SPECIAL AND PRORATA PARTIAL WITHDRAWAL ADJUSTMENTS. For any partial withdrawal, the Death Benefit components will be reduced by Prorata Partial Withdrawal Adjustments. A Prorata Partial Withdrawal Adjustment will be made unless a Special Partial Withdrawal Adjustment applies to the component for the withdrawal. Special Partial Withdrawal Adjustments are made when partial withdrawals in any Contract Year do not exceed [7%] of the sum of cumulative premiums, but only if partial withdrawals in each prior year did not exceed [7%] of the sum of premiums paid prior to that year. The Special Partial Withdrawal Adjustment is equal to the amount of the Accumulation Value withdrawn. GA-IA-1083 3D4 THE SCHEDULE CONTRACT FACTS (continued) ------------------------------------------------------------------------------ |-----------------------------------------------------------------------------| | 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] | |-----------------------------------------------------------------------------| Special Partial Withdrawal Adjustments are applicable only in the calculation of the Maximum Guaranteed Death Benefit and the Guaranteed Death Benefit Base, and in all other cases withdrawals are treated as Prorata Partial Withdrawal Adjustments. The Prorata Partial Withdrawal Adjustment to a Death Benefit component for a partial withdrawal is equal to (1) divided by (2), ) multiplied by (3), where: (1) is the Accumulation Value withdrawn; (2) is the Accumulation Value immediately prior to withdrawal; and (3) is the amount of the applicable Death Benefit component immediately prior to the withdrawal. Separate adjustments will apply to the amounts in the Special and non-Special Funds.. CHANGE OF OWNER --------------- A change of Owner will result in recalculation of the Death Benefit and the Guaranteed Death Benefit. If the Owner's or the oldest of multiple Owners' attained age at the time of the change is less than [85], the Guaranteed Death Benefit in effect prior to the change will remain in effect and the Death Benefit provision shall apply. If any owner's or oldest multiple owners attained age is [86] or greater at the time of the change, the Guaranteed Death Benefit will be zero, and the Death Benefit will then be the Cash Surrender Value. SPOUSAL CONTINUATION UPON DEATH OF OWNER ---------------------------------------- If at the Owner's death, the surviving spouse of the deceased Owner is the Beneficiary and such surviving spouse elects to continue the Contract as their own pursuant to Internal Revenue Code Section 72(s) or the equivalent provisions of U.S. Treasury Department rules for qualified plans, the following will apply: (a) If the Guaranteed Death Benefit as of the date we receive due proof of death of the Owner, minus the Accumulation Value, also as of that date, is greater than zero, we will add such difference to the Accumulation Value. Such addition will be allocated to the divisions of the Separate Account in the same proportion as the Accumulation Value in each division bears to the Accumulation Value in the Separate Account. If there is no Accumulation Value in the Separate Account, the addition will be allocated to the Liquid Asset division, or its successor. (b) The Guaranteed Death Benefit will continue to apply, with all age criteria using the surviving spouse's age as the determining age. (c) At subsequent surrender, any surrender charge applicable to premiums paid prior to the date we receive due proof of death of the Owner will be waived. Any premiums paid later will be subject to any applicable surrender charge. This addition to Accumulation Value is available only to the spouse of the Owner as of the date of death of the Owner if such spouse under the provisions if this Contract elects to continue the Contract as their own. DEDUCTIONS FROM THE DIVISIONS ----------------------------- MORTALITY AND EXPENSE RISK CHARGE - We deduct a charge from the assets in each Separate Account division on a daily basis of not more than [0.004002%] (equivalent to an annual maximum rate of [1.45%]) for mortality and expense risks. The charge is not deducted from the Fixed Account or General Account accumulation values. RESTRICTED FUNDS Restricted Funds are subject to limits as to amounts which may be invested or transferred into such divisions. The designation of a division as a Restricted Fund may be changed upon 30 days notice to the Owner with regard to future transfers and premium payments into such division. When a new division is made available it may be designated as a Restricted Fund. If so designated, the rules regarding its restrictions will be sent to the Owner. Also listed below are the total Contract limits for Restricted Funds. Listed below are the total Contract limits for Restricted Funds. 103 THRESHOLDS -------------------------------------------------------------------------------- MAXIMUM ALLOCATION % OF MAXIMUM ACCUMULATION VALUE PREMIUM % DOLLAR CAP ------------------ --------- ---------- Contract Limits [30%] [99.999%] [$9,999,999] THRESHOLDS ---------- Each Restricted Fund has one or more thresholds at which point no further amounts may be allocated to that division. Compliance with a threshold is verified whenever there is a transaction initiated which is subject to such threshold (premium payments, transfers, withdrawals). A threshold is applied to the total Accumulation Value of each Restricted Fund. Thresholds may be changed by the Company for new premiums, transfers or withdrawals by Restricted Fund upon 30 day notice. DOLLAR CAP ---------- The Dollar Cap is the dollar amount at which no further Accumulation Value may be added to Restricted Funds. PREMIUM THRESHOLD ----------------- The threshold for premium by Restricted Fund limits the amount of any premium which may be allocated to that division. Should a request for allocation to a Restricted Fund exceed the limit in effect for that division or for the Contract, any excess over that amount shall be allocated prorata to any non-Restricted Fund(s) in which the Contract is then invested. Should the Contract not be invested in other non-Restricted Funds, the excess will be invested in the Specially Designated Division unless we receive written instructions to do otherwise. Premium allocations must also satisfy the Allocation Threshold. ALLOCATION THRESHOLD -------------------- Allocations into a Restricted Fund are limited to that amount such that the Accumulation Value in that Restricted Fund after such allocation does not exceed the threshold for that division and does not cause the Contract's total limit on allocation to Restricted Funds to be exceeded. If the amount of an allocation would cause either limit to be exceeded, the allocation will only be executed to the extent the lower limit would allow. Allocations from a Restricted Fund will be allowed even if the amount remaining in the Restricted Fund after an allocation exceeds the Allocation Threshold. If a program of allocations over time is authorized by us, verification of the threshold will be performed at the initiation of such program. If such program is modified at a later date, a testing of thresholds will be done at that time. THRESHOLDS - EFFECT ON WITHDRAWALS ---------------------------------- If a withdrawal is requested while any Accumulation Value is allocated to Restricted Funds and the Allocation Threshold percentage is currently exceeded, the percentage for funds invested in Restricted Funds for the total Contract, after taking into account the withdrawal, may not be higher than prior to the withdrawal. Should the calculated effect of a withdrawal result in the total Contract threshold being exceeded, the excess portion of the withdrawal will be processed prorata from all variable divisions. Systematic withdrawals, while the Contract has investments in Restricted Funds, if not withdrawn prorata from all divisions, shall be monitored annually to assure threshold compliance. Should the effect of such withdrawals cause a Restricted Fund to exceed its threshold, the divisions from which the withdrawals are processed may be adjusted to assure that the percentage of Accumulation Value in the Restricted Funds does not increase. 104 THRESHOLD PROCESSING -------------------- For the purpose of calculating any thresholds, the values for the divisions will be determined using the prior day's closing index of investment experience. All other provisions of the Contract to which this Endorsement is attached remain unchanged. Signed: /s/ Xxxxxxx Xxxxxxx ----------------- Xxxxxxx Xxxxxxx 105

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Samples: Golden American Life Insurance Co /Ny/