Form of
Amendment No. 4
Amendment to the Participation Agreement among ReliaStar Life Insurance Company
of New York (formerly ReliaStar Bankers Security Life Insurance Company) (the
"Company"), Variable Insurance Products Fund II (the "Fund") and Fidelity
Distributors Corporation (the "Underwriter") dated March 9, 1995 (the
Agreement").
1) Schedule A is hereby revised as follows:
Schedule A
Name of Separate Account Policy Form Numbers of Contracts Fidelity Fund/Initial Class
and Date Established by Funded by Separate Account ---------------------------
Board of Directors --------------------------
------------------
ReliaStar Life Insurance 85-499 VIP II Contrafund Portfolio
Company of New York VIP II Index 500 Portfolio
Variable Annuity Separate VIP II Investment Grade
Account II Bond Portfolio
IN WITNESS WHEREOF, each of the parties has caused this Amendment to be executed
in its name and on its behalf by its duly authorized representative as of
_______________, 199__.
RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK
By: _____________________________
Name:
Title:
VARIABLE INSURANCE PRODUCTS FUND II
By: _____________________________
Name: Xxxxxx X. Xxxxx
Title: Senior Vice President
FIDELITY DISTRIBUTORS CORPORATION
By: _____________________________
Name: Xxxxx X. Xxxxx
Title: Vice President
