SURVIVORSHIP FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY - ------------------------------------------------- Variable and/or Fixed Accumulation Values Flexible Premiums Payable During Lifetime of Surviving Joint Insured Adjustable Face Amount Death Benefit Guarantee Death Benefit Options Nonparticipating - -------------------------------------------------- NOTICE Right to Return Policy Please read this policy carefully. If for any reason you don't want it, you may return it for a refund of all premiums paid. You must return this policy to us or your agent by midnight of the 10th day after you receive it. We will then consider this policy void from the start and refund all premiums you paid. The Death Benefit is payable on the death of the Surviving Joint Insured. We will pay the proceeds according to the Death Benefits portion of the Summary of Benefits on page 3, if we receive written proof that the Surviving Joint Insured died while this policy was in force. However, you must give us written proof of the first death of a Joint Insured as soon as it occurs. This policy also provides other benefits and rights. We issue this policy in consideration of the application and payment of the initial premium. THE AMOUNT OF THE PROCEEDS PAYABLE AT THE SURVIVING JOINT INSURED'S DEATH PRIOR TO AGE 100 OF THE YOUNGER JOINT INSURED WILL BE AT LEAST EQUAL TO THE FACE AMOUNT OF THE POLICY AS LONG AS THIS POLICY IS IN FORCE AND THERE IS NO LOAN AMOUNT OR UNPAID MONTHLY DEDUCTIONS. THE PERIOD OF TIME THIS LIFE INSURANCE STAYS IN FORCE WILL VARY DEPENDING ON THE INVESTMENT PERFORMANCE OF THE VARIABLE ACCOUNT, INTEREST CREDITED TO THE NET PREMIUMS ALLOCATED TO THE FIXED ACCOUNT, THE AMOUNT OF PREMIUMS YOU PAY, ANY PARTIAL WITHDRAWALS, LOANS, AND CHARGES MADE AGAINST THIS POLICY. IF YOU PAY PREMIUMS SUFFICIENT TO MAINTAIN THE DEATH BENEFIT GUARANTEE, WE GUARANTEE THIS POLICY WILL STAY IN FORCE DURING THE DEATH BENEFIT GUARANTEE PERIOD SHOWN ON THE POLICY DATA PAGE. THE VARIABLE ACCUMULATION VALUE WILL INCREASE OR DECREASE REFLECTING THE INVESTMENT PERFORMANCE OF THE VARIABLE ACCOUNT. RELIASTAR RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK Executed at our Home Office P.O. Box 9004 John H. Flittie President 1000 Woodbury Road, Suite 102 /s/ John H. Flittie Woodbury, NY 11797-9004 Susan M. Bergen Secretary ---------------------------- /s/ Susan M. Bergen Page 1 85-438 INDEX PAGE Accumulation Value 10 Age and Sex 27 Allocation of Premiums 8 Amendment 29 Annual Statement 28 Beneficiary 20 Cash Surrender Value 17 Cash Value 17 Changes in Face Amount 6 Changes in Death Benefit Option 7 Claims 30 Contract 3 Control of Policy 20 Conversion Right 27 Death Benefit 5 Definitions 3 Death Benefit Guarantee 9 Fixed Accumulation Value 10 General Provisions 25 Grace Period 9 Incontestability 27 Insureds 1 Monthly Deduction 12 Net Premium 7 Nonforfeiture Provision 14 Ownership 20 Partial Withdrawal 17 Payment of Proceeds 26 Policy Data Page A Policy Loans 18 Premiums 7 Reinstatement 9 Right to Return Policy 1 Settlement Options 21 Suicide 27 Summary of Benefits 3 Termination 27 Total Surrender 17 Transfers 14 Variable Accumulation Value 11 Voting of Mutual Fund Shares 25 Additional benefits and restrictions, if any, are listed on the Policy Data Page. Page 2 5391 Summary of Benefits Living Benefits While any Joint Insured is alive, subject to this policy's provisions, you may: Change the amount and frequency of your premium payments; Change the allocation of your premiums; Make transfers between accounts; Surrender this policy for its Cash Surrender Value; Make a Partial Withdrawal; Take a Policy Loan; Assign this policy as collateral; Change the beneficiary; Transfer ownership; and Exercise any other rights this policy provides. While both Joint Insureds are alive, subject to this policy's provisions, you may: Change the Face Amount; and Change the Death Benefit Option. Death Benefits At the Surviving Joint Insured's death, the proceeds payable include the Death Benefit then in force: Plus any additional amounts provided by rider; Plus a refund of any policy loan interest we have charged but not earned; Minus any Loan Amount; and .Minus any unpaid Monthly Deductions. The Death Benefit Option in effect is shown on the Policy Data Page. All values are determined as of the Valuation Date on or next following the date of the Surviving Joint Insured's death. The Death Benefit after the younger Joint Insured reaches age 100 is the Accumulation Value. The Contract This policy is a legal contract. Read your policy carefully! You rely on us to provide its benefits; we rely on you to pay its premiums. The entire contract is this policy and all applications, Policy Data Pages, riders, and amendments attached at time of issue or agreed upon later. All statements made by or on behalf of anyone covered by this policy are representations and not warranties. No statement can be used to cancel this policy or can be used in our defense if we refuse to pay a claim, unless it is found in an application, rider, or amendment. Changes Policy changes must be in writing and signed by our President or Secretary, or one of our Vice Presidents or Assistant Secretaries. No agent or any other person may alter or change the terms and conditions of this policy. General Definitions In Force This policy is in effect. Joint Insureds The persons upon whose lives this policy is issued. The Policy Data Page lists the Joint Insureds. Surviving Joint Insured The Joint Insured who remains alive after the other Joint Insured dies. Proceeds The amount we pay when the Surviving Joint Insured dies or when this policy is surrendered. We, Us, Our ReliaStar Life Insurance Company of New York at our Home Office in Woodbury, New York. 85-439 Page 3 General Definitions Written, In Writing A written request or notice, signed and dated, and received at our Home Office. The form and content of the request or notice must be acceptable to us. You, Your The owner of this policy, as shown on the Policy Data Page, unless changed as allowed in this policy. The Joint Insureds own this policy as joint tenants with right of surviviorship, unless another owner is named. During the lifetime of the Joint Insureds, if owners, we reserve the right to require both Joint Insured's to sign any request to exercise rights under this policy. Policy Definitions Accumulation Unit A unit of measure used to determine the Variable Accumulation Value. Accumulation Value The total amount that this policy provides for investment at any time. The Accumulation Value is the total of the Fixed Accumulation Value and the Variable Accumulation Value. Average Age The sum of the ages of the Joint Insureds divided by two, rounded to the higher age. Cash Value The Accumulation Value minus any Surrender Charge. Cash Surrender Value The amount payable to you if you surrender this policy. It is the Cash Value minus any Loan Amount and unpaid Monthly Deductions. The Code The Internal Revenue Code of 1986, as amended. Face Amount The minimum Death Benefit payable as long as this policy is in force. The Initial Face Amount is shown on the Policy Data Page. You may change the Face Amount as described in this policy. Fixed Account All our assets other than those allocated to the Variable Account or any other separate account. We have complete ownership and control of the assets in the Fixed Account. Loan Amount The sum of all unpaid policy loans including preferred loans. Monthly Anniversary Whenever your Monthly Anniversary falls on a date other than a Valuation Date, the Monthly Anniversary will be the next Valuation Date. The first Monthly Anniversary is on the Policy Date. Policy Date The Policy Date is shown on the Policy Data Page. We use the Policy Date to determine policy years, policy months, Monthly Anniversaries, and policy anniversaries. Sub-Account A subdivision of the Variable Account. Each Sub-account invests exclusively in the shares of one of the mutual funds shown on the Policy Data Page, or added later. 5392 Page 4 Valuation Date The close of business each day that the New York Stock Exchange is open for trading and valuations have not been suspended by the Securities and Exchange Commission. We may also declare a Valuation Date on any other day on which there is sufficient trading in the mutual funds' portfolio to materially affect the Accumulation Unit Value in the corresponding Sub-account. Valuation Period The period of time between a Valuation Date and the next Valuation Date. Variable Account ReliaStar Life Insurance Company of New York Variable Life Separate Account I, a separate investment account of ours. The Variable Account is used only to receive and invest Net Premiums paid under our variable life insurance policies. The assets of the Variable Account will be valued on each Valuation Date. We have complete ownership and control of the assets in the Variable Account. Assets of the Variable Account equal to its liabilities will not be charged with liabilities arising out of any other business we conduct. However, we may transfer any assets which exceed the liabilities of the Variable Account to our Fixed Account. The Variable Account is treated as a unit investment trust under federal securities laws. It is registered with the Securities and Exchange Commission according to the Investment Company Act of 1940. It was established under the insurance laws of the State of New York. Any change in the investment policy of the Variable Account must be approved by the Department of Insurance of the State of New York according to the approval process on file with the State. Death Benefit Options This policy has two Death Benefit Options. The Death Benefit Option in effect on the Policy Date is shown on the Policy Data Page. All values are determined as of the Valuation Date on or next following the date of the Surviving Joint Insured's death. The two Death Benefit Options are: Option A (Level Amount Option) The Death Benefit prior to age 100 of the younger Joint Insured is the greater of: The Face Amount; or The Accumulation Value multiplied by the Corridor Percentage, as shown on the Policy Data Page, according to the younger Joint Insured's attained age. Option B (Variable Amount Option) The Death Benefit prior to Age 100 of the younger Joint Insured is the greater of: The Face Amount plus the Accumulation Value; or The Accumulation Value multiplied by the Corridor Percentage, as shown on the Policy Data Page, according to the younger Joint Insured's attained age. 85-440 Page 5 Requested Changes in Face Amount After the fourth policy year, you may request an increase or decrease in your Face Amount by notifying us in writing. Changes in Death Benefit Option also change the Face Amount. (See Changes in DeathBenefit Option.) Increases Increases in Face Amount must be at least $5,000. You cannot increase the Face Amount after any Joint Insured's age exceeds age 85. We may require written proof that each Joint Insured is still insurable before making an increase. An approved increase goes into effect on the Monthly Anniversary on or next following the date of the approval. Decreases You cannot decrease the Face Amount below the Minimum Face Amount shown on the Policy Data Page. You cannot decrease the Face Amount if any Survivorship Term Rider (STR) is attached. If, following a requested decrease in Face Amount, this Policy would no longer qualify as life insurance under federal tax law, we will limit the decrease to an amount that would maintain that qualification. Changes go into effect on the Monthly Anniversary on or next following the date we receive your request. At least six months must lapse between decreases. For the purpose of determining the cost of insurance when more than one Rate Class applies to the current Face Amount, the Face Amount will be reduced in the following order: The Face Amount provided by the most recent increase; The next most recent increases successively; and The Initial Face Amount. 5393 Page 6 Requested Changes in Face Amount Effect of Requested Changes in Face Amount A change in Face Amount will affect the Monthly Deduction because the cost of insurance and the Monthly Expense Charge are based on the Face Amount. The cost of certain rider benefits may also be affected. If the Death Benefit Guarantee is in effect, we will calculate a new Minimum Monthly Premium for the Death Benefit Guarantee from the effective date of the change in Face Amount. Additional premium payments may be required to maintain the Death Benefit Guarantee. A decrease in Face Amount will reduce the Minimum Monthly Premium. We will send you a new Policy Data Page with the new Minimum Monthly Premium. An increase in Face Amount will increase Surrender Charges. We will send you a new Policy Data Page showing the amount and duration of the new Surrender Charges. Decreases in Face Amount do not reduce the Surrender Charge. Changes in Death Benefit Option You may request in writing to change the Death Benefit Option. A change in Death Benefit Option will also change the Face Amount. If you change from Option A (Level Amount Option) to Option B (Variable Amount Option), the Face Amount is decreased by an amount equal to the Accumulation Value on the effective date of the change. The change is effective on the Monthly Anniversary on or next following the date we receive your request. You cannot change the Death Benefit Option if the resulting Face Amount would fall below the Minimum Face Amount shown on the Policy Data Page. :p.If you change from Option B (Variable Amount Option) to Option A (Level Amount Option), the Face Amount is increased by an amount equal to the Accumulation Value on the effective date of the change. The change is effective on the Monthly Anniversary on or next following the date we receive your request. A change in Face Amount due to a change in Death Benefit Option will affect the Monthly Deduction because the cost of insurance and the Monthly Expense Charge depend on the Face Amount. The cost of certain rider benefits may also be affected. The Surrender Charges will not be affected by a change in the Death Benefit Option. Premiums There is no insurance under this policy until the initial premium is paid. The initial premium is shown on the Policy Data Page. All premiums are payable in advance of the period to which they apply. Net Premium When you pay a premium, we deduct the Premium Expense Charge. The Premium Expense Charge is equal to 1 plus 2, (1 + 2), where: Is the premium multiplied by the Percent of Premium Charge shown on the Policy Data Page; and Is the Premium Processing Charge. The Premium Processing Charge is subject to change, but will not exceed the Maximum Premium Processing Charge shown on the Policy Data Page. The amount remaining after we have deducted the Premium Expense Charge from a premium is the Net Premium. The Net Premium is credited to the Fixed Account and the Sub-accounts of the Variable Account according to your allocation. The portion of the Net Premium allocated to the Fixed Account earns interest as described in the Fixed Accumulation Value provision of the policy. The portion of the Net Premium allocated to a Sub-account is invested at net asset value in shares of a specified mutual fund. As of the Policy Date, the mutual funds in which the Sub-accounts invest are listed on the Policy Data Page. A Sub-account may be added later or deleted according to the "Substitution of Mutual Fund Shares" provision of this policy. 85-441 Page 7 Premiums Allocation of Premiums The initial allocation of premiums to the Fixed Account and the Sub-accounts of the Variable Account is specified on the application for this policy, and is shown on the Policy Data Page. You may change the allocation at any time by notifying us in writing. Changes will not be effective until the date we receive your notice, and will only affect premiums we receive on or after that date. You may allocate 100% to any account or divide your allocation in whole percentage points totaling 100%. We reserve the right to adjust your allocations to eliminate fractional percentages. Amount and Timing of Premium Payments The amount and frequency of premium payments will affect the Accumulation Value, the Cash Surrender Value, and how long the life insurance provided by this policy will remain in force. After the initial premium you may determine the amount and timing of premium payments, within the following restrictions: We may require proof which satisfies us that each Joint Insured is still insurable if any premium, planned or unscheduled, would increase the difference between the Death Benefit and the Accumulation Value; We reserve the right to refuse to accept any premium which would disqualify your policy for favorable tax treatment under the Code. If premiums paid exceed the maximum permitted under the Code, we will return the excess premiums with interest to you within 60 days after the end of the policy year. However, you have the right to pay the premium required to keep this policy in force to the end of the policy year; We may refuse to accept any premium less than $25; and We will not accept premium payments after age 100 of the younger Joint Insured. You may pay premiums by sending them to the address shown below. Please include your policy number. The current address for payment is: ReliaStar Life Insurance Company of New York P.O. Box 802511 Chicago, Illinois 60680-2511 Upon request, we will send you a receipt signed by one of our officers. Planned Periodic Premiums You may pay planned periodic premiums annually, semi-annually, quarterly, or, if you choose, we can also deduct planned periodic premiums from your bank account monthly. We will notify you of your planned periodic premium at least once a year. The amount and frequency of the initial planned periodic premiums are shown on the Policy Data Page. You may change the frequency and amount of planned periodic premiums by notifying us in writing of the change. We reserve the right to limit the amount of any increase in planned periodic premiums if such increase would result in planned periodic premiums that are larger than either of 1 or 2, where: Is the maximum premium we would accept under the terms of the Amount and Timing of Premium Payments provision; and Is a planned periodic premium which would total more than $50,000 per year. We may send you periodic premium notices depending on the frequency and method of premium payment you have chosen. Unscheduled Additional Premiums Premiums, other than planned periodic premiums, may be paid at any time. We may limit the number and amount of these additional payments. (See "Amount and Timing of Premium Payments" above.) 5394 Page 8 Death Benefit Guarantee The Death Benefit Guarantee Period is shown on the Policy Data Page and begins on the Policy Date. The Death Benefit Guarantee is in effect during the Death Benefit Guarantee Period if, on each Monthly Anniversary since the Policy Date, 1 is equal to or greater than 2, where: Is the sum of all premiums paid minus any partial withdrawals and any Loan Amount; and Is the sum of Minimum Monthly Premiums since the Policy Date, including the Minimum Monthly Premium for the current Monthly Anniversary. If the Death Benefit Guarantee is in effect, we guarantee that we will not lapse your policy, even if the Cash Surrender Value is not sufficient to pay the Monthly Deduction that is due. Although we determine each month whether or not you have made sufficient premium payments to maintain the Death Benefit Guarantee, you do not have to pay premiums monthly. If, on any Monthly Anniversary you have not paid sufficient premiums to maintain the Death Benefit Guarantee, we will send you notice of the required payment. If we do not receive the required payment within 61 days following the date we mail you written notice, the Death Benefit Guarantee is no longer in effect and cannot be reinstated. Policy Changes Affecting the Minimum Monthly Premium and the Death Benefit Guarantee Period The Minimum Monthly Premium may be affected by requested changes in Face Amount, changes in the Death Benefit Option, and may also be changed when a rider is added or terminated. The new Minimum Monthly Premium and Death Benefit Guarantee Period will be shown on a new Policy Data Page and applies from the date of the change. Grace Period and Policy Lapse If on any Monthly Anniversary the Death Benefit Guarantee is not in effect and the Cash Surrender Value is less than the Monthly Deduction due, within 30 days we will send you written notice of the payment required to keep this policy in force. If we do not receive sufficient premium from you within 61 days from the date we send written notice to you, this policy will lapse. Sufficient premium is any premium such that the Net Premium is larger than the sum of 1 plus 2, (1 + 2), where: Is the amount by which the Accumulation Value is less than the Surrender Charge as of the beginning of the grace period; and Is the sum of past due Monthly Deductions. The grace period begins on the date we send you written notice of the required payment. If the Surviving Joint Insured dies during the grace period, we deduct any Loan Amount and any unpaid Monthly Deductions from the proceeds. If the Death Benefit Guarantee is in effect, we will not lapse the policy. Reinstatement Reinstatement means putting a lapsed policy back in force. You may reinstate this policy by written request any time within five years after it has lapsed, as long as it has not been surrendered for its Cash Surrender Value. This policy will be reinstated only as of a Monthly Anniversary. To reinstate this policy and any riders, you must: Submit proof which satisfies us that each Joint Insured, or Surviving Joint Insured, is still insurable. You must also submit due proof that any Joint Insured not living when you apply for reinstatement died while the policy was in force. Pay a premium large enough such that the Net Premium is as large as the sum of the Surrender Charge after reinstatement, plus the Monthly Deductions for the date of reinstatement and the following Monthly Anniversary. This policy will be reinstated only as of a Monthly Anniversary. If you have met the above conditions, and the Surviving Joint Insured dies before the Monthly Anniversary on which the policy would be reinstated, we will pay the Death Benefit as of that Monthly Anniversary. The Accumulation Value on the date of reinstatement will be the amount provided by the Net Premium paid to reinstate this policy. Subsequent Accumulation Values will be calculated as shown in the Accumulation Value provision of this policy. The Surrender Charges will also be reinstated. The Death Benefit Guarantee cannot be reinstated. 85-442 Page 9 Accumulation Value The Accumulation Value of this policy is equal to the sum of the Fixed Accumulation Value plus the Variable Accumulation Value. Fixed Accumulation Value The Fixed Accumulation Value on the Policy Date is your Net Premium credited to the Fixed Account on that date minus the Monthly Deduction applicable to the Fixed Accumulation Value for the first policy month. After the Policy Date, the Fixed Accumulation Value is calculated as 1 + 2 + 3 + 4 -5 - 6, where: Is the Fixed Accumulation Value on the preceding Monthly Anniversary, plus interest from the Monthly Anniversary to the date of the calculation; Is the total of your Net Premiums credited to the Fixed Account since the preceding Monthly Anniversary, plus interest from the date premiums are credited to the date of the calculation; Is the total of your transfers from the Variable Account to the Fixed Account since the preceding Monthly Anniversary, plus interest from the date of transfer to the date of the calculation; Is the total of your Loan Amount transferred from the Variable Account since the preceding Monthly Anniversary; Is the total of your transfers to the Variable Account from the Fixed Account since the preceding Monthly Anniversary, plus interest from the date of transfer to the date of the calculation; and Is the total of your partial withdrawals from the Fixed Account since the preceding Monthly Anniversary, plus interest from the date of withdrawal to the date of the calculation. If the date of the calculation is a Monthly Anniversary, we also reduce the Fixed Accumulation Value by the applicable Monthly Deduction for the policy month following the Monthly Anniversary. Interest Rate on the Fixed Accumulation Value The interest rate applied in the calculation of the Fixed Accumulation Value will not be less than the Minimum Annual Interest Rate shown on the Policy Data Page. This rate is an effective annual interest rate compounded yearly. Interest in excess of the Minimum Annual Interest Rate may be applied in the calculation of your Fixed Accumulation Value in a manner which our Board of Directors determines. We will credit interest no less frequently than annually. The interest rate applied to any portion of the Accumulation Value which represents the Loan Amount may be less than the interest rate applied to the rest of the Accumulation Value, but not less than the Minimum Annual Interest Rate. Any interest is nonforfeitable, except as it is subject to the deductions and charges, including Surrender Charges, stated elsewhere in this policy. Interest credited on the loaned Accumulation Value is credited annually on the Policy Anniversary to the Fixed Account and the Variable Account according to your premium allocation. 5395 Page 10 Accumulation Value Variable Accumulation Value The Variable Accumulation Value is the total of your values in each Sub-account. The value for each Sub-account is equal to 1 multiplied by 2, (1 x 2), where: Is your current number of Accumulation Units; and Is the current Unit Value. The Variable Accumulation Value will vary from Valuation Date to Valuation Date reflecting changes in 1 and 2 above. Accumulation Units When transactions are made which affect the Variable Accumulation Value, dollar amounts are converted to Accumulation Units. The number of Accumulation Units for a transaction is found by dividing the dollar amount of the transaction by the current Unit Value. The number of Accumulation Units for a Sub-account increases when: Net Premiums are credited to that Sub-account; or Transfers from the Fixed Account or other Sub-accounts are credited to that Sub-account. The number of Accumulation Units for a Sub-account decreases when: You take out a Policy Loan from that Sub-account; You take a partial withdrawal from that Sub-account; We take a portion of the Monthly Deduction from that Sub-account; or Transfers are made from that Sub-account to the Fixed Account or other Sub-accounts. Unit Value The Unit Value for a Sub-account on any Valuation Date is equal to the previous Unit Value multiplied by the Net Investment Factor for that Sub-account for the Valuation Period ending on that Valuation Date. 85-443 Page 11 Accumulation Value Net Investment Factor The Net Investment Factor is a number that reflects charges to this policy and the investment performance during a Valuation Period of the mutual fund in which a Sub-account is invested. If the Net Investment Factor is greater than one, the Unit Value is increased. If the Net Investment Factor is less than one, the Unit Value is decreased. The Net Investment Factor for a Sub-account is determined by dividing 1 by 2, ( 1 / 2 ), where: Is the result of: The net asset value per share of the mutual fund shares in which the Sub-account invests, determined at the end of the current ValuationPeriod; Plus the per share amount of any dividend or capital gain distributions made on the mutual fund shares in which the Sub-account invests during the current Valuation Period; and Plus or minus a per share charge or credit for any taxes reserved for which we determine to have resulted from the investment operations of the Sub-account and to be applicable to this policy. Is the result of: The net asset value per share of the mutual fund shares held in the Sub-account, determined at the end of the last prior Valuation Period; and Plus or minus a per share charge or credit for any taxes reserved for which we determine to have resulted from the investment operations of the Sub-account and to be applicable to this policy. Monthly Deduction The Monthly Deduction is a charge made monthly against the Accumulation Value. The Monthly Deduction for a policy month will be calculated as 1, plus 2, plus 3, plus 4, plus 5, (1 + 2 + 3 + 4 + 5), where: Is the cost of insurance for this policy for the policy month; Is the Monthly Expense Charge for the policy month; Is the cost of any rider benefits, other than any Waiver of Monthly Deduction rider, for the policy month; Is the Monthly Mortality and Expense Risk Charge for the policy month; and Is the cost of any Waiver of Monthly Deduction rider for the policy month. The Monthly Deduction is deducted from the Fixed Accumulation Value and the Variable Accumulation Value as of the Monthly Anniversary. The amount of the Monthly Deduction we deduct from the Fixed Accumulation Value is 1 multiplied by 2 divided by 3, ((1 x 2) / 3)), where: Is the cost of any riders benefits plus the cost of insurance for this policy plus the Monthly Expense Charge, for the policy month; Is the Fixed Accumulation Value minus the Loan Amount; and Is the Accumulation Value minus the Loan Amount. The remainder of the Monthly Deduction is deducted from the Variable Accumulation Value. The portion of the Monthly Deduction we deduct from each Sub-account of the Variable Accumulation Value is the amount of Monthly Deduction deducted from the Variable Accumulation Value times the ratio of the value of each Sub-account to the Variable Accumulation Value. 5396 Page 12 Cost of Insurance We determine the cost of insurance on a monthly basis. The cost of insurance for a policy month is calculated as 1 multiplied by the result of 2 minus 3, 1 x (2 - - 3), where: Is the cost of insurance rate as described in the Cost of Insurance Rates provision of this policy; Is the Death Benefit at the beginning of the policy month, divided by the sum of 1.000000 plus the Minimum Monthly Interest Rate shown on the Policy Data Page; and Is the Accumulation Value immediately before the Monthly Deduction, for the policy month. The cost of insurance is determined separately for the Initial Face Amount and any increases made later. If the rate class for the Initial Face Amount is different from that of an increase, the Accumulation Value used in 3 above will first be considered a part of the InitialFace Amount. If the Accumulation Value on the Monthly Anniversary exceeds the Initial Face Amount, it will be considered to be part of any increase in the Face Amount in order of the increases. Cost of Insurance Rates The monthly cost of insurance rate for this policy is based on each Joint Insured's sex, issue age, and rate class as shown on the Policy Data Page, and the policy year. If your Death Benefit is a percentage of the Accumulation Value as described under the definition of "Death Benefit" in Level Amount Option, item 2, or Variable Amount Option, item 2, the rate class with the most recent effective date will apply. Issue age means age last birthday on the effective date of the coverage. Except for Face Amounts when one or both Joint Insureds are in a rated Rate Class, the cost of insurance charges can never be greater than those shown in the Table of Monthly Guaranteed Cost of Insurance Rates. This table is based on the Commissioners Standard Ordinary (CSO) Tables shown on the Policy Data Page. For Face Amounts where one or both Joint Insureds are in a rated Rate Class, the guaranteed cost of insurance rates are calculated based on appropriate adjustments to the appropriate CSO tables. The rates may also be increased by any extra cost of insurance shown on the Policy Data Page for either or both Joint Insureds. Monthly Expense Charge The Monthly Expense Charge for a policy month will be calculated as 1, plus 2, plus 3, plus 4, (1 + 2 + 3 + 4), where: Is the Monthly Administrative Charge. The Monthly Administrative Charge is subject to change, but will not exceed the Maximum Monthly Administrative Charge shown on the Policy Data Page. The Monthly Administrative Charge will not exceed the product of $5.00 and the ratio(not to exceed 2.00) of a to b, where: Is the Consumer Price Index (for all urban households) for the preceding September; and Is the Consumer Price Index for September 1985. Is the Death Benefit Guarantee Charge and the Term shown on the Policy Data Page; Is the Monthly Policy Charge. This charge and the Term during which it is applied are shown on the Policy Data Page; and Is the Monthly Amount Charge. This charge is equal to the Monthly Amount Charge per $1,000, as shown on the Policy Data Page, multiplied by the Face Amount divided by $1,000. This charge applies to the Initial Face Amount during the Term shown on the Policy Data Page. An Additional Monthly Amount Charge Per $1,000 will apply to any approved increase in Face Amount. We will send you written notice of the amount and Term of the Additional Monthly Amount Charge. Any change in Face Amount due solely to a change of Death Benefit Option does not affect the charge. 85-444 Page 13 Monthly Deduction Monthly Mortality and Expense Risk Charge The Monthly Mortality and Expense Risk Charge for a policy month will be calculated as 1 multiplied by 2, ( 1 x 2), where: Is the Mortality and Expense Risk Charge, which will not exceed the Maximum Mortality and Expense Risk Charge shown on the Policy Data Page, divided by 12; and Is the Variable Accumulation Value before the Monthly Deduction, minus the portion which was taken from the Variable Account for each of the following deductions: The Cost of Insurance for the policy month; The cost of any rider benefits, other than any Waiver of Monthly Deduction rider, for the policy month; The Monthly Expense Charge for the policy month. Basis of Computations Where required, a detailed statement of the method of computation of cash values under this policy has been filed with the insurance department of the state in which this policy was delivered. Cash values under this policy are not less than the minimums required by the state in which this policy was delivered. Adjustments to Policy Cost Factors Adjustments to the monthly cost of insurance rate and Monthly Administrative Charge will be by Rate Class and based upon changes in future expectations for mortality, persistency, interest, taxes, and expenses. Any changes to the monthly cost of insurance rate or Monthly Administrative Charge will be made only prospectively, based on future expectations, in accordance with procedures and standards on file with the New York Insurance Department. Changes will not be used to recoup past losses or distribute past gains. The experience underlying the monthly cost of insurance rate will be reviewed at regular intervals, no less often than every five years. Continuation of Insurance Even if you do not make additional premium payments, your insurance coverage under this policy, and any benefits provided by rider, will stay in force as long as the Cash Surrender Value is large enough to cover the Monthly Deduction. If the Cash Surrender Value is less than the Monthly Deduction due, we will use the Cash Surrender Value to continue the insurance during the grace period. Transfers You may request in writing the transfer of all or part of your Accumulation Value between the Fixed Account and the Sub-accounts of the Variable Account. We consider all transfers received in the same request and made on the same Valuation Date as one transfer. We make a transfer on the first Valuation Date after we receive your written request. We do not make a charge for the first 12 transfers in a policy year. However, we may make a charge for each transfer in excess of the first 12 transfers in a policy year, but the charge may not exceed $25.00. We reserve the right to limit the number of transfers to 12 per year. All transfers are also subject to any charges and conditions imposed by the mutual fund whose shares are involved. 5397 Page 14 Transfers Transfers from the Fixed Account To transfer all or part of your Fixed Accumulation Value, you must meet the following conditions: The request to transfer must be postmarked no more than 30 days before the policy anniversary, and no later than 30 days after the policy anniversary. Only one transfer is allowed during this period; The Fixed Accumulation Value after the transfer must be at least equal to the Loan Amount; No more than 50% of the Fixed Accumulation Value (minus any Loan Amount) may be transferred unless the balance, after the transfer, would be less than $1,000. If the balance would fall below $1,000, the full Fixed Accumulation Value (minus any Loan Amount) may be transferred; and You must transfer at least: $500; or The total Fixed Accumulation Value (minus any Loan Amount) if less than $500. Transfers from a Sub-account To transfer from a Sub-account, Accumulation Units are redeemed on the next Valuation Date after we receive your request and their value is reinvested in other Sub-accounts, or the Fixed Account, as directed in your request. We will effect transfers and determine all values in connection with transfers at the end of the Valuation Period during which we receive your request, except as otherwise specified for the Dollar Cost Averaging or Portfolio Rebalancing Services. With respect to future net premium payments, however, your current premium allocation will remain in effect unless you have requested the Portfolio Rebalancing Service, or you are transferring all of the Variable Accumulation Value from the Variable Account to the Fixed Account in exercise of conversion rights. 85-451 Page 15 Transfers Dollar Cost Averaging Service You may request this service if your Face Amount is at least $100,000 and either your Accumulation Value, less any Loan Amount, is at least $5,000 or your initial premium is at least $5,000. If you request this service in writing, we will make specific periodic transfers of a fixed dollar amount from any of the Sub-accounts to one or more of the Sub-accounts or to the Fixed Account. No transfers from the Fixed Account are permitted under this service. Transfers of this type may be made on a monthly, quarterly, semi-annual, or annual basis. We make no guarantees that Dollar Cost Averaging will result in a profit or protect against loss. The Dollar Cost Averaging service will be discontinued immediately: If you make a written request to discontinue this service; On receipt of any request to begin a Portfolio Rebalancing service; If the policy is in the grace period on any date when Dollar Cost Averaging transfers are scheduled; If the specified transfer amount from any Sub-account is more than the Accumulation Value in that Sub-account; or Thirty-six months after the Dollar Cost Averaging start date. We reserve the right to discontinue, modify, or suspend this service. Any such modification or discontinuation would not affect any Dollar Cost Averaging service requests already commenced. Portfolio Rebalancing Service You may request this service if your Accumulation Value, less any Loan Amount, is at least $10,000. If you request this service in writing, we will make periodic transfers to maintain your specified percentage allocation of Accumulation Value, less any Loan Amount, among the Sub-accounts of the Variable Account and the Fixed Account. Your allocation of future Net Premium payments will also be changed to be equal to this specified percentage allocation. Transfers made under this service may be made on a quarterly, semi-annual, or annual basis. The Portfolio Rebalancing service will be discontinued immediately: If you make a written request to discontinue this service; On receipt of any request to change the allocation of premiums to the Fixed Account and Sub-account of the Variable Account; On receipt of any request to begin a Dollar Cost Averaging service; On receipt of any request to transfer Accumulation Value among the Fixed Account or Sub-accounts; If the policy is in the grace period; or The Accumulation Value, less any Loan Amount, is less than $7,500 on any Valuation Date when Portfolio Rebalancing transfers are scheduled. We reserve the right to discontinue, modify, or suspend this service. Any such modification or discontinuation could affect Portfolio Rebalancing services currently in effect, but only after 30 days notice to you. 5409 Page 16 Cash Value, Cash Surrender Value, Total Surrender, and Partial Withdrawal Cash Value The Cash Value of this policy is the Accumulation Value minus any Surrender Charge. The Cash Value is never less than zero. Cash Surrender Value The Cash Surrender Value of this policy is the Cash Value minus the Loan Amount and any unpaid Monthly Deductions. Surrender Charge We make a Surrender Charge if you surrender this policy or it lapses. The Surrender Charge is the Maximum Surrender Charge minus the Premium Related Surrender Charge Reduction. The Surrender Charge is not less than zero. Initial Face Amount The Maximum Surrender Charge applicable to the Initial Face Amount depends on the Initial Face Amount. The amount and duration of the Unadjusted Surrender Charge applicable to the Initial Face Amount is shown on the Policy Data Page. Whenever the total premiums paid are less than the Surrender Charge Whole Life Premium shown on the Policy Data Page, the Surrender Charge applicable to the Initial Face Amount will be reduced by the Premium Related Surrender Charge Reduction. The Premium Related Surrender Charge Reduction is calculated as 1 multiplied by the result of 2 minus 3, (1 x (2 -3)), where: Is the Surrender Charge Reduction Factor shown on the Policy Data Page; Is the Surrender Charge Whole Life Premium Shown on the Policy Data Page; and Is the total premiums paid. Requested Changes in Face Amount Additional Surrender Charges will apply to any approved increase in Face Amount. The additional Surrender Charge depends on the amount of the increase in Face Amount and the Joint Insureds' sex, Average Age, and rate class on the effective date of the increase. We will send you written notice of the amount and duration of the additional Surrender Charge. No Premium Related Surrender Charge Reductions are made for additional Surrender Charges applicable to increases in Face Amount. If Surrender Charges are shown on an annual basis, they grade uniformly by policy month between the consecutive years shown. Any increases or decreases in Face Amount resulting from changes in the Death Benefit Option, and any requested decreases in Face Amount, do not affect the Surrender Charges. Total Surrender You may surrender this policy for its Cash Surrender Value by sending us a written request. Partial Withdrawal After the first policy year, you may withdraw part of your Cash Surrender Value by sending us a written request. The amount of any partial withdrawal must be at least equal to $500.00. The maximum partial withdrawal equals the Cash Surrender Value multiplied by the Percent of Partial Withdrawal shown on the Policy Data Page. Only one partial withdrawal is allowed in any policy year. We may make a charge for each partial withdrawal, but the charge will not exceed $25.00. Unless you specify, we make partial withdrawals from the Fixed Accumulation Value and the Variable Accumulation Value on a proportionate basis. For the purpose of calculating the proportion, the Loan Amount is subtracted from the Fixed Accumulation Value. We make partial withdrawals from a Sub-account by the automatic surrender of Accumulation Units. 85-445 Page 17 Cash Value, Cash Surrender Value, Total Surrender, and Partial Withdrawal Benefits The Effect of Partial Withdrawals The Accumulation Value will be reduced by the amount of any partial withdrawal. The Death Benefit will also be reduced by the amount of the withdrawal, or, if the Death Benefit is based on the Corridor Percentage of Accumulation Value, by an amount equal to the Corridor Percentage times the amount of the withdrawal. The Face Amount will be reduced by the amount of the partial withdrawal if Option A (Level Amount Option) is in effect. We do not allow a withdrawal if the Face Amount after a partial withdrawal would be less than the Minimum Face Amount shown on the Policy Data Page. If more than one Premium Class applies to the current Face Amount, for the purpose of determining the cost of insurance, the Face Amount will be reduced in the following order: The Face Amount provided by the most recent increase; The next most recent increases successively; and The Initial Face Amount. If Death Benefit Option B (Variable Amount Option) is in effect, a partial withdrawal does not affect the Face Amount. A partial withdrawal may cause the Death Benefit Guarantee to terminate. The amount of the partial withdrawal is deducted from the total premium paid in calculating whether sufficient premiums have been paid to maintain the Death Benefit Guarantee. Policy Loans After the first policy year, if this policy has a Loan Value, you may take out a loan from us by written request. We use this policy as security for the loan. Each loan must be at least $500. We will not lend you more than the Loan Value. The Loan Value is 1, minus 2, (1 - - 2), where: Is the Cash Value; and Is the existing Loan Amount. When we make a policy loan, the amount of the policy loan will be segregated within the Fixed Accumulation Value of your policy as security for the loan. Unless you specify, amounts held as security for the loan will come from the Fixed Accumulation Value and the Variable Accumulation Value on a proportionate basis. For the purpose of determining the proportion, we subtract any existing Loan Amount from the Fixed Accumulation Value. Amounts equal to the portion of the policy loans coming from the Sub-accounts of the Variable Account are transferred to the Fixed Account, reducing the Variable Accumulation Value. These transfers are not treated as transfers for the purpose of the transfer charge or the limit on the number of transfers in a policy year. 5398 Page 18 Policy Loans Effect of the Policy Loans If not repaid, we deduct any unpaid policy loans before paying the proceeds. If, at any time, the Loan Amount exceeds the Cash Value, the grace period goes into effect and we may lapse this policy. A loan may cause the Death Benefit Guarantee to terminate. The Loan Amount is deducted from the total premiums paid in calculating whether you have paid premiums sufficient to maintain the Death Benefit Guarantee. Loan Interest We charge interest on the Loan Amount at the Loan Interest Rate shown on the Policy Data Page. After the tenth policy year, we charge interest at the Preferred Loan Interest Rate shown on the Policy Data Page on the portion of your Loan Amount that is not greater than the result of 1 minus 2 plus 3, ( 1 - 2 + 3 ), where: Is the Accumulation Value; Is the sum of all premiums paid; and Is the sum of all partial withdrawals. This result is called the Preferred Loan Amount. The Preferred Loan Amount is calculated on the date of any loan and on each policy anniversary thereafter. Policy loan repayments received will be applied first to reduce the portion of your policy loan that is not the Preferred Loan Amount, and then to reduce the Preferred Loan Amount. On the date of any policy loan, interest is due in advance for the remainder of the policy year. On each policy anniversary thereafter, interest is due in advance for the next full policy year. Any unpaid interest is added to the Loan Amount, and we charge interest on it. If, on any Monthly Anniversary, the Loan Amount exceeds the Cash Value, we will notify you within 30 days. If we do not receive sufficient payment within 61 days from the date we send notice to you, this policy will lapse. Repayment You may repay all or part of any policy loan during any Joint Insured's lifetime. If not repaid during the Surviving Joint Insured's lifetime, we deduct the Loan Amount from the proceeds. We generally consider any payments we receive, planned or unscheduled, as a premium payment subject to a Premium Expense Charge. Therefore, when you make a payment on a policy loan, to avoid a Premium Expense Charge, you must tell us that you are making a loan payment. We reserve the right to treat a loan payment as a premium payment if doing so will: Prevent this policy from lapsing; or Prevent borrowing from this policy to pay premiums. Loan repayments reduce the Loan Amount. We will transfer from the Fixed Account to each Sub-account of the Variable Account, 1 multplied by 2, ( 1 x 2 ), where: Is the amount of the loan repayment; and Is the current proportion used to allocate premiums to that Sub-account. These transfers are not treated as transfers for the purpose of the transfer charge or the limit on the number of transfers in a policy year. Delay of Payment on Surrender, Partial Withdrawals and Loans The amount surrendered, withdrawn, or loaned will normally be paid to you within seven days of: Receipt of your written request; and Receipt of your policy, if required We may delay making the payment when we are not able to determine the Variable Accumulation Value because: The New York Stock Exchange is closed for trading; or The Securities and Exchange Commission determines that a state of emergency exists. 85-446 Page 19 Delay of Payment on Surrender, Partial Withdrawals and Loans We have the right to delay making a surrender, partial withdrawal, or loan from the Fixed Account for up to six months from the date we receive your request. If we delay payment for 10 days or more, we pay interest at the same rate we are currently paying on proceeds at death from the date of the surrender, partial withdrawal, or loan request to the date of payment. Beneficiary The beneficiary is named to receive the proceeds to be paid at the Surviving Joint Insured's death. You may name one or more beneficiaries on the application. Later, you may name, add, or change beneficiaries by written request as described below. You may also choose to name a beneficiary whom you cannot change without his or her consent. This is an irrevocable beneficiary. :subhead. Naming, Adding, or Changing Beneficiaries You can name, add, or change beneficiaries by written request if all of these are true: This policy is in force; The Surviving Joint Insured is alive; and We have the written consent of all irrevocable beneficiaries. A change will take effect as of the date it is signed but will not affect any payment we make or action we take before receiving your request. Paying Proceeds We pay death proceeds in the following order: Collateral assignees, if any, have first priority; The beneficiary, if any, receives any proceeds that remain. If there is more than one beneficiary, each receives an equal share, unless you have requested another method in writing. Unless otherwise provided, to receive proceeds, a beneficiary must be living on the 10th day after the Surviving Joint Insured's death; then If there are no beneficiaries, you receive any proceeds that remain. Control of Policy Ownership As owner, you have the rights and duties outlined in this policy. However, we need the written consent of all irrevocable beneficiaries and collateral assignees, if you wish to: Surrender this policy or make a partial withdrawal; Take out a policy loan; Change the owner; Name or change a contingent owner; Add or delete a term insurance rider; Change the Face Amount; or Change the Death Benefit Option 5399 Page 20' Control of Policy We need the written consent of all irrevocable beneficiaries, if you wish to: Change a beneficiary; Choose or change a Settlement Option; or Assign this policy or any of its benefits as collateral. Your rights, as outlined in this policy, end at the Surviving Joint Insured's death. Collateral Assignment You may assign the benefits of this policy as collateral for a debt. This limits your rights to the Cash Surrender Value and the beneficiary's rights to the proceeds. A collateral assignment does not change the owner. A collateral assignee does not have ownership rights. An assignment is not binding on us until we receive written notice of it. We assume no responsibility as to the validity of any assignment. When we pay proceeds, we may rely on what the collateral assignee states as the debt due. Changing Ownership You can change the owner of this policy by sending us a written request. This is called an "absolute assignment." You transfer all your rights and duties as owner to a new owner. The new owner can then make any change the policy allows. You can also name a contingent owner who will own this policy at your death. You may name, change, or withdraw a contingent owner by sending us a written request. An absolute assignment or contingent owner request: Does not change the coverage or the beneficiary; Applies only if we receive your request; Takes effect from the date signed; Does not affect any payment we make or action we take before receiving your request; and Is not a collateral assignment. Settlement Options Settlement Options are ways of paying the proceeds of this policy. These options apply to: Payment of proceeds at death; and Proceeds payable upon full surrender of this policy for its Cash Surrender Value. Proceeds applied under a settlement option no longer earn interest at the rate applied to the Fixed Account or participate in the investment experience of the Variable Account. 85-447 Page 21 Settlement Options Choosing Options Settlement Options are chosen or withdrawn by making a written agreement with us or by sending us written notice. Our approval is needed for an option to be chosen or withdrawn. Before the Surviving Joint Insured's death, only you can choose or withdraw an option. After the Surviving Joint Insured's death, a beneficiary may choose an option depending on prior restrictions made by you or a collateral assignee. A change of beneficiary or owner withdraws all chosen options; you must choose again any options you want. We issue a supplemental contract for proceeds applied under any option. We need not accept an option where less than $2,500 will be applied for each payee. In this case, we may pay a payee's proceeds in one sum. Under an installment option, each payment must be at least $25. If needed, we may increase the time between payments to three months, six months, or a year to make each payment at least $25. Paying Proceeds We pay proceeds to a payee. A payee is one to whom we may pay part or all of the proceeds or interest. The primary payee is the first person to whom benefits are payable. If the primary payee dies before we have made all payments under Options 2, 3, or 4, we pay the remaining payments to any contingent payee. We pay the proceeds in one sum, unless one or more of the following options are requested and we agree to it. We will also use any other method of payment that is acceptable to you and to us. Under Options 2, 3, 4, and 5, we pay the first installment as of the date we issue a supplemental contract to pay the proceeds. Under Option 6, we pay the first installment at the end of the interval it applies to. Option 1 The proceeds are left with us to earn interest. The withdrawal rights, the length of time we will hold the proceeds, and any future change of option are subject to our approval. Interest is guaranteed to be at least 3.5% per year. Option 2 We pay the proceeds with interest in equal installments for the amount you choose at equal intervals until the proceeds and interest are all paid. The interval you choose may be a month, 3 months, 6 months, or a year. The amount chosen for each installment must be such that the total installments payable in any 12 months is at least 7% of the total amount of the proceeds. The last installment will be for the remaining proceeds and interest, and might not be equal to the other installments. Interest is guaranteed to be at least 3.5% per year. Option 3 We pay the proceeds in equal installments at equal intervals for the number of years you choose. The interval may be a month, three months, six months, or a year. Use the Option 3 Table to determine the amount of each installment. If you ask, we will tell you the payment amounts for numbers of years or intervals not shown. The Option 3 Table is computed assuming 3.5% interest per year. Interest is guaranteed to be at least 3.5% per year. 5400 Page 22 Settlement Options Option 3 Table Monthly Payments Number of Per $1000 Years of Proceeds 5 $18.12 10 9.83 15 7.10 20 5.75 25 4.96 Option 4 The proceeds are used to provide an annuity with 60, 120, 180, or 240 months "certain". This means that we continue paying the primary payee in equal monthly installments for as long as the primary payee lives with a number of months "certain". "Certain" means that we make payments for at least as long as the period you choose (either 60, 120, 180, or 240 months), no matter when the primary payee dies. If the primary payee dies before the "certain" period ends, the remaining payments are payable to the contingent payee. We compute the installments using the calendar year in which the proceeds are applied and the payee's sex and age at that time. We require written proof of the payee's sex and age. If you ask, we will tell you payment amounts for this option. The amount of the installments are computed using the 1983 Table a with Projection Scale G and interest at 3.5% per year. 85-448 Page 23 Settlement Options Option 5 The proceeds are used to provide a "joint and two-thirds to survivor" life income for two payees. We make monthly payments jointly to the two payees as long as they both live. When one payee dies, the other receives two-thirds of the amount of the joint monthly payment for life. Payments stop when both payees have died. We compute the payment amounts using the calendar year in which the proceeds are applied and the payees' sexes and ages when the proceeds are applied. We require written proof of the payees' ages. If you ask, we will tell you any of these amounts. The amounts of the monthly payments are computed using the 1983 Table a with Projection Scale G and interest at 3.5% per year. Option 6 (Annuity Option) The proceeds are used to provide an annuity. Each annuity installment is 103% of the payment that we would make if the payee had used the proceeds to buy a similar, nonparticipating, single premium immediate annuity at our rates on the date the proceeds are applied. We pay these installments at the end of the interval to which they apply. We will not apply this option if a similar option would be more favorable to the payee when proceeds are applied. Death of Payee Unless we have agreed otherwise, if a payee dies after we have paid or credited proceeds under Option 1, we will pay the proceeds and any unpaid interest in one sum to the payee's estate. Unless we have agreed otherwise, if a payee dies after we have paid or credited proceeds under Options 2, 3, or 4, we will pay the remaining payments to any contingent payees. If there are no contingent payees, we pay the following amounts to the primary payee's estate. Under Option 2, we will pay any unpaid sum left with us plus any unpaid interest on that sum. Under Option 3, we will pay the commuted value (based on interest at an effective annual rate of 3-1/2%) of any unpaid installments. Under Option 4, we will pay the commuted value (based on interest at an effective annual rate of 3-1/2%) of any unpaid installments remaining in the "certain" period. 5401 Page 24 Settlement Options Protection of Proceeds Unless we agree to it, a payee may not do any of the following: Withdraw any part of the proceeds or interest; Change the fixed payment intervals or the length of the payment period; Change the settlement option; Change the amount of payment; Surrender the supplemental contract for cash; Borrow against the supplemental contract; or Assign the supplemental contract. If the payee chooses Options 1, 2, or 3, the payee may change the option and transfer the funds that remain to a new option. This applies unless prevented by a written agreement with us. A payee's creditors may not claim any of the proceeds or interest. This provision applies unless altered by federal or state law. Interest on Settlement Options We base the interest rate for proceeds applied under Options 1 and 2 on the interest rate we declare on funds that we consider to be in the same classification based on the option, restrictions on withdrawal, and other factors. The interest rate will never be less than an effective annual rate of 3-1/2%. In determining amounts to be paid under Options 3 and 4, we assume interest at an effective annual rate of 3-1/2%. Also, for Option 3 and "certain" periods under Option 4, we credit any excess interest we may declare on funds that we consider to be in the same classification based on the option, restrictions on withdrawal, and other factors. General Provisions Voting of Mutual Fund Shares While this policy is in force, you have the right to instruct us how to vote the mutual fund shares attributable to this policy. All fund proxy material and forms used to give voting instructions will be sent to persons having voting interests. We will vote the mutual fund shares held in Sub-accounts according to the instructions received, as long as: The Variable Account is registered as a unit investment trust under the Investment Company Act of 1940; and The assets of the Variable Account are allocated to Sub-accounts that are invested in mutual funds shares. We may vote the mutual fund shares held in the Sub-accounts at our discretion if we determine that, because of applicable law or regulation, we do not have to vote the mutual fund shares according to the voting instructions received. If we do not receive timely voting instructions from you, we will vote the applicable mutual fund shares in proportion to the instructions which are received with respect to the other policies providing benefits related to the applicable Sub-account. The persons entitled to give voting instructions and the number of votes affected by their instructions will be determined as of a record date selected by us, not more than 90 days before the meeting of the applicable mutual fund. This policy does not give you the right to vote at meetings of our stockholders and/or policyholders. 85-449 Page 25 General Provisions Substitution of Mutual Fund Shares We reserve the right, if permitted by law and subject to the approval of the Superintendent, to: move, add, or combine Sub-accounts and make the new Sub-accounts available to you at our discretion; :li.Substitute shares of other investment funds or series thereof for those of the investment funds and series made available under the policy; Transfer assets of the ReliaStar Life Insurance Company of New York Variable Life Separate Account I which we determine to be associated with the class of contracts to which this policy belongs, to another variable account (if this type of transfer is made, the term "ReliaStar Life Insurance Company of New York Variable Life Separate Account I" as used in this policy will then mean the variable account to which the assets were transferred); Deregister the ReliaStar Life Insurance Company of New York Variable Life Separate Account I under the Investment Company Act, of 1940, if registration is no longer required; Make any changes required by the Investment Company Act of 1940; Operate the ReliaStar Life Insurance Company of New York Variable Life Separate Account I as a managed company under the Investment Company Act of 1940, or any other form permitted by law; and Restrict or eliminate any voting privileges you or other persons may have as to the ReliaStar Life Insurance Company of New York Variable Life Separate Account I. Payment of Proceeds We pay all proceeds of this policy when we receive this policy and proof of death. We make payments under Settlement Options 4, 5, and 6 only to a natural person in that person's own right. We adjust the proceeds payable on the death of the Surviving Joint Insured as follows: We refund any policy loan interest charged but not earned; We deduct any Loan Amount; and We deduct any unpaid Monthly Deductions due on or before the Surviving Joint Insured's death. As of the date of death, the proceeds no longer earn interest at the rate applied to the Fixed Account or participate in the investment experience of the Variable Account. If payment is delayed more than 10 days, we pay interest on the proceeds at death for the time between the Surviving Joint Insured's death and the earlier of the following: The date we pay proceeds; or The date we issue a supplemental contract. Interest on these funds will be the current interest rate being credited on the interest only settlement option (Option I) but it will never be less than an effective annual rate of 3.5%. Simultaneous Death If the Joint Insureds die simultaneously or in circumstances making it uncertain who is the Surviving Joint Insured, the older Joint Insured will be deemed to have been the Surviving Joint Insured, and no payment will be made for the death of the younger Joint Insured. 5402 Page 26 General Provisions Incontestability This policy has a two-year contestable period running from the Issue Date shown on the Policy Data Page. During this period, we could ask for information that could lead us to contest this policy or refuse to pay its benefits. After this policy has been in force during both Joint Insured's lifetime for two years from the Issue Date, we cannot claim your policy is void or refuse to pay any proceeds unless the policy has lapsed. If you make a Face Amount increase or premium payment which requires proof of insurability, the corresponding Death Benefit increase has its own two-year contestable period measured from the date of the increase in Death Benefit. If this policy is reinstated, this provision will be measured from the date of reinstatement. Age and Sex If any Joint Insured's age or sex is misstated, the Death Benefit will be the amount that the most recent cost of insurance would purchase using the current cost of insurance rate for the correct age and sex. Suicide If any Joint Insured commits suicide within two years of the Issue Date, we do not pay the Death Benefit. Instead, we refund all premiums paid on this policy and any attached riders, minus any Loan Amounts and partial withdrawals. If you make a Face Amount increase or premium payment which requires proof of insurability, the corresponding Death Benefit increase has its own two-year suicide limitation for the proceeds associated with that increase. If any Joint Insured commits suicide within two years of the effective date of the increase, we pay the Death Benefit prior to the increase and refund the cost of insurance for that increase. Termination This policy terminates when any of the following occur: The required payment is not paid by the end of the grace period; The Surviving Joint Insured dies; The policy is surrendered for its full Cash Surrender Value; or The policy is amended according to the Amendment provision of this policy and you do not accept the amendment. If we make a Monthly Deduction from the Accumulation Value after this policy terminates, the deduction is not considered a reinstatement of the policy or a waiver of the termination. 85-450 Page 27 General Provisions Conversion Right During the first two policy years and the first 24 months following the effective date of an increase in Face Amount, you may, by written request, convert this policy without evidence of insurability to a policy in which the benefits do not vary with the investment performance of the Variable Account. This conversion is done by transferring all or part of your Variable Accumulation Value to your Fixed Accumulation Value. You must tell us you are exercising your conversion rights when requesting the transfer. We will then waive the transfer charge and that transfer is not counted against the limit on the number of trasnfers in a policy year. You are allowed only one such transfer in each of these 24-month periods. Also, in the event of a material change in the investment policy of any Sub-account of the Variable Account, you may, by written request convert this policy to a policy in which benefits do not vary with the investment performance of the Variable Account. This conversion is done by transferring all or part of your Variable Accumulation Value to your Fixed Accumulation Value. You must tell us you are exercising your conversion rights when requesting the transfer. We will then waive the transfer charge and that transfer is not counted against the limit on the number of transfers in a policy year. The option to convert is exercisable within 60 days after the effective date of such change in the investment policy or your receipt of the notice of the change in investment policy, whichever is later. If you exercise this conversion right, we will automatically credit all future premium payments to the Fixed Account, until you specify a change in allocation. At the time of the transfer, there is no effect on the policy's Death Benefit, Accumulation Value, Face Amount, net amount at risk, rate class, or issue age. Annual Statement Each year we will send you an annual statement, free of charge, showing the following: Premiums paid; Planned periodic premiums; Interest credits; Death Benefit; Loan Amounts; Partial withdrawals; Transfers; and Charges since the last statement. We will make a charge not to exceed $50 for any additional statements you request. 5403 Page 28 General Provisions Projection Report If you ask we will provide a report projecting future results. The report will be based on the following: The Death Benefit Option you specify; Planned periodic premiums you specify; The Accumulation Value at the end of the prior policy year; and Any other assumptions specified by you or us, subject to any limitations imposed by the Securities and Exchange Commission. We will charge a fee for each report after the first report in any policy year. Nonparticipating This contract does not entitle you to participate in our surplus. Amendment We reserve the right to amend this policy to include any future changes relating to the following: Any Securities and Exchange Commission rulings and regulations; This policy's qualification for treatment as a life insurance policy under the following: The Code; Internal Revenue Service rulings and regulations; and Any requirements imposed by the Internal Revenue Service. We will send you any amendments promptly. Disclaimer We are not liable for any tax or tax penalty you owe resulting from failure to comply with the requirements of the Code, regulations and rulings imposed on this policy. 85-465 Page 29 SURVIVORSHIP FLEXIBLE PREMIUM VARIABLE LIFE INSURANCE POLICY - --------------------------------------------------- Variable and/or Fixed Accumulation Values Flexible Premiums Payable During Lifetime of Surviving Joint lnsured Adjustable Face Amount Death Benefit Guarantee Death Benefit Options Nonparticipating - ----------------------------------------------- NOTICE To make a claim or exercise your rights under this policy, please write to us at the address below and include your policy number: Writing directly to us will save time and expense. You do not need to hire any person, firm, or corporation unless, because of a dispute, you wish to. RELIASTAR RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK P. O. Box 9004 1000 Woodbury Road, Suite 102 Woodbury, NY 11797-9004 85-438 Page 30 Four Year Term Insurance Rider (FTR) This rider is a part of the base policy whose number is shown below. If not shown below, the Rider Data is shown on the Policy Data Page. Rider Data Base Policy Number Definitions Joint Insureds The persons upon whose lives this policy is issued. The Policy Data Pages list the Joint Insureds. Surviving Joint Insured The Joint Insured who remains alive after the other Joint Insured has died. You, Your The current owner(s) of the base policy. We, Us, Our ReliaStar Life Insurance Company of New York at our Home Office in Woodbury, New York. Written, In Writing A written request or notice, signed and dated, and received at our Home Office in a form we accept. You may get forms for this purpose from us. Benefits When we have written proof that the Surviving Joint Insured died while this rider was in force, we will pay the FTR Face Amount, as shown on the Policy Data Page, then in force. Beneficiary The beneficiary of the proceeds of this rider is the beneficiary of the proceeds of the base policy. When you name, add, or change a beneficiary of the base policy the change will also apply to this rider. If you assign the benefits of this rider as collateral for a debt, this limits the beneficiary's rights to the proceeds. Cost of Insurance and Monthly Amount Charges The total monthly deduction for this rider equals the sum of 1 plus 2 where: Is the Monthly Amount Charge per $1,000 (as shown on the Policy Data Page) multiplied by the FTR Face Amount divided by 1000. This chargeapplies during the Term shown on the Policy Data Page; and Is the FTR Face Amount times the monthly cost of insurance rate described on the next page. 85-453 Page 1 Cost of Insurance Rates The monthly cost of insurance rate for this rider is based on each Joint Insured's sex, issue age, and premium class as shown on the Policy Data Page, and the policy year. Issue age means age last birthday on the effective date of the coverage. We will determine monthly cost of insurance rates based upon expectations as to future cost factors. Any change in cost of insurance rates will apply to all in the same insurance class whose policies have been in force for the same period of time. The cost of insurance rates can never be greater than those shown in the Table of Monthly Guaranteed Cost of Insurance Rates as shown on the Policy Data Page. Paying Proceeds We pay proceeds in the following order: Collateral assignees, if any, have first priority; The beneficiary, if any, receives any proceeds that remain. If there is more than one beneficiary, each receives an equal share, unless you have requested another method in writing. To receive proceeds, a beneficiary must be living on the 10th day after the death of the Surviving Joint Insured under this rider; then If there are no beneficiaries, you receive any proceeds that remain Termination This rider ends: Four years after the Rider Effective Date; If the base policy is surrendered or ends; or If you ask us in writing to end this rider. In this case, we may ask that you return the policy and this rider so that we can endorse them. This rider will end on the first Monthly Anniversary Date after we receive your written request to end this rider. After this rider ends, we are not liable for its benefits, even if we have included the cost of insurance and monthly amount charges for this rider in the total monthly deduction for the base policy. We will refund any such amounts that we deduct after this rider ends. 5404 Page 2 Reinstatement If the base policy lapses, this rider will also lapse. You can reinstate this rider if: This rider was in effect when the base policy lapsed; The Rider Expiry Date has not occurred; and You reinstate the base policy. To reinstate this rider, you must do both of the following: Give us proof of each Joint Insured's insurability; and Pay a premium large enough to keep the base policy and this rider in force for at least 2 months. The base policy may be reinstated without this rider, in which case proof and payment for this rider are not needed. Age and Sex If any Joint Insured's age or sex is misstated, the Death Benefit will be the amount that the most recent cost of insurance would purchase using the current cost of insurance rates for the correct age and sex. Suicide The Suicide provision of the base policy applies to this rider from the Rider Effective Date in the same way that it applies to the base policy from the base policy's Issue Date. Incontestability If you apply for this rider with the base policy, the Incontestable provision of the base policy applies to this rider from the Rider Effective Date. During this 2-year period, we may ask for information that could lead to our contesting this rider or refusing to pay its benefits. After this rider has been in force for 2 years from the Rider Effective Date, we cannot claim this rider is void or refuse to pay any benefits with respect to the FTR Face Amount, unless this rider has lapsed for nonpayment of premiums. If this rider is reinstated, this provision will be measured from the reinstatement date with respect to statements made in the application for reinstatement. General Provisions This rider does not increase any cash or loan values of the base policy. All base policy provisions apply to this rider, unless changed by this rider. 85-454 Page 3 Policy Split Option Rider (PSO) This rider is a part of the base policy whose number is shown below. If not shown below, the Base Policy Number is shown on the Policy Data Page. Rider Data Base Policy Number Definitions Joint Insureds The persons upon whose lives this policy is issued. The Policy Data Page lists the Joint Insureds. You, Your The current owner(s) of the base policy. We, Us, Our ReliaStar Life Insurance Company of New York at our Home Office in Woodbury, New York. Written, In Writing A written request or notice, signed and dated, and received at our Home Office, in a form we accept. You may get forms for this purpose from us. Policy Split Option The owner may request to split this policy, not including any riders, into two new individual permanent life insurance policies we are then offering. One individual policy will be issued on the life of each Joint Insured. We may require evidence of insurability. The owner may request this option by notifying us in writing within 90 days following: The enactment or the effective date of a change in the federal estate tax laws that would eliminate the unlimited marital deduction or reduce by at least 50% the estate taxes payable upon death; The effective date of a final divorce decree between the Joint Insureds; or The dissolution of the business partnership of the Joint Insureds. If there is more than one owner, each owner must elect the Policy Split Option. The New Policy The Death Benefit of each individual policy cannot be greater than 50% of the base policy's Death Benefit, not including any riders. The Accumulation Value less any outstanding loan amount of the base policy will be divided equally and each portion will be applied as premiums to each of the new individual policies. 85-456 Page 1 The New Policy If one Joint Insured does not meet our insurability requirements, you may do one of the following: The individual policies will be subject to our minimum and maximum specified amounts and issue ages for the plan of insurance chosen. If one of the Joint Insureds is older than the individual policy's maximum issue age at the time the Policy Split Option is elected, our approval is needed to elect the option. The premiums for the individual policies will be based on each Joint Insured's attained age and premium rate class based on evidence of insurability submitted for this option. Premiums are payable as of the policy dates for each individual policy. The policy date for each individual policy will be the Monthly Anniversary following your written request to elect the Policy Split Option. The owner for each individual policy will be the Joint Insured whose life is insured under the individual policy, unless otherwise specified. The beneficiary for each individual policy will be the beneficiary named for the base policy, unless otherwise specified. Cost of Insurance The total monthly deduction for this rider is shown on the Policy Data Page. Policies Returned Under Free Look If you return either of the new policies under a free look or right to return policy provision, we will refund for each policy returned an amount equal to one-half of the Cash Surrender Value of the base policy plus all additional premiums paid for the new policy. General Provisions This rider does not increase any cash or loan values of the base policy. All base policy provisions apply to this rider, unless changed by this rider. Termination This rider ends: If the base policy is surrendered or ends; At age 100 of the younger Joint Insured; On the Rider Expiry Date shown on the Policy Data Page; or If you ask us in writing to end this rider. In this case, we may ask that you return the policy and this rider so that we can endorse them. This rider will end on the first Monthly Anniversary Date after e receive your written request. 5405 Page 2 Survivorship Term Rider (STR) This rider is a part of the base policy whose number is shown below. If not shown below, the Rider Data is shown on the Policy Data Page. Rider Data Base Policy Number Definitions Joint Insureds The persons upon whose lives this policy is issued. The Policy Data Pages list the Joint Insureds. Surviving Joint Insured The Joint Insured who remains alive after the other Joint Insured has died. You, Your The current owner(s) of the base policy. We, Us, Our ReliaStar Life Insurance Company of New York at our Home Office in Woodbury, New York. Written, In Writing A written request or notice, signed and dated, and received at our Home Office in a form we accept. You may get forms for this purpose from us. Benefits When we have written proof that the Surviving Joint Insured died while this rider was in force, we will pay the STR Face Amount, as shown on the Policy Data Page, then in force. Beneficiary The beneficiary of the proceeds of this rider is the beneficiary of the proceeds of the base policy. When you name, add, or change a beneficiary of the base policy the change will also apply to this rider. If you assign the benefits of this rider as collateral for a debt, this limits the beneficiary's rights to the proceeds. Cost of Insurance and Monthly Amount Charges The total monthly deduction for this rider equals the sum of 1 plus 2 where: Is the Monthly Amount Charge per $1,000 (as shown on the Policy Data Page) multiplied by the STR Face Amount divided by 1000. This charge applies during the Term shown on the Policy Data Page; and Is the STR Face Amount times the monthly cost of insurance rate described on the next page. 85-457 Page 1 Cost of Insurance Rates The monthly cost of insurance rate for this rider is based on each Joint Insured's sex, issue age, and premium class as shown on the Policy Data Page, and the policy year. Issue age means age last birthday on the effective date of the coverage. We will determine monthly cost of insurance rates based upon expectations as to future cost factors. Any change in cost of insurance rates will apply to all in the same insurance class whose policies have been in force for the same period of time. The cost of insurance rates can never be greater than those shown in the Table of Monthly Guaranteed Cost of Insurance Rates as shown on the Policy Data Page. Paying Proceeds We pay proceeds in the following order: Collateral assignees, if any, have first priority; The beneficiary, if any, receives any proceeds that remain. If there is more than one beneficiary, each receives an equal share, unless you have requested another method in writing. To receive proceeds, a beneficiary must be living on the 10th day after the death of the Surviving Joint Insured under this rider; then If there are no beneficiaries, you receive any proceeds that remain. Conversion This rider may be converted to a new survivorship flexible premium variable life insurance policy for the Joint Insureds without proof of insurability only: While both Joint Insureds are alive; While this rider is in force; and Before any Joint Insured reaches age 75. Application for conversion must be in writing. Only you may apply. If you wish to convert your policy, we may require that you send us the base policy and this rider so that we can endorse them. The New Policy The Face Amount of the new policy cannot be greater than the Face Amount of this rider. The date of the new policy will be the date of the conversion. The new policy, which will be in the same premium class as this rider, can be on any of our plans in use at the time of the conversion that: We would normally issue; Do not participate in our surplus; and Do not contain any benefits or rights involving a greater aggregate risk, relative to premium, than is insured under this rider. 5406 Page 2 Termination This rider ends: On the Rider Expiry Date shown on the Policy Data Page; If this rider is converted; If the base policy is surrendered or ends; If the Surviving Joint Insured dies; or If you ask us in writing to end this rider. In this case, we may ask that you return the policy and this rider so that we can endorse them. This rider will end on the first Monthly Anniversary Date after we receive your written request to end this rider. After this rider ends, we are not liable for its benefits, even if we have included the cost of insurance and monthly amount charges for this rider in the total monthly deduction for the base policy. We will refund any such amounts that we deduct after this rider ends. Reinstatement If the base policy lapses, this rider will also lapse. You can,reinstate this rider if: This rider was in effect when the base policy lapsed; The Rider Expiry Date has not occurred; and You reinstate the base policy. To reinstate this rider, you must do both of the following: Give us proof of each Joint Insured's insurability; and Pay a premium large enough to keep the base policy and this rider in force for at least 2 months. The base policy may be reinstated without this rider, in which case proof and payment for this rider are not needed. Age and Sex If any Joint Insured's age or sex is misstated, the Death Benefit will be the amount that the most recent cost of insurance would purchase using the current cost of insurance rates for the correct age and sex. Suicide The Suicide provision of the base policy applies to this rider from the Rider Effective Date in the same way that it applies to the base policy from the base policy's Issue Date. Incontestability If you apply for this rider with the base policy, the Incontestable provision of the base policy applies to this rider from the Rider Effective Date. During this 2-year period, we may ask for information that could lead to our contesting this rider or refusing to pay its benefits. After this rider has been in force for 2 years from the Rider Effective Date, we cannot claim this rider is void or refuse to pay any benefits with respect to the STR Face Amount, unless this rider has lapsed for nonpayment of premiums. If this rider is reinstated, this provision will be measured from the reinstatement date with respect to statements made in the application for reinstatement. General Provisions This rider does not increase any cash or loan values of the base policy. All base policy provisions apply to this rider, unless changed by this rider. 85-458 Page 3 Modification Rider This rider is a part of the base policy whose number is shown below. If not shown below, the Base Policy Number is shown on the Policy Data Page. Rider Data Base Policy Number Policies Returned Under Free Look If you return this policy under a free look or right to return policy provision, we will refund an amount equal to: One-half of the Cash Surrender Value of the Survivorship Flexible Premium Variable Life Insurance policy through which you purchased this policy under the Policy Split Option Rider, plus Any additional premiums paid for this policy. 85-461 Page 1