FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT. NO DIVIDENDS. ------------------------------------------------------------------------------ Variable Cash Surrender Values while the Annuitant and Owner are living and prior to the Annuity Commencement Date. Death Benefit subject to guaranteed minimum. Partial Withdrawal Option. Non-participating. Investment results reflected in values. GA-IA-1083 THE SCHEDULE (7% DB) CONTRACT FACTS ------------------------------------------------------------------------------ |-----------------------------------------------------------------------------| | Annuitant Owner | | [THOMAS J. DOE] [JOHN Q. DOE] | |-----------------------------------------------------------------------------| | Initial Premium Annuity Option Annuity Commencement Date | | [$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | | ----------------------------------------------------------------------------| | Separate Account(s) Contract Number | | [SEPARATE ACCOUNT B] [123456] | |-----------------------------------------------------------------------------|
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Samples: Flexible Premium Deferred Variable Annuity Contract (Golden American Life Insurance Co /Ny/)
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT. NO DIVIDENDS. ------------------------------------------------------------------------------ DIVIDENDS ------------------------------------------------------------------------------- Variable Cash Surrender Values while the Annuitant and Owner are living and prior to the Annuity Commencement Date. Death Benefit subject to guaranteed minimum. Partial Withdrawal Option. Non-participating. Investment results reflected in values. GA-IA-1083 IA-1082 THE SCHEDULE (7% DB) CONTRACT FACTS ------------------------------------------------------------------------------ |-----------------------------------------------------------------------------| | Annuitant |Annuitant Owner | | [THOMAS |[THOMAS J. DOE] [JOHN Q. DOE] | | | |-----------------------------------------------------------------------------| | Initial |Initial Premium Annuity Option Annuity Commencement Date | | [$10,000Date| |[$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | | ----------------------------------------------------------------------------| | Separate |-----------------------------------------------------------------------------| |Separate Account(s) Contract Number | | [SEPARATE |[SEPARATE ACCOUNT BB AND THE FIXED ACCOUNT] [123456] | |-----------------------------------------------------------------------------||-----------------------------------------------------------------------------| CONTRACT FACTS Contract Processing Date The Contract Processing Date for your Contract is [April 1] of each year.
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FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT. NO DIVIDENDS. ------------------------------------------------------------------------------ DIVIDENDS ------------------------------------------------------------------------------- Variable Cash Surrender Values while the Annuitant and Owner are living and prior to the Annuity Commencement Date. Death Benefit subject to guaranteed minimum. Partial Withdrawal Option. Non-participating. Investment results reflected in values. GA-IA-1083 IA-1082 THE SCHEDULE (7% DB) CONTRACT FACTS ------------------------------------------------------------------------------ |-----------------------------------------------------------------------------| | Annuitant |Annuitant Owner | | [THOMAS J. DOE|[XXXXXX X. XXX] [JOHN Q. DOEXXXX X. XXX] | | | |-----------------------------------------------------------------------------| | Initial |Initial Premium Annuity Option Annuity Commencement Date | | [$10,000Date| |[$10,000] [LIFE 10-YEAR CERTAIN] [JANUARY 1, 2026] | | ----------------------------------------------------------------------------| | Separate |-----------------------------------------------------------------------------| |Separate Account(s) Contract Number | | [SEPARATE |[SEPARATE ACCOUNT BB AND THE FIXED ACCOUNT] [123456] | |-----------------------------------------------------------------------------||-----------------------------------------------------------------------------| CONTRACT FACTS Contract Processing Date The Contract Processing Date for your Contract is [April 1] of each year.
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Samples: Annuity Contract (Separate Account B of Golden American Life Insurance Co)
FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT. NO DIVIDENDS. ------------------------------------------------------------------------------ Variable Cash Surrender Values while the Annuitant and Owner are living and prior to the Annuity Commencement Date. Death Benefit subject to guaranteed minimum. Partial Withdrawal Option. Non-participating. Investment results reflected in values. GA-IA-1083 THE SCHEDULE (7% DB) CONTRACT FACTS ------------------------------------------------------------------------------ |-----------------------------------------------------------------------------| | Annuitant Owner | | [THOMAS J. DOEXXXXXX X. XXX] [JOHN Q. DOEXXXX 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] [123456] | |-----------------------------------------------------------------------------|
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