Group Flexible Premium Fixed and Variable Deferred Annuity Certificate Sample Contracts

GROUP FLEXIBLE PREMIUM FIXED AND VARIABLE DEFERRED ANNUITY CERTIFICATE Non- Participating
Group Flexible Premium Fixed and Variable Deferred Annuity Certificate • July 12th, 2011 • Separate Account I of National Integrity Life Ins Co

To allocate the Contributions made to this Certificate to the Investment Options available under the Variable or Fixed Accounts offered on the Participation Date;