Common use of DAY RIGHT TO EXAMINE CONTRACT Clause in Contracts

DAY RIGHT TO EXAMINE CONTRACT. IF NOT SATISFIED WITH THE CONTRACT, RETURN IT TO GWL&A OR THE ANNUITY SERVICE CENTER WITHIN 10 DAYS OF RECEIVING IT. THE CONTRACT WILL BE VOID FROM THE START, AND GWL&A WILL REFUND THE GREATER OF: 1) CONTRIBUTIONS (LESS ANY SURRENDERS, WITHDRAWALS, AND DISTRIBUTIONS TAKEN DURING THE RIGHT OF CANCELLATION PERIOD); OR 2) THE ANNUITY ACCOUNT VALUE. FLEXIBLE PREMIUM VARIABLE ANNUITY. Contributions may be made until the Payout Commencement Date or until the death benefit is payable to a Beneficiary. The Owner is as shown on the Contract Data Page unless changed as provided for in this Contract. GWL&A will pay the Annuitant the first of a series of annuity payouts on the Annuity Commencement Date by applying the Owner's Annuity Account Value according to the Payout Options Provisions. Subsequent payouts will be paid on the same day of each frequency period according to the provisions of this Contract. Non-Participating. Not eligible to share in GWL&A's divisible surplus. Signed for Great-West Life & Annuity Insurance Company on the issuance of this Contract. [OBJECT OMITTED] [OBJECT OMITTED] X.X. Xxxxxx, X.X. XxXxxxxx, Secretary President and Chief Executive Officer ANNUITY INFORMATION Annuity Contract Number: 1234567 Effective Date: March 1, 2000 Status of Annuity: Non-Qualified Initial Contribution: $50,000 Annuity Commencement Date: March 1, 2010

DAY RIGHT TO EXAMINE CONTRACT. (IF THIS CONTRACT IS ISSUED AS A REPLACEMENT OF EXISTING LIFE INSURANCE OR ANNUITY COVERAGE, THE RIGHT TO EXAMINE PERIOD IS EXTENDED TO 30 DAYS FROM THE DATE OF RECEIVING IT.) IF YOU ARE NOT SATISFIED WITH THE CONTRACT, RETURN IT TO GWL&A GREAT-WEST RETIREMENT RESOURCE OPERATIONS CENTER OR THE ANNUITY SERVICE CENTER WITHIN 10 DAYS AN AGENT OF RECEIVING ITGREAT-WEST. THE CONTRACT WILL BE VOID FROM THE START, AND GWL&A GREAT-WEST WILL REFUND THE GREATER OF: 1) THE CONTRIBUTIONS (LESS ANY SURRENDERS, WITHDRAWALS, WITHDRAWALS AND DISTRIBUTIONS TAKEN DURING THE RIGHT OF CANCELLATION TO EXAMINE PERIOD); OR 2) THE ANNUITY ACCOUNT VALUE. INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY. Contributions may be made until only during the Payout Commencement Date Accumulation Period or until the death benefit is payable to a Beneficiary. The Owner is as shown on the Contract Data Page unless changed as provided for in this ContractPage. GWL&A Great-West will pay the Annuitant the first of a series of annuity payouts on the Annuity Commencement Date by applying the Owner's ’s Annuity Account Value according to the Payout Options Provisionsprovisions of this Contract. Subsequent payouts will be paid on the same day of each frequency period according to the provisions of this Contract. NonThis Contract is non-Participating. Not participating and not eligible to share in GWL&A's Great-West’s divisible surplus. Signed for Great-West Life & Annuity Insurance Company on the issuance of this Contract. [OBJECT OMITTEDXxxxxxx Xxxxxxx], [Secretary] [OBJECT OMITTED] Xxxxxxxx X.X. XxxxxxXxxxx], X.X. XxXxxxxx, Secretary [President and Chief Executive Officer Officer] ICC11-J555 ANNUITY INFORMATION OWNER INFORMATION Annuity Contract Number: 1234567 [1234567] Owner: [XXXX X. XXX] Effective Date: March [July 1, 2000 2012] Date of Birth: [April 1, 1969] Status of Annuity: [Non-Qualified Annuity ] Initial Tax ID Number: Joint Owner: Date of Birth: Tax ID Number: [000-00-0000] [XXXX X. XXX] [November 12, 1973] [###-##-####] Contribution: [$50,000 50,000] Annuity Commencement Date: [March 1, 20102014] ANNUITANT INFORMATION Annuitant: [XXXX X. XXX] Date of Birth: [March 22, 1967] Tax ID Number: [###-##-####] Contingent Annuitant: [XXXXX X. XXX] Date of Birth: [June 6, 1989] Tax ID Number: [###-##-####] BENEFICIARY INFORMATION Beneficiary: [Xxxxx Xxxxx] Date of Birth: [January 17, 1981] Tax ID Number: [###-##-####] Contingent Beneficiary: [Xxxxx Xxxxx] Date of Birth: [January 17, 1981] Tax ID Number: [###-##-####] TRANSFERS Number of Free Transfers Allowed: [12] each Contract Year Transfer Fee: $[0] for each transfer in excess of the free transfers permitted CONTRIBUTIONS Initial Contribution Amount: $[10,000] Minimum Additional Contribution: $[500] Automatic Bank Draft Plan Minimum: $[100] Maximum Total Contributions: $[1,000,000] ANNUITY PAYMENT Minimum Annuity Payment: $50 Annuity Mortality Table: [Modified Annuity 2000 Mortality Table] Assumed Interest Rate: [2.5%] MISSTATEMENT OF AGE OR SEX Interest Rate to be Applied in Adjusting for Misstatement of Age or Sex [1%] CHARGES AND DEATH BENEFIT INFORMATION

DAY RIGHT TO EXAMINE CONTRACT. IF THE CONTRACT IS ISSUED AS A REPLACEMENT OF EXISTING LIFE INSURANCE OR ANNUITY COVERAGE, THE RIGHT TO EXAMINE PERIOD IS EXTENDED TO 60 DAYS FROM THE DATE OF RECEIVING IT. IF NOT SATISFIED WITH THE CONTRACT, RETURN IT TO GWL&A FGWL&A OR THE ANNUITY SERVICE CENTER WITHIN 10 DAYS OF RECEIVING IT. THE CONTRACT WILL BE VOID FROM THE START, AND GWL&A FGWL&A WILL REFUND THE GREATER OF: 1) CONTRIBUTIONS (LESS ANY SURRENDERS, WITHDRAWALS, WITHDRAWALS AND DISTRIBUTIONS TAKEN DURING THE RIGHT OF CANCELLATION FREE LOOK PERIOD); OR 2) THE ANNUITY ACCOUNT VALUE. FLEXIBLE PREMIUM VARIABLE ANNUITY. Contributions may be made until the Payout Commencement Date or until the death benefit is payable to a Beneficiary. The Owner is as shown on the Contract Data Page unless changed as provided for in this Contract. GWL&A FGWL&A will pay the Annuitant the first of a series of annuity payouts on the Annuity Commencement Date by applying the Owner's ’s Annuity Account Value according to the Payout Options Provisions. Subsequent payouts will be paid on the same day of each frequency period according to the provisions of this Contract. Any paid-up annuity, cash surrender value or death benefits that may be available under this contract will not be less than the minimum benefits required by any statute in which this contract is delivered. Non-Participating. Not eligible to share in GWL&A's FGWL&A’s divisible surplus. Signed for First Great-West Life & Annuity Insurance Company on the issuance of this Contract. [OBJECT OMITTEDRxxxxxx Xxxxxxx,] [OBJECT OMITTEDSecretary] X.X. Xxxxxx, X.X. [W.X. XxXxxxxx, Secretary ,] [President and Chief Executive Officer Officer] J444NY (07) CONTRACT DATA PAGE ANNUITY INFORMATION OWNER INFORMATION Annuity Contract Number: 1234567 [1234567] Owner: [JXXX X. XXX] Effective Date: [March 1, 2000 2004] Date of Birth: [April 1, 1969] Status of Annuity: Non-Qualified Tax ID Number: [100-00-0000] Initial Contribution: [$50,000 50,000] Joint Owner: [JXXX X. XXX] Annuity Commencement Date: [March 1, 20102014] Date of Birth: [November 12, 1973] Tax ID Number: [###-##-####] ANNUITANT INFORMATION Contingent Annuitant: [DXXXX X. XXX] Annuitant: [JXXX X. XXX] Date of Birth: [June 6, 1989] Date of Birth: [March 22, 1967] Tax ID Number: [###-##-####] Tax ID Number: [###-##-####] BENEFICIARY INFORMATION Beneficiary: [Sxxxx Xxxxx] Date of Birth: [January 17, 1981] Tax ID Number: [###-##-####] Contingent Beneficiary: [Sxxxx Xxxxx] Date of Birth: [January 17, 1981] Tax ID Number: [###-##-####] J444NY Page 1 CHARGES AND DEATH BENEFIT INFORMATION

DAY RIGHT TO EXAMINE CONTRACT. IF NOT SATISFIED WITH THE CONTRACTWithin 10 days of the date of receipt of this Contract by the Owner, RETURN IT TO GWL&A OR THE ANNUITY SERVICE CENTER WITHIN 10 DAYS OF RECEIVING IT. THE CONTRACT WILL BE VOID FROM THE START, AND GWL&A WILL REFUND THE GREATER OF: 1) CONTRIBUTIONS (LESS ANY SURRENDERS, WITHDRAWALS, AND DISTRIBUTIONS TAKEN DURING THE RIGHT OF CANCELLATION PERIOD); OR 2) THE ANNUITY ACCOUNT VALUE. FLEXIBLE PREMIUM VARIABLE ANNUITY. Contributions it may be made returned by delivering or mailing it to SAFECO or to the agent through whom it was purchased. When this Contract is received by SAFECO, it will be voided as if it had never been in force, and SAFECO will refund the Contract Value. This may be more or less than Purchase Payments. In states where required SAFECO will refund the Purchase Payments rather than the Contract Value. SAFECO reserves the right to allocate all payments to the Money Market Sub-Account until the Payout Commencement Date expiration of 15 days from the date the first Purchase Payment is received. If SAFECO so allocates payments, SAFECO will refund the greater of Purchase Payments or until the death benefit is payable to a Beneficiary. The Owner is as shown on the Contract Data Page unless changed as provided Value. Signed for in this Contractthe Company /s/ R.A. XXXXXXX /s/ R.E. Zunkxx ---------------------------------------------- ---------------------- R.A. Xxxxxxx, Xx. GWL&A will pay the Annuitant the first of a series of annuity payouts on the Annuity Commencement Date by applying the Owner's Annuity Account Value according to the Payout Options Provisions. Subsequent payouts will be paid on the same day of each frequency period according to the provisions of this Contract. Xxxe President and Secretary R.E. Zunkxx, Xxesident BRIEF DESCRIPTION Individual Variable Annuity, Flexible Premium Deferred Annuity, Non-Participating, Monthly Income at Annuity Date, Cash Value Payable at Death of Owner before Annuity Date. Not eligible to share in GWL&A's divisible surplusVALUES PROVIDED BY THIS CONTRACT ARE BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT AND ARE, THEREFORE, VARIABLE AND NOT GUARANTEED AS TO DOLLAR AMOUNT. Signed for Great-West Life & Annuity Insurance Company on the issuance SEE SECTION D OF YOUR CONTRACT FOR DETAILS REGARDING THE SEPARATE ACCOUNT PROVISIONS. -------------------------------------------------------------------------------- LPC-412 7/93 (R) Registered trademark of this Contract. [OBJECT OMITTED] [OBJECT OMITTED] X.X. Xxxxxx, X.X. XxXxxxxx, Secretary President and Chief Executive Officer ANNUITY INFORMATION Annuity Contract Number: 1234567 Effective Date: March 1, 2000 Status of Annuity: Non-Qualified Initial Contribution: $50,000 Annuity Commencement Date: March 1, 2010SAFECO Corporation 2 INDEX

DAY RIGHT TO EXAMINE CONTRACT. IF THE CONTRACT IS ISSUED AS A REPLACEMENT OF EXISTING LIFE INSURANCE OR ANNUITY COVERAGE, THE RIGHT TO EXAMINE PERIOD IS EXTENDED TO 60 DAYS FROM THE DATE OF RECEIVING IT. IF NOT SATISFIED WITH THE CONTRACT, RETURN IT TO GWL&A FIRST GREAT-WEST OR THE ANNUITY SERVICE CENTER WITHIN 10 DAYS OF RECEIVING IT. THE CONTRACT WILL BE VOID FROM THE START, AND GWL&A FIRST GREAT-WEST WILL REFUND THE GREATER OF: 1) CONTRIBUTIONS (LESS ANY SURRENDERS, WITHDRAWALS, WITHDRAWALS AND DISTRIBUTIONS TAKEN DURING THE RIGHT OF CANCELLATION FREE LOOK PERIOD); OR 2) THE ANNUITY ACCOUNT VALUE. INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY. Contributions may be made until only during the Payout Commencement Date Accumulation Period or until the death benefit is payable to a Beneficiary. The Owner is as shown on the Contract Data Page unless changed as provided for in this ContractPage. GWL&A First Great-West will pay the Annuitant the first of a series of annuity payouts on the Annuity Commencement Date by applying the Owner's ’s Annuity Account Value according to the Payout Options Provisionsprovisions of this Contract. Subsequent payouts will be paid on the same day of each frequency period according to the provisions of this Contract. NonThis Contract is non-Participating. Not participating and not eligible to share in GWL&A's First Great-West’s divisible surplus. Signed for First Great-West Life & Annuity Insurance Company on the issuance of this Contract. [OBJECT OMITTED[ ] [ ] [OBJECT OMITTEDXxxxxxx Xxxxxxx], [Xxxxxxxx X.X. Xxxxx], [Secretary] X.X. Xxxxxx, X.X. XxXxxxxx, Secretary [President and Chief Executive Officer Officer] ANNUITY INFORMATION OWNER INFORMATION Annuity Contract Number: 1234567 [1234567] Owner: [XXXX X. XXX] Effective Date: March [July 1, 2000 2012] Date of Birth: [April 1, 1969] Status of Annuity: [Non-Qualified Annuity ] Tax ID Number: [000-00-0000] Initial Contribution: [$50,000 50,000] Joint Owner: [XXXX X. XXX] Annuity Commencement Date: [March 1, 20102014] Date of Birth: [November 12, 1973] Maximum Annuitization Age: 90 years Tax ID Number: [###-##-####] ANNUITANT INFORMATION Annuitant: [XXXX X. XXX] Date of Birth: [March 22, 1967] Tax ID Number: [###-##-####] Contingent Annuitant: [XXXXX X. XXX] Date of Birth: [June 6, 1989] Tax ID Number: [###-##-####] BENEFICIARY INFORMATION Beneficiary: [Xxxxx Xxxxx] Date of Birth: [January 17, 1981] Tax ID Number: [###-##-####] Contingent Beneficiary: [Xxxxx Xxxxx] Date of Birth: [January 17, 1981] Tax ID Number: [###-##-####] J555-NY CHARGES AND DEATH BENEFIT INFORMATION

DAY RIGHT TO EXAMINE CONTRACT. IF THE CONTRACT IS ISSUED AS A REPLACEMENT OF EXISTING LIFE INSURANCE OR ANNUITY COVERAGE, THE RIGHT TO EXAMINE PERIOD IS EXTENDED TO 60 DAYS FROM THE DATE OF RECEIVING IT. IF NOT SATISFIED WITH THE CONTRACT, RETURN IT TO GWL&A FGWL&A OR THE ANNUITY SERVICE CENTER WITHIN 10 DAYS OF RECEIVING IT. THE CONTRACT WILL BE VOID FROM THE START, AND GWL&A FGWL&A WILL REFUND THE GREATER OF: 1) CONTRIBUTIONS (LESS ANY SURRENDERS, WITHDRAWALS, WITHDRAWALS AND DISTRIBUTIONS TAKEN DURING THE RIGHT OF CANCELLATION FREE LOOK PERIOD); OR 2) THE ANNUITY ACCOUNT VALUE. FLEXIBLE PREMIUM VARIABLE ANNUITY. Contributions may be made until the Payout Commencement Date or until the death benefit is payable to a Beneficiary. The Owner is as shown on the Contract Data Page unless changed as provided for in this Contract. GWL&A FGWL&A will pay the Annuitant the first of a series of annuity payouts on the Annuity Commencement Date by applying the Owner's ’s Annuity Account Value according to the Payout Options Provisions. Subsequent payouts will be paid on the same day of each frequency period according to the provisions of this Contract. Any paid-up annuity, cash surrender value or death benefits that may be available under this contract will not be less than the minimum benefits required by any statute in which this contract is delivered. Non-Participating. Not eligible to share in GWL&A's FGWL&A’s divisible surplus. Signed for First Great-West Life & Annuity Insurance Company on the issuance of this Contract. [OBJECT OMITTED] [OBJECT OMITTED] X.X. Xxxxxx, X.X. XxXxxxxx, Secretary President and Chief Executive Officer ANNUITY INFORMATION Annuity Contract Number: 1234567 Effective Date: March 1, 2000 Status of Annuity: Non-Qualified Initial Contribution: $50,000 Annuity Commencement Date: March 1, 2010]