Contract Data BENEFICIARY Clause Samples

Contract Data BENEFICIARY. As stated in the application or in any subsequent agreements, amendments, or endorsements. The Annuitant Male 9999999 ▇▇▇▇ ▇▇▇ July 01, 2002 July 01, 2032 $5.65 per $1,000 of maturity proceeds 120 Months Section 1. Contract Data (Continued) DATE PREPARED: 07/01/2002 ANNUITANT CONTRACT NUMBER ▇▇▇▇ ▇▇▇ 9999999 ANNUAL PREMIUMS FORM NO. BENEFIT DESCRIPTION AMOUNT PAYABLE --------- ------------------------- ----------- ------ J159 Flexible Premium $25,000 To age 65* Variable Annuity Contract Nonparticipating TOTAL ANNUAL PREMIUM $25,000 * Premiums are payable according to the flexible premium provision of this contract.