Common use of RIGHT TO EXAMINE CONTRACT Clause in Contracts

RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/ANNUITANT: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ CONTRACT NUMBER: Traditional ▇▇-▇▇▇▇▇▇-▇ EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.

RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date ▇▇▇▇ ▇▇▇ 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 9 Change of Allocations 8 9 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 10 Accumulation Units 9 10 Accumulation Unit Value 9 10 Accumulation Unit Value Change Factor 9 10 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 11 Withdrawals and Transfers 10 11 Amount of Withdrawal or Transfer 10 11 Requests for Withdrawal or Transfer 10 11 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 12 Annuity Options 11 12 Specified Payments Option 12 13 Death Benefit 12 13 Spousal Continuation 12 13 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 16 Adjustments to Current Rate of Interest and Expense Charges 17 16 Contract 17 16 Evidence of Survival 17 16 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 17 Non-Waiver 18 17 Notices 18 17 Participating Contract 18 17 Dividends 18 17 Payment of Benefits 18 17 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 18 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/ANNUITANT: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇ CONTRACT NUMBER: Traditional ▇▇-▇▇▇▇▇▇-▇ EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.

RIGHT TO EXAMINE CONTRACT. This Contract may be returned to the Company for cancellation any reason within ten (10) calendar days after the date it is received its receipt by the Contract Owner. It may be delivered returned by delivering or mailed mailing it to the Company or to any agent of the Company, along with a written request for cancellationat its Annuity Service Center. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date When this Contract is delivered or mailed to received by the CompanyCompany it will be voided as if it had never been in force. Upon its return, along with the request for cancellation. This Company will refund, within seven days, the Contract is issued in consideration Value next computed after receipt of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on Annuity Service Center. This may be more or less than the Date of Issue shown in the Specifications Section of this ContractPurchase Payments. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/ANNUITANT: [ /s/ ▇▇▇ ▇. ▇▇▇▇▇▇ ] [ /s/ ▇▇▇▇▇ ▇. ▇▇▇▇ ] [page break] CONTRACT SCHEDULE 4 DEFINITIONS 5 PURCHASE PAYMENT PROVISIONS 8 PURCHASE PAYMENTS 8 PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF PURCHASE PAYMENTS 8 SEPARATE ACCOUNT PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUTION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND EXPENSE RISK CHARGE 10 ADMINISTRATIVE CHARGE 10 DISTRIBUTION CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE CHARGE 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFERS 10 TRANSFERS DURING THE ACCUMULATION PERIOD 10 TRANSFERS DURING THE ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE 13 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT 14 PAYMENT OF DEATH BENEFIT 14 BENEFICIARY 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 15 [page break] ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE CONTRACT 16 GENERAL PROVISIONS 16 THE CONTRACT 16 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 INCONTESTABILITY 17 MISSTATEMENT OF AGE OR SEX 17 NON-BUSINESS DAYS 18 NON-PARTICIPATING 18 PROTECTION OF PROCEEDS 18 REGULATORY REQUIREMENTS 18 REPORTS 18 TAXES 18 ANNUITY PROVISIONS 19 ANNUITY GUIDELINES 19 ANNUITY PAYMENTS 19 FIXED ANNUITY 20 VARIABLE ANNUITY 20 ANNUITY UNITS AND PAYMENTS 20 ANNUITY UNIT VALUE 20 ANNUITY OPTIONS 21 Annuity Option A - Life Income 21 Annuity Option B - Life Income with Period Certain 21 Annuity Option C - Joint and Last Survivor Payments 21 Annuity Option D - Joint and 2/3 Survivor Annuity 21 Annuity Option E - Period Certain 21 Annuity Option F - Special Income Settlement Agreement 21 Fixed Annuity Rates 22 Fixed Annuity Rates Table 1 Fixed Annuity Rates Table 2 Fixed Annuity Rates Table 3 Fixed Annuity Rates Table 4 Variable Annuity Rates Variable Annuity Rates Table 5 Variable Annuity Rates Table 6 Variable Annuity Rates Table 7 Variable Annuity Rates Table 8 [page break] [VARIABLE INFORMATION] Panorama Premier REVISION DATE: August 31, 1994 CONTRACT OWNER: [▇▇▇▇ ▇▇▇] AGE AND SEX: [35 Male] ANNUITANT: [▇▇▇▇ ▇▇▇] AGE AND SEX: [35 Male] CONTRACT NUMBER: Traditional ▇▇-▇▇▇▇▇▇-▇ EFFECTIVE [1234 CML] ISSUE DATE: Month DayJuly 30, YYYY DATE OF ISSUE1995 ANNUITY DATE: Month Day[August 31, YYYY STATE OF DELIVERY2024] PURCHASE PAYMENTS: Generic SEPARATE ACCOUNT CHARGE Maximum of 2% annually of INITIAL PURCHASE PAYMENT: [Non-Qualified: $5,000; Qualified: $2,000] MINIMUM SUBSEQUENT PURCHASE PAYMENT: [$250, or, if the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of automatic investment option is elected, $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%100.]

RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within [10] days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled cancelled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; , plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is made, subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. IRA-2004 IRA-2004 INHER ▇▇▇-2010 INHER ▇▇▇-2010 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION DEFINITIONS 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 5 Code 6 Commuted Value 5 Contract 6 Contract Charge 6 Current Rate of Interest 6 Date of Issue 6 Designated Beneficiary 6 Effective Date 6 Eligible Rollover Distribution 6 Guaranteed Rate of Interest 6 Home Office ▇▇▇ 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Beginning Date 7 Retirement Plan 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States ▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇ Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 8 Accounts 9 8 General Account 9 8 Separate Account 9 8 Account Value 9 8 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 9 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 10 SECTION 6 - BENEFITS DISTRIBUTIONS 10 Rules for Distribution 10 Distribution Methods 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 DESIGNATED BENEFICIARY 12 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 12 Adjustments to Current Rate of Interest and Expense Charges 17 12 Contract 17 12 Evidence of Survival 17 12 Overpayments 13 Incontestability 17 Misstatements of Age 17 13 Non-Alienation of Benefits 17 13 Non-Assignment of Contract 18 13 Non-Waiver 18 13 Notices 18 13 Participating Contract 18 13 Dividends 18 13 Payment of Benefits 18 13 Reports 18 14 Severability of Provisions 18 14 Termination of Contract 18 14 SECTION 10 - TABLE OF RATES 19 SECTION 11 9 - LIST OF ACCOUNTS AND FUNDS 20 14 OWNER/ANNUITANT: [▇▇▇▇ ▇▇▇], beneficiary of [▇▇▇▇ ▇▇▇▇▇▇ CONTRACT NUMBER: Traditional ▇▇-▇▇▇▇▇▇-▇ EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic ] SEPARATE ACCOUNT CHARGE Maximum of [2% %] annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of [$2.00 2.50] for administrative expenses[, except the monthly charge shall not exceed 1/12 of 1% of the Account Value]. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% [2%] and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00[3%]. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%[1.20]%.

RIGHT TO EXAMINE CONTRACT. This Contract contract may be returned for cancellation within 10 days after the date it is received by the Owneryou. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall contract will then be canceled cancelled as of the Date of Issue and the Company shall will refund to the Owner you an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the date of surrender date of all contributions allocated to any Investment FundAccount associated with an Investment Fund of the Separate Account. For purposes the purpose of this paragraph onlyprovision, the date of surrender date shall will be the date this Contract contract is delivered or mailed to the Company, along with the request Company for cancellation. This Contract The contract is issued in consideration of the application for this Contract contract and payment of the first contribution (premium)required contribution. Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall The contract will take effect on the Effective Date shown in below. This page and the Specifications Section following pages are a part of this Contractcontract. All benefits payable are subject to the provisions of this contract. This Contract contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contractcontract. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/ANNUITANT: ▇▇/s/ ▇▇▇▇▇ ▇▇▇▇▇▇ CONTRACT NUMBER: Traditional ▇▇-/s/ ▇▇▇▇▇▇ ▇-. ▇▇▇▇▇ EFFECTIVE DATE: Month DayVice President Chairman, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic President & Chief Executive Officer ASSETS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY’S GENERAL ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment FundTHAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND CERTAIN OTHER CONTRACTS. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective DateTHE ASSETS OF THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND WILL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafterDESCRIPTION OF THE SEPARATE ACCOUNT IS DESCRIBED IN THE PROVISION OF THIS CONTRACT ENTITLED “DESCRIPTION OF ACCOUNTS”. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%DEATH BENEFIT PAYABLE UPON YOUR DEATH BEFORE THE ANNUITY COMMENCEMENT DATE. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.THIS IS A PARTICIPATING CONTRACT. ANNUITANT AND OWNER: (Herein called “you” and “your”) CONTRACT SPECIFICATIONS 5 BENEFIT PROVISIONS 5 MONTHLY ANNUITY BENEFITS 5 AMOUNT OF ANNUITY BENEFIT 5 ANNUITY COMMENCEMENT DATE 5 REQUIRED BEGINNING DATE 5 VALID TRANSACTION DATE 6 DISTRIBUTIONS 6 TERMINATION OF THIS CONTRACT 7 CONTRIBUTIONS 7 CONTRIBUTIONS 7 ALLOCATION OF CONTRIBUTIONS 8 ALLOCATIONS 8 CHANGE OF ALLOCATIONS 8 ACCUMULATION VALUE 8 ACCUMULATION VALUE 8 DESCRIPTION OF ACCOUNTS 9 TYPES OF ACCOUNTS 9 GENERAL ACCOUNT 10 SEPARATE ACCOUNT 10 ACCUMULATION UNITS 12 ACCUMULATION UNIT VALUE 12 ACCUMULATION UNIT VALUE CHANGE FACTOR 12 VALUATION DAY AND VALUATION PERIOD 12 CHANGES TO SEPARATE ACCOUNT 12 VALUATION OF ASSETS 12 STATEMENT OF ACCOUNTS 13 CHARGES 13 TYPES AND AMOUNTS OF CHARGES 13 CHANGE IN THE AMOUNT OF CHARGES 13 SPECIFIED PAYMENTS OPTIONS 14 ELECTION OF SPECIFIED PAYMENTS OPTION 14 PAYMENT OF SPECIFIED AMOUNT 14 WITHDRAWALS AND TRANSFERS 14 WITHDRAWALS AND TRANSFERS 14 WITHDRAWALS 14 TRANSFERS 15 AMOUNT OF WITHDRAWAL OR TRANSFER 15 REQUESTS 15 POSTPONEMENT OF PAYMENTS, WITHDRAWALS OR TRANSFERS 15 ANNUITY OPTIONS 15 ELECTION OF FORM OF ANNUITY 15 BENEFICIARY 16 CHANGE OF BENEFICIARY 17 FIXED AMOUNT OPTION 17 FIXED AMOUNT OPTION 17 GENERAL PROVISIONS 17 THE CONTRACT 17 INCONTESTABILITY 17 MISSTATEMENTS OF AGE 18 ASSIGNMENT 18 CHANGES TO THIS CONTRACT 18 SURVIVAL OF PAYEE 18 CLAIMS OF CREDITORS 18 CORRESPONDENCE 18 PARTICIPATING CONTRACT 18 DIVIDENDS 18 REQUIRED INFORMATION 18 NON-WAIVER 19 TABLE OF RATES 20

RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Employer 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 8 Accounts 9 8 General Account 9 8 Separate Account 9 8 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 9 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 10 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 12 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 17 Non-Waiver 18 17 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Report to Employer 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/ANNUITANT: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ Simple CONTRACT NUMBER: Traditional ▇▇-▇▇▇▇▇▇-▇ EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.

RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within [10] days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled cancelled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium)) of at least [$10] . Additional contributions may be made at any time prior to the Annuity Commencement Date Date, the death of the Annuitant or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/ANNUITANT: ▇▇/s/ ▇▇▇▇▇ ▇▇▇▇▇▇ CONTRACT NUMBER: Traditional ▇▇-/s/ ▇▇▇▇▇▇ ▇-. ▇▇▇▇▇ EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic ------------------------------- ------------------------------------- Vice President President and Chief Executive Officer AMOUNTS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY'S GENERAL ACCOUNT AND/OR THE COMPANY'S SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment FundTHAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND CERTAIN OTHER CONTRACTS. CONTRACT CHARGE A monthly contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective DateTHE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafterDESCRIPTION OF THE SEPARATE ACCOUNT APPEARS IN THE ACCOUNTS SECTION OF THIS CONTRACT. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%A DESCRIPTION OF THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.THIS IS A PARTICIPATING CONTRACT. THIS PAGE LEFT BLANK INTENTIONALLY

RIGHT TO EXAMINE CONTRACT. This Within 10 days of the date of receipt of this contract, or 60 days if a replacement contract, of the date of receipt of this Contract by the Owner, it may be returned for cancellation within days after by delivering or mailing it to the date Company at its Administrative Office or to the Registered Representative through whom it was purchased. When the Contract is received by the OwnerCompany, it will be voided as if it had never been in force. It may be delivered or mailed to The Company will refund the Contract Value computed as of the Business Day the Company receives the returned contract at its Administrative Office. This refund amount will be the Contract Value plus the amount of fees and other charges deducted from gross consideration or to any agent imposed under the contract, if applicable. The refund will be issued within 10 days of the Company, along with a written request receipt of policy or contract for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation AccountJNL-2300-1-NY CONTRACT SCHEDULE 4 DEFINITIONS 7 PURCHASE PAYMENT PROVISIONS 8 PURCHASE PAYMENTS 8 ALLOCATION OF PURCHASE PAYMENTS 8 SEPARATE ACCOUNT PROVISIONS 8 THE SEPARATE ACCOUNTS 8 VARIABLE ACCOUNT 8 VALUATION OF ASSETS 8 ACCUMULATION UNITS 8 ACCUMULATION UNIT VALUE 9 CONTRACT VALUE 9 SUBSCRIPTION FEE 9 DEDUCTION FOR SUBSCRIPTION FEE 9 DEDUCTION FOR LOW COST PLATFORM FEE 10 DEDUCTION FOR OPTIONAL ASSET ALLOCATION MODEL FEE TRANSFERS 11 TRANSFERS DURING THE ACCUMULATION PERIOD 11 WITHDRAWAL PROVISIONS 11 WITHDRAWALS 11 PROCEEDS PAYABLE ON DEATH 11 DEATH OF OWNER DURING THE ACCUMULATION PERIOD 11 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 11 DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD 12 DEATH OF OWNER DURING THE ANNUITY PERIOD 12 DEATH OF ANNUITANT 12 PAYMENT OF DEATH BENEFIT 12 BENEFICIARY 12 CHANGE OF BENEFICIARY 13 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 13 OWNER, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph onlyANNUITANT, the surrender date shall be the date this Contract is delivered or mailed to the Company▇▇▇▇▇▇▇▇▇, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/ANNUITANT: ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ CONTRACT NUMBER: Traditional ▇▇-▇▇▇▇▇ ▇▇ OWNER 13 JOINT OWNER 13 ANNUITANT 13 ASSIGNMENT OF A CONTRACT 13 ANNUITY PROVISIONS 14 GENERAL 14 ANNUITY DATE 14 SELECTION OF AN ANNUITY OPTION 14 FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS 14 ANNUITY OPTIONS 14 OPTION 1. LIFETIME ONLY ANNUITY: 14 OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS 14 OPTION 3. PAYMENT FOR A FIXED PERIOD: 14 OPTION 4. JOINT AND SURVIVOR ANNUITY 14 ANNUITY 14 FIXED ANNUITY 14 MORTALITY TABLES 15 GENERAL PROVISIONS 15 THE CONTRACT 15 MISSTATEMENT OF AGE 15 INCONTESTABILITY 15 MODIFICATION 15 NON-PARTICIPATING 15 EVIDENCE OF SURVIVAL 15 PROOF OF AGE 15 PROTECTION OF PROCEEDS 15 REPORTS 15 TAXES 15 REGULATORY REQUIREMENTS 15 ANNUITY OPTION TABLES 16-18 PRIMARY OWNER: [▇▇-▇▇ EFFECTIVE ▇▇▇] CONTRACT ISSUE DATE: Month Day, YYYY DATE OF ISSUE[1/1/2015] JOINT OWNER: Month Day, YYYY STATE OF DELIVERY[▇▇▇▇ ▇▇▇] ANNUITANT: Generic SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. [▇▇▇▇ ▇▇▇] ANNUITANT AGE: [35 ] ANNUITANT GENDER: [Male/Female] ANNUITY DATE: [1/1/2055] CONTRACT CHARGE A monthly contract charge of NUMBER: [12345678] INITIAL PURCHASE PAYMENT: [$2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.25,000.00] MINIMUM TOTAL PURCHASE PAYMENT: [$25,000.00] MAXIMUM TOTAL PURCHASE PAYMENT: [$10,000,000.00] without prior Company approval

RIGHT TO EXAMINE CONTRACT. This Within 10 days of the date of receipt of this Contract by the Owner, it may be returned for cancellation within days after by delivering or mailing it to the date Company at its Administrative Office or to the Agent through whom it was purchased. When the Contract is received by the OwnerCompany, it will be voided as if it had never been in force. It may be delivered or mailed to The Company will refund the Contract Value computed as of the Business Day the Company or to any agent of receives the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company returned contract at its Home Office in New YorkAdministrative Office. Secretary President INCOME PAYMENTS, New York on the Date of Issue shown in the Specifications Section of this ContractWITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. IRA-2004 IRA-2004 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date CONTRACT SCHEDULE 4 DEFINITIONS 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice PURCHASE PAYMENT PROVISIONS 7 Owner PURCHASE PAYMENTS 7 Required Distribution Date ALLOCATION OF PURCHASE PAYMENTS 7 Separate Account SEPARATE ACCOUNT PROVISIONS 7 SIMPLE IRA THE SEPARATE ACCOUNTS 7 Surviving Spouse VARIABLE ACCOUNT 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions VALUATION OF ASSETS 8 Change of Allocations ACCUMULATION UNITS 8 SECTION 4 - ACCOUNTS ACCUMULATION UNIT VALUE 8 CONTRACT VALUE 8 SUBSCRIPTION FEE 8 DEDUCTION FOR SUBSCRIPTION FEE 8 DEDUCTION FOR TRANSACTION FEE 9 Accounts TRANSFERS 9 General Account TRANSFERS DURING THE ACCUMULATION PERIOD 9 Separate Account WITHDRAWAL PROVISIONS 9 Account Value WITHDRAWALS 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account PROCEEDS PAYABLE ON DEATH 10 SECTION 5 - WITHDRAWALS AND TRANSFERS DEATH OF OWNER DURING THE ACCUMULATION PERIOD 10 Withdrawals and Transfers DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 10 Amount of Withdrawal or Transfer DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD 10 Requests for Withdrawal or Transfer DEATH OF OWNER DURING THE ANNUITY PERIOD 10 Postponement of Withdrawals or Transfers DEATH OF ANNUITANT 10 PAYMENT OF DEATH BENEFIT 11 SECTION 6 - BENEFITS BENEFICIARY 11 Annuity Benefit CHANGE OF BENEFICIARY 11 Amount of Annuity Benefit SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/, ANNUITANT: , ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ CONTRACT NUMBER: Traditional ▇▇-▇▇▇▇▇ ▇▇▇ OWNER 11 JOINT OWNER 11 ANNUITANT 11 ASSIGNMENT OF A CONTRACT 12 ANNUITY PROVISIONS 12 GENERAL 12 ANNUITY DATE 12 SELECTION OF AN ANNUITY OPTION 12 FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS 12 ANNUITY OPTIONS 12 OPTION 1. LIFETIME ONLY ANNUITY: 12 OPTION 2. LIFETIME ANNUITY WITH GUARANTEED PERIODS 12 OPTION 3. PAYMENT FOR A FIXED PERIOD: 12 OPTION 4. JOINT AND SURVIVOR ANNUITY 12 ANNUITY 12 FIXED ANNUITY 13 MORTALITY TABLES 13 GENERAL PROVISIONS 13 THE CONTRACT 13 MISSTATEMENT OF AGE 13 INCONTESTABILITY 13 MODIFICATION 13 NON-▇ EFFECTIVE PARTICIPATING 13 EVIDENCE OF SURVIVAL 13 PROOF OF AGE 13 PROTECTION OF PROCEEDS 13 REPORTS 13 TAXES 13 REGULATORY REQUIREMENTS 14 PAYMENTS TO THIRD PARTIES 14 PAYMENTS FROM THIRD PARTIES 14 ANNUITY OPTION TABLES 15 CONTRACT SCHEDULE OWNER: «FIRSTNAM» «LASTNAME» CONTRACT ISSUE DATE: Month Day, YYYY DATE OF ISSUE«COVISS» JOINT OWNER: Month Day, YYYY STATE OF DELIVERY«JFIRSTNM» «JLASTNAM» ANNUITY DATE: Generic SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets in each Investment Fund. «EXPDAT» CONTRACT CHARGE A monthly contract charge of NUMBER: «POLNUM» INITIAL PURCHASE PAYMENT: «INITPREM» MAXIMUM TOTAL PURCHASE PAYMENT: $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%.[10,000,000.00] without prior Company approval ALLOCATION GUIDELINES:

RIGHT TO EXAMINE CONTRACT. This Contract You may be returned cancel this contract for any reason within 10 days of receipt or within any longer period as required by applicable law in the state where this contract was delivered by sending written notice of cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any an agent of the Company, along with a written request for by phone at {▇-▇▇▇-▇▇▇-▇▇▇▇} or by return of this contract to the office of the Company. If this contract is replacing another contract, the time period in which You may cancel this contract is 30 days unless another time period is applicable under state law. Upon cancellation. This Contract shall then be canceled and , the Company shall refund to the Owner will return an amount equal to: (a) all contributions allocated to the Interest Accumulation AccountContract Value, with no deductions; plus (b) unless applicable state law requires the value return to be based on the surrender date of all contributions allocated to Purchase Payments paid or another amount) less any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to proceeds paid by the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. IRA-2004 IRA-2004 22-D-RILA-BASE 1 05/22 SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution Date 7 Separate Account 7 SIMPLE IRA 7 Surviving Spouse 7 Underlying Investment Company 7 United States Bank 7 Valid Transaction Date 7 Valuation Day 7 Valuation Period 7 SECTION 3 - CONTRIBUTIONS 7 Contributions 7 Allocation of Contributions 8 Change of Allocations 8 SECTION 4 - ACCOUNTS 9 Accounts 9 General Account 9 Separate Account 9 Account Value 9 Accumulation Units 9 Accumulation Unit Value 9 Accumulation Unit Value Change Factor 9 Changes To Separate Account 10 SECTION 5 - WITHDRAWALS AND TRANSFERS 10 Withdrawals and Transfers 10 Amount of Withdrawal or Transfer 10 Requests for Withdrawal or Transfer 10 Postponement of Withdrawals or Transfers 11 SECTION 6 - BENEFITS 11 Annuity Benefit 11 Amount of Annuity Benefit 11 Annuity Options 11 Specified Payments Option 12 Death Benefit 12 Spousal Continuation 12 Death Benefit Settlement Options 13 SECTION 7 - DISTRIBUTIONS 14 SECTION 8 - BENEFICIARY 16 IRA-2004 Page I – DEFINITIONS 3 SECTION 9 - GENERAL PROVISIONS 17 Adjustments to Current Rate of Interest and Expense Charges 17 Contract 17 Evidence of Survival 17 Incontestability 17 Misstatements of Age 17 Non-Alienation of Benefits 17 Non-Assignment of Contract 18 Non-Waiver 18 Notices 18 Participating Contract 18 Dividends 18 Payment of Benefits 18 Reports 18 Severability of Provisions 18 Termination of Contract 18 SECTION 10 - TABLE II – CONTRACT VALUES AND CHARGES 7 PURCHASE PAYMENTS 7 CONTRACT VALUE 7 OWNERSHIP OF RATES 19 SECTION 11 - LIST OF ACCOUNTS AND FUNDS 20 OWNER/ANNUITANT: ASSETS 8 INTEREST 8 REALLOCATIONS TO AVAILABLE STRATEGIES 8 ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ AND SURRENDERS 8 WITHDRAWAL CHARGES 9 SURRENDER VALUE 10 SECTION III – PROVISIONS FOLLOWING THE DEATH OF AN OWNER OR ANNUITANT 10 DEATH OF AN OWNER (DEATH BENEFIT) 10 DEATH OF THE ANNUITANT 11 SECTION IV – SETTLEMENT AND PAYMENT OF PROCEEDS 12 PAYMENTS IN GENERAL 12 PAYMENTS TO MINORS 12 SETTLEMENT OPTIONS 12 ANNUITIZATION UPON MATURITY 13 SECTION V – GENERAL PROVISIONS 14 CONTRACT NUMBER: Traditional ▇▇14 ANNUAL STATEMENTS 14 DEFERRAL OF PAYMENTS 14 RELIANCE 15 INCONTESTABILITY 15 NON-▇▇▇▇▇▇PARTICIPATING 15 MISSTATEMENT OF AGE OR SEX 15 OWNERSHIP 15 ASSIGNMENT INCLUDING OWNERSHIP CHANGE OF THIS CONTRACT 15 CHANGE OF BENEFICIARY 16 MODIFICATION 16 TAXES 16 MINIMUM BENEFITS 16 SPENDTHRIFT PROVISION 16 PROOF OF AGE AND SURVIVAL 16 CONFORMITY WITH LAWS FOR LEGAL ACTIONS 16 22-▇ EFFECTIVE DATE: Month Day, YYYY DATE OF ISSUE: Month Day, YYYY STATE OF DELIVERY: Generic SEPARATE ACCOUNT CHARGE Maximum of 2% annually of the net assets D-RILA-BASE 2 05/22 Capitalized terms have specific definitions as detailed in each Investment Fund. CONTRACT CHARGE A monthly this contract charge of $2.00 for administrative expenses, except the monthly charge shall not exceed 1/12 of 1% of the Account Value. An explanation of all charges appears under Administrative Charges in the Definitions section of this Contract. The Current Rate of Interest is declared from time to time by the Company, but shall in no event be less than the Guaranteed Rate of Interest. The Guaranteed Rate of Interest on the Effective Date results in an effective annual yield of 0.00% and shall apply from the Effective Date until the first December 31st following the Effective Date. A redetermined Guaranteed Rate of Interest shall be applicable for each calendar year thereafter. The Current Rate of Interest on the Date of Issue results in an effective annual yield of 0.00%. The total expense charge currently being deducted as a Separate Account Charge on the Date of Issue of this Contract is 1.20%outlined below.