Common use of Additional Details Clause in Contracts

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 Correspondence 5 Beneficiaries 5 Assignment 6 Qualified Domestic Relations Orders 6 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 Supplemental Information 7 Certificate Errors and Replacement Certificate 7 Entire Contract 7 Rights of Payees 7 Prudential Telephone Number 7 Deductions from Annuity Payments 8 Additional Details 8 Appendix 1.3 - 9 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Trust, a New York trust]A [Name of Plan: ] A [Vita Salaried Retirement Plan]A Group Annuity Contract Number: [Article P of GA-300] A Form of Annuity: Spousal Joint and Survivor Life Annuity Annuity Riders: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Death Benefit RiderNone] A

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete Appendix 1.3 - 27 description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 2 Correspondence 5 2 Beneficiaries 5 3 Assignment 6 3 Qualified Domestic Relations Orders 6 3 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 3 Misstatements 3 Supplemental Information 7 4 Certificate Errors and Replacement Certificate 7 4 Entire Contract 7 4 Rights of Payees 7 4 Prudential Telephone Number 7 5 Deductions from Annuity Payments 8 5 Additional Details 8 5 Appendix 1.3 - 9 28 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Trust, a New York trust]A [Name of Plan: ] A [Vita Salaried Retirement Plan]A Group Annuity Contract Number: [Article P of GA-300] A Form of Annuity: Spousal Joint and Survivor Window Single Life Annuity Annuity Riders: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Refund Death Benefit RiderNone] A Annuity Commencement Date: [Date] A [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A [Maximum Refund Death Benefit: ]A [$XXX.XX] A [Beneficiary(ies): ] A [Names(s)/As shown on Prudential's records] A [Share(s)] A

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 Correspondence 5 Beneficiaries 5 6 Assignment 6 Qualified Domestic Relations Orders 6 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 Supplemental Information 7 Certificate Errors and Replacement Certificate 7 Entire Contract 7 8 Rights of Payees 7 8 Prudential Telephone Number 7 8 Deductions from Annuity Payments 8 Additional Details 8 Appendix 1.3 - OCC-RL300-SingleLife 9 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Single Life Annuity CONFIDENTIAL Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Employes Pension Trust, a New York trust]A [Name of Plan: ] A [Vita Retirement Program for Salaried Retirement Plan]A Employees]A Group Annuity Contract Number: [Amended and Restated Article P of Group Annuity Contract GA-300] A Form of Annuity: Spousal Joint and Survivor Life Period Certain Annuity Annuity RidersCommencement Date: [Special Benefit RiderLevel Benefit Rider PopDate] A [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A Guaranteed Number of Payments [#] A Beneficiary(ies): [Name(s)/As shown on Prudential's records] A [Shares(s)] A OCC-Up RiderRefund Death Benefit RiderNone] ARL300-PeriodCertain Period Certain Annuity CONFIDENTIAL This Certificate describes the monthly payments irrevocably guaranteed to you by The Prudential Insurance Company of America ("Prudential") under the Group Annuity Contract referred to above (the "Contract"). Prudential will make the payments owed by it under the Contract when those payments are due.

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: OCC-RL300-WindowSingleLife 5 Window Single Life Annuity CONFIDENTIAL Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 2 Correspondence 5 3 Beneficiaries 5 3 Assignment 6 3 Qualified Domestic Relations Orders 6 3 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 3 Misstatements 4 Supplemental Information 7 4 Certificate Errors and Replacement Certificate 7 4 Entire Contract 7 5 Rights of Payees 7 5 Prudential Telephone Number 7 5 Deductions from Annuity Payments 8 5 Additional Details 8 Appendix 1.3 - 9 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information 5 OCC-RL300-WindowSingleLife 6 Window Single Life Annuity CONFIDENTIAL CONFIDENTIAL Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Employes Pension Trust, a New York trust]A [Name of Plan: ] A [Vita Retirement Program for Salaried Retirement Plan]A Employees]A Group Annuity Contract Number: [Amended and Restated Article P of Group Annuity Contract GA-300] A Form of Annuity: Window Spousal Joint and Survivor Life Annuity Annuity Riders: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Refund Death Benefit RiderNone] A Annuity Commencement Date: [Date] A [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A [Contingent Life: ] A [Contingent Life Name] A [Contingent Life's Sex and Date of Birth: ]A [Male/Female, Date] A [Contingent Life Amount: ]A [$XXX.XX] A [Total Plan Refund Death Benefit:] A [$XXX.XX] A [Pre 1985 Death Benefit Percentage:] A [XX.XX%] A [Beneficiary(ies): ] A [Names(s)/As shown on Prudential's records] A [Share(s)] A

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 2 Correspondence 5 2 Beneficiaries 5 3 Assignment 6 3 Qualified Domestic Relations Orders 6 3 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 3 Misstatements 3 Supplemental Information 7 4 Certificate Errors and Replacement Certificate 7 4 Entire Contract 7 4 Rights of Payees 7 4 Prudential Telephone Number 7 5 Deductions from Annuity Payments 8 5 Additional Details 8 5 Appendix 1.3 - 9 23 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Trust, a New York trust]A [Name of Plan: ] A [Vita Salaried Retirement Plan]A Group Annuity Contract Number: [Article P of GA-300] A Form of Annuity: Spousal Joint and Survivor Life Period Certain Annuity Annuity RidersCommencement Date: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Death Benefit RiderNoneDate] AA [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A Guaranteed Number of Payments [#] A Beneficiary(ies): [Name(s)/As shown on Prudential's records] A [Shares(s)] A [The benefits of the policy providing your coverage are governed primarily by the law of a state other than Florida.]B Prudential's Guarantee: This Certificate describes the monthly payments irrevocably guaranteed to you by The Prudential Insurance Company of America ("Prudential") under the Group Annuity Contract referred to above (the "Contract"). Prudential will make the payments owed by it under the Contract when those payments are due. Definitions & References:

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 2 Correspondence 5 2 Beneficiaries 5 3 Assignment 6 3 Qualified Domestic Relations Orders 6 3 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 3 Misstatements 3 Supplemental Information 7 4 Certificate Errors and Replacement Certificate 7 4 Entire Contract 7 4 Rights of Payees 7 4 Prudential Telephone Number 7 5 Deductions from Annuity Payments 8 5 Additional Details 8 Appendix 1.3 - 9 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information 5 OCC-RL300-LifePeriodCertain 5 Single Life and Period Certain Annuity CONFIDENTIAL Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Employes Pension Trust, a New York trust]A [Name of Plan: ] A [Vita Retirement Program for Salaried Retirement Plan]A Employees]A Group Annuity Contract Number: [Amended and Restated Article P of Group Annuity Contract GA-300] A Form of Annuity: Spousal Contingent Joint and Survivor Life Annuity Annuity Riders: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Refund Death Benefit RiderNone] A

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: OCC-RL300-SpousalJ&S 10 Spousal Joint and Survivor Life Annuity CONFIDENTIAL Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 6 Correspondence 5 7 Beneficiaries 5 7 Assignment 6 7 Qualified Domestic Relations Orders 6 7 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 7 Misstatements 8 Supplemental Information 7 8 Certificate Errors and Replacement Certificate 7 9 Entire Contract 7 9 Rights of Payees 7 9 Prudential Telephone Number 7 9 Deductions from Annuity Payments 8 9 Additional Details 8 Appendix 1.3 - 9 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information 11 OCC-RL300-SpousalJ&S 11 Spousal Joint and Survivor Life Annuity CONFIDENTIAL Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Employes Pension Trust, a New York trust]A [Name of Plan: ] A [Vita Retirement Program for Salaried Retirement Plan]A Employees]A Group Annuity Contract Number: [Amended and Restated Article P of Group Annuity Contract GA-300] A Form of Annuity: Spousal Joint and Survivor Single Life Annuity Annuity Riders: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Death Benefit RiderNone] AA Conversion Options: [Post-Retirement Marriage Conversion OptionDisabled Age 55 Conversion OptionNone] A Annuity Commencement Date: [Date] A [Original Retirement Date: ] A [Date] A [Covered Life Amount: ] A [See “Payment Terms” Provision ] A [Pre 62+1 Pension Amount] A [$XXX.XX subject to stated limitations] A [Post 62+1 Pension Amount] A [$XXX.XX subject to stated limitations] A [Total Plan Refund Death Benefit: ] A [$XXX.XX] A [Pre 1985 Death Benefit Percentage:] A [XX.XX%] A OCC-RL300-SingleLife Single Life Annuity CONFIDENTIAL [Beneficiary(ies): ] A [Name(s)/As shown on Prudential's records] A [Shares(s)] A [Part A Basic Amount: ] A [$XXX.XX] A [Pre 1985 Covered Life Part B Primary Amount: ] A [$XXX.XX] A [Post 1985 Covered Life Part B Primary Amount: ] A [$XXX.XX] A [Contingent Life: ] A [Contingent Life Name] A [Contingent Life's Sex and Date of Birth: ] A [Male/Female, Date] A [Contingent Life Level Benefit Rider Eligibility] A [Yes/No] A [Disability Temporary Amount] A [$XXX.XX] A [Disability Age 55 Pre 62+1 Pension Amount] A [$XXX.XX subject to stated limitations] A [Disability Age 55 Post 62+1 Pension Amount] A [$XXX.XX subject to stated limitations] A [Special Benefit Amount] A [$XXX.XX] A [Level Benefit Amount] A [$XXX.XX subject to stated limitations] A [Retired from Vested Terminated Status?]A [Yes/No]A OCC-RL300-SingleLife 2 Single Life Annuity CONFIDENTIAL This Certificate describes the monthly payments irrevocably guaranteed to you by The Prudential Insurance Company of America ("Prudential") under the Group Annuity Contract referred to above (the "Contract"). Prudential will make the payments owed by it under the Contract when those payments are due. We do not owe any payments to anyone under this Annuity Form if you have died before the Annuity Commencement Date.

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: OCC-RL300-WindowJ&S 6 Window Spousal J&S Life Annuity CONFIDENTIAL Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 3 Correspondence 5 3 Beneficiaries 5 3 Assignment 6 3 Qualified Domestic Relations Orders 6 4 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 4 Misstatements 4 Supplemental Information 7 4 Certificate Errors and Replacement Certificate 7 5 Entire Contract 7 5 Rights of Payees 7 5 Prudential Telephone Number 7 5 Deductions from Annuity Payments 8 5 Additional Details 8 Appendix 1.3 - 9 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information 6 OCC-RL300-WindowJ&S 7 Window Spousal J&S Life Annuity CONFIDENTIAL Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Employes Pension Trust, a New York trust]A [Name of Plan: ] A [Vita Retirement Program for Salaried Employees Retirement Plan]A Group Annuity Contract Number: [Amended and Restated Article P of GA-300Group Annuity ContractGA-300] A Form of Annuity: Spousal Joint and Survivor Life Annuity Annuity Riders: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Death Benefit RiderNone] A

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 2 Correspondence 5 2 Beneficiaries 5 3 Assignment 6 3 Qualified Domestic Relations Orders 6 3 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 3 Misstatements 3 Supplemental Information 7 4 Certificate Errors and Replacement Certificate 7 4 Entire Contract 7 4 Rights of Payees 7 4 Prudential Telephone Number 7 5 Deductions from Annuity Payments 8 5 Additional Details 8 Appendix 1.3 - 9 5 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Appendix 1.3 - 24 Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Trust, a New York trust]A [Name of Plan: ] A [Vita Salaried Retirement Plan]A Group Annuity Contract Number: [Article P of GA-300] A Form of Annuity: Spousal Joint and Survivor Life Period Certain Annuity Annuity RidersCommencement Date: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Death Benefit RiderNoneDate] AA [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A Guaranteed Number of Payments [#] A Beneficiary(ies): [Name(s)/As shown on Prudential's records] A [Shares(s)] A [The benefits of the policy providing your coverage are governed primarily by the law of a state other than Florida.]B Prudential's Guarantee: This Certificate describes the monthly payments irrevocably guaranteed to you by The Prudential Insurance Company of America ("Prudential") under the Group Annuity Contract referred to above (the "Contract"). Prudential will make the payments owed by it under the Contract when those payments are due. Definitions & References:

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. INDEX: Appendix 1.3 - 8 INDEX: 28 Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 2 Correspondence 5 2 Beneficiaries 5 3 Assignment 6 3 Qualified Domestic Relations Orders 6 3 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 3 Misstatements 3 Supplemental Information 7 4 Certificate Errors and Replacement Certificate 7 4 Entire Contract 7 4 Rights of Payees 7 4 Prudential Telephone Number 7 5 Deductions from Annuity Payments 8 5 Additional Details 8 Appendix 1.3 - 9 5 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Appendix 1.3 - 29 Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Trust, a New York trust]A [Name of Plan: ] A [Vita Salaried Retirement Plan]A Group Annuity Contract Number: [Article P of GA-300] A Form of Annuity: Spousal Joint and Survivor Window Single Life Annuity Annuity Riders: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Refund Death Benefit RiderNone] A Annuity Commencement Date: [Date] A [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A [Maximum Refund Death Benefit: ]A [$XXX.XX] A [Beneficiary(ies): ] A [Names(s)/As shown on Prudential's records] A [Share(s)] A

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. Appendix 1.3 - 8 INDEX: Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 Correspondence 5 6 Beneficiaries 5 6 Assignment 6 Qualified Domestic Relations Orders 6 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 7 Misstatements 7 Supplemental Information 7 Certificate Errors and Replacement Certificate 7 8 Entire Contract 7 8 Rights of Payees 7 8 Prudential Telephone Number 7 8 Deductions from Annuity Payments 8 Additional Details 8 Appendix 1.3 - 9 18 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Trust, a New York trust]A [Name of Plan: ] A [Vita Salaried Retirement Plan]A Group Annuity Contract Number: [Article P of GA-300] A Form of Annuity: Spousal Joint Single Life and Survivor Life Period Certain Annuity Annuity RidersCommencement Date: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Death Benefit RiderNoneDate] AA [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A Guaranteed Number of Payments [#] A Beneficiary(ies): [Name(s)/As shown on Prudential's records] A [Shares(s)] A [The benefits of the policy providing your coverage are governed primarily by the law of a state other than Florida.]B Appendix 1.3 - 19

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. INDEX: Appendix 1.3 - 8 INDEX: 18 Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 Correspondence 5 6 Beneficiaries 5 6 Assignment 6 Qualified Domestic Relations Orders 6 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 7 Misstatements 7 Supplemental Information 7 Certificate Errors and Replacement Certificate 7 8 Entire Contract 7 8 Rights of Payees 7 8 Prudential Telephone Number 7 8 Deductions from Annuity Payments 8 Additional Details 8 Appendix 1.3 - 9 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Appendix 1.3 - 19 Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Trust, a New York trust]A [Name of Plan: ] A [Vita Salaried Retirement Plan]A Group Annuity Contract Number: [Article P of GA-300] A Form of Annuity: Spousal Joint Single Life and Survivor Life Period Certain Annuity Annuity RidersCommencement Date: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Death Benefit RiderNoneDate] AA [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A Guaranteed Number of Payments [#] A Beneficiary(ies): [Name(s)/As shown on Prudential's records] A [Shares(s)] A [The benefits of the policy providing your coverage are governed primarily by the law of a state other than Florida.]B Prudential's Guarantee: This Certificate describes the monthly payments irrevocably guaranteed to you by The Prudential Insurance Company of America ("Prudential") under the Group Annuity Contract referred to above (the "Contract"). Prudential will make the payments owed by it under the Contract when those payments are due. Definitions & References:

Additional Details. This Certificate contains a summary of certain important terms of the Contract. The Contract contains a more complete description of your rights and Prudential's obligations. The Contract will control in the event of a conflict between the terms of this Certificate and the terms of the Contract. Upon a change in the requirements of applicable law or a regulation administered by a governmental agency, we may change the Contract and/or this Certificate. If a change is made, it may be done without the consent of the Payee. Any change will be made only as strictly necessary to satisfy the requirements of law or regulation. INDEX: Appendix 1.3 - 8 INDEX: 33 Annuity Certificate Section: Page Number Table of Information 1 Prudential's Guarantee 2 Definitions & References 2 Payment Terms 2 Method of Payment 5 2 Correspondence 5 3 Beneficiaries 5 3 Assignment 6 3 Qualified Domestic Relations Orders 6 3 Reliance Upon Affidavit or Other Evidence 6 Misstatements, 6 3 Misstatements 3 Supplemental Information 7 4 Certificate Errors and Replacement Certificate 7 4 Entire Contract 7 5 Rights of Payees 7 5 Prudential Telephone Number 7 5 Deductions from Annuity Payments 8 5 Additional Details 8 Appendix 1.3 - 9 5 THE PRUDENTIAL INSURANCE COMPANY OF AMERICA Newark, New Jersey ANNUITY CERTIFICATE Table of Information Appendix 1.3 - 34 Covered Life: [Covered Life Name] A Covered Life's Sex and Date of Birth: [Male/Female, Date] A Annuity Certificate Number: [Certificate Number] A [Contract-Holder: ] A [NAME OF TRUST BANK, as Directed Trustee of the Vita Salaried Retirement Trust, a New York trust]A [Name of Plan: ] A [Vita Salaried Retirement Plan]A Group Annuity Contract Number: [Article P of GA-300] A Form of Annuity: Window Spousal Contingent Joint and Survivor Life Annuity Annuity Riders: [Special Benefit RiderLevel Benefit Rider Pop-Up RiderRefund Refund Death Benefit RiderNone] AA Annuity Commencement Date: [Date] A [Original Retirement Date: ] A [Date] A Covered Life Amount: [$XXX.XX subject to stated limitations] A [Contingent Life: ] A [Contingent Life Name] A [Contingent Life's Sex and Date of Birth: ]A [Male/Female, Date] A [Contingent Life Amount: ]A [$XXX.XX] A [Maximum Refund Death Benefit: ]A [$XXX.XX] A [Beneficiary(ies): ] A [Names(s)/As shown on Prudential's records] A [Share(s)] A [Pre-1985 Covered Life Part B Primary Amount: ] A [$XXX.XX] A [Post-1985 Covered Life Part B Primary Amount] A [$XXX.XX] A [Pre-1985 Contingent Life Part B Primary Amount] A [$XXX.XX] A [Post-1985 Contingent Life Part B Primary Amount] A [$XXX.XX] A [The benefits of the policy providing your coverage are governed primarily by the law of a state other than Florida.]B Prudential's Guarantee: This Certificate describes the monthly payments irrevocably guaranteed to you by The Prudential Insurance Company of America ("Prudential") under the Group Annuity Contract referred to above (the "Contract"). Prudential will make the Appendix 1.3 - 35 payments owed by it under the Contract when those payments are due. We do not owe any payments to anyone under this Annuity Form if you have died before the Annuity Commencement Date. Definitions & References: