Document:

va710nycontract

   Home Office:                  Service Center:  [2900 Westchester Avenue      [P.O. Box 24068  Purchase, New York 10577]     Lansing, MI 48909-4068                                   1-800-599-5651                                   www.jackson.com]                             Jackson National Life Insurance Company of New York®      Thank you for choosing Jackson National Life Insurance Company of New York, also referred to as "the   Company" or "Jackson of NY®."                                       READ YOUR CONTRACT CAREFULLY.      This annuity contract is issued by the Company and is a legal agreement between the Owner ("You") and   Jackson of NY.      AMOUNTS YOU ALLOCATE TO THE INVESTMENT DIVISIONS DURING THE ACCUMULATION AND   ANNUITY PERIODS ARE NOT GUARANTEED AND MAY INCREASE OR DECREASE IN VALUE BASED   UPON THE PERFORMANCE OF THE FUNDS UNDERLYING THE SEPARATE ACCOUNT.      IF THE ACTUAL INVESTMENT RATES EXPERIENCED BY THE SEPARATE ACCOUNT ASSETS (PRIOR TO   DEDUCTION OF THE ASSET-BASED CHARGES SPECIFIED IN THIS CONTRACT) ARE LESS THAN   [2.10%], VARIABLE ANNUITY PAYMENTS WILL DECREASE OVER TIME.      AMOUNTS ALLOCATED TO THE FIXED ACCOUNT OPTIONS WILL EARN INTEREST AT THE CURRENT   INTEREST RATE FOR THE DURATION OF THE FIXED ACCOUNT OPTION PERIOD. THE INTEREST RATE   CREDITED FOR SUBSEQUENT PERIODS IS SUBJECT TO CHANGE AS DECLARED BY THE COMPANY.      THE FIXED ACCOUNT OPTIONS ARE SUBJECT TO A MARKET VALUE ADJUSTMENT FORMULA WHICH   MAY INCREASE OR DECREASE THE VALUE OF AMOUNTS TRANSFERRED OR WITHDRAWN FROM THE   FIXED ACCOUNT OPTIONS, BUT THE FIXED ACCOUNT CONTRACT VALUE WILL NEVER DECREASE TO   LESS THAN THE FIXED ACCOUNT MINIMUM VALUE.      THE CONTRACT VALUE HELD UNDER A FIXED ACCOUNT OPTION MAY BE WITHDRAWN WITHOUT A   MARKET VALUE ADJUSTMENT UPON RECEIPT OF WRITTEN NOTICE WITHIN 30 DAYS FOLLOWING THE   END OF THE CORRESPONDING FIXED ACCOUNT OPTION.      PLEASE  READ  THE  IMPORTANT  CONTRACT  DISCLOSURES  ON  THE  FOLLOWING   PAGE.      NOTICE OF RIGHT TO EXAMINE CONTRACT   YOU MAY RETURN THIS CONTRACT TO THE FINANCIAL PROFESSIONAL WHO SOLD YOU THE   CONTRACT OR THE COMPANY NO LATER THAN 20 DAYS AFTER YOU RECEIVE IT (60 DAYS AFTER YOU   RECEIVE IT IF YOU PURCHASED THE CONTRACT AS A REPLACEMENT CONTRACT). THE COMPANY   WILL REFUND THE CONTRACT VALUE CALCULATED ON THE BUSINESS DAY ON WHICH THE   CONTRACT IS RETURNED TO THE SELLING FINANCIAL PROFESSIONAL OR THE COMPANY RECEIVES   THE CONTRACT AT ITS SERVICE CENTER, INCLUDING ANY FEES OR OTHER CHARGES DEDUCTED   FROM THE PREMIUMS OR IMPOSED UNDER THE CONTRACT. RETURNED CONTRACTS ARE VOID.      Please Note: The Company reserves the right to allocate all Premium received during the "Notice of Right to   Examine Contract" period to a money market Investment Division or the Fixed Account. After the "Notice of Right   to Examine Contract" period expires, the Company will allocate the Contract Value to the Contract Options You   have specified.                                                                   This Contract is signed by the Company INDIVIDUAL DEFERRED VARIABLE AND FIXED  ANNUITY CONTRACT WITH MARKET VALUE                                                     ADJUSTMENT. (FLEXIBLE PREMIUM).  DEATH BENEFIT AVAILABLE.   INCOME OPTIONS AVAILABLE.  NONPARTICIPATING.  CONTAINS PROVISIONS THAT                                                                          President  WAIVE WITHDRAWAL CHARGES.         VA710NY                                                                                      Secretary 

 

       Home Office:                  Service Center:  [2900 Westchester Avenue      [P.O. Box 24068  Purchase,  New York 10577]    Lansing, MI 48909-4068                                1-800-599-5651                                www.jackson.com]                                           IMPORTANT - CONTRACT DISCLOSURES                                                                                       PLEASE READ CAREFULLY                                                                                   PLEASE REVIEW THE CONTRACT DATA PAGES FOR CONTRACT CHARGES.              THE COMPANY WILL RE-DETERMINE THE CONTRACT'S FIXED ACCOUNT MINIMUM INTEREST       RATE EACH JANUARY ON THE REDETERMINATION DATE.              THE COMPANY MAY RESTRICT OR REFUSE FUTURE PREMIUM PAYMENTS, PREMIUM       ALLOCATION, TRANSFERS TO, OR DISCONTINUE THE FIXED ACCOUNT OPTION(S) AT ANY       TIME, ON A NONDISCRIMINATORY BASIS, IF THE YIELD ON INVESTMENT WOULD NOT       SUPPORT THE MINIMUM INTEREST RATE GUARANTEED UNDER THE FIXED ACCOUNT(S).       SHOULD THE COMPANY IMPOSE SUCH RESTRICTIONS, THE COMPANY WILL GIVE AT LEAST 30       DAYS ADVANCE NOTICE TO YOU. THE COMPANY WILL ALSO PROVIDE WRITTEN NOTICE       WHEN SUCH RESTRICTIONS NO LONGER EXIST.              ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE       ISSUE DATE. PLEASE CHECK THE CONTRACT DATA PAGES TO DETERMINE WHICH DCA+       FIXED ACCOUNT OPTIONS ARE CURRENTLY AVAILABLE.              ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE AFTER ISSUE       OF THIS CONTRACT.            VA710NY                       Contract Cover Page Continued 

 

                             TABLE OF CONTENTS                      Provision                             Page Number                 Contract Data Pages                                    [3a                 Definitions                                             4                 General Provisions                                      8                 Accumulation Provisions                                13                 Withdrawal Provisions                                  16                 Death Benefit Provisions                               21                 Income Provisions                                      24                 Termination Provision                                  28]    If You have questions about this Contract or require information about coverage or complaint  resolutions, You may contact the Company's Service Center identified on the Contract's cover  page.       VA710NY                            2 

 

                           CONTRACT DATA PAGES    Contract Number:                    [1234567890]                                        Owner:                              [John Doe]                                        Owner Issue Age:                    [35]                                        Joint Owner:                        [Jane Doe]                                        Joint Owner Issue Age:              [35]                                        Annuitant:                          [John Doe]                                        Annuitant Issue Age:                [35]                                        Joint Annuitant:                    [Jane Doe]                                        Joint Annuitant Issue Age:          [35]                                        Initial Premium:                    [$50,000]                                        Issue Date:                         [May 1, 2020]                                        Issue State:                        NY                                        Income Date:                        [May 1, 2080]     Primary Beneficiary(ies):           [Brian Doe]     Contingent Beneficiary(ies):        [Mary Doe]                                                                                                                                                                                                                                                                                                                                                            VA710NY-CB1                           3a 

 

                      CONTRACT DATA PAGES (CONT'D)    FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION:    Initial Fixed Account Minimum Interest Rate: [1.00%]  The Company will re-determine the Fixed Account Minimum Interest Rate each January on the  Redetermination Date. The Fixed Account Minimum Interest Rate is the guaranteed minimum  interest rate under the Contract and may change each year on the Redetermination Date.    Initial Base Interest Rate:       [1.00% for the 1-Year Fixed Account Option Period                                    1.00% for the 3-Year Fixed Account Option Period                                    1.00% for the 5-Year Fixed Account Option Period                                    1.00% for the 7-Year Fixed Account Option Period]    Initial Current Interest Rate:    [1.00% for the 1-Year Fixed Account Option Period                                    1.00% for the 3-Year Fixed Account Option Period                                    1.00% for the 5-Year Fixed Account Option Period                                    1.00% for the 7-Year Fixed Account Option Period]                                      Initial Current DCA+ Interest Rate: [6-month [X.XX%] [NOT CURRENTLY AVAILABLE]                                    [12-month [X.XX%] [NOT CURRENTLY AVAILABLE]    ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON  THE ISSUE DATE. AVAILABILITY IS INDICATED ABOVE.    Maximum DCA+ Rate: [8.00%] over the net investment earnings rate.    Interest Rate for Adjustments Due to Misstatement of Age or Sex: [1.00%]    Annual Contract Maintenance Charge: [$30]  The Company will deduct the Annual Contract Maintenance Charge from the Contract Value  (but not the Remaining Premium) on each Contract Anniversary that occurs on or before the  Income Date or when You withdraw the Contract Value in full on a date other than a Contract  Anniversary. The Company will only deduct the Annual Contract Maintenance Charge from  Contracts with a Contract Value less than [$50,000].    Core Contract Charge: [1.1000%]  The Core Contract Charge is expressed as an annual percentage and is deducted daily from  the Separate Account Contract Value (but not the Remaining Premium). The Company will  reduce the Core Contract Charge to [1.0000%] if the Contract Value on the later of the Issue  Date or the most recent Contract Quarterly Anniversary is greater than or equal to [$1,000,000].  If the Contract Value subsequently falls below [$1,000,000] on any Contract Quarterly  Anniversary, the Company will reinstate the charge of [1.1000%] for the following Contract  Quarter.    Total Asset-Based Charges: [1.1000%]  The Total Asset-Based Charges are expressed as an annual percentage and are deducted daily  from the Separate Account Contract Value (but not the Remaining Premium). The Company will  deduct asset-based charges daily as part of the Accumulation Unit Value calculation. Total  Asset-Based Charges include the Core Contract Charge and asset-based charges for add-on  benefits.  VA710NY-CB1                           3b  

 

                      CONTRACT DATA PAGES (CONT'D)    FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION (continued):    Transfer Charge: [$25]  The Company allows [25] free transfers between Contract Options in a Contract Year. The  Company charges a fee for each transfer You make in excess of the [25] free transfers in any  Contract Year. The Company deducts Transfer Charges from the amount You seek to transfer  before allocation to the new Contract Option. The Company does not assess Transfer Charges  on transfers under any of the Company's systematic investment programs, and the Company  does not count those transfers against the [25] free transfers allowed in a Contract Year. Free  transfers not utilized during a given Contract Year cannot be carried forward to subsequent  Contract Years.    Add-on Benefit Charges:  If applicable, refer to the supplemental contract data pages of any attached add-on benefits for  additional charges and fees associated with Your Contract.    WITHDRAWALS:    Withdrawal Charge Schedule:             Completed Years Since                    Withdrawal Charge            Receipt of Premium                         Percentage                    0                                    7.00%                    1                                    6.00%                    2                                    5.00%                    3                                    4.00%                    4                                    3.00%                    5                                    2.00%                    6                                    1.00%                    7+                                   0.00%    Please see Withdrawal Provisions for a complete explanation of the determination of Withdrawal  Charges.    Minimum partial withdrawal amount unless as a scheduled part of an automatic  withdrawal program: [$500]    Minimum partial withdrawal amount as a scheduled part of an automatic withdrawal  program: [$50]    Minimum Contract Value remaining after a partial withdrawal: [$2,000]    Free Withdrawal Percentage: [10%]    Waiver of Withdrawal Charge for Extended Care  Eligibility Date:                                           [May 1, 2021]    Waiver of Withdrawal Charge for Extended Care Maximum Amount: [100%] of the Contract  Value, not to exceed [$250,000].   VA710NY-CB1                           3c 

 

                      CONTRACT DATA PAGES (CONT'D)    MARKET VALUE ADJUSTMENT (MVA):    An MVA is a positive or negative adjustment the Company applies to amounts You remove from  a Fixed Account Option due to withdrawals or transfers.    The MVA reflects the movement in the Base Interest Rate since the date of Your allocation to  the Fixed Account Option from which You remove Fixed Account Contract Value, which is  valued over the number of months remaining in the Fixed Account Option period.    The MVA may:  1.  reduce the value of the amount paid or transferred if the Base Interest Rate on the date You     remove Fixed Account Contract Value from a Fixed Account Option is greater than the Base     Interest Rate on the date of Your allocation to that Fixed Account Option; or  2.  increase the value of the amount paid or transferred if the Base Interest Rate on the date     You remove Fixed Account Contract Value from a Fixed Account Option is less than the     Base Interest Rate on the date of Your allocation to that Fixed Account Option.    The Company applies the same MVA formula regardless of whether the formula results in an  increase or decrease to amounts You remove from a Fixed Account Option.    The Company applies the MVA formula to the amount You remove less any applicable charges.    MVA formula. The Company calculates the MVA by multiplying the amount You remove from a  Fixed Account Option by the result of the formula below:                                      (m/12)                               [1+ I ]                                         -1                                   (m/12)                               [1+J  ]               where:    I  is  the Base Interest Rate the Company credits to the Fixed Account Option from which You        are removing Fixed Account Contract Value.  J  is  the Base Interest Rate the Company credits on new allocations to Fixed Account        Options with a duration equal to the number of years remaining in the Fixed Account        Option from which You remove Fixed Account Contract Value, increased by 0.0025. If        the Company does not offer such a Fixed Account Option on the date of the removal, the        Company will establish "J" by straight-line interpolation between the two (2) Fixed        Account Options with durations closest to the number of years remaining in the Fixed        Account Option from which You remove Fixed Account Contract Value.  m  is  the number of complete months remaining from the date of the removal to the end of the        period of the Fixed Account Option from which You are removing Fixed Account        Contract Value.    The Company makes no MVA when J is greater than I by less than 0.0025.    In no event will a total withdrawal from a Fixed Account Option be less than the Fixed Account  Minimum Value.   VA710NY-CB1                           3d 

 

                      CONTRACT DATA PAGES (CONT'D)    MVA (continued):    The Company will not apply an MVA to:  1.  death benefit proceeds;  2.  payment of charges or fees;  3.  amounts annuitized;  4.  exercise of Your Notice of Right to Examine Contract provision;  5.  withdrawals taken under the Free Withdrawal provision;  6.  amounts required to satisfy the Required Minimum Distribution (RMD);  7.  amounts You remove from the 1-Year Fixed Account Option;  8.  amounts You remove from any Fixed Account Option on the Latest Income Date; or  9.  amounts You remove from any Fixed Account Option in the 30-day period following the end     of a Fixed Account Option.     Unavailability of Base Interest Rate. In the event that the Base Interest Rate cannot be  determined on the date You remove Fixed Account Contract Value from a Fixed Account  Option, the MVA will be determined by using the asked yield to maturity of the U.S. Treasury  Notes with the same remaining term, using straight-line interpolation where necessary as  published in The Wall Street Journal on the next succeeding Business Day following the  effective date of the MVA.    TRANSFERS:    Transfer among Investment Divisions. At any time, You may transfer all or a portion of Your  Contract Value in any Investment Division to any available Investment Division(s).    Transfer from an Investment Division to a Fixed Account Option. Before the Income Date,  You may transfer all or a portion of Your Contract Value in an Investment Division to any  available Fixed Account Option(s). Additional details regarding restrictions on transfers are  outlined in the Transfer Provisions on page 11.    Transfer from a Fixed Account Option to an Investment Division or to a Fixed Account  Option. Before the Income Date, You may transfer all or a portion of Your Contract Value in a  Fixed Account Option, subject to any applicable MVA, to any available Investment Division(s) or  any available Fixed Account Option(s). Additional details regarding restrictions on transfers are  outlined in the Transfer Provisions on page 11 and in the Fixed Account Provisions on page 13.    Transfer Effective Date: Transfers You request will be effective as of the end of the Business  Day upon which the Company receives Your transfer request in Good Order at the Company's  Service Center.    Additional details on transfer restrictions are outlined in the Transfer of Funds Restrictions  section of the General Provisions on page 11.    VA710NY-CB1                           3e 

 

                      CONTRACT DATA PAGES (CONT'D)    PREMIUM(S):    This is a flexible Premium Contract. You may change the amount, frequency and timing of  Premium payments, subject to the minimum and maximum Premium payment amounts  specified below. The Company may waive the minimums or maximums at any time.    Minimum Initial Premium for Non-Qualified Plan Contract: [$50,000]    Minimum Initial Premium for Qualified Plan Contract: [$50,000]    Minimum Subsequent Premium: [$500] ([$50] if made as a scheduled part of an automatic  payment plan)    Maximum Total Premium under a Contract: [$2,500,000]    Minimum Amount Allocated to an Investment Division or Fixed Account Option: [$100]    The Company may restrict or reject Premium allocations to a Fixed Account Option(s) at any  time as outlined in the Transfer Provisions on page 11 and in the Fixed Account Provisions on  page 13. The Company will allocate any Premium payment subsequent to issue according to  Your most recent instructions on file with the Company, provided that each allocation complies  with the Company's then current minimum amounts and restrictions.    Minimum Contract Value to Participate in the Enhanced Interest Rate Dollar Cost  Averaging Program: [$15,000]    CONTRACT OPTIONS:    Investment Divisions: Investment Division(s) available at issue are identified in the application,  if attached, current prospectus and any supplements. The Company may offer new Investment  Divisions, or eliminate, substitute, or combine Investment Divisions.    Separate Account: [JNLNY Separate Account I]    Fixed Account Options: [1-Year Period; 3-Year Period; 5-Year Period; and 7-Year Period; the  availability of each option will be determined by the Company.] The 1-Year, 3-Year, 5-Year, and  7-Year periods may not be available at all times. In the event the Company discontinues the  availability of the Fixed Account Option(s) a money market Investment Division will be made  available for Premium allocation and transfers.    Available Fixed Account Options are identified in the current prospectus and any supplements.    Maximum Contract Option Allocations Allowed: The number of allocations to the Contract  Options may not exceed [99] at any one time.    The Company will identify the Contract Options You select in a confirmation the Company  sends You on or after the Issue Date and are stated in the application or any supplemental  application attached to this Contract, if any.    VA710NY-CB1                           3f 

 

                                                                  CONTRACT DATA PAGES (CONT'D)                                                                                  TABLE OF INCOME OPTIONS                              The following table shows income values for each $1,000 of net proceeds applied to the Income               Option.                  UNDER OPTION 4                                                           MONTHLY INSTALLMENTS UNDER OPTIONS 1 OR 3                                                                                                                                                                                                  Age of                               Age of                                  Age of                                 Age of                       No. of     Monthly     Annui-          No. of Mos.          Annui-           No. of Mos.            Annui-           No. of Mos.           Annui-              No. of Mos.  Monthly      Install-    tant             Certain              tant              Certain               tant              Certain              tant                Certain   Install-    ments   ments                           Male      Life     120      240      Male       Life      120      240      Female      Life     120      240      Female       Life       120        240     60        17.09        40       2.33     2.32     2.31      68        4.72      4.57     4.02       40        2.22     2.22     2.21        68        4.36       4.26       3.86     72        14.31        41       2.37     2.36     2.35      69        4.90      4.72     4.09       41        2.26     2.26     2.25        69        4.52       4.40       3.94     84        12.33        42       2.41     2.41     2.39      70        5.09      4.89     4.16       42        2.30     2.30     2.29       70         4.69       4.55       4.02     96        10.84        43       2.45     2.45     2.43      71        5.31      5.06     4.23       43        2.34     2.34     2.32        71        4.87       4.70       4.09    108         9.68        44       2.50     2.50     2.47      72        5.54      5.24     4.29       44        2.38     2.38     2.36        72        5.06       4.87       4.16    120         8.76        45       2.55     2.54     2.52      73        5.79      5.43     4.34       45        2.42     2.42     2.40        73        5.28       5.04       4.22    132         8.00        46       2.60     2.59     2.56      74        6.06      5.63     4.39       46        2.47     2.47     2.45        74        5.51       5.23       4.28    144         7.37        47       2.65     2.64     2.61      75        6.35      5.83     4.43       47        2.52     2.51     2.49        75        5.76       5.42       4.34    156         6.84        48       2.71     2.70     2.66      76        6.67      6.04     4.47       48        2.57     2.56     2.54       76         6.03       5.62       4.38    168         6.38        49       2.77     2.76     2.71      77        7.02      6.26     4.50       49        2.62     2.61     2.59        77        6.33       5.83       4.43    180         5.98        50       2.83     2.82     2.76      78        7.40      6.48     4.52       50        2.67     2.67     2.64        78        6.65       6.04       4.46    192         5.64        51       2.89     2.88     2.82      79        7.81      6.70     4.54       51        2.73     2.72     2.69        79        7.01       6.26       4.49    204         5.33        52       2.96     2.94     2.88      80        8.27      6.92     4.56       52        2.79     2.78     2.74        80        7.40       6.48       4.52    216         5.06        53       3.03     3.01     2.94      81        8.76      7.13     4.57       53        2.85     2.84     2.80        81        7.83       6.70       4.54    228         4.82        54       3.10     3.08     3.00      82        9.30      7.34     4.58       54        2.92     2.91     2.85       82         8.29       6.92       4.56    240         4.60        55       3.18     3.16     3.06      83        9.89      7.53     4.58       55        2.99     2.98     2.91        83        8.80       7.13       4.57    252         4.40        56       3.26     3.23     3.13      84       10.54      7.72     4.59       56        3.07     3.05     2.98        84        9.35       7.33       4.58    264         4.22        57       3.35     3.32     3.19      85       11.26      7.88     4.59       57        3.14     3.12     3.04        85        9.95       7.52       4.58    276         4.06        58       3.44     3.40     3.26      86       12.05      8.03     4.59       58        3.23     3.20     3.11        86       10.59       7.70       4.59    288         3.90        59       3.54     3.49     3.34      87       12.91      8.17     4.59       59        3.31     3.29     3.18        87       11.28       7.87       4.59    300         3.77        60       3.64     3.59     3.41      88       13.86      8.28     4.60       60        3.40     3.37     3.25       88        12.03       8.02       4.59    312         3.64        61       3.74     3.69     3.48      89       14.88      8.38     4.60       61        3.50     3.46     3.32        89       12.84       8.15       4.59    324         3.52        62       3.86     3.79     3.56      90       15.99      8.46     4.60       62        3.60     3.56     3.40        90       13.71       8.27       4.60    336         3.41        63       3.98     3.91     3.64      91       17.17      8.53     4.60       63        3.71     3.66     3.47        91       14.66       8.37       4.60    348         3.31        64       4.11     4.02     3.71      92       18.43      8.58     4.60       64        3.82     3.77     3.55        92       15.70       8.45       4.60    360         3.21        65       4.24     4.15     3.79      93       19.78      8.63     4.60       65        3.95     3.88     3.63        93       16.86       8.53       4.60                            66       4.39     4.28     3.87      94       21.20      8.66     4.60       66        4.07     4.00     3.71       94        18.13       8.58       4.60                            67       4.55     4.42     3.95      95       22.67      8.68     4.60       67        4.21     4.12     3.79        95       19.53       8.63       4.60                              Note: Due to the volume of relevant information, the Table does not provide income values for               Option 2 described in the Income Provisions. Those values are available from the Company's               Service Center upon request. You may contact the Company's Service Center as shown on the               cover page of the Contract.                              BASIS OF COMPUTATION. The 2012 Individual Annuity Mortality Period Table, with an               assumed net investment rate of 1.00% and a 0% expense load, provides the actuarial basis for               the Table of Income Options. The Table of Income Options does not include any applicable tax.                 VA710NY-CB1                                                                 3g 

 

                                  DEFINITIONS    ACCUMULATION UNIT. A unit of measure the Company uses to calculate the value of  amounts allocated to an Investment Division before the Income Date.    ANNUITANT. The natural person(s) so designated on the Contract Data Pages, or by  subsequent designation, on whose life the Company determines the amount of Income  Payments provided by the Contract. References to the Annuitant include all Joint Annuitants, if  applicable.    ANNUITIZE. When You elect to convert the Contract Value into Income Payments.    ANNUITY UNIT. A unit of measure the Company uses to calculate each Variable Annuity  Payment.    BASE INTEREST RATE. The annual percentage, declared by the Company, at which Your  money grows for a specified Fixed Account Option period.    BENEFICIARY(IES). The natural person(s) or legal entity(ies) You designate as Primary or  Contingent Beneficiary(ies) to receive any death benefit provided by the Contract. The initial  designated Beneficiary(ies) are shown on the Contract Data Pages.    BUSINESS DAY. Any day that the New York Stock Exchange (NYSE) is open for business. The  Business Day ends when the NYSE closes for the day.    CONTRACT. The Individual Deferred Variable and Fixed Annuity Contract described herein.    CONTRACT ANNIVERSARY. Each one-year anniversary of the Issue Date.    CONTRACT OPTION(S). The Investment Divisions and Fixed Account Options the Contract  offers, as shown on the Contract Data Pages. Each Contract Option is explained in the  Accumulation Provisions.    CONTRACT QUARTERLY ANNIVERSARY. Each three-month anniversary of the Issue Date.    CONTRACT VALUE. The current value of the amounts under this Contract allocated to the  Investment Divisions and Fixed Account Options.    CONTRACT YEAR. The twelve-month period beginning on the Issue Date and on any Contract  Anniversary thereafter while the Contract remains in force.    CURRENT INTEREST RATE. The Base Interest Rate plus any additional interest rate the  Company credits. The Current Interest Rate will never be less than the Fixed Account Minimum  Interest Rate.    DESIGNATED OPTION(S). The Investment Division(s) and/or Fixed Account Option(s) You  select, to which amounts will be transferred from a Source Option pursuant to one of the  Company's systematic investment programs.    VA710NY                               4 

 

                             DEFINITIONS (CONT'D)    DUE PROOF. Evidence of death, including but not limited to, a certified death certificate issued  by the governmental authority for the location of the death, or other lawful evidence the  Company requires.    FIXED ACCOUNT. The Fixed Account is part of the Company's general account. A Fixed  Account earns a specified interest rate, not less than the guaranteed minimum interest rate, to  which You may allocate Premium and Contract Value unless the Company has restricted such  allocations.    FIXED ACCOUNT CONTRACT VALUE. The sum of all amounts allocated to the Fixed Account  Options, reduced by the gross amount of withdrawals and transfers from the Fixed Account  Options, and applicable charges and taxes, plus all interest credited to the Fixed Account  Options.    FIXED ACCOUNT MINIMUM INTEREST RATE. The Fixed Account Minimum Interest Rate is  the minimum annual percentage at which Your money allocated to the Fixed Account will grow.  The Company uses this rate to determine the Fixed Account Minimum Value. The Initial Fixed  Account Minimum Interest Rate is shown on the Contract Data Pages.    FIXED ACCOUNT MINIMUM VALUE. The Fixed Account Minimum Value is equal to all  amounts allocated to the Fixed Account Options, net of applicable taxes, reduced by partial  withdrawals, transfers, and charges from the Fixed Account Options, accumulated at the Fixed  Account Minimum Interest Rate, less any Withdrawal Charges or tax due.    FIXED ACCOUNT OPTION. A Contract Option within the Fixed Account that specifies a fixed  period for which the Company credits the Current Interest Rate.    GOOD ORDER. The Company's receipt of all information, documentation, instructions and/or  Premium the Company requires before it will issue the Contract or execute any transaction.    INCOME DATE. The date on which Income Payments are to begin as described in the Income  Provisions. The Income Date must be at least thirteen (13) months after the Contract Issue  Date.    INCOME OPTION. One of the payment options provided under the Income Provisions.    INCOME PAYMENTS. Fixed Annuity Payments and Variable Annuity Payments offered by the  Company at the Income Date.    INVESTMENT DIVISIONS. Separate and distinct divisions of the Separate Account, each of  which invests in a specific Underlying Mutual Fund, and for which Accumulation Units and  Annuity Units are separately maintained. The Separate Account Contract Value in the  Investment Divisions will increase or decrease depending on the performance of the Underlying  Mutual Funds.    ISSUE DATE. The date the Company issued the Contract. The Issue Date is shown on the  Contract Data Pages.    VA710NY                               5 

 

                             DEFINITIONS (CONT'D)    JOINT OWNER. Each of the Contract Owners.    LATEST INCOME DATE. The Contract Anniversary on which You will be 95 years old, or such  earlier date required by a Qualified Plan, law or regulation.    NON-QUALIFIED PLAN. A retirement plan which does not qualify for favorable tax treatment  under Sections 401, 403, 408, 408A or 457 of the Internal Revenue Code, as amended.    OWNER ("YOU," "YOUR"). The natural person(s) or legal entity(ies) shown on the Contract  Data Pages, or by subsequent designation. In this Contract, "You" and "Your" also mean the  Owner. The primary Owner is the first Owner specified on the Contract Data Pages. References  to the Owner include the Joint Owner, if applicable.    PREMIUM(S). Money paid into this Contract for allocation to a Contract Option.    QUALIFIED PLAN. A retirement plan which qualifies for favorable tax treatment under Sections  401, 403, 408, 408A or 457 of the Internal Revenue Code, as amended.    REDETERMINATION DATE. The date the Fixed Account Minimum Interest Rate is reset as  described in the Fixed Account Minimum Interest Rate provision. It is the date each January that  coincides with the Issue Date. For example, if Your Contract's Issue Date is May 23, the  Redetermination Date will be January 23 each year following the Issue Date.    REDETERMINATION PERIOD. The twelve-month period that begins on each Redetermination  Date.    REMAINING PREMIUM. Total Premium paid into the Contract, reduced by withdrawals of  Premium, including the Withdrawal Charges, before withdrawals are adjusted for any applicable  MVA or charges.    REQUIRED MINIMUM DISTRIBUTION (RMD). For certain Qualified Plan contracts, the  RMD is the amount defined by the Internal Revenue Code and the implementing regulations  as the minimum distribution requirement that applies to this Contract only.    SEPARATE ACCOUNT. An asset account the Company has established and maintains in  accordance with applicable law. The Company has allocated a portion of its assets to this  account for this Contract and certain other contracts. The name of the Separate Account is  shown on the Contract Data Pages.    SEPARATE ACCOUNT CONTRACT VALUE. The current value of the amounts under this  Contract allocated to the Separate Account's Investment Divisions.    SERVICE CENTER. The Company's administrative address and telephone number as identified  on the Contract's cover page or as the Company may designate from time to time.    VA710NY                               6 

 

                             DEFINITIONS (CONT'D)    SOURCE OPTION. The Investment Division or Fixed Account Option You select from those the  Company makes available, from which amounts will be transferred to a Designated Option(s)  pursuant to one of the Company's systematic investment programs.    UNDERLYING MUTUAL FUNDS. The registered management investment companies in which  the assets of the Investment Divisions will be invested.    WITHDRAWAL CHARGE. A charge assessed against certain withdrawals. The Withdrawal  Charge Schedule is shown on the Contract Data Pages.    WITHDRAWAL VALUE. The Contract Value, less any tax payable, applicable Withdrawal  Charges, Annual Contract Maintenance Charge, and charges due under any add-on benefit,  adjusted for any applicable MVA.    VA710NY                               7 

 

                            GENERAL PROVISIONS    ANNUITANT. You may change the Annuitant at any time before the Income Date, unless the  Contract is owned by a legal entity. If the Contract is owned by a legal entity, the Company will  use the oldest Annuitant's age for all Contract purposes unless otherwise specified in the  Contract. The Company reserves the right to limit the number of Joint Annuitants to two (2).  When the Owner is a legal entity, the Annuitant(s) shall be entitled to the Waiver of Withdrawal  Charge for Extended Care.    ASSIGNMENT. You may assign ownership of this Contract subject to the interests of assignees  and irrevocable Beneficiaries. The Company will only be bound by an assignment if a request is  submitted in a form acceptable to the Company and received in Good Order at the Company's  Service Center. Unless You specify otherwise, an assignment will take effect on the date the  request is signed by You, subject to any payments the Company has made or other actions the  Company has taken before the Company receives Your request.     The Company assumes no responsibility for the validity or tax consequences of any  assignment. If You make an assignment, You may have to pay taxes. The Company  encourages You to seek legal and/or tax advice.    BENEFICIARY. You may change the Beneficiaries, subject to the interest of assignees and  irrevocable Beneficiaries. The Company will only be bound by a change in Beneficiary if a  request is submitted in a form acceptable to the Company and received in Good Order at the  Company's Service Center. Any previously designated irrevocable Beneficiary must consent in  writing to any change in Beneficiary. Unless You specify otherwise, a change in Beneficiary will  take effect on the date the request is signed by You, subject to any payments the Company has  made or other actions the Company has taken before the Company receives Your request, and  while You are alive.    CHARGES AND FEES. The Contract permits the Company to assess certain charges and fees.  Charges and fees associated with Your Contract are listed on the Contract Data Pages.    CONFORMITY WITH LAWS. This Contract will be interpreted under the laws of the state of  New York as of the date issued and any applicable federal laws. Any provision that is in conflict  with New York law or any federal law is amended to conform to the minimum requirements of  such law. Non-conforming provisions may be enforced against the Company to the extent  provided by applicable New York or federal law.    DEFERRAL OF FIXED ACCOUNT PAYMENTS. The Company may defer payment of Your  request for a partial and/or total withdrawal from a Fixed Account Option for a period not  exceeding six (6) months. Such deferral will be made after the Company receives approval in  writing by the chief insurance regulator of the state of New York, if required. The Company will  credit interest on deferred amounts pursuant to New York law. The Company will not defer  death benefit payments, annuity payments, previously scheduled guaranteed living benefit  payments or payments made to comply with the RMD requirements of the Internal Revenue  Code, as applicable.    ENTIRE CONTRACT. The Contract, attached application or supplemental application, if any,  and any attached endorsements, add-on benefits and amendments together make up the entire  Contract between You and the Company. All statements made by, or under the authority of, the  applicant for issuance of the Contract, shall be deemed representations and not warranties.   VA710NY                               8 

 

                       GENERAL PROVISIONS (CONT'D)    INCONTESTABILITY. The Company will not contest this Contract from its Issue Date, as  shown on the Contract Data Pages.    MINIMUM BENEFITS. For any paid-up annuity option, cash value or death benefit, the amount  available under this Contract shall not be less than the minimum benefits required by the state  of New York.    MISSTATEMENT OF AGE AND/OR SEX. If Your or the Annuitant's age and/or sex is misstated  at the time the Contract's Income Payments become payable, the Company will adjust the  payments to reflect income consistent with the correct age and/or sex. Immediately upon  discovery, the Company will adjust the next payment due as a credit or charge, as appropriate,  for any underpayments or overpayments using the Interest Rate for Adjustments Due to  Misstatement of Age or Sex shown on the Contract Data Pages.    MODIFICATION OF CONTRACT. No financial professional has authority to change or waive  any of this Contract's provisions. No change to or waiver of this Contract's terms is valid unless  in writing and signed by the Company's President, Vice President, Secretary or Assistant  Secretary; and approved by the New York Department of Financial Services prior to use. Your  written consent will be obtained prior to changing any terms and conditions of the Contract in a  manner that diminishes Your rights and/or benefits under the Contract.    NONPARTICIPATING. This Contract is nonparticipating and does not share in the Company's  surplus or earnings.    OWNER. You may change the Owner or the Joint Owner. The Company will only be bound by a  change of ownership if submitted in a form acceptable to the Company and received in Good  Order at the Company's Service Center. No person whose age exceeds the maximum issue  age the Company had set as of the Issue Date may become a new Owner. Unless You specify  otherwise, a change of ownership will take effect on the date the request is signed by You,  subject to any payments the Company has made or other actions the Company has taken  before the Company receives Your request. Joint Owners have equal ownership rights;  therefore, each Owner must authorize any exercise of Contract rights unless the Joint Owners  instruct the Company in writing to act upon authorization of an individual Joint Owner. The  maximum number of Joint Owners allowed is two (2).    The Company assumes no responsibility for the validity or tax consequences of any  ownership change. If You make an ownership change, You may have to pay taxes. The  Company encourages You to seek legal and/or tax advice.    PROOF OF AGE, SEX AND/OR SURVIVAL. The Company may require proof of age and/or  sex satisfactory to the Company at any time. If any payment required by this Contract depends  on a living Annuitant, Owner, or Beneficiary, the Company may require proof of that person's  survival satisfactory to the Company.    PROTECTION OF PROCEEDS. A Beneficiary may not assign Contract proceeds before the  proceeds are payable. Contract proceeds are not subject to the claims of creditors or to legal  process unless required by New York law.    VA710NY                               9 

 

                       GENERAL PROVISIONS (CONT'D)    REPORTS. The Company will send a report to Your last address in the Company's records at  least annually before the Income Date. In the case of Joint Owners, the Company will send  reports only to the primary Owner's address. Each report will provide at least the following  information:  1.  the dates that begin and end the reporting period;  2.  the Contract Value at the beginning and at the end of the current reporting period prior to the     application of any MVA;  3.  the Withdrawal Charge and MVA amount the Company used to determine the Withdrawal     Value;  4.  the amounts the Company has credited to and deducted from the Contract Value during the     reporting period;  5.  the Withdrawal Value at the end of the reporting period;  6.  the death benefit at the end of the reporting period; and  7.  any other information state and federal law require.    You may receive copies of reports the Company provides upon request at no additional charge.    SUBSTITUTION OF UNDERLYING MUTUAL FUND(S). If the Company determines that an  Underlying Mutual Fund is no longer available or appropriate for Contract purposes, the  Company may replace that Underlying Mutual Fund with another Underlying Mutual Fund  without Your consent. No replacement or substitution will be made without notice to You or  without prior approval of the New York Department of Financial Services. Changes of the  Underlying Mutual Fund(s) are subject to federal securities laws and the laws of the state of  New York. In the event the Company replaces an Underlying Mutual Fund, You are permitted to  transfer Your Contract Value and allocate future Premiums among the available Investment  Divisions, consistent with Your rights under the Contract.    SUSPENSION OF SEPARATE ACCOUNT PAYMENTS. The Company may suspend or delay  withdrawals of Separate Account Contract Value or transfers to or from an Investment Division  for any period when:  1.  the NYSE is closed (other than customary weekend and holiday closings);  2.  under applicable Securities and Exchange Commission (SEC) rules, trading on the NYSE is     restricted;  3.  under applicable SEC rules, an emergency exists such that it is not reasonably practicable     to dispose of securities in the Separate Account or to determine the value of its assets; or  4.  the SEC, by order, so permits.    The Company will not suspend death benefit payments, annuity payments, previously  scheduled guaranteed living benefit payments or payments made to comply with the RMD  requirements of the Internal Revenue Code, as applicable.    TAXES. The Company will deduct any taxes attributed to the Contract and payable to the state  of New York or other government entity from the Contract Value as they are incurred.    VA710NY                               10 

 

                       GENERAL PROVISIONS (CONT'D)    TRANSFER OF FUNDS. The Contract Data Pages describe the conditions for transfers of  funds between Contract Options.    Transfer of Funds Restrictions. The Company may restrict the number and frequency of  transfers into and between Contract Options in certain circumstances. This includes,  circumstances in which the Company determines, that a reasonably designed restriction is  required to prevent transfers that would disadvantage an Owner. The Company may impose a  restriction including:  1.  a minimum time between transfers;  2.  a limitation on transfer requests of an agent acting for one or more Owners; and  3.  a limitation on the dollar amount of any transfer.    The Company may also impose restrictions on Your ability to make transfers to or from the 1- Year Fixed Account Option. This includes a restriction that transfers from the 1-Year Fixed  Account Option in any Contract Year may not exceed the maximum amount, as defined below:  1.  in the first Contract Year that transfer restrictions are in effect, or if in the prior Contract Year     the maximum amount was not transferred out of the 1-Year Fixed Account Option, the     maximum amount that You may transfer out of the 1-Year Fixed Account Option is equal to     1/3 of the Contract Value in the 1-Year Fixed Account Option at the beginning of the current     Contract Year;  2.  if the maximum amount (1/3 of the value of the 1-Year Fixed Account Option at the     beginning of the prior Contract Year) was transferred from the 1-Year Fixed Account Option     in the prior Contract Year, the maximum amount that You may transfer out of the 1-Year     Fixed Account Option in the current Contract Year is equal to 1/2 of the Contract Value in     the 1-Year Fixed Account Option at the beginning of the current Contract Year. Any     transfers out of the 1-Year Fixed Account Option cannot begin until twelve (12) calendar     months after the last transfer out of the 1-Year Fixed Account Option in the prior Contract     Year;  3.  if the maximum amount (1/3 and then 1/2 of the value of the 1-Year Fixed Account Option at     the beginning of each of the two (2) prior Contract Years, respectively) was transferred from     the 1-Year Fixed Account Option in each of the two (2) prior Contract Years, You may     transfer the remaining Contract Value in the 1-Year Fixed Account Option. Any transfers out     of the 1-Year Fixed Account Option cannot begin until twelve (12) calendar months after the     last transfer out of the 1-Year Fixed Account Option in the prior Contract Year.    If the 1-Year Fixed Account Option restriction is imposed, the Company may:  1.  limit Your ability to transfer into or allocate new Premium to the 1-Year Fixed Account Option     in any Contract Year in which You make a transfer from the 1-Year Fixed Account Option.  2.  limit Your ability to transfer from the 1-Year Fixed Account Option in any Contract Year in     which You make a transfer into or allocate new Premium to the 1-Year Fixed Account     Option.  3.  offer an optional automated systematic transfer program to allow for systematic transfers out     of the 1-Year Fixed Account Option.    If the 1-Year Fixed Account Option restriction is imposed transfers under systematic investment  programs do not count against the maximum amount, and the Contract Value under such  programs is excluded from the determination of the maximum amount.    VA710NY                               11 

 

                       GENERAL PROVISIONS (CONT'D)    Systematic Investment Programs. The Company may from time to time offer systematic  investment programs that allow You to systematically transfer funds between the Contract  Options. These programs may include, but are not limited to, dollar cost averaging, portfolio  rebalancing, and the automatic monthly transfer of earnings from the 1-Year Fixed Account  Option and/or money market Investment Division to the Designated Option(s). After issue of  Your Contract, You may elect one of the programs by contacting the Company's Service Center  to obtain materials and forms that describe, and are required to participate in, these programs.  The Company makes no guarantee that these programs will result in a profit or protect against  loss.    The Company's optional dollar cost averaging program permits You to authorize the automatic  monthly, quarterly, semiannual, or annual transfer of a fixed dollar amount or selected  percentage of the value of a Source Option, to one (1) or more Designated Option(s).    The Company may offer an enhanced interest rate on Premium which an Owner that selects  dollar cost averaging allocates to the 1-Year Fixed Account Option (as the Source Option). You  may participate in the enhanced interest rate dollar cost averaging program only if Your  Contract Value is at least equal to the minimum shown on the Contract Data Pages. Under an  enhanced interest rate dollar cost averaging program, amounts You allocate to the Source  Option are automatically transferred to the Designated Option(s) of Your choice at a monthly  frequency within a 6-month or 12-month duration until all amounts in the Source Option have  been transferred. The Company may elect not to offer one or both durations at any time. When  offered, You may contact the Company's Service Center to request the interest rates and the  specified periods applicable to the enhanced interest rate dollar cost averaging program.     If You elected the enhanced interest rate dollar cost averaging program when this Contract was  issued, the duration and interest rates will be specified on the Contract Data Pages. If You elect  this program after issue of Your Contract, a confirmation showing the duration and interest rate  applicable will be sent to You. The predetermined level monthly transfer amount is calculated  such that the entire balance of the Source Option will be completely transferred by the end of  the specified duration. In the event You cancel participation in the enhanced interest rate dollar  cost averaging program, the Company will transfer the Source Option balance, including any  interest, into the Designated Option(s) You selected.    WRITTEN NOTICE. Written information or instructions You intend to give to the Company must  be in Good Order and delivered to the Company's Service Center, unless the Company advises  You otherwise. A notice relating to Owner, Beneficiary designation or assignment changes shall  take effect on the date the request is signed by You, subject to any payments the Company has  made or other actions the Company has taken before the Company receives the request.  Otherwise, instructions included in a Written Notice will take effect on the date the Company  receives the notice at the Company's Service Center.    The Company will deliver any notice or communication to Your last known address in the  Company's records unless You request otherwise in writing. You are responsible for promptly  notifying the Company of any address change or any error in a Company notice sent to You. In  the case of Joint Owners, the Company will send notices and other communications to the  primary Owner's address.    VA710NY                               12 

 

                        ACCUMULATION PROVISIONS    You may not allocate funds to more than the maximum number of Contract Options, shown on  the Contract Data Pages, at any one time.     SEPARATE ACCOUNT. The Separate Account is an asset account shown on the Contract  Data Pages. The Separate Account consists of assets the Company has set aside and has kept  separate from the Company's general account assets and other separate accounts. The  Separate Account assets will not be charged with liabilities arising out of any other Company  business. The Company credits or charges all the income, gains, and losses resulting from the  Separate Account assets exclusively to the contracts supported by the Separate Account. The  Separate Account assets will be available to cover the liabilities of the Company's general  account only to the extent that they exceed the Separate Account liabilities arising from the  Contracts supported by the Separate Account. The Separate Account is divided into several  Investment Divisions. The Company will value the Separate Account assets at their fair market  value at least monthly.    Accumulation Units. The Separate Account Contract Value may increase or decrease  depending on the performance of the Investment Divisions. The Company uses a unit of  measure called an Accumulation Unit to measure the Separate Account Contract Value before  the Income Date. The value of an Accumulation Unit may increase or decrease from Business  Day to Business Day. Transactions affecting the Separate Account Contract Value, such as  withdrawals, transfers, and certain charges, result in the redemption of Accumulation Units but  do not change the value of Accumulation Units.    When You make an allocation to the Investment Divisions, the Company credits Your Contract  with Accumulation Units. The Company determines the number of Accumulation Units credited  to Your Contract by dividing the amount You allocate to each Investment Division by its  Accumulation Unit Value at the close of the Business Day on which You make the allocation.    Accumulation Unit Value. The Company determines the Accumulation Unit Value for each of  the Investment Divisions by:  1.  determining the total amount of money allocated to that particular Investment Division;  2.  subtracting from that amount any applicable Core Contract Charge and taxes; and  3.  dividing the result by the number of outstanding Accumulation Units.    FIXED ACCOUNT. Allocations You make to Fixed Account Options are included in the  Company's general account. The Company's general account consists of all the Company's  assets, other than those in the Separate Account and other asset accounts.    You may select from the Fixed Account Options made available by the Company. Amounts in  the Fixed Account Option You select will earn interest at that option's Current Interest Rate  during the Fixed Account Option period. Interest will be credited no less frequently than annually  and will be credited from the date of the deposit to the date of withdrawal. The Company may  declare Base Interest Rates higher or lower than any Base Interest Rates the Company  previously declared but the interest rate credited to the Fixed Account Option will never be less  than the Fixed Account Minimum Interest Rate.    VA710NY                               13 

 

                   ACCUMULATION PROVISIONS (CONT'D)    You may allocate Premium, or make transfers from the Investment Divisions and/or Fixed  Account Options, to the Fixed Account Options at any time before the Income Date, subject to  the provisions of this Contract. You may not select any Fixed Account Option, other than the 1- Year Fixed Account Option, that extends beyond the Income Date.    Within at least fifteen (15) days, but not more than forty-five (45) days, prior to the end of any  Fixed Account Option period, the Company will notify You of Your ability to:  1.  withdraw amounts allocated to the Fixed Account Option within thirty (30) days following the     end of that Fixed Account Option without an MVA;  2.  elect any available Fixed Account Option of a different duration within thirty (30) days following     the end of that Fixed Account Option;  3.  elect a transfer to Investment Division(s) within thirty (30) days following the end of that Fixed     Account Option; or  4.  elect a Fixed Account Option with the same duration, if available, within thirty (30) days     following the end of that Fixed Account Option.    When the period of a Fixed Account Option ends:  1.  If the option ends within one (1) year of the Income Date, the Company will renew You into     the 1-Year Fixed Account Option;   2.  If the option ends more than one (1) year before the Income Date, You may select a new     Fixed Account Option that does not extend beyond the Income Date within thirty (30) days     of the end of the expired Fixed Account Option;   3.  If You do not select a Fixed Account Option within thirty (30) days of the end of the expired     Fixed Account Option:     a.  if the same option is available at the time and does not extend beyond the Income Date,        the Company will renew You into the same Fixed Account Option.     b.  if the same option is available at the time but extends beyond the Income Date, the        Company will select the available Fixed Account Option that ends closest to but before        the Income Date.     c.  if the same option is not available at the time but would not extend beyond the Income        Date were it available, the Company will select the available Fixed Account Option with        the period closest to but less than the Fixed Account Option that just ended.  4.  If there are no Fixed Account Option periods available at the end of the Fixed Account     Option period the Company will default to a money market Investment Division, unless You     specify otherwise.    The Company may restrict or refuse future Premium payments, Premium allocation and  transfers to the Fixed Account Option(s) at any time, on a nondiscriminatory basis, if the yield on  investment would not support the minimum interest rate guaranteed under the Fixed Account(s).  Should the Company impose such restrictions, the Company will give at least thirty (30) days  advance notice to You.     The Company will also provide Written Notice when such restrictions no longer exist.    If the Company restricts or discontinues the Fixed Account Option(s) all transfers or withdrawals  will be at least equal to the Contract Value without being subject to a negative MVA or Transfer  Charges.    VA710NY                               14 

 

                   ACCUMULATION PROVISIONS (CONT'D)    Fixed Account Minimum Interest Rate. The Initial Fixed Account Minimum Interest Rate  established on the Issue Date is shown on the Contract Data Pages. The Company will re- determine the Fixed Account Minimum Interest Rate on each Redetermination Date for that  Redetermination Period.    The Fixed Account Minimum Interest Rate on each Redetermination Date will be equal to:  1.  the average of all the daily reported five-year Constant Maturity Treasury Rates during     October of the year then ended, rounded to the nearest 1/20th of one (1) percent;  2.  less 1.25 percentage points;  3.  but never less than 1.00% or greater than 3.00%.    The Fixed Account Minimum Interest Rate is the guaranteed minimum interest rate under the  Contract and may change each year on the Redetermination Date. The Company will send You  notice of the re-determined Fixed Account Minimum Interest Rate annually.    VA710NY                               15 

 

                          WITHDRAWAL PROVISIONS    On or before the Income Date You may request a total or partial withdrawal of the Contract  Value by submitting a request to the Company's Service Center in a form acceptable to the  Company.     Amounts You withdraw from the Contract Value may be subject to Withdrawal Charges. In  addition to Withdrawal Charges, amounts You withdraw from a Fixed Account Option may also  incur an MVA. The Company will adjust the amount You request for withdrawal for any  applicable taxes, charges, including Withdrawal Charges, and MVA.     TOTAL WITHDRAWAL. Upon a total withdrawal, You will receive the Withdrawal Value. The  Withdrawal Value will be determined at the end of the Business Day on which the Company  receives Your withdrawal request in Good Order at the Company's Service Center. If a total  withdrawal is requested, You must submit the Contract to the Company's Service Center. A total  withdrawal terminates Your Contract.    No withdrawal may exceed the Withdrawal Value.    PARTIAL WITHDRAWAL. Any partial withdrawal must be either:  1.  an amount not less than the Minimum partial withdrawal amount shown on the Contract     Data Pages; or  2.  an amount equal to Your entire interest in an Investment Division or a Fixed Account Option.    The amount payable as a result of the partial withdrawal will be determined at the end of the  Business Day on which the Company receives Your request for withdrawal in Good Order at the  Company's Service Center.    Your Contract Value will be reduced by the gross withdrawal amount requested. Unless You  request otherwise, a partial withdrawal will be deducted from each Contract Option in proportion  to its current value. The partial withdrawal will be reduced for any applicable taxes and charges,  including Withdrawal Charges, and then adjusted for any applicable MVA.    At least the Minimum Contract Value remaining after a partial withdrawal, as shown on the  Contract Data Pages, must remain after any partial withdrawal. If the partial withdrawal would  reduce the Contract Value below the Minimum Contract Value remaining after a partial  withdrawal, as shown on the Contract Data Pages, the Company will treat the withdrawal  request as a total withdrawal and the Withdrawal Value will be paid.    QUALIFIED PLAN CONTRACT REQUIRED MINIMUM DISTRIBUTIONS. Qualified Plan  Contract Required Minimum Distributions are based upon Your Contract Value, the value of  any add-on benefits as calculated by the Company, and applicable federal tax law  requirements. You may request a withdrawal for an RMD by submitting a written request to  the Service Center on a Company-provided form.    The Company will waive the Withdrawal Charges if the amount withdrawn does not exceed  the Contract's RMD. However, if a withdrawal amount is greater than the Contract's RMD,  the excess of the partial withdrawal over the Contract's RMD may be subject to Withdrawal  Charges.    VA710NY                               16 

 

                    WITHDRAWAL PROVISIONS (CONT'D)    AUTOMATIC WITHDRAWAL. You may elect to take an automatic withdrawal by withdrawing a  specific sum or a certain percentage of the Contract Value on a monthly, quarterly, semiannual  or annual basis, subject to the Minimum partial withdrawal amount made as a scheduled part of  an automatic withdrawal program, as shown on the Contract Data Pages. Automatic  withdrawals are treated as a partial withdrawal and will be counted in determining the amount  taken as a Free Withdrawal in any Contract Year. Automatic withdrawals in excess of the Free  Withdrawal amount may be subject to Withdrawal Charges and/or MVA. If an automatic  withdrawal causes the Withdrawal Value to fall to zero, future automatic withdrawals will  terminate. If the automatic withdrawal would reduce the Contract Value below the Minimum  Contract Value remaining after a partial withdrawal, as shown on the Contract Data Pages,  the Company will treat the withdrawal request as a total withdrawal and the Withdrawal  Value will be paid.    WITHDRAWAL CHARGE. For purposes of determining the Withdrawal Charge, the Contract  Value is divided into earnings and Remaining Premium, as defined in the Contract. Earnings are  not subject to a Withdrawal Charge. For the sole purposes of determining the amount of the  Withdrawal Charge, earnings are defined as any excess of the Contract Value over Remaining  Premium.     A Withdrawal Charge will be imposed upon certain withdrawals of Remaining Premium. The  Withdrawal Charge will be calculated in accordance with the Withdrawal Charge Schedule  shown on the Contract Data Pages. The Withdrawal Charge is equal to the applicable  Withdrawal Charge Percentage applied to the gross amount of Remaining Premium withdrawn  (not the net amount of Remaining Premium received by You), excluding any amount for which  the Contract expressly provides for waived, or no, Withdrawal Charge. In the event of a total  withdrawal, the applicable Withdrawal Charge Percentage(s) is/are applied to the full value of  Remaining Premium immediately prior to the withdrawal, less any Free Withdrawal available at  the time of the total withdrawal. The Withdrawal Charge reduces Remaining Premium and  Contract Value. The Withdrawal Charge will be taken from the Contract Options in the same  proportion as the requested withdrawal.    Withdrawals will be allocated first to earnings (which may be withdrawn free of any Withdrawal  Charge), if any, and second to Remaining Premium on a first-in, first-out basis so that all  withdrawals will be allocated to Remaining Premium to which the lowest (if any) Withdrawal  Charges apply.    Any portion of the Withdrawal Charge that would reduce the Fixed Account Contract Value  below the Fixed Account Minimum Value will be waived.    FREE WITHDRAWAL. During a Contract Year, You may make partial withdrawals from the  Contract without incurring a Withdrawal Charge or MVA. The amount of Free Withdrawal  available in any Contract Year is equal to:  1.  the Free Withdrawal Percentage, as shown on the Contract Data Pages, multiplied by the     Remaining Premium at the beginning of the Contract Year, that is subject to a Withdrawal     Charge according to the Withdrawal Charge Schedule shown on the Contract Data Pages;     plus  2.  the Free Withdrawal Percentage, as shown on the Contract Data Pages, multiplied by     Premium received during the Contract Year; less  3.  earnings, as defined in the Withdrawal Charge provision of this Contract.   VA710NY                               17 

 

                    WITHDRAWAL PROVISIONS (CONT'D)    The amount of Free Withdrawal is subject to a minimum of zero. The Free Withdrawal can be  taken as a single withdrawal or multiple withdrawals throughout the Contract Year. The amount  of Your Free Withdrawal available will vary throughout the Contract Year depending on previous  withdrawals of Your Free Withdrawal amount, previous withdrawals of earnings, and the amount  of earnings present at the time of the withdrawal. The amount of Your Free Withdrawal available  will reduce due to withdrawals during the Contract Year.    Any amount withdrawn to satisfy an RMD may reduce the amount of Your Free Withdrawal  available.    No Free Withdrawal may exceed the Withdrawal Value.    Amounts withdrawn under the Free Withdrawal provision reduce both the  Contract  Value  and  Remaining  Premium. Withdrawals  during  the  Contract  Year  in  excess  of  the  amount  of  Free  Withdrawal may be subject to any applicable Withdrawal Charges and applicable MVAs.    WAIVER OF WITHDRAWAL CHARGE FOR EXTENDED CARE.    If You are confined as an inpatient in a Nursing Home or Hospital for ninety (90) consecutive  days starting after the Issue Date shown on the Contract Data Pages, the Company will waive  the Withdrawal Charge on the amount You withdraw from the Contract, up to the maximum  amount shown on the Contract Data Pages. Upon Your compliance with the Claim  Requirements described below, You will be eligible for this waiver on the Eligibility Date shown  on the Contract Data Pages.    The availability of access to guarantees or values is not intended to provide long-term care or  nursing home insurance.    The Company will allocate the withdrawal amount to each Contract Option according to the  method described in the Withdrawal Provisions. The Company will determine values at the end  of the Business Day on which the Company receives the request for withdrawal in Good Order  at the Company's Service Center. A withdrawal from the Fixed Account Option(s) is subject to  any applicable MVA. Withdrawals under this provision reduce Remaining Premium.    This Waiver of Withdrawal Charge for Extended Care is available only once, no matter the  amount withdrawn or in the circumstances of multiple confinements for the same or a different  medical condition and/or Joint Owners.    VA710NY                               18 

 

                    WITHDRAWAL PROVISIONS (CONT'D)    For the purpose of this waiver, the following definitions apply:      Hospital. A facility that:     1.  is located within the United States or its territories;        ;     2.  operates primarily for the inpatient care and treatment of sick and injured persons;     3.  provides continuous twenty-four (24) hour a day nursing service by or under the        supervision of a registered nurse (R.N.);     4.  is supervised by a staff of licensed physicians; and     5.  has its own medical and diagnostic facilities or has access to such facilities on a        prearranged basis.         Immediate Family - means the individual's spouse/domestic partner, child, brother, sister,     parent or grandparent.      Medically Necessary - means consistent with Your diagnosis, in accordance with accepted     standards of medical practice and without which Your medical condition would be adversely     affected.      Nursing Home. A facility that:     1.  is licensed by the appropriate governmental licensing agency as a Nursing Home in the        state in which it maintains such facilities;     2.  issues patients or their insurance provider a bill or an amount due;     3.  is primarily engaged in providing nursing care (skilled, intermediate or custodial) by or        under the supervision of a licensed Physician and room and board accommodations;     4.  provides continuous twenty-four (24) hour a day nursing services by or under the        supervision of a registered nurse (R.N.);     5.  maintains a daily medical record of each patient; and     6.  maintains control and records of dispensed medications.      Physician - means an individual who is licensed to practice medicine and treat illness or     injury in the state where treatment is received and who is acting within the scope of his or     her license. The term Physician only refers to a Physician licensed and currently practicing     in the United States or its territories. The term Physician does not include a person who is:     1.  an Annuitant or Joint Annuitant;     2.  an Owner or Joint Owner;     3.  a Beneficiary;     4.  a member of the Annuitant's, Joint Annuitant's, Owner's or Joint Owner's Immediate        Family.      Physician's Statement - means a written statement signed by a Physician which provides     the Physician's diagnosis of Your medical condition.    You will be considered confined to a Nursing Home or Hospital only if Your confinement is  prescribed by a Physician and Medically Necessary.    VA710NY                               19 

 

                    WITHDRAWAL PROVISIONS (CONT'D)    Claim Requirements. Ninety (90) days after the date of Your confinement, Your request to the  Company must include (1) a completed claim form, (2) Your signed release for records of all  Physicians and institutions that have treated You for the medical condition You claim, and (3) a  Physician's Statement to the Company's Service Center in Good Order.     The Company will send You a form to claim the Waiver of Withdrawal Charge for Extended  Care within ten (10) Business Days of the Company's receipt of Your request. If the Company  fails to send the claim form within ten (10) Business Days, You will be deemed to have complied  with the above claim requirements.    Claim Determination. Upon receipt of the Claim Requirements, the Company will complete an  initial review for Good Order within thirty (30) Business Days. The Company reserves the right  to deny Your claim if You do not satisfy the Claim Requirements. If the Company denies Your  waiver of Withdrawal Charge for an extended care claim, the Company will send You a letter  with the reason(s) for the denial. If You would like to appeal the Company's denial of Your  waiver of Withdrawal Charge for an extended care claim, You may submit a Written Notice to  the Company's Service Center. If You are unable to satisfy the Claim Requirements, You will  then have the opportunity to submit a standard withdrawal request subject to any applicable  Withdrawal Charges and any applicable MVA. Termination of the Contract will not prejudice any  payment made under the extended care waiver that occurred while this Contract was in force.    YOU  MAY  OWE  TAX  ON  WITHDRAWALS  FOR  EXTENDED  CARE.  THE  COMPANY  ENCOURAGES YOU TO SEEK LEGAL AND/OR TAX ADVICE.    VA710NY                               20 

 

                         DEATH BENEFIT PROVISIONS    NATURAL OWNER'S DEATH BEFORE THE INCOME DATE. Upon Your death or the death of  the Joint Owner before the Income Date, the Company will pay the death benefit to the  Beneficiary(ies) designated by You. In the event of the death of a Joint Owner, the surviving  Joint Owner, if any, will be the Primary Beneficiary. Any other Beneficiary designation on record  at the Company's Service Center at the time of death will be treated as a Contingent  Beneficiary.    DEATH BENEFIT AMOUNT BEFORE THE INCOME DATE. The death benefit amount before  the Income Date is equal to the greater of:    1.  the current Contract Value; or  2.  all Premiums (net of any applicable tax) paid into the Contract, reduced for any withdrawals     (including any applicable charges and adjustments for such withdrawals). All adjustments for     amounts withdrawn will reduce the death benefit in the same proportion that the Contract     Value was reduced on the date of the withdrawal.    DEATH BENEFIT PAYMENT OPTIONS BEFORE THE INCOME DATE. Unless You  designated a Pre-selected Death Benefit Option, a Beneficiary entitled to the death benefit  before the Income Date must request that the Company pay the death benefit according to one  of the death benefit payment options below, or, if eligible, has the option to continue the  Contract under the Spousal Continuation Option Instead of Death Benefit provision:    Option 1 - single lump-sum payment;  Option 2 - payment of the entire death benefit distributed within five (5) years of the date of the           relevant death; or  Option 3 - Income Payments of the death benefit (i) over the lifetime of the Beneficiary, or (ii)          over a period not extending beyond the life expectancy of the Beneficiary, with          distribution beginning within one (1) year of the date of the relevant death.    The Company may make available other death benefit payment options.    A Beneficiary that wishes to elect payment under the life income option (Option 3) must do so  no later than sixty (60) days from the date the Company receives Due Proof of death in Good  Order at the Company's Service Center.    Any portion of the death benefit not applied under the life income option (Option 3) must be paid  within five (5) years from Your death. The death benefit will remain invested in accordance with  the allocation selected by You until a payout option is selected or the Beneficiary specifies  otherwise.    ANNUITANT'S DEATH BEFORE THE INCOME DATE. Upon the death of an Annuitant who is  not an Owner before the Income Date, the Contract remains in force and the Owner becomes  the Annuitant. The Owner may designate a new Annuitant. However, if the Contract is owned by  a legal entity, upon the death of any Annuitant, the Company will pay the death benefit to the  Beneficiary(ies) designated by the Owner, or, if no Beneficiary(ies) survive the applicable death,  to the Owner.    VA710NY                               21 

 

                   DEATH BENEFIT PROVISIONS (CONT'D)    BENEFICIARY'S ENTITLEMENT TO DEATH BENEFIT BEFORE THE INCOME DATE. The  Company will pay the death benefit to Primary Beneficiaries or, if none exist, to Contingent  Beneficiaries, in equal shares (the "default allocation") unless You have designated otherwise  (the "designated allocation"). A Beneficiary that dies before or within ten (10) days (or different  period as prescribed by applicable law) of Your death is not entitled to any death benefit. In that  circumstance, the Company will pay the deceased Beneficiary's benefit to surviving  Beneficiaries in the same proportion as the designated allocation or, if applicable, the default  allocation. If no Beneficiary survives You, the Company will pay the death benefit to Your estate.    PAYMENT OF DEATH BENEFIT PROCEEDS. The Company will pay the death benefit  proceeds to the Beneficiary upon receipt of a request for payment with Due Proof of death in  Good Order at the Company's Service Center. If the Company has received Due Proof of death,  the Company will calculate the share of the death benefit due to a Beneficiary using Contract  values established at the end of the Business Day on the date the Company receives from that  Beneficiary a claim form with a payment option elected. If the Company has not received Due  Proof of death or any other required documentation, the Company will calculate the share of the  death benefit due to a Beneficiary using Contract values established at the end of the Business  Day on the date the Company receives any remaining required documentation. As a result,  market fluctuation may cause the calculation of a Beneficiary's death benefit share to differ from  the calculation of another Beneficiary's death benefit share.     Each Beneficiary entitled to the death benefit bears the investment risk associated with amounts  allocated to any Investment Division until the Company calculates their share of the death  benefit.    If any death benefit proceed is due to an Owner's estate, the Company will pay it in a single  lump-sum payment.    With the exception of death benefit Option 3 above, the Company will pay a Beneficiary that  elects a death benefit option within seven (7) calendar days of the date the Company receives  request for payment, provided the Company has received Due Proof of death in Good Order at  the Company's Service Center.    If the Company does not distribute death benefit proceeds within seven (7) calendar days, the  death benefit proceeds will include interest accrued and payable from the eighth day following  the date that Due Proof of death was received in Good Order at the Company's Service Center  until the death benefit is paid. The rate of interest will equal the rate of interest applicable to  death benefit proceeds left on deposit with the Company on the date of Your death.    Spousal Continuation Option Instead of Death Benefit. Unless the Contract is subject to a  Pre-selected Death Benefit Option, a spouse who is a Joint Owner or Beneficiary of the  deceased Owner, has the option to continue the Contract in his or her own name and exercise  the Owner's rights under the Contract instead of taking the standard death benefit.    For purposes of the Spousal Continuation Option, the "continuation date" is the date on which  the Company receives the spouse's written request to elect the Spousal Continuation Option  and Due Proof of the relevant death in Good Order at the Company's Service Center.    VA710NY                               22 

 

                   DEATH BENEFIT PROVISIONS (CONT'D)    If the Contract Value on the continuation date is less than the death benefit, an amount will be  added to the Contract Value to make up the difference. This amount is referred to as the  continuation adjustment. The Company will allocate the continuation adjustment to the Contract  Options based on the current allocation rules for the Contract. The continuation adjustment will  have no effect on the Fixed Account Minimum Value. Withdrawal Charges will continue with the  same schedule as prior to the original Owner's death. However, no Withdrawal Charge will  apply to the continuation adjustment.    For purposes of determining the future death benefits for the surviving spouse under the  continuing Contract, the Contract Value following the application of any continuation adjustment  will be considered the initial Premium of the continuing Contract.    The Spousal Continuation Option is void in the event the original Contract Owner is no longer  the Contract Owner or in the event the Contract has been assigned. This Spousal Continuation  Option may be exercised only once, and may not be available if You designated a Pre-selected  Death Benefit Option.    Pre-selected Death Benefit Option. Before the Income Date, You may designate the option  according to which the Company will pay the death benefit from the death benefit payment  options described in the Contract, or other death benefit payment options made available by the  Company. You may do so by submitting a designation in a form acceptable to the Company in  Good Order to the Company's Service Center. Pre-selected Death Benefit Options will take  effect on the date the request is signed by You, subject to any payments the Company has  made or other actions the Company has taken before the Company received Your request. The  Company will pay the death benefit consistent with Your Pre-selected Death Benefit Option  unless the Internal Revenue Code requires otherwise, or Your election requires payment over a  period that exceeds the Beneficiary's life expectancy.    Only You may revoke or change a Pre-selected Death Benefit Option. To do so, You must  submit a request in a form acceptable to the Company to the Company's Service Center. Unless  You specify otherwise, revocations of and changes to a Pre-selected Death Benefit Option will  take effect on the date the request is signed by You, subject to any payments the Company has  made or other actions the Company has taken before the Company received Your request.    VA710NY                               23 

 

                             INCOME PROVISIONS    INCOME DATE. Income Payments will begin on the Income Date. The Income Date must be at  least thirteen (13) months after the Contract Issue Date. If You do not select an Income Date,  the Income Date is the Latest Income Date. You may change the Income Date to any date that  is not later than the Latest Income Date by submitting Written Notice in Good Order to the  Company's Service Center at least seven (7) days before the Income Date.    INCOME PAYMENT. On or before the Income Date, You can elect payment in a single lump- sum. A single lump-sum payment is considered a total withdrawal and terminates the Contract.  The Company will make payment to You or another payee You specify. Alternatively, You may  elect an Income Option. The Company will apply the Contract Value to provide You Fixed  Annuity Payments or Variable Annuity Payments according to Your selected Income Option. If  You do not choose how to receive Your Income Payments, Your Income Payments will be  Variable Annuity Payments.    Income Options. You may elect payment as provided in Options 1, 2, 3 or 4 below. You may  elect an Income Option at any time before the Income Date and You can change an Income  Option up to seven (7) days before the Income Date by submitting Written Notice in Good Order  to the Company's Service Center.    If You do not select an Income Option, the Company will make payments as provided in Option  3 below, with 120 months certain. The Company will make payments monthly, quarterly,  semiannually or annually as You elect. However, if the Contract Value on the Income Date is  less than $2,000, the Company may pay out the Contract Value in one (1) lump-sum payment  instead of providing Income Payments according to the Income Option You elect. The single  lump-sum payment will not be less than the amount which would have been applied under an  Income Option. On the Income Date, if the first monthly payment provided would be less than  $20, the Company may make payments quarterly, semiannually or annually to achieve an initial  payment of at least $20, or the Company may pay out the Contract Value in one (1) single lump- sum payment.    At the time of their commencement, Income Payments will not be less than those that would be  provided by the application of an equivalent amount to purchase a single premium immediate  annuity contract from the Company at purchase rates the Company offered on the Income Date  to annuitants in the same class as the Annuitant.    The amount applied to an Income Option will not be less than the greater of the Withdrawal  Value or 95% of what the Withdrawal Value would be if there were no Withdrawal Charge.    YOU MAY NOT TAKE WITHDRAWALS DURING ANY PERIOD THE COMPANY IS MAKING  PAYMENTS FOR AN ANNUITANT'S LIFETIME.    OPTION 1 - LIFE INCOME. A monthly payment for the Annuitant's lifetime. All payments end  upon the Annuitant's death. However, in the event of the Annuitant's death before the first  monthly payment, the Company will pay the amount allocated to this Income Option to You or, if  You are deceased, to Your Beneficiary.     VA710NY                               24 

 

                        INCOME PROVISIONS (CONT'D)    OPTION 2 - JOINT AND SURVIVOR INCOME. A monthly payment for the longer of the  Annuitant's lifetime or that of a second person You designate. Upon the occasion of the first  person to die, monthly payments continue during the survivor's lifetime at either the full amount  previously payable or as a percentage (either one-half or two-thirds) of the full amount, as You  select at the time You elect the Income Option. If reduced Income Payments to the survivor are  desired, the Company will calculate Variable Annuity Payments using either one-half or two- thirds of the number of Annuity Units for each Investment Division comprising the Variable  Annuity Payments payable during the joint life of the Annuitant and the designated second  person. The Company will calculate Fixed Annuity Payments equal to either one-half or two- thirds of the Fixed Annuity Payment payable during the joint life of the Annuitant and the  designated second person.    All payments end upon the death of the last surviving Annuitant. However, in the event of the  deaths of the Annuitant and the designated second person before the first monthly payment, the  Company will pay the amount allocated to this Income Option to You or, if You are deceased,  Your Beneficiary.     OPTION 3 - LIFE INCOME WITH 120 OR 240 MONTHLY PAYMENTS GUARANTEED. A  monthly payment for the Annuitant's lifetime with the guarantee that the Company will make no  fewer than 120 or 240 monthly payments to You. If the Owner is an entity, at the Annuitant's  death, if fewer than the guaranteed number of payments have been made, the remaining  guaranteed payments will be made to the Owner as previously scheduled. If the Owner is the  Annuitant, in the event You die before the Company makes the specified number of guaranteed  payments, Your Beneficiary may elect to continue to receive the Income Payments according to  the terms of this Contract, or alternatively may elect to receive the present value of any  remaining guaranteed payments in a single lump-sum payment. The present value of any  remaining guaranteed payments will be based on the total Income Payments as of the date of  the calculation. The Company will determine the interest rate used in this present value  calculation, but in no instance will it be greater than (one) 1 percentage point higher than the  rate used to calculate the initial Income Payment.     OPTION 4 - INCOME FOR A SPECIFIED PERIOD. A monthly payment for any whole number  of years ranging from 5 to 30. In the event You die before the Company makes the specified  number of payments, Your Beneficiary may elect to continue to receive the Income Payments  according to the terms of this Contract, or alternatively may elect to receive the present value of  any remaining guaranteed payments in a single lump-sum payment. The present value of any  remaining guaranteed payments will be based on the total Income Payments as of the date of  the calculation. The Company will determine the interest rate used in this present value  calculation, but in no instance will it be greater than (one) 1 percentage point higher than the  rate used to calculate the initial Income Payment.     ADDITIONAL INCOME OPTIONS. The Company may make available other Income Options.    VA710NY                               25 

 

                        INCOME PROVISIONS (CONT'D)    You may elect either fixed or variable annuity payments as described below.    FIXED ANNUITY PAYMENTS. The Company will determine Fixed Annuity Payments by  applying annuity rates consistent with the age and sex (unless unisex rates apply) of the  Annuitant and, if applicable, the designated second person, to the portion of the Contract Value  allocated to the Fixed Annuity Payment options. Annuity rates applied will not be less than the  rates provided in the Contract's Table of Income Options.    Once begun, the Company will not change the amount of the Fixed Annuity Payments, except  upon the first death between the Annuitant and the designated second person under Option 2.    VARIABLE ANNUITY PAYMENTS. The Company will determine the initial Variable Annuity  Payment by applying annuity rates consistent with the age and sex (unless unisex rates apply)  of the Annuitant and, if applicable, the designated second person, to the portion of the Contract  Value allocated to the Variable Annuity Payment options. Annuity rates applied will not be less  than the rates provided in the Contract's Table of Income Options.    The Company will determine the second and subsequent Variable Annuity Payments in two (2)  steps. First, the Company will divide the initial Variable Annuity Payment by the Annuity Unit  Value calculated on the Income Date to establish a number of Annuity Units. Second, the  Company will multiply that number of Annuity Units by the Annuity Unit Value determined on the  Business Day next preceding the date on which each payment is due. The result of each  calculation determines the Variable Annuity Payment due.    Once Variable Annuity Payments have begun, the number of Annuity Units remains constant  absent a reallocation between the Investment Divisions. Variable Annuity Payments are not  affected by expenses other than taxes.    Neither expenses actually incurred, other than taxes on the investment return, nor the mortality  actually experienced, shall adversely affect the dollar amount of Variable Annuity Payments  after such payments have commenced.    Annuity Unit Value. The Company sets the initial value of an Annuity Unit of each Investment  Division when the Company establishes the Investment Division. The Annuity Unit Value  reflects the investment performance of an Investment Division and may increase or decrease  from one Business Day to the next. The Contract's Table of Income Options assumes the net  investment rates described in the Contract's Basis of Computation provision. Therefore, if an  Investment Division's actual net investment rate is greater than or less than the assumed net  investment rate, Variable Annuity Payments will increase or decrease accordingly over time.    The Company calculates each Investment Division's Annuity Unit Value for any Business Day in  two (2) steps:    First, the Company multiplies the immediately preceding Business Day's Annuity Unit Value by  the Business Day's "net investment factor" determined on the day of the calculation. The  Company determines the "net investment factor," which reflects changes in the Investment  Division's net asset value, by dividing the value established at (1) below by the value  established at (2) below, and then subtracting the value established at (3) below, where:    VA710NY                               26 

 

                        INCOME PROVISIONS (CONT'D)    (1)  Is the net result of:     a.  the Investment Division's net asset value at the end of the Business Day; plus     b.  the per share amount of any dividend or other distribution declared by the Investment        Division if the "ex-dividend" date occurs on the Business Day; plus or minus     c.  a per share credit or charge with respect to any taxes paid or reserved for by the        Company which are determined by the Company to be attributable to the operation of        the Investment Division (no federal income taxes are applicable under present law); and  (2)  Is the Investment Division's net asset value at the end of the preceding Business Day; and  (3)  Is the asset charge factor the Company determines for the Business Day to reflect the     applicable Core Contract Charge.    Second, the Company multiplies the result from the first step above by a factor equal to the ratio  of one over one plus the assumed net investment rate, raised to the number of calendar days  between the previous Business Day and the current Business Day over the number of calendar  days in the current year. The factor is expressed formulaically as follows:                                              &#0;                                       1   &#0;                                   &#0;      &#0;                                      1+ 퐴퐼푅   where:    AIR  is  the assumed net investment rate.  t    is  the number of calendar days between the previous Business Day and the current           Business Day.  y    is  the number of calendar days in the current year.    NATURAL OWNER'S DEATH AFTER THE INCOME DATE. Upon Your death or the death of  the Joint Owner, who is not also an Annuitant, after the Income Date, remaining Income  Payments due continue as before. Upon Your death after the Income Date, the Beneficiary  becomes the Owner.    ANNUITANT'S DEATH AFTER THE INCOME DATE. Upon the death of the Annuitant after the  Income Date, the death benefit, if any, will be as specified in the Income Option elected. Death  benefits will be paid at least as rapidly as under the method of distribution in effect at the  Annuitant's death.    BENEFICIARY'S ENTITLEMENT TO INCOME PAYMENTS AFTER THE INCOME DATE.  Upon Your death or the death of the Joint Owner, the Company will pay remaining Income  Payments due to Primary Beneficiaries or, if none exist, to the Contingent Beneficiaries, in equal  shares (the "default allocation") unless You have designated otherwise (the "designated  allocation"). A Beneficiary that dies before or within ten (10) days (or different period as  prescribed by applicable law) of Your death is not entitled to any remaining Income Payments  due; in that circumstance, the Company will pay remaining Income Payments due the deceased  Beneficiary to surviving Beneficiaries in the same proportion as the designated allocation or, if  applicable, the default allocation. If no Beneficiary survives You, the Company will pay  remaining Income Payments to Your estate.    VA710NY                               27 

 

                           TERMINATION PROVISION    This Contract terminates and all Contract benefits, including those provided by any add-on  benefits unless otherwise specified in the add-on benefits, will end on the earlier of:  1.  the date You take a total withdrawal;  2.  the date the Contract Value is reduced to zero for any reason or insufficient to pay Contract     charges; or  3.  the date upon which the Company receives Due Proof of Your (or the Joint Owner's) death     and receives all Beneficiaries' elections of death benefit payment options in Good Order at     the Company's Service Center, unless the Contract is continued by the spouse under the     Spousal Continuation Option.    VA710NY                               28va720nycontract

   Home Office:                  Service Center:  [2900 Westchester Avenue      [P.O. Box 24068  Purchase, New York 10577]     Lansing, MI 48909-4068                                   1-800-599-5651                                   www.jackson.com]                             Jackson National Life Insurance Company of New York®      Thank you for choosing Jackson National Life Insurance Company of New York, also referred to as "the   Company" or "Jackson of NY®."                                       READ YOUR CONTRACT CAREFULLY.      This annuity contract is issued by the Company and is a legal agreement between the Owner ("You") and   Jackson of NY.      AMOUNTS YOU ALLOCATE TO THE INVESTMENT DIVISIONS DURING THE ACCUMULATION AND   ANNUITY PERIODS ARE NOT GUARANTEED AND MAY INCREASE OR DECREASE IN VALUE BASED   UPON THE PERFORMANCE OF THE FUNDS UNDERLYING THE SEPARATE ACCOUNT.      IF THE ACTUAL INVESTMENT RATES EXPERIENCED BY THE SEPARATE ACCOUNT ASSETS (PRIOR TO   DEDUCTION OF THE ASSET-BASED CHARGES SPECIFIED IN THIS CONTRACT) ARE LESS THAN   [2.00%], VARIABLE ANNUITY PAYMENTS WILL DECREASE OVER TIME.      AMOUNTS ALLOCATED TO THE FIXED ACCOUNT OPTIONS WILL EARN INTEREST AT THE CURRENT   INTEREST RATE FOR THE DURATION OF THE FIXED ACCOUNT OPTION PERIOD. THE INTEREST RATE   CREDITED FOR SUBSEQUENT PERIODS IS SUBJECT TO CHANGE AS DECLARED BY THE COMPANY.      THE FIXED ACCOUNT OPTIONS ARE SUBJECT TO A MARKET VALUE ADJUSTMENT FORMULA WHICH   MAY INCREASE OR DECREASE THE VALUE OF AMOUNTS TRANSFERRED OR WITHDRAWN FROM THE   FIXED ACCOUNT OPTIONS, BUT THE FIXED ACCOUNT CONTRACT VALUE WILL NEVER DECREASE TO   LESS THAN THE FIXED ACCOUNT MINIMUM VALUE.      THE CONTRACT VALUE HELD UNDER A FIXED ACCOUNT OPTION MAY BE WITHDRAWN WITHOUT A   MARKET VALUE ADJUSTMENT UPON RECEIPT OF WRITTEN NOTICE WITHIN 30 DAYS FOLLOWING THE   END OF THE CORRESPONDING FIXED ACCOUNT OPTION.      PLEASE  READ  THE  IMPORTANT  CONTRACT  DISCLOSURES  ON  THE  FOLLOWING   PAGE.      NOTICE OF RIGHT TO EXAMINE CONTRACT   YOU MAY RETURN THIS CONTRACT TO THE FINANCIAL PROFESSIONAL WHO SOLD YOU THE   CONTRACT OR THE COMPANY NO LATER THAN 20 DAYS AFTER YOU RECEIVE IT (60 DAYS AFTER YOU   RECEIVE IT IF YOU PURCHASED THE CONTRACT AS A REPLACEMENT CONTRACT). THE COMPANY   WILL REFUND THE CONTRACT VALUE CALCULATED ON THE BUSINESS DAY ON WHICH THE   CONTRACT IS RETURNED TO THE SELLING FINANCIAL PROFESSIONAL OR THE COMPANY RECEIVES   THE CONTRACT AT ITS SERVICE CENTER, INCLUDING ANY FEES OR OTHER CHARGES DEDUCTED   FROM THE PREMIUMS OR IMPOSED UNDER THE CONTRACT. RETURNED CONTRACTS ARE VOID.      Please Note: The Company reserves the right to allocate all Premium received during the "Notice of Right to   Examine Contract" period to a money market Investment Division or the Fixed Account. After the "Notice of Right   to Examine Contract" period expires, the Company will allocate the Contract Value to the Contract Options You   have specified.                                                                   This Contract is signed by the Company INDIVIDUAL DEFERRED VARIABLE AND FIXED  ANNUITY CONTRACT WITH MARKET VALUE                                                     ADJUSTMENT. (FLEXIBLE PREMIUM).  DEATH BENEFIT AVAILABLE.   INCOME OPTIONS AVAILABLE.  NONPARTICIPATING.  CONTAINS PROVISIONS THAT                                                                          President  WAIVE WITHDRAWAL CHARGES.         VA720NY                                                                                      Secretary 

 

       Home Office:                  Service Center:  [2900 Westchester Avenue      [P.O. Box 24068         Purchase, New York 10577]     Lansing, MI 48909-4068                                1-800-599-5651                                www.jackson.com]                                           IMPORTANT - CONTRACT DISCLOSURES                                                                                       PLEASE READ CAREFULLY                                                                                   PLEASE REVIEW THE CONTRACT DATA PAGES FOR CONTRACT CHARGES.              THE COMPANY WILL RE-DETERMINE THE CONTRACT'S FIXED ACCOUNT MINIMUM INTEREST       RATE EACH JANUARY ON THE REDETERMINATION DATE.              THE COMPANY MAY RESTRICT OR REFUSE FUTURE PREMIUM PAYMENTS, PREMIUM       ALLOCATION, TRANSFERS TO, OR DISCONTINUE THE FIXED ACCOUNT OPTION(S) AT ANY       TIME, ON A NONDISCRIMINATORY BASIS, IF THE YIELD ON INVESTMENT WOULD NOT       SUPPORT THE MINIMUM INTEREST RATE GUARANTEED UNDER THE FIXED ACCOUNT(S).       SHOULD THE COMPANY IMPOSE SUCH RESTRICTIONS, THE COMPANY WILL GIVE AT LEAST 30       DAYS ADVANCE NOTICE TO YOU. THE COMPANY WILL ALSO PROVIDE WRITTEN NOTICE       WHEN SUCH RESTRICTIONS NO LONGER EXIST.              ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON THE       ISSUE DATE. PLEASE CHECK THE CONTRACT DATA PAGES TO DETERMINE WHICH DCA+       FIXED ACCOUNT OPTIONS ARE CURRENTLY AVAILABLE.              ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE AFTER ISSUE       OF THIS CONTRACT.            VA720NY                       Contract Cover Page Continued 

 

                             TABLE OF CONTENTS                      Provision                             Page Number                 Contract Data Pages                                    [3a                 Definitions                                             4                 General Provisions                                      8                 Accumulation Provisions                                13                 Withdrawal Provisions                                  16                 Death Benefit Provisions                               21                 Income Provisions                                      24                 Termination Provision                                  28]    If You have questions about this Contract or require information about coverage or complaint  resolutions, You may contact the Company's Service Center identified on the Contract's cover  page.       VA720NY                            2 

 

                           CONTRACT DATA PAGES    Contract Number:                    [1234567890]                                        Owner:                              [John Doe]                                        Owner Issue Age:                    [35]                                        Joint Owner:                        [Jane Doe]                                        Joint Owner Issue Age:              [35]                                        Annuitant:                          [John Doe]                                        Annuitant Issue Age:                [35]                                        Joint Annuitant:                    [Jane Doe]                                        Joint Annuitant Issue Age:          [35]                                        Initial Premium:                    [$50,000]                                        Issue Date:                         [May 1, 2020]                                        Issue State:                        NY                                        Income Date:                        [May 1, 2080]     Primary Beneficiary(ies):           [Brian Doe]     Contingent Beneficiary(ies):        [Mary Doe]                                                                                                                                                                                                                                                                                                                                                            VA720NY-CB1                           3a 

 

                      CONTRACT DATA PAGES (CONT'D)    FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION:    Initial Fixed Account Minimum Interest Rate: [1.00%]  The Company will re-determine the Fixed Account Minimum Interest Rate each January on the  Redetermination Date. The Fixed Account Minimum Interest Rate is the guaranteed minimum  interest rate under the Contract and may change each year on the Redetermination Date.    Initial Base Interest Rate:       [1.00% for the 1-Year Fixed Account Option Period                                    1.00% for the 3-Year Fixed Account Option Period                                    1.00% for the 5-Year Fixed Account Option Period                                    1.00% for the 7-Year Fixed Account Option Period]    Initial Current Interest Rate:    [1.00% for the 1-Year Fixed Account Option Period                                    1.00% for the 3-Year Fixed Account Option Period                                    1.00% for the 5-Year Fixed Account Option Period                                    1.00% for the 7-Year Fixed Account Option Period]                                      Initial Current DCA+ Interest Rate: [6-month [X.XX%] [NOT CURRENTLY AVAILABLE]                                    [12-month [X.XX%] [NOT CURRENTLY AVAILABLE]    ONE OR BOTH OF THE DCA+ FIXED ACCOUNT OPTIONS MAY NOT BE AVAILABLE ON  THE ISSUE DATE. AVAILABILITY IS INDICATED ABOVE.    Maximum DCA+ Rate: [8.00%] over the net investment earnings rate.    Interest Rate for Adjustments Due to Misstatement of Age or Sex: [1.00%]    Annual Contract Maintenance Charge: [$30]  The Company will deduct the Annual Contract Maintenance Charge from the Contract Value  (but not the Remaining Premium) on each Contract Anniversary that occurs on or before the  Income Date or when You withdraw the Contract Value in full on a date other than a Contract  Anniversary. The Company will only deduct the Annual Contract Maintenance Charge from  Contracts with a Contract Value less than [$50,000].    Core Contract Charge: [1.0000%]  The Core Contract Charge is expressed as an annual percentage and is deducted daily from  the Separate Account Contract Value (but not the Remaining Premium). The Company will  reduce the Core Contract Charge to [0.9000%] if the Contract Value on the later of the Issue  Date or the most recent Contract Quarterly Anniversary is greater than or equal to [$1,000,000].  If the Contract Value subsequently falls below [$1,000,000] on any Contract Quarterly  Anniversary, the Company will reinstate the charge of [1.0000%] for the following Contract  Quarter.    Total Asset-Based Charges: [1.0000%]  The Total Asset-Based Charges are expressed as an annual percentage and are deducted daily  from the Separate Account Contract Value (but not the Remaining Premium). The Company will  deduct asset-based charges daily as part of the Accumulation Unit Value calculation. Total  Asset-Based Charges include the Core Contract Charge and asset-based charges for add-on  benefits.  VA720NY-CB1                           3b  

 

                      CONTRACT DATA PAGES (CONT'D)    FIXED ACCOUNT, INTEREST RATE AND CONTRACT CHARGE INFORMATION (continued):    Transfer Charge: [$25]  The Company allows [25] free transfers between Contract Options in a Contract Year. The  Company charges a fee for each transfer You make in excess of the [25] free transfers in any  Contract Year. The Company deducts Transfer Charges from the amount You seek to transfer  before allocation to the new Contract Option. The Company does not assess Transfer Charges  on transfers under any of the Company's systematic investment programs, and the Company  does not count those transfers against the [25] free transfers allowed in a Contract Year. Free  transfers not utilized during a given Contract Year cannot be carried forward to subsequent  Contract Years.    Add-on Benefit Charges:  If applicable, refer to the supplemental contract data pages of any attached add-on benefits for  additional charges and fees associated with Your Contract.    WITHDRAWALS:    Withdrawal Charge Schedule:             Completed Years Since                    Withdrawal Charge            Receipt of Premium                         Percentage                    0                                    7.00%                    1                                    6.00%                    2                                    5.00%                    3                                    4.00%                    4                                    3.00%                    5                                    2.00%                    6                                    1.00%                    7+                                   0.00%    Please see Withdrawal Provisions for a complete explanation of the determination of Withdrawal  Charges.    Minimum partial withdrawal amount unless as a scheduled part of an automatic  withdrawal program: [$500]    Minimum partial withdrawal amount as a scheduled part of an automatic withdrawal  program: [$50]    Minimum Contract Value remaining after a partial withdrawal: [$2,000]    Free Withdrawal Percentage: [10%]    Waiver of Withdrawal Charge for Extended Care  Eligibility Date:                                           [May 1, 2021]    Waiver of Withdrawal Charge for Extended Care Maximum Amount: [100%] of the Contract  Value, not to exceed [$250,000].   VA720NY-CB1                           3c 

 

                      CONTRACT DATA PAGES (CONT'D)    MARKET VALUE ADJUSTMENT (MVA):    An MVA is a positive or negative adjustment the Company applies to amounts You remove from  a Fixed Account Option due to withdrawals or transfers.    The MVA reflects the movement in the Base Interest Rate since the date of Your allocation to  the Fixed Account Option from which You remove Fixed Account Contract Value, which is  valued over the number of months remaining in the Fixed Account Option period.    The MVA may:  1.  reduce the value of the amount paid or transferred if the Base Interest Rate on the date You     remove Fixed Account Contract Value from a Fixed Account Option is greater than the Base     Interest Rate on the date of Your allocation to that Fixed Account Option; or  2.  increase the value of the amount paid or transferred if the Base Interest Rate on the date     You remove Fixed Account Contract Value from a Fixed Account Option is less than the     Base Interest Rate on the date of Your allocation to that Fixed Account Option.    The Company applies the same MVA formula regardless of whether the formula results in an  increase or decrease to amounts You remove from a Fixed Account Option.    The Company applies the MVA formula to the amount You remove less any applicable charges.    MVA formula. The Company calculates the MVA by multiplying the amount You remove from a  Fixed Account Option by the result of the formula below:                                      (m/12)                               [1+ I ]                                         -1                                   (m/12)                               [1+J  ]               where:    I  is  the Base Interest Rate the Company credits to the Fixed Account Option from which You        are removing Fixed Account Contract Value.  J  is  the Base Interest Rate the Company credits on new allocations to Fixed Account        Options with a duration equal to the number of years remaining in the Fixed Account        Option from which You remove Fixed Account Contract Value, increased by 0.0025. If        the Company does not offer such a Fixed Account Option on the date of the removal, the        Company will establish "J" by straight-line interpolation between the two (2) Fixed        Account Options with durations closest to the number of years remaining in the Fixed        Account Option from which You remove Fixed Account Contract Value.  m  is  the number of complete months remaining from the date of the removal to the end of the        period of the Fixed Account Option from which You are removing Fixed Account        Contract Value.    The Company makes no MVA when J is greater than I by less than 0.0025.    In no event will a total withdrawal from a Fixed Account Option be less than the Fixed Account  Minimum Value.   VA720NY-CB1                           3d 

 

                      CONTRACT DATA PAGES (CONT'D)    MVA (continued):    The Company will not apply an MVA to:  1.  death benefit proceeds;  2.  payment of charges or fees;  3.  amounts annuitized;  4.  exercise of Your Notice of Right to Examine Contract provision;  5.  withdrawals taken under the Free Withdrawal provision;  6.  amounts required to satisfy the Required Minimum Distribution (RMD);  7.  amounts You remove from the 1-Year Fixed Account Option;  8.  amounts You remove from any Fixed Account Option on the Latest Income Date; or  9.  amounts You remove from any Fixed Account Option in the 30-day period following the end     of a Fixed Account Option.     Unavailability of Base Interest Rate. In the event that the Base Interest Rate cannot be  determined on the date You remove Fixed Account Contract Value from a Fixed Account  Option, the MVA will be determined by using the asked yield to maturity of the U.S. Treasury  Notes with the same remaining term, using straight-line interpolation where necessary as  published in The Wall Street Journal on the next succeeding Business Day following the  effective date of the MVA.    TRANSFERS:    Transfer among Investment Divisions. At any time, You may transfer all or a portion of Your  Contract Value in any Investment Division to any available Investment Division(s).    Transfer from an Investment Division to a Fixed Account Option. Before the Income Date,  You may transfer all or a portion of Your Contract Value in an Investment Division to any  available Fixed Account Option(s). Additional details regarding restrictions on transfers are  outlined in the Transfer Provisions on page 11.    Transfer from a Fixed Account Option to an Investment Division or to a Fixed Account  Option. Before the Income Date, You may transfer all or a portion of Your Contract Value in a  Fixed Account Option, subject to any applicable MVA, to any available Investment Division(s) or  any available Fixed Account Option(s). Additional details regarding restrictions on transfers are  outlined in the Transfer Provisions on page 11 and in the Fixed Account Provisions on page 13.    Transfer Effective Date: Transfers You request will be effective as of the end of the Business  Day upon which the Company receives Your transfer request in Good Order at the Company's  Service Center.    Additional details on transfer restrictions are outlined in the Transfer of Funds Restrictions  section of the General Provisions on page 11.    VA720NY-CB1                           3e 

 

                      CONTRACT DATA PAGES (CONT'D)    PREMIUM(S):    This is a flexible Premium Contract. You may change the amount, frequency and timing of  Premium payments, subject to the minimum and maximum Premium payment amounts  specified below. The Company may waive the minimums or maximums at any time.    Minimum Initial Premium for Non-Qualified Plan Contract: [$50,000]    Minimum Initial Premium for Qualified Plan Contract: [$50,000]    Minimum Subsequent Premium: [$500] ([$50] if made as a scheduled part of an automatic  payment plan)    Maximum Total Premium under a Contract: [$2,500,000]    Minimum Amount Allocated to an Investment Division or Fixed Account Option: [$100]    The Company may restrict or reject Premium allocations to a Fixed Account Option(s) at any  time as outlined in the Transfer Provisions on page 11 and in the Fixed Account Provisions on  page 13. The Company will allocate any Premium payment subsequent to issue according to  Your most recent instructions on file with the Company, provided that each allocation complies  with the Company's then current minimum amounts and restrictions.    Minimum Contract Value to Participate in the Enhanced Interest Rate Dollar Cost  Averaging Program: [$15,000]    CONTRACT OPTIONS:    Investment Divisions: Investment Division(s) available at issue are identified in the application,  if attached, current prospectus and any supplements. The Company may offer new Investment  Divisions, or eliminate, substitute, or combine Investment Divisions.    Separate Account: [JNLNY Separate Account I]    Fixed Account Options: [1-Year Period; 3-Year Period; 5-Year Period; and 7-Year Period; the  availability of each option will be determined by the Company.] The 1-Year, 3-Year, 5-Year, and  7-Year periods may not be available at all times. In the event the Company discontinues the  availability of the Fixed Account Option(s) a money market Investment Division will be made  available for Premium allocation and transfers.    Available Fixed Account Options are identified in the current prospectus and any supplements.    Maximum Contract Option Allocations Allowed: The number of allocations to the Contract  Options may not exceed [99] at any one time.    The Company will identify the Contract Options You select in a confirmation the Company  sends You on or after the Issue Date and are stated in the application or any supplemental  application attached to this Contract, if any.    VA720NY-CB1                           3f 

 

                                                                  CONTRACT DATA PAGES (CONT'D)                                                                                  TABLE OF INCOME OPTIONS                              The following table shows income values for each $1,000 of net proceeds applied to the Income               Option.                  UNDER OPTION 4                                                           MONTHLY INSTALLMENTS UNDER OPTIONS 1 OR 3                                                                                                                                                                                                  Age of                               Age of                                  Age of                                 Age of                       No. of     Monthly     Annui-          No. of Mos.          Annui-           No. of Mos.            Annui-           No. of Mos.           Annui-              No. of Mos.  Monthly      Install-    tant             Certain              tant              Certain               tant              Certain              tant                Certain   Install-    ments   ments                           Male      Life     120      240      Male       Life      120      240      Female      Life     120      240      Female       Life       120        240     60        17.09        40       2.33     2.32     2.31      68        4.72      4.57     4.02       40        2.22     2.22     2.21        68        4.36       4.26       3.86     72        14.31        41       2.37     2.36     2.35      69        4.90      4.72     4.09       41        2.26     2.26     2.25        69        4.52       4.40       3.94     84        12.33        42       2.41     2.41     2.39      70        5.09      4.89     4.16       42        2.30     2.30     2.29       70         4.69       4.55       4.02     96        10.84        43       2.45     2.45     2.43      71        5.31      5.06     4.23       43        2.34     2.34     2.32        71        4.87       4.70       4.09    108         9.68        44       2.50     2.50     2.47      72        5.54      5.24     4.29       44        2.38     2.38     2.36        72        5.06       4.87       4.16    120         8.76        45       2.55     2.54     2.52      73        5.79      5.43     4.34       45        2.42     2.42     2.40        73        5.28       5.04       4.22    132         8.00        46       2.60     2.59     2.56      74        6.06      5.63     4.39       46        2.47     2.47     2.45        74        5.51       5.23       4.28    144         7.37        47       2.65     2.64     2.61      75        6.35      5.83     4.43       47        2.52     2.51     2.49        75        5.76       5.42       4.34    156         6.84        48       2.71     2.70     2.66      76        6.67      6.04     4.47       48        2.57     2.56     2.54       76         6.03       5.62       4.38    168         6.38        49       2.77     2.76     2.71      77        7.02      6.26     4.50       49        2.62     2.61     2.59        77        6.33       5.83       4.43    180         5.98        50       2.83     2.82     2.76      78        7.40      6.48     4.52       50        2.67     2.67     2.64        78        6.65       6.04       4.46    192         5.64        51       2.89     2.88     2.82      79        7.81      6.70     4.54       51        2.73     2.72     2.69        79        7.01       6.26       4.49    204         5.33        52       2.96     2.94     2.88      80        8.27      6.92     4.56       52        2.79     2.78     2.74        80        7.40       6.48       4.52    216         5.06        53       3.03     3.01     2.94      81        8.76      7.13     4.57       53        2.85     2.84     2.80        81        7.83       6.70       4.54    228         4.82        54       3.10     3.08     3.00      82        9.30      7.34     4.58       54        2.92     2.91     2.85       82         8.29       6.92       4.56    240         4.60        55       3.18     3.16     3.06      83        9.89      7.53     4.58       55        2.99     2.98     2.91        83        8.80       7.13       4.57    252         4.40        56       3.26     3.23     3.13      84       10.54      7.72     4.59       56        3.07     3.05     2.98        84        9.35       7.33       4.58    264         4.22        57       3.35     3.32     3.19      85       11.26      7.88     4.59       57        3.14     3.12     3.04        85        9.95       7.52       4.58    276         4.06        58       3.44     3.40     3.26      86       12.05      8.03     4.59       58        3.23     3.20     3.11        86       10.59       7.70       4.59    288         3.90        59       3.54     3.49     3.34      87       12.91      8.17     4.59       59        3.31     3.29     3.18        87       11.28       7.87       4.59    300         3.77        60       3.64     3.59     3.41      88       13.86      8.28     4.60       60        3.40     3.37     3.25       88        12.03       8.02       4.59    312         3.64        61       3.74     3.69     3.48      89       14.88      8.38     4.60       61        3.50     3.46     3.32        89       12.84       8.15       4.59    324         3.52        62       3.86     3.79     3.56      90       15.99      8.46     4.60       62        3.60     3.56     3.40        90       13.71       8.27       4.60    336         3.41        63       3.98     3.91     3.64      91       17.17      8.53     4.60       63        3.71     3.66     3.47        91       14.66       8.37       4.60    348         3.31        64       4.11     4.02     3.71      92       18.43      8.58     4.60       64        3.82     3.77     3.55        92       15.70       8.45       4.60    360         3.21        65       4.24     4.15     3.79      93       19.78      8.63     4.60       65        3.95     3.88     3.63        93       16.86       8.53       4.60                            66       4.39     4.28     3.87      94       21.20      8.66     4.60       66        4.07     4.00     3.71       94        18.13       8.58       4.60                            67       4.55     4.42     3.95      95       22.67      8.68     4.60       67        4.21     4.12     3.79        95       19.53       8.63       4.60                              Note: Due to the volume of relevant information, the Table does not provide income values for               Option 2 described in the Income Provisions. Those values are available from the Company's               Service Center upon request. You may contact the Company's Service Center as shown on the               cover page of the Contract.                              BASIS OF COMPUTATION. The 2012 Individual Annuity Mortality Period Table, with an               assumed net investment rate of 1.00% and a 0% expense load, provides the actuarial basis for               the Table of Income Options. The Table of Income Options does not include any applicable tax.                 VA720NY-CB1                                                                 3g 

 

                                  DEFINITIONS    ACCUMULATION UNIT. A unit of measure the Company uses to calculate the value of  amounts allocated to an Investment Division before the Income Date.    ANNUITANT. The natural person(s) so designated on the Contract Data Pages, or by  subsequent designation, on whose life the Company determines the amount of Income  Payments provided by the Contract. References to the Annuitant include all Joint Annuitants, if  applicable.    ANNUITIZE. When You elect to convert the Contract Value into Income Payments.    ANNUITY UNIT. A unit of measure the Company uses to calculate each Variable Annuity  Payment.    BASE INTEREST RATE. The annual percentage, declared by the Company, at which Your  money grows for a specified Fixed Account Option period.    BENEFICIARY(IES). The natural person(s) or legal entity(ies) You designate as Primary or  Contingent Beneficiary(ies) to receive any death benefit provided by the Contract. The initial  designated Beneficiary(ies) are shown on the Contract Data Pages.    BUSINESS DAY. Any day that the New York Stock Exchange (NYSE) is open for business. The  Business Day ends when the NYSE closes for the day.    CONTRACT. The Individual Deferred Variable and Fixed Annuity Contract described herein.    CONTRACT ANNIVERSARY. Each one-year anniversary of the Issue Date.    CONTRACT OPTION(S). The Investment Divisions and Fixed Account Options the Contract  offers, as shown on the Contract Data Pages. Each Contract Option is explained in the  Accumulation Provisions.    CONTRACT QUARTERLY ANNIVERSARY. Each three-month anniversary of the Issue Date.    CONTRACT VALUE. The current value of the amounts under this Contract allocated to the  Investment Divisions and Fixed Account Options.    CONTRACT YEAR. The twelve-month period beginning on the Issue Date and on any Contract  Anniversary thereafter while the Contract remains in force.    CURRENT INTEREST RATE. The Base Interest Rate plus any additional interest rate the  Company credits. The Current Interest Rate will never be less than the Fixed Account Minimum  Interest Rate.    DESIGNATED OPTION(S). The Investment Division(s) and/or Fixed Account Option(s) You  select, to which amounts will be transferred from a Source Option pursuant to one of the  Company's systematic investment programs.    VA720NY                               4 

 

                             DEFINITIONS (CONT'D)    DUE PROOF. Evidence of death, including but not limited to, a certified death certificate issued  by the governmental authority for the location of the death, or other lawful evidence the  Company requires.    FIXED ACCOUNT. The Fixed Account is part of the Company's general account. A Fixed  Account earns a specified interest rate, not less than the guaranteed minimum interest rate, to  which You may allocate Premium and Contract Value unless the Company has restricted such  allocations.    FIXED ACCOUNT CONTRACT VALUE. The sum of all amounts allocated to the Fixed Account  Options, reduced by the gross amount of withdrawals and transfers from the Fixed Account  Options, and applicable charges and taxes, plus all interest credited to the Fixed Account  Options.    FIXED ACCOUNT MINIMUM INTEREST RATE. The Fixed Account Minimum Interest Rate is  the minimum annual percentage at which Your money allocated to the Fixed Account will grow.  The Company uses this rate to determine the Fixed Account Minimum Value. The Initial Fixed  Account Minimum Interest Rate is shown on the Contract Data Pages.    FIXED ACCOUNT MINIMUM VALUE. The Fixed Account Minimum Value is equal to all  amounts allocated to the Fixed Account Options, net of applicable taxes, reduced by partial  withdrawals, transfers, and charges from the Fixed Account Options, accumulated at the Fixed  Account Minimum Interest Rate, less any Withdrawal Charges or tax due.    FIXED ACCOUNT OPTION. A Contract Option within the Fixed Account that specifies a fixed  period for which the Company credits the Current Interest Rate.    GOOD ORDER. The Company's receipt of all information, documentation, instructions and/or  Premium the Company requires before it will issue the Contract or execute any transaction.    INCOME DATE. The date on which Income Payments are to begin as described in the Income  Provisions. The Income Date must be at least thirteen (13) months after the Contract Issue  Date.    INCOME OPTION. One of the payment options provided under the Income Provisions.    INCOME PAYMENTS. Fixed Annuity Payments and Variable Annuity Payments offered by the  Company at the Income Date.    INVESTMENT DIVISIONS. Separate and distinct divisions of the Separate Account, each of  which invests in a specific Underlying Mutual Fund, and for which Accumulation Units and  Annuity Units are separately maintained. The Separate Account Contract Value in the  Investment Divisions will increase or decrease depending on the performance of the Underlying  Mutual Funds.    ISSUE DATE. The date the Company issued the Contract. The Issue Date is shown on the  Contract Data Pages.    VA720NY                               5 

 

                             DEFINITIONS (CONT'D)    JOINT OWNER. Each of the Contract Owners.    LATEST INCOME DATE. The Contract Anniversary on which You will be 95 years old, or such  earlier date required by a Qualified Plan, law or regulation.    NON-QUALIFIED PLAN. A retirement plan which does not qualify for favorable tax treatment  under Sections 401, 403, 408, 408A or 457 of the Internal Revenue Code, as amended.    OWNER ("YOU," "YOUR"). The natural person(s) or legal entity(ies) shown on the Contract  Data Pages, or by subsequent designation. In this Contract, "You" and "Your" also mean the  Owner. The primary Owner is the first Owner specified on the Contract Data Pages. References  to the Owner include the Joint Owner, if applicable.    PREMIUM(S). Money paid into this Contract for allocation to a Contract Option.    QUALIFIED PLAN. A retirement plan which qualifies for favorable tax treatment under Sections  401, 403, 408, 408A or 457 of the Internal Revenue Code, as amended.    REDETERMINATION DATE. The date the Fixed Account Minimum Interest Rate is reset as  described in the Fixed Account Minimum Interest Rate provision. It is the date each January that  coincides with the Issue Date. For example, if Your Contract's Issue Date is May 23, the  Redetermination Date will be January 23 each year following the Issue Date.    REDETERMINATION PERIOD. The twelve-month period that begins on each Redetermination  Date.    REMAINING PREMIUM. Total Premium paid into the Contract, reduced by withdrawals of  Premium, including the Withdrawal Charges, before withdrawals are adjusted for any applicable  MVA or charges.    REQUIRED MINIMUM DISTRIBUTION (RMD). For certain Qualified Plan contracts, the  RMD is the amount defined by the Internal Revenue Code and the implementing regulations  as the minimum distribution requirement that applies to this Contract only.    SEPARATE ACCOUNT. An asset account the Company has established and maintains in  accordance with applicable law. The Company has allocated a portion of its assets to this  account for this Contract and certain other contracts. The name of the Separate Account is  shown on the Contract Data Pages.    SEPARATE ACCOUNT CONTRACT VALUE. The current value of the amounts under this  Contract allocated to the Separate Account's Investment Divisions.    SERVICE CENTER. The Company's administrative address and telephone number as identified  on the Contract's cover page or as the Company may designate from time to time.    VA720NY                               6 

 

                             DEFINITIONS (CONT'D)    SOURCE OPTION. The Investment Division or Fixed Account Option You select from those the  Company makes available, from which amounts will be transferred to a Designated Option(s)  pursuant to one of the Company's systematic investment programs.    UNDERLYING MUTUAL FUNDS. The registered management investment companies in which  the assets of the Investment Divisions will be invested.    WITHDRAWAL CHARGE. A charge assessed against certain withdrawals. The Withdrawal  Charge Schedule is shown on the Contract Data Pages.    WITHDRAWAL VALUE. The Contract Value, less any tax payable, applicable Withdrawal  Charges, Annual Contract Maintenance Charge, and charges due under any add-on benefit,  adjusted for any applicable MVA.    VA720NY                               7 

 

                            GENERAL PROVISIONS    ANNUITANT. You may change the Annuitant at any time before the Income Date, unless the  Contract is owned by a legal entity. If the Contract is owned by a legal entity, the Company will  use the oldest Annuitant's age for all Contract purposes unless otherwise specified in the  Contract. The Company reserves the right to limit the number of Joint Annuitants to two (2).  When the Owner is a legal entity, the Annuitant(s) shall be entitled to the Waiver of Withdrawal  Charge for Extended Care.    ASSIGNMENT. You may assign ownership of this Contract subject to the interests of assignees  and irrevocable Beneficiaries. The Company will only be bound by an assignment if a request is  submitted in a form acceptable to the Company and received in Good Order at the Company's  Service Center. Unless You specify otherwise, an assignment will take effect on the date the  request is signed by You, subject to any payments the Company has made or other actions the  Company has taken before the Company receives Your request.     The Company assumes no responsibility for the validity or tax consequences of any  assignment. If You make an assignment, You may have to pay taxes. The Company  encourages You to seek legal and/or tax advice.    BENEFICIARY. You may change the Beneficiaries, subject to the interest of assignees and  irrevocable Beneficiaries. The Company will only be bound by a change in Beneficiary if a  request is submitted in a form acceptable to the Company and received in Good Order at the  Company's Service Center. Any previously designated irrevocable Beneficiary must consent in  writing to any change in Beneficiary. Unless You specify otherwise, a change in Beneficiary will  take effect on the date the request is signed by You, subject to any payments the Company has  made or other actions the Company has taken before the Company receives Your request, and  while You are alive.    CHARGES AND FEES. The Contract permits the Company to assess certain charges and fees.  Charges and fees associated with Your Contract are listed on the Contract Data Pages.    CONFORMITY WITH LAWS. This Contract will be interpreted under the laws of the state of  New York as of the date issued and any applicable federal laws. Any provision that is in conflict  with New York law or any federal law is amended to conform to the minimum requirements of  such law. Non-conforming provisions may be enforced against the Company to the extent  provided by applicable New York or federal law.    DEFERRAL OF FIXED ACCOUNT PAYMENTS. The Company may defer payment of Your  request for a partial and/or total withdrawal from a Fixed Account Option for a period not  exceeding six (6) months. Such deferral will be made after the Company receives approval in  writing by the chief insurance regulator of the state of New York, if required. The Company will  credit interest on deferred amounts pursuant to New York law. The Company will not defer  death benefit payments, annuity payments, previously scheduled guaranteed living benefit  payments or payments made to comply with the RMD requirements of the Internal Revenue  Code, as applicable.    ENTIRE CONTRACT. The Contract, attached application or supplemental application, if any,  and any attached endorsements, add-on benefits and amendments together make up the entire  Contract between You and the Company. All statements made by, or under the authority of, the  applicant for issuance of the Contract, shall be deemed representations and not warranties.   VA720NY                               8 

 

                       GENERAL PROVISIONS (CONT'D)    INCONTESTABILITY. The Company will not contest this Contract from its Issue Date, as  shown on the Contract Data Pages.    MINIMUM BENEFITS. For any paid-up annuity option, cash value or death benefit, the amount  available under this Contract shall not be less than the minimum benefits required by the state  of New York.    MISSTATEMENT OF AGE AND/OR SEX. If Your or the Annuitant's age and/or sex is misstated  at the time the Contract's Income Payments become payable, the Company will adjust the  payments to reflect income consistent with the correct age and/or sex. Immediately upon  discovery, the Company will adjust the next payment due as a credit or charge, as appropriate,  for any underpayments or overpayments using the Interest Rate for Adjustments Due to  Misstatement of Age or Sex shown on the Contract Data Pages.    MODIFICATION OF CONTRACT. No financial professional has authority to change or waive  any of this Contract's provisions. No change to or waiver of this Contract's terms is valid unless  in writing and signed by the Company's President, Vice President, Secretary or Assistant  Secretary; and approved by the New York Department of Financial Services prior to use. Your  written consent will be obtained prior to changing any terms and conditions of the Contract in a  manner that diminishes Your rights and/or benefits under the Contract.    NONPARTICIPATING. This Contract is nonparticipating and does not share in the Company's  surplus or earnings.    OWNER. You may change the Owner or the Joint Owner. The Company will only be bound by a  change of ownership if submitted in a form acceptable to the Company and received in Good  Order at the Company's Service Center. No person whose age exceeds the maximum issue  age the Company had set as of the Issue Date may become a new Owner. Unless You specify  otherwise, a change of ownership will take effect on the date the request is signed by You,  subject to any payments the Company has made or other actions the Company has taken  before the Company receives Your request. Joint Owners have equal ownership rights;  therefore, each Owner must authorize any exercise of Contract rights unless the Joint Owners  instruct the Company in writing to act upon authorization of an individual Joint Owner. The  maximum number of Joint Owners allowed is two (2).    The Company assumes no responsibility for the validity or tax consequences of any  ownership change. If You make an ownership change, You may have to pay taxes. The  Company encourages You to seek legal and/or tax advice.    PROOF OF AGE, SEX AND/OR SURVIVAL. The Company may require proof of age and/or  sex satisfactory to the Company at any time. If any payment required by this Contract depends  on a living Annuitant, Owner, or Beneficiary, the Company may require proof of that person's  survival satisfactory to the Company.    PROTECTION OF PROCEEDS. A Beneficiary may not assign Contract proceeds before the  proceeds are payable. Contract proceeds are not subject to the claims of creditors or to legal  process unless required by New York law.    VA720NY                               9 

 

                       GENERAL PROVISIONS (CONT'D)    REPORTS. The Company will send a report to Your last address in the Company's records at  least annually before the Income Date. In the case of Joint Owners, the Company will send  reports only to the primary Owner's address. Each report will provide at least the following  information:  1.  the dates that begin and end the reporting period;  2.  the Contract Value at the beginning and at the end of the current reporting period prior to the     application of any MVA;  3.  the Withdrawal Charge and MVA amount the Company used to determine the Withdrawal     Value;  4.  the amounts the Company has credited to and deducted from the Contract Value during the     reporting period;  5.  the Withdrawal Value at the end of the reporting period;  6.  the death benefit at the end of the reporting period; and  7.  any other information state and federal law require.    You may receive copies of reports the Company provides upon request at no additional charge.    SUBSTITUTION OF UNDERLYING MUTUAL FUND(S). If the Company determines that an  Underlying Mutual Fund is no longer available or appropriate for Contract purposes, the  Company may replace that Underlying Mutual Fund with another Underlying Mutual Fund  without Your consent. No replacement or substitution will be made without notice to You or  without prior approval of the New York Department of Financial Services. Changes of the  Underlying Mutual Fund(s) are subject to federal securities laws and the laws of the state of  New York. In the event the Company replaces an Underlying Mutual Fund, You are permitted to  transfer Your Contract Value and allocate future Premiums among the available Investment  Divisions, consistent with Your rights under the Contract.    SUSPENSION OF SEPARATE ACCOUNT PAYMENTS. The Company may suspend or delay  withdrawals of Separate Account Contract Value or transfers to or from an Investment Division  for any period when:  1.  the NYSE is closed (other than customary weekend and holiday closings);  2.  under applicable Securities and Exchange Commission (SEC) rules, trading on the NYSE is     restricted;  3.  under applicable SEC rules, an emergency exists such that it is not reasonably practicable     to dispose of securities in the Separate Account or to determine the value of its assets; or  4.  the SEC, by order, so permits.    The Company will not suspend death benefit payments, annuity payments, previously  scheduled guaranteed living benefit payments or payments made to comply with the RMD  requirements of the Internal Revenue Code, as applicable.    TAXES. The Company will deduct any taxes attributed to the Contract and payable to the state  of New York or other government entity from the Contract Value as they are incurred.    VA720NY                               10 

 

                       GENERAL PROVISIONS (CONT'D)    TRANSFER OF FUNDS. The Contract Data Pages describe the conditions for transfers of  funds between Contract Options.    Transfer of Funds Restrictions. The Company may restrict the number and frequency of  transfers into and between Contract Options in certain circumstances. This includes,  circumstances in which the Company determines, that a reasonably designed restriction is  required to prevent transfers that would disadvantage an Owner. The Company may impose a  restriction including:  1.  a minimum time between transfers;  2.  a limitation on transfer requests of an agent acting for one or more Owners; and  3.  a limitation on the dollar amount of any transfer.    The Company may also impose restrictions on Your ability to make transfers to or from the 1- Year Fixed Account Option. This includes a restriction that transfers from the 1-Year Fixed  Account Option in any Contract Year may not exceed the maximum amount, as defined below:  1.  in the first Contract Year that transfer restrictions are in effect, or if in the prior Contract Year     the maximum amount was not transferred out of the 1-Year Fixed Account Option, the     maximum amount that You may transfer out of the 1-Year Fixed Account Option is equal to     1/3 of the Contract Value in the 1-Year Fixed Account Option at the beginning of the current     Contract Year;  2.  if the maximum amount (1/3 of the value of the 1-Year Fixed Account Option at the     beginning of the prior Contract Year) was transferred from the 1-Year Fixed Account Option     in the prior Contract Year, the maximum amount that You may transfer out of the 1-Year     Fixed Account Option in the current Contract Year is equal to 1/2 of the Contract Value in     the 1-Year Fixed Account Option at the beginning of the current Contract Year. Any     transfers out of the 1-Year Fixed Account Option cannot begin until twelve (12) calendar     months after the last transfer out of the 1-Year Fixed Account Option in the prior Contract     Year;  3.  if the maximum amount (1/3 and then 1/2 of the value of the 1-Year Fixed Account Option at     the beginning of each of the two (2) prior Contract Years, respectively) was transferred from     the 1-Year Fixed Account Option in each of the two (2) prior Contract Years, You may     transfer the remaining Contract Value in the 1-Year Fixed Account Option. Any transfers out     of the 1-Year Fixed Account Option cannot begin until twelve (12) calendar months after the     last transfer out of the 1-Year Fixed Account Option in the prior Contract Year.    If the 1-Year Fixed Account Option restriction is imposed, the Company may:  1.  limit Your ability to transfer into or allocate new Premium to the 1-Year Fixed Account Option     in any Contract Year in which You make a transfer from the 1-Year Fixed Account Option.  2.  limit Your ability to transfer from the 1-Year Fixed Account Option in any Contract Year in     which You make a transfer into or allocate new Premium to the 1-Year Fixed Account     Option.  3.  offer an optional automated systematic transfer program to allow for systematic transfers out     of the 1-Year Fixed Account Option.    If the 1-Year Fixed Account Option restriction is imposed transfers under systematic investment  programs do not count against the maximum amount, and the Contract Value under such  programs is excluded from the determination of the maximum amount.    VA720NY                               11 

 

                       GENERAL PROVISIONS (CONT'D)    Systematic Investment Programs. The Company may from time to time offer systematic  investment programs that allow You to systematically transfer funds between the Contract  Options. These programs may include, but are not limited to, dollar cost averaging, portfolio  rebalancing, and the automatic monthly transfer of earnings from the 1-Year Fixed Account  Option and/or money market Investment Division to the Designated Option(s). After issue of  Your Contract, You may elect one of the programs by contacting the Company's Service Center  to obtain materials and forms that describe, and are required to participate in, these programs.  The Company makes no guarantee that these programs will result in a profit or protect against  loss.    The Company's optional dollar cost averaging program permits You to authorize the automatic  monthly, quarterly, semiannual, or annual transfer of a fixed dollar amount or selected  percentage of the value of a Source Option, to one (1) or more Designated Option(s).    The Company may offer an enhanced interest rate on Premium which an Owner that selects  dollar cost averaging allocates to the 1-Year Fixed Account Option (as the Source Option). You  may participate in the enhanced interest rate dollar cost averaging program only if Your  Contract Value is at least equal to the minimum shown on the Contract Data Pages. Under an  enhanced interest rate dollar cost averaging program, amounts You allocate to the Source  Option are automatically transferred to the Designated Option(s) of Your choice at a monthly  frequency within a 6-month or 12-month duration until all amounts in the Source Option have  been transferred. The Company may elect not to offer one or both durations at any time. When  offered, You may contact the Company's Service Center to request the interest rates and the  specified periods applicable to the enhanced interest rate dollar cost averaging program.     If You elected the enhanced interest rate dollar cost averaging program when this Contract was  issued, the duration and interest rates will be specified on the Contract Data Pages. If You elect  this program after issue of Your Contract, a confirmation showing the duration and interest rate  applicable will be sent to You. The predetermined level monthly transfer amount is calculated  such that the entire balance of the Source Option will be completely transferred by the end of  the specified duration. In the event You cancel participation in the enhanced interest rate dollar  cost averaging program, the Company will transfer the Source Option balance, including any  interest, into the Designated Option(s) You selected.    WRITTEN NOTICE. Written information or instructions You intend to give to the Company must  be in Good Order and delivered to the Company's Service Center, unless the Company advises  You otherwise. A notice relating to Owner, Beneficiary designation or assignment changes shall  take effect on the date the request is signed by You, subject to any payments the Company has  made or other actions the Company has taken before the Company receives the request.  Otherwise, instructions included in a Written Notice will take effect on the date the Company  receives the notice at the Company's Service Center.    The Company will deliver any notice or communication to Your last known address in the  Company's records unless You request otherwise in writing. You are responsible for promptly  notifying the Company of any address change or any error in a Company notice sent to You. In  the case of Joint Owners, the Company will send notices and other communications to the  primary Owner's address.    VA720NY                               12 

 

                        ACCUMULATION PROVISIONS    You may not allocate funds to more than the maximum number of Contract Options, shown on  the Contract Data Pages, at any one time.     SEPARATE ACCOUNT. The Separate Account is an asset account shown on the Contract  Data Pages. The Separate Account consists of assets the Company has set aside and has kept  separate from the Company's general account assets and other separate accounts. The  Separate Account assets will not be charged with liabilities arising out of any other Company  business. The Company credits or charges all the income, gains, and losses resulting from the  Separate Account assets exclusively to the contracts supported by the Separate Account. The  Separate Account assets will be available to cover the liabilities of the Company's general  account only to the extent that they exceed the Separate Account liabilities arising from the  Contracts supported by the Separate Account. The Separate Account is divided into several  Investment Divisions. The Company will value the Separate Account assets at their fair market  value at least monthly.    Accumulation Units. The Separate Account Contract Value may increase or decrease  depending on the performance of the Investment Divisions. The Company uses a unit of  measure called an Accumulation Unit to measure the Separate Account Contract Value before  the Income Date. The value of an Accumulation Unit may increase or decrease from Business  Day to Business Day. Transactions affecting the Separate Account Contract Value, such as  withdrawals, transfers, and certain charges, result in the redemption of Accumulation Units but  do not change the value of Accumulation Units.    When You make an allocation to the Investment Divisions, the Company credits Your Contract  with Accumulation Units. The Company determines the number of Accumulation Units credited  to Your Contract by dividing the amount You allocate to each Investment Division by its  Accumulation Unit Value at the close of the Business Day on which You make the allocation.    Accumulation Unit Value. The Company determines the Accumulation Unit Value for each of  the Investment Divisions by:  1.  determining the total amount of money allocated to that particular Investment Division;  2.  subtracting from that amount any applicable Core Contract Charge and taxes; and  3.  dividing the result by the number of outstanding Accumulation Units.    FIXED ACCOUNT. Allocations You make to Fixed Account Options are included in the  Company's general account. The Company's general account consists of all the Company's  assets, other than those in the Separate Account and other asset accounts.    You may select from the Fixed Account Options made available by the Company. Amounts in  the Fixed Account Option You select will earn interest at that option's Current Interest Rate  during the Fixed Account Option period. Interest will be credited no less frequently than annually  and will be credited from the date of the deposit to the date of withdrawal. The Company may  declare Base Interest Rates higher or lower than any Base Interest Rates the Company  previously declared but the interest rate credited to the Fixed Account Option will never be less  than the Fixed Account Minimum Interest Rate.    VA720NY                               13 

 

                   ACCUMULATION PROVISIONS (CONT'D)    You may allocate Premium, or make transfers from the Investment Divisions and/or Fixed  Account Options, to the Fixed Account Options at any time before the Income Date, subject to  the provisions of this Contract. You may not select any Fixed Account Option, other than the 1- Year Fixed Account Option, that extends beyond the Income Date.    Within at least fifteen (15) days, but not more than forty-five (45) days, prior to the end of any  Fixed Account Option period, the Company will notify You of Your ability to:  1.  withdraw amounts allocated to the Fixed Account Option within thirty (30) days following the     end of that Fixed Account Option without an MVA;  2.  elect any available Fixed Account Option of a different duration within thirty (30) days following     the end of that Fixed Account Option;  3.  elect a transfer to Investment Division(s) within thirty (30) days following the end of that Fixed     Account Option; or  4.  elect a Fixed Account Option with the same duration, if available, within thirty (30) days     following the end of that Fixed Account Option.    When the period of a Fixed Account Option ends:  1.  If the option ends within one (1) year of the Income Date, the Company will renew You into     the 1-Year Fixed Account Option;   2.  If the option ends more than one (1) year before the Income Date, You may select a new     Fixed Account Option that does not extend beyond the Income Date within thirty (30) days     of the end of the expired Fixed Account Option;   3.  If You do not select a Fixed Account Option within thirty (30) days of the end of the expired     Fixed Account Option:     a.  if the same option is available at the time and does not extend beyond the Income Date,        the Company will renew You into the same Fixed Account Option.     b.  if the same option is available at the time but extends beyond the Income Date, the        Company will select the available Fixed Account Option that ends closest to but before        the Income Date.     c.  if the same option is not available at the time but would not extend beyond the Income        Date were it available, the Company will select the available Fixed Account Option with        the period closest to but less than the Fixed Account Option that just ended.  4.  If there are no Fixed Account Option periods available at the end of the Fixed Account     Option period the Company will default to a money market Investment Division, unless You     specify otherwise.    The Company may restrict or refuse future Premium payments, Premium allocation and  transfers to the Fixed Account Option(s) at any time, on a nondiscriminatory basis, if the yield on  investment would not support the minimum interest rate guaranteed under the Fixed Account(s).  Should the Company impose such restrictions, the Company will give at least thirty (30) days  advance notice to You.     The Company will also provide Written Notice when such restrictions no longer exist.    If the Company restricts or discontinues the Fixed Account Option(s) all transfers or withdrawals  will be at least equal to the Contract Value without being subject to a negative MVA or Transfer  Charges.    VA720NY                               14 

 

                   ACCUMULATION PROVISIONS (CONT'D)    Fixed Account Minimum Interest Rate. The Initial Fixed Account Minimum Interest Rate  established on the Issue Date is shown on the Contract Data Pages. The Company will re- determine the Fixed Account Minimum Interest Rate on each Redetermination Date for that  Redetermination Period.    The Fixed Account Minimum Interest Rate on each Redetermination Date will be equal to:  1.  the average of all the daily reported five-year Constant Maturity Treasury Rates during     October of the year then ended, rounded to the nearest 1/20th of one (1) percent;  2.  less 1.25 percentage points;  3.  but never less than 1.00% or greater than 3.00%.    The Fixed Account Minimum Interest Rate is the guaranteed minimum interest rate under the  Contract and may change each year on the Redetermination Date. The Company will send You  notice of the re-determined Fixed Account Minimum Interest Rate annually.    VA720NY                               15 

 

                          WITHDRAWAL PROVISIONS    On or before the Income Date You may request a total or partial withdrawal of the Contract  Value by submitting a request to the Company's Service Center in a form acceptable to the  Company.     Amounts You withdraw from the Contract Value may be subject to Withdrawal Charges. In  addition to Withdrawal Charges, amounts You withdraw from a Fixed Account Option may also  incur an MVA. The Company will adjust the amount You request for withdrawal for any  applicable taxes, charges, including Withdrawal Charges, and MVA.     TOTAL WITHDRAWAL. Upon a total withdrawal, You will receive the Withdrawal Value. The  Withdrawal Value will be determined at the end of the Business Day on which the Company  receives Your withdrawal request in Good Order at the Company's Service Center. If a total  withdrawal is requested, You must submit the Contract to the Company's Service Center. A total  withdrawal terminates Your Contract.    No withdrawal may exceed the Withdrawal Value.    PARTIAL WITHDRAWAL. Any partial withdrawal must be either:  1.  an amount not less than the Minimum partial withdrawal amount shown on the Contract     Data Pages; or  2.  an amount equal to Your entire interest in an Investment Division or a Fixed Account Option.    The amount payable as a result of the partial withdrawal will be determined at the end of the  Business Day on which the Company receives Your request for withdrawal in Good Order at the  Company's Service Center.    Your Contract Value will be reduced by the gross withdrawal amount requested. Unless You  request otherwise, a partial withdrawal will be deducted from each Contract Option in proportion  to its current value. The partial withdrawal will be reduced for any applicable taxes and charges,  including Withdrawal Charges, and then adjusted for any applicable MVA.    At least the Minimum Contract Value remaining after a partial withdrawal, as shown on the  Contract Data Pages, must remain after any partial withdrawal. If the partial withdrawal would  reduce the Contract Value below the Minimum Contract Value remaining after a partial  withdrawal, as shown on the Contract Data Pages, the Company will treat the withdrawal  request as a total withdrawal and the Withdrawal Value will be paid.    QUALIFIED PLAN CONTRACT REQUIRED MINIMUM DISTRIBUTIONS. Qualified Plan  Contract Required Minimum Distributions are based upon Your Contract Value, the value of  any add-on benefits as calculated by the Company, and applicable federal tax law  requirements. You may request a withdrawal for an RMD by submitting a written request to  the Service Center on a Company-provided form.    The Company will waive the Withdrawal Charges if the amount withdrawn does not exceed  the Contract's RMD. However, if a withdrawal amount is greater than the Contract's RMD,  the excess of the partial withdrawal over the Contract's RMD may be subject to Withdrawal  Charges.    VA720NY                               16 

 

                    WITHDRAWAL PROVISIONS (CONT'D)    AUTOMATIC WITHDRAWAL. You may elect to take an automatic withdrawal by withdrawing a  specific sum or a certain percentage of the Contract Value on a monthly, quarterly, semiannual  or annual basis, subject to the Minimum partial withdrawal amount made as a scheduled part of  an automatic withdrawal program, as shown on the Contract Data Pages. Automatic  withdrawals are treated as a partial withdrawal and will be counted in determining the amount  taken as a Free Withdrawal in any Contract Year. Automatic withdrawals in excess of the Free  Withdrawal amount may be subject to Withdrawal Charges and/or MVA. If an automatic  withdrawal causes the Withdrawal Value to fall to zero, future automatic withdrawals will  terminate. If the automatic withdrawal would reduce the Contract Value below the Minimum  Contract Value remaining after a partial withdrawal, as shown on the Contract Data Pages,  the Company will treat the withdrawal request as a total withdrawal and the Withdrawal  Value will be paid.    WITHDRAWAL CHARGE. For purposes of determining the Withdrawal Charge, the Contract  Value is divided into earnings and Remaining Premium, as defined in the Contract. Earnings are  not subject to a Withdrawal Charge. For the sole purposes of determining the amount of the  Withdrawal Charge, earnings are defined as any excess of the Contract Value over Remaining  Premium.     A Withdrawal Charge will be imposed upon certain withdrawals of Remaining Premium. The  Withdrawal Charge will be calculated in accordance with the Withdrawal Charge Schedule  shown on the Contract Data Pages. The Withdrawal Charge is equal to the applicable  Withdrawal Charge Percentage applied to the gross amount of Remaining Premium withdrawn  (not the net amount of Remaining Premium received by You), excluding any amount for which  the Contract expressly provides for waived, or no, Withdrawal Charge. In the event of a total  withdrawal, the applicable Withdrawal Charge Percentage(s) is/are applied to the full value of  Remaining Premium immediately prior to the withdrawal, less any Free Withdrawal available at  the time of the total withdrawal. The Withdrawal Charge reduces Remaining Premium and  Contract Value. The Withdrawal Charge will be taken from the Contract Options in the same  proportion as the requested withdrawal.    Withdrawals will be allocated first to earnings (which may be withdrawn free of any Withdrawal  Charge), if any, and second to Remaining Premium on a first-in, first-out basis so that all  withdrawals will be allocated to Remaining Premium to which the lowest (if any) Withdrawal  Charges apply.    Any portion of the Withdrawal Charge that would reduce the Fixed Account Contract Value  below the Fixed Account Minimum Value will be waived.    FREE WITHDRAWAL. During a Contract Year, You may make partial withdrawals from the  Contract without incurring a Withdrawal Charge or MVA. The amount of Free Withdrawal  available in any Contract Year is equal to:  1.  the Free Withdrawal Percentage, as shown on the Contract Data Pages, multiplied by the     Remaining Premium at the beginning of the Contract Year, that is subject to a Withdrawal     Charge according to the Withdrawal Charge Schedule shown on the Contract Data Pages;     plus  2.  the Free Withdrawal Percentage, as shown on the Contract Data Pages, multiplied by     Premium received during the Contract Year; less  3.  earnings, as defined in the Withdrawal Charge provision of this Contract.   VA720NY                               17 

 

                    WITHDRAWAL PROVISIONS (CONT'D)    The amount of Free Withdrawal is subject to a minimum of zero. The Free Withdrawal can be  taken as a single withdrawal or multiple withdrawals throughout the Contract Year. The amount  of Your Free Withdrawal available will vary throughout the Contract Year depending on previous  withdrawals of Your Free Withdrawal amount, previous withdrawals of earnings, and the amount  of earnings present at the time of the withdrawal. The amount of Your Free Withdrawal available  will reduce due to withdrawals during the Contract Year.    Any amount withdrawn to satisfy an RMD may reduce the amount of Your Free Withdrawal  available.    No Free Withdrawal may exceed the Withdrawal Value.    Amounts withdrawn under the Free Withdrawal provision reduce both the  Contract  Value  and  Remaining  Premium. Withdrawals  during  the  Contract  Year  in  excess  of  the  amount  of  Free  Withdrawal may be subject to any applicable Withdrawal Charges and applicable MVAs.    WAIVER OF WITHDRAWAL CHARGE FOR EXTENDED CARE.    If You are confined as an inpatient in a Nursing Home or Hospital for ninety (90) consecutive  days starting after the Issue Date shown on the Contract Data Pages, the Company will waive  the Withdrawal Charge on the amount You withdraw from the Contract, up to the maximum  amount shown on the Contract Data Pages. Upon Your compliance with the Claim  Requirements described below, You will be eligible for this waiver on the Eligibility Date shown  on the Contract Data Pages.    The availability of access to guarantees or values is not intended to provide long-term care or  nursing home insurance.    The Company will allocate the withdrawal amount to each Contract Option according to the  method described in the Withdrawal Provisions. The Company will determine values at the end  of the Business Day on which the Company receives the request for withdrawal in Good Order  at the Company's Service Center. A withdrawal from the Fixed Account Option(s) is subject to  any applicable MVA. Withdrawals under this provision reduce Remaining Premium.    This Waiver of Withdrawal Charge for Extended Care is available only once, no matter the  amount withdrawn or in the circumstances of multiple confinements for the same or a different  medical condition and/or Joint Owners.    VA720NY                               18 

 

                    WITHDRAWAL PROVISIONS (CONT'D)    For the purpose of this waiver, the following definitions apply:      Hospital. A facility that:     1.  is located within the United States or its territories;        ;     2.  operates primarily for the inpatient care and treatment of sick and injured persons;     3.  provides continuous twenty-four (24) hour a day nursing service by or under the        supervision of a registered nurse (R.N.);     4.  is supervised by a staff of licensed physicians; and     5.  has its own medical and diagnostic facilities or has access to such facilities on a        prearranged basis.         Immediate Family - means the individual's spouse/domestic partner, child, brother, sister,     parent or grandparent.      Medically Necessary - means consistent with Your diagnosis, in accordance with accepted     standards of medical practice and without which Your medical condition would be adversely     affected.      Nursing Home. A facility that:     1.  is licensed by the appropriate governmental licensing agency as a Nursing Home in the        state in which it maintains such facilities;     2.  issues patients or their insurance provider a bill or an amount due;     3.  is primarily engaged in providing nursing care (skilled, intermediate or custodial) by or        under the supervision of a licensed Physician and room and board accommodations;     4.  provides continuous twenty-four (24) hour a day nursing services by or under the        supervision of a registered nurse (R.N.);     5.  maintains a daily medical record of each patient; and     6.  maintains control and records of dispensed medications.      Physician - means an individual who is licensed to practice medicine and treat illness or     injury in the state where treatment is received and who is acting within the scope of his or     her license. The term Physician only refers to a Physician licensed and currently practicing     in the United States or its territories. The term Physician does not include a person who is:     1.  an Annuitant or Joint Annuitant;     2.  an Owner or Joint Owner;     3.  a Beneficiary;     4.  a member of the Annuitant's, Joint Annuitant's, Owner's or Joint Owner's Immediate        Family.      Physician's Statement - means a written statement signed by a Physician which provides     the Physician's diagnosis of Your medical condition.    You will be considered confined to a Nursing Home or Hospital only if Your confinement is  prescribed by a Physician and Medically Necessary.    VA720NY                               19 

 

                    WITHDRAWAL PROVISIONS (CONT'D)    Claim Requirements. Ninety (90) days after the date of Your confinement, Your request to the  Company must include (1) a completed claim form, (2) Your signed release for records of all  Physicians and institutions that have treated You for the medical condition You claim, and (3) a  Physician's Statement to the Company's Service Center in Good Order.     The Company will send You a form to claim the Waiver of Withdrawal Charge for Extended  Care within ten (10) Business Days of the Company's receipt of Your request. If the Company  fails to send the claim form within ten (10) Business Days, You will be deemed to have complied  with the above claim requirements.    Claim Determination. Upon receipt of the Claim Requirements, the Company will complete an  initial review for Good Order within thirty (30) Business Days. The Company reserves the right  to deny Your claim if You do not satisfy the Claim Requirements. If the Company denies Your  waiver of Withdrawal Charge for an extended care claim, the Company will send You a letter  with the reason(s) for the denial. If You would like to appeal the Company's denial of Your  waiver of Withdrawal Charge for an extended care claim, You may submit a Written Notice to  the Company's Service Center. If You are unable to satisfy the Claim Requirements, You will  then have the opportunity to submit a standard withdrawal request subject to any applicable  Withdrawal Charges and any applicable MVA. Termination of the Contract will not prejudice any  payment made under the extended care waiver that occurred while this Contract was in force.    YOU  MAY  OWE  TAX  ON  WITHDRAWALS  FOR  EXTENDED  CARE.  THE  COMPANY  ENCOURAGES YOU TO SEEK LEGAL AND/OR TAX ADVICE.    VA720NY                               20 

 

                         DEATH BENEFIT PROVISIONS    NATURAL OWNER'S DEATH BEFORE THE INCOME DATE. Upon Your death or the death of  the Joint Owner before the Income Date, the Company will pay the death benefit to the  Beneficiary(ies) designated by You. In the event of the death of a Joint Owner, the surviving  Joint Owner, if any, will be the Primary Beneficiary. Any other Beneficiary designation on record  at the Company's Service Center at the time of death will be treated as a Contingent  Beneficiary.    DEATH BENEFIT AMOUNT BEFORE THE INCOME DATE. The death benefit amount before  the Income Date is equal to the Contract Value.    DEATH BENEFIT PAYMENT OPTIONS BEFORE THE INCOME DATE. Unless You  designated a Pre-selected Death Benefit Option, a Beneficiary entitled to the death benefit  before the Income Date must request that the Company pay the death benefit according to one  of the death benefit payment options below, or, if eligible, has the option to continue the  Contract under the Spousal Continuation Option Instead of Death Benefit provision:    Option 1 - single lump-sum payment;  Option 2 - payment of the entire death benefit distributed within five (5) years of the date of the           relevant death; or  Option 3 - Income Payments of the death benefit (i) over the lifetime of the Beneficiary, or (ii)          over a period not extending beyond the life expectancy of the Beneficiary, with          distribution beginning within one (1) year of the date of the relevant death.    The Company may make available other death benefit payment options.    A Beneficiary that wishes to elect payment under the life income option (Option 3) must do so  no later than sixty (60) days from the date the Company receives Due Proof of death in Good  Order at the Company's Service Center.    Any portion of the death benefit not applied under the life income option (Option 3) must be paid  within five (5) years from Your death. The death benefit will remain invested in accordance with  the allocation selected by You until a payout option is selected or the Beneficiary specifies  otherwise.    ANNUITANT'S DEATH BEFORE THE INCOME DATE. Upon the death of an Annuitant who is  not an Owner before the Income Date, the Contract remains in force and the Owner becomes  the Annuitant. The Owner may designate a new Annuitant. However, if the Contract is owned by  a legal entity, upon the death of any Annuitant, the Company will pay the death benefit to the  Beneficiary(ies) designated by the Owner, or, if no Beneficiary(ies) survive the applicable death,  to the Owner.    VA720NY                               21 

 

                   DEATH BENEFIT PROVISIONS (CONT'D)    BENEFICIARY'S ENTITLEMENT TO DEATH BENEFIT BEFORE THE INCOME DATE. The  Company will pay the death benefit to Primary Beneficiaries or, if none exist, to Contingent  Beneficiaries, in equal shares (the "default allocation") unless You have designated otherwise  (the "designated allocation"). A Beneficiary that dies before or within ten (10) days (or different  period as prescribed by applicable law) of Your death is not entitled to any death benefit. In that  circumstance, the Company will pay the deceased Beneficiary's benefit to surviving  Beneficiaries in the same proportion as the designated allocation or, if applicable, the default  allocation. If no Beneficiary survives You, the Company will pay the death benefit to Your estate.    PAYMENT OF DEATH BENEFIT PROCEEDS. The Company will pay the death benefit  proceeds to the Beneficiary upon receipt of a request for payment with Due Proof of death in  Good Order at the Company's Service Center. If the Company has received Due Proof of death,  the Company will calculate the share of the death benefit due to a Beneficiary using Contract  values established at the end of the Business Day on the date the Company receives from that  Beneficiary a claim form with a payment option elected. If the Company has not received Due  Proof of death or any other required documentation, the Company will calculate the share of the  death benefit due to a Beneficiary using Contract values established at the end of the Business  Day on the date the Company receives any remaining required documentation. As a result,  market fluctuation may cause the calculation of a Beneficiary's death benefit share to differ from  the calculation of another Beneficiary's death benefit share.     Each Beneficiary entitled to the death benefit bears the investment risk associated with amounts  allocated to any Investment Division until the Company calculates their share of the death  benefit.    If any death benefit proceed is due to an Owner's estate, the Company will pay it in a single  lump-sum payment.    With the exception of death benefit Option 3 above, the Company will pay a Beneficiary that  elects a death benefit option within seven (7) calendar days of the date the Company receives  request for payment, provided the Company has received Due Proof of death in Good Order at  the Company's Service Center.    If the Company does not distribute death benefit proceeds within seven (7) calendar days, the  death benefit proceeds will include interest accrued and payable from the eighth day following  the date that Due Proof of death was received in Good Order at the Company's Service Center  until the death benefit is paid. The rate of interest will equal the rate of interest applicable to  death benefit proceeds left on deposit with the Company on the date of Your death.    Spousal Continuation Option Instead of Death Benefit. Unless the Contract is subject to a  Pre-selected Death Benefit Option, a spouse who is a Joint Owner or Beneficiary of the  deceased Owner, has the option to continue the Contract in his or her own name and exercise  the Owner's rights under the Contract instead of taking the standard death benefit.    For purposes of the Spousal Continuation Option, the "continuation date" is the date on which  the Company receives the spouse's written request to elect the Spousal Continuation Option  and Due Proof of the relevant death in Good Order at the Company's Service Center.    VA720NY                               22 

 

                   DEATH BENEFIT PROVISIONS (CONT'D)    The Spousal Continuation Option is void in the event the original Contract Owner is no longer  the Contract Owner or in the event the Contract has been assigned. This Spousal Continuation  Option may be exercised only once, and may not be available if You designated a Pre-selected  Death Benefit Option.    Pre-selected Death Benefit Option. Before the Income Date, You may designate the option  according to which the Company will pay the death benefit from the death benefit payment  options described in the Contract, or other death benefit payment options made available by the  Company. You may do so by submitting a designation in a form acceptable to the Company in  Good Order to the Company's Service Center. Pre-selected Death Benefit Options will take  effect on the date the request is signed by You, subject to any payments the Company has  made or other actions the Company has taken before the Company received Your request. The  Company will pay the death benefit consistent with Your Pre-selected Death Benefit Option  unless the Internal Revenue Code requires otherwise, or Your election requires payment over a  period that exceeds the Beneficiary's life expectancy.    Only You may revoke or change a Pre-selected Death Benefit Option. To do so, You must  submit a request in a form acceptable to the Company to the Company's Service Center. Unless  You specify otherwise, revocations of and changes to a Pre-selected Death Benefit Option will  take effect on the date the request is signed by You, subject to any payments the Company has  made or other actions the Company has taken before the Company received Your request.    VA720NY                               23 

 

                             INCOME PROVISIONS    INCOME DATE. Income Payments will begin on the Income Date. The Income Date must be at  least thirteen (13) months after the Contract Issue Date. If You do not select an Income Date,  the Income Date is the Latest Income Date. You may change the Income Date to any date that  is not later than the Latest Income Date by submitting Written Notice in Good Order to the  Company's Service Center at least seven (7) days before the Income Date.    INCOME PAYMENT. On or before the Income Date, You can elect payment in a single lump- sum. A single lump-sum payment is considered a total withdrawal and terminates the Contract.  The Company will make payment to You or another payee You specify. Alternatively, You may  elect an Income Option. The Company will apply the Contract Value to provide You Fixed  Annuity Payments or Variable Annuity Payments according to Your selected Income Option. If  You do not choose how to receive Your Income Payments, Your Income Payments will be  Variable Annuity Payments.    Income Options. You may elect payment as provided in Options 1, 2, 3 or 4 below. You may  elect an Income Option at any time before the Income Date and You can change an Income  Option up to seven (7) days before the Income Date by submitting Written Notice in Good Order  to the Company's Service Center.    If You do not select an Income Option, the Company will make payments as provided in Option  3 below, with 120 months certain. The Company will make payments monthly, quarterly,  semiannually or annually as You elect. However, if the Contract Value on the Income Date is  less than $2,000, the Company may pay out the Contract Value in one (1) lump-sum payment  instead of providing Income Payments according to the Income Option You elect. The single  lump-sum payment will not be less than the amount which would have been applied under an  Income Option. On the Income Date, if the first monthly payment provided would be less than  $20, the Company may make payments quarterly, semiannually or annually to achieve an initial  payment of at least $20, or the Company may pay out the Contract Value in one (1) single lump- sum payment.    At the time of their commencement, Income Payments will not be less than those that would be  provided by the application of an equivalent amount to purchase a single premium immediate  annuity contract from the Company at purchase rates the Company offered on the Income Date  to annuitants in the same class as the Annuitant.    The amount applied to an Income Option will not be less than the greater of the Withdrawal  Value or 95% of what the Withdrawal Value would be if there were no Withdrawal Charge.    YOU MAY NOT TAKE WITHDRAWALS DURING ANY PERIOD THE COMPANY IS MAKING  PAYMENTS FOR AN ANNUITANT'S LIFETIME.    OPTION 1 - LIFE INCOME. A monthly payment for the Annuitant's lifetime. All payments end  upon the Annuitant's death. However, in the event of the Annuitant's death before the first  monthly payment, the Company will pay the amount allocated to this Income Option to You or, if  You are deceased, to Your Beneficiary.     VA720NY                               24 

 

                        INCOME PROVISIONS (CONT'D)    OPTION 2 - JOINT AND SURVIVOR INCOME. A monthly payment for the longer of the  Annuitant's lifetime or that of a second person You designate. Upon the occasion of the first  person to die, monthly payments continue during the survivor's lifetime at either the full amount  previously payable or as a percentage (either one-half or two-thirds) of the full amount, as You  select at the time You elect the Income Option. If reduced Income Payments to the survivor are  desired, the Company will calculate Variable Annuity Payments using either one-half or two- thirds of the number of Annuity Units for each Investment Division comprising the Variable  Annuity Payments payable during the joint life of the Annuitant and the designated second  person. The Company will calculate Fixed Annuity Payments equal to either one-half or two- thirds of the Fixed Annuity Payment payable during the joint life of the Annuitant and the  designated second person.    All payments end upon the death of the last surviving Annuitant. However, in the event of the  deaths of the Annuitant and the designated second person before the first monthly payment, the  Company will pay the amount allocated to this Income Option to You or, if You are deceased,  Your Beneficiary.     OPTION 3 - LIFE INCOME WITH 120 OR 240 MONTHLY PAYMENTS GUARANTEED. A  monthly payment for the Annuitant's lifetime with the guarantee that the Company will make no  fewer than 120 or 240 monthly payments to You. If the Owner is an entity, at the Annuitant's  death, if fewer than the guaranteed number of payments have been made, the remaining  guaranteed payments will be made to the Owner as previously scheduled. If the Owner is the  Annuitant, in the event You die before the Company makes the specified number of guaranteed  payments, Your Beneficiary may elect to continue to receive the Income Payments according to  the terms of this Contract, or alternatively may elect to receive the present value of any  remaining guaranteed payments in a single lump-sum payment. The present value of any  remaining guaranteed payments will be based on the total Income Payments as of the date of  the calculation. The Company will determine the interest rate used in this present value  calculation, but in no instance will it be greater than (one) 1 percentage point higher than the  rate used to calculate the initial Income Payment.     OPTION 4 - INCOME FOR A SPECIFIED PERIOD. A monthly payment for any whole number  of years ranging from 5 to 30. In the event You die before the Company makes the specified  number of payments, Your Beneficiary may elect to continue to receive the Income Payments  according to the terms of this Contract, or alternatively may elect to receive the present value of  any remaining guaranteed payments in a single lump-sum payment. The present value of any  remaining guaranteed payments will be based on the total Income Payments as of the date of  the calculation. The Company will determine the interest rate used in this present value  calculation, but in no instance will it be greater than (one) 1 percentage point higher than the  rate used to calculate the initial Income Payment.     ADDITIONAL INCOME OPTIONS. The Company may make available other Income Options.    VA720NY                               25 

 

                        INCOME PROVISIONS (CONT'D)    You may elect either fixed or variable annuity payments as described below.    FIXED ANNUITY PAYMENTS. The Company will determine Fixed Annuity Payments by  applying annuity rates consistent with the age and sex (unless unisex rates apply) of the  Annuitant and, if applicable, the designated second person, to the portion of the Contract Value  allocated to the Fixed Annuity Payment options. Annuity rates applied will not be less than the  rates provided in the Contract's Table of Income Options.    Once begun, the Company will not change the amount of the Fixed Annuity Payments, except  upon the first death between the Annuitant and the designated second person under Option 2.    VARIABLE ANNUITY PAYMENTS. The Company will determine the initial Variable Annuity  Payment by applying annuity rates consistent with the age and sex (unless unisex rates apply)  of the Annuitant and, if applicable, the designated second person, to the portion of the Contract  Value allocated to the Variable Annuity Payment options. Annuity rates applied will not be less  than the rates provided in the Contract's Table of Income Options.    The Company will determine the second and subsequent Variable Annuity Payments in two (2)  steps. First, the Company will divide the initial Variable Annuity Payment by the Annuity Unit  Value calculated on the Income Date to establish a number of Annuity Units. Second, the  Company will multiply that number of Annuity Units by the Annuity Unit Value determined on the  Business Day next preceding the date on which each payment is due. The result of each  calculation determines the Variable Annuity Payment due.    Once Variable Annuity Payments have begun, the number of Annuity Units remains constant  absent a reallocation between the Investment Divisions. Variable Annuity Payments are not  affected by expenses other than taxes.    Neither expenses actually incurred, other than taxes on the investment return, nor the mortality  actually experienced, shall adversely affect the dollar amount of Variable Annuity Payments  after such payments have commenced.    Annuity Unit Value. The Company sets the initial value of an Annuity Unit of each Investment  Division when the Company establishes the Investment Division. The Annuity Unit Value  reflects the investment performance of an Investment Division and may increase or decrease  from one Business Day to the next. The Contract's Table of Income Options assumes the net  investment rates described in the Contract's Basis of Computation provision. Therefore, if an  Investment Division's actual net investment rate is greater than or less than the assumed net  investment rate, Variable Annuity Payments will increase or decrease accordingly over time.    The Company calculates each Investment Division's Annuity Unit Value for any Business Day in  two (2) steps:    First, the Company multiplies the immediately preceding Business Day's Annuity Unit Value by  the Business Day's "net investment factor" determined on the day of the calculation. The  Company determines the "net investment factor," which reflects changes in the Investment  Division's net asset value, by dividing the value established at (1) below by the value  established at (2) below, and then subtracting the value established at (3) below, where:    VA720NY                               26 

 

                        INCOME PROVISIONS (CONT'D)    (1)  Is the net result of:     a.  the Investment Division's net asset value at the end of the Business Day; plus     b.  the per share amount of any dividend or other distribution declared by the Investment        Division if the "ex-dividend" date occurs on the Business Day; plus or minus     c.  a per share credit or charge with respect to any taxes paid or reserved for by the        Company which are determined by the Company to be attributable to the operation of        the Investment Division (no federal income taxes are applicable under present law); and  (2)  Is the Investment Division's net asset value at the end of the preceding Business Day; and  (3)  Is the asset charge factor the Company determines for the Business Day to reflect the     applicable Core Contract Charge.    Second, the Company multiplies the result from the first step above by a factor equal to the ratio  of one over one plus the assumed net investment rate, raised to the number of calendar days  between the previous Business Day and the current Business Day over the number of calendar  days in the current year. The factor is expressed formulaically as follows:                                              &#0;                                       1   &#0;                                   &#0;      &#0;                                      1+ 퐴퐼푅   where:    AIR  is  the assumed net investment rate.  t    is  the number of calendar days between the previous Business Day and the current           Business Day.  y    is  the number of calendar days in the current year.    NATURAL OWNER'S DEATH AFTER THE INCOME DATE. Upon Your death or the death of  the Joint Owner, who is not also an Annuitant, after the Income Date, remaining Income  Payments due continue as before. Upon Your death after the Income Date, the Beneficiary  becomes the Owner.    ANNUITANT'S DEATH AFTER THE INCOME DATE. Upon the death of the Annuitant after the  Income Date, the death benefit, if any, will be as specified in the Income Option elected. Death  benefits will be paid at least as rapidly as under the method of distribution in effect at the  Annuitant's death.    BENEFICIARY'S ENTITLEMENT TO INCOME PAYMENTS AFTER THE INCOME DATE.  Upon Your death or the death of the Joint Owner, the Company will pay remaining Income  Payments due to Primary Beneficiaries or, if none exist, to the Contingent Beneficiaries, in equal  shares (the "default allocation") unless You have designated otherwise (the "designated  allocation"). A Beneficiary that dies before or within ten (10) days (or different period as  prescribed by applicable law) of Your death is not entitled to any remaining Income Payments  due; in that circumstance, the Company will pay remaining Income Payments due the deceased  Beneficiary to surviving Beneficiaries in the same proportion as the designated allocation or, if  applicable, the default allocation. If no Beneficiary survives You, the Company will pay  remaining Income Payments to Your estate.    VA720NY                               27 

 

                           TERMINATION PROVISION    This Contract terminates and all Contract benefits, including those provided by any add-on  benefits unless otherwise specified in the add-on benefits, will end on the earlier of:  1.  the date You take a total withdrawal;  2.  the date the Contract Value is reduced to zero for any reason or insufficient to pay Contract     charges; or  3.  the date upon which the Company receives Due Proof of Your (or the Joint Owner's) death     and receives all Beneficiaries' elections of death benefit payment options in Good Order at     the Company's Service Center, unless the Contract is continued by the spouse under the     Spousal Continuation Option.    VA720NY                               28

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