RILA290NY Jackson National Life Insurance Company of New York® Thank you for choosing Jackson National Life Insurance Company of New York, also referred to as "the Company" or "Jackson of NY®." READ YOUR CONTRACT CAREFULLY. This annuity contract is...

RILA290NY Xxxxxxx National Life Insurance Company of New York® Thank you for choosing Xxxxxxx National Life Insurance Company of New York, also referred to as "the Company" or "Jackson of NY®." READ YOUR CONTRACT CAREFULLY. This annuity contract is issued by the Company and is a legal agreement between the Owner ("You") and Xxxxxxx of NY. PLEASE NOTE THAT THIS CONTRACT REFERS TO AND UTILIZES EXTERNAL INDEXES. WHILE THE CONTRACT VALUES MAY BE AFFECTED BY THE EXTERNAL INDEXES, THE CONTRACT DOES NOT DIRECTLY PARTICIPATE IN ANY STOCK OR EQUITY INVESTMENTS. AN INDEX ADJUSTMENT TO THE INDEX ACCOUNT IS NOT GUARANTEED AND MAY VARY BASED UPON THE PERFORMANCE OF THE INDEXES. THE INDEX RETURN MAY BE POSITIVE, NEGATIVE OR ZERO AND INVESTMENT IN THIS CONTRACT MAY RESULT IN A LOSS OF PRINCIPAL. IN SOME INSTANCES, THE POTENTIAL INVESTMENT LOSS FOR THIS PRODUCT MAY BE SIGNIFICANTLY GREATER THAN THE POTENTIAL INVESTMENT GAIN. IN EXCHANGE FOR SOME LOSS PROTECTION, YOU MAY SACRIFICE POTENTIAL GAIN. THERE MAY BE LIMITS ON GAINS THAT COULD DELAY OR PREVENT YOU FROM EARNING BACK LOSSES. AMOUNTS ALLOCATED TO THE FIXED ACCOUNT WILL EARN INTEREST AT THE CURRENT INTEREST RATE FOR THE DURATION OF THE FIXED ACCOUNT PERIOD. THE INTEREST RATE CREDITED FOR SUBSEQUENT PERIODS IS SUBJECT TO CHANGE AS DECLARED BY THE COMPANY. THE WITHDRAWAL VALUE AVAILABLE UNDER THIS CONTRACT IS EQUAL TO THE CONTRACT VALUE LESS ANY APPLICABLE WITHDRAWAL CHARGE. PLEASE READ THE IMPORTANT CONTRACT DISCLOSURES ON THE FOLLOWING PAGE. NOTICE OF RIGHT TO EXAMINE CONTRACT YOU MAY RETURN THIS CONTRACT TO THE FINANCIAL PROFESSIONAL WHO SOLD YOU THE CONTRACT OR THE COMPANY WITHIN [10] DAYS AFTER YOU RECEIVE IT ([60] DAYS AFTER YOU RECEIVE IT IF IT WAS PURCHASED AS A REPLACEMENT CONTRACT). THE COMPANY WILL REFUND THE PREMIUM PAID TO THE FIXED ACCOUNT, LESS THE AMOUNT OF ANY PARTIAL WITHDRAWALS FROM THE FIXED ACCOUNT, PLUS THE INDEX ACCOUNT VALUE WITHOUT DEDUCTION FOR ANY FEES AND CHARGES. RETURNED CONTRACTS ARE VOID. INDIVIDUAL SINGLE PREMIUM DEFERRED REGISTERED INDEX-LINKED ANNUITY. DEATH BENEFIT AVAILABLE. INCOME OPTION AVAILABLE. NON-PARTICIPATING. CONTAINS PROVISIONS WAIVING WITHDRAWAL CHARGES. Home Office: Customer Care Center: [0000 Xxxxxxxxxxx Xxxxxx [P.O. Box 24068 Purchase, New York 10577] Lansing, MI 48909-4068 1-800-599-5651 xxx.xxxxxxx.xxx] This Contract is signed by the Company President Secretary

RILA290NY Contract Cover Page Continued Home Office: Customer Care Center: [0000 Xxxxxxxxxxx Xxxxxx [P.O. Box 24068 Purchase, New York 10577] Lansing, MI 48909-4068 1-800-599-5651 xxx.xxxxxxx.xxx] IMPORTANT - CONTRACT DISCLOSURES PLEASE READ CAREFULLY PLEASE REVIEW THE CONTRACT DATA PAGES FOR WITHDRAWAL CHARGE INFORMATION. THE COMPANY MAY RESTRICT TRANSFERS TO INDEX ACCOUNT OPTIONS AT ANY TIME, ON A NON-DISCRIMINATORY BASIS, IF THE YIELD ON INVESTMENT OR COST OF HEDGING WOULD NOT SUPPORT THE MINIMUM GUARANTEES OF THE INDEX ACCOUNT OPTION(S). HOWEVER, AT LEAST ONE (1) INDEX ACCOUNT OPTION WILL ALWAYS REMAIN AVAILABLE FOR ALLOCATION. SHOULD THE COMPANY IMPOSE SUCH RESTRICTIONS, THE COMPANY WILL GIVE AT LEAST 30 DAYS ADVANCE NOTICE TO YOU. THE COMPANY WILL ALSO PROVIDE WRITTEN NOTICE WHEN SUCH RESTRICTIONS NO LONGER EXIST. THE COMPANY WILL NOT RESTRICT TRANSFERS TO THE FIXED ACCOUNT OPTION(S) AT ANY TIME. ffice: Customer Care Center: [ tchester Avenue [P.O. Box 24068 r , r ] Lansing, MI 48909-4068 1-800-599-5651 xxx.xxxxxxx.xxx]

RILA290NY-CB1 3a CONTRACT DATA PAGES Contract Number: [1234567890] Owner: [Xxxx Xxx] Owner Issue Age: [45] Joint Owner: [No Joint Owner] Joint Owner Issue Age: [N/A] Annuitant: [Xxxx Xxx] Annuitant Issue Age: [45] Joint Annuitant: [No Joint Annuitant] Joint Annuitant Issue Age: [N/A] Issue Date: [June 1, 2023] Issue State: NY Premium Amount: [$25,000] Income Date: [June 1, 2073] Primary Beneficiary(ies): [Xxxxx Xxx] Contingent Beneficiary(ies): [Xxxx Xxx]

RILA290NY-CB1 3b CONTRACT DATA PAGES (CONT'D) FIXED ACCOUNT INFORMATION: Initial 1-Year Fixed Account Option Interest Rate: [1.00%] Fixed Account Minimum Interest Rate (FAMIR): [1.00%] INTEREST RATE FOR ADJUSTMENTS DUE TO MISSTATEMENT OF AGE OR SEX: [1.00%] WITHDRAWALS: Withdrawal Charge Schedule: Contract Year Withdrawal Charge Percentage 1 8.00% 2 8.00% 3 7.00% 4 6.00% 5 5.00% 6 4.00% 7+ 0.00% Please see Withdrawal Provisions for complete explanation of the determination of Xxxxxxxxxx Xxxxxxx. Minimum partial withdrawal amount unless as a scheduled part of an automatic withdrawal program: [$500] Minimum partial withdrawal amount as a scheduled part of an automatic withdrawal program: [$50] Minimum Contract Value remaining after a partial withdrawal: [$2,000] Free Withdrawal Percentage: [10%]

RILA290NY-CB1 3c CONTRACT DATA PAGES (CONT'D) Waiver of Withdrawal Charge for Extended Care Eligibility Date: [June 1, 2024] Waiver of Withdrawal Charge for Extended Care Maximum Amount: [100%] of the Contract Value, not to exceed [$250,000] PREMIUM: This is a single Premium Contract. The Company may waive minimum and maximum Premium at any time, on a non-discriminatory basis. Minimum Premium: [$25,000] Maximum Premium under a Contract: [$1,000,000] SEPARATE ACCOUNT: [JNLNY RILA Separate Account I]

RILA290NY-CB1 3d CONTRACT DATA PAGES (CONT'D) TABLE OF INCOME OPTIONS The following table shows income values for each $1,000 of net proceeds applied to the Income Option. UNDER OPTION 4 MONTHLY INSTALLMENTS UNDER OPTIONS 1 OR 3 No. of Monthly Install- ments Monthly Install- ments Age of Annui- tant No. of Mos. Certain Age of Annui- tant No. of Mos. Certain Age of Annui- tant No. of Mos. Certain Age of Annui- tant No. of Mos. Certain Male Life 120 240 Male Life 120 240 Female Life 120 240 Female Life 120 240 60 17.09 40 2.33 2.32 2.31 68 4.72 4.57 4.02 40 2.22 2.22 2.21 68 4.36 4.26 3.86 72 14.31 41 2.37 2.36 2.35 69 4.90 4.72 4.09 41 2.26 2.26 2.25 69 4.52 4.40 3.94 84 12.33 42 2.41 2.41 2.39 70 5.09 4.89 4.16 42 2.30 2.30 2.29 70 4.69 4.55 4.02 96 10.84 43 2.45 2.45 2.43 71 5.31 5.06 4.23 43 2.34 2.34 2.32 71 4.87 4.70 4.09 108 9.68 44 2.50 2.50 2.47 72 5.54 5.24 4.29 44 2.38 2.38 2.36 72 5.06 4.87 4.16 120 8.76 45 2.55 2.54 2.52 73 5.79 5.43 4.34 45 2.42 2.42 2.40 73 5.28 5.04 4.22 132 8.00 46 2.60 2.59 2.56 74 6.06 5.63 4.39 46 2.47 2.47 2.45 74 5.51 5.23 4.28 144 7.37 47 2.65 2.64 2.61 75 6.35 5.83 4.43 47 2.52 2.51 2.49 75 5.76 5.42 4.34 156 6.84 48 2.71 2.70 2.66 76 6.67 6.04 4.47 48 2.57 2.56 2.54 76 6.03 5.62 4.38 168 6.38 49 2.77 2.76 2.71 77 7.02 6.26 4.50 49 2.62 2.61 2.59 77 6.33 5.83 4.43 180 5.98 50 2.83 2.82 2.76 78 7.40 6.48 4.52 50 2.67 2.67 2.64 78 6.65 6.04 4.46 192 5.64 51 2.89 2.88 2.82 79 7.81 6.70 4.54 51 2.73 2.72 2.69 79 7.01 6.26 4.49 204 5.33 52 2.96 2.94 2.88 80 8.27 6.92 4.56 52 2.79 2.78 2.74 80 7.40 6.48 4.52 216 5.06 53 3.03 3.01 2.94 81 8.76 7.13 4.57 53 2.85 2.84 2.80 81 7.83 6.70 4.54 228 4.82 54 3.10 3.08 3.00 82 9.30 7.34 4.58 54 2.92 2.91 2.85 82 8.29 6.92 4.56 240 4.60 55 3.18 3.16 3.06 83 9.89 7.53 4.58 55 2.99 2.98 2.91 83 8.80 7.13 4.57 252 4.40 56 3.26 3.23 3.13 84 10.54 7.72 4.59 56 3.07 3.05 2.98 84 9.35 7.33 4.58 264 4.22 57 3.35 3.32 3.19 85 11.26 7.88 4.59 57 3.14 3.12 3.04 85 9.95 7.52 4.58 276 4.06 58 3.44 3.40 3.26 86 12.05 8.03 4.59 58 3.23 3.20 3.11 86 10.59 7.70 4.59 288 3.90 59 3.54 3.49 3.34 87 12.91 8.17 4.59 59 3.31 3.29 3.18 87 11.28 7.87 4.59 300 3.77 60 3.64 3.59 3.41 88 13.86 8.28 4.60 60 3.40 3.37 3.25 88 12.03 8.02 4.59 312 3.64 61 3.74 3.69 3.48 89 14.88 8.38 4.60 61 3.50 3.46 3.32 89 12.84 8.15 4.59 324 3.52 62 3.86 3.79 3.56 90 15.99 8.46 4.60 62 3.60 3.56 3.40 90 13.71 8.27 4.60 336 3.41 63 3.98 3.91 3.64 91 17.17 8.53 4.60 63 3.71 3.66 3.47 91 14.66 8.37 4.60 348 3.31 64 4.11 4.02 3.71 92 18.43 8.58 4.60 64 3.82 3.77 3.55 92 15.70 8.45 4.60 360 3.21 65 4.24 4.15 3.79 93 19.78 8.63 4.60 65 3.95 3.88 3.63 93 16.86 8.53 4.60 66 4.39 4.28 3.87 94 21.20 8.66 4.60 66 4.07 4.00 3.71 94 18.13 8.58 4.60 67 4.55 4.42 3.95 95 22.67 8.68 4.60 67 4.21 4.12 3.79 95 19.53 8.63 4.60 Note: Due to the volume of relevant information, the Table does not provide income values for Option 2 described in the Income Provisions. Those values are available from the Company's Customer Care Center upon request. You may contact the Company's Customer Care Center as shown on the cover page of the Contract. BASIS OF COMPUTATION. The 2012 Individual Annuity Mortality Period Table, with an interest rate of 1.00% and a 0% expense load, provides the actuarial basis for the Table of Income Options. The Table of Income Options does not include any applicable tax.

RILA290NY 7 DEFINITIONS (CONT'D) OWNER ("YOU," "YOUR"). The natural person(s) or legal entity(ies) that has all rights under the Contract, and is shown on the Contract Data Pages, or by subsequent designation. In this Contract, "You" and "Your" also mean the Owner. References to the Owner include the Joint Owners, if applicable. PREMIUM. Money paid into this Contract for allocation into the Contract Options. QUALIFIED PLAN. A retirement plan which qualifies for favorable tax treatment under Sections 401, 403, 408, or 408A of the Internal Revenue Code, as amended. REMAINING PREMIUM. Total Premium paid into the Contract reduced by withdrawals of Premium before the withdrawal is adjusted for any charges, including Withdrawal Charges. This value is used solely for the purpose of calculating the Withdrawal Charge. REQUIRED MINIMUM DISTRIBUTION (RMD). For Qualified Plan contracts, the RMD is the amount defined by the Internal Revenue Code and the implementing regulations as the minimum distribution requirement that applies to this Contract. SHORT DURATION FIXED ACCOUNT OPTION. A limited-purpose Fixed Account Option that is used for Intra-Term Performance Locks and the spousal continuation adjustment. The Short Duration Fixed Account Option cannot be independently elected. WITHDRAWAL CHARGE. A charge assessed against certain withdrawals from the Fixed Account Option(s) and/or the Index Account Option(s). The Withdrawal Charge Schedule is shown on the Contract Data Pages. WITHDRAWAL VALUE. The amount available upon a total withdrawal. The Withdrawal Value is equal to the Contract Value, less any applicable Withdrawal Charge.

RILA290NY 10 GENERAL PROVISIONS (CONT'D) OWNER. To the extent allowed by New York law, the Company may refuse consent to an ownership change at any time, on a non-discriminatory basis, if the ownership change would result in noncompliance with any New York or federal regulation. Unless restricted by endorsement, or federal tax law, You may change the Owner or the Joint Owner. The Company will use the oldest Owner's age for all Contract purposes unless otherwise specified in the Contract. The Company will only be bound by a change of ownership if submitted in a form acceptable to the Company and received in Good Order at the Company's Customer Care Center. No person whose age exceeds the maximum issue age in effect for this Contract as of the Issue Date may become a new Owner. Unless You specify otherwise, a change of ownership will take effect on the date the request is signed by You, subject to any payments the Company has made or other actions the Company has taken before the Company receives Your request. Joint Owners have equal ownership rights; therefore, each Owner must authorize any exercise of Contract rights unless the Joint Owners instruct the Company in writing to act upon authorization of an individual Joint Owner. The maximum number of Joint Owners allowed is two (2). If the Owner is a natural person, then the Owner is the life the death benefit is based on. For Contracts issued to Joint Owners, the death benefit is based on the first Joint Owner to die. If the Owner is a legal entity, a Joint Owner is not permitted and the Annuitant is the life the death benefit is based on. If the Owner is a legal entity and there are Joint Annuitants, the death benefit is based on the first Joint Annuitant to die. The Company assumes no responsibility for the validity or tax consequences of any ownership change. If You make an ownership change, You may have to pay taxes. The Company encourages You to seek legal and/or tax advice. PROOF OF AGE, SEX AND/OR SURVIVAL. The Company may require proof of age and/or sex, satisfactory to the Company, at any time. If any payment required by this Contract depends on a living Annuitant, Owner, or Beneficiary, the Company may require proof of that person's survival, satisfactory to the Company. PROTECTION OF PROCEEDS. A Beneficiary may not assign Contract proceeds before the proceeds are payable to such Beneficiary. Contract proceeds are not subject to the claims of creditors or to legal process unless required by New York law.

RILA290NY 11 GENERAL PROVISIONS (CONT'D) REPORTS. The Company will send a report to Your last address in the Company's records at least annually before the Income Date. In the case of Joint Owners, the Company will send reports only to the address of the first Owner listed on the Contract Data Pages. If You have elected electronic delivery, a report may be provided in the form of an email to Your last email address in the Company's records, or a notice to You of a document's availability on the Company's website. Each report will provide at least the following information: 1. the dates that begin and end the reporting period; 2. the Contract Value at the beginning and at the end of the current reporting period; 3. the Withdrawal Value at the end of the reporting period; 4. the Withdrawal Charge the Company used to determine the Withdrawal Value; 5. the amounts the Company has credited to and deducted from the Contract Value during the reporting period; 6. the death benefit at the end of the reporting period; and 7. any other information New York and federal law require. You may receive copies of reports the Company provides upon request at no additional charge by contacting the Company's Customer Care Center as shown on the cover page of the Contract. You will receive a confirmation statement for certain transactions at the time they occur. SEPARATE ACCOUNT. The Company holds certain investments supporting the assets allocated to the Index Account in a non-insulated, non-unitized Separate Account. The Separate Account is established pursuant to the applicable law solely for the purpose of supporting obligations under the Contract. You do not directly participate in the performance of assets held in the Separate Account and do not have any direct claim on them. Assets of the Separate Account are chargeable with the claims of any of the Company's contract owners as well as the Company's creditors and are subject to the liabilities arising out of any other business the Company conducts. The Separate Account is not registered under the Investment Company Act of 1940. The name of the Separate Account is shown on the Contract Data Pages. TAXES. This Contract is intended to be treated as an annuity contract for federal income tax purposes. Accordingly, for all Non-Qualified Contracts all provisions of this Contract shall be interpreted and administered in accordance with the requirements of Section 72(s) of the Internal Revenue Code. The Company will deduct any taxes attributed to the Contract and payable to the state of New York or other government entity from the Contract Value as they are incurred. The Company reserves the right to deduct any amounts the Company might advance to pay taxes from the Contract Value. The Company will withhold taxes required by law from any amounts payable from this Contract.

RILA290NY 12 GENERAL PROVISIONS (CONT'D) WRITTEN NOTICE. Written information or instructions You intend to give the Company must be in Good Order and delivered to the Company's Customer Care Center in a format currently accepted by the Company, unless the Company advises You otherwise. A notice relating to Owner, Beneficiary designation or assignment changes shall take effect on the date the request is signed by You, subject to any payments the Company has made or other actions the Company has taken before the Company receives the request. Otherwise, instructions included in a Written Notice will take effect on the date the Company receives the notice at the Company's Customer Care Center. The Company will deliver any notice or communication to Your last known address in the Company's records unless You request otherwise in writing. If You have elected electronic delivery, communication may be provided in the form of an email to Your last email address in the Company's records, or a notice to You of a document's availability on the Company's website. You are responsible for notifying the Company of any address change, email address change, or any error in a Company notice sent to You. In the case of Joint Owners, the Company will send notices and other communications to the address of the first Owner listed on the Contract Data Pages.

RILA290NY 14 CONTRACT OPTION PROVISIONS (CONT'D) Index Account Value. The Index Account Value is equal to the sum of the Index Account Option values. The Index Account Option value at the beginning of the Index Account Option term is equal to the amount allocated or transferred to the Index Account Option less the amount transferred out of the Index Account Option. During the Index Account Option term, the Index Account Option value is equal to the Interim Value. The Interim Value is the greater of the Index Account Option value at the beginning of the term reduced for any Intra-Term Performance Locks and withdrawals from the Index Account Option during the Index Account Option term, including any Withdrawal Charges, in the same proportion as the Interim Value was reduced on the date of the Intra-Term Performance Lock or withdrawal, plus the Index Adjustment subject to prorated Index Adjustment Factor(s), or zero. Additional detail on Index Adjustment Factor(s) can be found in the Crediting Method endorsements and Supplemental Contract Data Pages. On the Index Account Option Term Anniversary, the Index Account Option value is equal to the greater of the Index Account Option value at the beginning of the Index Account Option term, reduced for any Intra-Term Performance Lock and withdrawals from the Index Account Option during the Index Account Option term, including any Withdrawal Charges, in the same proportion as the Interim Value was reduced on the date of the Intra-Term Performance Lock or withdrawal, plus the Index Adjustment subject to Index Adjustment Factor(s), or zero. Additional detail on Index Adjustment Factor(s) can be found in the Crediting Method endorsements and Supplemental Contract Data Pages. TRANSFERS. Transfers may only occur on the Contract Anniversary, when transferring out of the Fixed Account Option(s), and on the Index Account Option Term Anniversary when transferring out of an Index Account Option. You will be sent a notice thirty (30) days prior to the Contract Anniversary and/or Index Account Option Term Anniversary. The notice will advise You of how You may obtain information on the Contract Options and current rates available to You. You may request a transfer to or from the 1-Year Fixed Account Option and to or from the Index Account Option(s). You may also request transfers among the available Index Account Options within the Index Account. A request for a transfer must be received in Good Order at the Company's Customer Care Center prior to the Contract Anniversary or Index Account Option Term Anniversary, as applicable. If no transfer request is received on or prior to the Contract Anniversary, the 1-Year Fixed Account Option value will remain in the 1-Year Fixed Account Option.

RILA290NY 15 CONTRACT OPTION PROVISIONS (CONT'D) If no transfer request is received on or prior to the Index Account Option Term Anniversary, the Index Account Option value(s) will be reallocated as follows: 1. if the same Index Account Option term with the same Index, Crediting Method, and negative Index Adjustment protection is available at the time and does not extend beyond the LID, the Company will renew the Index Account Option into the same Index Account Option term with the same Index, Crediting Method, and downside protection; 2. if the same Index Account Option term with the same Index, Crediting Method, and negative Index Adjustment protection is available at the time but extends beyond the LID, the Company will select the available Index Account Option term with the same Index, Crediting Method, and downside protection that ends closest to but before the LID; 3. if the same Index Account Option term is not available at the time but would not extend beyond the LID were it available, the Company will select the available Index Account Option term with the period closest to but less than the Index Account Option term that just ended with the same Index and Crediting Method as well as the closest equal or greater downside protection available for that term. If the Crediting Method or Index is no longer available as of the Index Account Option Term Anniversary, the Index Account Option value(s) will be reallocated to the 1-Year Fixed Account Option. Transfers into the Short Duration Fixed Account Option are only allowed in connection with an Intra-Term Performance Lock. Transfers from an Index Account Option in connection with an Intra-Term Performance Lock may occur at any time, see Intra-Term Performance Lock for details. Unless specified otherwise, transfers on a Contract Anniversary will be taken from the Index Account Option(s) that have reached their Index Account Option Term Anniversary and the Fixed Account Option(s) in proportion to their current value. The Company reserves the right to restrict or prohibit transfers from the 1-Year Fixed Account Option to the Index Account Option on a non-discriminatory basis, at any time. Transfers from a Fixed Account Option will reduce the Fixed Account Value by the transfer amount requested. Transfers into a 1-Year Fixed Account Option will increase the 1-Year Fixed Account Option value by the transfer amount requested. Transfers from an Index Account Option will reduce the Index Account Option value by the transfer amount requested. Transfers into an Index Account Option will increase the Index Account Option value by the transfer amount requested. The Company may restrict transfers to an Index Account Option(s) at any time, on a non- discriminatory basis, if the yield on investment or cost of hedging would not support the minimum guarantees of the Index Account Option(s). However, at least one (1) Index Account Option will always remain available for allocation. Should the Company impose such restrictions, the Company will give at least thirty (30) days advance notice to You. The Company will also provide Written Notice when such restrictions no longer exist. Whenever the Company restricts or discontinues an Index Account Option(s), the Company will waive all Withdrawal Charges while those restrictions/discontinuations are in effect.

RILA290NY 20 WITHDRAWAL PROVISIONS (CONT'D) WAIVER OF WITHDRAWAL CHARGE FOR EXTENDED CARE. If You are confined as an inpatient in a Nursing Home or Hospital for ninety (90) consecutive days starting after the Issue Date shown on the Contract Data Pages, the Company will waive the Withdrawal Charge on the amount You withdraw from the Contract up to the Waiver of Withdrawal Charge for Extended Care maximum amount shown on the Contract Data Pages. Upon Your compliance with the Claim Requirements described below, You will be eligible for this waiver on the Eligibility Date shown on the Contract Data Pages. All other Contract values will be reduced proportionately for the amount withdrawn. The Company will allocate the withdrawal amount to each Contract Option according to the method described in the Withdrawal Provisions. The Company will determine values at the end of the Business Day on which the Company receives the request for withdrawal in Good Order at the Company's Customer Care Center. Withdrawals under this provision may reduce Remaining Premium. The availability of access to guarantees or values is not intended to provide long-term care or nursing home insurance. This Waiver of Withdrawal Charge for Extended Care is available only once, no matter the amount withdrawn or in the circumstances of multiple confinements for the same or a different medical condition and/or Joint Owners. For the purpose of this waiver, the following definitions apply: Hospital. A facility that: 1. is located within the United States or its territories; 2. operates primarily for the inpatient care and treatment of sick and injured persons; 3. provides continuous twenty-four (24) hour a day nursing service by or under the supervision of a registered nurse (R.N.); 4. is supervised by a staff of licensed physicians; and 5. has its own medical and diagnostic facilities or has access to such facilities on a prearranged basis. Immediate Family - means the individual's spouse, domestic partner, child, brother, sister, parent, or grandparent. Medically Necessary - means consistent with Your diagnosis in accordance with accepted standards of medical practice without which Your medical condition would be adversely affected.

RILA290NY 21 WITHDRAWAL PROVISIONS (CONT'D) Nursing Home. A facility that: 1. is licensed by the appropriate governmental licensing agency as a Nursing Home in the state in which it maintains such facilities; 2. issues patients, or their insurance provider, a bill or amount due; 3. is primarily engaged in providing nursing care (skilled, intermediate or custodial) by or under the supervision of a licensed Physician and room and board accommodations; 4. provides continuous twenty-four (24) hour a day nursing services by or under the supervision of a registered nurse (R.N.); 5. maintains a daily medical record of each patient; and 6. maintains control and records of dispensed medications. Physician - means an individual who is licensed to practice medicine and treat illness or injury in the state where treatment is received and who is acting within the scope of his or her license. The term Physician only refers to a Physician licensed and currently practicing in the United States or its territories. The term Physician does not include: 1. an Annuitant or Joint Annuitant; 2. an Owner or Joint Owner; 3. a Beneficiary; 4. a member of the Annuitant's, Joint Annuitant's, Owner's or Joint Owner's Immediate Family. Physician's Statement - means a written statement signed by a Physician which provides the Physician's diagnosis of Your medical condition. You will be considered confined to a Nursing Home or Hospital only if Your confinement is prescribed by a Physician and Medically Necessary.

RILA290NY 22 WITHDRAWAL PROVISIONS (CONT'D) Claim Requirements. Ninety (90) days after the date of Your confinement, You may submit a request, which must include (1) a completed claim form, (2) Your signed release for records of all Physicians and institutions that have treated You for the medical condition You claim, and (3) a Physician's Statement to the Company's Customer Care Center in Good Order. The Company will send You a form to claim the Waiver of Withdrawal Charge for Extended Care within ten (10) Business Days of the Company's receipt of Your request. If the Company fails to send the claim form within ten (10) Business Days, You will be deemed to have complied with the above claim requirements. Claim Determination. Upon receipt of the Claim Requirements, the Company will complete an initial review for Good Order within thirty (30) Business Days. The Company reserves the right to deny Your claim if You do not satisfy the Claim Requirements. If the Company denies Your Waiver of Withdrawal Charge for Extended Care claim, the Company will send You a letter with the reason(s) for the denial. If You would like to appeal the Company's denial of Your Waiver of Withdrawal Charge for Extended Care claim, You may submit a Written Notice to the Company's Customer Care Center. If You are unable to satisfy the Claim Requirements, You will then have the opportunity to submit a standard withdrawal request, subject to any applicable Withdrawal Charge. Termination of the Contract will not prejudice any payment made under the extended care waiver that occurred while this Contract was in force. YOU MAY OWE TAX ON WITHDRAWALS FOR EXTENDED CARE. THE COMPANY ENCOURAGES YOU TO SEEK LEGAL AND/OR TAX ADVICE.

RILA290NY 27 INCOME PROVISIONS INCOME DATE. Income Payments begin on the Income Date. The Income Date must be at least thirteen (13) months after the Contract Issue Date. If You do not select an Income Date, the Income Date is the LID. You may change the Income Date by submitting Written Notice in Good Order to the Company's Customer Care Center at least seven (7) days before the current Income Date. The LID may be changed to a later date upon request, if the Company agrees to the change in writing. Requests to extend the LID must be submitted in writing and received by the Company's Customer Care Center at least seven (7) days before the current LID. INCOME PAYMENT. On or before the Income Date, You may elect payment in a single lump- sum. A single lump-sum payment is considered a total withdrawal and terminates the Contract. The Company will make payment to You or another payee You specify. Alternatively, You may elect an Income Option to begin on the Income Date. The Company will apply the Contract Value, less applicable taxes, to provide You income according to Your selected Income Option. INCOME OPTIONS. You may elect payment as provided in Options 1, 2, 3, or 4 below. You may elect an Income Option up to thirty (30) days before the Income Date by submitting Written Notice in Good Order to the Company's Customer Care Center. The Company will make payment to You or another payee You specify. If You do not select an Income Option the Company will make payments as provided in Option 3 below, with 120 months certain. The Company will make payments monthly, quarterly, semiannually, or annually as You elect. However, if the Contract Value on the Income Date is less than $2,000, the Company may pay out the Contract Value in one (1) lump-sum payment instead of providing Income Payments according to the Income Option You elect. The single lump-sum payment will not be less than the amount which would have been applied under an Income Option on the Income Date. If the first monthly payment provided would be less than $20, the Company may make payments quarterly, semiannually, or annually to achieve an initial payment of at least $20, or the Company may pay out the Contract Value in one (1) single lump- sum payment. At the time of their commencement, Income Payments will not be less than those that would be provided by the application of an equivalent amount to purchase a single premium immediate annuity contract from the Company at purchase rates the Company offered on the Income Date to annuitants in the same class as the Annuitant. The amount applied to an Income Option will not be less than the greater of the Withdrawal Value or 95% of the Contract Value. YOU MAY NOT TAKE WITHDRAWALS DURING ANY PERIOD THE COMPANY IS MAKING PAYMENTS FOR AN ANNUITANT'S LIFETIME. OPTION 1 - LIFE INCOME. A monthly payment for the Annuitant's lifetime. All payments end upon the Annuitant's death. However, in the event of the Annuitant's death before the first monthly payment, the Company will pay the amount allocated to this Income Option to You or, if You are deceased, to Your Beneficiary.

RILA290NY 28 INCOME PROVISIONS (CONT'D) OPTION 2 - JOINT AND SURVIVOR INCOME. A monthly payment for the longer of the Annuitant's lifetime or that of a Joint Annuitant. Upon the occasion of the first person to die, monthly payments continue during the survivor's lifetime at either the full amount previously payable or as a percentage (either one-half or two-thirds) of the full amount, as You select at the time You elect the Income Option. All payments end upon the death of the last surviving Annuitant. However, in the event of the deaths of the Annuitant and Joint Annuitant before the first monthly payment, the Company will pay the amount allocated to this Income Option to You or, if You are deceased, Your Beneficiary. OPTION 3 - LIFE INCOME WITH 120 OR 240 MONTHLY PAYMENTS GUARANTEED. A monthly payment for the Annuitant's lifetime with the guarantee that the Company will make at least 120 or 240 monthly payments, whichever You elect, to You. If the Owner is an entity, at the Annuitant's death, if fewer than the guaranteed number of payments have been made, the remaining guaranteed payments will be made to the Owner as previously scheduled. If the Owner is the Annuitant, in the event You die before the Company makes the specified number of guaranteed payments, the Income Payments will be made to Your Beneficiary according to the terms of this Contract unless the Beneficiary elects to receive the present value of any remaining guaranteed payments in a single lump-sum payment. The present value of any remaining guaranteed payments will be based on the total Income Payments as of the date of the calculation. The Company will determine the interest rate used in this present value calculation, but in no instance will it be greater than one (1) percentage point higher than the rate used to calculate the initial Income Payment. OPTION 4 - INCOME FOR A SPECIFIED PERIOD. A monthly payment for any whole number of years ranging from 5 to 30. In the event You die before the Company makes the specified number of payments, the Income Payments will be made to Your Beneficiary according to the terms of this Contract unless the Beneficiary elects to receive the present value of any remaining guaranteed payments in a single lump-sum payment. The present value of any remaining guaranteed payments will be based on the total Income Payments as of the date of the calculation. The Company will determine the interest rate used in this present value calculation, but in no instance will it be greater than one (1) percentage point higher than the rate used to calculate the initial Income Payment. ADDITIONAL INCOME OPTIONS. The Company may make available other Income Options.