Document:

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THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK

ENDORSEMENT

Notwithstanding any provision in the Contract or Certificate (“Contract”) to the
contrary, this Endorsement becomes a part of the Contract to which it is attached. Should any
provision in this Endorsement conflict with the Contract, the provisions of this Endorsement will
prevail.

	 	 	“Pursuant to Section 3 of the federal Defense of Marriage Act (“DOMA”), same-sex marriages
currently are not recognized for purposes of federal law. Therefore, the favorable
income-deferral options afforded by federal tax law to an opposite-sex spouse under Internal
Revenue Code sections 72(s) and 401(a)(9) are currently NOT available to a same-sex spouse.
Same-sex spouses who own or are considering the purchase of annuity products that provide
benefits based upon status as a spouse should consult a tax advisor. To the extent that an
annuity contract or certificate accords to spouses other rights or benefits that are not
affected by DOMA, same-sex spouses remain entitled to such rights or benefits to the same
extent as any annuity holder’s spouse.”

Signed for the Company to be effective as of the Contract Date.

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK

 ¬1

FSE-6249 (12/09)exv4wu

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK

OPTIONAL GUARANTEED LIVING BENEFIT ENDORSEMENT

Notwithstanding any provision in the Contract or Certificate (“Contract”) to the contrary, this
Endorsement becomes a part of the Contract to which it is attached. Should any provision in this
Endorsement conflict with the Contract, the provisions of this Endorsement will prevail.

Subject to the terms and conditions set forth herein this optional Guaranteed Living Benefit
Endorsement provides for guaranteed income over the lifetime of the Covered Person(s). You may
take Withdrawals under the Guaranteed Living Benefit as prescribed by this Endorsement while this
Endorsement is in effect.

ENDORSEMENT DATA PAGE

	 	 	 
	COVERED PERSON(S):

	 	[John Doe

Jane Doe]¬1
	 
	 	 
	ENDORSEMENT EFFECTIVE DATE:

	 	[May 1, 2011]¬1
	 
	 	 
	ELIGIBLE PURCHASE PAYMENTS:

	 	2®[100%] of Purchase Payments received in the3® [1st] Contract Year
	 
	 	 
	GROSS PURCHASE PAYMENT LIMIT:  
4®

	 	The sum of Purchase Payments cannot exceed [$1,500,000] without prior
Company approval
	 
	 	 
	SECURE VALUE ACCOUNT ALLOCATION:  
5®

	 	[20%] of every Purchase Payment(s), Spousal Beneficiary Contribution, and
Payment Enhancements if applicable

	 	 	 

	ENDORSEMENT FEE:

	 	 ̄6 

The Endorsement Fee is assessed against the Income Base and deducted from the Contract Value
allocated to the Variable Portfolio(s) or Subaccount(s) at the end of each Benefit [Quarter]. The
Initial Annual Fee Rate is guaranteed not to change for the [first] Benefit [Year]. After the
[first] Benefit [Year], on each Benefit [Quarter Anniversary], we will (1) deduct the fee in effect
for the previous Benefit [Quarter]; and (2) determine the fee rate applicable to the next Benefit
[Quarter]. The fee rate can increase or decrease each Benefit [Quarter], subject to the minimums
and maximums in the table below:

 ̄7

	 	 	 	 	 	 	 	 	 
	Number of Covered	 	 	 	 	 	 	 	Maximum Annualized
	Persons on	 	 	 	 	 	 	 	Fee Rate Increase or
	Endorsement	 	Initial Annual	 	Maximum Annual	 	Minimum Annual	 	Decrease Each Benefit
	Effective Date	 	Fee Rate	 	Fee Rate	 	Fee Rate	 	[Quarter]¬6*
	One Covered Person
	 	[1.10%]
	 	[2.20%]
	 	[0.60%]
	 	+/- [0.25%]
	Two Covered Persons
	 	[1.35%]
	 	[2.70%]
	 	[0.60%]
	 	+/- [0.25%]

 

			
	*	 	The fee rate can increase or decrease no more than [0.0625%] each quarter [(0.25%/4)].

	 	 	 
	INCOME CREDIT PERCENTAGE:

	 	[8%] ¬8
	INCOME CREDIT PERIOD:

	 	Beginning on the Endorsement Effective Date and
ending [12]¬9years later

MAXIMUM ANNUAL WITHDRAWAL AND PROTECTED INCOME PAYMENT PERCENTAGES:

 ̄10

	 	 	 	 	 	 	 	 	 
	 	 	Maximum Annual Withdrawal	 	 
	 	 	Percentage	 	Protected Income Payment Percentage
	Age at First	 	One Covered	 	Two Covered	 	One Covered	 	 
	Withdrawal	 	Person	 	Persons	 	Person	 	Two Covered Persons
	[Less than Age 65

	 	[3.75%]
	 	[3.25%]
	 	[3.75%]
	 	[3.25%]
	Age 65 and older]¬11

	 	[4.75%]
	 	[4.25%]
	 	[4.75%]
	 	[4.25%]

	 	 	 
	MINIMUM INCOME BASE:

	 	[200%]¬12 of Eligible Purchase Payments received in the
[1st] Benefit [Year] effective on the
[12th] Benefit [Year] Anniversary provided
no Withdrawals are taken before the [12th]
Benefit [Year] Anniversary.

á6;9

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DEFINITIONS

For purposes of this Endorsement, the following definitions apply. Terms not defined in this
Endorsement shall have the same meaning as defined in the Contract.

AGE

The attained age as of the Covered Person’s last birthday. If there are two Covered Persons on the
Endorsement Data Page, the Age of the younger Covered Person or in the event of the death of one
Covered Person, the surviving Covered Person as of their last birthday.

	 	 	 

	BENEFIT ANNIVERSARY VALUE

	 	 ̄6 

The Contract Value including any applicable Payment Enhancement(s) or Spousal Beneficiary
Continuation Contribution minus cumulative Ineligible Purchase Payments, as measured on each
Benefit [Year] Anniversary.

BENEFIT [QUARTER]

Each consecutive [3 month] period starting on the Endorsement Effective Date.

BENEFIT [QUARTER] ANNIVERSARY

The date following each consecutive [3 month] period starting on the Endorsement Effective Date.
If the next Benefit [Quarter] Anniversary is on any non-business day of the month for which there
is no corresponding date the Benefit [Quarter] Anniversary will be deemed to be the following
business day.

BENEFIT [YEAR]

Each consecutive [one] [year] period starting on the Endorsement Effective Date.

BENEFIT [YEAR] ANNIVERSARY

The date on which each Benefit Year begins.

CONTRACT YEAR

Each consecutive one year period starting on the Contract Date.

COVERED PERSON(S)

The person(s) named on the Endorsement Data Page whose lives are used to determine the amount and
duration of Withdrawals.

ELIGIBLE PURCHASE PAYMENTS

Purchase Payments or portions thereof made on or after the Endorsement Effective Date as shown on
the Endorsement Data Page that are included in the calculation of the Income Base. If this
Endorsement is added after the Contract Date, for purposes of determining the Income Base, Income
Credit Base, if applicable, and Minimum Income Base, if applicable, the Contract Value on the
Endorsement Effective Date is considered the initial Eligible Purchase Payment and Purchase
Payments added prior to the Endorsement Effective Date are not considered Eligible Purchase
Payments. The calculation of Eligible Purchase Payments does not include Payment Enhancements,
Income Credits, or Spousal Beneficiary Continuation contribution, if any.

ENDORSEMENT EFFECTIVE DATE

The date when this Endorsement becomes effective as shown on the Endorsement Data Page.

EXCESS WITHDRAWAL

Any Withdrawal in a Benefit [Year] taken after the Maximum Annual Withdrawal Amount has
been withdrawn, or any portion of a Withdrawal that causes the total Withdrawals in a Benefit
[Year] to exceed the Maximum Annual Withdrawal Amount.

HIGHEST ANNIVERSARY VALUE

The Benefit Anniversary Value that is the greater of (1) all Benefit Anniversary Values; and (2)
Eligible Purchase Payments, while this Endorsement is effective and the Contract Value is greater
than zero.

INCOME BASE

The Income Base is used to determine the Endorsement Fee, the Maximum Annual Withdrawal Amount and
the Protected Income Payment.

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INCOME CREDIT

An amount that may be added to the Income Base during the Income Credit Period that is equal to the
Income Credit Percentage multiplied by the Income Credit Base.

INCOME CREDIT BASE

A factor which is used to determine the amount of any Income Credit during the Income Credit
Period.

INCOME CREDIT PERIOD

The period of time over which We calculate an Income Credit that may be added to the Income Base.

INELIGIBLE PURCHASE PAYMENTS

Purchase Payments or portions thereof that are not included in the calculations of the Income Base,
Minimum Income Base, and the Income Credit Base.

MAXIMUM ANNUAL WITHDRAWAL AMOUNT

The maximum amount that may be withdrawn each Benefit Year while the Contract Value is greater than
zero without reducing the Income Base and the Income Credit Base, if applicable.

MAXIMUM ANNUAL WITHDRAWAL PERCENTAGE
         
  ̄6 

The percentage, as referenced on the Endorsement Data Page used to determine the Maximum Annual
Withdrawal Amount available for Withdrawal each Benefit [Year] while the Contract Value is greater
than zero and the Covered Person(s) is living.

MINIMUM INCOME BASE

The guaranteed minimum amount to which the Income Base and the Income Credit Base, if applicable,
could be increased on a specified Benefit Year Anniversary provided no Withdrawals are taken before
the [12th ] ¬9Benefit [Year] Anniversary.

PROTECTED INCOME PAYMENT

The amount to be paid each year over the remaining lifetime of the Covered Person(s) after the
Contract Value is reduced to zero but the Income Base is still greater than zero.

PROTECTED INCOME PAYMENT PERCENTAGE

The percentage, as referenced on the Endorsement Data Page, used to determine the Protected Income
Payment.

YOU, YOUR

The Covered Person(s) under this Endorsement.

GUARANTEED LIVING BENEFIT PROVISIONS

The Guaranteed Living Benefit described in this Endorsement provides for guaranteed Withdrawals
over the lifetime of the Covered Person(s), subject to the following provisions:

Calculation of the Factors of the Guaranteed Living Benefit

To determine the Guaranteed Living Benefit, We use the following factors: Income Base, Income
Credit Base, Income Credit, Income Credit Percentage, Income Credit Period, Minimum Income Base,
and Maximum Annual Withdrawal Amount. These factors are not used in the calculation of the
Contract Value or any other benefits under the Contract.

Withdrawals taken under this Living Benefit are treated like any other Withdrawal under the
Contract for purposes of calculating Contract Value, including any fees and charges applicable to
such Withdrawals and any other benefits under the Contract. In any Benefit Year, Withdrawals up to
Maximum Annual Withdrawal Amount are free of Withdrawal Charges.

Calculation of the Income Base

Calculation of the Income Base if the Endorsement is Elected on the Contract Date

If this Living Benefit is elected on the Contract Date, the initial Income Base is equal to
the initial Eligible Purchase Payment.

Calculation of the Income Base if the Endorsement is Elected After the Contract Date

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If this Living Benefit is elected after the Contract Date, the initial Income Base is
the Contract Value on the Endorsement Effective Date, which is considered the initial
Eligible Purchase Payment and is subject to the Eligible Purchase Payment limits shown on
the Endorsement Data Page.

 ̄6

Thereafter, on each Benefit [Year] Anniversary, the Income Base is automatically increased
to the greater of (a), or (b) where:

(a) is the Highest Anniversary Value; and

(b) is the current Income Base, plus the Income Credit, if any.

The Income Base will continue to be calculated on each Benefit [Year] Anniversary while this
Endorsement is in effect and both the Contract Value and Income Base are greater than zero.

Calculation of the Income Credit Base

Calculation of the Income Credit Base if the Endorsement is Elected on the Contract Date

The Income Credit Base is used to calculate the amount of the Income Credit during the
Income Credit Period. If this Living Benefit is elected on the Contract Date, the initial
Income Credit Base is equal to the initial Eligible Purchase Payment.

Calculation of the Income Credit Base if the Endorsement is Elected After the Contract Date

If this Living Benefit is elected after the Contract Date, the initial Income Credit Base is
the Contract Value on the Endorsement Effective Date, which is considered the initial
Eligible Purchase Payment and is subject to the Eligible Purchase Payment limits shown on
the Endorsement Data Page.

Thereafter, the Income Credit Base is increased and decreased as follows:

Increases in the Income Credit Base

The Income Credit Base increases each time Eligible Purchase Payments are made. The Income
Credit Base also increases to the Highest Anniversary Value when the Income Base is
increased to the Highest Anniversary Value.

Decreases in the Income Credit Base

The Income Credit Base decreases each time an Excess Withdrawal is taken, in the same
proportion by which the Contract Value is reduced by the amount in excess of the Maximum
Annual Withdrawal Amount.

Calculation of the Income Credit

On each Benefit Year Anniversary during the Income Credit Period, if Withdrawals were not
taken during the previous Benefit [Year], the Income Credit is determined by multiplying the
Income Credit Percentage by the Income Credit Base. If any Withdrawals were taken in the
previous Benefit [Year], then the Income Credit is reduced to zero for that Benefit [Year].

Calculation of the Minimum Income Base

Calculation of the Minimum Income Base if the Endorsement is Elected on the Contract Date

If this Living Benefit is elected on the Contract Date, the Minimum Income Base is as shown
on the Endorsement Data Page.

Calculation of the Minimum Income Base if the Endorsement is Elected After the Contract Date

If this Living Benefit is elected after the Contract Date, the Minimum Income Base is
[200%] ¬12of the Contract Value on the Endorsement Effective Date and is considered the initial
Eligible Purchase Payment and is subject to the Eligible Purchase Payment limits shown on
the Endorsement Data Page.

The Income Base and Income Credit Base, if applicable, will be increased to at least the
Minimum Income Base on the [12th] Benefit Year Anniversary, provided no
Withdrawals are taken prior to that anniversary. If You are eligible for the Minimum Income
Base, the Income Base on the [12th]¬2 Benefit [Year] Anniversary is the greater of
(a) or (b), where:

(a) is the current Income Base; and

(b) is the Minimum Income Base.

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Calculation of the Maximum Annual Withdrawal Amount

The Maximum Annual Withdrawal Amount is calculated by multiplying the Income Base by the Maximum
Annual Withdrawal Percentage as shown on the Endorsement Data Page ,which is determined by Your Age
at the time You take Your first Withdrawal from Your Contract.

 ̄6

Withdrawals during a Benefit [Year] that in total are less than or equal to the Maximum Annual
Withdrawal Amount will not reduce the Maximum Annual Withdrawal Amount and the Income Base, and the
Income Credit Base if applicable. If you take an Excess Withdrawal in a Benefit [Year], the Income
Credit is reduced to zero for that Benefit [Year]. If You choose to take less than the Maximum
Annual Withdrawal Amount in any Benefit [Year], You may not carry over the unused amount for
withdrawal in subsequent Benefit [Years]. Your Maximum Annual Withdrawal Amount in any year will
not be recalculated solely as a result of taking less than the entire Maximum Annual Withdrawal
Amount in the prior year.

Calculation of the Protected Income Payment

If you have taken Withdrawals up to the Maximum Annual Withdrawal Amount but your Contract
Value has been reduced to zero due to unfavorable investment performance, if you live longer
than expected, or any combination of these factors, You may be eligible to receive the
Protected Income Payment. When the Contract Value is reduced to zero, but the Income Base
is still greater than zero, the Protected Income Payment is calculated by multiplying the
Income Base by the applicable Protected Income Payment Percentage, which is determined by
Your Age at the time You take Your first Withdrawal from Your Contract, as shown on the
Endorsement Data Page. Thereafter, You will receive the Protected Income Payment each year
for the remaining lifetime of the Covered Person.

The following describes how increases and decreases in the Income Base can impact Your Maximum
Annual Withdrawal Amount

Increases in the Income Base

The Income Base is increased anytime an Eligible Purchase Payment is allocated to Your Contract.
The Income Base is also increased by any available Income Credit on any Benefit [Year] Anniversary
during the Income Credit Period, or as a result of a Highest Anniversary Value being achieved
resulting in the Income Base being stepped up on a Benefit [Year] Anniversary. In addition, the
Income Base can also be increased to the Minimum Income Base on the [12th]
¬9 Benefit
[Year] Anniversary, provided no Withdrawals are taken before the [12th]
¬9 Benefit [Year]
Anniversary. In any Benefit [Year] during which Eligible Purchase Payments are allocated to Your
Contract, any remaining Withdrawals of the Maximum Annual Withdrawal Amount will be based on the
increased Maximum Annual Withdrawal Amount reduced by Withdrawals previously taken in that Benefit
[Year]. If the Income Base is increased on a Benefit [Year] Anniversary, the Maximum Annual
Withdrawal Amount will be recalculated on that Benefit [Year] Anniversary, for the upcoming Benefit
[Year], by multiplying the increased Income Base by the applicable Maximum Annual Withdrawal
Percentage. The Endorsement Fee will be assessed on the increased Income Base.

Decreases in the Income Base

Excess Withdrawals reduce Your Income Base on the date the Excess Withdrawal occurs. Any Excess
Withdrawal in a Benefit [Year] reduces the Income Base in the same proportion by which the Contract
Value is reduced by the Excess Withdrawal. As a result of a reduction of the Income Base, the
Maximum Annual Withdrawal Amount will also be reduced. The new Maximum Annual Withdrawal Amount
will be equal to the reduced Income Base multiplied by the applicable Maximum Annual Withdrawal
Percentage. The last recalculated Maximum Annual Withdrawal Amount in a given Benefit [Year] is
available for Withdrawal at the beginning of the next Benefit [Year] and may be lower than the
previous Benefit [Year’s] Maximum Annual Withdrawal Amount. When the Contract Value is less than
the Income Base, Excess Withdrawals will reduce the Income Base by an amount which is greater than
the amount of the Excess Withdrawal. In addition, no Income Credit will be added to the Income
Base in that Benefit [Year].

Required Minimum Distributions

This provision applies only to the Contract to which this Endorsement is attached. If you are
taking Required Minimum Distributions and the Required Minimum Distribution amount, based only on
this Contract, is greater than the Maximum Annual Withdrawal Amount in any given Benefit [Year], no
portion of the Required Minimum Distribution will be treated as an Excess Withdrawal provided you
enroll in the Company’s systematic withdrawal program for Required Minimum Distributions. However,
any portion of a Withdrawal in a Benefit [Year] that is more than the greater of both the Maximum
Annual Withdrawal Amount and the Required Minimum Distribution amount will be considered an Excess
Withdrawal for the purpose of the recalculation of the Income Credit Base, if applicable, Income
Base and Maximum Annual Withdrawal Amount.

If Your Contract Value is Reduced to Zero

If Your Contract Value is reduced to zero because of an Excess Withdrawal, no further benefits will
be payable under this Endorsement or the Contract, and Your Contract along with the Endorsement
will terminate. However, if You have taken Withdrawals up to the Maximum Annual Withdrawal Amount
and Your Contract Value is reduced to zero due to unfavorable

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 ̄6

investment performance and/or fees, if you live longer than expected, or any combination of these
factors, and the Income Base is greater than zero, We will pay the remaining Maximum Annual
Withdrawal Amount for that Benefit [Year] in the same frequency withdrawals had been taken, i.e.
monthly or quarterly. Thereafter, we will pay the Protected Income Payment over the remaining
lifetime of the Covered Person(s) which will be calculated by multiplying the Income Base by the
Protected Income Payment Percentage, as shown on the Endorsement Data Page.

Because the Contract Value has been reduced to zero, the Income Base will no longer be increased to
the Highest Anniversary Value nor will Income Credits be applied, if applicable. In addition, all
other benefits under the Contract, will be terminated and You may no longer make subsequent
Purchase Payments or transfers, and no Death Benefit is payable.

When the Contract Value equals zero and the Income Base is greater than zero, to receive any
remaining Living Benefit, you must select one of the following options:

	 	1.	 	The current Protected Income Payment, divided equally and paid on a monthly, quarterly,
semi-annual or annual frequency as selected by You until the date of Your death(s); or
	 
	 	2.	 	Any payment option mutually agreeable between You and Us.

Once You elect a payment option, it cannot be changed. If You do not select a payment option
above, the remaining benefit will be paid as an amount based on the Protected Income Payment
Percentage. This amount will be divided equally and paid on a [quarterly] basis until the date of
death of the Covered Person(s).

Latest Annuity Date

If the Contract Value and the Income Base are greater than zero on the Latest Annuity Date, You
must select one of the following options:

	 	1.	 	Annuitize the Contract Value under the Annuity Provisions of the Contract; or
	 
	 	2.	 	Elect to receive the current Protected Income Payment, as of the Latest Annuity Date,
divided equally and paid on a monthly, quarterly, semi-annual or annual frequency as
selected by You until the date of death of the Covered Person(s); or
	 
	 	3.	 	Any payment option mutually agreeable between You and Us.

If You do not select an option listed above, on the Latest Annuity Date, We may annuitize the
Contract Value in accordance with Annuity Provisions of the Contract, option 2 above or payments
that do not exceed Your life expectancy as required by the IRS.

Secure Value Account Allocation

The Secure Value Account Allocation as shown on the Endorsement Data Page, is required only while
the Endorsement is effective. Amounts allocated to the Secure Value Account are not subject to the
Separate Account Charge. We will not rebalance amounts allocated to the Secure Value Account in
accordance with the automatic asset rebalancing program. You may not transfer into or out of the
Secure Value Account. You may not request the entire amount of any Withdrawal to be deducted
solely from the Secure Value Account. Rather, any Withdrawal reduces the amount invested in the
Secure Value Account in the same proportion that the Withdrawal reduces the Contract Value.

Investment Requirements

In addition to the Secure Value Account Allocation while the Endorsement is effective, We require
that you allocate your Purchase Payment(s), Spousal Continuation Contribution, and Payment
Enhancements, if applicable, and Contract Value in accordance with established requirements stated
in the Prospectus. We require enrollment in a quarterly automatic asset rebalancing program that
complies with the investment requirements. In addition to quarterly asset rebalancing, We will
initiate rebalancing in accordance with your most current and compliant automatic asset rebalancing
instructions on file after any Withdrawal or transfer You initiate.

Termination of Withdrawals Over Two Lives

If there are two Covered Persons on the Endorsement Effective Date, Withdrawals guaranteed for the
life of one of the Covered Persons will terminate if:

	 	1.	 	One of the two Covered Persons is removed from the Endorsement due to any reason other
than death; or
	 
	 	2.	 	The Covered Persons are no longer married at the time of death of the first Covered
Person.

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Termination of Withdrawals guaranteed for the life of one Covered Person does not impact any
other terms and conditions of this Endorsement, including the applicable Endorsement Fee, which is
based on the number of Covered Persons on this Endorsement Effective Date.

 ̄6

Cancellation of the Guaranteed Living Benefit

You cannot cancel this Endorsement in the first [5]  ¬9
Benefit [Years] unless You surrender Your
Contract. You may cancel this Endorsement as detailed below. The Guaranteed Living Benefit may
not be re-elected or reinstated after a cancellation.

Cancellation Effective Date

If Your cancellation request is received:

	 	1.	 	In the first [5]¬9 Benefit [Years],
 the cancellation is effective on the [5th]
 ¬9 Benefit [Year] Anniversary;
	 
	 	2.	 	In any Benefit [Year] after the [5th]  ¬9
 Benefit [Year] Anniversary, the
cancellation is effective on the Benefit [Quarter] Anniversary following Our receipt of the
cancellation request.

This Endorsement and the Endorsement Fee will cancel automatically upon the occurrence of one of
the following:

	 	1.	 	Death of the Covered Person, or if there were two Covered Persons, upon the death of
the surviving Covered Person; or
	 
	 	2.	 	A Death Benefit is paid resulting in the Contract being terminated; or
	 
	 	3.	 	The Contract is annuitized; or
	 
	 	4.	 	An Excess Withdrawal that reduces the Contract Value and Income Base to zero; or
	 
	 	5.	 	Any change occurs that removes all Covered Persons from the Contract; or
	 
	 	6.	 	The Contract is cancelled or surrendered for any reason.

On the Cancellation Effective Date, amounts allocated to the Secure Value Account will be
automatically transferred to a 1-Year Fixed Account option, if available, or the Cash Management
Variable Portfolio. You may no longer allocate Purchase Payments to the Secure Value Account after
cancellation. From the day following the automated transfer, you may transfer this amount to
another available investment option under the Contract for a period of [90 days]  ¬13 during which the
transfer will not count against the annual number of free transfers or incur a transfer fee.

If You cancel the Endorsement or surrender Your Contract while Your Contract Value is greater than
zero, We will assess a pro-rata charge for the Endorsement Fee applicable to the Benefit [Quarter] ¬6
in which the cancellation or surrender occurs if the Contract was cancelled or surrendered before
the end of a Benefit [Quarter] ¬6. The pro-rated charge is calculated by multiplying the fee by the
number of days between the date when the prior fee was last assessed and the date of cancellation
or surrender, divided by the number of days between the prior and the next Benefit [Quarter] ¬6
Anniversaries. Thereafter, You will no longer be charged a fee.

Death of Covered Person(s)

If there is one Covered Person and that person dies, this Endorsement and the Endorsement Fee will
be terminated.

If there are two Covered Persons, upon the first death, if the surviving Covered Person elects to
continue the Contract, this Endorsement is also continued. Upon the election of continuation, the
Endorsement Effective Date and applicable Endorsement Fee based on two Covered Persons will not
change.

Signed for the Company to be effective on the Endorsement Effective Date.

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK

	 	 	 

	¬14

	 	 

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