Common use of ADDITIONAL PREMIUM PAYMENT INFORMATION Clause in Contracts

ADDITIONAL PREMIUM PAYMENT INFORMATION. Except in the case of a contract issued as an XXX, we will accept additional premium payments until either the Annuitant or Owner reaches the Attained Age of 85. The minimum additional payment which may be made is $500.00. If this Contract is issued as an XXX, no contributions may be made for the taxable year in which you attain age 70 1/2 and thereafter (except for rollover contributions). The minimum additional payment which may be made to a contract issued as an XXX is $250.00. GA-IA-1074 3A1 <PAGE> <PAGE> THE SCHEDULE PAYMENT AND INVESTMENT INFORMATION (continued) ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Annuitant's Issue Age Annuitant's Sex Owner's Issue Age | | [55] [MALE] [35] | |------------------------------------------------------------------------ ----| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |------------------------------------------------------------------------ ----| | Contract Date Issue Date Residence Status | | [JANUARY 1, 1996] [JANUARY 1, 1996] [DELAWARE] | |------------------------------------------------------------------------ ----| | Separate Account(s) | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] | Contract Number [123456] ------------------------------------------------------------------------------ ACCUMULATION VALUE ALLOCATION RULES The maximum number of Divisions in which you may be invested at any one time is twenty. You are allowed unlimited allocation changes per Contract Year without charge. We reserve the right to impose a charge for any allocation change in excess of twelve per Contract Year. The Excess Allocation Charge is shown in the Schedule. Allocations into and out of the Guaranteed Interest Divisions are subject to restrictions (see General Account). ALLOCATION CHANGES BY TELEPHONE You may request allocation changes by telephone during our telephone request business hours. You may call our Customer Service Center at 1-800-366-0066 to make allocation changes by using the personal identification number you will receive. You may also mail any notice or request for allocation changes to our Customer Service Center at the address shown on the cover page. GA-IA-1074 3A2 <PAGE> <PAGE> THE SCHEDULE THE VARIABLE SEPARATE ACCOUNTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |------------------------------------------------------------------------ ----| | Annuitant's Issue Age Annuitant's Sex Owner's Issue Age | [55] [MALE] [35] | |------------------------------------------------------------------------ ----| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |------------------------------------------------------------------------ ----| | Contract Date Issue Date Residence Status | | [JANUARY 1, 1996] [JANUARY 1, 1996] [DELAWARE] | |------------------------------------------------------------------------ ----| | Separate Account(s) | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] Contract Number [123456] | ------------------------------------------------------------------------- ----- DIVISIONS INVESTING IN SHARES OF A MUTUAL FUND Separate Account B (the "Account") is a unit investment trust Separate Account, organized in and governed by the laws of the State of Delaware, our state of domicile. The Account is divided into Divisions. Each Division listed below invests in shares of the mutual fund portfolio (the "Series") designated. Each portfolio is a part of The GCG Trust managed by Directed Services, Inc. SERIES ------ [Multiple Allocation Fully Managed Value Equity Small Cap Capital Appreciation Rising Dividend Capital Growth Developing World Large Cap Value Growth Mid-Cap Growth SERIES ------ Real Estate Hard Assets Emerging Markets Limited Maturity Bond Liquid Assets Strategic Equity Managed Global Global Fixed Income Total Return All-Cap Investors Research Equity Income] GA-IA-1074 3B <PAGE> <PAGE> THE SCHEDULE THE GENERAL ACCOUNT ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] [123456] | ------------------------------------------------------------------------------ GENERAL ACCOUNT [Guaranteed Interest Division A Guaranteed Interest Division provides an annual minimum interest rate of 3%. At our sole discretion, we may periodically declare higher interest rates for specific Guarantee Periods. Such rates will apply to periods following the date of declaration. Any declaration will be by class and will be based on our future expectations. Limitations of Allocations We reserve the right to restrict allocations into and out of the General Account. Such limits may be dollar restrictions on allocations into the General Account or we may restrict reallocations into the General Account. Transfers from a Guaranteed Interest Division We currently require that an amount allocated to a Guarantee Period not be transferred until the Maturity Date, except pursuant to our published rules. We reserve the right not to allow amounts previously transferred from a Guaranteed Interest Division to the Variable Separate Account Divisions or to a Fixed Allocation to be transferred back to a Guaranteed Interest Division for a period of at least six months from the date of transfer. GA-IA-1074 3C <PAGE> <PAGE> THE SCHEDULE CONTRACT FACTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] [123456] | ------------------------------------------------------------------------------ CONTRACT FACTS Contract Processing Date The Contract Processing Date for your Contract is [April 1] of each year. Specially Designated Divisions When a distribution is made from an investment portfolio underlying a Separate Account Division in which reinvestment is not available, we will allocate the amount of the distribution to the [Liquid Asset Division] unless you specify otherwise. PARTIAL WITHDRAWALS The maximum amount that can be withdrawn each Contract Year without being considered an Excess Partial Withdrawal is described below. We will collect a Surrender Charge for Excess Partial Withdrawals and a charge for any unrecovered premium taxes. In no event may a Partial Withdrawal be greater than 90% of the Cash Surrender Value. After a Partial Withdrawal, the remaining Accumulation Value must be at least $100 to keep the Contract in force. Systematic Partial Withdrawals and Conventional Partial Withdrawals may not be taken in the same Contract Year. To determine the Surrender Charge on Excess Partial Withdrawals, the withdrawals will occur in the following order:

ADDITIONAL PREMIUM PAYMENT INFORMATION. Except in the case of a contract issued as an XXXIRA, we will accept additional premium payments until either the Annuitant or Owner reaches the Attained Age of 85. The minimum additional payment which may be made is $500.00. If this Contract Certificate is issued as an XXXIRA, no contributions may be made for the taxable year in which you attain age 70 1/2 and thereafter (except for rollover contributions). The minimum additional payment which may be made to a contract issued as an XXX IRA is $250.00. GA-IA-1074 CA-1074 3A1 <PAGE> <PAGE> THE SCHEDULE PAYMENT AND INVESTMENT INFORMATION (continued) ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Annuitant's Issue Age Annuitant's Sex Owner's Issue Age | | [55] [MALE] [35] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Contract Date Issue Date Residence Status | | [JANUARY 1, 1996] [JANUARY 1, 1996] [DELAWARE] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] | Contract Number [123456] | ------------------------------------------------------------------------------ ACCUMULATION VALUE ALLOCATION RULES The maximum number of Divisions in which you may be invested at any one time is twenty. You are allowed unlimited allocation changes per Contract Certificate Year without charge. We reserve the right to impose a charge for any allocation change in excess of twelve per Contract Certificate Year. The Excess Allocation Charge is shown in the Schedule. Allocations into and out of the Guaranteed Interest Divisions are subject to restrictions (see General Account). ALLOCATION CHANGES BY TELEPHONE You may request allocation changes by telephone during our telephone request business hours. You may call our Customer Service Center at 1-800-366-0066 to make allocation changes by using the personal identification number you will receive. You may also mail any notice or request for allocation changes to our Customer Service Center at the address shown on the cover page. GA-IA-1074 CA-1074 3A2 <PAGE> <PAGE> THE SCHEDULE THE VARIABLE SEPARATE ACCOUNTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |------------------------------------------------------------------------ ----| | Annuitant's Issue Age Annuitant's Sex Owner's Issue Age | [55] [MALE] [35] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |------------------------------------------------------------------------ ----| | Contract Date Issue Date Residence Status | | [JANUARY 1, 1996] [JANUARY 1, 1996] [DELAWARE] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] Contract Number [123456] | ------------------------------------------------------------------------- ----- ------------------------------------------------------------------------------ DIVISIONS INVESTING IN SHARES OF A MUTUAL FUND Separate Account B (the "Account") is a unit investment trust Separate Account, organized in and governed by the laws of the State of Delaware, our state of domicile. The Account is divided into Divisions. Each Division listed below invests in shares of the mutual fund portfolio (the "Series") designated. Each portfolio is a part of The GCG Trust managed by Directed Services, Inc. SERIES SERIES ------ ------ [Multiple Allocation Real Estate Fully Managed Hard Assets Value Equity Emerging Markets Small Cap Limited Maturity Bond Capital Appreciation Liquid Assets Rising Dividend Strategic Equity Capital Growth Managed Global Developing World Global Fixed Income Large Cap Value Total Return Growth All-Cap Mid-Cap Growth SERIES ------ Real Estate Hard Assets Emerging Markets Limited Maturity Bond Liquid Assets Strategic Equity Managed Global Global Fixed Income Total Return All-Cap Investors Research Equity Income] GA-IA-1074 CA-1074 3B <PAGE> <PAGE> THE SCHEDULE THE GENERAL ACCOUNT ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] [123456] | ------------------------------------------------------------------------------ GENERAL ACCOUNT [Guaranteed Interest Division A Guaranteed Interest Division provides an annual minimum interest rate of 3%. At our sole discretion, we may periodically declare higher interest rates for specific Guarantee Periods. Such rates will apply to periods following the date of declaration. Any declaration will be by class and will be based on our future expectations. Limitations of Allocations We reserve the right to restrict allocations into and out of the General Account. Such limits may be dollar restrictions on allocations into the General Account or we may restrict reallocations into the General Account. Transfers from a Guaranteed Interest Division We currently require that an amount allocated to a Guarantee Period not be transferred until the Maturity Date, except pursuant to our published rules. We reserve the right not to allow amounts previously transferred from a Guaranteed Interest Division to the Variable Separate Account Divisions or to a Fixed Allocation to be transferred back to a Guaranteed Interest Division for a period of at least six months from the date of transfer. .] GA-IA-1074 CA-1074 3C <PAGE> <PAGE> THE SCHEDULE CONTRACT CERTIFICATE FACTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] [123456] | ------------------------------------------------------------------------------ CONTRACT CERTIFICATE FACTS Contract Certificate Processing Date The Contract Certificate Processing Date for your Contract Certificate is [April 1] of each year. Specially Designated Divisions When a distribution is made from an investment portfolio underlying a Separate Account Division in which reinvestment is not available, we will allocate the amount of the distribution to the [Liquid Asset Division] unless you specify otherwise. PARTIAL WITHDRAWALS The maximum amount that can be withdrawn each Contract Certificate Year without being considered an Excess Partial Withdrawal is described below. We will collect a Surrender Charge for Excess Partial Withdrawals and a charge for any unrecovered premium taxes. In no event may a Partial Withdrawal be greater than 90% of the Cash Surrender Value. After a Partial Withdrawal, the remaining Accumulation Value must be at least $100 to keep the Contract Certificate in force. Systematic Partial Withdrawals and Conventional Partial Withdrawals may not be taken in the same Contract Certificate Year. To determine the Surrender Charge on Excess Partial Withdrawals, the withdrawals will occur in the following order:.

ADDITIONAL PREMIUM PAYMENT INFORMATION. Except in the case of a contract issued as an XXX, we will accept additional premium payments until either the Annuitant or Owner reaches the Attained Age of 85. The minimum additional payment which may be made is $500.00. If this Contract is issued as an XXX, no contributions may be made for the taxable year in which you attain age 70 1/2 and thereafter (except for rollover contributions). The minimum additional payment which may be made to a contract issued as an XXX is $250.00. GA-IA-1074 IA-1075 3A1 <PAGE> <PAGE> THE SCHEDULE PAYMENT AND INVESTMENT INFORMATION (continued) ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| |--------------------------------------------------------------------------| | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| |--------------------------------------------------------------------------| | Annuitant's Issue Age Annuitant's Sex Owner's Issue Age | | [55] [MALE] [35] | |------------------------------------------------------------------------ ----| |--------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |------------------------------------------------------------------------ ----| |--------------------------------------------------------------------------| | Contract Date Issue Date Residence Status | | [JANUARY January 1, 1996] [JANUARY January 1, 1996] [DELAWAREDelaware] | |------------------------------------------------------------------------ ----| |--------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNTB] | Contract Number [123456] ------------------------------------------------------------------------------ | |--------------------------------------------------------------------------| ACCUMULATION VALUE ALLOCATION RULES The maximum number of Divisions in which you may be invested at any one time is twenty. You are allowed unlimited allocation changes per Contract Year without charge. We reserve the right to impose a charge for any allocation change in excess of twelve per Contract Year. The Excess Allocation Charge is shown in the Schedule. Allocations into and out of the Guaranteed Interest Divisions are subject to restrictions (see General Account). ALLOCATION CHANGES BY TELEPHONE You may request allocation changes by telephone during our telephone request business hours. You may call our Customer Service Center at 11- 000-800000-366-0066 0000 to make allocation changes by using the personal identification number you will receive. You may also mail any notice or request for allocation changes to our Customer Service Center at the address shown on the cover page. GA-IA-1074 IA-1075 3A2 <PAGE> <PAGE> THE SCHEDULE THE VARIABLE SEPARATE ACCOUNTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ |--------------------------------------------------------------------------| | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |------------------------------------------------------------------------ ----| | Annuitant's Issue Age Annuitant's Sex Owner's Issue Age | [55] [MALE] [35] | |------------------------------------------------------------------------ ----| |--------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |------------------------------------------------------------------------ ----| | Contract Date Issue Date Residence Status | | [JANUARY 1, 1996] [JANUARY 1, 1996] [DELAWARE] | |------------------------------------------------------------------------ ----| |--------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNTB] Contract Number [123456] | ------------------------------------------------------------------------- ----- |--------------------------------------------------------------------------| DIVISIONS INVESTING IN SHARES OF A MUTUAL FUND Separate Account B (the "Account") is a unit investment trust Separate Account, organized in and governed by the laws of the State of Delaware, our state of domicile. The Account is divided into Divisions. Each Division listed below invests in shares of the mutual fund portfolio (the "Series") designated. Each portfolio is a part of The GCG Trust managed by Directed Services, Inc. SERIES ------ [Multiple Allocation Fully Managed Value Equity Small Cap Capital Appreciation Rising Dividend Capital Growth Developing World Large Cap Value Growth Mid-Cap Growth Research SERIES ------ Real Estate Hard Assets Emerging Markets Limited Maturity Bond Liquid Assets Strategic Equity Managed Global Global Fixed Income Total Return All-Cap Investors Research Equity Income] GA-IA-1074 3B <PAGE> <PAGE> IA-1075 3C THE SCHEDULE THE GENERAL ACCOUNT ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| ------------------------------------------------------------------------------- |--------------------------------------------------------------------------| | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| |--------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |----------------------------------------------------------------------------| |--------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNTB] [123456] | ------------------------------------------------------------------------------ |--------------------------------------------------------------------------| GENERAL ACCOUNT [Guaranteed Interest Division A Guaranteed Interest Division provides an annual minimum interest rate of 3%. At our sole discretion, we may periodically declare higher interest rates for specific Guarantee Periods. Such rates will apply to periods following the date of declaration. Any declaration will be by class and will be based on our future expectations. Limitations of Allocations We reserve the right to restrict allocations into and out of the General Account. Such limits may be dollar restrictions on allocations into the General Account or we may restrict reallocations into the General Account. Transfers from Guarantee Periods Each allocation to a Guaranteed Interest Division will be guaranteed an interest rate for the entire Initial Guarantee Period elected. We currently offer Initial Guarantee Periods of one, two, three, five, seven and ten years. The Initial Guarantee Period starts on the day an allocation is made to a Guaranteed Interest Division and ends on the last day of the calendar month following one, two, three, five, seven or ten year(s), as appropriate, the Maturity Date. At the end of a Guarantee Period, you may transfer the Accumulation Value in such Guarantee Period to the Variable Separate Account Divisions or to a Guarantee Period we then offer. If we do not receive notification by the Maturity Date, your Accumulation Value in the maturing Guarantee Period will automatically be transferred to a one-year Guarantee Period. Upon such automatic transfer you will have thirty days to reallocate any of your Accumulation Value to the Divisions. Deduction for Charges We do not deduct the Mortality and Expense Risk Charge and the Asset- Based Administrative Charge with respect to the amount of the Accumulation Value allocated to a Guaranteed Interest Division while such Accumulation Value remains allocated to a Guaranteed Interest Division. Transfers from the Guaranteed Interest Division On a Maturity Date, 100% of the Accumulation Value in the maturing Guarantee Period may be transferred. We currently require that an amount allocated to a Guarantee Period not be transferred until the Maturity Date, except pursuant to our published rules. We reserve the right not to allow amounts previously transferred from a Guaranteed Interest Division to the Variable Separate Account Divisions or to a Fixed Allocation to be transferred back to a the Guaranteed Interest Division for a period of at least six months from the date of transfer. We reserve the right to reduce the amount otherwise available for transfer from a Guaranteed Interest Division by any amounts previously withdrawn from that Guaranteed Interest Division. GA-IA-1074 IA-1075 3C <PAGE> <PAGE> THE SCHEDULE CONTRACT FACTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| ------------------------------------------------------------------------------- |--------------------------------------------------------------------------| | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| |--------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |----------------------------------------------------------------------------| |--------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNTB] [123456] | ------------------------------------------------------------------------------ CONTRACT FACTS Contract Processing Date The Contract Processing Date for your Contract is [April 1] of each year. Specially Designated Divisions When a distribution is made from an investment portfolio underlying a Separate Account Division in which reinvestment is not available, we will allocate the amount of the distribution to the [Liquid Asset Division] unless you specify otherwise. PARTIAL WITHDRAWALS The maximum amount that can be withdrawn each Contract Year without being considered an Excess Partial Withdrawal is described below. We will collect a Surrender Charge for Excess Partial Withdrawals and a charge for any unrecovered premium taxes. In no event may a Partial Withdrawal be greater than 90% of the Cash Surrender Value. After a Partial Withdrawal, the remaining Accumulation Value must be at least $100 to keep the Contract in force. Systematic Partial Withdrawals and Conventional Partial Withdrawals may not be taken in the same Contract Year. To determine the Surrender Charge on Excess Partial Withdrawals, the withdrawals will occur in the following order:|--------------------------------------------------------------------------|

ADDITIONAL PREMIUM PAYMENT INFORMATION. Except in the case of a contract issued as an XXX, we will accept additional premium payments until either the Annuitant or Owner reaches the Attained Age of 85. The minimum additional payment which may be made is $500.00. If this Contract is issued as an XXX, no contributions may be made for the taxable year in which you attain age 70 1/2 and thereafter (except for rollover contributions). The minimum additional payment which may be made to a contract issued as an XXX is $250.00. GA-IA-1074 3A1 <PAGE> <PAGE> THE SCHEDULE PAYMENT AND INVESTMENT INFORMATION (continued) ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Annuitant's Issue Age Annuitant's Sex Owner's Issue Age | | [55] [MALE] [35] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Contract Date Issue Date Residence Status | | [JANUARY 1, 1996] [JANUARY 1, 1996] [DELAWARE] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] | Contract Number [123456] | ------------------------------------------------------------------------------ ACCUMULATION VALUE ALLOCATION RULES The maximum number of Divisions in which you may be invested at any one time is twenty. You are allowed unlimited allocation changes per Contract Year without charge. We reserve the right to impose a charge for any allocation change in excess of twelve per Contract Year. The Excess Allocation Charge is shown in the Schedule. Allocations into and out of the Guaranteed Interest Divisions are subject to restrictions (see General Account). ALLOCATION CHANGES BY TELEPHONE You may request allocation changes by telephone during our telephone request business hours. You may call our Customer Service Center at 11- 000-800000-366-0066 0000 to make allocation changes by using the personal identification number you will receive. You may also mail any notice or request for allocation changes to our Customer Service Center at the address shown on the cover page. GA-IA-1074 3A2 <PAGE> <PAGE> THE SCHEDULE THE VARIABLE SEPARATE ACCOUNTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Annuitant's Issue Age Annuitant's Sex Owner's Issue Age | | [55] [MALE] [35] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Contract Date Issue Date Residence Status | | [JANUARY 1, 1996] [JANUARY 1, 1996] [DELAWARE] | |------------------------------------------------------------------------ ----| |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] Contract Number [123456] | ------------------------------------------------------------------------- ----- ------------------------------------------------------------------------------ DIVISIONS INVESTING IN SHARES OF A MUTUAL FUND Separate Account B (the "Account") is a unit investment trust Separate Account, organized in and governed by the laws of the State of Delaware, our state of domicile. The Account is divided into Divisions. Each Division listed below invests in shares of the mutual fund portfolio (the "Series") designated. Each portfolio is a part of The GCG Trust managed by Directed Services, Inc. SERIES SERIES ------ ------ [Multiple Allocation Real Estate Fully Managed Hard Assets Value Equity Emerging Markets Small Cap Limited Maturity Bond Capital Appreciation Liquid Assets Rising Dividend Strategic Equity Capital Growth Managed Global Developing World Global Fixed Income Large Cap Value Total Return Growth All-Cap Mid-Cap Growth SERIES ------ Real Estate Hard Assets Emerging Markets Limited Maturity Bond Liquid Assets Strategic Equity Managed Global Global Fixed Income Total Return All-Cap Investors Research Equity Income] GA-IA-1074 3B <PAGE> <PAGE> THE SCHEDULE THE GENERAL ACCOUNT ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] [123456] | ------------------------------------------------------------------------------ GENERAL ACCOUNT [Guaranteed Interest Division A Guaranteed Interest Division provides an annual minimum interest rate of 3%. At our sole discretion, we may periodically declare higher interest rates for specific Guarantee Periods. Such rates will apply to periods following the date of declaration. Any declaration will be by class and will be based on our future expectations. Limitations of Allocations We reserve the right to restrict allocations into and out of the General Account. Such limits may be dollar restrictions on allocations into the General Account or we may restrict reallocations into the General Account. Transfers from a Guaranteed Interest Division We currently require that an amount allocated to a Guarantee Period not be transferred until the Maturity Date, except pursuant to our published rules. We reserve the right not to allow amounts previously transferred from a Guaranteed Interest Division to the Variable Separate Account Divisions or to a Fixed Allocation to be transferred back to a Guaranteed Interest Division for a period of at least six months from the date of transfer. GA-IA-1074 3C <PAGE> <PAGE> THE SCHEDULE CONTRACT FACTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------| ------------------------------------------------------------------------------ | Annuitant Owner | | [XXXXXX X. XXX] [XXXX X. XXX] | |----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date| | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | |----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B AND THE FIXED ACCOUNT] [123456] | ------------------------------------------------------------------------------ CONTRACT FACTS Contract Processing Date The Contract Processing Date for your Contract is [April 1] of each year. Specially Designated Divisions When a distribution is made from an investment portfolio underlying a Separate Account Division in which reinvestment is not available, we will allocate the amount of the distribution to the [Liquid Asset Division] unless you specify otherwise. PARTIAL WITHDRAWALS The maximum amount that can be withdrawn each Contract Year without being considered an Excess Partial Withdrawal is described below. We will collect a Surrender Charge for Excess Partial Withdrawals and a charge for any unrecovered premium taxes. In no event may a Partial Withdrawal be greater than 90% of the Cash Surrender Value. After a Partial Withdrawal, the remaining Accumulation Value must be at least $100 to keep the Contract in force. Systematic Partial Withdrawals and Conventional Partial Withdrawals may not be taken in the same Contract Year. To determine the Surrender Charge on Excess Partial Withdrawals, the withdrawals will occur in the following order:------------------------------------------------------------------------------