Document:

<PAGE>
<PAGE>
                                                 EXHIBIT 4(a)

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

Golden American is a stock company domiciled in Delaware.
------------------------------------------------------------------------------

------------------------------------------------------------------------------
| 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 AND THE FIXED ACCOUNT]     [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 Variable Separate
Account, the General Account and the Fixed 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.  ALL PAYMENTS AND VALUES, WHEN BASED ON
THE FIXED ACCOUNT, MAY BE SUBJECT TO A MARKET VALUE ADJUSTMENT, THE
OPERATION OF WHICH MAY CAUSE SUCH PAYMENTS AND VALUES TO INCREASE OR
DECREASE.

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,
ADJUSTED FOR ANY MARKET VALUE ADJUSTMENT, 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

------------------------------------------------------------------------------
DEFERRED COMBINATION VARIABLE AND FIXED 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-1052

<PAGE>
<PAGE>

                            CONTRACT CONTENTS
------------------------------------------------------------------------------

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-1052
                                    2

<PAGE>
<PAGE>

                              THE SCHEDULE
                   PAYMENT AND INVESTMENT INFORMATION
------------------------------------------------------------------------------

------------------------------------------------------------------------------
| 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 AND THE FIXED ACCOUNT]        [123456]                 |
------------------------------------------------------------------------------

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                         5%
            Hard Assets                          5%
          Emerging Markets                       5%
           Managed Global                        5%
          Limited Maturity Bond                  5%
            Liquid Asset                         5%
          Strategic Equity                       5%
        Fixed Allocation - 1 Year                5%]
    -------------------------------   -------------------------
               Total                           100%
               =====                           ====

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].]

GA-IA-1052

                                    3A1

<PAGE>
<PAGE>

                              THE SCHEDULE
             PAYMENT AND INVESTMENT INFORMATION (continued)
------------------------------------------------------------------------------

------------------------------------------------------------------------------
| 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 AND THE FIXED ACCOUNT]        [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-1052

                                    3A2

<PAGE>
<PAGE>

                              THE SCHEDULE
                     THE VARIABLE SEPARATE ACCOUNTS
------------------------------------------------------------------------------

------------------------------------------------------------------------------
| 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 AND THE FIXED ACCOUNT]        [123456]                 |
------------------------------------------------------------------------------

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-1052

                                    3B

<PAGE>
<PAGE>

                              THE SCHEDULE
                           THE GENERAL ACCOUNT

------------------------------------------------------------------------------

------------------------------------------------------------------------------
| 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 AND THE FIXED ACCOUNT]        [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.

    Transfers from a Guaranteed Interest Division
    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 or to a Fixed Allocation to be transferred back to a Guaranteed
    Interest Division for a period of at least six months from the date of
    transfer.

GA-IA-1052

                                    3C

<PAGE>
<PAGE>

                              THE SCHEDULE
                             CONTRACT FACTS
------------------------------------------------------------------------------

------------------------------------------------------------------------------
| 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 AND THE FIXED ACCOUNT]        [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.

    Earnings and 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.

    Any Conventional Partial Withdrawal is subject to a Market Value
    Adjustment unless withdrawn from a Fixed Allocation within 30 days prior
    to the Maturity Date.

GA-IA-1052

                                    3D1

<PAGE>
<PAGE>

                              THE SCHEDULE
                       CONTRACT FACTS (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 AND THE FIXED ACCOUNT]        [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.
  Fixed Allocations and
  Guaranteed Interest Divisions:       Interest earned on a Fixed Allocation
                                       or Guaranteed Interest Division for the
                                       prior month, quarter or year (depending
                                       on the frequency selected).

The Maximum Withdrawal Amount available for a year as a Systematic Partial
                                        Withdrawal is 10% of Premium Payments
                                        not previously withdrawn.
A Systematic Partial Withdrawal from a Fixed Allocation is not subject to
Market Value Adjustment.  Systematic Partial Withdrawals and Conventional
Partial Withdrawals may not be taken in the same Contract Year. 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 ADJUSTMENTS

    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-1052

                                    3D2

<PAGE>
<PAGE>

                              THE SCHEDULE
                       CONTRACT FACTS (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 AND THE FIXED ACCOUNT]        [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 owners' attained age at the time of
    the change is less than (86), the Death Benefit will remain in effect. If
    any owner's or 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
    certificate 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-1052

                                    3D3

<PAGE>
<PAGE>

                              THE SCHEDULE
                       CONTRACT FACTS (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 AND THE FIXED ACCOUNT]        [123456]                 |
------------------------------------------------------------------------------

ATTAINED AGE

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

FIXED ACCOUNT

    Minimum Fixed Allocation
    The minimum allocation to the Fixed Account in any one Fixed Allocation is
    [$250.00].

    Minimum Guaranteed Interest Rate - [3%.]

    Guarantee Periods
    We currently offer Guarantee Periods of [1,2,3,4,5,6,7,8,9 and 10] year(s).
    We reserve the right to offer Guarantee Periods of durations other than
    those available on the Contract Date.  We also reserve the right to cease
    offering a particular Guarantee Period or Periods.

    Index Rate
    The Index Rate is the average of the Ask Yields for the U.S. Treasury
    Strips as reported by a national quoting service for the applicable
    maturity.  The average is based on the period from the 22nd day of the
    calendar month two months prior to the calendar month of Index Rate
    determination to the 21st day of the calendar month immediately prior to
    the month of determination.  The applicable maturity date for these U.S.
    Treasury Strips is on or next following the last day of the Guarantee
    Period.  If the Ask Yields are no longer available, the Index Rate will
    be determined using a suitable replacement method.

    We currently set the Index Rate once each calendar month.  However, we
    reserve the right to set the Index Rate more frequently than monthly, but
    in no event will such Index Rate be based on a period less than 28 days.

GA-IA-1052

                                    3D4

<PAGE>
<PAGE>

                              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 AND THE FIXED ACCOUNT]        [123456]                 |
------------------------------------------------------------------------------

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-1052

                                    3E1

<PAGE>
<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 AND THE FIXED ACCOUNT]        [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 Fixed 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
    Fixed Account values.

CHARGE DEDUCTION DIVISION

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

GA-IA-1052

                                    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 AND THE FIXED ACCOUNT]        [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-1052

                                    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-1052

                                    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.

FIXED ACCOUNT - This is the Separate Account established to support Fixed
  Allocations.

FIXED ALLOCATION - An amount allocated to the Fixed Account that is
  credited with a Guaranteed Interest Rate for a specified Guarantee
  Period.

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

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

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 Separate Accounts.

GUARANTEED MINIMUM INTEREST RATE - The minimum interest rate which can be
  declared by us for Fixed Allocations or 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.

MARKET VALUE ADJUSTMENT - A positive or negative adjustment to a Fixed
  Allocation.  It may apply if all or part of a Fixed Allocation is
  withdrawn, transferred, or applied to an Annuity Option prior to the
  end of the Guarantee Period.

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-1052

                                    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-1052

                                    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-1052

                                    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
           and allocations to the Fixed 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 and allocations to the Fixed Account in proportion
           to the amount of Accumulation Value in each Division or Fixed
           Allocation.

    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 and Fixed Allocations 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 and allocations to the Fixed Account are shown in the
    Schedule.  An allocation from the Fixed Account may be subject to a
    Market Value Adjustment.  See 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-1052

                                    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-1052

                                    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 and Fixed Allocation 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 Divisions of the Variable Separate Account and General Account and
    allocations to the Fixed Account.  You select the Divisions of the
    Variable Separate Account and General Account and the Fixed Allocations
    to the Fixed Account to which to allocate the Accumulation Value.  The
    maximum number of Divisions and Fixed Allocations to which the
    Accumulation Value may be allocated at any one time is shown in the
    Schedule.

ACCUMULATION VALUE IN EACH DIVISION AND FIXED ALLOCATION

    On the Contract Date
    On the Contract Date, the Accumulation Value is allocated to each
    Division and Fixed Allocation 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 and Fixed Allocation will be
    calculated as follows:
      (1)  We take the Accumulation Value in the Division or Fixed
           Allocation 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 calculate the
           interest to be credited to a Fixed Allocation or 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 or
           Fixed Allocation during the current Valuation Period.
      (5)  We add or subtract allocations to or from that Division or
           Fixed Allocation during the current Valuation Period.
      (6)  We subtract from (5) any Partial Withdrawals which are
           allocated to the Division or Fixed Allocation  during the current
           Valuation Period.
      (7)  We subtract from (6) the amounts allocated to that Division or
           Fixed Allocation 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 or Fixed Allocation in
    the proportion that (6) bears to the Accumulation Value unless the Charge
    Deduction Division has been specified (see the Schedule).

FIXED ACCOUNT

    The Fixed Account is a Separate Account under state insurance law and is
    not required to be registered with the Securities and Exchange Commission
    under the Investment Company Act of 1940.  The Fixed Account includes
    various Fixed Allocations which we credit with fixed rates of interest
    for the Guarantee Period or Periods you select.  We reset the interest
    rates for new Fixed Allocations periodically based on our sole
    discretion.

GA-IA-1052

                                    10

<PAGE>
<PAGE>

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

    Guarantee Periods
    Each Fixed Allocation is guaranteed an interest rate or rates for a
    Guarantee Period.  The Guaranteed Interest Rates for a Fixed Allocation
    are effective for the entire period.  The Maturity Date of a Guarantee
    Period will be on the last day of the calendar month in which the
    Guarantee Period ends.  Withdrawals and transfers made during a Guarantee
    Period may be subject to a Market Value Adjustment unless made within
    thirty days prior to the Maturity Date.

    Upon the expiry of a Guarantee Period, we will transfer the Accumulation
    Value of the expiring Fixed Allocation to a Fixed Allocation with a
    Guarantee Period equal in length to the expiring Guarantee Period, unless
    you select another period prior to a Maturity Date.  We will notify you
    at least thirty days prior to a Maturity Date of your options for
    renewal.  If the period remaining from the expiry of the previous
    Guarantee Period to the Annuity Commencement Date is less than the period
    you have elected or the period expiring, the next shortest period then
    available that will not extend beyond the Annuity Commencement Date will
    be offered to you.  If a period is not available, the Accumulation Value
    will be transferred to the Specially Designated Division.

    We will declare Guaranteed Interest Rates for the then available Fixed
    Allocation Guarantee Periods.  These interest rates are based solely on
    our expectation as to our future earnings.  Declared Guaranteed Interest
    Rates are subject to change at any time prior to application to specific
    Fixed Allocations, although in no event will the rates be less than the
    Minimum Guaranteed Interest Rate (see the Schedule).

    Market Value Adjustments
    A Market Value Adjustment will be applied to a Fixed Allocation upon
    withdrawal, transfer or application to an Income Plan if made more than
    thirty days prior to such Fixed Allocation's Maturity Date, except on
    Systematic Partial Withdrawals and IRA Partial Withdrawals.  The Market
    Value Adjustment is applied to each Fixed Allocation separately.

    The Market Value Adjustment is determined by multiplying the amount of
    the Accumulation Value withdrawn, transferred or applied to an Income
    Plan by the following factor:

                    (   1+I   )N/365
                    (---------)         -1
                    (1+J+.0050)

    Where I is the Index Rate for a Fixed Allocation on the first day of the
    applicable Guarantee Period:  J is the Index Rate for new Fixed
    Allocations with Guarantee Periods equal to the number of years
    (fractional years rounded up to the next full year) remaining in the
    Guarantee Period at the time of calculation; and N is the remaining
    number of days in the Guarantee Period at the time of calculation.  (The
    Index Rate is described in the Schedule.)

    Market Value Adjustments will be applied as follows:
      (1)  The Market Value Adjustment will be applied to the amount
           withdrawn before deduction of any applicable Surrender Charge.
      (2)  For a Partial Withdrawal, partial transfer or in the case where
           a portion of an allocation is applied to an Income Plan, the Market
           Value Adjustment will be calculated on the total amount that must
           be withdrawn, transferred or applied to an Income Plan in order to
           provide the amount requested.
      (3)  If the Market Value Adjustment is negative, it will be assessed
           first against any remaining Accumulation Value in the particular
           Fixed Allocation.  Any remaining Market Value Adjustment will be
           applied against the amount withdrawn, transferred or applied to
           an Income Plan.
      (4)  If the Market Value Adjustment is positive, it will be credited
           to any remaining Accumulation Value in the particular Fixed
           Allocation.  If a cash surrender, full transfer or full application
           to an Income Plan has been requested, the Market Value Adjustment
           is added to the amount withdrawn, transferred or applied to an
           Income Plan.

GA-IA-1052

                                    11

<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.

    Interest Credited to a Fixed Allocation
    A Fixed Allocation 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 that Fixed
    Allocation's Maturity Date.  Interest will be credited daily at a rate to
    yield the declared annual Guaranteed Interest Rate.

    We periodically declare Guaranteed Interest Rates for then available
    Guarantee Periods. No Guaranteed Interest Rate will be less than the
    Minimum Interest Rate shown in the Schedule.

    CHARGES DEDUCTED FROM ACCUMULATION VALUE ON EACH CONTRACT PROCESSING DATE

    Expense charges and fees are shown in the Schedule.

GA-IA-1052

                                    12

<PAGE>
<PAGE>

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

    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 any Fixed Allocations and
           Guaranteed Interest Divisions.

    Any charges taken from the Fixed Account or the General Account will be
    taken from the Fixed Allocations and 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-1052

                                    13

<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 adjust for any applicable Market Value Adjustment;
      (3)  We deduct any Surrender Charges;
      (4)  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.

GA-IA-1052

                                    14

<PAGE>
<PAGE>

                   YOUR CONTRACT BENEFITS (continued)
------------------------------------------------------------------------------

    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-1052

                                    15

<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-1052

                                    16

<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 guaranteed 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-1052

                                    17

<PAGE>
<PAGE>

                       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-1052

                                    18

<PAGE>
<PAGE>

                 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 and as to amounts allocated to Fixed Allocations of the
    Fixed 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 Fixed Allocations or 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-1052

                                    19

<PAGE>
<PAGE>

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-1052

<PAGE>
<PAGE><PAGE>
<PAGE>
                                                 EXHIBIT 4(b)

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

Golden American is a stock company domiciled in Delaware.
---------------------------------------------------------

|----------------------------------------------------------------------------|
| Contractholder                                    Group Contract Number    |
| [GOLDEN INVESTORS TRUST]                            [G000011-OE]           |
|----------------------------------------------------------------------------|
| 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)                                    Certificate  Number |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]                  [123456]       |
|----------------------------------------------------------------------------|

In this Certificate you or your refers to the Owner shown above.  We,
our or us refers to Golden American Life Insurance Company.  You may
allocate this Certificate's Accumulation Value among the Variable
Separate Account, the General Account and the Fixed Account shown in
the Schedule.

This Certificate describes the benefits and provisions of the group
contract.  The group contract, as issued to the Contractholder by us
with any Riders or Endorsements, alone makes up the agreement under
which benefits are paid.  The group contract may be inspected at the
office of the Contractholder.  In consideration of any application
for this Certificate and the payment of premiums, we agree, subject
to the terms and conditions of the group contract, to provide the
benefits described in this Certificate to the Owner.  The Annuitant
under this Certificate must be eligible under the terms of the group
contract.  If the group contract and this Certificate are in force,
we will make income payments to the Owner starting on the Annuity
Commencement Date as shown in the Schedule.  If the Owner dies prior
to the Annuity Commencement Date, we will pay a death benefit to the
Beneficiary.  The amount of such benefit is subject to the terms of
this Certificate.

The benefits of the Certificate will be paid according to the
provisions of the Certificate and group contract.

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

ALL PAYMENTS AND VALUES, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A
VARIABLE SEPARATE ACCOUNT DIVISION, MAY INCREASE OR DECREASE,
DEPENDING ON THE CERTIFICATE'S INVESTMENT RESULTS.  ALL PAYMENTS AND
VALUES BASED ON THE FIXED ACCOUNT MAY BE SUBJECT TO A MARKET VALUE
ADJUSTMENT, THE OPERATION OF WHICH MAY CAUSE SUCH PAYMENTS AND VALUES
TO INCREASE OR DECREASE.

                              Secretary: /s/Myles R. Tashman
Customer Service Center                 --------------------
1475 Dunwoody Drive
West Chester, PA  19380       President: /s/Barnett Chernow
                                        --------------------
-----------------------------------------------------------------------------
DEFERRED COMBINATION VARIABLE AND FIXED
ANNUITY CERTIFICATE - 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-CA-1052

<PAGE>
<PAGE>

                   CERTIFICATE CONTENTS
-----------------------------------------------------------------------------

THE SCHEDULE...................3   YOUR CERTIFICATE BENEFITS........14

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

IMPORTANT TERMS................4   CHOOSING AN INCOME PLAN..........15

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

PREMIUM PAYMENTS AND                 OTHER IMPORTANT INFORMATION....17
  ALLOCATION CHANGES. ..........8
                                     Sending Notice to Us
  Initial Premium Payment            Reports to Owner
  Additional Premium Payment         Assignment - Using this
     Option                             Certificate as Collateral
  Your Right to Change Allocation       Security
     of Accumulation Value           Changing this Certificate
  What Happens if a Variable         Certificate Changes -
     Separate Account Division is       Applicable Tax Law
     Not Available                   Misstatement of Age or Sex
                                     Non-Participating
                                     Payments We May Defer
                                     Authority to Make Agreements
                                     Required Note on Our
                                        Computations
HOW WE MEASURE THE CERTIFICATE'S
ACCUMULATION VALUE..............9

  The Variable Separate Accounts
  The General Account
  Valuation Period
  Accumulation Value
  Accumulation Value in each
     Division and Fixed
     Allocation
  Fixed Account
  Measurement of Investment Experience
  Charges Deducted from Accumulation
   Value on each Certificate Processing Date

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

     THE SCHEDULE

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

GA-CA-1052

<PAGE>
<PAGE>

                            THE SCHEDULE
                 PAYMENT AND INVESTMENT INFORMATION
------------------------------------------------------------------------------

|-----------------------------------------------------------------------------|
| 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]    |
|-----------------------------------------------------------------------------|
| Certificate Date                Issue Date         Residence Status         |
| [JANUARY 1, 1996]             [JANUARY 1, 1996]        [DELAWARE]           |
|-----------------------------------------------------------------------------|
| Separate Account(s)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [123456]            |
|-----------------------------------------------------------------------------|

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%
  Large Cap Value                       10%
    Real Estate                         10%
    Value Equity                         5%
    Hard Assets                          5%
  Emerging Markets                       5%
   Managed Global                        5%
  Limited Maturity                       5%
        Bond                             5%
    Liquid Asset                         5%
  Strategic Equity                      5%]
Fixed Allocation - 1 Year
-------------------------               ---
       Total                            100%
       =====                            ===

GA-CA-1052                   3A1

<PAGE>
<PAGE>

                            THE SCHEDULE
           PAYMENT AND INVESTMENT INFORMATION (continued)
------------------------------------------------------------------------------

|-----------------------------------------------------------------------------|
| 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]    |
|-----------------------------------------------------------------------------|
| Certificate Date                Issue Date         Residence Status         |
| [JANUARY 1, 1996]             [JANUARY 1, 1996]        [DELAWARE]           |
|-----------------------------------------------------------------------------|
| Separate Account(s)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [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 Certificate Year without charge.  We reserve the right to impose
a charge for any allocation change in excess of [twelve] per
Certificate 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-CA-1052                   3A2

<PAGE>
<PAGE>

                            THE SCHEDULE
                   THE VARIABLE SEPARATE ACCOUNTS
------------------------------------------------------------------------------

|-----------------------------------------------------------------------------|
| 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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [123456]            |
|-----------------------------------------------------------------------------|

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-CA-1052                   3B

<PAGE>
<PAGE>

                            THE SCHEDULE
                         THE GENERAL ACCOUNT
------------------------------------------------------------------------------

|-----------------------------------------------------------------------------|
| 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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [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.

Transfers from a Guaranteed Interest Division
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 or to a Fixed Allocation to be
transferred back to a Guaranteed Interest Division for a period of
at least six months from the date of transfer.]

GA-CA-1052                   3C

<PAGE>
<PAGE>
                            THE SCHEDULE
                          CERTIFICATE FACTS
------------------------------------------------------------------------------

|-----------------------------------------------------------------------------|
| 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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [123456]            |
|-----------------------------------------------------------------------------|
CERTIFICATE FACTS

Certificate Processing Date
The Certificate Processing Date for your Certificate 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 Certificate 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 Certificate in force.

Systematic Partial Withdrawals and Conventional Partial Withdrawals
may not be taken in the same Certificate 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 certificate 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.

Any Conventional Partial Withdrawal is subject to a Market Value
Adjustment unless withdrawn from a Fixed Allocation within 30 days
prior to the Maturity Date.

GA-CA-1052                   3D1

<PAGE>
<PAGE>

                            THE SCHEDULE
                    CERTIFICATE FACTS (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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [123456]            |
|-----------------------------------------------------------------------------|

Systematic Partial Withdrawals
Systematic Partial Withdrawals may be elected to commence after 28
days from the Certificate 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 Certificate 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.
  Fixed Allocations and
  Guaranteed Interest Divisions:       Interest earned on a Fixed
                                       Allocation or Guaranteed Interest
                                       Division 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.  Systematic Partial Withdrawals from  Fixed Allocations are
not subject to a Market Value Adjustment.  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 ADJUSTMENTS

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-CA-1052                   3D2

<PAGE>
<PAGE>
                            THE SCHEDULE
                    CERTIFICATE FACTS (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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [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 owners' attained age at the
time of the change is less than (86), the Death Benefit will remain
in effect. If any owner's or 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
certificate 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 Certificate as their own.

CHOOSING AN INCOME PLAN

Required Date of Annuity Commencement
[Distributions from a Certificate 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
Certificate 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-CA-1052                   3D3

<PAGE>
<PAGE>

                            THE SCHEDULE
                    CERTIFICATE FACTS (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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [123456]            |
|-----------------------------------------------------------------------------|

ATTAINED AGE

    The Issue Age of the Annuitant or Owner plus the number of full
     years elapsed since the Certificate Date.

FIXED ACCOUNT

Minimum Fixed Allocation
The minimum allocation to the Fixed Account in any one Fixed
Allocation is [$250.00].

Minimum Guaranteed Interest Rate - [3%.]

Guarantee Periods
We currently offer Guarantee Periods of [1,2,3,4,5,6,7,8,9 and 10]
year(s).  We reserve the right to offer Guarantee Periods of
durations other than those available on the Certificate Date.  We
also reserve the right to cease offering a particular Guarantee
Period or Periods.

Index Rate
The Index Rate is the average of the Ask Yields for the U.S.
Treasury Strips as reported by a national quoting service for the
applicable maturity.  The average is based on the period from the
22nd day of the calendar month two months prior to the calendar
month of Index Rate determination to the 21st day of the calendar
month immediately prior to the month of determination.  The
applicable maturity date for these U.S. Treasury Strips is on or
next following the last day of the Guarantee Period.  If the Ask
Yields are no longer available, the Index Rate will be determined
using a suitable replacement method.

We currently set the Index Rate once each calendar month.  However,
we reserve the right to set the Index Rate more frequently than
monthly, but in no event will such Index Rate be based on a period
less than 28 days.

GA-CA-1052                   3D4

<PAGE>
<PAGE>

                            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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [123456]            |
|-----------------------------------------------------------------------------|

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 Certificate Processing Period.  The charge is
incurred at the beginning of the Certificate Processing Period and
deducted on the Certificate 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
Certificate 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 Certificate 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               Surrender
Elapsed Since Premium           Charges
      Payment                   -------
      -------
         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 Certificate is permitted at or before the
commencement of annuity payments.

GA-CA-1052                   3E1

<PAGE>
<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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [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 Fixed 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 Fixed Account values.

CHARGE DEDUCTION DIVISION

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

GA-CA-1052                   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)                                 Certificate Number      |
| [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT]              [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 Period   Monthly     Fixed     Monthly    Fixed  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-CA-1052                   3F

<PAGE>
<PAGE>

                           IMPORTANT TERMS
-----------------------------------------------------------------------------
ACCUMULATION VALUE - The amount that a Certificate 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 Certificate, 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 Certificate 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 Certificate.

CERTIFICATE ANNIVERSARY - The anniversary of the Certificate Date.

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

CERTIFICATE ISSUE DATE - The date the Certificate is issued at our
  Customer Service Center.

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

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

CERTIFICATE YEAR - The period between Certificate Anniversaries.

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 ISSUE DATE - The date the group contract is issued at our
  Customer Service Center.

CONTRACTHOLDER - the entity to whom the group contract is issued.

GA-CA-1052                   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.

FIXED ACCOUNT - This is the Separate Account established to support
  Fixed Allocations.

FIXED ALLOCATION - An amount allocated to the Fixed Account that is
  credited with a Guaranteed Interest Rate for a specified
  Guarantee Period.

GUARANTEE PERIOD - The period of years a rate of interest is
  guaranteed to be credited to a Fixed Allocation or allocations 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 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 Fixed Allocations or Guaranteed
  Interest Divisions.

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
  Certificate in effect.

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

MARKET VALUE ADJUSTMENT - A positive or negative adjustment to a
  Fixed Allocation.  It may apply if all or part of a Fixed
  Allocation is withdrawn, transferred, or applied to an Annuity
  Option prior to the end of the Guarantee Period.

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

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

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

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-CA-1052                   5

<PAGE>
<PAGE>

                  INTRODUCTION TO THIS CERTIFICATE
-----------------------------------------------------------------------------

THE CERTIFICATE

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

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

THE OWNER

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

One or more people may own this Certificate.  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
Certificate 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 Certificate.  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-CA-1052                   6

<PAGE>
<PAGE>

            INTRODUCTION TO THIS CERTIFICATE (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
Certificate.

CHANGE OF OWNER OR BENEFICIARY

During your lifetime and while this Certificate is in effect you can
transfer ownership of this Certificate 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 Certificate.  See
Proceeds Payable to Beneficiary.

GA-CA-1052                   7

<PAGE>
<PAGE>

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

INITIAL PREMIUM PAYMENT

The Initial Premium Payment is required to put this Certificate 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 Certificate
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 and allocations to the Fixed 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 and allocations
      to the Fixed Account in proportion to the amount of
      Accumulation Value in each Division or Fixed Allocation.

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 and Fixed Allocations 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 and allocations to
the Fixed Account are shown in the Schedule.  An allocation from the
Fixed Account may be subject to a Market Value Adjustment.  See 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-CA-1052                   8

<PAGE>
<PAGE>

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

The variable Annuity Benefits under this Certificate 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 Certificates
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 Certificate'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 the group 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 the group 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 the
group 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-CA-1052                   9

<PAGE>
<PAGE>

HOW WE MEASURE THE CERTIFICATE'S ACCUMULATION VALUE THE GENERAL ACCOUNT
                        (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 and Fixed Allocation 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 Certificate is the sum of the amounts
in each of the Divisions of the Variable Separate Account and
General Account and allocations to the Fixed Account.  You select
the Divisions of the Variable Separate Account and General Account
and the Fixed Allocations of the Fixed Account to which to allocate
the Accumulation Value.  The maximum number of Divisions and Fixed
Allocations to which the Accumulation Value may be allocated at any
one time is shown in the Schedule.

ACCUMULATION VALUE IN EACH DIVISION AND FIXED ALLOCATION

On the Certificate Date
On the Certificate Date, the Accumulation Value is allocated to each
Division and Fixed Allocation 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 and Fixed Allocation will be
calculated as follows:
  (1) We take the Accumulation Value in the Division or Fixed
      Allocation 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 calculate the interest to be credited to a Fixed
      Allocation or 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 or Fixed Allocation during the current Valuation
      Period.
  (5) We add or subtract allocations to or from that Division or
      Fixed Allocation during the current Valuation Period.
  (6) We subtract from (5) any Partial Withdrawals which are
      allocated to the Division or Fixed Allocation  during the
      current Valuation Period.
  (7) We subtract from (6) the amounts allocated to that
      Division or Fixed Allocation 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 or Fixed
Allocation  in the proportion that (6) bears to the Accumulation
Value unless the Charge Deduction Division has been specified (see
the Schedule).

FIXED ACCOUNT

The Fixed Account is a Separate Account under state insurance law
and is not required to be registered with the Securities and
Exchange Commission under the Investment Company Act of 1940.  The
Fixed Account includes various Fixed Allocations which we credit
with fixed rates of interest for the Guarantee Period or Periods you
select.  We reset the interest rates for new Fixed Allocations
periodically based on our sole discretion.

GA-CA-1052                   10

<PAGE>
<PAGE>

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

Guarantee Periods
Each Fixed Allocation is guaranteed an interest rate or rates for a
Guarantee Period.  The Guaranteed Interest Rates for a Fixed
Allocation are effective for the entire period.  The Maturity Date
of a Guarantee Period will be on the last day of the calendar month
in which the Guarantee Period ends.  Withdrawals and transfers made
during a Guarantee Period may be subject to a Market Value
Adjustment unless made within thirty days prior to the Maturity
Date.

Upon the expiry of a Guarantee Period, we will transfer the
Accumulation Value of the expiring Fixed Allocation to a Fixed
Allocation with a Guarantee Period equal in length to the expiring
Guarantee Period, unless you select another period prior to a
Maturity Date.  We will notify you at least thirty days prior to a
Maturity Date of your options for renewal.  If the period remaining
from the expiry of the previous Guarantee Period to the Annuity
Commencement Date is less than the period you have elected or the
period expiring, the next shortest period then available that will
not extend beyond the Annuity Commencement Date will be offered to
you.  If a period is not available, the Accumulation Value will be
transferred to the Specially Designated Division.

We will declare Guaranteed Interest Rates for the then available
Fixed Allocation Guarantee Periods.  These interest rates are based
solely on our expectation as to our future earnings.  Declared
Guaranteed Interest Rates are subject to change at any time prior to
application to specific Fixed Allocations, although in no event will
the rates be less than the Minimum Guaranteed Interest Rate (see the
Schedule).

Market Value Adjustments
A Market Value Adjustment will be applied to a Fixed Allocation upon
withdrawal, transfer or application to an Income Plan if made more
than thirty days prior to such Fixed Allocation's Maturity Date,
except on Systematic Partial Withdrawals and IRA Partial
Withdrawals.  The Market Value Adjustment is applied to each Fixed
Allocation separately.

The Market Value Adjustment is determined by multiplying the amount
of the Accumulation Value withdrawn, transferred or applied to an
Income Plan by the following factor:
                       ( 1  +  I        )     N/365
                         ---------------
                       ( 1  +  J  +  .0050)        -1

Where I is the Index Rate for a Fixed Allocation on the first day of
the applicable Guarantee Period:  J is the Index Rate for new Fixed
Allocations with Guarantee Periods equal to the number of years
(fractional years rounded up to the next full year) remaining in the
Guarantee Period at the time of calculation; and N is the remaining
number of days in the Guarantee Period at the time of calculation.
(The Index Rate is described in the Schedule.)

Market Value Adjustments will be applied as follows:
  (1) The Market Value Adjustment will be applied to the amount
      withdrawn before deduction of any applicable Surrender Charge.
  (2) For a Partial Withdrawal, partial transfer or in the case
      where a portion of an allocation is applied to an Income Plan,
      the Market Value Adjustment will be calculated on the total
      amount that must be withdrawn, transferred or applied to an
      Income Plan in order to provide the amount requested.
  (3) If the Market Value Adjustment is negative, it will be
      assessed first against any remaining Accumulation Value in the
      particular Fixed Allocation.  Any remaining Market Value
      Adjustment will be applied against the amount withdrawn,
      transferred or applied to an Income Plan.
  (4) If the Market Value Adjustment is positive, it will be
      credited to any remaining Accumulation Value in the particular
      Fixed Allocation.  If a cash surrender, full transfer or full
      application to an Income Plan has been requested, the Market
      Value Adjustment is added to the amount withdrawn, transferred
      or applied to an Income Plan.

GA-CA-1052                   11

<PAGE>
<PAGE>

HOW WE MEASURE THE CERTIFICATE'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.

Interest Credited to a Fixed Allocation
A Fixed Allocation 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 that Fixed Allocation's Maturity Date.  Interest will be
credited daily at a rate to yield the declared annual Guaranteed
Interest Rate.

We periodically declare Guaranteed Interest Rates for then available
Guarantee Periods. No Guaranteed Interest Rate will be less than the
Minimum Interest Rate shown in the Schedule.

CHARGES DEDUCTED FROM ACCUMULATION VALUE ON EACH CERTIFICATE PROCESSING DATE

Expense charges and fees are shown in the Schedule.

GA-CA-1052                   12

<PAGE>
<PAGE>

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

Charge Deduction Division Option
We will deduct all charges against the Accumulation Value of this
Certificate 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 any Fixed Allocations and
      Guaranteed Interest Divisions.

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

At any time while this Certificate 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-CA-1052                   13

<PAGE>
<PAGE>

                      YOUR CERTIFICATE BENEFITS
-----------------------------------------------------------------------------

While this Certificate 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 Certificate's Accumulation Value;
  (2) We adjust for any applicable Market Value Adjustment;
  (3) We deduct any Surrender Charges;
  (4) 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 Certificate to us.  To do
this, you must return this Certificate 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 Certificate and
your signed request in our Customer Service Center.  All benefits
under this Certificate 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 Certificate 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 Certificate.  In all events, distributions under the
Certificate must be made as required by applicable law.

GA-CA-1052                   14

<PAGE>
<PAGE>

                YOUR CERTIFICATE BENEFITS (continued)
-----------------------------------------------------------------------------

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-CA-1052                   15

<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
Certificate.  If this Certificate has been lost, we require the
applicable lost Certificate form.

ANNUITY COMMENCEMENT DATE SELECTION

You select the Annuity Commencement Date.  You may select any date
following the fifth Certificate 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 Certificate 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 Certificate 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-CA-1052                   16

<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 guaranteed 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 Certificate.  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-CA-1052                   17

<PAGE>
<PAGE>

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

ENTIRE CONTRACT

The group contract, including any attached Rider, endorsement,
amendment and the application of the Contractholder, constitute the
entire contract between the Contractholder and us.  All statements
made by the Contractholder, any Owner or any Annuitant will be
deemed representations and not warranties.  No such statement will
be used in any contest unless it is contained in the application
signed by the Owner, a copy of which has been furnished to the
Owner, the Beneficiary or to the Contractholder.

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 Certificate number in all
correspondence.

REPORTS TO OWNER

We will send you a report at least once during each Certificate
Year.  The report will show the Accumulation Value and the Cash
Surrender Value as of the end of the Certificate 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
Certificate 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 CERTIFICATE AS COLLATERAL SECURITY

You can assign this Certificate 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 CERTIFICATE

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

CERTIFICATE CHANGES - APPLICABLE TAX LAW

We reserve the right to make changes in this Certificate or its
Riders to the extent we deem it necessary to continue to qualify
this Certificate as an annuity.  Any such changes will apply
uniformly to all Certificates 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 Certificate will be those that the Premium Payment
made would have bought at the correct age or sex.

NON-PARTICIPATING

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

GA-CA-1052                   18

<PAGE>
<PAGE>

               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 and as to amounts allocated to Fixed Allocations of
the Fixed 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 Fixed Allocations or
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 Certificate'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
Certificate 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-CA-1052                   19

<PAGE>
<PAGE>

DEFERRED COMBINATION VARIABLE AND FIXED ANNUITY CERTIFICATE - 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-CA-1052

<PAGE>
<PAGE>

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00001-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00001-of-00352.parquet"}]]