Document:

Exhibit

Exhibit 10.2

RESTRICTED STOCK UNITS AGREEMENT

Edward Carroll 

October 13, 2016

Dear Ed:
Pursuant to the AMC Networks Inc. 2016 Employee Stock Plan (the “Plan”), you have been selected by the Compensation Committee of the Board of Directors (as more fully described in Section 11, the “Committee”) of AMC Networks Inc. (the “Company”), effective as of October 13, 2016 (the “Grant Date”), to receive 242,813 restricted stock units (“Units”). The Units are granted subject to the terms and conditions set forth below and in the Plan.
Capitalized terms used but not defined in this agreement (this “Agreement”) have the meanings given to them in the Plan.  The Units are subject to the terms and conditions set forth below:  
1.Awards.  Each Unit shall represent an unfunded, unsecured promise by the Company to deliver to you one share of the Company’s Class A Common Stock, par value $.01 per share (“Share”), on the Delivery Date.  In accordance with Section 10(b) of the Plan, in the discretion of the Committee, in lieu of all or any portion of the Shares otherwise deliverable in respect of your Units, the Company may deliver a cash amount equal to the number of such Shares multiplied by the Fair Market Value of a Share on the date when Shares would otherwise have been issued, as determined by the Committee.
2.    Vesting.  Subject to Sections 3 and 4, none of your Units will vest and you will forfeit all of them if you do not remain continuously employed with the Company or one of the AMC Subsidiaries from the Grant Date through December 31, 2021 (the “Vesting Date”), provided the performance criteria set forth in Annex 2 attached hereto (the “Performance Criteria”) have been satisfied as of the Vesting Date, as determined by the Committee.
3.    Vesting in the Event of Death.  If your employment is terminated as a result of your death, all of the Units will vest as of the termination date without regard to satisfaction of the Performance Criteria.    
4.    Change of Control/Going Private Transaction.  As set forth in Annex 1 attached hereto, your entitlement to the Units may be affected in the event of a Change of Control of the Company or a going-private transaction (each as defined in Annex 1 attached hereto). 
5.    Transfer Restrictions.  You may not transfer, assign, pledge or otherwise encumber the Units, other than to the extent provided in the Plan.  

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6.    Right to Vote and Receive Dividends.  You shall not be deemed to be the holder of Shares, and shall not have any of the rights of a stockholder with respect to any Units, unless and until the Company shall have issued and delivered Shares to you and your name shall have been entered as a stockholder of record on the books of the Company.  Pursuant to Section 10(c) of the Plan, all ordinary (as determined by the Committee in its sole discretion) cash dividends that would have been paid upon any Shares underlying your Units had such Shares been issued will be retained by the Company for your account until your Units vest and such dividends will be paid to you (without interest) on the Delivery Date to the extent that your Units vest.
7.    Tax Representations and Tax Withholding.  You hereby acknowledge that you have reviewed with your own tax advisors the federal, state and local tax consequences of receiving the Units.  You hereby represent to the Company that you are relying solely on such advisors and not on any statements or representations of the Company, its Affiliates or any of their respective agents.  If, in connection with the Units, the Company is required to withhold any amounts by reason of any federal, state or local tax, such withholding shall be effected in accordance with Section 16 of the Plan.
8.    Section 409A.  It is the Company’s intent that payments under this Agreement shall comply with Section 409A of the Internal Revenue Code (“Section 409A”) to the extent applicable, and that the Agreement be administered accordingly. Notwithstanding anything to the contrary contained in this Agreement or any employment agreement you have entered into with the Company, to the extent that any payment or benefit under this Agreement, or any other plan or arrangement of the Company or its affiliates, is determined by the Company to constitute “non-qualified deferred compensation” subject to Section 409A and is payable to you by reason of your termination of employment, then (a) such payment or benefit shall be made or provided to you only upon a “separation from service” as defined for purposes of Section 409A under applicable regulations and (b) if you are a “specified employee” (within the meaning of Section 409A and as determined by the Company), such payment or benefit shall not be made or provided before the date that is six months after the date of your separation from service (or your earlier death).  Each payment under this Agreement will be treated as a separate payment under Section 409A of the IRC.
9.    Delivery.  Subject to Sections 8, 10 and 13 and except as otherwise provided in this Agreement, the Shares will be delivered in respect of vested Units (if any) on the first to occur of the following events (i) to you on or promptly after the Vesting Date (but in no case more than 15 days after such date), (ii) in the event of your death to your estate after your death and during the calendar year in which your death occurs (or such later date as may be permitted under Section 409A) and (iii) in the event of any other termination of your employment (including pursuant to the provisions of Annex 1), to you on the ninetieth (90th) day following your termination of employment (the “Delivery Date”). Unless otherwise determined by the Committee, delivery of the Shares at the Delivery Date will be by book-entry credit to an account in your name that the Company has established at a custody agent (the “custodian”).  The Company’s transfer agent, Wells Fargo Bank, N.A., shall act as the custodian of the Shares; however, the Company may in its sole discretion appoint another custodian to replace Wells Fargo Bank, N.A.  On the Delivery Date, if you have complied with your obligations under this Agreement and provided that your tax obligations with respect to the vested Units are appropriately satisfied, we will instruct the custodian to electronically 

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transfer your Shares to a brokerage or other account on your behalf (or make such other arrangements for the delivery of the Shares to you as we reasonably determine). 
10.    Right of Offset.  You hereby agree that the Company shall have the right to offset against its obligation to deliver shares of Class A Common Stock, cash or other property under this Agreement to the extent that it does not constitute “non-qualified deferred compensation” pursuant to Section 409A, any outstanding amounts of whatever nature that you then owe to the Company or any of the AMC Subsidiaries.
11.    The Committee.  For purposes of this Agreement, the term “Committee” means the Compensation Committee of the Board of Directors of the Company or any replacement committee established under, and as more fully defined in, the Plan.
12.    Committee Discretion.  The Committee has full discretion with respect to any actions to be taken or determinations to be made in connection with this Agreement, and its determinations shall be final, binding and conclusive.  
13.    Amendment.  The Committee reserves the right at any time to amend the terms and conditions set forth in this Agreement, except that the Committee shall not make any amendment or revision in a manner unfavorable to you (other than if immaterial), without your consent.  No consent shall be required for amendments made pursuant to Section 12 of the Plan, except that, for purposes of Section 19 of the Plan, Section 4 and Annex 1 of this Agreement are deemed to be “terms of an Award Agreement expressly refer[ring] to an Adjustment Event.” Any amendment of this Agreement shall be in writing and signed by an authorized member of the Committee or a person or persons designated by the Committee.   
14.    Units Subject to the Plan.  The Units covered by this Agreement are subject to the Plan.
15.    AMC Subsidiaries.  For purposes of this Agreement, “AMC Subsidiaries” shall mean the direct or indirect subsidiaries of the Company (or, in the case of a going private transaction or Change in Control, the direct or indirect subsidiaries of the Surviving Entity).
16.    Entire Agreement.  Except for any employment agreement between you and the Company or any of its Affiliates in effect as of the date of the grant hereof (as such employment agreement may be modified, renewed or replaced), this Agreement and the Plan constitute the entire understanding and agreement of you and the Company with respect to the Units covered hereby and supersede all prior understandings and agreements.  Except as provided in Sections 8 and 15, in the event of a conflict among the documents with respect to the terms and conditions of the Units covered hereby, the documents will be accorded the following order of authority: the terms and conditions of the Plan will have highest authority followed by the terms and conditions of your employment agreement, if any, followed by the terms and conditions of this Agreement.
17.    Successors and Assigns.  The terms and conditions of this Agreement shall be binding upon, and shall inure to the benefit of, the Company and its successors and assigns.

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18.    Governing Law.  This Agreement shall be deemed to be made under, and in all respects be interpreted, construed and governed by and in accordance with, the laws of the State of New York.
19.    Jurisdiction and Venue.  You irrevocably submit to the jurisdiction of the courts of the State of New York and the Federal courts of the United States located in the Southern District and Eastern District of the State of New York in respect of the interpretation and enforcement of the provisions of this Agreement, and hereby waive, and agree not to assert, as a defense that you are not subject thereto or that the venue thereof may not be appropriate.  You agree that the mailing of process or other papers in connection with any action or proceeding in any manner permitted by law shall be valid and sufficient service.
20.    Waiver.  No waiver by the Company at any time of any breach by you of, or compliance with, any term or condition of this Agreement or the Plan to be performed by you shall be deemed a waiver of the same, any similar or any dissimilar term or condition at the same or at any prior or subsequent time.
21.    Severability.  The provisions of this Agreement shall be deemed severable and the invalidity or unenforceability of any term or condition hereof shall not affect the validity or enforceability of the other terms and conditions set forth herein.
22.    Exclusion from Compensation Calculation.  By acceptance of this Agreement, you shall be deemed to be in agreement that the Units covered hereby shall be considered special incentive compensation and will be exempt from inclusion as “wages” or “salary” in pension, retirement, life insurance and other employee benefits arrangements of the Company and its Affiliates, except as determined otherwise by the Company.  In addition, each of your beneficiaries shall be deemed to be in agreement that all such shares be exempt from inclusion in “wages” or “salary” for purposes of calculating benefits of any life insurance coverage sponsored by the Company or any of its Affiliates.
23.    No Right to Continued Employment.  Nothing contained in this Agreement or the Plan shall be construed to confer on you any right to continue in the employ of the Company or any Affiliate, or derogate from the right of the Company or any Affiliate, as applicable, to retire, request the resignation of, or discharge you, at any time, with or without cause.
24.    Restrictive Covenants.  You agreed to be bound by the restrictive covenants set forth in Annex 3.
25.    Headings.  The headings in this Agreement are for purposes of convenience only and are not intended to define or limit the construction of the terms and conditions of this Agreement.
26.    Effective Date.  Upon execution by you, this Agreement shall be effective from and as of the Grant Date.

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27.    Signatures.  Execution of this Agreement by the Company and/or you may be in the form of an electronic, manual or similar signature, and such signature shall be treated as an original signature for all purposes.
	
		
	AMC NETWORKS INC.

	By:
	/s/ Joshua Sapan                                     
 
Name:  Joshua Sapan
Title:  President and CEO

    
By your electronic signature, you (i) acknowledge that a complete copy of the Plan and this Agreement have been made available to you and (ii) agree to all of the terms and conditions set forth in the Plan and this Agreement.

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Annex 1 
to 
Restricted Stock Units Agreement
In the event of a “Change of Control” of the Company or a “going private transaction,” as defined below, your entitlement to Units shall be as follows:
1.    If the Company or the Surviving Entity, as defined below, has shares of common stock (or partnership units) traded on a national stock exchange or on the over-the-counter market as reported on NASDAQ or any other stock exchange, the Committee shall, no later than the effective date of the transaction which results in a Change of Control or going private transaction, deem the Performance Criteria to be satisfied and either (A) convert your unvested Units into an amount of cash equal to (i) the number of your unvested Units multiplied by (ii) the “offer price per share,” the “acquisition price per share” or the “merger price per share,” each as defined below, whichever of such amounts is applicable or (B) arrange to have the Surviving Entity grant to you an award of restricted stock units (or partnership units) for shares of the Surviving Entity on the same terms and with a value equivalent to your unvested Units which will, in the good faith determination of the Committee, provide you with an equivalent profit potential.
2.    If the Company or the Surviving Entity does not have shares of common stock (or partnership units) traded on a national stock exchange or on the over-the-counter market as reported on NASDAQ or any other stock exchange, the Committee shall deem the Performance Criteria to be satisfied and convert your unvested Units into an amount of cash equal to the amount calculated as per Paragraph 1(A) above.
3.    Provided that you remain continuously employed with the Company, the Surviving Entity or one of the AMC Subsidiaries, any cash award provided for in Paragraph 1(A) or 2 shall become payable to you (or your estate), and any substitute restricted stock unit award of the Surviving Entity provided in Paragraph 1(B) will vest, at the earlier of (a) the date of a Change of Control, (b) the date on which your Units would otherwise have vested had they continued in effect, (c) the date of your death or (d) the date on which your employment with the Company, the Surviving Entity or one of the AMC Subsidiaries is terminated (i) by the Company, the Surviving Entity or one of the AMC Subsidiaries other than for Cause, (ii) by you for “good reason,” as defined below, or (iii) by you for any reason at least six (6) months, but not more than nine (9) months after the effective date of the going private transaction; provided that clause (iii) herein shall not apply in the event that your rights in the Units are converted into a right to receive an amount of cash in accordance with Paragraph 1(A).  The amount payable in cash shall be payable together with interest from the effective date of the Change of Control or going private transaction until the date of payment at (a) the weighted average cost of capital of the Company immediately prior to the effectiveness of the Change of Control or going private transaction, or (b) if the Company (or the Surviving Entity) sets aside the funds in a trust or other funding arrangement, the actual earnings of such trust or other funding arrangement. 
4.    As used herein,

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“Acquisition price per share” shall mean the greater of (i) the highest price per share stated on the Schedule 13D or any amendment thereto filed by the holder of twenty percent (20%) or more of the Company’s voting power which gives rise to the Change of Control or going private transaction, and (ii) the highest fair market value per share of common stock during the ninety-day period ending on the date of such Change of Control or going private transaction.
“Cause” means your (i) commission of an act of fraud, embezzlement, misappropriation, willful misconduct, gross negligence or breach of fiduciary duty against the Company or any of its Affiliates, or (ii) commission of any act or omission that results in a conviction, plea of no contest, plea of nolo contendere, or imposition of unadjudicated probation for any crime involving moral turpitude or any felony.
“Change of Control” means the acquisition, in a transaction or a series of related transactions, by any person or group, other than Charles F. Dolan or members of the immediate family of Charles F. Dolan or trusts for the benefit of Charles F. Dolan or his immediate family (or an entity or entities controlled by any of them) or any employee benefit plan sponsored or maintained by the Company, of the power to direct the management of the Company or substantially all its assets (as constituted immediately prior to such transaction or transactions).
“Going private transaction” means a transaction involving the purchase of Company securities described in Rule 13e-3 to the Securities and Exchange Act of 1934.
“Good reason” means 
a.    without your express written consent any reduction in your base salary or target bonus opportunity, or any material impairment or material adverse change in your working conditions (as the same may from time to time have been improved or, with your written consent, otherwise altered, in each case, after the Grant Date) at any time after or within ninety (90) days prior to the Change of Control including, without limitation, any material reduction of your other compensation, executive perquisites or other employee benefits (measured, where applicable, by level or participation or percentage of award under any plans of the Company), or material impairment or material adverse change of your level of responsibility, authority, autonomy or title, or to your scope of duties;
b.    any failure by the Company to comply with any of the provisions of this Agreement, other than an insubstantial or inadvertent failure remedied by the Company promptly after receipt of notice thereof given by you;
c.    the Company’s requiring you to be based at any office or location more than thirty-five (35) miles from your location immediately prior to such event except for travel reasonably required in the performance of your responsibilities; or
d.    any failure by the Company to obtain the assumption and agreement to perform this Agreement by a successor as contemplated by Paragraph 1.

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“Merger price per share” shall mean, in the case of a merger, consolidation, sale, exchange or other disposition of assets that results in a Change of Control or going private transaction (a “Merger”), the greater of (i) the fixed or formula price for the acquisition of shares of common stock occurring pursuant to the Merger, and (ii) the highest fair market value per share of common stock during the ninety-day period ending on the date of such Change of Control or going private transaction.  Any securities or property which are part or all of the consideration paid for shares of common stock pursuant to the Merger shall be valued in determining the merger price per share at the higher of (A) the valuation placed on such securities or property by the Company, person or other entity which is a party with the Company to the Merger, or (B) the valuation placed on such securities or property by the Committee.
“Offer price per share” shall mean, in the case of a tender offer or exchange offer which results in a Change of Control or going private transaction (an “Offer”), the greater of (i) the highest price per share of common stock paid pursuant to the Offer, or (ii) the highest fair market value per share of common stock during the ninety-day period ending on the date of a Change of Control or going private transaction.  Any securities or property which are part or all of the consideration paid for shares of common stock in the Offer shall be valued in determining the Offer Price per Share at the higher of (A) the valuation placed on such securities or property by the Company, person or other entity making such offer or (B) the valuation placed on such securities or property by the Committee. 
“Surviving Entity” means the entity that owns, directly or indirectly, after consummation of any transaction, substantially all the assets of the Company as constituted immediately prior to consummation of such transaction.  If any such entity is at least majority-owned, directly or indirectly, by any entity (a “parent entity”) which has shares of common stock (or partnership units) traded on a national stock exchange or the over-the-counter market, as reported on NASDAQ or any other stock exchange, then such parent entity shall be deemed to be the Surviving Entity, provided that if there shall be more than one such parent entity, the parent entity closest to ownership of substantially all the assets of the Company shall be deemed to be the Surviving Entity.  If in connection with any transaction, a Change of Control or going private transaction occurs and no entity shall own, after consummation of such transaction, substantially all the assets of the Company as constituted immediately prior to consummation of such transaction, then, notwithstanding any other provision of this Paragraph 4 to the contrary, there shall not be deemed to be a Surviving Entity so that the provisions of Paragraph 1(B) shall not be applicable.

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Annex 2 
to 
Restricted Stock Units Agreement
The performance objective for this Agreement is the achievement by the Company, in any of fiscal years 2017 or 2018, of Business Unit AOCF equal to at least 90% of Business Unit AOCF for fiscal year 2015. 
Definitions.  For purposes of this Annex 2:
“AOCF” means adjusted operating cash flow, as adjusted operating cash flow is defined in the earnings release of the Company dated February 25, 2016, but excluding the impact of this Award and all other performance-based long-term incentive awards.
“Business Unit AOCF” means the combined AOCF of the Company’s operating businesses.
Business Unit AOCF will be based on actual financial performance for the periods January 1 through December 31, 2015, 2017 and 2018 (as determined in the manner described above) modified to neutralize the impact of the following items in each year, in each case to the extent not already contemplated by the five-year plan presented to the Company’s Board of Directors on December 9, 2015:

		
	a)
	Acquisitions of businesses or planned acquisitions that are not completed (including costs for acquisitions that are not completed);

		
	b)
	Dispositions of businesses or discontinued businesses, in each case in a manner that neutralizes the impact of the associated effects on corporate or other expenses that otherwise would have been allocated to such businesses;

		
	c)
	Investments in new business ventures or initiatives not budgeted or forecasted (as opposed to over budget or forecast) in order to achieve new revenue opportunities or significantly improve existing revenue opportunities, or the impact of any changed or alternative structure of such investments;

		
	d)
	Position eliminations or reductions in force, occurring in any of 2017 or 2018, which accelerate expense and, therefore, benefit future periods;

		
	e)
	Disputes under or a termination of any affiliate agreement by distributors in connection with significant litigation (including any litigation costs or settlements);

		
	f)
	The impact of any increased or decreased tax rates, imposition of any new tax, fee or surcharge by any government or regulatory entity (other than those that would be billed or passed through to customers);

		
	g)
	Currency gains or losses resulting from exchange rates;

		
	h)
	The impact of litigation (including legal fees, settlements and judgments),  provided that adjustments will be made only to the extent that the amount by which the impact was not contemplated by the five-year plan exceeds $1 million; 

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	i)
	Any change affecting the costs and/or operation of the business resulting from changes to laws, rules or regulations by any government or regulatory entity (including, without limitation, changes in taxes, fees or surcharges), provided that adjustments will be made only for any such individual item to the extent the change results in a positive or negative variance greater than $1 million; 

		
	j)
	The dissolution, bankruptcy or liquidation of a third-party with whom the Company does business, including in each case, without limitation, the rejection of any agreement in bankruptcy, provided that in each case adjustments will be made only for any such individual third-party if such amount is greater than $1 million;

		
	k)
	Changes in generally accepted accounting principles (GAAP) or in the application of GAAP different from what was assumed in the five-year plan or an acceleration of expense due to a change in useful life that was not budgeted or forecasted, provided that adjustments will be made only  to the extent that the net cumulative impact of such changes results in a positive or negative variance of greater than $2 million; and 

		
	l)
	Acts of God, terrorism or vandalism.

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Annex 3
to 
Restricted Stock Units Agreement

RESTRICTIVE COVENANTS 

You agree to comply with the following covenants. 

1. CONFIDENTIALITY

You agree to retain in strict confidence and not divulge, disseminate, copy or disclose to any third party any Confidential Information, other than for legitimate business purposes of the Company and its subsidiaries. As used herein, “Confidential Information” means any non-public information that is material or of a confidential, proprietary, commercially sensitive or personal nature of, or regarding, the Company or its Affiliates or any current or former director, officer or member of senior management of any of the foregoing (collectively “Covered Parties”). The term Confidential Information includes information in written, digital, oral or any other format and includes, but is not limited to (i) information designated or treated as confidential; (ii) budgets, plans, forecasts or other financial or accounting data; (iii) subscriber, customer, fan, vendor or shareholder lists or data; (iv) technical or strategic information regarding the Covered Parties’ cable, data, telephone, programming, advertising, film production, motion picture exhibition, newspaper, multichannel video data and distribution services or other businesses; (v) advertising, business, sales or marketing tactics and strategies; (vi) policies, practices, procedures or techniques; (vii) trade secrets or other intellectual property; (viii) information, theories or strategies relating to litigation, arbitration, mediation, investigations or matters relating to governmental authorities; (ix) terms of agreements with third parties and third party trade secrets; (x) information regarding employees, agents, consultants, advisors or representatives, including their compensation or other human resources policies and procedures; and (xi) any other information the disclosure of which may have an adverse effect on the Covered Parties’ business reputation, operations or competitive position, reputation or standing in the community. 

If disclosed, Confidential Information or Other Information could have an adverse effect on the Company’s standing in the community, its business reputation, operations or competitive position or the standing, reputation, operations or competitive position of any of its affiliates subsidiaries, officers, directors, employees, teams, players, coaches, consultants or agents or any of the Covered Parties. 

Notwithstanding the foregoing, the obligations of this section, other than with respect to subscriber information, shall not apply to Confidential Information which is: 

a) already in the public domain; 

b) disclosed to you by a third party with the right to disclose it in good faith; or

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c) specifically exempted in writing by the Company from the applicability of this Agreement.

Notwithstanding anything elsewhere in this Agreement, you are authorized to make any disclosure required of you by any federal, state and local laws or judicial, arbitral or governmental agency proceedings, after providing the Company with prior written notice and an opportunity to respond prior to such disclosure. In addition, this Agreement in no way restricts or prevents you from providing truthful testimony concerning the Company to judicial, administrative, regulatory or other governmental authorities. 

2.  NON-DISPARAGEMENT

You agree, for yourself and others acting on your behalf, that you (and they) have not disparaged and will not disparage, make negative statements about or act in any manner which is intended to or does damage to the good will of, or the business or personal reputations of the Company or any of its incumbent or former officers, directors, agents, consultants, employees, successors and assigns or any of the Covered Parties. 

3. COMPANY PROPERTY

As an employee of the Company, you agree that all original works of authorship that result from your activities within the scope of your employment and which are protectable by copyright are “works made for hire,” as the term is defined in the United States Copyright Act (17 USCA, Section 101).  In addition, you agree that the Company is the owner of, and you hereby assign to the Company, without further consideration, all rights, title and interest in and to all programming and programming ideas, trademarks, copyrights, content, trade secrets, domain names, social media accounts and other intellectual property relating thereto, documents, tapes, videos, designs, plans, formulas, models, processes, computer programs,  inventions (whether patentable or not), schematics, music, lyrics and other technical, business, financial, advertising, sales, marketing, customer or product development concepts, plans, forecasts, strategies, information and materials (in any medium whatsoever) developed or prepared by you or with your cooperation during the course of your employment by the Company (the “Materials”), excluding only those assets that that Executive Vice President and Chief Financial Officer and the Executive Vice President and General Counsel have agreed to in writing to except. All such “works made for hire” and assigned assets are the sole property of the Company and freely transferable by the Company throughout the world.  The Company will have the sole and exclusive authority to use the Materials in any manner that it deems appropriate, in perpetuity, without additional payment to you.  Notwithstanding the terms set forth in this Section 3, in the event that the terms of your written employment agreement or other written agreement with the Company conflict with the terms set forth in this Section 3, the terms of those agreements will control. 

4.  FURTHER COOPERATION

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Following the date of termination of your employment with the Company (the “Expiration Date”), you will no longer provide any regular services to the Company or represent yourself as a Company agent. If, however, the Company so requests, you agree to cooperate fully with the Company in connection with any matter with which you were involved prior to the Expiration Date, or in any litigation or administrative proceedings or appeals (including any preparation therefore) where the Company believes that your personal knowledge, attendance and participation could be beneficial to the Company or its Affiliates. This cooperation includes, without limitation, participation on behalf of the Company or its Affiliates in any litigation or administrative proceeding brought by any former or existing employee, team, player, coach, guest, representative, agent or vendor of the Company or its Affiliates. 

The Company will provide you with reasonable notice in connection with any cooperation it requires in accordance with this section and will take reasonable steps to schedule your cooperation in any such matters so as not to materially interfere with your other professional and personal commitments. The Company will reimburse you for any reasonable out-of-pocket expenses you reasonably incur in connection with the cooperation you provide hereunder as soon as practicable after you present appropriate documentation evidencing such expenses. You agree to provide the Company with an estimate of such expense before you incur the same. 

5.  NON-HIRE OR SOLICIT

You agree not to hire, seek to hire, or cause any person or entity to hire or seek to hire (without the prior written consent of the Company), directly or indirectly (whether for your own interest or any other person or entity’s interest) any then current employee of the Company, or any of its Affiliates, until the first anniversary of the date of your termination of employment with the Company. This restriction does not apply to any employee who was discharged by the Company. In addition, this restriction will not prevent you from providing references. 

6.  ACKNOWLEDGMENTS

You acknowledge that the restrictions contained in this Annex 3, in light of the nature of the Company’s business and your position and responsibilities, are reasonable and necessary to protect the legitimate interests of the Company. You acknowledge that the Company has no adequate remedy at law and would be irreparably harmed if you breach or threaten to breach the provisions of this Annex 3, and therefore agree that the Company shall be entitled to injunctive relief, to prevent any breach or threatened breach of any of those provisions and to specific performance of the terms of each of such provisions in addition to any other legal or equitable remedy it may have. You further agree that you will not, in any equity proceeding relating to the enforcement of the provisions of this Annex 3, raise the defense that the Company has an adequate remedy at law. Nothing in this Annex 3 shall be construed as prohibiting the Company from pursuing any other remedies at law or in equity that it may have or any other rights that it may have under any other agreement. If it is determined that any of the provisions of this Annex 3 or any part thereof, is unenforceable because of the duration or scope (geographic or otherwise) of such provision, it is the intention of the parties that the duration or scope of such provision, as 

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the case may be, shall be reduced so that such provision becomes enforceable and, in its reduced form, such provision shall then be enforceable and shall be enforced. 

7. SURVIVAL

The provisions of this Annex 3 shall survive any termination of your employment by the Company or the expiration of the Agreement. 

8. CLAWBACK

If you breach any of the covenants in this Annex 3, then the Company will be entitled to (i) seek injunctive relief in accordance with Section 6 of this Annex 3 or (ii) exercise its right to receive, and you will be obligated to immediately repay to the Company upon demand therefor, the gross (pre-tax) amount of (i) the fair market value of any Shares deliverable in respect of the Units granted under this Agreement (based on the closing price of the Shares on the Delivery Date or the most immediately preceding trading day) and (ii) any cash payable in respect of the Units granted under this Agreement.

-14-Contract

Table of Contents

 BRIGHTHOUSE LIFE INSURANCE COMPANY OF NY 

(A Stock Company) 
 [200 Park Avenue 

New York, NY 10166] 
 NOTICE 

To obtain information about your policy or if you need assistance or need help in resolving a complaint, you may call [(800)-638-7732]. 

Brighthouse Life Insurance Company of NY (referred to as “we”, “us”, “our”, and the “Company”) will make
Income Payments as described in this Contract beginning on the Annuity Date. 
 This Policy is a legal contract between the policyholder and the
Company. 
 FREE LOOK PROVISION - RIGHT TO CANCEL 
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Contract may be returned for any reason within [10] days after you receive it by mailing or delivering the Contract to either us or the agent who sold it. Return of this Contract by mail is effective on being postmarked, properly addressed and
postage prepaid. We will promptly refund your Account Value plus the sum of all fees, taxes, and charges deducted from the Purchase Payment as of the effective date of the Free Look on the Business Day we receive your Contract. Your Account Value
may be more or less than your Purchase Payment. 
 Signed for the Company. 
  

			
	

	  	

	 [Secretary]
	  	[President]

 INDIVIDUAL SINGLE PREMIUM DEFERRED INDEX-LINKED SEPARATE ACCOUNT ANNUITY CONTRACT 

[This Contract contains Shield Options and a Fixed Account. The initial interest rate for the Fixed Account is guaranteed for one year.] 

NONPARTICIPATING 
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CAREFULLY. 
 VALUES AND DETERMINATION OF ANNUITY PAYMENTS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE VALUE OF THE SHIELD OPTION(S) SUBJECT TO THE SHIELD
RATE AND THE CAP OR STEP RATE, ARE VARIABLE, MAY INCREASE OR DECREASE, BASED ON WHETHER THE INDEX PERFORMANCE IS POSITIVE, NEGATIVE, OR EQUAL TO ZERO, AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. INVESTMENT IN THE CONTRACT INVOLVES INVESTMENT
RISKS, INCLUDING POSSIBLE LOSS OF PRINCIPAL. 
 [We reserve the right with 30 days advance written notice to restrict transfers and allocations into the Fixed
Account during the Transfer Period if the declared interest rate that would apply equals the Minimum Guaranteed Interest Rate and the Company is unable to support the Minimum Guaranteed Interest Rate. We will notify you if these restrictions on
transfers and allocations are subsequently lifted.] 

  

					
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 TABLE OF CONTENTS 

 

			
	 	  	PAGE
		
	 CONTRACT SCHEDULE
	  	[3
		
	 DEFINITIONS
	  	4
		
	 GENERAL PROVISIONS
	  	5
		
	 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS
	  	6
		
	 BENEFICIARY PROVISIONS
	  	7
		
	 PURCHASE PAYMENT PROVISIONS
	  	7
		
	 RENEWAL PROVISIONS
	  	8
		
	 ACCOUNT VALUE PROVISIONS
	  	8
		
	 WITHDRAWAL PROVISIONS
	  	10
		
	 DEATH BENEFIT PROVISIONS
	  	11
		
	 ANNUITY PROVISIONS
	  	12]

  

					
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 DEFINITIONS 

Account Value 
 Is the total of the value of the Shield
Option(s) under this Contract, adjusted for any amounts that may be included by rider during the Accumulation Period. Also referred to as “Contract Value.” 

Accumulation Period 
 The period prior to the Annuity Date. 

Annuity Service Office 
 The office indicated on the Contract
Schedule to which notices and requests must be sent, or as otherwise changed by notice from us. 
 Annuitant 

The natural person listed on the Contract Schedule on whose life Income Payments are based. Any reference to Annuitant shall also include any Joint
Annuitant under an Annuity Option. 
 Annuity Date 
 A date
on which you choose to begin receiving Income Payments. If we agree, you may change the Annuity Date subject to the requirements shown under the Annuity Option Information section on the Contract Schedule. If you do not choose an Annuity Date, the
Annuity Date will be the Annuity Date described on the Contract Schedule. Also referred to as “Maturity Date.” 
 Attained Age 

The age of any Owner, Beneficiary or Annuitant on his/her last birthday. 

Beneficiary 
 The person(s) or entity(ies) you name to receive
a death benefit payable under this Contract upon the death of the Owner or a Joint Owner, or in certain circumstances, an Annuitant. 
 Business Day 

Any day our Annuity Service Office, shown on the Contract Schedule, is open for business. For purposes of administrative requests and transactions, a
Business Day ends at 4:00PM Eastern Standard Time. 
 Code 
 The Internal
Revenue Code of 1986, as amended. 
 Company 
 Brighthouse Life Insurance
Company of NY. 
 Contract Anniversary 
 An anniversary of the Issue Date of
this Contract. 
 Contract Year 
 A one-year period starting on the Issue
Date and on each Contract Anniversary thereafter. 
 Income Payments 
 A
series of payments made by us during an Income Period, which we guarantee as to dollar amount. 
 Income Period 

A period starting on an Annuity Date during which Income Payments are payable. 

Investment Amount 
 The Investment Amount for each Shield
Option is the amount that is allocated to the Shield Option. The Investment Amount will be reduced for any withdrawal by the same percentage that the withdrawal reduces the Interim Value attributable to that Shield Option. The Investment Amount is
adjusted by the Performance Rate at the end of the Term. 
 Issue Date 
 The
date this Contract was issued. The Issue Date is shown on the Contract Schedule. 

  

					
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 Joint Owner 
 If there is more
than one Owner, each Owner shall be a Joint Owner of the Contract. 
 Notice 

Any form of communication providing information we need, either in a signed writing or another manner that we approve in advance. All Notices to us must
be sent to our Annuity Service Office and received in good order. To be effective for a Business Day, a Notice must be received in good order prior to the end of that Business Day. 

Owner 
 The person(s) entitled to the ownership rights under
this Contract. If Joint Owners are named, all references to Owner shall mean Joint Owners. (Referred to as “you”, “yours” or “policyholder.”) 

Purchase Payment 
 The amount paid to us under this Contract as consideration
for the benefits it provides. 
 Shield Option 
 This is an
investment option offered in this product. The option shields the client from a specified amount of investment losses. Each Shield Option has an associated Index, Term, Shield Rate, and either a Cap Rate or Step Rate. For example, a Shield 10
represents an investment option where if the contract holder holds the investment until the end of the Term, the Company will cover the first 10% of any losses. 

GENERAL PROVISIONS 
 The
Contract 
 The Contract consists of this contract and any attached riders or endorsements. We may require this Contract to be returned to us prior
to the payment of any benefit. It is important to review any riders or endorsements. In case of conflict with any other provision of this Contract, the provisions of the Rider or Endorsement will control. 

Non-Participating 
 This Contract will not share in any distribution by us of
Company dividends. 
 Misstatement of Age or Sex 
 We may
require proof of the age or sex of the Annuitant, Owner and/or Beneficiary before making any payments under this Contract that are measured by the Annuitant’s, Owner’s or Beneficiary’s life. If the age or sex of the Annuitant, Owner
or Beneficiary has been misstated, the amount payable will be the amount that the Account Value would have provided at the correct age and sex. 
 Once
Income Payments have begun, the amount of any overpayments or underpayments, with interest at 6% per annum, will be, as appropriate, deducted from or added to the payment or payments made after the adjustment. 

Reports 
 At least once each calendar year we will furnish you
with a report showing the Account Value and any other information as may be required by law. The Report shall provide current information as of a date not more than four months prior to the date of mailing. We will send you confirmations of certain
transactions, the beginning and end dates of the current Report period, the Account Value, if any, at the beginning of the current Report period and at the end of the current Report period, the Withdrawal Value, if any, at the end of the current
Report period, the amounts that have been credited and debited to the Account Value such as Purchase Payment, partial withdrawals, and any applicable Withdrawal Charges and any additional benefit values, if any at the end of the current Report
period, added by Rider to this Contract. Reports and confirmations will be sent to your last known address on our records. 
 Premium and Other Taxes 

Any taxes paid by us to any governmental entity relating to this Contract will be deducted from the Purchase Payments or Account Value when incurred. We
will, at our sole discretion, determine when taxes relate to the Contract, including when they have resulted from: the investment experience of the Separate Account; receipt by us of the Purchase Payments; or commencement of Annuity Payments. We
may, at our sole discretion, pay taxes when due and deduct that amount from the Account Value at a later date. Payment at an earlier date does not waive any right we may have to deduct amounts at a later date. We will deduct any withholding taxes
required by applicable law. 
 Evidence of Survival 
 We may
require proof that any person(s) on whose life Income Payments are based is alive. We reserve the right to discontinue Income Payments until satisfactory proof is received. 

  

					
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 Modification of Contract 

This Contract may be changed by us in order to maintain compliance with applicable state and federal law. This Contract may be changed or altered only in
writing signed by our President, Vice-President, or Secretary. 
 Notwithstanding any provision of this Contract to the contrary, this Contract will
be construed and administered in accordance with applicable sections of the Code. To preserve this Contract’s status as an annuity and comply with applicable sections of the Code and applicable Treasury Regulations, we may, if necessary amend
this Contract. We will notify you of any amendments and, when required by law, we will obtain your approval and the approval of the New York Department of Financial Services. 

Incontestability 
 We will not contest this contract from the Issue Date. 

Deferral of Payments 
 After receipt of a Notice of withdrawal
from you, we reserve the right to defer payment for a withdrawal for the period permitted by law, but not for more than six (6) months. 
 Interest of Delayed
Payments 
 We will pay interest on any payments of death benefits from the date of death. We will also pay interest on withdrawals paid ten
Business Days or later after receipt by us of any Notice to complete the transactions. Interest, in either instance, will be paid in accordance with laws and regulations in effect in the state of New York. 

Suspension of Payments or Transfers 
 We may be required to
suspend or delay the payment ofwithdrawals, and transfers when we cannot obtain an Index Value under the following circumstances: 
  

	 	•	 	the New York Stock Exchange is closed (other than customary weekend and holiday closings); 

  

	 	•	 	trading on the New York Stock Exchange is restricted; 

  

	 	•	 	an emergency exists such that we cannot value Investment Amounts; or 

  

	 	•	 	during any other period when a regulator by order, so permits. 

ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 

Owner 
 You, as the Owner, have all the interest and rights
under this Contract. The Owner is the person named as such on the Issue Date, unless changed. 
 You may change the Owner at any time. Any change of
Owner request may be refused in a non-discriminatory manner in order to comply with any applicable laws, rules or regulations in effect at the time of the request. A change of Owner will automatically revoke any prior named Owner. A request for
change must be: 
  

	 	1.	by Notice; and 

  

	 	2.	received by us at the Annuity Service Office. 

 The change will become effective as of the date the Notice
is signed by you. Naming a new Owner will not apply to any payment made or action taken by us prior to the time the new naming was received at our Annuity Service Office. 

Joint Owner 
 A Contract may be owned by Joint Owners, both of
whom must be natural persons. Either Joint Owner can exercise all rights under the Contract unless you inform us otherwise or in a Notice to us. Upon the death of either Owner, the surviving Joint Owner will be deemed to be the primary Beneficiary
unless you inform us otherwise. Any other Beneficiary naming will be treated as a contingent Beneficiary unless otherwise indicated on the Contract Schedule or in a Notice to us. 

Annuitant 
 The Annuitant is the person on whose life Annuity
Payments are based. The Annuitant is the person named by you as of the Issue Date, unless changed prior to the Annuity Date. The Annuitant may not be changed in a Contract which is owned by a non-natural person. Any change of Annuitant is subject to
the specified maximum age in effect at the time of the request. 

  

					
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 Assignment 
 You
may assign your rights under this Contract unless restricted by the Internal Revenue Code or other applicable law. For example, in certain tax markets assignment of this Contract is prohibited by the Internal Revenue Code. If your contract is
assigned absolutely, we will treat it as a change of ownership and all rights will be transferred. We are not bound by any assignment unless it is in writing and until it is received at our Annuity Service Office. We are not responsible for the
validity of any assignment. Assignments will be effective as of the date the written notice of assignment was signed subject to all payments made and actions taken by us before a copy of the signed assignment form is received by us at our Annuity
Service Office. 
 BENEFICIARY PROVISIONS 

Beneficiary 
 The Beneficiary is the person(s) outlined on the
Contract Schedule or the surviving Joint Owner, unless changed. Unless you provide otherwise, the death benefit will be paid to or in equal shares as follows: 
  

	 	1.	to the primary Beneficiary(ies) who survive you (or who survive the Annuitant if the Owner is a non-natural person); or if there are none, then 

 

	 	2.	to the contingent Beneficiary(ies) who survive you (or who survive the Annuitant if the Owner is a non-natural person); or if there are none, then 

 

	 	3.	to your estate. 

 Change of Beneficiary 

Subject to the rights, including the written consent, of any irrevocable Beneficiary and any applicable laws or regulations, you may change the primary
Beneficiary or contingent Beneficiary. A change may be made by filing a Notice with us. The change will take effect as of the date the Notice is signed, but we will not be liable for any payment made or action taken before we have received the
Notice. 
 PURCHASE PAYMENT PROVISIONS 

Separate Account 
 The Purchase Payment made to this Contract
is invested in the Separate Account shown on the Contract Schedule. We have exclusive and absolute ownership and control of the assets of the Separate Account. It is a non-unitized separate account. You do not share in the investment performance of
assets allocated to the Separate Account. All investment income, gains and losses, whether or not realized, from assets allocated to the Separate Account are borne by the Company. The obligations under this Contract are independent of the investment
performance of the Separate Account and are the obligations of the Company. 
 We will maintain in the Separate Account assets with an aggregate value
at least equal to the reserves for all contracts issued on the Separate Account. 
 If the aggregate value of such assets should fall below such
amount, the Company will transfer assets into the Separate Account so that the value of the Separate Account’s assets is at least equal to such amount. Assets supporting reserves for annuity benefits under such contracts, in the course of
payment, shall not be maintained in the Separate Account. 
 Shield Options 

On the Issue Date, you may allocate your Purchase Payment to one or more of the available Shield Options listed on the Contract Schedule. At the end of
each Term, you may transfer the Account Value attributable to the Shield Option(s) to one or more of the available Shield Options subject to the Transfer Requirements and Minimum Allocation shown on the Contract Schedule and the Renewal Provisions.

 Each Shield Option has an associated Index, Term, Shield Rate, and either a Cap Rate or a Step Rate as defined below. 

Term 
 The initial Term(s) begin on the Issue Date. A Term
ends and a subsequent Term begins, on the Contract Anniversary coinciding with the term duration of the then current Term for that Shield Option. 
 Index 

There is a specific Index associated with each Shield Option. The Index is the price index of certain securities, excluding dividends, or commodities.

  

					
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 Index Value 
 The
Index Value of an Index, on a Business Day, is the published closing value of the Index on that Business Day. We will use consistent sources to obtain Index Values. If these sources are no longer available for specific indices, we will select an
alternative published source(s) for these Index Values. The Index Value on any day that is not a Business Day is the value as of the prior Business Day. 
 Index
Performance 
 Index Performance is the percentage change in an Index Value measured from the beginning of a Term to any day, including the last
day, within the Term. Index Performance can be positive, negative, or zero. 
 Shield Rate 

The Shield Rate is the amount of any negative Index Performance that is absorbed by us at the end of the Term. Any negative Index Performance beyond the
Shield Rate will reduce the Investment Amount. For example, a -15% Index Performance with a 10% Shield Rate will result in a -5% Performance Rate; or, a -10% Index Performance with a 25% Shield Rate will result in a 0% Performance Rate. 

The Shield Rate may vary between Shield Options, and it is not an annual rate. 

Cap Rate 
 The Cap Rate is the maximum rate that may be
credited at the end of a Term based on Index Performance. A new Cap Rate is declared for each subsequent Term, and such rate will not be less than the Minimum Guaranteed Cap Rate on the Contract Schedule. 

The Cap Rate may vary between Shield Options, and it is not an annual rate. 
 Step
Rate 
 The Step Rate is the rate credited at the end of a Term if the Index Performance is greater than or equal to zero. A new Step Rate is
declared for each subsequent Term, and such rate will not be less than the Minimum Guaranteed Step Rate on the Contract Schedule. 
 The Step Rate may vary between
Shield Options, and it is not an annual rate. 
 RENEWAL PROVISIONS 

For renewals into the same Shield Option, a new Cap Rate or Step Rate, whichever is applicable, will be declared and will go into effect on the Contract
Anniversary that coincides with the beginning of the new Shield Option. 
 Discontinuation or Substantial Change to an Index 

If any Index is discontinued or, we determine that our use of such Index should be discontinued, or if the calculation of an Index is substantially
changed, we may substitute a comparable index. We will send you 30 days advance written notice if we determine that such Index should be discontinued and reasonable written Notice should the Index be discontinued by the Index provider. Upon
substitution of an Index, we will calculate your Index Performance on the existing Index up until the date of substitution and the new Index from the date of substitution to the end of the Term. A substitute Index will not change the Shield Rate,
Cap Rate or Step Rate for an existing Shield Option. 
 Addition or Discontinuance of a Shield Option 

We can add or discontinue any Shield Option. When a change is made to the Shield Options or Indices referenced on the Contract Schedule or as changed
subsequent to the Issue Date, we will send notification to you which will describe any changes to the Shield Options then available under the Contract as required by law. This change will take effect upon your Contract as of the next Contract
Anniversary for any allowable transfers into the Shield Option(s). If you are currently invested in a Shield Option which is no longer available, you will remain in that Shield Option until the end of the Term, but that Shield Option will not be
available thereafter. At least one Shield Option will be available at all times. 
 ACCOUNT VALUE PROVISIONS 

The Account Value attributable to each Shield Option is as determined below and will be the Interim Value on any day during the Term and the Investment
Amount as adjusted for the Performance Rate at the end of the Term as defined below. 
 Performance Rate 

The Performance Rate is the rate credited at the end of the Term. The Performance Rate at the end of a particular Term is the Index Performance, adjusted
for the applicable Shield Rate, Cap Rate, or Step Rate. The Performance Rate can be positive, negative, or equal to zero. At the end of the Term, any increase or reduction in a particular Shield Option is

  

					
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determined by multiplying the Performance Rate by the Investment Amount of the Shield Option on the last day of the Term. 

The Performance Rate is determined as follows: 
 Shield Options with a Cap Rate:

 If Index Performance is equal to or less than zero, then the Performance Rate will equal the lesser of zero, or the Index Performance increased
by the Shield Rate. (For example: a -15% Index Performance with a 10% Shield Rate will result in a -5% Performance Rate.) The Performance Rate can never be greater than zero if the Index Performance is negative. 

If Index Performance is greater than zero and less than the Cap Rate, then the Performance Rate will equal the Index Performance. 

If Index Performance is greater than zero and equals or exceeds the Cap Rate, then the Performance Rate will equal the Cap Rate. 

Shield Options with a Step Rate: 
 If Index Performance is less
than zero, then the Performance Rate will equal the lesser of zero or the Index Performance increased by the Shield Rate. (For example: a -15%Index Performance with a 10% Shield Rate will result in a -5% Performance Rate.) The Performance Rate can
never be greater than zero if the Index Performance is negative. 
 If Index Performance is equal to or greater than zero, the Performance Rate will equal the Step
Rate. 
 Interim Value 
 The Interim Value for each Shield
Option is the value we assign on any Business Day prior to the end of the Term. During the Transfer Period set forth in the Contract Schedule, the Interim Value of each Shield Option will equal the Investment Amount in that Shield Option. After the
Transfer Period, the Interim Value of that Shield Option is equal to the Investment Amount in the Shield Option, adjusted for the Index Performance of the associated Index and subject to the applicable Accrued Shield Rate, Accrued Cap Rate, or
Accrued Step Rate, as defined below. 
 On the date of a withdrawal from the Shield Option(s), your Interim Value will be reduced by the amount withdrawn. 

Accrued Shield Rate 
 The Accrued Shield Rate is the portion
of the Shield Rate that has accrued from the beginning of a Term to any day within the Term. This is the amount that will be applied in calculating the Interim Value on any day prior to the end of the Term if Index Performance is less than zero. The
Accrued Shield Rate is equal to the Shield Rate multiplied by the number of days elapsed since the beginning of the Term, divided by the total number of days in the Term. 

Accrued Cap Rate 
 The Accrued Cap Rate is the portion of the
Cap Rate that has accrued from the beginning of a Term to any day within the Term. This is the maximum Index Performance that may be applied in calculating the Interim Value on any day prior to the end of the Term if Index Performance is greater
than zero. The Accrued Cap Rate is equal to the Cap Rate multiplied by the number of days elapsed since the beginning of the Term, divided by the total number of days in the Term. 

Accrued Step Rate 
 The Accrued Step Rate is the portion of
the Step Rate that has accrued from the beginning of a Term to any day within the Term. This is the rate that will be applied in calculating the Interim Value on any day prior to the end of the Term if Index Performance is equal to or greater than
zero. The Accrued Step Rate is equal to the Step Rate multiplied by the number of days elapsed since the beginning of the Term divided by the total number of days in the Term. 

Performance Rate for Determination of Interim Value 
 Except
as indicated in the Interim Value section above, the Performance Rate during a particular Term is the Index Performance, adjusted for the applicable Accrued Shield Rate, Accrued Cap Rate, or Accrued Step Rate. 

For purposes of determining the Accrued Shield Rate, Accrued Cap Rate, and Accrued Step Rate, the total number of days in each calendar year of a Term is
365. 
 The following are hypothetical examples that show the determination of the Interim Value when the Index Performance is greater than zero and
less than zero. These hypothetical examples are rounded for illustrative purposes: 

  

					
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 Example #1 – Index Performance is positive – Interim Value calculated 306 days into a Term of 3 Years.

  

			
		
	Issue Date	  	March 1, 2013
		
	Investment Amount	  	$100,000
		
	Shield Option	  	XYZ 10
		
	Term	  	3 Years
		
	Shield Rate	  	10%
		
	Cap Rate	  	25%
		
	Index Value at Beginning of Term	  	1000
		
	Number of Days in Term	  	1095  (3 X 365 = 1095)
		
	Index Value at close of Business Day on January 1, 2014	  	1100
		
	Index Performance	  	10%
		
	Accrued Days	  	306

 The Accrued Cap Rate as of January 1, 2014 is 6.986% 306 days
into the 3 year term (25%*(306/1095)). The Index Performance is calculated at 10% (1100/1000 - 1). Since the Index Performance is positive, the Interim Value is then determined by multiplying the Investment Amount by the lesser of the Index
Performance or the Accrued Cap Rate and adding that amount to the Investment Amount. As of the close of the Business Day January 1, 2014, the Interim Value is $106,986 ($100,000+$100,000 * 6.986%). 

Example #2 – Index Performance is negative– Interim Value calculated 306 days into a Term of 3 Years. 

 

			
		
	Issue Date	  	March 1, 2013
		
	Investment Amount	  	$100,000
		
	Shield Option	  	XYZ 10
		
	Term	  	3 Years
		
	Shield Rate	  	10%
		
	Cap Rate	  	25%
		
	Index Value at Beginning of Term	  	1000
		
	Number of Days in Term	  	1095  (3 X 365 = 1095)
		
	Index Value at close of Business Day on January 1, 2014	  	950
		
	Index Performance	  	-5%
		
	Accrued Days	  	306

 The Accrued Shield Rate as of January 1, 2014 is 2.795% 306
days into the 3 year term (10% * (306/1095)). The Index Performance is calculated at -5% (950/1000 - 1). Since the Index Performance is negative, the Interim Value is then determined by multiplying the Investment Amount by the Index Performance plus
the Accrued Shield Rate (-5% + 2.795% = -2.205%) and adding that amount to the Investment Amount. As of the close of Business Day January 1, 2014, the Interim Value is $97,795 ($100,000+$100,000*-2.205%). 

WITHDRAWAL PROVISIONS 

Withdrawals 
 Prior to the Annuity Date, you may, upon Notice
to us, request a full or a partial withdrawal and we will withdraw that amount from the Account Value (“the amount withdrawn”). A withdrawal will result in a reduction to each Shield Option in the ratio that each Shield Option bears to the
total Account Value, as determined under the Account Value Provisions above, unless otherwise directed by you. The amount payable to you will be a net amount equal to the amount withdrawn adjusted for any applicable Withdrawal Charge shown on the
Contract Schedule and Premium and Other Taxes. The Free Withdrawal Amount shown on the Contract Schedule defines the amount You may withdraw free from any Withdrawal Charge. 

The total amount withdrawn from the Account Value must not be less than the Minimum Partial Withdrawal amount shown on the Contract Schedule. If the
withdrawal would result in the remaining Account Value being less than the Minimum 

  

					
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Account Value shown on the Contract Schedule, we will treat the withdrawal request as a request for a full withdrawal. 

If you request a full or partial withdrawal, the amount withdrawn after adjustments for any Withdrawal Charge will result in our paying you a net amount.
The net amount payable to you is equal to (a)-(b)-(c), where: 
  

	 	(a)	is the amount withdrawn from the Account Value, and 

  

	 	(b)	is the Withdrawal Charge, if any, as described on the Contract Schedule, and 

  

	 	(c)	is the Premium and Other Taxes, if any. 

 The amount withdrawn will reduce the Investment Amount, as
defined in the Definitions section, for each Shield Option by the percentage reduction in the Interim Value of such Shield Option. 
 
DEATH BENEFIT PROVISIONS 
 Death of Owner During the Accumulation Period 

During the Accumulation Period, the death benefit will be paid to your Beneficiary(ies) upon your death, or the first death of a Joint Owner. If the
Contract is owned by a non-natural person, the Annuitant will be deemed the Owner for purposes of determining the death benefit. 
 Death Benefit Amount During the
Accumulation Period 
 The “Death Benefit Amount” is the Account Value, as defined under the Account Value Provisions above, determined
as of the end of the Business Day on which we have received Notice of both due proof of death and the first acceptable election for the payment method. 
 Death
Benefit Options During the Accumulation Period 
 In the event an Owner (or the Annuitant where the Owner is not an individual) dies during the
Accumulation Period, a Beneficiary must choose payment of the death benefit under one of the options below (unless the Owner has previously chosen an option). The death benefit options available under the Contract include the following and any other
options acceptable to you and us: 
 Option 1 - lump sum payment of the death benefit; or 

Option 2 - the payment of the entire death benefit within five years of the date of death of the Owner or the first Joint Owner to die; or 

Option 3 - payment of the death benefit under an Annuity Option or other periodic payment option acceptable to us in substantially equal periodic
payments (made at least annually) over the lifetime of the Beneficiary or over a period not extending beyond the life expectancy of the Beneficiary with distribution beginning within one year of the date of death of the Owner or the first Joint
Owner to die. 
 Any portion of the death benefit not applied under Option 3 within one (1) year of the date of the Owner’s or Joint
Owner’s death must be distributed within five years of the date of death. 
 Beneficiary Continuation Options During Accumulation Period 

We offer two types of Beneficiary Continuation Options during the Accumulation Period: the Spousal Continuation and Non-Spousal Beneficiary Continuation
Options described below. We must receive Notice of the election of one of these Beneficiary Continuation Options by the end of the 90th day after we receive Notice of due proof of death. If the surviving spouse qualifies for Spousal Continuation and
has not chosen one of the death benefit options above by the end of the 90 day period, the Spousal Continuation Option will be automatically applied on the 90th day. If a Non-Spousal Beneficiary qualifies for Non-Spousal Beneficiary Continuation and
has not chosen one of the death benefit options above by the end of the 90 day period, the Non-Spousal Beneficiary Continuation Option will be automatically applied on the 90th day. 

Spousal Continuation During Accumulation Period 
 If the Owner
dies during the Accumulation Period and the Beneficiary is his or her spouse, the spouse may choose to continue the Contract in his or her own name and exercise all the Owner’s rights under the Contract. The Death Benefit Amount under the
continued contract payable upon the continuing spouse’s death will be computed as described above in the Death Benefit Amount During the Accumulation Period section. 

Non-Spousal Beneficiary Continuation During Accumulation Period 

A Beneficiary who is not a spouse can choose to continue the Contract until the fifth anniversary of the Owner’s death. The Contract can be
continued by a Beneficiary only if his or her share of the death benefit is at least equal to the Contract Minimum specified on the Contract Schedule. If the Beneficiary continues the Contract under this provision his or her share will not be paid.
It will instead be continued in the Contract on the date we determine the Death Benefit Amount. Such Beneficiary will have the right to make partial and full withdrawals of his/her share of the Contract, not subject to

  

					
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Withdrawal Charges. Such Beneficiary will also have the right to make transfers at the end of a Term as described on the Contract Schedule. 

During the continuation period the Beneficiary can choose to receive his/her share of this Contract in a single lump sum payment or apply it to an
Annuity Option or other option acceptable to us that must be payable for the life of the Beneficiary or for a term no longer than the life expectancy of the Beneficiary starting within one year after the death of the Owner. 

On the fifth anniversary of the Owner’s death any Beneficiary will be paid his/her share of the Account Value that has not been applied to an
Annuity option or other settlement option permissible under the Code, in a single lump sum payment and this Contract will terminate. 
 Death of Annuitant During
Income Period 
 Upon the death of the Annuitant during the Income Period, the remaining Income Payments, if any, will be as specified in the
Annuity Option chosen. Income Payments will be paid at least as rapidly as under the method of distribution in effect at the Annuitant’s death. 
 Death of
Owner During the Income Period 
 If the Owner (or a Joint Owner), is not the Annuitant, and dies during the Income Period, any remaining payments
under the Annuity Option will continue at least as rapidly as under the method of distribution in effect at the time of the Owner’s (or Joint Owner’s) death. Upon the death of the Owner (or a Joint Owner) during the Income Period, the
Beneficiary becomes entitled to exercise the rights of the Owner. If an Owner (or Joint Owner) is the Annuitant and dies during the Income Period, the remaining Income Payments, if any, will be as specified in the Annuity Option chosen and will
continue at least as rapidly as under the method of distribution in effect at the time of the Owner’s (or Joint Owner’s) death. 
 Death of Annuitant
During Accumulation Period 
 Upon the death of an Annuitant, who is not the Owner or Joint Owner, during the Accumulation Period, the Owner (or
Oldest Joint Owner) automatically becomes the Annuitant, unless the Owner, subject to the maximum specified age in effect at the time of request, chooses a new Annuitant. If the Owner is a non-natural person, the death of the Annuitant will be
treated as the death of an Owner (see Death of Owner During the Accumulation Period discussed above). 
 Payment of Death Benefit 

We will require Notice of both due proof of death and an acceptable election for the payment method before any death benefit is paid. Our obligations are
subject to all payments made and actions taken by us before our receipt of Notice of due proof of death. 
 ANNUITY
PROVISIONS 
 Election of Annuity Option 
 The Annuity
Option is chosen by you or your Beneficiary in a form satisfactory to us. We will automatically send you information about Annuity Options before your Annuity Date. If you do not choose an Annuity Option, make a full withdrawal by the Annuity Date,
or ask us to continue the Contract by the Annuity Date, we will automatically pay you under Option 2: Life Annuity with Ten (10) Years of Income Payments Guaranteed. You can make, change, or revoke your Annuity Option choice before the death
benefit becomes payable or the Annuity Date, whichever occurs first. 
 Annuity Options 

You may choose to receive Income Payments monthly, quarterly, semi-annually or annually. The following Annuity Options, or any other options acceptable
to you and us, may be chosen: 
 Option 1: Life Annuity 
 Income Payments
that are paid as long as the Annuitant is living. 
 Option 2: Life Annuity with 10 Years of Income Payments Guaranteed 

Income Payments that continue as long as the Annuitant is living but are guaranteed to be paid for ten years. 

Option 3: Joint and Last Survivor Life Annuity 
 Income Payments that are paid
as long as either of two Annuitants is living. 
 Option 4: Joint and Last Survivor Annuity with 10 Years of Income Payments Guaranteed 

Income Payments that continue as long as either of the two Annuitants are living but are guaranteed to be paid for ten years. 

  

					
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 If, as of the Annuity Date, the then current Annuity rates applicable to this class of contracts provide an
Income Payment greater than the one guaranteed under this Contract for the same Annuity Option, then the greater payment will be made. 
 Income Payments 

Income Payments are based upon the Annuity Option chosen, the Account Value, as defined under the Account Value Provisions above, applied to the Annuity
Option, the Annuitant’s Attained Age and sex, and the appropriate Fixed Annuity Table. 
 Frequency and Amount of Income Payments 

Income Payments will be paid as monthly installments or at any frequency acceptable to you and us. If the amount of the Account Value to be applied under
an Annuity Option is less than $5,000, we reserve the right to make one lump sum payment equal to the then current Account Value in lieu of Income Payments. If the amount of the Income Payment would be less than $100, we may reduce the frequency of
payments to an interval which will result in the payment being at least $100, but with a frequency of no less than annually. 
 Basis of Payments 

The Annuity Tables are based on the tables defined under the Annuity Option Information described in the Contract Schedule. The amount of each Income
Payment is guaranteed by us. 
 Betterment of Rates 

Annuity payments will not be less than those that would be provided by the application of the Account Value to purchase a single consideration immediate
annuity contract of the same type as the settlement option elected, which is offered by Us or our affiliates on the Annuity Date to the same class of annuitants. 

  

					
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 FIXED ANNUITY TABLES 

AMOUNT OF MONTHLY INCOME PAYMENT 
 PER $1000
OF Account Value 
 Annuitant Only 

 

 Option 1: Life Annuity 
  

 
  

					
	 Attained Age

of Annuitant
	  	Male	  	Female          
	 55
	  	2.74	  	2.59
	 60
	  	3.07	  	2.89
	 65
	  	3.50	  	3.27
	 70
	  	4.07	  	3.77
	 75
	  	4.84	  	4.45
	 80
	  	5.93	  	5.42
	 85
	  	7.50	  	6.86

 Option 2: Life Annuity with 10 

Years of Income Payments Guaranteed 
  

					
	 Attained Age

of Annuitant
	  	Male	  	Female          
	 55
	  	2.73	  	2.59
	 60
	  	3.05	  	2.88
	 65
	  	3.46	  	3.24
	 70
	  	3.99	  	3.72
	 75
	  	4.66	  	4.34
	 80
	  	5.50	  	5.16
	 85
	  	6.45	  	6.16

 
 

  
 Option 3: Joint and Last Survivor Life Annuity

  

													
	 	  	 Age of Female Annuitant

 
	  	 
	 Attained age

of Male Annuitant
	  	 10 Years

Younger
	  	 5 Years

Younger
	  	 Same

Age
	  	 5 Years

Older
	  	 10 Years

Older
	  	  
	 55
	  	2.09	  	2.21	  	2.34	  	2.45	  	2.54	  	
	 60
	  	2.26	  	2.42	  	2.57	  	2.71	  	2.82	  	
	 65
	  	2.48	  	2.67	  	2.86	  	3.04	  	3.19	  	
	 70
	  	2.75	  	3.00	  	3.25	  	3.49	  	3.69	  	
	 75
	  	3.10	  	3.42	  	3.77	  	4.09	  	4.37	  	
	 80
	  	3.55	  	4.00	  	4.48	  	4.95	  	5.33	  	
	 85
	  	4.18	  	4.82	  	5.51	  	6.17	  	6.69	  	 

 Option 4: Joint and Last Survivor Annuity with 10 Years of Income Payments Guaranteed 

 

													
	 	  	 Age of Female Annuitant

 
	  	 
	 Attained age

of Male Annuitant
	  	 10 Years

Younger
	  	 5 Years

Younger
	  	 Same

Age
	  	 5 Years

Older
	  	 10 Years

Older
	  	  
	 55
	  	2.09	  	2.21	  	2.34	  	2.45	  	2.54	  	
	 60
	  	2.26	  	2.42	  	2.57	  	2.71	  	2.82	  	
	 65
	  	2.48	  	2.67	  	2.86	  	3.04	  	3.19	  	
	 70
	  	2.75	  	2.99	  	3.25	  	3.48	  	3.68	  	
	 75
	  	3.09	  	3.42	  	3.76	  	4.08	  	4.34	  	
	 80
	  	3.55	  	3.99	  	4.45	  	4.88	  	5.19	  	
	 85
	  	4.15	  	4.76	  	5.38	  	5.89	  	6.22	  	 

 Monthly installments for ages not shown will be furnished on request 

  

					
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 INDIVIDUALSINGLE PREMIUM DEFERRED INDEX-LINKED
SEPARATE ACCOUNT ANNUITY CONTRACT 
 NONPARTICIPATING 
 NO DIVIDENDS

 BRIGHTHOUSE LIFE INSURANCE COMPANY OF NY 

(A Stock Company) 
 [200 Park Avenue 

New York, NY 10166] 

Table of Contents

 CONTRACT SCHEDULE 
  

					
	 OWNER: [John Doe]
	  		  	SEX: [M]        AGE AT ISSUE: [35]
			
	 JOINT OWNER: [Jane Doe]
	  		  	SEX: [F]         AGE AT ISSUE: [35]
			
	 ANNUITANT: [John Doe]
	  		  	SEX: [M]        AGE AT ISSUE: [35]
			
	 CONTRACT NUMBER: [12345678]
	  		  	ISSUE DATE: [February 15, 2013]
			
	 PLAN TYPE: [Non-Qualified]
	  		  	ANNUITY DATE: [February 15, 2068]

 MAXIMUM TERMINAL ILLNESS RIDER ISSUE AGE: [80] 

MAXIMUM NURSING HOME OR HOSPITAL CONFINEMENT RIDER ISSUE AGE: [80] 

SINGLE PURCHASE PAYMENT:   [$50,000] 
 CONTRACT MINIMUM:
[$2,000] 
 Minimum
Allocation:                                 [$500] 

SHIELD OPTIONS 
 SEPARATE
ACCOUNT:            [REDACTED] 
 Shield Options and Indices by Term Available at Issue:

 Each Shield Option will have an associated Cap Rate or a Step Rate. 
  

					
	Shield Options
	  Term	  	Index	  	Minimum Guaranteed Cap/Step Rate
	[Shield 25
	     [6] Year Term
	  	 [S&P 500® Index1
 Russell 2000® Index2
 MSCI EAFE Index3
	  	
[6%
  6%

   6%]]

	[Shield 15
	     [3] Year Term
	  	 [S&P 500® Index
 Russell 2000® Index

MSCI EAFE Index]
	  	
[3%
  3%

   3%]]

	     [6] Year Term
	  	 [S&P 500® Index
 Russell 2000® Index

MSCI EAFE Index]
	  	
[6%
  6%

   6%]]

	[Shield 10
	  

  [1] Year Term
	  	 [S&P 500® Index
 S&P 500® Index Step Rate

Russell 2000® Index

NASDAQ-100 Index®4
 MSCI EAFE
Index
 Bloomberg Commodity IndexSM5]
	  	
[1%]
 [1%]

[1%]
 [1%]

[1%]
 [1%]

	  

  [3] Year Term
	  	 [S&P 500® Index
 S&P 500® Index Step Rate

Russell 2000® Index

NASDAQ-100 Index®
 MSCI EAFE
Index
 Bloomberg Commodity IndexSM]
	  	
[3%]
 [3%]

[3%]
 [3%]

[3%]

[3%]

  

					
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	 	  	 [S&P
500® Index
	  	 
	   [6] Year Term
	  	 Russell 2000® Index
	  	[6%]]
	 	  	 MSCI EAFE Index]
	  	 

 [Return of Premium Death Benefit Maximum Cap or Step Rate Reduction: [60%]] 

Index-linked returns do not include the portion of returns generated by dividends; and the elements used in determining the credited rate from the index
are not guaranteed and can be changed by the Company, subject to any contract guarantees, and any such changes can affect the return. 
 [FIXED ACCOUNT

  

			
	     Initial Interest Rate*:
	  	[1.00% annually]
		
	     Interest Rate Term:
	  	[1 year]
		
	     Minimum Guaranteed Interest Rate**:
	  	[1.00 % annually]]

 Any paid-up annuity, cash surrender value, or death benefits that are available under this contract will not be less
than the minimum benefits required by the statutes of the state in which this contract is delivered. 
 TRANSFER REQUIREMENTS: 

[TRANSFER PERIOD: 
 The [5 Calendar Days] following the
Contract Anniversary coinciding with the end of the Term for each applicable Shield Option and/or the end of the Interest Rate Term for the Fixed Account.] 

TRANSFERS: 
 [During the Accumulation Period you may only
make a transfer to the Fixed Account and to a new Shield Option(s) during the Transfer Period, subject to availability. The effective date of such transfer is the first day of the Fixed Account Interest Rate Term and/or Shield Option(s) to which the
transfer is made. 
 At the end of the Term, the Investment Amount will automatically be renewed into the same Shield Option unless you elect to
transfer into a different Shield Option or the Fixed Account Option at that time. If the Shield Option is no longer available at the end of the existing Term, these amounts will automatically transfer into the Fixed Account at the end of the Term
unless otherwise directed by You. If the Fixed Account is not available, these amounts will automatically transfer into the Shield Option with, in order of priority, the shortest Term, the highest Shield Rate, and the lowest Cap Rate from the Shield
Options available at the end of the Term unless otherwise directed by You. 
 At the end of the Interest Rate Term, the Fixed Account Value will
automatically be renewed into the Fixed Account unless you elect to transfer into a Shield Option at that time. If the Fixed Account is no longer available at the end of the existing Fixed Account Term, these amounts will automatically transfer into
the Shield Option with, in order of priority, the shortest Term, the highest Shield Rate, and the lowest Cap Rate from the Shield Options available at the end of the Interest Rate Term unless otherwise directed by You.] 

BENEFICIARY: As designated by you as of the Issue Date unless changed in accordance with the Contract provisions. 

WITHDRAWALS: 
 Free Withdrawal Amount: Each Contract
Year after the first Contract Year, you may withdraw a portion of your Account Value free from any Withdrawal Charge. The Free Withdrawal Amount each Contract Year is equal to [10%] of the Account Value as of the prior Contract Anniversary less the
total amount withdrawn, as described in the Withdrawal 
  
  

[* Initial Interest Rate – the interest rate credited to your initial allocation to the Fixed Account during the Interest Rate Term beginning
on the Issue Date. 
 ** We reserve the right with 30 days advance written notice to restrict transfers and allocations into the Fixed Account
during the Transfer Period if the declared interest rate that would apply equals the Minimum Guaranteed Interest Rate. We will provide you notice if these restrictions on transfers and allocations are subsequently lifted.] 

  

					
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Provisions, from the Account Value in the current Contract Year. The Free Withdrawal Amount is non-cumulative and is not carried over to other Contract Years. 

Withdrawal Charge: The Withdrawal Charge is a percentage of the amount withdrawn from the Account Value in a Contract Year in excess of the Free Withdrawal
Amount. The Withdrawal Charge is calculated at the time of each withdrawal using the appropriate withdrawal charge percentage from the following schedule: 
  

							
	 	 	            WITHDRAWAL CHARGE PERCENTAGES	 	 
				
	 	 	             Number of Complete

            Contract Years Since Issue

            Date
	 	      % Charge	 	 
		 	0	 	      7%	 	
		 	1	 	      7%	 	
		 	2	 	      6%	 	
		 	3	 	      6%	 	
		 	4	 	      5%	 	
		 	5	 	      5%	 	
		 	              6 or more	 	      0%	 	

 In addition to any waiver of Withdrawal Charges set forth in the Contract or Rider(s), no Withdrawal Charge will be deducted from the
Account Value in the event of: 
  

	1.	Maturity of the Contract; or 

	2.	Payment of the Death Benefit; or 

	3.	Application of your Account Value to an Annuity Option; or 

	4.	If the withdrawal is required for you to avoid Federal Income Tax penalties or to satisfy Federal Income Tax rules concerning minimum distribution requirements that apply to this annuity (except for RMDs on a decedent
Roth IRA.) For purposes of this exception, we assume that this annuity is the only contract or funding vehicle from which distributions are required to be taken, and we will ignore all other Account Values; or 

	5.	If you properly “re-characterize” as permitted under Federal Tax Law your traditional IRA deferred annuity or Roth IRA deferred annuity issued by us; or 

	6.	If we agree in writing that none will apply. We may waive the Withdrawal Charge if you directly transfer the amount withdrawn to a Brighthouse Life Insurance Company of NY or Brighthouse Financial affiliate annuity
contract pre-approved by us. 

 Minimum Partial
Withdrawal:                 [$500.00] 
 Minimum Account Value which must
remain in the Contract after a Partial Withdrawal: [$2,000.00] 
 ANNUITY OPTION INFORMATION: 

	1.	 [The Annuity Date must be the first day of a calendar month. Unless otherwise directed by you, the Annuity Date is the
first day of the calendar month following the Annuitant’s 90th birthday or 10 years from the Issue Date, whichever is later, or a later date if we agree.] 

	2.	 The Annuity Date must not be less than 13 months from the Issue Date. 

	3.	 For Income Payments, the Fixed Annuity Tables are based on the Annuity 2000 Mortality Table with 15 years of mortality
improvement based upon projection Scale AA, a 7 year age setback and interest at 1.00%. 

 ANNUITY SERVICE OFFICE: 

Brighthouse Life Insurance Company of NY 
 [P.O. Box 10366 

Des Moines, IA 50306-0366] 
 [(800) 777-5897] 

  

					
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 ENDORSEMENTS AND RIDERS ATTACHED TO THIS CONTRACT: 

[Fixed Account Rider 
 Death Benefit Rider – Return of Premium 

Waiver of Withdrawal Charge for Nursing Home Confinement Rider 
 Waiver of Withdrawal
Charge for Terminal Illness Rider 
 Individual Retirement Annuity Qualification Rider 

Roth Individual Retirement Annuity (“Roth IRA”) Endorsement 
 Individual
Non-Qualified Annuity Endorsement 
 Designated Beneficiary Non-Qualified Endorsement] 

  

					
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