Document:

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                                                 EXHIBIT 4(c)

         -----GOLDEN
      --------AMERICAN                      DEFERRED COMBINATION
    ----------LIFE INSURANCE                VARIABLE AND FIXED
       -------COMPANY                       ANNUITY CERTIFICATE

Golden American is a stock company domiciled in Delaware.
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| Annuitant            Owner                                                 |
| [THOMAS J. DOE]      [JOHN Q. DOE]                                         |
|                                                                            |
|----------------------------------------------------------------------------|
| Initial Premium      Annuity Option            Annuity Commencement Date   |
| [$10,000]            [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]           |
|----------------------------------------------------------------------------|
| Separate Account(s)                            Contract Number             |
| [SEPARATE ACCOUNT B]                           [123456]                    |
------------------------------------------------------------------------------

    This is a legal Contract between its Owner and us.  Please read it
    carefully.  In this contract you or your refers to the Owner shown above.
    We, our or us refers to Golden American Life Insurance Company.  You may
    allocate this Contract's Accumulation Value among the Divisions of the
    Variable Separate Account and the General Account shown in the Schedule.

    If this Contract is in force, we will make income payments to you
    starting on the Annuity Commencement Date.  If the Owner dies prior to
    the Annuity Commencement Date, we will pay a death benefit to the
    Beneficiary.  The amount of such benefits is subject to the terms of this
    Contract.

    ALL PAYMENTS AND VALUES, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A
    VARIABLE SEPARATE ACCOUNT, MAY INCREASE OR DECREASE, DEPENDING ON THE
    CONTRACT'S INVESTMENT RESULTS.

    RIGHT TO EXAMINE THIS CONTRACT:  YOU MAY RETURN THIS CONTRACT TO US OR
    THE AGENT THROUGH WHOM YOU PURCHASED IT WITHIN 10 DAYS AFTER YOU RECEIVE
    IT.  IF SO RETURNED, WE WILL TREAT THE CONTRACT AS THOUGH IT WERE NEVER
    ISSUED.  UPON RECEIPT WE WILL PROMPTLY REFUND THE ACCUMULATION VALUE PLUS
    ANY CHARGES WE HAVE DEDUCTED AS OF THE DATE THE RETURNED CONTRACT IS
    RECEIVED BY US.

Customer Service Center             Secretary: /s/ Myles R. Tashman
1475 Dunwoody Drive
West Chester, PA  19380             President: /s/ Barnett Chernow

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DEFERRED VARIABLE ANNUITY CONTRACT - NO DIVIDENDS
    Variable Cash Surrender Values while the Annuitant and Owner are living
    and prior to the Annuity Commencement Date.  Death benefit subject to
    guaranteed minimum.  Additional Premium Payment Option.  Partial
    Withdrawal Option.  Non-participating.  Investment results reflected in
    values.

GA-IA-1053

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                            CONTRACT CONTENTS
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THE SCHEDULE                                YOUR CONTRACT BENEFITS........14

  Payment and Investment Information...3A     Cash Value Benefit
  The Variable Separate Accounts.......3B     Partial Withdrawal Option
    The General Account................3C     Proceeds Payable to the
                                               Beneficiary
    Contract Facts.....................3D
    Charges and Fees...................3E
    Income Plan Factors................3F   CHOOSING AN INCOME PLAN.......16

IMPORTANT TERMS .......................4

INTRODUCTION TO THIS CONTRACT..........6      Annuity Benefits
                                              Annuity Commencement Date
     The Contract                               Selection
     The Owner                                Frequency Selection
     The Annuitant                            The Income Plan
     The Beneficiary                          The Annuity Options
     Change of Owner or Beneficiary           Payment When Named Person Dies

PREMIUM PAYMENTS AND ALLOCATION             OTHER IMPORTANT INFORMATION...18
   CHANGES.............................8

     Initial Premium Payment                  Sending Notice to Us
     Additional Premium Payment Option        Reports to Owner
     Your Right to Change Allocation of       Assignment - Using this Contract
        Accumulation Value                      as Collateral Security
     What Happens if a Variable               Changing this Contract
        Separate Account                      Contract Changes -
     Division is Not Available                  Applicable Tax Law
                                              Misstatement of Age or Sex
                                              Non-Participating
HOW WE MEASURE THE CONTRACT'S                 Payments We May Defer
   ACCUMULATION VALUE..................9       Authority to Make Agreements
                                              Required Note on Our Computations
     The Variable Separate Accounts
     The General Account
     Valuation Period
     Accumulation Value
     Accumulation Value in each Division
     Measurement of Investment Experience
     Charges Deducted from Accumulation Value
       on each Contract Processing Date

       Copies of any application and any additional Riders and
       Endorsements are at the back of this Contract.

     THE SCHEDULE

       The Schedule gives specific facts about this Contract and its
       coverage.  Please refer to the Schedule while reading this
       Contract.

GA-IA-1053
                                    2

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                              THE SCHEDULE
                   PAYMENT AND INVESTMENT INFORMATION
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| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Annuitant's Issue Age   Annuitant's Sex           Owner's Issue Age        |
| [55]                    [MALE]                    [35]                     |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Contract Date           Issue Date                Residence   Status       |
| [JANUARY 1, 1996]       [JANUARY 1, 1996]         [DELAWARE]               |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
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INITIAL INVESTMENT

    Initial Premium Payment received:            [$10,000]

    Your initial Accumulation Value has been invested as follows:

                                               Percentage of
                 Divisions                   Accumulation Value
                 ---------                   ------------------
            [Multiple Allocation                    10%
               Fully Managed                        10%
            Capital Appreciation                    10%
              Rising Dividends                      10%
                 All-Growth                         10%
                Real Estate                         10%
                Value Equity                        10%
                Hard Assets                          5%
              Emerging Markets                       5%
               Managed Global                        5%
              Limited Maturity                       5%
                    Bond                             5%
                Liquid Asset                         5%]
              Strategic Equity
        -------------------------       -------------------------
                   Total                            100%
                   -----                            ----

GA-IA-1053

                                    3A1

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                              THE SCHEDULE
                   PAYMENT AND INVESTMENT INFORMATION(continued)
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| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Annuitant's Issue Age   Annuitant's Sex           Owner's Issue Age        |
| [55]                    [MALE]                    [35]                     |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Contract Date           Issue Date                Residence   Status       |
| [JANUARY 1, 1996]       [JANUARY 1, 1996]         [DELAWARE]               |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
------------------------------------------------------------------------------

ADDITIONAL PREMIUM PAYMENT INFORMATION

    [We will accept additional premium payments until either the Annuitant or
    Owner reaches the Attained Age of 85.  The minimum additional payment
    which may be made is [$100.00].]

    [In no event may you contribute to your IRA for the taxable year in which
    you attain age 70 1/2 and thereafter (except for rollover contributions).
    The minimum additional payment which may be made is [$250.00].]

ACCUMULATION VALUE ALLOCATION RULES

    The maximum number of Divisions in which you may be invested at any one
    time is [sixteen].  You are allowed unlimited allocation changes per
    Contract Year without charge.  We reserve the right to impose a charge
    for any allocation change in excess of [twelve] per Contract Year.  The
    Excess Allocation Charge is shown in the Schedule.  Allocations into and
    out of the Guaranteed Interest Divisions are subject to restrictions (see
    General Account).

ALLOCATION CHANGES BY TELEPHONE

    You may request allocation changes by telephone during our telephone
    request business hours.  You may call our Customer Service Center at
    1-800-366-0066 to make allocation changes by using the personal
    identification number you will receive.  You may also mail any notice
    or request for allocation changes to our Customer Service Center at
    the address shown on the cover page.

GA-IA-1053

                                    3A2

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                              THE SCHEDULE
                     THE VARIABLE SEPARATE ACCOUNTS
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| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
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DIVISIONS INVESTING IN SHARES OF A MUTUAL FUND

    Separate Account B (the "Account") is a unit investment trust Separate
    Account, organized in and governed by the laws of the State of Delaware,
    our state of domicile. The Account is divided into Divisions.  Each
    Division listed below invests in shares of the mutual fund portfolio (the
    "Series") designated.  Each portfolio is a part of The GCG Trust managed
    by Directed Services, Inc.

              SERIES                             SERIES
              ------                             ------
              [Multiple Allocation               Real Estate
              Fully Managed                      Hard Assets
              Value Equity                       Emerging Markets
              Small Cap                          Limited Maturity Bond
              Capital Appreciation               Liquid Assets
              Rising Dividend                    Strategic Equity
              Capital Growth                     Managed Global
              Developing World                   Global Fixed Income
              Large Cap Value                    Total Return
              Growth                             All-Cap
              Mid-Cap Growth                     Investors
              Research                           Equity Income]

    Each Division listed below invests in shares of the mutual fund portfolio
    (the "Portfolio") designated.  Each portfolio is a part of the Evergreen
    Trust managed by Evergreen Asset Management, Inc.

              PORTFOLIO
              ---------
              [Equity Index
              Foundation
              Global Leaders
              Small Cap Value]

GA-IA-1053

                                    3B

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                              THE SCHEDULE
                           THE GENERAL ACCOUNT
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| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
------------------------------------------------------------------------------

GENERAL ACCOUNT

    [Guaranteed Interest Division
    A Guaranteed Interest Division provides an annual minimum interest rate
    of 3%.  At our sole discretion, we may periodically declare higher
    interest rates for specific Guarantee Periods.  Such rates will apply to
    periods following the date of declaration.  Any declaration will be by
    class and will be based on our future expectations.

    Limitations of Allocations
    We reserve the right to restrict allocations into and out of the General
    Account.  Such limits may be dollar restrictions on allocations into the
    General Account or we may restrict reallocations into the General
    Account.

    Guarantee Periods
    Each allocation to a Guaranteed Interest Division will be guaranteed an
    interest rate for the entire Initial Guarantee Period elected.  We
    currently offer Initial Guarantee Periods of one, two, three, five, seven
    and ten years.  The Initial Guarantee Period starts on the day an
    allocation is made to a Guaranteed Interest Division and ends on the last
    day of the calendar month following one, two, three, five, seven or ten
    year(s), as appropriate, the Maturity Date.

    At the end of a Guarantee Period, you may transfer the Accumulation Value
    in such Guarantee Period to the Variable Separate Account Divisions or to
    a Guarantee Period we then offer.  If we do not receive notification by
    the Maturity Date, your Accumulation Value in the maturing Guarantee
    Period will automatically be transferred to a one-year Guarantee Period.
    Upon such automatic transfer you will have thirty days to reallocate any
    of your Accumulation Value to the Divisions.

    Deduction for Charges
    We do not deduct the Mortality and Expense Risk Charge and the Asset-
    Based Administrative Charge with respect to the amount of the
    Accumulation Value allocated to a Guaranteed Interest Division while such
    Accumulation Value remains allocated to a Guaranteed Interest Division.

    Transfers from the Guaranteed Interest Division
    On a Maturity Date, 100% of the Accumulation Value in the maturing
    Guarantee Period may be transferred.

    We currently require that an amount allocated to a Guarantee Period not
    be transferred until the Maturity Date, except pursuant to our published
    rules.  We reserve the right not to allow amounts previously transferred
    from a Guaranteed Interest Division to the Variable Separate Account
    Divisions to be transferred back to the Guaranteed Interest Division for
    a period of at least six months from the date of transfer.  We reserve
    the right to reduce the amount otherwise available for transfer from a
    Guaranteed Interest Division by any amounts previously withdrawn from
    that Guaranteed Interest Division.

GA-IA-1053

                                    3C

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                              THE SCHEDULE
                             CONTRACT FACTS
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| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
------------------------------------------------------------------------------

CONTRACT FACTS

    Contract Processing Date
    The Contract Processing Date for your Contract is [April 1] of each year.

    Specially Designated Divisions
    When a distribution is made from an investment portfolio underlying a
    Separate Account Division in which reinvestment is not available, we will
    allocate the amount of the distribution to the [Liquid Asset Division]
    unless you specify otherwise.

PARTIAL WITHDRAWALS

    The maximum amount that can be withdrawn each Contract Year without being
    considered an Excess Partial Withdrawal is described below.  We will
    collect a Surrender Charge for Excess Partial Withdrawals and a charge for
    any unrecovered premium taxes.  In no event may a Partial Withdrawal be
    greater than 90% of the Cash Surrender Value.  After a Partial Withdrawal,
    the remaining Accumulation Value must be at least $100 to keep the Contract
    in force.

    Systematic Partial Withdrawals and Conventional Partial Withdrawals may not
    be taken in the same Contract Year.

    To determine the Surrender Charge on Excess Partial Withdrawals, the
    withdrawals will occur in the following order:
      (1)  Any remaining Free Amount;
      (2)  Premium Payments which were received more than ten years prior to
           the withdrawal; and,
      (3)  Premium Payments which were received less than ten years prior
           to withdrawal.

    Free Amounts are not treated as withdrawals of Premium Payments for
    purposes of calculating any Surrender Charge.

    The Free Amount for a Contract Year is equal to 10% of Premium Payments
    received within ten years prior to the date of withdrawal which were not
    previously withdrawn.

    Conventional Partial Withdrawals

    Minimum Withdrawal Amount:  $100.

GA-IA-1053

                                    3D1

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                              THE SCHEDULE
                       CONTRACT FACTS (continued)
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| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
------------------------------------------------------------------------------

    Systematic Partial Withdrawals
    Systematic Partial Withdrawals may be elected to commence after 28 days
    from the Contract Issue Date and may be taken on a monthly, quarterly or
    annual basis.  You select the day withdrawals will be made, but no later
    than the 28th day of the month.  If you do not elect a day, the Contract
    Date will be used.

    Maximum Withdrawal Amounts:

      Variable Separate Account Divisions: .833% monthly, 2.5% quarterly or
                                           10% annually of Premium Payments
                                           not previously withdrawn.

      Guaranteed Interest Divisions:       Interest earned on the Guaranteed
                                           Interest Divisions for the prior
                                           month,quarter or year (depending
                                           on the frequency selected).

    The Maximum Withdrawal Amount available per year as a Systematic Partial
    Withdrawal is 10% of Premium Payments not previously withdrawn.  A
    Systematic Partial Withdrawal in excess of the Free Amount may be subject
    to a Surrender Charge.

    [IRA Partial Withdrawals for Qualified Plans Only
    IRA Partial Withdrawals may be taken on a monthly, quarterly or annual
    basis.  A minimum withdrawal of $100.00 is required.  You select the day
    the withdrawals will be made, but no later than the 28th day of the month.
    If you do not elect a day, the Certificate Date will be used.  Systematic
    Partial Withdrawals and Conventional Partial Withdrawals are not allowed
    when IRA Partial Withdrawals are being taken.  An IRA Partial Withdrawal
    in excess of the maximum amount allowed under the Systematic Partial
    Withdrawal option may be subject to a Market Value Adjustment.]

DEATH BENEFITS

    [The Death Benefit is the greatest of (i), (ii), (iii) below, where:
         (i)    the Accumulation Value;
         (ii)   the Cash Surrender Value;
         (iii)  the sum of premiums paid, reduced by Prorata Partial Withdrawal
                Adjustment(s) for Accumulation Value withdrawn.

PRORATA PARTIAL WITHDRAWAL BENEFITS

    For any partial withdrawal, the Death Benefit components will be reduced
    by Prorata Partial Withdrawal Adjustments. The Prorata Partial Withdrawal
    Adjustment to a death benefit component for a partial withdrawal is equal
    to  (1) divided by (2), multiplied by (3), where: (1) is the Accumulation
    Value withdrawn, (2) is the Accumulation Value immediately prior to the
    withdrawal, and (3) is the amount of the applicable death benefit
    component immediately prior to the withdrawal.

GA-IA-1053

                                    3D2

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                              THE SCHEDULE
                       CONTRACT FACTS (continued)
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------------------------------------------------------------------------------
| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
------------------------------------------------------------------------------

CHANGE OF OWNER

A change of Owner will result in recalculation of the Death Benefit. If
  the Owner's or the oldest of multiple owner's attained age at the time of
  the change is less than (86), the Death Benefit will remain in effect. If
  any owner's or the oldest multiple owners' attained age at the time of
  the change is (86) or greater, the Death Benefit thereafter will be the
  cash surrender value.

SPOUSAL CONTINUATION UPON DEATH OF OWNER

If at the Owner's death, the surviving spouse of the deceased Owner is the
  beneficiary and such surviving spouse elects to continue the Contract as
  their own pursuant to Internal Revenue Code Section 72(s) or the
  equivalent provisions of the U.S. Treasury Department rules for qualified
  plans, the following will apply:
   (a) If the Death Benefit as of the date we receive due proof of the
       death of the Owner, minus the Accumulation Value, also of that date, is
       greater than zero, we will add such difference to the Accumulation
       Value.  Such addition will be allocated to the divisions of the Separate
       Account in proportion to the Accumulation Value in the Separate Account.
       If there is no Accumulation Value in the Separate Account, the addition
       will be allocated to the Liquid Assets division, or its successor.
   (b) The Death Benefit will continue to apply, with all age criteria
       using the surviving spouse's age as the determining age.
   (c) At subsequent surrender, any surrender charge applicable to premiums
       paid prior to the date we receive due proof of death of the Owner
       will be waived. Any premiums paid later will be subject to any
       applicable surrender charge.
 This Addition to the Accumulation Value is available only to the spouse
 of the Owner as of the date of death of the Owner is such spouse under
 the provisions of this certificate elects to continue the Contract as
 their own.

CHOOSING AN INCOME PLAN

 Required Date of Annuity Commencement
 [Distributions from a Contract funding a qualified plan must commence no
 later than [April 1st] of the calendar year following the calendar year
 in which the Owner attains age 70 1/2.]

 The Annuity Commencement Date is required to be the same date as the
 Contract Processing Date in the month following the Annuitant's 90th
 birthday.  If, on the Annuity Commencement Date, a Surrender Charge
 remains, your elected Annuity Option must include a period certain of at
 least five years duration.  In applying the Accumulation Value, we may
 first collect any Premium Taxes due us.
 Minimum Annuity Income Payment
 The minimum monthly annuity income payment that we will make is [$20].

 Optional Benefit Riders - [None.]

GA-IA-1053

                                    3D3

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                              THE SCHEDULE
                            CHARGES AND FEES
------------------------------------------------------------------------------

------------------------------------------------------------------------------
| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
------------------------------------------------------------------------------
ATTAINED AGE

     The Issue Age of the Annuitant or Owner plus the number of full years
     elapsed since the Contract Date.
DEDUCTIONS FROM PREMIUMS

    [None.]

DEDUCTIONS FROM ACCUMULATION VALUE

    Initial Administrative Charge
    [None.]

    Administrative Charge
    We charge [$50] to cover a portion of our ongoing administrative expenses
    for each Contract Processing Period.  The charge is incurred at the
    beginning of the Contract Processing Period and deducted on the Contract
    Processing Date at the end of the period.

    Excess Allocation Charge
    Currently none, however, we reserve the right to charge [$25] for a change
    if you make more than [twelve] allocation changes per Contract Year.  Any
    charge will be deducted in proportion to the amount being transferred from
    each Division.

    Surrender Charge
    A Surrender Charge is imposed as a percentage of unliquidated premium if
    the Contract is surrendered or an Excess Partial Withdrawal is taken. The
    percentage imposed at time of surrender or Excess Partial Withdrawal
    depends on the number of complete years that have elapsed since a premium
    payment was made.  The Surrender Charge expressed as a percentage of each
    premium payment is as follows:

                  Complete Years Elapsed             Surrender
                   Since Premium Payment              Charges
                   ---------------------              -------
                            [0                          8.5%
                             1                          8.5%
                             2                          8.5%
                             3                          8.5%
                             4                          8.5%
                             5                          8.0%
                             6                          7.0%
                             7                          6.0%
                             8                          4.0%
                             9                          2.0%
                            10+                         0.0%

    Surrender of the Contract is permitted at or before the commencement of
    annuity payments.

GA-IA-1053

                                    3E1

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<PAGE>

                              THE SCHEDULE
                      CHARGES AND FEES (continued)
------------------------------------------------------------------------------

------------------------------------------------------------------------------
| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
------------------------------------------------------------------------------

    [Premium Taxes
    We deduct the amount of any premium or other state and local taxes levied
    by any state or governmental entity when such taxes are incurred.

    We reserve the right to defer collection of Premium Taxes until surrender
    or until application of Accumulation Value to an Annuity Option.  An
    Excess Partial Withdrawal will result in the deduction of any Premium Tax
    then due us on such amount.  We reserve the right to change the amount we
    charge for Premium Tax charges on future premium payments to conform with
    changes in the law or if the Owner changes state of residence.]

    Deductions from the Divisions
    [Mortality and Expense Risk Charge - We deduct 0.003446% of the assets in
    each Variable Separate Account Division on a daily basis (equivalent to
    an annual rate of 1.25%) for mortality and expense risks.  This charge is
    not deducted from the General Account values.]

    [Asset Based Administrative Charge - We deduct 0.000411% of the assets in
    each Variable Separate Account Division on a daily basis (equivalent to
    an annual rate of 0.15%) to compensate us for a portion of our ongoing
    administrative expenses.  This charge is not deducted from the General
    Account values.]

CHARGE DEDUCTION DIVISION

    All charges against the Accumulation Value in this Contract will be
    deducted from the [Liquid Asset Division].

GA-IA-1053

                                    3E2

<PAGE>
<PAGE>

                              THE SCHEDULE
                           INCOME PLAN FACTORS
------------------------------------------------------------------------------

------------------------------------------------------------------------------
| Annuitant               Owner                                              |
| [THOMAS J. DOE]         [JOHN Q. DOE]                                      |
|----------------------------------------------------------------------------|
| Initial Premium         Annuity Option            Annuity Commencement Date|
| [$10,000]               [LIFE 10-YEAR CERTAIN]    [JANUARY 1, 2026]        |
|----------------------------------------------------------------------------|
| Separate Account(s)                               Contract Number          |
| [SEPARATE ACCOUNT B]                              [123456]                 |
------------------------------------------------------------------------------

    Values for other payment periods, ages or joint life combinations are
    available on request.  Monthly payments are shown for each $1,000
    applied.

                       TABLE FOR INCOME FOR A FIXED PERIOD

        Fixed                  Fixed                  Fixed
       Period   Monthly       Period    Monthly       Period    Monthly
     of Years    Income     of Years     Income     of Years     Income

       [5        17.95         14         7.28         23         5.00
       6         15.18         15         6.89         24         4.85
       7         13.20         16         6.54         25         4.72
       8         11.71         17         6.24         26         4.60
       9         10.56         18         5.98         27         4.49
       10          9.64        19         5.74         28         4.38
       11          8.88        20         5.53         29         4.28
       12          8.26        21         5.33         30        4.19]
       13          7.73        22         5.16

                        TABLE FOR INCOME FOR LIFE

                Male/Female         Male/Female         Male/Female
  Age              10 Years            20 Years              Refund
                    Certain             Certain             Certain

[50              $4.06/3.83          $3.96/3.77          $3.93/3.75
55                4.43/4.14           4.25/4.05           4.25/4.03
60                4.90/4.56           4.57/4.37           4.66/4.40
65                5.51/5.10           4.90/4.73           5.12/4.83
70                6.26/5.81           5.18/5.07           5.76/5.42
75                7.11/6.70           5.38/5.33           6.58/6.19
80                7.99/7.70           5.48/5.46           7.69/7.21
85                8.72/8.59           5.52/5.51           8.72/8.59
90                9.23/9.18           5.53/5.53         10.63/10.53]

GA-IA-1053

                                    3F

<PAGE>
<PAGE>

                             IMPORTANT TERMS
------------------------------------------------------------------------------

ACCUMULATION VALUE - The amount that a Contract provides for investment
  at any time.  Initially, this amount is equal to the premium paid.

ANNUITANT - The person designated by the Owner to be the measuring life
  in determining Annuity Payments.

ANNUITY COMMENCEMENT DATE - For each Contract, the date on which Annuity
  Payments begin.

ANNUITY OPTIONS - Options the Owner selects that determine the form and
  amount of annuity payments.

ANNUITY PAYMENT - The periodic payment an Owner receives.  It may be
  either a fixed or a variable amount based on the Annuity Option
  chosen.

ATTAINED AGE - The Issue Age of the Annuitant or Owner plus the number of
  full years elapsed since the Contract Date.

BENEFICIARY - The person designated to receive benefits in the case of
  the death of the Owner.

BUSINESS DAY - Any day the New York Stock Exchange ("NYSE") is open for
  trading, exclusive of federal holidays, or any day on which the
  Securities and Exchange Commission ("SEC") requires that mutual funds,
  unit investment trusts or other investment portfolios be valued.

CASH SURRENDER VALUE - The amount the Owner receives upon surrender of
  the Contract.

CHARGE DEDUCTION DIVISION - The Division from which all charges are
  deducted if so designated or elected by the Owner.

CONTINGENT ANNUITANT - The person designated by the Owner who, upon the
  Annuitant's death prior to the Annuity Commencement Date, becomes the
  Annuitant.

CONTRACT ANNIVERSARY - The anniversary of the Contract Date.

CONTRACT DATE - The date we received the initial premium and upon which
  we begin determining the Contract values.  It may not be the same as
  the Contract Issue Date.  This date is used to determine Contract
  months, processing dates, years, and anniversaries.

CONTRACT ISSUE DATE - The date the Contract is issued at our Customer
  Service Center.

CONTRACT PROCESSING DATES - The days when we deduct certain charges from
  the Accumulation Value.  If the Contract Processing Date is not a
  Valuation Date, it will be on the next succeeding Valuation date.  The
  Contract Processing Date will be on the Contract Anniversary of each
  year.

CONTRACT PROCESSING PERIOD - The period between successive Contract
  Processing Dates unless it is the first Contract Processing Period.
  In that case, it is the period from the Contract Date to the first
  Contract Processing Date.

CONTRACT YEAR - The period between Contract Anniversaries.

GA-IA-1053

                                    4

<PAGE>
<PAGE>

                       IMPORTANT TERMS (continued)
------------------------------------------------------------------------------

EXPERIENCE FACTOR - The factor which reflects the investment experience
  of the portfolio in which a Variable Separate Account Division invests
  and also reflects the charges assessed against the Division for a
  Valuation Period.

GUARANTEE PERIOD - The period of years a rate of interest is guaranteed
  to be credited to a Guaranteed Interest Division.

GUARANTEED INTEREST DIVISION - An investment option available in the
  General Account, an account which contains all of our assets other
  than those held in our Variable Separate Accounts.

GUARANTEED INTEREST RATE - The effective annual interest rate which we
  will credit for a specified Guarantee Period.

GUARANTEED MINIMUM INTEREST RATE - The minimum interest rate which can be
  declared by us for allocations to a Guaranteed Interest Division.

INDEX OF INVESTMENT EXPERIENCE - The index that measures the performance
  of a Variable Separate Account Division.

INITIAL PREMIUM - The payment amount required to put each Contract in
  effect.

ISSUE AGE - The Annuitant's or Owner's age on the last birthday on or
  before the Contract Date.

MATURITY DATE - The date on which a Guarantee Period matures.

OWNER - The person who owns a Contract and is entitled to exercise all
  rights of the Contract.  This person's death also initiates payment of
  the death benefit.

RIDERS - Riders add provisions or change the terms of the Contract.

SPECIALLY DESIGNATED DIVISION - Distributions from a portfolio underlying
  a Division in which reinvestment is not available will be allocated to
  this Division unless you specify otherwise.

VALUATION DATE - The day at the end of  a Valuation Period when each
  Division is valued.

VALUATION PERIOD - Each business day together with any non-business days
  before it.

VARIABLE SEPARATE ACCOUNT DIVISION - An investment option available in
  the Variable Separate Account shown in the Schedule.

GA-IA-1053

                                    5

<PAGE>
<PAGE>

                      INTRODUCTION TO THIS CONTRACT
------------------------------------------------------------------------------

THE CONTRACT

    This is a legal contract between you and us.  We provide benefits as
    stated in this Contract.  In return, you supply us with the Initial
    Premium Payment required to put this Contract in effect.

    This Contract, together with any Riders or Endorsements, constitutes the
    entire Contract.  Riders and Endorsements add provisions or change the
    terms of the basic Contract.

THE OWNER

    You are the Owner of this Contract.  You are also the Annuitant unless
    another Annuitant has been named in the application and is shown in the
    Schedule.  You have the rights and options described in this Contract,
    including but not limited to the right to receive the Annuity Benefits on
    the Annuity Commencement Date.

    One or more people may own this Contract.  If there are multiple Owners
    named, the age of the oldest Owner will be used to determine the
    applicable death benefit.  In the case of a sole Owner who dies prior to
    the Annuity Commencement Date, we will pay the Beneficiary the death
    benefit then due.  If the sole Owner is not an  individual, we will treat
    the Annuitant as Owner for the purpose of determining when the Owner dies
    under the death benefit provision (if there is no Contingent Annuitant),
    and the Annuitant's age will determine the applicable death benefit
    payable to the Beneficiary.  The sole Owner's estate will be the
    Beneficiary if no Beneficiary designation is in effect, or if the
    designated Beneficiary has predeceased the Owner.  In the case of a joint
    Owner of the Contract dying prior to the Annuity Commencement Date, the
    surviving Owner(s) will be deemed as the Beneficiary(ies).

THE ANNUITANT

    The Annuitant is the measuring life of the Annuity Benefits provided
    under this Contract.  You may name a Contingent Annuitant.  The Annuitant
    may not be changed during the Annuitant's lifetime.

    If the Annuitant dies before the Annuity Commencement Date, the
    Contingent Annuitant becomes the Annuitant.  You will be the Contingent
    Annuitant unless you name someone else.  The Annuitant must be a natural
    person.  If the Annuitant dies and no Contingent Annuitant has been
    named, we will allow you sixty days to designate someone other than
    yourself as an Annuitant.  If all Owners are not individuals and, through
    the operation of this provision, an Owner becomes Annuitant, we will pay
    the death proceeds to the Beneficiary.  If there are joint Owners, we
    will treat the youngest of the Owners as the Contingent Annuitant
    designated, unless you elect otherwise.

THE BENEFICIARY

    The Beneficiary is the person to whom we pay death proceeds if any Owner
    dies prior to the Annuity Commencement Date.  See Proceeds Payable to the
    Beneficiary for more information.  We pay death proceeds to the primary
    Beneficiary (unless there are joint Owners in which case the death
    benefit proceeds are payable to the surviving Owner).  If the primary
    Beneficiary dies before the Owner, the death proceeds are paid to the
    Contingent Beneficiary, if any.  If there is no surviving Beneficiary,
    we pay the death proceeds to the Owner's estate.

GA-IA-1053

                                    6

<PAGE>
<PAGE>

                INTRODUCTION TO THIS CONTRACT (continued)
------------------------------------------------------------------------------

    One or more persons may be named as primary Beneficiary or contingent
    Beneficiary.  In the case of more than one Beneficiary, we will assume
    any death proceeds are to be paid in equal shares to the surviving
    Beneficiaries.  You can specify other than equal shares.

    You have the right to change Beneficiaries, unless you designate the
    primary Beneficiary irrevocable.  When an irrevocable Beneficiary has
    been designated, you and the irrevocable Beneficiary may have to act
    together to exercise the rights and options under this Contract.

CHANGE OF OWNER OR BENEFICIARY

    During your lifetime and while this Contract is in effect you can
    transfer ownership of this Contract or change the Beneficiary.  To make
    any of these changes, you must send us written notice of the change in a
    form satisfactory to us.  The change will take effect as of the day the
    notice is signed.  The change will not affect any payment made or action
    taken by us before recording the change at our Customer Service Center.
    A Change of Owner may affect the amount of death benefit payable under
    this Contract.  See Proceeds Payable to Beneficiary.

GA-IA-1053

                                    7

<PAGE>
<PAGE>

                 PREMIUM PAYMENTS AND ALLOCATION CHARGES
------------------------------------------------------------------------------

INITIAL PREMIUM PAYMENT

    The Initial Premium Payment is required to put this Contract in effect.
    The amount of the Initial Premium Payment is shown in the Schedule.

ADDITIONAL PREMIUM PAYMENT OPTION

    You may make additional premium payments under this Contract after the
    end of the Right to Examine period.  Restrictions on additional premium
    payments, such as the Attained Age of the Annuitant or Owner and the
    timing and amount of each payment, are shown in the Schedule. We reserve
    the right to defer acceptance of or to return any additional premium
    payments.

    As of the date we receive and accept your additional premium payment:

      (1)  The Accumulation Value will increase by the amount of the
           premium payment less any premium deductions as shown in the
           Schedule.
      (2)  The increase in the Accumulation Value will be allocated among
           the Divisions of the Variable Separate Account and General Account
           in accordance with your instructions.  If you do not provide such
           instructions, allocation will be among the Divisions of the Variable
           Separate Account and General Account in proportion to the amount of
           Accumulation Value in each Division.

    Where to Make Payments
    Remit the premium payments to our Customer Service Center at the address
    shown on the cover page.  On request we will give you a receipt signed by
    our treasurer.

YOUR RIGHT TO CHANGE ALLOCATION OF ACCUMULATION VALUE

    You may change the allocation of the Accumulation Value among the
    Divisions after the end of the Right to Examine period.  The number of
    free allocation changes each year that we will allow is shown in the
    Schedule.  To make an allocation change, you must provide us with
    satisfactory notice at our Customer Service Center.  The change will take
    effect when we receive the notice.  Restrictions for reallocation into
    and out of Divisions of the Variable Separate Account and General Account
    are shown in the Schedule.

WHAT HAPPENS IF A VARIABLE SEPARATE ACCOUNT DIVISION IS NOT AVAILABLE

    When a distribution is made from an investment portfolio supporting a
    unit investment trust Separate Account Division in which reinvestment is
    not available, we will allocate the distribution to the Specially
    Designated Division shown in the Schedule unless you specify otherwise.

    Such a distribution may occur when an investment portfolio or Division
    matures, when distribution from a portfolio or Division cannot be
    reinvested in the portfolio or Division due to the unavailability of
    securities, or for other reasons.  When this occurs because of maturity,
    we will send written notice to you thirty days in advance of such date.
    To elect an allocation to other than the Specially Designated Division
    shown in the Schedule, you must provide satisfactory notice to us at
    least seven days prior to the date the investment matures.  Such
    allocations will not be counted as an allocation change of the
    Accumulation Value for purposes of the number of free allocations
    permitted.

GA-IA-1053

                                    8

<PAGE>
<PAGE>

            HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE
------------------------------------------------------------------------------

    The variable Annuity Benefits under this Contract are provided through
    investments which may be made in our Separate Accounts.

THE VARIABLE SEPARATE ACCOUNTS

    These accounts, which are designated in the Schedule, are kept separate
    from our General Account and any other Separate Accounts we may have.
    They are used to support Variable Annuity Contracts and may be used for
    other purposes permitted by applicable laws and regulations.  We own the
    assets in the Separate Accounts.  Assets equal to the reserves and other
    liabilities of the accounts will not be charged with liabilities that
    arise from any other business we conduct; but, we may transfer to our
    General Account assets which exceed the reserves and other liabilities of
    the Variable Separate Accounts.  Income and realized and unrealized gains
    or losses from assets in these Variable Separate Accounts are credited to
    or charged against the account without regard to other income, gains or
    losses in our other investment accounts.

    The Variable Separate Account will invest in mutual funds, unit
    investment trusts and other investment portfolios which we determine to
    be suitable for this Contract's purposes.  The Variable Separate Account
    is treated as a unit investment trust under Federal securities laws.  It
    is registered with the Securities and Exchange Commission ("SEC") under
    the Investment Company Act of 1940.  The Variable Separate Account is
    also governed by state law as designated in the Schedule.  The trusts may
    offer non-registered series.

    Variable Separate Account Divisions
    A unit investment trust Separate Account includes Divisions, each
    investing in a designated investment portfolio.  The Divisions and the
    investment portfolios designated may be managed by a separate investment
    adviser.  Such adviser may be registered under the Investment Advisers
    Act of 1940.

    Changes within the Variable Separate Accounts
    We may, from time to time, make additional Variable Separate Account
    Divisions available to you.  These Divisions will invest in investment
    portfolios we find suitable for this Contract.  We also have the right to
    eliminate Divisions from a Variable Separate Account, to combine two or
    more Divisions or to substitute a new portfolio for the portfolio in
    which a Division invests.  A substitution may become necessary if, in our
    judgment, a portfolio or Division no longer suits the purpose of this
    Contract.  This may happen due to a change in laws or regulations, or a
    change in a portfolio's investment objectives or restrictions, or because
    the portfolio or Division is no longer available for investment, or for
    some other reason.  We may get prior approval from the insurance
    department of our state of domicile before making such a substitution.
    We will also get any required approval from the SEC and any other
    required approvals before making such a substitution.

    Subject to any required regulatory approvals, we reserve the right to
    transfer assets of the Variable Separate Account which we determine to be
    associated with the class of contracts to which this Contract belongs, to
    another Variable Separate Account or Division.

    When permitted by law, we reserve the right to:
      (1)  deregister a Variable Separate Account under the Investment
           Company Act of 1940;
      (2)  operate a Variable Separate Account as a management company
           under the Investment Company Act of 1940, if it is operating as a
           unit investment trust;
      (3)  operate a Variable Separate Account as a unit investment trust
           under the Investment Company Act of 1940, if it is operating as a
           managed Variable Separate Account;
      (4)  restrict or eliminate any voting rights of Owners, or other
           persons who have voting rights to a Variable Separate Account; and,
      (5)  combine a Variable Separate Account with other Variable
           Separate Accounts.

GA-IA-1053

                                    9

<PAGE>
<PAGE>

      HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE (continued)
------------------------------------------------------------------------------
THE GENERAL ACCOUNT

    The General Account contains all assets of the Company other than those
    in the Separate Accounts we establish.  The Guaranteed Interest Divisions
    available for investment are shown in the Schedule.  We may, from time to
    time, offer other Divisions where assets are held in our General Account.

VALUATION PERIOD

    Each Division will be valued at the end of each Valuation Period on a
    Valuation Date.  A Valuation Period is each Business Day together with
    any non-Business Days before it.  A Business Day is any day the New York
    Stock Exchange (NYSE) is open for trading, and the SEC requires mutual
    funds, unit investment trusts, or other investment portfolios to value
    their securities.

ACCUMULATION VALUE

    The Accumulation Value of this Contract is the sum of the amounts in each
    of the Separate and General Account Divisions.  You select the Divisions
    of the Variable Separate Account and General Account to which to allocate
    the Accumulation Value.  The maximum number of Divisions to which the
    Accumulation Value may be allocated at any one time is shown in the
    Schedule.

ACCUMULATION VALUE IN EACH DIVISION

    On the Contract Date
    On the Contract Date, the Accumulation Value is allocated to each
    Division as elected by you, subject to certain terms and conditions
    imposed by us.  We reserve the right to allocate premium to the Specially
    Designated Division during any Right to Examine period.  After such time,
    allocation will be made proportionately in accordance with the initial
    allocation(s) as elected by you.

    On each Valuation Date
    At the end of each subsequent Valuation Period, the amount of
    Accumulation Value in each Division will be calculated as follows:
      (1)  We take the Accumulation Value in the Division at the end of
           the preceding Valuation Period.
      (2)  We multiply (1) by the Variable Separate Account Division's Net
           Rate of Return for the current Valuation Period or we calculated
           the interest to be credited to a Guaranteed Interest Division for
           the current Valuation Period.
      (3)  We add (1) and (2).
      (4)  We add to (3) any additional premium payments (less any premium
           deductions as shown in the Schedule) allocated to the Division
           during the current Valuation Period.
      (5)  We add or subtract allocations to or from that Division during
           the current Valuation Period.
      (6)  We subtract from (5) any Partial Withdrawals which are
           allocated to the Division during the current Valuation Period.
      (7)  We subtract from (6) the amounts allocated to that Division
           for:
             (a) any charges due for the Optional Benefit Riders as shown
                 in the Schedule;
             (b) any deductions from Accumulation Value as shown in the
                 Schedule.
    All amounts in (7) are allocated to each Division in the proportion that
    (6) bears to the Accumulation Value unless the Charge Deduction Division
    has been specified (see the Schedule).

GA-IA-1053

                                    10

<PAGE>
<PAGE>

      HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE (continued)
------------------------------------------------------------------------------

MEASUREMENT OF INVESTMENT EXPERIENCE

    Index of Investment Experience
    The Investment Experience of a Variable Separate Account Division is
    determined on each Valuation Date.  We use an Index to measure changes in
    each Division's experience during a Valuation Period.  We set the Index
    at $10 when the first investments in a Division are made.  The Index for
    a current Valuation Period equals the Index for the preceding Valuation
    Period multiplied by the Experience Factor for the current Valuation
    Period.

    How We Determine the Experience Factor
    For Divisions of a unit investment trust Separate Account the Experience
    Factor reflects the Investment Experience of the portfolio in which the
    Division invests as well as the charges assessed against the Division for
    a Valuation Period.  The factor is calculated as follows:
      (1)  We take the net asset value of the portfolio in which the
           Division invests at the end of the current Valuation Period.
      (2)  We add to (1) the amount of any dividend or capital gains
           distribution declared for the investment portfolio and reinvested
           in such portfolio during the current Valuation Period.  We subtract
           from that amount a charge for our taxes, if any.
      (3)  We divide (2) by the net asset value of the portfolio at the
           end of the preceding Valuation Period.
      (4)  We subtract the daily Mortality and Expense Risk Charge for
           each Division shown in the Schedule for each day in the Valuation
           Period.
      (5)  We subtract the daily Asset Based Administrative Charge shown
           in the Schedule for each day in the Valuation Period.

    Calculations for Divisions investing in unit investment trusts are on
    a per unit basis.

    Net Rate of Return for a Variable Separate Account Division
    The Net Rate of Return for a Variable Separate Account Division during a
    Valuation Period is the Experience Factor for that Valuation Period minus
    one.

    Interest Credited to a Guaranteed Interest Division
    Accumulation Value allocated to a Guaranteed Interest Division will be
    credited with the  Guaranteed Interest Rate for the Guarantee Period in
    effect on the date the premium or reallocation is applied.  Once applied,
    such rate will be guaranteed until the Maturity Date of that Guarantee
    Period.  Interest will be credited daily at a rate to yield the declared
    annual Guaranteed Interest Rate.  No Guaranteed Interest Rate will be
    less than the Minimum Interest Rate shown in the Schedule.

GA-IA-1053

                                    11

<PAGE>
<PAGE>

      HOW WE MEASURE THE CONTRACT'S ACCUMULATION VALUE (continued)
------------------------------------------------------------------------------

    CHARGES DEDUCTED FROM ACCUMULATION VALUE ON EACH CONTRACT PROCESSING DATE

    Expense charges and fees are shown in the Schedule.

    Charge Deduction Division Option
    We will deduct all charges against the Accumulation Value of this
    Contract from the Charge Deduction Division if you elected this option on
    the application (see the Schedule).  If you did not elect this Option or
    if the charges are greater than the amount in the Charge Deduction
    Division, the charges against the Accumulation Value will be deducted as
    follows:

      (1)  If these charges are less than the Accumulation Value in the
           Variable Separate Account Divisions, they will be deducted
           proportionately from all Divisions.
      (2)  If these charges exceed the Accumulation Value in the Variable
           Separate Account Divisions, any excess over such value will be
           deducted proportionately from the Guaranteed Interest Divisions.

    Any charges taken from the General Account will be taken from the
    Guaranteed Interest Divisions starting with the Guarantee Period nearest
    its Maturity Date until such charges have been paid.

    At any time while this Contract is in effect, you may change your
    election of this Option.  To do this you must send us a written request
    to our Customer Service Center.  Any change will take effect within seven
    days of the date we receive your request.

GA-IA-1053

                                    12

<PAGE>
<PAGE>

                         YOUR CONTRACT BENEFITS
------------------------------------------------------------------------------

    While this Contract is in effect, there are important rights and benefits
    that are available to you.  We discuss these rights and benefits in this
    section.

CASH VALUE BENEFIT

    Cash Surrender Value
    The Cash Surrender Value, while the Annuitant is living and before the
    Annuity Commencement Date, is determined as follows:
      (1)  We take the Contract's Accumulation Value;
      (2)  We deduct any Surrender Charges;
      (3)  We deduct any charges shown in the Schedule that have been
           incurred but not yet deducted, including:
          (a)  any administrative charge that has not yet been deducted;
          (b)  the pro rata part of any charges for Optional Benefit
               Riders; and
          (c)  any applicable premium or other tax.

    Cancelling to Receive the Cash Surrender Value
    At any time while the Annuitant is living and before the Annuity
    Commencement Date, you may surrender this Contract to us.  To do this,
    you must return this Contract with a signed request for cancellation to
    our Customer Service Center.

    The Cash Surrender Value will vary daily.  We will determine the Cash
    Surrender Value as of the date we receive the Contract and your signed
    request in our Customer Service Center.  All benefits under this Contract
    will then end.

    We will usually pay the Cash Surrender Value within seven days; but, we
    may delay payment as described in the Payments We May Defer provision.

PARTIAL WITHDRAWAL OPTION

    After the Contract Date, you may make Partial Withdrawals.  Partial
    Withdrawals may be subject to a Partial Withdrawal Charge (see the
    Schedule).  The minimum amount that may be withdrawn is shown in the
    Schedule.  The maximum amount that may be withdrawn without Surrender
    Charge is shown in the Schedule.  To take a Partial Withdrawal, you must
    provide us satisfactory notice at our Customer Service Center.

PROCEEDS PAYABLE TO THE BENEFICIARY

    Prior to the Annuity Commencement Date
    If the sole Owner dies prior to the Annuity Commencement Date, we will
    pay the Beneficiary the death benefit.  If there are joint Owners and any
    Owner dies, we will pay the surviving Owners the death benefit.  We will
    pay the amount on receipt of due proof of the Owner's death at our
    Customer Service Center.  Such amount may be received in a single lump
    sum or applied to any of the Annuity Options (see Choosing an Income
    Plan).  When the Owner (or all Owners where there are joint Owners) is
    not an individual, the death benefit will become payable on the death of
    the Annuitant prior to the Annuity Commencement Date (unless a Contingent
    Annuitant survived the Annuitant).  Only one death benefit is payable
    under this Contract.  In all events, distributions under the Contract
    must be made as required by applicable law.

    How to Claim Payments to Beneficiary
    We must receive proof of the Owner's (or the Annuitant's) death before we
    will make any payments to the Beneficiary.  We will calculate the death
    benefit as of the date we receive due proof of death.  The Beneficiary
    should contact our Customer Service Center for instructions.

GA-IA-1053

                                    13

<PAGE>
<PAGE>

                         CHOOSING AN INCOME PLAN
------------------------------------------------------------------------------

ANNUITY BENEFITS

    If the Annuitant and Owner are living on the Annuity Commencement Date,
    we will begin making payments to the Owner.  We will make these payment
    under the Annuity Option (or Options) as chosen in the application or as
    subsequently selected.  You may choose or change an Annuity Option by
    making a written request at least 30 days prior to the Annuity
    Commencement Date.  Unless you have chosen otherwise, Option 2 on a 10-
    year period certain basis will become effective.  The amounts of the
    payments will be determined by applying the Accumulation Value on the
    Annuity Commencement Date in accordance with the Annuity Options section
    below (see Payments We Defer).  Before we pay any Annuity Benefits, we
    require the return of this Contract.  If this Contract has been lost, we
    require the applicable lost Contract form.

ANNUITY COMMENCEMENT DATE SELECTION

    You select the Annuity Commencement Date.  You may select any date
    following the fifth Contract Anniversary but before the required date of
    Annuity Commencement as shown in the Schedule.  If you do not select a
    date, the Annuity Commencement Date will be in the month following the
    required date of Annuity Commencement.

FREQUENCY SELECTION

    You may choose the frequency of the Annuity Payments.  They may be
    monthly, quarterly, semi-annually or annually.  If we do not receive
    written notice from you, the payments will be made monthly.

THE INCOME PLAN

    While this Contract is in effect and before the Annuity Commencement
    Date, you may chose one or more Annuity Options for the payment of death
    benefits proceeds.  If, at the time of the Owner's death, no Option has
    been chosen for paying the death benefit proceeds, the Beneficiary may
    choose an Option within one year.  You may also elect an Annuity Option
    on surrender of the Contract for its Cash Surrender Value.  For each
    Option we will issue a separate written agreement putting the Option into
    effect.

    Our approval is needed for any Option where:
      (1)  the person named to receive payment is other than the Owner or
           Beneficiary; or
      (2)  the person named is not a natural person, such as a
           corporation; or
      (3)  any income payment would be less than the minimum annuity
           income payment shown in the Schedule.

THE ANNUITY OPTIONS

    There are four Options to choose from.  They are:

    Option 1.  Income for a Fixed Period
    Payment is made in equal installments for a fixed number of years.  We
    guarantee each monthly payment will be at least the Income for Fixed
    Period amount shown in the Schedule.  Values for annual, semiannual or
    quarterly payments are available on request.

GA-IA-1053

                                    14

<PAGE>
<PAGE>

                   CHOOSING AN INCOME PLAN (continued)
------------------------------------------------------------------------------

    Option 2.  Income for Life
    Payment is made to the person named in equal monthly installments and
    guaranteed for at least a period certain.  The period certain can be 10
    or 20 years.  Other periods certain are available on request.  A refund
    certain may be chosen instead.  Under this arrangement, income is
    guaranteed until payments equal the amount applied.  If the person named
    lives beyond the Guarantee Period, payments continue until his or her
    death.

    We guarantee each payment will be at least the amount shown in the
    Schedule.  By age, we mean the named person's age on his or her nearest
    birthday before the Option's effective date.  Amounts for ages not shown
    are available on request.

    Option 3.  Joint Life Income
    This Option is available if there are two persons named to receive
    payments.  At least one of the persons named must be either the Owner of
    Beneficiary of this Contract.  Monthly payments are guaranteed and are
    made as long as at least one of the named persons is living.  The monthly
    payment amounts are available upon request.  Such amounts are guaranteed
    and will be calculated on the same basis as the Table for Income for
    Life, however, the amounts will be based on two lives.

    Option 4.  Annuity Plan
    An amount can be used to buy any single premium immediate annuity we
    offer for the Option's effective date.

    The minimum rates for Option 1 are based on 3% interest, compounded
    annually.  The minimum rates for Options 2 and 3 are based on 3%
    interest, compounded annually, and the Annuity 2000 Mortality Table.  We
    may pay a higher rate at our discretion.

PAYMENT WHEN NAMED PERSON DIES

    When the person named to receive payment dies, we will pay any amounts
    still due as provided by the Option agreement.  The amounts still due are
    determined as follows:
      (1)  For Option 1 or for any remaining guaranteed payments in Option
           2, payments will be continued.
      (2)  For Option 3, no amounts are payable after both named persons
           have died.
      (3)  For Option 4, the annuity agreement will state the amount due,
           if any.

GA-IA-1053

                                    15

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                       OTHER IMPORTANT INFORMATION
------------------------------------------------------------------------------

SENDING NOTICE TO US

    Whenever written notice is required, send it to our Customer Service
    Center.  The address of our Customer Service Center is shown on the cover
    page.  Please include your Contract number in all correspondence.

REPORTS TO OWNER

    We will send you a report at least once during each Contract Year.  The
    report will show the Accumulation Value and the Cash Surrender Value as
    of the end of the Contract Processing Period.  The report will also show
    the allocation of the Accumulation Value as of such date and the amounts
    deducted from or added to the Accumulation Value since the last report.
    The report will also include any information that may be currently
    required by the insurance supervisory official of the jurisdiction in
    which the Contract is delivered.

    We will also send you copies of any shareholder reports of the portfolios
    in which the Divisions of the Variable Separate Account invest, as well
    as any other reports, notices or documents required by law to be
    furnished to Owners.

ASSIGNMENT - USING THIS CONTRACT AS COLLATERAL SECURITY

    You can assign this Contract as collateral security for a loan or other
    obligation.  This does not change the ownership.  Your rights and any
    Beneficiary's right are subject to the terms of the assignment.  To make
    or release an assignment, we must receive written notice satisfactory to
    us, at our Customer Service Center.  We are not responsible for the
    validity of any assignment.

CHANGING THIS CONTRACT

    This Contract or any additional benefit riders may be changed to another
    annuity plan according to our rules at the time of the change.

CONTRACT CHANGES - APPLICABLE TAX LAW

    We reserve the right to make changes in this Contract or its Riders to
    the extent we deem it necessary to continue to qualify this Contract as
    an annuity.  Any such changes will apply uniformly to all Contracts that
    are affected.  You will be given advance written notice of such changes.

MISSTATEMENT OF AGE OR SEX

    If an age or sex has been misstated, the amounts payable or benefits
    provided by this Contract will be those that the premium payment made
    would have bought at the correct age or sex.

NON-PARTICIPATING

    This Contract does not participate in the divisible surplus of Golden
    American Life Insurance Company.

GA-IA-1053

                                    16

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                 OTHER IMPORTANT INFORMATION (continued)
------------------------------------------------------------------------------

PAYMENTS WE MAY DEFER

    We may not be able to determine the value of the assets of the Variable
    Separate Account Divisions because:
      (1)  The NYSE is closed for trading;
      (2)  the SEC determines that a state of emergency exists;
      (3)  an order or pronouncement of the SEC permits a delay for the
           protection of Owners; or
      (4)  the check used to pay the premium has not cleared through the
           banking system.  This may take up to 15 days.

    During such times, as to amounts allocated to the Divisions of the
    Variable Separate Account, we may delay;
      (1)  determination and payment of the Cash Surrender Value;
      (2)  determination and payment of any death benefit if death occurs
           before the Annuity Commencement Date;
      (3)  allocation changes of the Accumulation Value; or,
      (4)  application of the Accumulation Value under an income plan.

    As to the amounts allocated to a Guaranteed Interest Division in the
    General Account, we may, at any time, defer payment of the Cash Surrender
    Value for up to six months after we receive a request for it.  We will
    allow interest of at least 3.00% a year on any Cash Surrender Value
    payment derived from the Guaranteed Interest Divisions that we defer 30
    days or more.

AUTHORITY TO MAKE AGREEMENTS

    All agreements made by us must be signed by one of our officers.  No
    other person, including an insurance agent or broker, can:
      (1)  change any of this Contract's terms;
      (2)  extend the time for premium payments; or
      (3)  make any agreement binding on us.

REQUIRED NOTE ON OUR COMPUTATIONS

    We have filed a detailed statement of our computations with the insurance
    supervisory official in the jurisdiction where this Contract is
    delivered.  The values are not less than those required by the law of
    that state or jurisdiction.  Any benefit provided by an attached Optional
    Benefit Rider will not increase these values unless otherwise stated in
    that Rider.

GA-IA-1053

                                    17

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<PAGE>

DEFERRED VARIABLE ANNUITY CONTRACT - NO DIVIDENDS.  FLEXIBLE PREMIUMS.
------------------------------------------------------------------------------

Variable Cash Surrender Values while the Annuitant and Owner are living
and prior to the Annuity Commencement Date.  Death benefit subject to
guaranteed minimum.  Additional Premium Payment Option.  Partial
Withdrawal Option.  Non-participating.  Investment results reflected in
values.

GA-IA-1053

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<PAGE><PAGE>
<PAGE>
                                                 EXHIBIT 4(d)

GOLDEN AMERICAN                                   Individual Retirement
LIFE INSURANCE COMPANY                            Annuity Rider
A stock domiciled in Wilmington, Delaware
------------------------------------------------------------------------

   On the basis of the application for the Contract to which this Rider
   is attached, this Contract is issued as an Individual Retirement
   Annuity ("IRA") intended to qualify as such under Section 408(b) of
   the Internal Revenue Code, as amended (the "Code").  This Contract is
   established for the exclusive benefit of the Owner and the
   beneficiaries named.

   In the event of any conflict between the provisions of this Rider and
   the Contract to which it is attached, the provisions of this Rider
   will control.  Golden American Life Insurance Company of, ("Golden
   American"), reserves the right to amend or administer the Contract and
   Rider as necessary to comply with applicable tax requirements.  Any such
   change will apply uniformily to all contracts that are affected and the
   Owner will have the right to accept or reject such changes.

CONTRIBUTIONS

   Except in the case of a rollover contribution or a contribution made
   in accordance with the terms of a simplified employee pension ("SEP"),
   no contributions will be accepted unless they are in cash, and the
   total of such contributions will not exceed $2,000 for any taxable
   year.

   No contribution will be accepted under a SIMPLE plan established by
   any employer pursuant to Code section 408(p). No transfer or rollover
   of funds attributable to contributions made by a particular employer
   under its SIMPLE plan will be accepted from a SIMPLE IRA, that is, an
   IRA used in conjunction with a SIMPLE plan, prior to the expiration
   of the 2-year period beginning on the date the individual first
   participated in that employer's SIMPLE plan.

   Any refund of premiums (other that those attributable to excess
   contributions) will be applied before the close of the calendar year
   following the year of the refund towards the payment or future payment
   of the future premiums or the purchase of additional benefits.

NONFORFEITABILITY AND NONTRANSFERABILITY

   The Owner's IRA account will be 100% nonforfeitable at all times and
   will be maintained for the exclusive benefit of the Owner and the
   beneficiaries named.  This IRA may not be attached or alienated except
   where permitted by law.

   The Owner may not transfer ownership of any part or all of this IRA at
   any time, or pledge any part of it or use any part of it as
   collateral.

ROLLOVERS

   The Owner may make rollover premium purchase payments under the IRA as
   permitted by Section 402(c), 403(a)(4), 403(b)(8), 408(p)(7) or
   408(d)(3).  The Insurer may require that the Owner furnish
   documentation that a rollover premium purchase payment qualifies as a
   rollover under the Code.

SIMPLIFIED EMPLOYEE PENSIONS

   This IRA will accept premium purchase payments made on behalf of the
   Owner by the Owner's employer pursuant to a simplified employee
   pension plan ("SEP") under Code Section 408(k).

GA-RA-1009-08/97                        1

<PAGE>
<PAGE>
MINIMUM DISTRIBUTION RULES

   (a) IRA required minimum annual distributions must commence to the
       Owner no later than April 1st of the calendar year following the
       calendar year in which the Owner attains age 70 1/2.  The method
       of distribution elected must insure that the entire interest of
       the Owner must be distributed by that date.  Alternatively, the
       distribution method elected must commence by that date and
       provide that the Owner's entire interest be distributed over a
       period not to exceed:

       (i)  the life expectancy of the Owner or the joint and last
            survivor expectancy of the Owner and the designated
            beneficiaries; or,
       (ii) a period certain not in excess of the life expectancy of
            the Owner or the joint and last survivor expectancy of the
            Owner and the designated beneficiaries.

       All distributions made hereunder will be made in accordance with
       the requirements of section 401(a) (9) of the Code, including the
       incidental death benefit requirements of section 401(a) (9) (G)
       of the Code, and the regulations thereunder, including the
       minimum distribution incidental benefit requirement of section
       1.401(a) (9)-2 of the Proposed Income Tax Regulations.

       In addition, payments must be either nonincreasing or they may
       increase only as provided in Q&A F-3 of section 1.401(a) (9)-1 of
       the Proposed Income Tax Regulations.

   (b) All payments are to be made in equal annual installments,
       except where a cashout accelerates payment.  There is no account
       balance, which would vary from year to year, as in a 408(a) IRA.

   (c) Life expectancy is computed by use of the expected return
       multiples in Tables V and VI of section 1.72-9 of the Income Tax
       Regulations.  Unless otherwise elected by the individual by the
       time distributions are required to begin, life expectancies will
       be recalculated annually.  Such election will be irrevocable by
       the individual and will apply to all subsequent years.  The life
       expectancy of non-spouse beneficiary may not be recalculated.
       Instead, life expectancy will be calculated using the attained
       age of such beneficiary during the calendar year in which the
       beneficiary attains age 70 1/2, and payments for subsequent years
       will be calculated based on such life expectancy reduced by one
       for each calendar year which has elapsed since the calendar year
       life expectancy was first calculated.

   (d) In the event the Owner dies before distribution of his or her
       interest commences under this IRA, 100% of the balance under the
       IRA will be distributed to the beneficiaries named.  Distribution
       will be completed no later than the last day of the calendar year
       in which the fifth anniversary of the Owner's death occurs.  If
       the individual's interest is payable to a designated beneficiary,
       then the entire interest of the individual may be distributed
       over the life or over a period certain not greater than the life
       expectancy of the designated beneficiary commencing on or before
       December 31 of the calendar year immediately following the
       calendar year in which the individual died.  The designated
       beneficiary may elect at any time to receive greater payments.

   (e) In the event the Owner dies after the commencement of benefits
       to him under this IRA, distribution of the remaining benefits
       under the IRA will be made to the beneficiaries named in a method
       at least as rapid as that in effect as of the date of the Owner's
       death.  Commencement of distributions under this section to the
       beneficiaries must be no later than the last day of the calendar
       year in which occurs the first anniversary of the Owner's death.

   (f) The provisions of (d) and (e) will not apply where the
       beneficiary is the Owner's surviving spouse.  The surviving
       spouse may elect to delay commencement of required distributions
       until the December 31st of the calendar year in which the
       deceased Owner would have attained age 70 1/2.  Alternatively,
       the surviving spouse may elect to rollover the entire balance of
       the deceased Owner's IRA to the surviving spouse's own IRA.

       Life expectancy is computed by use of the expected return
       multiples in Tables V and VI of section 1.72-9 of the Income Tax
       Regulations.  For purposes of distributions beginning after the
       individual's death, unless otherwise elected by the surviving
       spouse by the time distributions are required to begin, life
       expectancies will be recalculated annually.

GA-RA-1009-08/97                        2

<PAGE>
<PAGE>
MINIMUM DISTRIBUTION RULES (CONTINUED)

       Such election will be irrevocable by the surviving
       spouse and will apply to all subsequent years.  In
       the case of any other designated beneficiary, life
       expectancies will be calculated using the attained
       age of such beneficiary during the calendar year
       in which distributions are required to begin
       pursuant to this section, and payments for any
       subsequent calendar year will be calculated based
       on such life expectancy reduced by one for each
       calendar year which has elapsed since the calendar
       year life expectancy was first calculated.

       Distributions under this section are considered to
       have begun if distributions are made on account of
       the individual reaching his or her required
       beginning date or if prior to the required
       beginning date distributions irrevocably commence
       to an individual over a period permitted and in an
       annuity form acceptable under section 1.401(a) (9)
       of the Regulations.

   (g) The designated beneficiary may elect to receive
       greater payments than those required under this
       section.  If there is more than one beneficiary,
       the designated beneficiary will be that person
       with the shortest life expectancy for the purposes
       of determining the distribution period.
   (h) For purposes of this Section, any amounts paid
       to a minor child of the Owner will be treated as
       having been paid to the surviving spouse if the
       remainder of the IRA is payable to the surviving
       spouse when the child attains the age of majority.

REPORTS

       The issuer of an individual retirement annuity
       will furnish annual calendar year reports
       concerning the status of the annuity.

GA-RA-1009-08/97                        3

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<PAGE>

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