Common use of Variable Annuity Payments Clause in Contracts

Variable Annuity Payments. 21 FORM T1575Z The American Franklin Life Insurance Company SCHEDULE PAGE INITIAL PURCHASE PAYMENT: $10,000 MINIMUM ADDITIONAL PURCHASE PAYMENTS (Per Division or Guarantee Period): $ 100 ADDITIONAL BENEFITS: NONE MAXIMUM ASSET CHARGE FACTORS (Separate Account Only) ANNUAL RATE: 1.40% MAXIMUM ANNUAL CONTRACT FEE: $ 30 TRANSFER CHARGE: $ 25 ISSUE AGE: 35 ANNUITY COMMENCEMENT DATE: JANUARY 1, 2026 INITIAL ALLOCATION: Net Dollar Amount of Percentage Allocations VIP Money Market Portfolio 100% $10,000 VIP High Income Portfolio xx% $ xxx VIP Investment Grade Bond Portfolio xx% $ xxx VIP Equity-Income Portfolio xx% $ xxx VIP Growth Portfolio xx% $ xxx VIP Overseas Portfolio xx% $ xxx VIP Asset Manager Portfolio xx% $ xxx VIP Index 500 Portfolio xx% $ xxx VIP II Contrafund Portfolio xx% $ xxx MFS Emerging Growth Portfolio xx% $ xxx MFS Research Portfolio xx% $ xxx MFS Growth With Income Portfolio xx% $ xxx MFS Total Return Portfolio xx% $ xxx MFS Utilities Portfolio xx% $ xxx MFS Value Portfolio xx% $ xxx Fixed Account 1 Year Guarantee Period xx% $ xxx 3 Year Guarantee Period xx% $ xxx 5 Year Guarantee Period xx% $ xxx ------ ----------- Total Allocations 100% $10,000 ANNUITANT: ▇▇▇▇ ▇▇▇ CONTRACT NUMBER: 123456

Variable Annuity Payments. 21 FORM T1575Z T1575 2 The American Franklin Life Insurance Company SCHEDULE PAGE INITIAL PURCHASE PAYMENT: $10,000 MINIMUM ADDITIONAL PURCHASE PAYMENTS (Per Division or Guarantee Period): $ 100 ADDITIONAL BENEFITS: NONE MAXIMUM ASSET CHARGE FACTORS (Separate Account Only) ANNUAL RATE: 1.40% MAXIMUM ANNUAL CONTRACT FEE: $ 30 TRANSFER CHARGE: $ 25 ISSUE AGE: 35 ANNUITY COMMENCEMENT DATE: JANUARY 1, 2026 INITIAL ALLOCATION: Net Dollar Amount of Percentage Allocations VIP Money Market Portfolio 100% $10,000 VIP High Income Portfolio xx% $ xxx VIP Investment Grade Bond Portfolio xx% $ xxx VIP Equity-Income Portfolio xx% $ xxx VIP Growth Portfolio xx% $ xxx VIP Overseas Portfolio xx% $ xxx VIP Asset Manager Portfolio xx% $ xxx VIP Index 500 Portfolio xx% $ xxx VIP II Contrafund Portfolio xx% $ xxx MFS Emerging Growth Portfolio xx% $ xxx MFS Research Portfolio xx% $ xxx MFS Growth With Income Portfolio xx% $ xxx MFS Total Return Portfolio xx% $ xxx MFS Utilities Portfolio xx% $ xxx MFS Value Portfolio xx% $ xxx Fixed Account 1 Year Guarantee Period xx% $ xxx 3 Year Guarantee Period xx% $ xxx 5 Year Guarantee Period xx% $ xxx ------ ----------- --------- Total Allocations 100% $10,000 ANNUITANT: ▇▇▇▇ ▇▇▇ CONTRACT NUMBER: 123456