index Performance is less
than zero, then the Performance Rate will equal the lesser of zero or the Index Performance increased by the Shield Rate. (For example: a -15%Index Performance with a 10% Shield Rate will result in a -5% Performance Rate.) The Performance Rate can
never be greater than zero if the Index Performance is negative. 
 If Index Performance is equal to or greater than zero, the Performance Rate will equal the Step
Rate. 
 Interim Value 
 The Interim Value for each Shield
Option is the value we assign on any Business Day prior to the end of the Term. During the Transfer Period set forth in the Contract Schedule, the Interim Value of each Shield Option will equal the Investment Amount in that Shield Option. After the
Transfer Period, the Interim Value of that Shield Option is equal to the Investment Amount in the Shield Option, adjusted for the Index Performance of the associated Index and subject to the applicable Accrued Shield Rate, Accrued Cap Rate, or
Accrued Step Rate, as defined below. 
 On the date of a withdrawal from the Shield Option(s), your Interim Value will be reduced by the amount withdrawn. 

Accrued Shield Rate 
 The Accrued Shield Rate is the portion
of the Shield Rate that has accrued from the beginning of a Term to any day within the Term. This is the amount that will be applied in calculating the Interim Value on any day prior to the end of the Term if Index Performance is less than zero. The
Accrued Shield Rate is equal to the Shield Rate multiplied by the number of days elapsed since the beginning of the Term, divided by the total number of days in the Term. 

Accrued Cap Rate 
 The Accrued Cap Rate is the portion of the
Cap Rate that has accrued from the beginning of a Term to any day within the Term. This is the maximum Index Performance that may be applied in calculating the Interim Value on any day prior to the end of the Term if Index Performance is greater
than zero. The Accrued Cap Rate is equal to the Cap Rate multiplied by the number of days elapsed since the beginning of the Term, divided by the total number of days in the Term. 

Accrued Step Rate 
 The Accrued Step Rate is the portion of
the Step Rate that has accrued from the beginning of a Term to any day within the Term. This is the rate that will be applied in calculating the Interim Value on any day prior to the end of the Term if Index Performance is equal to or greater than
zero. The Accrued Step Rate is equal to the Step Rate multiplied by the number of days elapsed since the beginning of the Term divided by the total number of days in the Term. 

Performance Rate for Determination of Interim Value 
 Except
as indicated in the Interim Value section above, the Performance Rate during a particular Term is the Index Performance, adjusted for the applicable Accrued Shield Rate, Accrued Cap Rate, or Accrued Step Rate. 

For purposes of determining the Accrued Shield Rate, Accrued Cap Rate, and Accrued Step Rate, the total number of days in each calendar year of a Term is
365. 
 The following are hypothetical examples that show the determination of the Interim Value when the Index Performance is greater than zero and
less than zero. These hypothetical examples are rounded for illustrative purposes: 

  

					
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 Example #1 – Index Performance is positive – Interim Value calculated 306 days into a Term of 3 Years.

  

			
		
	Issue Date	  	March 1, 2013
		
	Investment Amount	  	$100,000
		
	Shield Option	  	XYZ 10
		
	Term	  	3 Years
		
	Shield Rate	  	10%
		
	Cap Rate	  	25%
		
	Index Value at Beginning of Term	  	1000
		
	Number of Days in Term	  	1095  (3 X 365 = 1095)
		
	Index Value at close of Business Day on January 1, 2014	  	1100
		
	Index Performance	  	10%
		
	Accrued Days	  	306

 The Accrued Cap Rate as of January 1, 2014 is 6.986% 306 days
into the 3 year term (25%*(306/1095)). The Index Performance is calculated at 10% (1100/1000 - 1). Since the Index Performance is positive, the Interim Value is then determined by multiplying the Investment Amount by the lesser of the Index
Performance or the Accrued Cap Rate and adding that amount to the Investment Amount. As of the close of the Business Day January 1, 2014, the Interim Value is $106,986 ($100,000+$100,000 * 6.986%). 

Example #2 – Index Performance is negative– Interim Value calculated 306 days into a Term of 3 Years. 

 

			
		
	Issue Date	  	March 1, 2013
		
	Investment Amount	  	$100,000
		
	Shield Option	  	XYZ 10
		
	Term	  	3 Years
		
	Shield Rate	  	10%
		
	Cap Rate	  	25%
		
	Index Value at Beginning of Term	  	1000
		
	Number of Days in Term	  	1095  (3 X 365 = 1095)
		
	Index Value at close of Business Day on January 1, 2014	  	950
		
	Index Performance	  	-5%
		
	Accrued Days	  	306

 The Accrued Shield Rate as of January 1, 2014 is 2.795% 306
days into the 3 year term (10% * (306/1095)). The Index Performance is calculated at -5% (950/1000 - 1). Since the Index Performance is negative, the Interim Value is then determined by multiplying the Investment Amount by the Index Performance plus
the Accrued Shield Rate (-5% + 2.795% = -2.205%) and adding that amount to the Investment Amount. As of the close of Business Day January 1, 2014, the Interim Value is $97,795 ($100,000+$100,000*-2.205%). 

WITHDRAWAL PROVISIONS 

Withdrawals 
 Prior to the Annuity Date, you may, upon Notice
to us, request a full or a partial withdrawal and we will withdraw that amount from the Account Value (“the amount withdrawn”). A withdrawal will result in a reduction to each Shield Option in the ratio that each Shield Option bears to the
total Account Value, as determined under the Account Value Provisions above, unless otherwise directed by you. The amount payable to you will be a net amount equal to the amount withdrawn adjusted for any applicable Withdrawal Charge shown on the
Contract Schedule and Premium and Other Taxes. The Free Withdrawal Amount shown on the Contract Schedule defines the amount You may withdraw free from any Withdrawal Charge. 

The total amount withdrawn from the Account Value must not be less than the Minimum Partial Withdrawal amount shown on the Contract Schedule. If the
withdrawal would result in the remaining Account Value being less than the Minimum 

  

					
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Account Value shown on the Contract Schedule, we will treat the withdrawal request as a request for a full withdrawal. 

If you request a full or partial withdrawal, the amount withdrawn after adjustments for any Withdrawal Charge will result in our paying you a net amount.
The net amount payable to you is equal to (a)-(b)-(c), where: 
  

	 	(a)	is the amount withdrawn from the Account Value, and 

  

	 	(b)	is the Withdrawal Charge, if any, as described on the Contract Schedule, and 

  

	 	(c)	is the Premium and Other Taxes, if any. 

 The amount withdrawn will reduce the Investment Amount, as
defined in the Definitions section, for each Shield Option by the percentage reduction in the Interim Value of such Shield Option. 
 
DEATH BENEFIT PROVISIONS 
 Death of Owner During the Accumulation Period 

During the Accumulation Period, the death benefit will be paid to your Beneficiary(ies) upon your death, or the first death of a Joint Owner. If the
Contract is owned by a non-natural person, the Annuitant will be deemed the Owner for purposes of determining the death benefit. 
 Death Benefit Amount During the
Accumulation Period 
 The “Death Benefit Amount” is the Account Value, as defined under the Account Value Provisions above, determined
as of the end of the Business Day on which we have received Notice of both due proof of death and the first acceptable election for the payment method. 
 Death
Benefit Options During the Accumulation Period 
 In the event an Owner (or the Annuitant where the Owner is not an individual) dies during the
Accumulation Period, a Beneficiary must choose payment of the death benefit under one of the options below (unless the Owner has previously chosen an option). The death benefit options available under the Contract include the following and any other
options acceptable to you and us: 
 Option 1 - lump sum payment of the death benefit; or 

Option 2 - the payment of the entire death benefit within five years of the date of death of the Owner or the first Joint Owner to die; or 

Option 3 - payment of the death benefit under an Annuity Option or other periodic payment option acceptable to us in substantially equal periodic
payments (made at least annually) over the lifetime of the Beneficiary or over a period not extending beyond the life expectancy of the Beneficiary with distribution beginning within one year of the date of death of the Owner or the first Joint
Owner to die. 
 Any portion of the death benefit not applied under Option 3 within one (1) year of the date of the Owner’s or Joint
Owner’s death must be distributed within five years of the date of death. 
 Beneficiary Continuation Options During Accumulation Period 

We offer two types of Beneficiary Continuation Options during the Accumulation Period: the Spousal Continuation and Non-Spousal Beneficiary Continuation
Options described below. We must receive Notice of the election of one of these Beneficiary Continuation Options by the end of the 90th day after we receive Notice of due proof of death. If the surviving spouse qualifies for Spousal Continuation and
has not chosen one of the death benefit options above by the end of the 90 day period, the Spousal Continuation Option will be automatically applied on the 90th day. If a Non-Spousal Beneficiary qualifies for Non-Spousal Beneficiary Continuation and
has not chosen one of the death benefit options above by the end of the 90 day period, the Non-Spousal Beneficiary Continuation Option will be automatically applied on the 90th day. 

Spousal Continuation During Accumulation Period 
 If the Owner
dies during the Accumulation Period and the Beneficiary is his or her spouse, the spouse may choose to continue the Contract in his or her own name and exercise all the Owner’s rights under the Contract. The Death Benefit Amount under the
continued contract payable upon the continuing spouse’s death will be computed as described above in the Death Benefit Amount During the Accumulation Period section. 

Non-Spousal Beneficiary Continuation During Accumulation Period 

A Beneficiary who is not a spouse can choose to continue the Contract until the fifth anniversary of the Owner’s death. The Contract can be
continued by a Beneficiary only if his or her share of the death benefit is at least equal to the Contract Minimum specified on the Contract Schedule. If the Beneficiary continues the Contract under this provision his or her share will not be paid.
It will instead be continued in the Contract on the date we determine the Death Benefit Amount. Such Beneficiary will have the right to make partial and full withdrawals of his/her share of the Contract, not subject to

  

					
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Withdrawal Charges. Such Beneficiary will also have the right to make transfers at the end of a Term as described on the Contract Schedule. 

During the continuation period the Beneficiary can choose to receive his/her share of this Contract in a single lump sum payment or apply it to an
Annuity Option or other option acceptable to us that must be payable for the life of the Beneficiary or for a term no longer than the life expectancy of the Beneficiary starting within one year after the death of the Owner. 

On the fifth anniversary of the Owner’s death any Beneficiary will be paid his/her share of the Account Value that has not been applied to an
Annuity option or other settlement option permissible under the Code, in a single lump sum payment and this Contract will terminate. 
 Death of Annuitant During
Income Period 
 Upon the death of the Annuitant during the Income Period, the remaining Income Payments, if any, will be as specified in the
Annuity Option chosen. Income Payments will be paid at least as rapidly as under the method of distribution in effect at the Annuitant’s death. 
 Death of
Owner During the Income Period 
 If the Owner (or a Joint Owner), is not the Annuitant, and dies during the Income Period, any remaining payments
under the Annuity Option will continue at least as rapidly as under the method of distribution in effect at the time of the Owner’s (or Joint Owner’s) death. Upon the death of the Owner (or a Joint Owner) during the Income Period, the
Beneficiary becomes entitled to exercise the rights of the Owner. If an Owner (or Joint Owner) is the Annuitant and dies during the Income Period, the remaining Income Payments, if any, will be as specified in the Annuity Option chosen and will
continue at least as rapidly as under the method of distribution in effect at the time of the Owner’s (or Joint Owner’s) death. 
 Death of Annuitant
During Accumulation Period 
 Upon the death of an Annuitant, who is not the Owner or Joint Owner, during the Accumulation Period, the Owner (or
Oldest Joint Owner) automatically becomes the Annuitant, unless the Owner, subject to the maximum specified age in effect at the time of request, chooses a new Annuitant. If the Owner is a non-natural person, the death of the Annuitant will be
treated as the death of an Owner (see Death of Owner During the Accumulation Period discussed above). 
 Payment of Death Benefit 

We will require Notice of both due proof of death and an acceptable election for the payment method before any death benefit is paid. Our obligations are
subject to all payments made and actions taken by us before our receipt of Notice of due proof of death. 
 ANNUITY
PROVISIONS 
 Election of Annuity Option 
 The Annuity
Option is chosen by you or your Beneficiary in a form satisfactory to us. We will automatically send you information about Annuity Options before your Annuity Date. If you do not choose an Annuity Option, make a full withdrawal by the Annuity Date,
or ask us to continue the Contract by the Annuity Date, we will automatically pay you under Option 2: Life Annuity with Ten (10) Years of Income Payments Guaranteed. You can make, change, or revoke your Annuity Option choice before the death
benefit becomes payable or the Annuity Date, whichever occurs first. 
 Annuity Options 

You may choose to receive Income Payments monthly, quarterly, semi-annually or annually. The following Annuity Options, or any other options acceptable
to you and us, may be chosen: 
 Option 1: Life Annuity 
 Income Payments
that are paid as long as the Annuitant is living. 
 Option 2: Life Annuity with 10 Years of Income Payments Guaranteed 

Income Payments that continue as long as the Annuitant is living but are guaranteed to be paid for ten years. 

Option 3: Joint and Last Survivor Life Annuity 
 Income Payments that are paid
as long as either of two Annuitants is living. 
 Option 4: Joint and Last Survivor Annuity with 10 Years of Income Payments Guaranteed 

Income Payments that continue as long as either of the two Annuitants are living but are guaranteed to be paid for ten years. 

  

					
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 If, as of the Annuity Date, the then current Annuity rates applicable to this class of contracts provide an
Income Payment greater than the one guaranteed under this Contract for the same Annuity Option, then the greater payment will be made. 
 Income Payments 

Income Payments are based upon the Annuity Option chosen, the Account Value, as defined under the Account Value Provisions above, applied to the Annuity
Option, the Annuitant’s Attained Age and sex, and the appropriate Fixed Annuity Table. 
 Frequency and Amount of Income Payments 

Income Payments will be paid as monthly installments or at any frequency acceptable to you and us. If the amount of the Account Value to be applied under
an Annuity Option is less than $5,000, we reserve the right to make one lump sum payment equal to the then current Account Value in lieu of Income Payments. If the amount of the Income Payment would be less than $100, we may reduce the frequency of
payments to an interval which will result in the payment being at least $100, but with a frequency of no less than annually. 
 Basis of Payments 

The Annuity Tables are based on the tables defined under the Annuity Option Information described in the Contract Schedule. The amount of each Income
Payment is guaranteed by us. 
 Betterment of Rates 

Annuity payments will not be less than those that would be provided by the application of the Account Value to purchase a single consideration immediate
annuity contract of the same type as the settlement option elected, which is offered by Us or our affiliates on the Annuity Date to the same class of annuitants. 

  

					
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 FIXED ANNUITY TABLES 

AMOUNT OF MONTHLY INCOME PAYMENT 
 PER $1000
OF Account Value 
 Annuitant Only 

 

 Option 1: Life Annuity 
  

 
  

					
	 Attained Age

of Annuitant
	  	Male	  	Female          
	 55
	  	2.74	  	2.59
	 60
	  	3.07	  	2.89
	 65
	  	3.50	  	3.27
	 70
	  	4.07	  	3.77
	 75
	  	4.84	  	4.45
	 80
	  	5.93	  	5.42
	 85
	  	7.50	  	6.86

 Option 2: Life Annuity with 10 

Years of Income Payments Guaranteed 
  

					
	 Attained Age

of Annuitant
	  	Male	  	Female          
	 55
	  	2.73	  	2.59
	 60
	  	3.05	  	2.88
	 65
	  	3.46	  	3.24
	 70
	  	3.99	  	3.72
	 75
	  	4.66	  	4.34
	 80
	  	5.50	  	5.16
	 85
	  	6.45	  	6.16

 
 

  
 Option 3: Joint and Last Survivor Life Annuity

  

													
	 	  	 Age of Female Annuitant

 
	  	 
	 Attained age

of Male Annuitant
	  	 10 Years

Younger
	  	 5 Years

Younger
	  	 Same

Age
	  	 5 Years

Older
	  	 10 Years

Older
	  	  
	 55
	  	2.09	  	2.21	  	2.34	  	2.45	  	2.54	  	
	 60
	  	2.26	  	2.42	  	2.57	  	2.71	  	2.82	  	
	 65
	  	2.48	  	2.67	  	2.86	  	3.04	  	3.19	  	
	 70
	  	2.75	  	3.00	  	3.25	  	3.49	  	3.69	  	
	 75
	  	3.10	  	3.42	  	3.77	  	4.09	  	4.37	  	
	 80
	  	3.55	  	4.00	  	4.48	  	4.95	  	5.33	  	
	 85
	  	4.18	  	4.82	  	5.51	  	6.17	  	6.69	  	 

 Option 4: Joint and Last Survivor Annuity with 10 Years of Income Payments Guaranteed 

 

													
	 	  	 Age of Female Annuitant

 
	  	 
	 Attained age

of Male Annuitant
	  	 10 Years

Younger
	  	 5 Years

Younger
	  	 Same

Age
	  	 5 Years

Older
	  	 10 Years

Older
	  	  
	 55
	  	2.09	  	2.21	  	2.34	  	2.45	  	2.54	  	
	 60
	  	2.26	  	2.42	  	2.57	  	2.71	  	2.82	  	
	 65
	  	2.48	  	2.67	  	2.86	  	3.04	  	3.19	  	
	 70
	  	2.75	  	2.99	  	3.25	  	3.48	  	3.68	  	
	 75
	  	3.09	  	3.42	  	3.76	  	4.08	  	4.34	  	
	 80
	  	3.55	  	3.99	  	4.45	  	4.88	  	5.19	  	
	 85
	  	4.15	  	4.76	  	5.38	  	5.89	  	6.22	  	 

 Monthly installments for ages not shown will be furnished on request 

  

					
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 INDIVIDUALSINGLE PREMIUM DEFERRED INDEX-LINKED
SEPARATE ACCOUNT ANNUITY CONTRACT 
 NONPARTICIPATING 
 NO DIVIDENDS

 BRIGHTHOUSE LIFE INSURANCE COMPANY OF NY 

(A Stock Company) 
 285 Madison Avenue 

New York, NY 10017 

Table of Contents

 CONTRACT SCHEDULE 
  

					
	 OWNER:  John Doe
	  		  	 SEX:  M        AGE AT ISSUE: 35

			
	 JOINT OWNER:  Jane Doe
	  		  	 SEX:  F         AGE AT ISSUE:
35

			
	 ANNUITANT:  John Doe
	  		  	 SEX:  M        AGE AT ISSUE: 35

			
	 CONTRACT NUMBER:  12345678
	  		  	ISSUE DATE:  February 15, 2013
			
	 PLAN TYPE:  Non-Qualified
	  		  	ANNUITY DATE:  February 15, 2068

 MAXIMUM TERMINAL ILLNESS RIDER ISSUE AGE:  75 

MAXIMUM NURSING HOME OR HOSPITAL CONFINEMENT RIDER ISSUE AGE:  75 

SINGLE PURCHASE PAYMENT:   $50,000 
 CONTRACT MINIMUM: 
$2,000 
 Minimum
Allocation:                                 $500 

SHIELD OPTIONS 
 SEPARATE
ACCOUNT:            BRIGHTHOUSE SEPARATE ACCOUNT SA II 
 Shield Options and Indices by Term
Available at Issue: 
 Each Shield Option will have an associated Cap Rate or a Step Rate. 

 

					
	Shield Options
	Term	  	Index	  	Minimum Guaranteed Cap/Step Rate
	Shield 15
	 3 Year Term
	  	 S&P 500® Index1
 Russell 2000® Index2
 MSCI EAFE Index3
	  	
6.00%
 6.00%

6.00%

	Shield 10
	 1 Year Term
	  	 S&P 500® Index
 S&P 500® Index Step Rate

Russell 2000® Index
 Russell
2000® Index Step Rate
 MSCI EAFE Index

MSCI EAFE Index Step Rate
	  	
2.00%
 1.50%

2.00%
 1.50%

2.00%
 1.50%

	 3 Year Term
	  	 S&P 500® Index
 Russell 2000® Index

MSCI EAFE Index
	  	
6.00%
 6.00%

6.00%

 Index-linked returns do not include the portion of returns generated by dividends; and the elements used in determining
the credited rate from the index are not guaranteed and can be changed by the Company, subject to any contract guarantees, and any such changes can affect the return. 

  

					
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 FIXED ACCOUNT 
  

			
	     Initial Interest
Rate*:
	  	1.00% annually
		
	     Interest Rate Term:
	  	1 year
		
	     Minimum Guaranteed Interest
Rate**:
	  	1.00 % annually

 Any paid-up annuity, cash surrender value, or death benefits that are available
under this contract will not be less than the minimum benefits required by the statutes of the state in which this contract is delivered. 
 TRANSFER REQUIREMENTS:

 TRANSFER PERIOD: 
 The 5 Calendar Days following the
Contract Anniversary coinciding with the end of the Term for each applicable Shield Option and/or the end of the Interest Rate Term for the Fixed Account. 

TRANSFERS: 
 During the Accumulation Period you may only make
a transfer to the Fixed Account and to a new Shield Option(s) during the Transfer Period, subject to availability. The effective date of such transfer is the first day of the Fixed Account Interest Rate Term and/or Shield Option(s) to which the
transfer is made.     
 At the end of the Term, the Investment Amount will automatically be renewed into the same Shield Option
unless you elect to transfer into a different Shield Option or the Fixed Account Option at that time. If the Shield Option is no longer available at the end of the existing Term, these amounts will automatically transfer into the Fixed Account at
the end of the Term unless otherwise directed by You. If the Fixed Account is not available, these amounts will automatically transfer into the Shield Option with, in order of priority, the shortest Term, the highest Shield Rate, and the lowest Cap
Rate from the Shield Options available at the end of the Term unless otherwise directed by You. 
 At the end of the Interest Rate Term, the Fixed
Account Value will automatically be renewed into the Fixed Account unless you elect to transfer into a Shield Option at that time. If the Fixed Account is no longer available at the end of the existing Fixed Account Term, these amounts will
automatically transfer into the Shield Option with, in order of priority, the shortest Term, the highest Shield Rate, and the lowest Cap Rate from the Shield Options available at the end of the Interest Rate Term unless otherwise directed by You.

 BENEFICIARY: As designated by you as of the Issue Date unless changed in accordance with the Contract provisions. 

WITHDRAWALS: 
 Free Withdrawal Amount: Each Contract
Year after the first Contract Year, you may withdraw a portion of your Account Value free from any Withdrawal Charge. The Free Withdrawal Amount each Contract Year is equal to 10% of the Account Value as of the prior Contract Anniversary less the
total amount withdrawn, as described in the Withdrawal Provisions, from the Account Value in the current Contract Year. The Free Withdrawal Amount is non-cumulative and is not carried over to other Contract
Years. 
 Withdrawal Charge: The Withdrawal Charge is a percentage of the amount withdrawn from the Account Value in a Contract Year in excess of the Free
Withdrawal Amount. The Withdrawal Charge is calculated at the time of each withdrawal using the appropriate withdrawal charge percentage from the following schedule: 
  

							
	 	 	            WITHDRAWAL CHARGE PERCENTAGES	 	 
				
	 	 	             Number of Complete

            Contract Years Since Issue

            Date
	 	  % Charge	 	 
		 	0	 	  6%	 	
		 	1	 	  6%	 	
		 	2	 	  5%	 	
		 	              3 or more	 	  0%	 	

  
 *
 Initial Interest Rate – the interest rate credited to your initial allocation to the Fixed Account during the Interest Rate Term beginning on the Issue Date. 

**  We reserve the right with 30 days advance written notice to restrict transfers and allocations into the Fixed Account during the Transfer Period
if the declared interest rate that would apply equals the Minimum Guaranteed Interest Rate. We will provide you notice if these restrictions on transfers and allocations are subsequently lifted. 

  

					
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 In addition to any waiver of Withdrawal Charges set forth in the Contract or Rider(s), no Withdrawal Charge will be
deducted from the Account Value in the event of: 
  

	1.	Maturity of the Contract; or 

	2.	Payment of the Death Benefit; or 

	3.	Application of your Account Value to an Annuity Option; or 

	4.	If the withdrawal is required for you to avoid Federal Income Tax penalties or to satisfy Federal Income Tax rules concerning minimum distribution requirements that apply to this annuity (except for RMDs on a decedent
Roth IRA.) For purposes of this exception, we assume that this annuity is the only contract or funding vehicle from which distributions are required to be taken, and we will ignore all other Account Values; or 

	5.	If you properly “re-characterize” as permitted under Federal Tax Law your traditional IRA deferred annuity or Roth IRA deferred annuity issued by us; or

	6.	If we agree in writing that none will apply. We may waive the Withdrawal Charge if you directly transfer the amount withdrawn to a Brighthouse Life Insurance Company of NY or Brighthouse Financial affiliate annuity
contract pre-approved by us. 

 Minimum Partial
Withdrawal:             $500.00 
 Minimum Account Value which must remain in the Contract after a
Partial Withdrawal: $2,000.00 
 ANNUITY OPTION INFORMATION: 

	1.	 The Annuity Date must be the first day of a calendar month. Unless otherwise directed by you, the Annuity Date is the
first day of the calendar month following the Annuitant’s 90th birthday or 10 years from the Issue Date, whichever is later, or a later date if we agree. 

	2.	 The Annuity Date must not be less than 13 months from the Issue Date. 

	3.	 For Income Payments, the Fixed Annuity Tables are based on the Annuity 2000 Mortality Table with 15 years of mortality
improvement based upon projection Scale AA, a 7 year age setback and interest at 1.00%. 

 ANNUITY SERVICE OFFICE: 

Brighthouse Life Insurance Company of NY 
 P.O. Box 10366 

Des Moines, IA  50306-0366 
 (800)
777-5897 

  

					
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Table of Contents

 ENDORSEMENTS AND RIDERS ATTACHED TO THIS CONTRACT: 

Fixed Account Rider 
 Death Benefit Rider – Return of Premium 

Waiver of Withdrawal Charge for Nursing Home Confinement Rider 
 Waiver of Withdrawal
Charge for Terminal Illness Rider 
 Individual Retirement Annuity Qualification Rider 

Roth Individual Retirement Annuity (“Roth IRA”) Endorsement 
 Individual Non-Qualified Annuity Endorsement 
 Designated Beneficiary Non-Qualified Endorsement 

  

					
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	  	3D	  	

Table of Contents

 1The S&P 500 Index is a product of S&P Dow
Jones Indices LLC (“SPDJI”), and has been licensed for use by affiliates of Brighthouse Financial, Inc. including Brighthouse Services, LLC and Brighthouse Life Insurance Company of NY (collectively, “Brighthouse Financial”).
Standard & Poor’s®, S&P® and S&P 500® are registered
trademarks of Standard & Poor’s Financial Services LLC (“S&P”); Dow Jones® is a registered trademark of Dow Jones Trademark Holdings LLC (“Dow Jones”);
and these trademarks have been licensed for use by SPDJI and sublicensed for certain purposes by Brighthouse Financial. This annuity product is not sponsored, endorsed, sold or promoted by SPDJI, Dow Jones, S&P, any of their respective
affiliates (collectively, “S&P Dow Jones Indices”). S&P Dow Jones Indices makes no representation or warranty, express or implied, to the owners of this annuity product any member of the public regarding the advisability of
investing in securities generally or in this annuity product particularly or the ability of the S&P 500 Index to track general market performance. S&P Dow Jones Indices’ only relationship to Brighthouse Financial with respect to the
S&P 500 Index is the licensing of the Index and certain trademarks, service marks and/or trade names of S&P Dow Jones Indices or its licensors. The S&P 500 Index is determined, composed and calculated by S&P Dow Jones Indices without
regard to Brighthouse Financial or this annuity product. S&P Dow Jones Indices have no obligation to take the needs of Brighthouse Financial or the owners of this annuity product into consideration in determining, composing or calculating the
S&P 500 Index. S&P Dow Jones Indices is not responsible for and has not participated in the determination of the prices, and amount of this annuity product or the timing of the issuance or sale of this annuity product or in the determination
or calculation of the equation by which this annuity product is to be converted into cash, surrendered or redeemed, as the case may be. S&P Dow Jones Indices has no obligation or liability in connection with the administration, marketing or
trading of this annuity product. There is no assurance that investment products based on the S&P 500 Index will accurately track index performance or provide positive investment returns. S&P Dow Jones Indices LLC is not an investment
advisor. Inclusion of a security within an index is not a recommendation by S&P Dow Jones Indices to buy, sell, or hold such security, nor is it considered to be investment advice. Notwithstanding the foregoing, CME Group Inc. and its affiliates
may independently issue and/or sponsor financial products unrelated to this annuity product currently being issued by Brighthouse Financial, but which may be similar to and competitive with this annuity product. In addition, CME Group Inc. and its
affiliates may trade financial products which are linked to the performance of the S&P 500 Index. 
 S&P DOW JONES INDICES DOES NOT GUARANTEE
THE ADEQUACY, ACCURACY, TIMELINESS AND/OR THE COMPLETENESS OF THE S&P 500 INDEX OR ANY DATA RELATED THERETO OR ANY COMMUNICATION, INCLUDING BUT NOT LIMITED TO, ORAL OR WRITTEN COMMUNICATION (INCLUDING ELECTRONIC COMMUNICATIONS) WITH RESPECT
THERETO. S&P DOW JONES INDICES SHALL NOT BE SUBJECT TO ANY DAMAGES OR LIABILITY FOR ANY ERRORS, OMISSIONS, OR DELAYS THEREIN. S&P DOW JONES INDICES MAKES NO EXPRESS OR IMPLIED WARRANTIES, AND EXPRESSLY DISCLAIMS ALL WARRANTIES, OF
MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE OR AS TO RESULTS TO BE OBTAINED BY BRIGHTHOUSE FINANCIAL, OWNERS OF THIS ANNUITY PRODUCT, OR ANY OTHER PERSON OR ENTITY FROM THE USE OF THE S&P 500 INDEX OR WITH RESPECT TO ANY DATA
RELATED THERETO. WITHOUT LIMITING ANY OF THE FOREGOING, IN NO EVENT WHATSOEVER SHALL S&P DOW JONES INDICES BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL, PUNITIVE, OR CONSEQUENTIAL DAMAGES INCLUDING BUT NOT LIMITED TO, LOSS OF PROFITS, TRADING
LOSSES, LOST TIME OR GOODWILL, EVEN IF THEY HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, WHETHER IN CONTRACT, TORT, STRICT LIABILITY, OR OTHERWISE. THERE ARE NO THIRD PARTY BENEFICIARIES OF ANY AGREEMENTS OR ARRANGEMENTS BETWEEN S&P DOW
JONES INDICES AND BRIGHTHOUSE FINANCIAL OTHER THAN THE LICENSORS OF S&P DOW JONES INDICES. 

2This annuity product is not sponsored, endorsed, sold or promoted by Frank Russell Company
(“Russell”). Russell makes no representation or warranty, express or implied, to the owners of this annuity product or any member of the public regarding the advisability of investing in securities generally or in this annuity product
particularly or the ability of the Russell 2000® Index to track general stock market performance or a segment of the same. Russell’s publication of the Russell 2000® Index in no way suggests or implies an opinion by Russell as to the advisability of investment in any or all of the securities upon which the Russell 2000® Index is based. Russell’s only relationship to affiliates of Brighthouse Financial, Inc. including Brighthouse Services, LLC and Brighthouse Life Insurance Company of NY (collectively,
“Brighthouse Financial”) is the licensing of certain trademarks and trade names of Russell and of the Russell 2000® Index which is determined, composed and calculated by Russell
without regard to Brighthouse Financial or this annuity product. Russell is not responsible for and has not reviewed this annuity product nor any associated literature or publications and Russell makes no representation or warranty express or
implied as to their accuracy or completeness, or otherwise. Russell reserves the right, at any time and without notice, to alter, amend, terminate or in any way change the Russell 2000® Index. Russell has no obligation or liability in connection with the administration, marketing or trading of this annuity product. 

RUSSELL DOES NOT GUARANTEE THE ACCURACY AND/OR THE COMPLETENESS OF THE RUSSELL 2000® INDEX OR
ANY DATA INCLUDED THEREIN AND RUSSELL SHALL HAVE NO LIABILITY FOR ANY ERRORS, OMISSIONS, OR INTERRUPTIONS THEREIN. RUSSELL MAKES NO WARRANTY, EXPRESS OR IMPLIED, AS TO 

Table of Contents

 
RESULTS TO BE OBTAINED BY BRIGHTHOUSE FINANCIAL, INVESTORS, OWNERS OF THIS ANNUITY PRODUCT OR ANY OTHER PERSON OR ENTITY FROM THE USE OF THE RUSSELL 2000® INDEX OR ANY DATA INCLUDED THEREIN. RUSSELL MAKES NO EXPRESS OR IMPLIED WARRANTIES, AND EXPRESSLY DISCLAIMS ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE WITH
RESPECT TO THE RUSSELL 2000® INDEX OR ANY DATA INCLUDED THEREIN. WITHOUT LIMITING ANY OF THE FOREGOING, IN NO EVENT SHALL RUSSELL HAVE ANY LIABILITY FOR ANY SPECIAL, PUNITIVE, INDIRECT, OR
CONSEQUENTIAL DAMAGES (INCLUDING LOST PROFITS), EVEN IF NOTIFIED OF THE POSSIBILITY OF SUCH DAMAGES. 

3THIS ANNUITY PRODUCT IS NOT SPONSORED, ENDORSED, SOLD OR PROMOTED BY MSCI INC.
(“MSCI”), ANY OF ITS AFFILIATES, ANY OF ITS INFORMATION PROVIDERS OR ANY OTHER THIRD PARTY INVOLVED IN, OR RELATED TO, COMPILING, COMPUTING OR CREATING ANY MSCI INDEX (COLLECTIVELY, THE “MSCI PARTIES”). THE MSCI
INDEXES ARE THE EXCLUSIVE PROPERTY OF MSCI. MSCI AND THE MSCI INDEX NAMES ARE SERVICE MARK(S) OF MSCI OR ITS AFFILIATES AND HAVE BEEN LICENSED FOR USE FOR CERTAIN PURPOSES BY AFFILIATES OF BRIGHTHOUSE FINANCIAL, INC. INCLUDING BRIGHTHOUSE SERVICES,
LLC AND BRIGHTHOUSE LIFE INSURANCE COMPANY OF NY (COLLECTIVELY, “BRIGHTHOUSE FINANCIAL”). NONE OF THE MSCI PARTIES MAKES ANY REPRESENTATION OR WARRANTY, EXPRESS OR IMPLIED, TO THE ISSUER OR OWNERS OF THIS ANNUITY PRODUCT OR ANY OTHER
PERSON OR ENTITY REGARDING THE ADVISABILITY OF INVESTING IN PRODUCTS GENERALLY OR IN THIS ANNUITY PRODUCT PARTICULARLY OR THE ABILITY OF ANY MSCI INDEX TO TRACK CORRESPONDING STOCK MARKET PERFORMANCE. MSCI OR ITS AFFILIATES ARE THE LICENSORS OF
CERTAIN TRADEMARKS, SERVICE MARKS AND TRADE NAMES AND OF THE MSCI INDEXES WHICH ARE DETERMINED, COMPOSED AND CALCULATED BY MSCI WITHOUT REGARD TO THIS ANNUITY PRODUCT OR THE ISSUER OR OWNERS OF THIS ANNUITY PRODUCT OR ANY OTHER PERSON OR ENTITY.
NONE OF THE MSCI PARTIES HAS ANY OBLIGATION TO TAKE THE NEEDS OF THE ISSUER OR OWNERS OF THIS ANNUITY PRODUCT OR ANY OTHER PERSON OR ENTITY INTO CONSIDERATION IN DETERMINING, COMPOSING OR CALCULATING THE MSCI INDEXES. NONE OF THE MSCI PARTIES IS
RESPONSIBLE FOR OR HAS PARTICIPATED IN THE DETERMINATION OF THE TIMING OF, PRICES AT, OR QUANTITIES OF THIS ANNUITY PRODUCT TO BE ISSUED OR IN THE DETERMINATION OR CALCULATION OF THE EQUATION BY OR THE CONSIDERATION INTO WHICH THIS ANNUITY PRODUCT
IS REDEEMABLE. FURTHER, NONE OF THE MSCI PARTIES HAS ANY OBLIGATION OR LIABILITY TO THE ISSUER OR OWNERS OF THIS ANNUITY PRODUCT OR ANY OTHER PERSON OR ENTITY IN CONNECTION WITH THE ADMINISTRATION, MARKETING OR OFFERING OF THIS ANNUITY PRODUCT. 

ALTHOUGH MSCI SHALL OBTAIN INFORMATION FOR INCLUSION IN OR FOR USE IN THE CALCULATION OF THE MSCI INDEXES FROM SOURCES THAT MSCI CONSIDERS RELIABLE, NONE
OF THE MSCI PARTIES WARRANTS OR GUARANTEES THE ORIGINALITY, ACCURACY AND/OR THE COMPLETENESS OF ANY MSCI INDEX OR ANY DATA INCLUDED THEREIN. NONE OF THE MSCI PARTIES MAKES ANY WARRANTY, EXPRESS OR IMPLIED, AS TO RESULTS TO BE OBTAINED BY THE ISSUER
OF THIS ANNUITY PRODUCT, OWNERS OF THIS ANNUITY PRODUCT, OR ANY OTHER PERSON OR ENTITY, FROM THE USE OF ANY MSCI INDEX OR ANY DATA INCLUDED THEREIN. NONE OF THE MSCI PARTIES SHALL HAVE ANY LIABILITY FOR ANY ERRORS, OMISSIONS OR INTERRUPTIONS OF OR
IN CONNECTION WITH ANY MSCI INDEX OR ANY DATA INCLUDED THEREIN. FURTHER, NONE OF THE MSCI PARTIES MAKES ANY EXPRESS OR IMPLIED WARRANTIES OF ANY KIND, AND THE MSCI PARTIES HEREBY EXPRESSLY DISCLAIM ALL WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A
PARTICULAR PURPOSE, WITH RESPECT TO EACH MSCI INDEX AND ANY DATA INCLUDED THEREIN. WITHOUT LIMITING ANY OF THE FOREGOING, IN NO EVENT SHALL ANY OF THE MSCI PARTIES HAVE ANY LIABILITY FOR ANY DIRECT, INDIRECT, SPECIAL, PUNITIVE, CONSEQUENTIAL OR ANY
OTHER DAMAGES (INCLUDING LOST PROFITS) EVEN IF NOTIFIED OF THE POSSIBILITY OF SUCH DAMAGES. 
 No purchaser, seller or holder of this annuity product,
or any other person or entity, should use or refer to any MSCI trade name, trademark or service mark to sponsor, endorse, market or promote this security without first contacting MSCI to determine whether MSCI’s permission is required. Under no
circumstances may any person or entity claim any affiliation with MSCI without the prior written permission of MSCI. 
  

  

					
	 BL-22495-NY
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	  	3GExhibit

Exhibit 10.1
FORD MOTOR COMPANY
EXECUTIVE SEPARATION ALLOWANCE PLAN
(Amended and Restated Effective as of January 1, 2017)

Section 1.  Introduction 

This Plan has been established for the purpose of providing employees on U.S. payroll of Leadership Level One or Two, hired or rehired prior to January 1, 2004, with an Executive Separation Allowance in the event of separation from employment with the Company under certain circumstances.

Section 2.  Definitions  

As used in the Plan, the following terms shall have the following meanings, respectively:

		
	2.01
	"Affiliate" shall mean, as applied with respect to any person or legal entity specified, a person or legal entity that directly or indirectly, through one or more intermediaries, controls or is controlled by, or is under common control with, the person or legal entity specified.

		
	2.02
	"BEP" shall mean the Ford Motor Company Benefit Equalization Plan, as amended.

		
	2.03
	"Code" shall mean the Internal Revenue Code of 1986, as amended.

		
	2.04
	"Committee" shall mean Group Vice President – Human Resources and Corporate Services and the Executive Vice President and Chief Financial Officer (or, in the event of a change in title, such officer's functional equivalent), and such person or persons to whom the Group Vice President – Human Resources and Corporate Services and the Executive Vice President and Chief Financial Officer delegate authority to administer the Plan.

		
	2.05
	"Company" shall mean Ford Motor Company and such of the subsidiaries of Ford Motor Company as, with the consent of Ford Motor Company, shall have adopted this Plan.

		
	2.06
	"Compensation Committee" shall mean the Compensation Committee of the Board of Directors of Ford Motor Company.

		
	2.07
	"Contributory Service" shall mean, without duplication, the years and any fractional year of contributory service at retirement, not exceeding one year for any calendar year, of the Eligible Leadership Level One or Two Employee under the Ford Motor Company GRP.

		
	2.08
	"Credited Service" shall mean, without duplication, the years and any fractional year of credited service at retirement, not exceeding one year for any calendar year, of the Eligible Leadership Level One or Two Employee under the GRP.

1

		
	2.09
	"DB SERP" shall mean the Ford Motor Company Defined Benefit Supplemental Executive Retirement Plan, as amended.

		
	2.10
	"Eligible Leadership Level One or Two Employee(s)" shall mean a Leadership Level One or Two Employee who was hired or rehired prior to January 1, 2004 and who meets the eligibility criteria set forth in Section 3, or for periods prior to January 1, 2000, shall mean an Executive Roll Employee who meets the eligibility criteria set forth in Section 3.

		
	2.11
	"Eligible Surviving Spouse" shall mean an individual to whom an Eligible Leadership Level One or Two Employee legally is married under the laws of the state or foreign jurisdiction where the marriage took place prior to such Retired Executive's benefit commencement date and for at least one year as of the date of the Retired Executive's death. 

		
	2.12
	"Executive Separation Allowance(s)" shall mean benefits payable under this Plan as determined in accordance with Section 4.

		
	2.13
	"GRP" shall mean the Ford Motor Company General Retirement Plan, as amended.

		
	2.14
	"Leadership Level One or Two Employee" shall mean an employee of the Company (but for periods prior to July 1, 1996, excluding a Company employee who is an employee of Jaguar Cars, a division of the Company) who is assigned to the Leadership Level One or Two, or its equivalent, as such term is defined in the Employee Relations Administration Manual as from time to time constituted.

		
	2.15
	"Named Executive Officer(s)" shall mean any Chief Executive Officer that served during the last completed fiscal year, any Chief Financial Officer that served during the last completed fiscal year, the next three most highly compensation executive officers at the end of the last completed fiscal year, and up to two additional individuals who would have been among the most three highly compensated executive officers had they been executive officers at the end of the previous fiscal year end.

		
	2.16
	"Plan" shall mean this Ford Motor Company Executive Separation Allowance Plan, as amended.

		
	2.17
	"Plan Administrator" shall mean such person or persons to whom the Committee shall delegate authority to administer the Plan, who does not already assume authority as a Committee member. 

		
	2.18
	"Separation From Service" shall be determined to have occurred on the date on which an Eligible Leadership Level One or Two Employee incurs a "separation from service" within the meaning of Code Section 409A.

		
	2.19
	"Special Executive Separation Allowance(s)" shall mean benefits payable under this Plan as determined in accordance with Section 4(C).

2

		
	2.20
	"Specified Employee" shall mean an employee of the Company who is a "Key Employee" as defined in Code Section 416(i)(1)(A)(i), (ii) or (iii), applied in accordance with the regulations thereunder and disregarding Subsection 416(i)(5).  A Specified Employee shall be identified as of December 31st of each calendar year and such identification shall apply to any Specified Employee who shall incur a Separation From Service in the 12-month period commencing April 1st of the immediately succeeding calendar year.  An employee who is determined to be a Specified Employee shall remain a Specified Employee throughout such 12-month period regardless of whether the employee meets the definition of "Specified Employee" on the date the employee incurs a Separation From Service.  This provision is effective for Specified Employees who incur a Separation From Service on or after January 1, 2005.  For purposes of determining Specified Employees, the definition of compensation under Treasury Regulation Section 1.415(c)-2(d)(3) shall be used, applied without the use of any of the special timing rules provided in Treasury Regulation Section 1.415(c)-2(e) or the special rule in Treasury Regulation Section 1.415(c)-2(g)(5)(i), but applied with the use of the special rule in Treasury Regulation Section 1.415(c)-2(g)(5)(ii).  

		
	2.21
	"SRP" shall mean the Ford Motor Company Select Retirement Plan, as amended.

		
	2.22
	"Subsidiary" shall mean, as applied with respect to any person or legal entity specified, (i) a person or legal entity, a majority of the voting stock of which is owned or controlled, directly or indirectly, by the person or legal entity specified, or (ii) any other type of business organization in which the person or legal entity specified owns or controls, directly or indirectly, a majority interest.

Section 3.  Eligibility  

Each Leadership Level One or Two Employee who:

(i)    was hired or rehired prior to January 1, 2004;

(ii)    incurs a Separation From Service with the approval of the Company;

(iii)    has at least five years of Credited Service at the Leadership Level One or Two level, or its equivalent;

(iv)    has at least ten years of combined Contributory Service or service in any other retirement plan sponsored by a Subsidiary to which the Level One or Two Employee contributed or, if contributions were not permitted, participated;

(v)    is at least 55 years of age; and

(vi)    retires from the Company prior to age 65

3

shall receive an Executive Separation Allowance as provided herein.  The Eligible Surviving Spouse of a Leadership Level One or Two Employee who (i) has not incurred a Separation From Service with the Company, (ii) meets the eligibility conditions set forth in Subsections (1) through (3) of this Section 3, and (iii) dies on or after January 1, 1981 shall be eligible to receive the Executive Separation Allowance that the Eligible Leadership Level One or Two Employee would have been eligible to receive if such employee had incurred a Separation From Service with the approval of the Company and retired on the date of such employee's death.

Except in the case of a Leadership Level One or Two Employee who has not incurred a Separation From Service with the Company, the eligibility conditions set forth in Subsections (iii) and (iv) of Section 3 may be waived (i) in the case of a Leadership Level One employee, by the Compensation Committee, and (ii) in the case of any other employee, by the President and Chief Executive Officer.

Section 4.  Calculation of Amount

		
	(a)
	Base Monthly Salary.  For purposes of the Plan, the "Base Monthly Salary" of a Leadership Level One or Two Employee shall be the highest monthly base salary rate of such employee during the employee's 12 months of service immediately preceding Separation From Service with the Company, prior to giving effect to any salary reduction agreement pursuant to an employee benefit plan, as defined in Section 3(3) of the Employee Retirement Income Security Act of 1974, as amended, (i) to which Code Section 125 or Code Section 402(e)(3), applies or (ii) which provides for the elective deferral of compensation.  It shall not include supplemental compensation or any other kind of extra or additional compensation.

		
	(b)
	Amount of Executive Separation Allowance.  Subject to any limitation in other provisions of the Plan, the gross monthly amount of the Executive Separation Allowance of an Eligible Leadership Level One or Two Employee under Section 3 above shall be such employee's Base Monthly Salary multiplied by a percentage, not to exceed 60%, equal to the sum of (i) 15%, (ii) five tenths of one percent (.5%) for each month (or fraction thereof) that such employee's age at Separation From Service exceeds 55, not to exceed thirty percent (30%), and (iii) one percent (1%) for each year of such employee's Credited Service in excess of 15, prorated for fractions of a year.

The gross amount for any month shall be reduced by any payments paid or payable for such month to the Eligible Leadership Level One or Two Employee, the employee's Eligible Surviving Spouse, contingent annuitant, or other beneficiary, (i) under the GRP, BEP,  SRP, or any other Company defined benefit retirement plan, or (ii) as a Pension Parity Benefit from the DB SERP, other than (a) Supplemental Benefit or Conditional Annuity payments paid or payable from the DB SERP, (b) under any other Company defined benefit retirement plan from which a voluntary distribution of a lump sum benefit has occurred before age 65, by the monthly annuity payment the Eligible Leadership Level One or Two Employee would have received had the lump sum distribution not occurred, or (c) under any other defined 

4

benefit retirement plan from which an involuntary distribution of a lump sum benefit on an actuarially equivalent basis occurred before age 65 and without the Eligible Leadership Level One or Two Employee's retirement.

		
	(c)
	Special Executive Separation Allowances.  In addition to any other Executive Separation Allowance provided under this Plan, the Company may, in its sole discretion, provide Special Executive Separation Allowances to certain Eligible Leadership Level One or Two Employees.  Special Executive Separation Allowances provided to Eligible Leadership Level One or Two Employees whose compensation is subject to the executive compensation disclosure rules under the Securities Exchange Act of 1934 shall be set forth in Appendix A.  Special Equalization Benefits provided to Eligible Leadership Level One or Two Employees who are not subject to such disclosure rules shall be set forth in a separate confidential schedule to the Plan that is administered by the HR Director-Executive Personnel Office.  Any Special Executive Separation Allowance provided pursuant to this Section shall be paid in accordance with the terms and conditions of this Plan, including without limitation Section 5.

Section 5.  Payments  

		
	(a)
	Subject to the earning out provisions of Section 6, Executive Separation Allowance payments to an Eligible Leadership Level One or Two Employee, in the net amount determined in accordance with Section 4B above, shall be made monthly from the Company's general funds commencing on or as soon as reasonably practicable after the first day of the month following the date on which the Eligible Leadership Level One or Two Employee has a Separation From Service.  Payments to an Eligible Leadership Level One or Two Employee shall cease at the end of the month in which such employee attains age 65 or dies, whichever occurs first.  In the event of death of an Eligible Leadership Level One or Two Employee prior to such employee attaining age 65, or in the event of death on or after January 1, 1981 of a Leadership Level One or Two Employee whose Eligible Surviving Spouse meets the eligibility conditions set forth in Section 3 for payments hereunder, payments shall be made to such employee's Eligible Surviving Spouse, if any, commencing as soon as reasonably practicable following the date of the Eligible Leadership Level One or Two Employee's death, and continuing until the earlier of the death of such Eligible Surviving Spouse, or the end of the month in which the Eligible Leadership Level One or Two Employee would have attained age 65.

		
	(b)
	Notwithstanding any other provision of the Plan to the contrary, but subject to the earning out provisions of Section 6, if a Specified Employee incurs a Separation From Service, other than as a result of such Specified Employee's death, payment of any Executive Separation Allowance benefit to such Specified Employee shall commence on, or as soon as reasonably practicable after, the first day of the seventh month following such Specified Employee's Separation From Service and any Executive Separation Allowance benefits to which such Specified Employee otherwise would have been entitled during the first six months following such 

5

Specified Employee's Separation From Service shall be accumulated and paid in a lump sum payment on or as soon as reasonably practicable after the first day of the seventh month following such Separation From Service. Any payments delayed under this Section shall not bear interest.

Section 6. Earning Out Conditions 

Notwithstanding anything in the Plan to the contrary, the right of any Eligible Leadership Level One or Two Employee to receive an Executive Separation Allowance hereunder for any month shall accrue, and such payment shall be payable (subject to Section 5), only if, during the entire period from the date of such Eligible Leadership Level One or Two Employee's Separation From Service to the end of such month in which payment otherwise would be made, such Eligible Leadership Level One or Two Employee shall have earned out such payment by refraining from engaging in any activity that is directly or indirectly in competition with any activity of the Company or any Subsidiary or Affiliate thereof. 
    
In the event of an Eligible Leadership Level One or Two Employee's nonfulfillment of the condition set forth in the immediately preceding paragraph, no further payment shall be paid to such Eligible Leadership Level One or Two Employee or Eligible Surviving Spouse, as applicable; provided, however, that the nonfulfillment of such condition may at any time (whether before, at the time of or subsequent to termination of such Eligible Leadership Level One or Two Employee's employment) be waived in the following manner:

		
	(1)
	with respect to any such Eligible Leadership Level One or Two Employee who at any time shall have been a member of the Board of Directors, a Leadership Level One employee or a Named Executive Officer, such waiver may be granted by the Compensation Committee upon its determination that, in its sole discretion, there shall have not been, and will not be, any substantial adverse effect upon the Company or any Subsidiary or Affiliate thereof by reason of the nonfulfillment of such condition; and

		
	(2)
	with respect to any other such Eligible Leadership Level One or Two Employee, such waiver may be granted by the Committee upon its determination that, in its sole discretion, there shall not have been and will not be any such substantial adverse effect upon the Company or any Subsidiary or Affiliate thereof by reason of the nonfulfillment of such condition.

Notwithstanding anything to the contrary herein, Executive Separation Allowance payments shall not be paid to or with respect to any person as to whom it has been determined that such person at any time (whether before or subsequent to termination of the Eligible Leadership Level One or Two's employment) acted in a manner inimical to the best interests of the Company.  Any such determination shall be made by (i) the Compensation Committee with respect to any Eligible Leadership Level One Employee who at any time, shall have been a member of the Board of Directors, a Leadership Level One employee or a Named Executive Officer, and (ii) the Committee with respect to any other Eligible Leadership Level One or Two Employee, and shall apply to any amounts payable after the date of the applicable committee's action hereunder, regardless of 

6

whether the person has commenced receiving Executive Separation Allowance.  Conduct which constitutes engaging in an activity that is directly or indirectly in competition with any activity of the Company or any Subsidiary or Affiliate thereof shall be governed by the preceding paragraphs of this Section and shall not be subject to any determination under this paragraph.

Section 7. General Provisions

		
	7.01
	Plan Administration and Interpretation.   

		
	(a)
	Notwithstanding any other provisions of the Plan to the contrary, the terms of the Plan shall determine the benefits payable to any person under the Plan, and no person shall be eligible for any benefit under the Plan that would be inconsistent with such terms.

		
	(b)
	Except as otherwise provided, full authority to administer and interpret this Plan shall be vested in the Committee. The Committee is authorized, in its sole discretion, from time to time, to establish such rules and regulations as it deems appropriate for the proper administration of the Plan, and to make such determinations under, and such interpretations of, and to take such actions in connection with, the Plan as it deems necessary or advisable. Each determination, interpretation, or other action hereunder by the Committee shall be final, binding and conclusive upon all persons for all purposes under the Plan. The Committee may act, in its sole discretion, to delegate administrative and interpretative authority under this Section to the Plan Administrator. 

		
	(c)
	In the event that an Article, Section or paragraph of the Code, Treasury Regulations, or the GRP is renumbered, such renumbered Article, Section or paragraph shall apply to applicable references in this Plan.

		
	7.02
	Local Payment Authorities.  The Vice President and Treasurer and the Assistant Treasurer (or, in the event of a change in title, such officer's functional equivalent) may act individually to delegate authority to administrative personnel for purposes of paying benefits under the Plan to any person.

		
	7.03
	Deductions. The Company may deduct from any payment of Executive Separation Allowance to an Eligible Leadership Level One or Two Employee or Eligible Surviving Spouse any and all amounts owed to it by such Eligible Leadership Level One or Two Employee, Eligible Surviving Spouse or any person for any reason, and all taxes required by law or government regulation to be deducted or withheld.

		
	7.04
	Tax Liabilities. The Company has no duty to design its compensation policies in a manner that minimizes an individual's tax liabilities, including tax liabilities arising as a result of Executive Separation Allowances provided under the Plan. No claim shall be made against the Plan relating to tax liabilities arising from employment 

7

with the Company and/or any compensation or benefit arrangements sponsored or maintained by the Company, including this Plan. 
		
	7.05
	No Contract of Employment.  The Plan is an expression of the Company's present policy with respect to Eligible Leadership Level One or Two Employees; it is not a part of any contract of employment.  No Leadership Level One or Two Employee, Eligible Surviving Spouse, or any other person shall have any legal or other right to any benefit under this Plan.

		
	7.06
	Executive Separation Allowances Not Funded.  The Company's obligations under this Plan shall not be funded and Executive Separation Allowance benefits under this Plan shall be payable only out of the general funds of the Company.

		
	7.07
	Governing Law. Except as otherwise provided under Federal law, the Plan, and all rights thereunder, shall be governed, construed and administered in accordance with the laws of the State of Michigan.

		
	7.08
	Amendment or Termination.  The Company shall have the right to amend, modify, discontinue or terminate this Plan, in whole or in part, at any time, without notice; provided, however, that no distribution of Executive Separation Allowances shall occur upon termination of this Plan, unless applicable requirements of Code Section 409A have been met. Notwithstanding anything to the contrary herein, benefits payable under this Plan remain subject to the claims of the Company's general creditors at all times.

		
	7.09
	Terms Not Otherwise Defined. Capitalized terms not otherwise defined in this Plan shall have the same meanings ascribed to such terms under the applicable plans.

		
	7.10
	No Alienation of Benefits. An Eligible Executive may not assign or alienate any Executive Separation Allowance, and the Plan will not recognize a domestic relations order that purports to assign any Executive Separation Allowance to another person.

		
	7.11
	Recovery of Overpayment.  Any individual shall repay promptly any and all Executive Separation Allowances received by the individual to which the individual is not entitled.  Written notice of any overpayment, the amount owed and actions that may be taken in connection with the overpayment will be sent to the individual.  If an individual fails to make timely repayment, this Plan shall proceed to recover the overpaid amount.  This Plan reserves the right to initiate formal recovery action through the use of a collection agency or through any applicable legal proceedings.

Section 8.  Visteon Corporation.  
The following shall be applicable to employees of Ford who were transferred to Visteon Corporation on April 1, 2000 ("U.S. Visteon Employees") and who ceased active participation in the Plan as of June 30, 2000 after Visteon Corporation was spun-off from Ford, June 28, 2000.

8

(a)    Group I and Group II Employees.
For purposes of this paragraph, a "Group I Employee" shall mean a U.S. Visteon Employee who as of July 1, 2000 was eligible for immediate normal or regular early retirement under the provisions of the GRP as in effect on July 1, 2000.  A "Group II Employee" shall mean a U.S. Visteon Employee who (i) was not a Group I Employee; (ii) had as of July 1, 2000 a combination of age and continuous service that equals or exceeds sixty (60) points (partial months disregarded); and (iii) could become eligible for normal or regular early retirement under the provisions of the GRP as in effect on July 1, 2000 within the period after July 1, 2000 equal to the employee's Ford service as of July 1, 2000.  A Group I or Group II Employee shall retain eligibility to receive an Executive Separation Allowance and shall receive such benefits as are applicable under the terms of the Plan in effect on the retirement date, based on meeting the minimum Leadership Level required for eligibility for such benefits as of July 1, 2000, service as of July 1, 2000, and the Base Monthly Salary as of the retirement date.
(b)    Group III Employees.
For purposes of this paragraph, a "Group III Employee" shall mean a U.S. Visteon Employee who participated in the GRP prior to July 1, 2000 other than a Group I or Group II Employee.  The Plan shall have no liability for any Executive Separation Allowance payable to Group III Employees who were otherwise eligible hereunder with respect to service prior to July 1, 2000 on or after July 1, 2000.   
Section 9.  Code Section 409A

		
	(a)
	The provisions of Code Section 409A are incorporated into the Plan by reference to the extent necessary for any benefit provided under the Plan that is subject to Code Section 409A to comply with such requirements and, except as otherwise expressly determined by the Company, the Plan shall be administered in accordance with Code Section 409A as if the requirements of Code Section 409A were set forth herein.  The Company reserves the right to take such action, on a uniform and consistent basis, as the Company deems necessary or desirable to ensure compliance with Code Section 409A, and applicable additional regulatory guidance thereunder, or to achieve the goals of the Plan without having adverse tax consequences under this Plan for any employee or beneficiary.  Unless determined otherwise by the Company, any such action shall be taken in a manner that will enable any benefit provided under the Plan that is intended to be exempt from Code Section 409A to continue to be so exempt, or to enable any benefit provided under the Plan that is intended to comply with Code Section 409A to continue to so comply.

		
	(b)
	In no event shall any transfer of liabilities to or from this Plan result in an impermissible acceleration or deferral of any Executive Separation Allowance under Code Section 409A. In the event such a transfer would cause an impermissible acceleration or deferral under Code Section 409A, such transfer shall not occur.

9

		
	(c)
	In no event will application of any eligibility requirements under this Plan cause an impermissible acceleration or deferral of any Plan benefits under Code Section 409A.

		
	(d)
	In the event an Eligible Leadership Level One or Two Employee who is receiving, or is entitled to receive, an Executive Separation Allowance is reemployed following a Separation From Service, distribution of any Executive Separation Allowance shall not cease or be deferred upon such Eligible Leadership Level One or Two Employee's reemployment.

		
	(e)
	After receipt of any benefits under the Plan, the obligations of the Company with respect to such benefits shall be satisfied and no Eligible Leadership Level One or Two Employee, or such Eligible Leadership Level One or Two Employee's Eligible Surviving Spouse, beneficiary, or other person shall have any further claims against the Plan or the Company with respect to Plan benefits.

Section 10. Claim for Benefits

		
	10.01
	Denial of a Claim.  A claim for benefits under the Plan shall be submitted in writing to the Plan Administrator.  If a claim for benefits or participation is denied in whole or in part by the Plan Administrator, the claimant will receive written notification within 90 days from the date the claim for benefits or participation is received.  Such notice shall be deemed given upon mailing, full postage prepaid in the United States mail or on the date sent electronically to the claimant.  If the Plan Administrator determines that an extension of time to consider a claim and render a decision is needed, written notice of the extension shall be furnished to the claimant as soon as practical.

		
	10.02
	Review of Denial of Claim.  In the event that the Plan Administrator denies a claim for benefits or participation, the claimant may request a review by filing a written appeal. If the appeal is from an active Leadership Level One employee, a Named Executive Officer or any individual who, at any time, shall have been a member of the Board of Directors, the appeal will be heard by the Compensation Committee. If the appeal is from any other appellant, the appeal will be heard by the Committee. All appeals must be filed within sixty (60) days of the date of the written notification of denial.  The appeal will be considered and a decision shall be rendered within 90 days from the date the appeal is received. Under special circumstances, an extension of time to consider the appeal and render a decision may be needed, in which case a decision shall be rendered as soon as practical. In the event such an extension of time is needed to consider the appeal and render a decision, written notice of such time extension shall be provided to the appellant.

		
	10.03
	Decision on Appeal.  The decision on review of the appeal shall be in writing.  Such notice shall be deemed given upon mailing, full postage prepaid in the United States mail or on the date sent electronically to the appellant.  Decisions rendered on the 

10

appeal are final and conclusive and are only subject to the arbitrary and capricious standard of judicial review.

		
	10.04
	Limitations Period.  No legal action for benefits under the Plan may be brought against the Plan until after the claim and appeal procedures have been exhausted.  Legal actions under the Plan for benefits must be brought no later than two (2) years after the date of the denial of the appeal.  No other action may be brought against the Plan more than six (6) months after the date of the last action that gave rise to the claim.

		
	10.05
	Venue.  An individual shall only bring an action in connection with the Plan in the United States District Court for the Eastern District of Michigan.

11

Appendix A
Special Executive Separation Allowances

Named Executive Officers

Section 1.  Special Executive Separation Allowances Based on Notional Service and Salary.  Special Executive Separation Allowances will be provided to each Eligible Leadership Level One or Two Employee listed in Subsection 1.D below for the period of time during which such Eligible Leadership Level One or Two Employee did not receive a cash base salary from the Company by determining the Executive Separation Allowance that otherwise would have been provided to such Eligible Leadership Level One or Two Employee for such period using notional service and salary as follows; provided that, in no event shall an Eligible Leadership Level One or Two Employee receive both an Executive Separation Allowance and a Special Executive Separation Allowance for the same period of service:

A.  Contributory Service.  Contributory Service, if any, for each such Eligible Leadership Level One or Two Employee for any period of time during which the Eligible Leadership Level One or Two Employee did not receive a cash base salary shall be determined by the Committee, in its sole discretion, based on the Contributory Service the Eligible Leadership Level One or Two Employee would have accrued had the Eligible Leadership Level One or Two Employee participated in the Ford Motor Company GRP on a contributory basis during such period of time.

B.  Credited Service.  Credited Service, if any, for each such Eligible Leadership Level One or Two Employee for any period of time during which the Eligible Leadership Level One or Two Employee did not receive a cash base salary shall be determined by the Committee, in its sole discretion, based on the Credited Service the Eligible Leadership Level One or Two Employee would have accrued had the Eligible Leadership Level One or Two Employee participated in, and accrued Credited Service under, the Ford Motor Company GRP during such period of time.

C.  Base Monthly Salary.  Base Monthly Salary for each such Eligible Leadership Level One or Two Employee shall be determined by the Committee, in its sole discretion, based on a notional base monthly salary for the period of time during which the Eligible Leadership Level One or Two Employee did not receive a cash base salary.

D.  Affected Eligible Leadership Level One or Two Employees.  The following Eligible Leadership Level One or Two Employees' Special Executive Separation Allowances shall be determined in accordance with this Section:

William Clay Ford, Jr.

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