Document:

Form of TSA Endorsement

 Exhibit 4.(ii) 
  

					
	

	  	Symetra Life Insurance Company	  	 
	  	[777 108th Avenue NE, Suite 1200]	  	Mailing address:
	  	[Bellevue, WA 98004-5135]	  	Symetra Life Insurance Company
	  	[Phone 1-800-796-3872]	  	[PO Box 3882]
	  	[TTY/TDD 1-800-833-6388]	  	[Seattle, WA 98124-3882]

 TAX-SHELTERED ANNUITY ENDORSEMENT 
 The annuity contract or the certificate under a group annuity contract (collectively, the “Contract”) to which this Endorsement is attached is
amended as specified below to qualify as a tax-sheltered annuity contract described in section 403(b) of the Internal Revenue Code of 1986, as amended (the “Code”), and the Income Tax Regulations thereunder. The Contract includes a
designated Roth account within the meaning of Code section 402A(b), into which any designated Roth contribution within the meaning of section 402A(c)(1) and any rollover contribution described in Code section 402A(c)(3) will be allocated. All the
provisions of the Contract and this Endorsement shall be interpreted in accordance with Code section 403(b) and the Income Tax Regulations thereunder, Code section 402A, and, if applicable, the requirements of the Employee Retirement Income Security
Act of 1974, as amended (“ERISA”). Where the provisions of this Endorsement are inconsistent with the provisions of the Contract, including the provisions of any other endorsements or riders issued with the Contract, the provisions of this
Endorsement will control. Any references to “premium” hereinafter mean “purchase payment” if that term is used in the Contract to which this Endorsement is attached. 
  

	I.	The Plan, Contractholder, and Participant 

 As used in this Endorsement, the term “Plan” refers to the plan under Code section 403(b) that is maintained by the Contractholder and pursuant to which the Contract is issued or, if applicable,
the agreement between the Contractholder and Symetra Life Insurance Company (the “Company”) to provide each other with information described in section 1.403(b)-10(b)(2)(C) of the Income Tax Regulations. The term “Contractholder”
refers to the employer described in Code section 403(b)(1)(A) and the Income Tax Regulations thereunder that maintains the Plan pursuant to which the Contract is issued. The term “Participant” refers to an employee or former employee of
the Contractholder for whose benefit the Contractholder maintains the Plan, and for whose benefit the Contract is issued under the Plan. 
  

	II.	Owner and Annuitant 

 Except as otherwise provided under applicable federal tax law, (1) the annuitant must be the Participant, (2) the owner must be the Contractholder, (3) the owner and the annuitant may not be changed, and (4) a joint
owner may not be named. 
  

	III.	Contributions 

  

	 	A.	In General 

 Contributions
shall not exceed the limits of Code section 415. The Company will not accept any contributions in excess of this limit and does not intend to separately account for any such excess contributions or amounts attributable to any such excess
contributions. 
 If the Plan includes a qualified Roth contribution program within the meaning of Code section 402A, a
Participant may elect to make designated Roth contributions in lieu of all or a portion of elective deferrals the Participant is otherwise eligible to make under the Plan. The amount of elective deferrals which a Participant may designate as Roth
contributions may not exceed the amount described in Code section 402A(c)(2). Unless specifically stated otherwise, a designated Roth contribution will be treated as an elective deferral within the meaning of Code section 402(g)(3)(C) for all
purposes under the Plan. 
  

	 	B.	Flexible Premium Contract 

 If flexible premiums are permitted under the Contract, a premium to the Contract must be made: 
  

	 	1.	as a contribution by the Contractholder on behalf of the Participant, 

  

 Symetra® and the Symetra Financial logo are registered service marks of Symetra Life Insurance Company. 
  

					
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	 	2.	as an exchange or plan-to-plan transfer described in section VI of this Endorsement, or 

  

	 	3.	as a rollover permitted under Code sections 402(c), 402(e)(6), 402A(c), 403(a)(4), 403(b)(8), 403(b)(10), 408(d)(3), and 457(e)(16). 

 To the extent permitted by the Plan, the Code, and the Income Tax Regulations, a contribution to the Contract may include a designated Roth
contribution, and a direct rollover contribution under Code section 402A(c) of a payment or distribution from a designated Roth account under an applicable retirement plan described in Code section 402A(e)(1). Such contributions will be accepted
only if they are contributed to the designated Roth account under the Contract. 
 Except as otherwise permitted by Code section
414(u), Code section 414(v), or other provisions of the federal tax law, contributions made pursuant to a salary reduction agreement shall not exceed the limits set forth in Code section 402(g). If contributions exceed this limit, the Company may
distribute the amount of the excess, together with any income allocable thereto, to the Participant as permitted by applicable federal tax law. 
  

	 	C.	Minimum Premiums 

 If a
minimum premium amount is required under the Contract, the Company will reduce this minimum premium amount if necessary to comply with Code section 403(b)(12). 
  

	IV.	Non-transferable and Non-forfeitable 

 The Contract is established for the benefit of the Participant and his or her beneficiaries. The interest of the Participant in the Contract is non-transferable and, except as provided by applicable law,
is non-forfeitable. In particular, except as otherwise provided under applicable law, the Contract may not be sold, assigned, discounted, or pledged as collateral for a loan or as security for the performance of an obligation or for any other
purpose, to any person other than the Company. Special rules may apply in the case of a transfer under the terms of a qualified domestic relations order, as defined in Code section 414(p) (a “QDRO”). 
  

	V.	Distribution Restrictions 

  

	 	A.	In General 

 Except as
otherwise provided under federal tax law, a distribution from the Contract shall be made only in accordance with the requirements of Code section 403(b), the Income Tax Regulations, the Plan, and, if applicable, section 205 of ERISA. Amounts may be
distributed pursuant to a QDRO to the extent permitted by applicable federal tax law. 
  

	 	B.	Elective Deferrals 

 As required by Code section 403(b)(11) and Code section 403(b)(7) and the applicable Income Tax Regulations thereunder, a distribution permitted under the Plan, if applicable, of Elective Deferrals may
not be made from the Contract earlier than the earliest of the date on which the Participant (1) has a severance from employment, (2) dies, (3) has a hardship, (4) becomes disabled (within the meaning of Code section 72(m)(7)),
or (5) attains age 59 1/2. A hardship
distribution is limited to the aggregate dollar amount of the Participant’s Elective Deferrals under the Contract (and may not include any income thereon), reduced by the aggregate dollar amount of the distributions previously made to the
Participant from the Contract. As used in this Endorsement, the term “Elective Deferrals” means contributions to the Contract made after December 31, 1988, pursuant to a salary reduction agreement, earnings on such contributions, and
earnings on any amounts held as of December 31, 1988. Elective Deferrals also include amounts attributable to contributions made to the Contract in a non-taxable transfer, or in an exchange or plan-to-plan transfer described in section VI of
this Endorsement, that are attributable to contributions made pursuant to a salary reduction agreement and are subject to the distribution restrictions under Code section 403(b)(7) or Code section 403(b)(11). Unless otherwise indicated, Elective
Deferrals include designated Roth contributions within the meaning of Code section 402A(c)(1). 
  

	 	C.	Contractholder Annuity Contributions 

 If the Contract is issued on or after January 1, 2009, a distribution of Contractholder Annuity Contributions may be made from the Contract no earlier than upon the earlier of the Participant’s

  

					
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severance from employment or upon the prior occurrence of some event, such as after a fixed number of years, the attainment of a stated age, or disability, as provided under the Plan. As used in
this Endorsement, the term “Contractholder Annuity Contributions” means amounts attributable to contributions made to an annuity Contract under Code section 403(b)(1) that are not made pursuant to a salary reduction agreement.
Contractholder Annuity Contributions do not include after-tax Participant contributions or earnings thereon. Contractholder Annuity Contributions include amounts attributable to contributions made to the Contract in an exchange or plan-to-plan
transfer described in section VI of this Endorsement that are subject to the distribution restrictions under section 1.403(b)-6(b) of the Income Tax Regulations. 
  

	 	D.	Contractholder Custodial Account Contributions 

 A distribution permitted under the Plan, if applicable, of Contractholder Custodial Account Contributions may not be paid from the Contract before the Participant (1) has a severance from employment,
(2) dies, (3) becomes disabled (within the meaning of Code section 72(m)(7)), or (4) attains age 59 1/2. As used in this Endorsement, the term “Contractholder Custodial Account Contributions” means amounts attributable to contributions made to the Contract in a non-taxable
transfer, or in an exchange or plan-to-plan transfer described in section VI of this Endorsement, that (1) are not made pursuant to a salary reduction agreement, (2) are not Contractholder Annuity Contributions, and (3) are subject to
the distribution restrictions under Code section 403(b)(7). 
  

	 	E.	Separate Accounting 

 If
the Contract includes both Elective Deferrals and other contributions, and the Elective Deferrals are not maintained in a separate account, then in accordance with section 1.403(b)-6(d)(3) of the Income Tax Regulations, distributions may not be made
earlier than the later of: 
  

	 	1.	any date permitted under subsection B of this section V of the Endorsement, and 

  

	 	2.	any date permitted under subsections C or D of this section V of the Endorsement (whichever applies to the contributions that are not Elective Deferrals).

 Unless required under the Plan, the Company is not obligated to maintain a separate account for Elective
Deferrals. 
 However, a designated Roth account is a separate account established for the designated Roth contributions of a
Participant and any earnings properly allocable to the contributions, and separate recordkeeping is maintained with respect to the designated Roth account, as required under Code section 402A(b)(2). 
  

	 	F.	Exchanges and Transfers 

 Amounts exchanged or transferred to the Contract pursuant to section VI of this Endorsement, and income attributable to such amounts, are subject to distribution restrictions that are not less stringent than those imposed under the Contract
being exchanged or under the transferor plan, whichever is applicable, in accordance with section 1.403(b)-10(b)(2) of the Income Tax Regulations. 
  

	 	G.	Exceptions 

  

	 	1.	Notwithstanding any other provision in this section V of the Endorsement, distributions are permitted to be made from the Contract to the extent (a) described in
sections III and VI of this Endorsement, (b) required by a QDRO, (c) described in Code section 72(t)(2)(G), (d) permitted by Code section 414(w)(2), or (e) otherwise allowed by applicable federal tax law.

  

	 	2.	If the Contractholder informs the Company that the Plan has been terminated in accordance with section 1.403(b)-10(a) of the Income Tax Regulations, the Company shall
follow the instructions of the Contractholder with regard to how the Contract or the accumulated benefits thereunder are to be distributed, provided that such instructions are in accordance with the requirements of Code section 403(b) and the Income
Tax Regulations thereunder. 

  

	 	3.	To the extent that the Company separately accounts for contributions to the Contract that are eligible rollover distributions as described in sections 1.403(b)-6(i) and
1.403(b)-10(d) of the Income Tax Regulations, such contributions (and any earnings thereon) are not subject to the distribution restrictions described in this section V of this Endorsement. The Company is not obligated to separately account for any
such amounts. 

  

					
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	VI.	Exchanges and Plan-to-Plan Transfers 

 Subject to the terms of the Plan, if applicable, exchanges within the Plan and plan-to-plan transfers involving the Contract will be allowed to the extent permitted under federal tax law. 
  

	VII.	Loans and Hardship Distributions 

  

	 	A.	In General 

 Except as
otherwise provided under section 1.403(b)-10(b)(2) of the Income Tax Regulations with respect to certain Contracts received in an exchange that occurred on or before September 24, 2007, and under section 8 of Revenue Procedure 2007-71 with
respect to certain Contracts issued before January 1, 2009, a loan and a distribution in the case of hardship that is permitted under section V of this Endorsement may be made under the Contract only if permitted under the Plan. 
  

	 	B.	Hardship Distributions 

 A
distribution in the case of hardship that is permitted under section V of this Endorsement may be made under the Contract. 
  

	 	C.	Loans 

 If permitted by
the Plan and approved by the Plan administrator, while the Contract is in force, loans may be made under the Contract, at the Company’s sole discretion, subject to the requirements and limitations imposed by the Plan, Code section 72(p), Code
section 403(b), the loan agreement and the Company. 
  

	 	1.	Definitions 

 Loan
Account: The sum of the loan principal and accrued loan interest credited at 3.0%, minus any loan payments made. 
 Loan
Amount: The sum of the loan principal and accrued loan interest charged at 5.5%, minus any loan payments made. 
 The
definition of Surrender Value in the Contract will be changed to the following: 
 Surrender Value: The
Participant Account Value minus any applicable surrender charge, withdrawal charge, outstanding Loan Amount, annual loan maintenance charge, and annual administration maintenance charge. 
  

	 	2.	Availability 

 Prior to
annuitization, and upon approval of the loan application, the Participant may borrow funds from the Company. If a loan is approved, the Participant grants the Company a security interest in the Participant Account Value to secure repayment of the
loan. The Fixed Account balance required as collateral must be at least 175% of the outstanding Loan Amount at all times. If the balance in the Fixed Account is less than the required minimum collateral balance, the Company will transfer money from
the Sub-Accounts, as selected by the Participant on the loan application, to the Fixed Account to reach the required minimum collateral balance. Any amount allocated to the Fixed Account as part of the required minimum collateral balance for a loan
will not be included for purposes of applying transfer and withdrawal restrictions. Withdrawals and transfers from the Fixed Account are not allowed to the extent they would cause the value in the Fixed Account to be less than the required minimum
collateral balance. 
 If a loan is outstanding when annuity payments are requested, the outstanding Loan Amount must be repaid.
The amount available to annuitize will be the Participant Account Value after the Loan Amount and any loan charges due have been paid. 
 The Company will subtract any outstanding Loan Amount and loan charges due from the death benefit before payment is made. 
 Any loan is subject to the terms of IRC Section 72(p) and the Income Tax Regulations thereunder. 
  

					
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 Each Participant may only have one loan outstanding with the Company, at any time. In
addition, the Company retains the right to defer payment of the loan for a period of 6 months after approving the loan application. 
  

	 	3.	Minimum and Maximum Amounts 

 The minimum loan principal available is $1,000. The maximum loan principal available is governed by IRC Section 72(p) and applicable regulations. 
  

	 	4.	Loan Charges 

 An
application charge, in the amount of $50.00 or 2.5% of the Loan Amount, whichever is less, will be deducted for each loan approved by the Company. 
 An annual loan maintenance charge, in the amount of $35.00 or 2.5% of the Loan Amount, whichever is less, will be deducted for each loan. The charge will be deducted on the anniversary of the loan
issuance each year the loan is outstanding and when the loan is repaid in full. These charges will be deducted from the Sub-Account with the highest balance at the time the deduction is made. If the amount available in the Sub-Account with the
highest balance is insufficient to cover the charge, the remaining charge will then be deducted from the Sub-Accounts in hierarchical order from highest balance to lowest balance until the charge is covered. If the amount available in the
Sub-Accounts is insufficient to cover the charge, the full or remaining charge will be deducted from the Fixed Account balance. 
 Surrender charges will not be applied to any loan made, and applicable loan charges deducted, under the Contract. 
  

	 	5.	Interest Rate 

 The Loan
Amount will be charged an annual effective rate of 5.5%. The Loan Account will be credited an annual effective rate of 3.0%.These interest rates are fixed over the period of the loan and cannot be changed. 
  

	 	6.	Loan Payments 

 A loan must be repaid within 5 years unless the loan is for the purchase of a principal residence. In any event, the term of a loan will not exceed 20 years and will not extend beyond the date the
Participant reaches age 70 1/2. The scheduled loan
payment amount is determined by level amortization of the Loan Amount over the repayment period at the loan’s rate of interest, and will be provided upon loan issuance. Loan payments must be made at least quarterly and may be made more rapidly,
if desired. Payments made in addition to the regularly scheduled payments will be applied first to the interest accrued since the last payment and then to reduce principal. Payments made in addition to regularly scheduled payments will not change
the amount of future loan payments, but may result in fewer payments. 
 If the Participant does not
make a quarterly loan payment and is either over age 59 1/2 or has pre-1989 funds sufficient to make the loan payment, the Company will withdraw the loan payment from the Participant Account Value and apply those funds toward payment of the loan. This withdrawal will occur 10 days after the missed
quarterly payment date and will include 20% Federal Income Tax withholding, when applicable. 
  

	 	7.	Default 

 If a loan
payment is more than 90 days past due, the loan is in default. The outstanding Loan Amount will be reported as a distribution and will be taxable income for the year in which the default occurred, as permitted by law. The outstanding Loan Amount
will continue to accrue interest until the Participant repays the loan or the Company forecloses on the Participant Account Value, in accordance with its security interest. The Company will not foreclose on the security interest to repay the
defaulted loan until a distributable event within the meaning of IRC Section 403(b)(11) occurs. 
 Loan payments made on a
defaulted loan will be considered after-tax contributions. 
  

					
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 The Company may permit the suspension of loan payments, without default, during any part of
a Participant’s leave of absence for any active military service, even if it exceeds one year. Interest will continue to accrue on the loan at the rate stated above. At the end of the military leave, a loan may be adjusted to a 5 year loan if
the previous term was less than 5 years. Loan payments must resume upon completion of military service and be made in substantially level installments. 
  

	 	8.	Discontinuance of Loan Provision 

 We reserve the right, upon advance written notice of at least 30 days, to discontinue the loan provisions described in this Endorsement. Any such discontinuance will not apply to loans that are outstanding on the effective date of such
discontinuance. 
  

	VIII.	Required Minimum Distributions and Incidental Benefits 

  

	 	A.	In General 

 Notwithstanding any provision in the Contract to the contrary, the distribution of the entire interest in the Contract shall be made in accordance with the requirements of Code sections 403(b)(10) and 401(a)(9), the Income Tax Regulations
thereunder, and, if applicable, section 205 of ERISA. Distributions from and benefits under the Contract also must satisfy the requirements relating to incidental benefits under section 1.401-1(b)(1)(ii) of the Income Tax Regulations. All such
requirements are incorporated herein by reference. Prior to the date the Contract is annuitized, the entire interest of the Participant or beneficiary under the Contract is the dollar amount credited to the Participant or beneficiary under the
Contract plus the actuarial present value of any additional benefit (such as survivor benefits in excess of the dollar amount credited to the Participant or beneficiary) that will be provided under the Contract, in accordance with Q&A-12 of
section 1.401(a)(9)-6 of the Income Tax Regulations. 
 To the extent permitted under the Plan and the Code, the minimum
distribution required under Code sections 403(b)(10) and 401(a)(9) with respect to the Contract may be taken from any one or more of the Participant’s Code section 403(b) Contracts under the Plan. 
 To the extent provided in Income Tax Regulations, a Contract that is part of a governmental plan (as defined in Code section 414(d)) shall,
for all years to which Code section 401(a)(9) applies to the Contract, be treated as having complied with Code section 401(a)(9) if the Contract complies with a reasonable good faith interpretation of Code section 401(a)(9). 
  

	 	B.	Required Beginning Date 

 The term “required beginning date” as used in this Endorsement means April 1 of the calendar year following the later of (1) the calendar year in which the Participant attains age
70 1/2, (2) the calendar year in which the
Participant retires, or (3) such later date provided by law. However, unless the Participant’s interest in the Contract is on account of the Participant’s participation in a governmental plan (as defined in Code section 414(d)) or
church plan (as defined in Code section 401(a)(9)(C)), if the Participant is a 5-percent owner (as defined in Code section 416) of the Contractholder with respect to the Plan year ending in the calendar year in which the Participant attains age
70 1/2, the required beginning date is April 1
of the calendar year following the calendar year in which the Participant attains age 70 1/2. In addition, if distributions commence to the Participant on a date before the Participant’s required beginning date over a period permitted under section 401(a)(9)(A)(ii) and the distribution form
is an annuity under which distributions are made in accordance with the provisions of Q&A-1 of 1.401(a)(9)-6 of the Income Tax Regulations, the annuity starting date will be treated as the required beginning date for purposes of applying the
rules of sections 1.401(a)(9)-2 and 1.401(a)(9)-6 of the Income Tax Regulations. 
  

	 	C.	Distributions During Participant’s Life 

 Unless otherwise permitted under applicable federal tax law, the entire interest shall be distributed, or commence to be distributed, no later than the required beginning date over (a) the life of
the Participant, or the lives of the Participant and his or her designated beneficiary (within the meaning of the Code section 401(a)(9)), or (b) a period not extending beyond the life expectancy of the Participant or the joint life and last
survivor expectancy of the Participant and his or her designated beneficiary, as

  

					
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required by law. Payments must be made periodically at intervals of no longer than one year and must be nonincreasing or they may increase only as provided in Q&As-1, -4, and -14 of section
1.401(a)(9)-6 of the Income Tax Regulations. Also, to the extent permitted under the Contract, payments may be changed in accordance with Q&A-13 of 1.401(a)(9)-6 of the Income Tax Regulations. In addition, any distribution must satisfy the
incidental benefit requirements specified in Q&A-2 of section 1.401(a)(9)-6 of the Income Tax Regulations. 
 The amount to
be distributed on or before the required beginning date, and by December 31 of each year, will be made in accordance with the requirements of Code section 401(a)(9) and the regulations thereunder. 
  

	 	D.	Distributions After Participant’s Death 

 Unless otherwise permitted under applicable federal tax law, if the Participant dies on or after required distributions commence, the entire remaining interest, if any, will be distributed at least as
rapidly as under the method of distribution being used as of the date of the Participant’s death. 
 Unless otherwise
permitted under applicable federal tax law, if the Participant dies before required distributions commence, the entire interest will be distributed by December 31 of the calendar year containing the fifth anniversary of the Participant’s
death, except that: 
  

	 	1.	if the interest is payable to an individual who is the Participant’s designated beneficiary, the designated beneficiary may elect to receive the entire interest
over the life of the designated beneficiary or over a period not extending beyond the life expectancy of the designated beneficiary, commencing on or before December 31 of the calendar year immediately following the calendar year in which the
Participant died; or 

  

	 	2.	if the sole designated beneficiary is the Participant’s surviving spouse, the surviving spouse may elect to receive the entire interest over the life of the
surviving spouse or over a period not extending beyond the life expectancy of the surviving spouse, commencing on or before the later of: 

  

	 	a.	December 31 of the calendar year immediately following the calendar year in which the Participant died, and 

  

	 	b.	 December 31 of the calendar year in which the Participant would have attained age 70 1/2. 

 If the surviving spouse dies before distributions begin to him or her, the remaining interest will be distributed, starting by the end of
the calendar year following the calendar year of the spouse’s death, over the spouse’s designated beneficiary’s remaining life expectancy determined using such beneficiary’s age as of his or her birthday in the year following the
death of the spouse, or, if elected, will be distributed by the end of the calendar year containing the fifth anniversary of the spouse’s death. 
 An irrevocable election of the method of distribution by a designated beneficiary who is the surviving spouse must be made no later than the earlier of December 31 of the calendar year containing the
fifth anniversary of the Participant’s death or the date distributions are required to begin pursuant to this subsection D.2 of the Endorsement. If no election is made, the entire interest will be distributed in accordance with the method of
distribution in this subsection D.2 of the Endorsement. 
 An irrevocable election of the method of distribution by a designated
beneficiary who is not the surviving spouse must be made no later than December 31 of the calendar year immediately following the calendar year in which the Participant died. If no such election is made, the entire interest will be distributed
by December 31 of the calendar year containing the fifth anniversary of the Participant’s death. 
 For purposes of
this section of the Endorsement regarding distributions after the Participant’s death, required distributions are considered to commence on the Participant’s required beginning date or, if applicable, on the date distributions are required
to begin to the Participant’s surviving spouse. However, if distributions start prior to the applicable date in the preceding sentence, on an irrevocable basis (except for acceleration) under an annuity Contract meeting the requirements of
1.401(a)(9)-6 of the Income Tax Regulations, then required distributions are considered to commence on the annuity starting date. 
  

					
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 Unless otherwise provided by applicable federal tax law, life expectancy is determined using
the Single Life Table in Q&A-1 of section 1.401(a)(9)-9 of the Income Tax Regulations. If distributions are being made to the Participant’s surviving spouse as the sole designated beneficiary, such spouse’s remaining life expectancy
for a year is the number in the Single Life Table corresponding to such spouse’s age in the year. In all other cases, remaining life expectancy for a year is the number in the Single Life Table corresponding to the beneficiary’s age in the
year following the calendar year of the Participant’s death (or in the case of a surviving spouse who is the Participant’s sole designated beneficiary and who dies before required distribution commence to him or her, the number in the
Single Life Table corresponding to the spouse’s designated beneficiary’s age in the year following the calendar year of the spouse’s death) reduced by 1 for each subsequent year. If benefits under the Contract are payable in
accordance with an annuity option provided under the Contract, life expectancy shall not be recalculated. 
  

	 	E.	Annuity Options 

 All
annuity payments under the Contract must meet the requirements of Code section 403(b)(10) and Code section 401(a)(9) and the applicable Income Tax Regulations. The provisions of this Endorsement reflecting these requirements override any annuity
payment option inconsistent with such requirements. If guaranteed payments are to be made under the Contract, the period over which any guaranteed payments are to be made must not exceed the period permitted under section 1.401(a)(9)-6 of the Income
Tax Regulations (except as otherwise permitted by applicable federal tax law). 
  

	IX.	Direct Rollovers 

 Except
as otherwise provided under applicable federal tax law, a distributee may elect, at the time and in the manner prescribed by the Company, to have any portion of an eligible rollover distribution that is equal to at least $500 paid directly to an
eligible retirement plan specified by the distributee in a direct rollover. If an eligible rollover distribution is less than $500, a distributee may not make the election described in the preceding sentence to roll over a portion of the eligible
rollover distribution. This limitation allowing the distributee to elect a direct rollover of a portion of an eligible rollover distribution only if the amount rolled over is at least $500 is applied by treating any amount distributed from the
designated Roth account as a separate distribution from any amount distributed from other accounts, even if the amounts are distributed at the same time. 
 An eligible rollover distribution is any distribution of all or any portion of the balance to the credit of the distributee, except that an eligible rollover distribution does not include (i) any
distribution that is one of a series of substantially equal periodic payments made (not less frequently than annually) for the life (or life expectancy) of the distributee or the joint lives (or joint life expectancies) of the distributee and the
distributee’s designated beneficiary, or for a specified period of ten years or more; (ii) any distribution to the extent such distribution is required under Code sections 403(b)(10) and 401(a)(9); (iii) any hardship distribution;
(iv) the portion of any other distribution(s) that is not includible in gross income (determined without regard to the exclusion for net unrealized appreciation with respect to Contractholder securities); (v) any other distribution(s) that
is reasonably expected to total less than $200 during a year; and (vi) any other amounts designated in published federal income tax guidance. For this purpose, any distribution from a designated Roth account is not taken into account in
determining whether distributions from other accounts are reasonably expected to total less than $200 during a year. 
 A portion
of a distribution shall not fail to be an eligible rollover distribution merely because the portion consists of after-tax Participant contributions which are not includible in gross income. However, such portion may be transferred only to an
individual retirement account or annuity described in Code section 408(a) or (b), respectively, or to a qualified defined contribution plan described in Code sections 401(a) or 403(a) that agrees to separately account for amounts so transferred,
including separately accounting for the portion of such distribution which is includible in gross income and the portion of the distribution which is not so includible. 
  

					
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 An eligible retirement plan is an eligible plan under Code section 457(b) which is
maintained by a state, political subdivision of a state, or any agency or instrumentality of a state or political subdivision of a state and which agrees to separately account for amounts transferred into such plan from the Contract, an individual
retirement account described in Code section 408(a), an individual retirement annuity described in Code section 408(b), an annuity plan described in Code section 403(a), an annuity Contract described in Code section 403(b), or a qualified plan
described in Code section 401(a), that accepts the distributee’s eligible rollover distribution. The definition of eligible retirement plan shall also apply in the case of a distribution to a surviving spouse, or to a spouse or former spouse
who is the alternate payee under a QDRO. 
 If any portion of an eligible rollover distribution is attributable to payments or
distributions from a designated Roth account, an eligible retirement plan with respect to such portion shall include only another designated Roth account of the individual from whose account the payments or distributions were made, or a Roth IRA
under Code section 408A of such individual. 
 A distributee includes the Participant. In addition, the Participant’s surviving spouse and
the Participant’s spouse or former spouse who is the alternative payee under a QDRO, are distributees with regard to the interest of the spouse or former spouse. 
 A direct rollover is a payment by the Plan to the eligible retirement plan specified by the distributee. 
  

	X.	Coordination with the Plan 

 Except to the extent that the Contract is not subject to the written plan requirement under section 1.403(b)-3(b)(3) of the Income Tax Regulations, the Contract is subject to the terms of the Plan, provided that the terms of the Plan do not
expand the terms of the Contract and do not impose any responsibilities or duties on the Company greater than those set forth in the Contract. For example, any terms of the Contract permitting loans and distributions in the case of hardship do not
apply if the Plan does not permit such loans or hardship distributions. In the event of a conflict between the terms of the Contract and any other terms of the Plan, such other terms of the Plan shall govern if necessary to ensure compliance with
Code section 403(b). 
 Federal law may require the Contractholder to share information with the Company that is necessary for
the Company to administer the Contract in accordance with the terms of the Plan and the Code. In such case, the Company shall rely upon such information in administering the Contract in accordance with the terms of the Plan and the Code. If the
Company does not receive such information from the Contractholder in the form and manner the Company deems acceptable, the Company will administer the Contract in the manner it deems appropriate. In some cases, this could mean that the Company has
no responsibility to make any distribution (including a loan) from the Contract before the Company receives the information it requires from the Contractholder. 
 Federal tax law also may require the Company to share information regarding the Contract with the Contractholder in order to ensure compliance with the terms of the Plan and the Code. The Company will
share such information as required by federal tax law and any agreement between the Company and the Contractholder. 
 The
Contractholder may identify a delegate to provide or receive the information described in this section X of the Endorsement. 
  

	XI.	Miscellaneous provisions 

  

	 	A.	Effective Date 

 The
effective date of this Endorsement is the effective date of the Contract. However, if the Contract was issued prior to January 1, 2009, and another endorsement or rider designed to modify the Contract to qualify as an annuity Contract described
in Code section 403(b) is attached to the Contract, this Endorsement replaces that other endorsement or rider, effective January 1, 2009. 
  

					
	RSE-0049 7/09	 	- 9 -	 	

	 	B.	Unisex Rates 

 The method
of calculating contributions and benefits under the Contract are to be based on unisex rates, and any references to sex or gender (with regard to rates and benefits) in the Contract are deleted. 
  

	 	C.	Automatic Rollovers 

 If
the Plan provides for a mandatory distribution described in Code section 401(a)(31)(B)(ii), and such a mandatory distribution greater than $1,000 is made on or after March 28, 2005, if the Participant does not properly elect to have such
distribution paid directly to an eligible retirement plan specified by the Participant in a direct rollover or to receive the distribution directly, then the Plan administrator will pay the distribution in a direct rollover to an individual
retirement plan designated by the Plan administrator. For purposes of determining whether a mandatory distribution is greater than $1000, the portion of the participant’s distribution attributable to any rollover contribution, including an
eligible rollover distribution from a designated Roth account, is included. 
 In addition, eligible rollover distributions from
a designated Roth account are taken into account in determining whether the total amount of the account balances exceeds $1,000 for purposes of the mandatory distributions from the Contract. 
  

	 	D.	Treatment as an Annuity Contract under Code Section 403(c) 

 If the Contract is not treated for federal tax purposes as an annuity Contract under Code section 403(b), the Contract will be treated as an annuity Contract described in Code section 403(c), the Contract
and all endorsements and riders attached to the Contract will be interpreted in accordance with Code section 403(c), and the entire interest in the Contract will be distributed in accordance with the requirements of Code section 72(s). 

 

	 	E.	Death Benefits under Qualified Active Military Service 

 To the extent required under Code sections 403(b)(14) and 401(a)(37), in the case of a Participant who dies while performing qualified military services (as defined in Code section 414(u)), the survivors
of the Participant are entitled to any additional benefits (other than benefit accruals relating to the period of qualified military service) provided under the Plan had the Participant resumed and then terminated employment on account of death.

  

	 	F.	ERISA 

 If this Contract
is being maintained pursuant to a plan that is subject to the requirements of Title I of ERISA, the Contractholder is solely responsible for assuring that the Plan complies at all times with such requirements, including assuring that all
distributions, consents, and elections under the Contract comply with the requirements of section 205 of ERISA. The Company shall be under no duty to determine whether a plan constitutes a Participant benefit plan that is subject to Title I of ERISA
and shall be fully entitled to rely on the Contractholder’s or Plan administrator’s representation of the Plan’s ERISA status. 
 Elections and consents required by ERISA, including a change in beneficiary, may be revoked in the form, time, and manner prescribed in section 205 of ERISA and applicable regulations. 
  

	 	G.	Misstatement of Age 

 The
Company may require satisfactory proof of correct age at any time. If annuity payments are based on life or life expectancy and the age of any Annuitant has been misstated, annuity payments will be based on the corrected information. Underpayments
will be made up in a lump sum with the next scheduled payment. Overpayments will be deducted from future payments until the total is repaid. We will not credit interest on underpayments or charge interest on overpayments. 
 All other terms and conditions of the Contract remain unchanged. 
 Symetra Life Insurance Company 
 [

] 
 [George Pagos] 
 [Secretary] 
  

					
	RSE-0049 7/09	 	- 10 -Group Contract Schedule Page

 Exhibit 4.(iii) 
 CONTRACT SCHEDULE PAGE 
  

			
	 PRODUCT NAME:
	  	Symetra [Retirement Passport] Group Variable Annuity
		
	 CONTRACTHOLDER:
	  	 [City Hall]
 [Box
1234]
 [Any Place, Washington 99876]

		
	 PLAN:
	  	[City Hall 403b Plan]
		
	 CONTRACT NUMBER:
	  	[000000000]
		
	 CONTRACT DATE:
	  	[03/01/2005]
		
	 DELIVERED IN THE STATE OF:
	  	[Any State] AND GOVERNED BY ITS LAWS.
		
	 MAXIMUM PARTICIPANT ISSUE AGE:
	  	[85] The Certificate Date must be prior to the Participant’s [86th] birthday.
		
	 MAXIMUM ANNUITIZATION AGE:
	  	[95] Annuity payments must begin prior to the Participant’s [96th] birthday.
		
	 MINIMUM PURCHASE PAYMENT:
	  	[$30.00]
		
	 MINIMUM SUBSEQUENT PURCHASE PAYMENT:
	  	[$30.00]
		
	 MINIMUM GUARANTEED INTEREST RATE:
	  	1.50% This is an annual effective interest rate.
		
	 ANNUAL ADMINISTRATION MAINTENANCE CHARGE:
	  	[$30.00] each Certificate year. The charge will not be deducted if the Participant Account Value is [$50,000] or more when the charge is to be deducted.
		
	 DAILY CHARGES:
	  	
		
	 Mortality and Expense Risk Charge:
	  	Equal on an annual basis to [1.25%] of the average daily net assets of each Portfolio.
		
	 [Sub-Account Fund Facilitation Fee:
	  	[.25%]. This is deducted if you are invested in any of the [Vanguard] Variable Insurance Fund Portfolios. [.10%]. This is deducted if you are invested in any of the [Calvert]
Variable Insurance Fund Portfolios.]

					
			
	SURRENDER CHARGE SCHEDULE:	  	 Years
 Elapsed Since
 Certificate
Date
	  	 Surrender Charge As
 A Percentage of Amount
                     Withdrawn            

		  	0	  	9% of amount withdrawn
		  	1	  	8% of amount withdrawn
		  	2	  	7% of amount withdrawn
		  	3	  	6% of amount withdrawn
		  	4	  	5% of amount withdrawn
		  	5	  	4% of amount withdrawn
		  	6	  	3% of amount withdrawn
		  	7	  	2% of amount withdrawn
		  	8	  	1% of amount withdrawn
		  	9+	  	0% of amount withdrawn

  

			
	RSC-0091 D 7/09	 	Page 1 of 4

			
		  	 [We will not deduct the surrender charge for the following:
  
 •     if the
total amount withdrawn during the Certificate Year does not exceed 10% of the Participant Account Value;
  
 •     payments made under an annuity option;
  
 •     the death
of a Participant;
  
 •     the disability of a Participant, as defined by the Plan;
  
 •     the retirement of a Participant in accordance with the Plan;
  
 •     a
separation of service with the employer sponsoring the Plan if the separation occurs after the Participant reaches ages 55 and the Participant has been invested in the Contract for at least five years unless the separation is due to Plan termination
or employer shutdown;
  
 •     payments of required minimum distributions to a Participant under Internal Revenue Code Section 401(a)(9) or other applicable section of the Internal Revenue Code requiring minimum
distributions;
  
 •     a loan to a Participant and applicable loan charges;
  
 •     withdrawals when the Participant Account has been in effect for at least 5 years
and the Participant has attained age 59 1/2;

  
 •     return of excess deferrals, excess contributions, or excess aggregate contributions as certified by the Plan;
  
 •     the annual administration maintenance charge, withdrawal charge, transfer charge
or premium taxes;
  
 •     repetitive withdrawals, if the withdrawals are equal or substantially equal and are expected to deplete the Participant Account Value over the Participant’s life expectancy or the joint life
expectancy of the Participant and Beneficiary; and
  
 •     to make a payment pursuant to a qualified domestic relations order.]

		
	 TRANSFERS:
	  	 [$50.00] minimum amount to transfer into any Investment Option.
  
 [$500.00] minimum amount to transfer out of an Investment Option at one time, or the
entire amount in an Investment Option, if the remaining balance will be less than [$500.00].
  
 [20%] allowed to be transferred out of the Fixed Account, per Certificate Year. After a transfer from the Fixed Account, the Participant may not make a transfer back into the Fixed Account for 180 days,
unless such transfer is part of a Symetra approved Investment Options rebalancing program.

		
	 TRANSFER CHARGE:
	  	 [12] transfers free of charge, each Certificate Year.
 Thereafter, [$10] or [2%] of the amount transferred, whichever is less.

		
	 WITHDRAWALS:
	  	 [$500.00] minimum amount or the entire amount from the Investment Option, if less.
  
 Remaining Participant Account Value required after the withdrawal [$2,000], unless
Purchase Payments for a Participant have been received within the past [12] months.

  

			
	RSC-0091 D 7/09	 	Page 2 of 4

			
	 WITHDRAWAL CHARGE:
	  	[$25.00] for each withdrawal after the first withdrawal in a Certificate Year.
		
	 PREMIUM TAXES:
	  	[0.00%]
		
	 SEPARATE ACCOUNT:
	  	SYMETRA SEPARATE ACCOUNT C

			
		
	 INVESTMENT OPTIONS:
	  	
	 [Symetra Fixed Account]
	  	
	 [AIM V.I. Mid Cap Core Equity Fund (Series II shares)]
	  	[Mutual Shares Securities Fund – Class 2]
	 [American Century VP Inflation Protection Class II Fund]
	  	[Templeton Developing Markets Securities Fund – Class 2]
	 [American Century VP International Class II Fund]
	  	[Templeton Global Bond Securities Fund – Class 2]
	 [BlackRock Global Allocation V.I. Fund, Class III]
	  	[Templeton Growth Securities Fund – Class 2]
	 [BlackRock Global Growth V.I. Fund, Class III]
	  	[Goldman Sachs VIT Government Income Fund – Service Shares
	 [BlackRock Large Cap Value V.I. Fund, Class III]
	  	[Neuberger Berman AMT Guardian Portfolio – Class S]
	 [Calvert Social Balanced Portfolio]
	  	[Neuberger Berman AMT Regency Portfolio– Class S]
	 [Calvert Social Equity Portfolio]
	  	[Neuberger Berman AMT Mid Cap Growth Portfolio –][
	 [Calvert Social Mid-Cap Growth Portfolio]
	  	[PIMCO All Asset Portfolio – Advisor Class Shares]
	 [Columbia Mid Cap Value Fund, Variable Series Class B Shares]
	  	[PIMCO Total Return Portfolio – Advisor Class Shares]
	 [Columbia Mid-Cap Growth Fund, Variable Series Class B Shares]
	  	[Vanguard VIF – Balanced Portfolio]
	 [Columbia Small Company Growth Fund, Variable Series Class B Shares]
	  	[Vanguard VIF – High Yield Bond Portfolio]
	 [Columbia Small Cap Value Fund, Variable Series Class B Shares]
	  	[Vanguard VIF – International Portfolio]
	 [DWS Capital Growth VIP – Class B Shares]
	  	[Vanguard VIF – Mid-Cap Index Portfolio]
	 [Fidelity VIP Contrafund® Portfolio – Service Class 2]
	  	[Vanguard VIF – REIT Index Portfolio]
	 [Fidelity VIP Freedom 2010 Portfolio – Service Class 2]
	  	[Vanguard VIF – Total Bond Market Index Portfolio]
	 [Fidelity VIP Freedom 2015 Portfolio – Service Class 2]
	  	[Vanguard VIF – Total Stock Market Index Portfolio]
	 [Fidelity VIP Freedom 2020 Portfolio – Service Class 2]
	  	
	 [Fidelity VIP Freedom 2025 Portfolio – Service Class 2]
	  	[Retail Funds available to the general public outside of variable annuity and variable life insurance contracts:]
	 [Fidelity VIP Freedom 2030 Portfolio – Service Class 2]
	  	
	 [Fidelity VIP Freedom 2035 Portfolio – Service Class 2]
	  	[American Funds AMCAP Fund]
	 [Fidelity VIP Freedom 2040 Portfolio – Service Class 2]
	  	[American Funds American Balanced Fund]
	 [Fidelity VIP Freedom 2045 Portfolio – Service Class 2]
	  	[American Funds American High-Income Trust Fund]
	 [Fidelity VIP Freedom 2050 Portfolio – Service Class 2]
	  	[American Funds Capital World Bond Fund]
	 [Fidelity VIP Freedom Income Portfolio – Service Class2]
	  	[American Funds EuroPacific Growth Fund]
	 [Fidelity VIP Freedom Income Portfolio – Service Class 2]
	  	[American Funds The Growth Fund of America]
	 [Fidelity VIP Money Market Portfolio – Service Class 2]
	  	[American Funds The Investment Company of
	 [Franklin Flex Cap Growth Securities Fund – Class 2]
	  	America]
	 [Franklin Income Securities Fund – Class 2]
	  	[American Funds New Perspective Fund]
	 [Franklin Small Cap Value Securities Fund – Class 2]
	  	[American Funds Washington Mutual Investors Fund]
	 [Franklin Small-Mid Cap Growth Securities Fund – Class 2]
	  	[DWS Dreman Small Cap Value Fund – Class A Shares]
	 [Franklin U.S. Government Fund – Class 2]
	  	[Neuberger Berman Genesis Fund – Advisor Class]
	 [Franklin Templeton VIP Founding Funds Allocation Fund – Class 2]]
	  	

  

			
	 ANNUITY SERVICE OFFICE:
	  	
	 Home Office:
	  	Mailing Address:
	 Symetra Life Insurance Company
	  	Symetra Life Insurance Company
	 Retirement Services
	  	Retirement Services
	 [777 108th Avenue NE Suite 1200]
	  	[P.O. Box 3882]
	 [Bellevue, Washington 98004]
	  	[Seattle, Washington 98124]
	 Telephone: [1-800-796-3872 x22299]
	  	Fax: [(866)-532-1359]

  

			
	RSC-0091 D 7/09	 	Page 3 of 4

  

			
	RSC-0091 D 5/09	 	Page 4 of 4

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