Document:

EX-4.n

 Exhibit 4.n 

Fidelity & Guaranty Life Insurance Company 

SURRENDER CHARGE WAIVER RIDER – IMPAIRMENT 

 
  

This rider is a part of the Contract to which it is attached. It is subject to the terms, conditions, and provisions contained in the Contract. The
following provisions are added to the Contract. This rider will supersede any conflicting provisions of the Contract. 
 The availability of access
to benefit guarantees or values is not intended to provide for long term care insurance. 
 RIDER SPECIFICATIONS TABLE 

 

			
	Impairment Qualifying Life	  	[Owner(s)]
	Impairment Ineligibility Period	  	[[1] Contract Year]
	Impairment Qualification Period	  	[90] consecutive days

 RIDER OVERVIEW 
 WHEN
IS THIS RIDER EFFECTIVE? 
 The rider effective date is the Issue Date. 

WHAT BENEFIT DOES THIS RIDER PROVIDE? 
 Subject to the
terms and qualification criteria outlined in this rider, any applicable Surrender Charges may be waived on Withdrawal and Surrender if the Impairment Qualifying Life is Impaired; this waiver is in lieu of, and not in addition to, any other Surrender
Charge waiver available under Your Contract, including those attached by rider and/or endorsement. 
 When this waiver is available and applied, the
Contract’s Account Value will not include application of a Surrender Charge. 
 RIDER SPECIFICATIONS 

WHAT SPECIFICATIONS APPLY TO THIS SURRENDER CHARGE WAIVER? 

This rider uses an Impairment Qualifying Life, Impairment Ineligibility Period, and Impairment Qualification Period. 

WHERE ARE THE SPECIFICATIONS LOCATED FOR THIS SURRENDER CHARGE WAIVER? 

All specifications applicable under this rider are shown in the Rider Specifications Table. 

WHICH SPECIFICATIONS ARE GUARANTEED? 
 All specifications
under this rider are guaranteed, including Impairment Qualifying Life, Impairment Ineligibility Period, and Impairment Qualification Period. These specifications are set on the rider effective date and will not change. 

WHICH SPECIFICATIONS ARE NOT GUARANTEED AND ARE SUBJECT TO CHANGE? 

All specifications applicable under this rider are guaranteed. However, the person(s) considered the Impairment Qualifying Life may change due to underlying
changes in Your base Contract. For example, if the Impairment Qualifying Life is Owner(s) and a change in Owner occurs, then qualification after the change is based on the new Owner(s). Similarly, if the Impairment Qualifying Life is Annuitant(s)
and a change in Annuitant occurs, then qualification after the change is based on the new Annuitant(s). 
 Any change to Owner(s) or Annuitant(s) is subject
to the limitations of Your base Contract. If the Impairment Qualifying Life is Owner(s), then in the case of Non-Natural Owners, the Impairment Qualifying Life shall be any Annuitant(s). 

  
 [1] 

RILA-SCWR-IMP (05-22) 

 Fidelity & Guaranty Life Insurance Company 

SURRENDER CHARGE WAIVER RIDER – IMPAIRMENT (CONTINUED) 

 
  

 RIDER DEFINITIONS 

ACTIVITIES OF DAILY LIVING (ADL) 
 Activities of Daily
Living include: 
  

	 	•	 	 Bathing: washing oneself by sponge bath or in either a tub or shower, including the tasks of getting into or out
of the tub or shower; 

  

	 	•	 	 Dressing: putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial
limbs; 

  

	 	•	 	 Transferring: sufficient mobility to move into or out of a bed, chair, or wheelchair or to move from place to
place, either via walking, a wheelchair, or other means; 

  

	 	•	 	 Toileting: getting to and from the toilet, getting on and off the toilet, and performing associated personal
hygiene; 

  

	 	•	 	 Continence: ability to maintain control of bowel or bladder function or, when unable to maintain control of bowel
or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag); 

  

	 	•	 	 Eating: feeding oneself by getting food into the body from a receptacle (such as a cup, plate, or table) or by
feeding tube or intravenously. 

 IMPAIRMENT QUALIFYING LIFE 

Impairment Qualifying Life means the person or persons whose Impairment may result in qualification to utilize the Surrender Charge waiver, assuming all other
qualifications outlined in this rider are met. Impairment Qualifying Life is shown in the Rider Specifications Table. 
 IMPAIRED 

Impaired means unable to perform at least two (2) of the six (6) Activities of Daily Living without the physical assistance of another person, or the
presence of another person within arm’s reach to prevent, by physical intervention, injury to the Impaired individual while performing the two (2) of six (6) Activities of Daily Living. 

IMPAIRMENT 
 Impairment means the state of being Impaired.
Impairment must be certified by a licensed Physician. 
 PHYSICIAN 

Physician means a doctor of medicine who is: 
  

	 	•	 	 Duly qualified; 

  

	 	•	 	 Licensed in the United States of America; and 

 

	 	•	 	 Performing within the scope of his or her license. 

A Physician must not be: You; the Annuitant; or the brother, sister, parent, Spouse, or child of either You or the Annuitant or any spouse of the above. 

WRITTEN PROOF OF IMPAIRMENT 
 Written Proof of Impairment
means documentation from the attending Physician of the Impairment Qualifying Life providing sufficient detail as to the Impairment Qualifying Life’s Impairment. 

  
 [2] 

RILA-SCWR-IMP (05-22) 

 Fidelity & Guaranty Life Insurance Company 

SURRENDER CHARGE WAIVER RIDER – IMPAIRMENT (CONTINUED) 

 
  

 SURRENDER CHARGE WAIVER REQUEST 

WHAT IMPAIRMENT QUALIFICATIONS MUST BE MET PRIOR TO WAIVER REQUEST? 

Surrender Charges may be waived upon receipt of Written Request for this benefit if all the following qualification criteria are met: 

 

	 	•	 	 The Impairment Qualifying Life shown in the Rider Specifications Table is Impaired. 

 

	 	•	 	 Impairment begins after the rider effective date. 

 

	 	•	 	 Impairment has continued for at least the Impairment Qualification Period. The Impairment Qualification Period is
shown in the Rider Specifications Table and is measured in terms of consecutive days. The Impairment Qualification Period may begin during the Impairment Ineligibility Period; however, the Surrender Charge Waiver request may not be made until both
the Impairment Ineligibility Period and Impairment Qualification Period have elapsed. No Surrender Charge applied during the Impairment Ineligibility Period will be waived. 

WHEN CAN THE SURRENDER CHARGE WAIVER REQUEST BE MADE? 

You may request the waiver of Surrender Charges after the Impairment Ineligibility Period has elapsed and all requirements outlined in the WHAT IMPAIRMENT
QUALIFICATIONS MUST BE MET PRIOR TO WAIVER REQUEST provision are satisfied. The waiver is not available during the Impairment Ineligibility Period. 

WHAT DOCUMENTATION IS REQUIRED TO REQUEST THE SURRENDER CHARGE WAIVER? 

We will require a Written Request for the Surrender Charge waiver. Written Request must be subsequently accompanied by Written Proof of Impairment while the
Impairment Qualifying Life is Impaired or within 90 days of the date on which the Impairment Qualifying Life was last Impaired. An exception to this time limit will be made for a period of up to one year when it can be shown that it was not
reasonably possible to make a Written Request and provide Written Proof of Impairment within the required time period. This time limit will be waived altogether in the absence of legal capacity. We reserve the right to request documentation at least
annually of continued Impairment. 
 WHEN DOES THE WAIVER APPLY, IF APPROVED? 

Surrender Charges will be waived on any Withdrawals or Surrender which occur after the Written Request and Written Proof of Impairment are received, subject to
Our approval. Written Proof of Impairment must be provided to Us according to the WHAT IMPAIRMENT QUALIFICATIONS MUST BE MET PRIOR TO WAIVER REQUEST and WHAT DOCUMENTATION IS REQUIRED TO REQUEST THE SURRENDER CHARGE WAIVER provisions. If Written
Proof of Impairment is not provided within the required time frame, then the Surrender Charge Waiver request will be denied and Surrender Charges will apply to any applicable Withdrawal or Surrender as described in the CAN THE REQUEST FOR SURRENDER
CHARGE WAIVER BE DENIED AND WHAT HAPPENS IF IT IS DENIED provision. 
 CAN THE REQUEST FOR SURRENDER CHARGE WAIVER BE DENIED AND WHAT HAPPENS IF IT IS
DENIED? 
 Yes; the request may be denied if (i) any of the above impairment qualification criteria are not met or (ii) the required
documentation is not provided. If Your request is denied, Withdrawal or Surrender proceeds will not be disbursed until You are notified of the denial and provided with the opportunity to accept or reject the proceeds including any Surrender Charge.

  
 [3] 

RILA-SCWR-IMP (05-22) 

 Fidelity & Guaranty Life Insurance Company 

SURRENDER CHARGE WAIVER RIDER – IMPAIRMENT (CONTINUED) 

 
  

 GENERAL PROVISIONS 

IS THIS RIDER PARTICIPATING AND DOES IT PROVIDE FOR PAYMENT OF DIVIDENDS? 

No; this Rider is not participating and dividends are not payable. 

IS THERE A CHARGE FOR THIS RIDER? 
 No; there is no
explicit charge deducted from your Account Value for this rider. 
 WHEN DOES THIS RIDER TERMINATE? 

The rider will terminate when the Contract terminates. Termination shall not prejudice the waiver of any Surrender Charges while the rider was in force. 

Signed for the Company. 
 Fidelity & Guaranty
Life Insurance Company 
  

	
	 [

	 Chris
Blunt                                        
            ]

	 President

  
 [4] 

RILA-SCWR-IMP (05-22)EX-4.o

 Exhibit 4.o 

Fidelity & Guaranty Life Insurance Company 

SURRENDER CHARGE WAIVER RIDER – NURSING HOME CONFINEMENT 

 
  

This rider is a part of the Contract to which it is attached. It is subject to the terms, conditions, and provisions contained in the Contract. The
following provisions are added to the Contract. This rider will supersede any conflicting provisions of the Contract. 
 The availability of access
to benefit guarantees or values is not intended to provide for nursing home insurance. 
 RIDER SPECIFICATIONS TABLE 

 

			
	Nursing Home Qualifying Life	  	[Owner(s)]
	Nursing Home Ineligibility Period	  	[[1] Contract Year]
	Nursing Home Qualification Period	  	[60] consecutive days

 RIDER OVERVIEW 
 WHEN
IS THIS RIDER EFFECTIVE? 
 The rider effective date is the Issue Date. 

WHAT BENEFIT DOES THIS RIDER PROVIDE? 
 Subject to the
terms and qualification criteria outlined in this rider, any applicable Surrender Charges may be waived on Withdrawal and Surrender if the Nursing Home Qualifying Life is confined to a Nursing Home; this waiver is in lieu of, and not in addition to,
any other Surrender Charge waiver available under Your Contract, including those attached by rider and/or endorsement. 
 When this waiver is available and
applied, the Contract’s Account Value will not include application of a Surrender Charge. 
 RIDER SPECIFICATIONS 

WHAT SPECIFICATIONS APPLY TO THIS SURRENDER CHARGE WAIVER? 

This rider uses a Nursing Home Qualifying Life, Nursing Home Ineligibility Period, and Nursing Home Qualification Period. 

WHERE ARE THE SPECIFICATIONS LOCATED FOR THIS SURRENDER CHARGE WAIVER? 

All specifications applicable under this rider are shown in the Rider Specifications Table. 

WHICH SPECIFICATIONS ARE GUARANTEED? 
 All specifications
under this rider are guaranteed, including Nursing Home Qualifying Life, Nursing Home Ineligibility Period, and Nursing Home Qualification Period. These specifications are set on the rider effective date and will not change. 

WHICH SPECIFICATIONS ARE NOT GUARANTEED AND ARE SUBJECT TO CHANGE? 

All specifications applicable under this rider are guaranteed. However, the person(s) considered the Nursing Home Qualifying Life may change due to underlying
changes in Your base Contract. For example, if the Nursing Home Qualifying Life is Owner(s) and a change in Owner occurs, then qualification after the change is based on the new Owner(s). Similarly, if the Nursing Home Qualifying Life is
Annuitant(s) and a change in Annuitant occurs, then qualification after the change is based on the new Annuitant(s). 
 Any change to Owner(s) or
Annuitant(s) is subject to the limitations of Your base Contract. If the Nursing Home Qualifying Life is Owner(s), then in the case of Non-Natural Owners, the Nursing Home Qualifying Life shall be any
Annuitant(s). 

  
 [1] 

RILA-SCWR-NHC (05-22) 

 Fidelity & Guaranty Life Insurance Company 

SURRENDER CHARGE WAIVER RIDER – NURSING HOME CONFINEMENT (CONTINUED) 

 
  

 RIDER DEFINITIONS 

NURSING HOME 
 Nursing Home means a state-licensed, nursing
long-term care facility that provides skilled, continuous nursing care or service under the supervision of a licensed nurse or physician. 
 NURSING HOME
QUALIFYING LIFE 
 Nursing Home Qualifying Life means the person or persons whose confinement to a Nursing Home may result in qualification to utilize
the Surrender Charge waiver, assuming all other qualifications outlined in this rider are met. Nursing Home Qualifying Life is shown in the Rider Specifications Table. 

WRITTEN PROOF OF CONFINEMENT 
 Written Proof of
Confinement means documentation providing sufficient detail that the Nursing Home Qualifying Life is confined to a Nursing Home. 
 SURRENDER CHARGE
WAIVER REQUEST 
 WHAT CONFINEMENT QUALIFICATIONS MUST BE MET TO REQUEST THE SURRENDER CHARGE WAIVER? 

Surrender Charges may be waived upon receipt of Written Request for this benefit if all the following qualification criteria are met: 

 

	 	•	 	 The Nursing Home Qualifying Life shown in the Rider Specifications Table is confined to a Nursing Home.

  

	 	•	 	 Confinement to such Nursing Home begins after the rider effective date. 

 

	 	•	 	 Confinement to the Nursing Home has continued for at least the Nursing Home Qualification Period. The Nursing
Home Qualification Period is shown in the Rider Specifications Table and is measured in terms of consecutive days. Confinement to the Nursing Home may begin during the Nursing Home Ineligibility Period; however, the Surrender Charge Waiver request
may not be made until both the Nursing Home Ineligibility Period and Nursing Home Qualification Period have elapsed. No Surrender Charge applied during the Nursing Home Ineligibility Period will be waived. 

WHEN CAN THE SURRENDER CHARGE WAIVER REQUEST BE MADE? 

You may request the waiver of Surrender Charges after the Nursing Home Ineligibility Period has elapsed and all requirements outlined in the WHAT CONFINEMENT
QUALIFICATIONS MUST BE MET PRIOR TO WAIVER REQUEST provision are satisfied. The waiver is not available during the Nursing Home Ineligibility Period. 

WHAT DOCUMENTATION IS REQUIRED TO REQUEST THE SURRENDER CHARGE WAIVER? 

We will require a Written Request for the Surrender Charge waiver. Written Request must be subsequently accompanied by Written Proof of Confinement while the
Nursing Home Qualifying Life is Confined or within 90 days of the date on which the Nursing Home Qualifying Life was last Confined. An exception to this time limit will be made for a period of up to one year when it can be shown that it was not
reasonably possible to make a Written Request and provide Written Proof of Confinement within the required time period. This time limit will be waived altogether in the absence of legal capacity. We reserve the right to request documentation at
least annually of continued confinement to a Nursing Home. 
 WHEN DOES THE WAIVER APPLY, IF APPROVED? 

Surrender Charges will be waived on any Withdrawals or Surrender which occur after the Written Request and Written Proof of Confinement are received, subject
to Our approval. Written Proof of Confinement must be provided to Us according to the WHAT CONFINEMENT QUALIFICATIONS MUST BE MET PRIOR TO WAIVER REQUEST and WHAT DOCUMENTATION IS REQUIRED TO REQUEST THE SURRENDER CHARGE WAIVER provisions. If
Written Proof of Confinement is not provided within the required time frame, then the Surrender Charge Waiver request will be denied and Surrender Charges will apply to any applicable Withdrawal or Surrender as described in the CAN THE REQUEST FOR
SURRENDER CHARGE WAIVER BE DENIED AND WHAT HAPPENS IF IT IS DENIED provision. 
 CAN THE REQUEST FOR SURRENDER CHARGE WAIVER BE DENIED AND WHAT HAPPENS
IF IT IS DENIED? 
 Yes; the request may be denied if (i) any of the above confinement qualification criteria are not met or (ii) the required
documentation is not provided. If Your request is denied, Withdrawal or Surrender proceeds will not be disbursed until You are notified of the denial and provided with the opportunity to accept or reject the proceeds including any Surrender Charge.

  
 [2] 

RILA-SCWR-NHC (05-22) 

 Fidelity & Guaranty Life Insurance Company 

SURRENDER CHARGE WAIVER RIDER – NURSING HOME CONFINEMENT (CONTINUED) 

 
  

 GENERAL PROVISIONS 

IS THIS RIDER PARTICIPATING AND DOES IT PROVIDE FOR PAYMENT OF DIVIDENDS? 

No; this Rider is not participating and dividends are not payable. 

IS THERE A CHARGE FOR THIS RIDER? 
 No; there is no
explicit charge deducted from your Account Value for this rider. 
 WHEN DOES THIS RIDER TERMINATE? 

The rider will terminate when the Contract terminates. Termination shall not prejudice the waiver of any Surrender Charges while the rider was in force. 

Signed for the Company. 
 Fidelity & Guaranty
Life Insurance Company 
  

	
	 [

	 Chris
Blunt                                        
            ]

	 President

  
 [3] 

RILA-SCWR-NHC (05-22)

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