EX-4c. Contract Schedule Page (Base)-S40875-ADV
| Contract Schedule |
| Owner: | [John Doe] | Contract Number: | [??687456] |
| [Joint Owner: | [Jane Doe]] | Issue Date: | [04/15/10] |
| Annuitant: | [John Doe] | Scheduled Annuity Date: | [04/01/65] |
| Determining Life (Lives): | [John Doe] | Maximum Issue Age: | [80] |
| [Jane Doe] |
| Purchase Payments | |
| Initial Purchase Payment: | $[10,000.00] |
| Minimum Additional Purchase Payment: | $[50.00] |
| Maximum Total Purchase Payments: | $[1 million; higher amounts may be accepted with our approval] |
| Transfers | |
| Number of Free Transfers Permitted: | [12] each Contract Year |
| Transfer Fee: | $[25.00] for each transfer in excess of the free transfers permitted |
| Transfer Index Anniversary: | Every [Sixth] Index Anniversary |
| Contract Charges | |
| Product Fee: | [0.25]% |
| Contract Maintenance Charge: | $[50.00] each Contract Year |
| Designated Amount: | Contract Value must be $[100,000.00] to waive the Contract Maintenance Charge |
| Withdrawals | |
| Minimum Partial Withdrawal: | $[100.00] |
| Minimum Required Value: | $[2,000.00] |
| Free Withdrawal Amount: | [10]% of total Purchase Payments |
Withdrawal Charge Percentages Table
| Number of Complete Years Since Receipt of Purchase Payment | Charge |
| [0 | 6.50% |
| 1 | 6.00% |
| 2 | 5.00% |
| 3 | 4.00% |
| 4 | 3.00% |
| 5 | 2.00% |
| 6 years or more | 0%] |
Annuity Payments
| Minimum Annuity Payment: | $[100.00] |
| Annuity Mortality Table: | [Annuity 2000 Mortality Table] |
| Minimum Annual Annuity Payment Rate: | [1.00]% |
Riders:
[The applicable riders based on the information from the application will populate this area.]
Guaranteed Purchase Rate Table
Upon request, we will furnish rates for ages and guaranteed periods not shown.
Annuity Options - Guaranteed monthly annuity payments per $1,000 | ||||||||||
| Option 1 | Option 2 | Option 3 | Option 4 | Option 5 | ||||||
| 10-year guaranteed period | 20-year guaranteed period | 100% joint and survivor | 10-year guaranteed period | |||||||
Age on Annuity Date | Male | Female | Male | Female | Male | Female | Male & Female Same Age | Male & Female Same Age | Male | Female |
| 30 | [2.08 | 1.97 | 2.08 | 1.97 | 2.07 | 1.97 | 1.84 | 1.84 | 2.00 | 1.92 |
| 40 | 2.45 | 2.29 | 2.45 | 2.29 | 2.42 | 2.28 | 2.10 | 2.10 | 2.29 | 2.19 |
| 50 | 3.02 | 2.78 | 3.00 | 2.77 | 2.92 | 2.73 | 2.49 | 2.49 | 2.70 | 2.57 |
| 60 | 3.95 | 3.57 | 3.87 | 3.53 | 3.59 | 3.37 | 3.12 | 3.11 | 3.29 | 3.14 |
| 70 | 5.66 | 5.03 | 5.28 | 4.83 | 4.24 | 4.13 | 4.22 | 4.20 | 4.18 | 4.00 |
| 80 | 8.93 | 8.09 | 7.07 | 6.79 | 4.55 | 4.53 | 6.37 | 6.04 | 5.54 | 5.38 |
| 90 | 15.24 | 14.64 | 8.36 | 8.30 | 4.59 | 4.59 | 10.68 | 7.98 | 7.66 | 7.50] |