NOTICE PURSUANT TO SCHEDULE C OF PARTICIPATION AGREEMENT
To: General Counsel c/o
Xxxxx Xxx (Xxxx@xxx.xxx) or Xxxxx Xxxxxxxx (xxxxxxx@xxx.xxx)
Fax: 000 000-0000
Franklin Xxxxxxxxx Investments
0 Xxxxxxxx Xxxxxxx,
Xxxx. 000, 0xx Xxxxx
Xxx Xxxxx, XX 00000
With respect to the following agreement(s) (collectively, the "Agreement")
(Please reproduce and complete table for multiple agreements):
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Date of Participation Agreement: November 1, 2012
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Insurance Company(ies): First Symetra National Life Insurance
Company of New York
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Insurance Company Distributor(s): Symetra Securities, Inc.
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As provided by Schedule C of the Agreement, this Notice proposes to Xxxxxxxx
Xxxxxxxxx Variable Insurance Products Trust, and Franklin/Xxxxxxxxx
Distributors, Inc. the addition as of the offering date(s) listed below of the
following Portfolios as additional investment options listed on Schedule C:
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Names and Classes of Shares of Additional Portfolios Offering Date(s)
Listing of current classes for your reference:
Class 1 (no 12b-1 fee);
Class 2 (12b-1 fee of 25 bps); or
Class 4 (12b-1 fee of 35 bps).
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Franklin Income Securities Class I February 1, 2013
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Name and title of authorized person of insurance company: Xxxxxxxxxx Xxxxxxxxx
Vice President and Associate General Counsel
Contact Information: Xxxxxxx Xxxxxxxxx (Xxxxxxx.xxxxxxxxx@xxxxxxx.xxx); with
copy to Xxxxxxx Xxxxx (Xxxxxxx.xxxxx@xxxxxxx.xxx)
Fax: 000-000-0000
Symetra Life Insurance Company & Symetra Securities, Inc.
000 000xx Xxx XX, Xxxxx 0000
Xxxxxxxx, X X 00000
