INDIVIDUAL FLEXIBLE PREMIUM DEFERRED ANNUITY CONTRACT FIXED AND VARIABLE ACCOUNTS NON-PARTICIPATING

Exhibit 99.4(a)

JEFFERSON NATIONAL LIFE INSURANCE COMPANY
Administrative Office: 0000 Xxxxxxxxx Xxxxxx Xx.,
Xxxxx 0000, Xxxxxxxxxx, Xxxxxxxx 00000
[Telephone: (000) 000-0000]
A Stock Company

THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY
READ YOUR CONTRACT CAREFULLY

Jefferson National Life Insurance Company ("the Company") agrees with the
contract Owner ("You/Your") to provide benefits to You, subject to the
provisions set forth in this contract and in consideration of the Purchase
Payments received.

RIGHT OF RETURN. WITHIN 10 DAYS OF THE RECEIPT OF THIS CONTRACT BY THE OWNER, IT
MAY BE RETURNED BY DELIVERING OR MAILING IT TO THE COMPANY AT ITS ADMINISTRATIVE
OFFICE. WHEN THE COMPANY RECEIVES THE CONTRACT, IT WILL BE VOIDED AS IF IT HAD
NEVER BEEN IN FORCE. THE COMPANY WILL REFUND THE CONTRACT VALUE COMPUTED AS OF
THE BUSINESS DAY THE COMPANY RECEIVES THE RETURNED CONTRACT AT ITS
ADMINISTRATIVE OFFICE.

ANNUITY PAYMENTS, WITHDRAWAL VALUES AND DEATH BENEFITS PROVIDED BY THIS
CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, MAY
INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT.

Signed for the Company at its Administrative Office in Louisville, Kentucky.

/s/ Xxxxx Xxxxxx /s/ Xxxxx Xxxxxxx
Secretary President

INDIVIDUAL FLEXIBLE PREMIUM DEFERRED ANNUITY CONTRACT
FIXED AND VARIABLE ACCOUNTS
NON-PARTICIPATING

TABLE OF CONTENTS

PAGE NUMBERS

PROVISIONS

CONTRACT SCHEDULE [3
DEFINITIONS 7
PURCHASE PAYMENTS PROVISIONS 9
SEPARATE ACCOUNT PROVISIONS 9
FIXED ACCOUNT PROVISIONS 10
CONTRACT VALUE PROVISION 10
CONTRACT MAINTENANCE FEE PROVISION 10
TRANSFER PROVISIONS 11
WITHDRAWAL PROVISIONS 12
PROCEEDS PAYABLE AT DEATH PROVISIONS 13
SUSPENSION OR DEFERRAL OF PAYMENTS PROVISONS 14
OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISONS 15
ANNUITIZATION PROVISIONS 16
GENERAL CONTRACT PROVISIONS 17
ANNUITY TABLES 19]

CONTRACT SCHEDULE

CONTRACT NUMBER: [3456]

OWNER: [XXXX XXX]

JOINT OWNER: [NONE]

ANNUITANT: [XXXX XXX]

JOINT ANNUITANT: [NONE]

CONTRACT ISSUE DATE: [JULY 1, 1999]

ANNUITY DATE: [JULY 1, 2025]

PURCHASE PAYMENT CREDIT: Each Purchase Payment received will be credited with a
Purchase Payment Credit at the rate shown below. The
Purchase Payment Credit will be allocated in the same manner
as the Purchase Payments at the time of receipt. The dollar
amount of any Purchase Payment Credit will be excluded from
the contract value if You exercise the Right of Return.

PURCHASE PAYMENT CREDIT RATE: 4%

INITIAL PURCHASE PAYMENT: [$XXX]

INITIAL PURCHASE PAYMENT CREDIT: [$XXX]

BENEFICIARY: As designated by the Owner at the Contract Issue Date or as
subsequently changed by the Owner.

MINIMUM INITIAL PURCHASE PAYMENT: $5,000 Nonqualified / $2,000 IRA's

MINIMUM SUBSEQUENT PURCHASE PAYMENT: [Nonqualified - $500; or if using automatic payment check,
$200/month.

IRA's - $50 per month.]

MAXIMUM TOTAL PURCHASE PAYMENTS: $2,000,000 (without prior Company approval)

ALLOCATION GUIDELINES: The Owner can select from among all the Sub-Accounts of the
Separate Account and the Fixed Account option. However,
Owners are limited to 15 Sub-accounts at any one time.

If the initial Purchase Payments and forms required to issue
the Contract have been received, the Purchase Payment will
be credited within two Business Days after its receipt at
the Company's Administrative Office. Additional Purchase
Payments will be credited to the Contract as of the Business
Day they are received.

Allocation percentages must be in whole numbers. Each
allocation must be at least 1%.

SEPARATE ACCOUNT: [Jefferson National Life Annuity Account H.]

FIXED ACCOUNT INTEREST RATE: 3% Minimum Guaranteed Rate
[3%] Current Rate as of Contract Issue Date.

INSURANCE CHARGES: The insurance charges, on an annual basis, are equal to
1.40% of the average daily net asset value of the Separate
Account. The Company may increase insurance charges,
however, the maximum increase will never exceed a total of
0.25% of the average daily net asset value of the Separate
Account, on an annual basis.

If the Guaranteed Minimum Death Benefit is selected at time
of application, the insurance charges for your contract, on
an annual basis, will be equal to 1.70% of the average daily
net asset value of the Separate Account. The Company may
increase the insurance charges, however, the maximum
increase will never exceed a total of 0.45% on an annual
basis.

If both the Guaranteed Minimum Death Benefit and the
Guaranteed Minimum Income Benefit are selected at the time
of application, the insurance charges for your contract, on
an annual basis, will be equal to 2% of the average daily
net asset value of the Separate Account. The Company may
increase the insurance charges, however, the maximum
increase will never exceed a total of 0.65% on an annual
basis.

In the event of any increase, the Company will give you 90
days prior notice.

CONTRACT MAINTENANCE FEE: [The contract maintenance fee is $30 each Contract Year. The
Company reserves the right to change the contract
maintenance fee but the fee will never exceed $60 per
Contract Year.

During the Accumulation Period, if the Contract Value on the
Contract Anniversary is at least $50,000, the contract
maintenance fee will be waived. During the Accumulation
Period, if a full withdrawal is made on other than a
Contract Anniversary and the Contract Value for the Business
Day during which the full withdrawal is made is less than
$50,000, the full contract maintenance fee will be deducted
at the time of full withdrawal. If, at annuitization, the
Annuity Date is not the Contract Anniversary and the
Contract Value on the Annuity Date is less than $50,000,
then the full contract maintenance fee will be deducted on
the Annuity Date. During the Annuity Period, all contract
maintenance fees will be waived.]

DISTRIBUTION EXPENSE CHARGE: [None]

TRANSFERS PERMITTED: [Subject to terms of the contract, there are currently no
limits on the number of transfers that can be made during
the Accumulation Period. Owners are permitted two transfers
per contract year during the annuity period. However,
transfers from the Fixed Account to the Separate Account are
limited to 20% of the Fixed Account value every six (6)
months.]

TRANSFER FEE: [During the Accumulation Period, the Company allows a
transfer among Sub-accounts once every 30 days without a
charge. If you transfer more often, you will be assessed a
$25 transfer fee for each additional transfer.

During the Annuity Period, the Owner is allowed two (2)
transfers per Contract Year without charge. The Company
reserves the right to change the amount of the transfer fee
and the frequency of permitted transfers.

All reallocations made on a given date count as one (1)
transfer. Transfer fees will be waived for: a) transfers
made by the Company at the end of the 10-day right to return
period; or b) transfers made pursuant to a pre-approved
dollar cost averaging or rebalancing program.]

MINIMUM TRANSFER AMOUNT: [$500 from any Sub-account or the Owner's entire interest in
the Sub-account, if less. This requirement is waived if the
transfer is pursuant to a pre-approved dollar cost averaging
program or rebalancing program.]

MINIMUM ACCOUNT BALANCE
AFTER TRANSFER: [$500 must remain in a Sub-account after a transfer is made
from it, unless the entire amount in the Sub-account is
transferred, creating a zero (0) balance. The fixed account
does not require a minimum balance.]

CONTINGENT DEFERRED SALES CHARGE: A contingent deferred sales charge may be assessed against
each Purchase Payment withdrawn and will result in a
reduction of the Contract Value. Each Purchase Payment is
tracked from its date of receipt and will be subject to its
own contingent deferred sales charge. For the purpose of
calculating contingent deferred sales charges, withdrawals
are assumed to be made first from Purchase Payments (oldest
to newest) and then from earned income. Charges are
determined as indicated below.

NO. OF YEARS FROM
RECEIPT CONTINGENT DEFERRED
OF PURCHASE PAYMENT SALES CHARGE PERCENT

0 to 1 8%
2 8%
3 8%
4 8%
5 7%
6 6%
7 5%
8 3%
9 1%
10 and more 0%

WAIVER OF CONTINGENT
DEFERRED SALES CHARGE: Once each Contract Year a withdrawal is available free of
contingent deferred sales charges in an amount equal to the
greater of: (i) 10% of the Contract Value, on a
non-cumulative basis; (ii) the IRS minimum distribution
requirement, if the Contract was issued in connection with
certain IRAs; or (iii) the Purchase Payment withdrawn that
has been in the contract for more than nine (9) complete
years.

MINIMUM PARTIAL WITHDRAWAL: [$500 from any Account. This includes withdrawals from any
Sub-account of the Separate Account and the Fixed Account.
The minimum withdrawal requirement is waived if the partial
withdrawal from any Account is a result of a systematic
withdrawal program or minimum distribution requirement if
contract was issued in connection with certain IRAs.]

MINIMUM CONTRACT VALUE AFTER
WITHDRAWAL: $500 must remain in at least one Sub-account of the Separate
Account after a partial withdrawal. There are no minimum
requirements for the Fixed Account. If the amount of a
withdrawal results in an amount less than this amount, then
the Company reserves the right to terminate the contract,
and pay you the Contract Withdrawal Value. The Company will
mail you a notice of its intent to terminate the contract.

MAXIMUM FIXED ACCOUNT WITHDRAWAL: Currently there is no limitation on the maximum amount that
can be withdrawn from the Fixed Account.

RIDERS: [None]

COMPANY ADDRESS: [Jefferson National Life Insurance Company
Administrative Office: 0000 Xxxxxxxxx Xxxxxx Xx., Xxxxx 0000
Xxxxxxxxxx, Xxxxxxxx 00000
Telephone Numbers: (000) 000-0000

DEFINITIONS

ACCOUNT(S). The Fixed Account and/or one or more of the Sub-accounts of the
Separate Account.

ACCUMULATION PERIOD. The period prior to the Annuity Date during which Purchase
Payments may be made by an Owner.

ACCUMULATION UNIT(S). A unit of measure used to determine the value of an
Owner's interest in a Sub-account of the Separate Account during the
Accumulation Period.

ADJUSTED CONTRACT VALUE. The Contract Value less any applicable premium tax, and
contract maintenance fee. This amount is applied to the applicable annuity table
to determine Annuity Payments.

AGE. The Age of any Owner or Annuitant on his/her last birthday. For Joint
Owners, all provisions that are based on Age are based on the Age of the older
of the Joint Owners.

ADMINISTRATIVE OFFICE. The Company's administrative address is indicated on the
Contract Schedule. All notices, requests and Purchase Payments must be sent to
this address. All sums payable to the Company under this contract are payable to
this address unless otherwise designated in writing by the Company.

ANNUITANT. The natural person on whose life Annuity Payments are based. On or
after the Annuity Date, the Annuitant shall also include any Joint Annuitant.

ANNUITY DATE. The date that Annuity Payments begin. The Annuity Date is shown on
the Contract Schedule.

ANNUITY OPTION(S). The different payment options available for Annuity Payments
under this contract.

ANNUITY PAYMENTS. A series of payments made to the Owner, or a named payee,
after the Annuity Date under the Annuity Option selected.

ANNUITY PERIOD. The period of time beginning with the Annuity Date during which
Annuity Payments are made.

ANNUITY UNIT. An accounting unit of measure used to calculate the amount of
Annuity Payments.

BENEFICIARY. The person(s) or entity(ies) who will receive the death benefit
payable under this contract.

BUSINESS DAY. Each day that the New York Stock Exchange is open for business.
The Separate Account will be valued each Business Day.

CONTRACT ANNIVERSARY. One year from your Contract Issue Date and every year
thereafter on the same month and day.

CONTRACT ISSUE DATE. The Contract Issue Date shown on the schedule page of this
contract.

CONTRACT VALUE. On a given business day, the contract value will equal the sum
of Purchase Payments, the initial Purchase Payment credit, earned interest, if
any, less withdrawals and/or charges.

CONTRACT WITHDRAWAL VALUE. The Contract Value, less any applicable premium tax,
less any contingent deferred sales charge and less any applicable contract
maintenance charge.

CONTRACT YEAR(S). The annual period begins on the Contract Issue Date.
Subsequent Contract Years begin on each anniversary day of the Contract Issue
Date.

CREDITED INTEREST RATE. The interest rate credited to the contract by the
Company for amounts allocated to the Fixed Account. The initial current Interest
rate is shown on the contract schedule.

ELIGIBLE FUND. An investment entity that is made available for this contract.

FIXED ACCOUNT. An investment option within the General Account.

FIXED ANNUITY. A series of payments made during the Annuity Period that are
guaranteed as to dollar amount by the Company.

GENERAL ACCOUNT. The Company's general investment account that contains all the
assets of the Company except for the Separate Account and other segregated asset
accounts.

OWNER/JOINT OWNER. The person(s) entitled to exercise all rights under this
contract (You, Your).

PORTFOLIO. A segment of an Eligible Fund which constitutes a separate and
distinct class of shares.

PREMIUM TAX(ES). Any Premium Taxes payable to any government entity and assessed
against Purchase Payments or Contract Value.

PURCHASE PAYMENT(S). A payment made by or for an Owner with respect to this
contract. All payments must be made payable to the Company.

SEPARATE ACCOUNT. A Separate Account is an account that provides investment
options where the benefits are held separate from other Company assets. The
Separate Account is not guaranteed as to the dollar amount shown on the contract
schedule.

SUB-ACCOUNT(S). Separate Account assets are divided into Sub-accounts. Each
Sub-account will invest its assets in shares of a single Eligible Fund or a
single Portfolio of an Eligible Fund.

WE, US, OUR. The Company.

WRITTEN REQUEST. A request in writing, in a form satisfactory to the Company,
that is received by the Administrative Office.

PURCHASE PAYMENT PROVISIONS

PURCHASE PAYMENTS. The initial Purchase Payment is due on the Contract Issue
Date. Subject to the maximum and minimum amounts shown on the contract schedule,
subsequent Purchase Payments may be made at any time during the Accumulation
Period. You may increase, decrease and change the frequency of such payments.
The Company reserves the right to reject any Application or Purchase Payment.

ALLOCATION OF PURCHASE PAYMENTS. Purchase Payments are allocated to the Fixed
Account and/or to one or more Sub-accounts of the Separate Account in accordance
with the selections made by the Owner. The allocation of the initial Purchase
Payment is made in accordance with the selection made by the Owner at the
Contract Issue Date. Unless otherwise changed by the Owner, subsequent Purchase
Payments are allocated in the same manner as the initial Purchase Payment.
Allocation of Purchase Payments are subject to the allocation guidelines shown
on the contract schedule.

SEPARATE ACCOUNT PROVISIONS

THE SEPARATE ACCOUNT. The Separate Account consist of assets set aside by the
Company, which are kept separate from that of the general assets and any other
Separate Account assets of the Company. The assets of the Separate Account will
not be charged with liabilities arising out of any other business the Company
may conduct.

The Separate Account assets are divided into Sub-accounts. The assets of the
Sub-accounts are allocated to the Eligible Fund(s) and the Portfolio(s), if any,
within an Eligible Fund. Should the shares of any such Eligible Fund(s), or any
Portfolio(s) within an Eligible Fund, become unavailable for investment by the
Separate Account, or the Company's Board of Directors deems further investment
in these shares inappropriate, the Company may limit further purchase of such
shares or substitute shares of another Eligible Fund or Portfolio for shares
already purchased under this contract.

VALUATION OF ASSETS. The assets of the Sub-accounts are valued at their fair
market value in accordance with Company procedures.

ACCUMULATION UNITS. Accumulation Units shall be used to account for all amounts
allocated to, or withdrawn from, the Sub-accounts of the Separate Account as a
result of Purchase Payments, withdrawals, transfers, fees and charges. The
Company will determine the number of Accumulation Units of a Sub-account
purchased or cancelled. This will be done by dividing the amount allocated to
(or the amount withdrawn from) the Sub-account by the dollar value of one
Accumulation Unit of the Sub-account as of the Business Day that the request for
the transaction is received at Our Administrative Office.

ACCUMULATION UNIT VALUE. The initial Accumulation Unit value for each
Sub-account was arbitrarily set at $10. Subsequent Accumulation Unit values for
each Sub-account are determined each Business Day by multiplying the
Accumulation Unit value for the immediately preceding Business Day by the net
investment factor for the Sub-account for the current Business Day. The net
investment factor for each Sub-account is determined by dividing A by B and
subtracting C where:

A is: (i) the net asset value per share of the Eligible Fund or
Portfolio of an Eligible Fund held by the Sub-account as of
the current Business Day; plus

(ii) any dividend or capital gain per share declared on
behalf of such Eligible Fund or Portfolio that has an
ex-dividend date as of the current Business Day; plus

(iii) a charge-factor, if any, for any taxes or any tax
reserve established by the Company as a result of the
operation or maintenance of the Sub-account(s).

B is the net asset value per share of the Eligible Fund or
Portfolio held by the Sub-account for the immediately
preceding Business Day.

C is the Business Day equivalent of the insurance charges, if
any, that are shown in the contract schedule.

The accumulation unit value may increase or decrease from Business Day to
Business Day.

INSURANCE CHARGES. Each business day the Company deducts insurance charges from
the Separate Account that are equal, on an annual basis, to the amount shown on
the contract schedule. The insurance charges compensate the Company for assuming
the mortality and expense risks, costs associated with the administration of
this contract, and if so elected, to provide for certain benefits.

FIXED ACCOUNT PROVISIONS

FIXED ACCOUNT VALUES. The Fixed Account portion of a contract at any time is
equal to:

1. the Purchase Payments allocated to the Fixed Account on behalf of
an Owner; plus

2. the Contract Value transferred to the Fixed Account; plus

3. interest credited to the Contract Value in the Fixed Account;
less

4. prior withdrawals of the Contract Value in the Fixed Account and
any contingent deferred sales charge; less

5. any Contract Value transferred from the Fixed Account; less

6. contract maintenance charges or transfer fees deducted from the
Contract Value allocated to the Fixed Account.

INTEREST TO BE CREDITED. The Company guarantees that the interest to be credited
to the Fixed Account will not be less than the minimum guaranteed interest rate
shown on the contract schedule. The Company may credit additional interest at
its sole discretion for any Fixed Account option. The Fixed Account option and
the initial current interest rate are shown on the contract schedule.

CONTRACT VALUE PROVISION

CONTRACT VALUE. The Contract Value as of any Business Day is the sum of the
Contract Value in each of the Sub-accounts of the Separate Account and the
Contract Value in the Fixed Account.

The Contract Value in a Sub-account of the Separate Account is determined by
multiplying the number of Accumulation Units allocated to the Owner's account
for the Sub-account by the Accumulation Unit value.

Withdrawals will result in the cancellation of Accumulation Units in a
Sub-account or a reduction in the Contract Value in the Fixed Account, as
applicable.

CONTRACT MAINTENANCE FEE PROVISION

CONTRACT MAINTENANCE FEE DEDUCTION. On each Contract Anniversary the Company
will deduct a contract maintenance fee from the Contract Value for reimbursement
of expenses relating to maintenance of the contract as shown on the contract
schedule. The Company will do this by reducing the Contract Value in the Fixed
Account and by canceling Accumulation Units from each applicable Sub-account.
The contract maintenance fee will be deducted first from the Fixed Account. If
there is insufficient value in the Fixed Account, then the contract maintenance
fee will be deducted from the Sub-account of the Separate Account with the
largest balance.

TRANSFER PROVISIONS

TRANSFERS DURING THE ACCUMULATION PERIOD. Subject to any limitation imposed by
the Company on the number of transfers during the Accumulation Period, shown on
the contract schedule, an Owner may transfer all or part of the Contract Value
in the Fixed Account or a Sub-account. The Owner may do this by Written Request.
All transfers are subject to the following:

1. If more than the number of free transfers have been made in a 30-day
period, the Company will deduct a transfer fee for each subsequent
transfer made. The frequency and number of free transfers are shown on
the contract schedule. The transfer fee is deducted from the Account
that is the source of the transfer. However, if the Owner's entire
interest in an Account is being transferred, then the transfer fee
will be deducted from the amount being transferred. If there are
multiple-source Accounts, the transfer fee will be allocated first to
the Fixed Account and then to the Sub-account with the largest balance
that is involved in the transfer transaction.

2. The contact schedule shows: a) the minimum amount that may be
transferred from a Sub-account; b) the minimum amount that must remain
in a Sub-account and the Fixed Account; and c) the maximum amount that
may be transferred from the Fixed Account to the Separate Account.

3. An Owner's right to make transfers is subject to modification if the
Company determines, in the Company's sole opinion, that the exercise
of the right by one or more Owners is or would be to the disadvantage
of other Owners. Restrictions may be applied in any manner reasonably
designed to prevent any use of the transfer right which is considered
by the Company to be to the disadvantage of the Owners. A modification
could be applied to the transfers to or from one or more of the
Sub-accounts and could include, but not be limited to: a) the
requirement of a minimum time period between each transfer; b) not
accepting a transfer request from an agent acting under a power of
attorney on behalf of more than one Owner; or c) limiting the dollar
amount that may be transferred between the Sub-accounts by an Owner at
any one time.

4. The Company reserves the right, at any time, and without prior notice
to any party, to terminate, suspend or modify the transfer privilege
described above.

If an Owner elects to use this transfer privilege, the Company will not be
liable for transfers made in accordance with the instructions received from the
Owner or other authorized persons. All amounts and Accumulation Units will be
determined as of the Business Day during which the request for transfer is
received at Our Administrative Office.

TRANSFERS DURING THE ANNUITY PERIOD. Subject to any limitations imposed by the
Company on the number of transfers allowed during the Annuity Period, shown on
the contract schedule, the Owner may transfer Annuity Units as follows:

1. Transfers may be made upon Written Request to the Company at least
thirty (30) days before the due date of the next Annuity Payment for
which the change will apply. Transfers will be made by converting the
number of Annuity Units being transferred to the number of Annuity
Units of the selected Sub-account to which the transfer is made, so
that the next Annuity Payment, if it were made at that time, would be
the same amount that it would have been without the transfer.
Thereafter, Annuity Payments will reflect changes in the value of the
new Annuity Units.

2. If more than the number of free transfers, shown on the contract
schedule, have been made in a Contract Year, the Company will deduct a
transfer fee, shown on the contract schedule, for each subsequent
transfer. The transfer fee is deducted from the Account that is the
source of the transfer. However, if the Owner's entire interest in an
Account is being transferred, the transfer fee will be deducted from
the amount that is transferred. If there are multiple-source Accounts,
the transfer fee will be deducted first from the Fixed Account and
then from the Sub-account with the largest balance that was involved
in the transaction.

3. No transfers can be made between the Fixed Account and the Separate
Account.

4. The minimum amount that can be transferred from a Sub-account is shown
on the contract schedule. The minimum amount that must remain in a
Sub-account and Fixed Account after a transfer is shown on the
contract schedule.

5. The Company reserves the right, at any time and without prior notice,
to terminate, suspend or modify the transfer privilege described
above.

If an Owner elects to use the transfer privilege, the Company will not be liable
for transfers made in accordance with instructions received from the Owner or
other authorized persons. All amounts and Annuity Units will be determined as of
the Business Day during which the request for transfer is received at Our
Administrative Office.

WITHDRAWAL PROVISIONS

WITHDRAWALS. During the Accumulation Period, the Owner may make full or partial
withdrawals of the Contract Withdrawal Value by Written Request. The Owner must
indicate in the Written Request which Sub-account or Fixed Account is intended
to be the source of the partial withdrawal.

We will pay the amount of any withdrawal from the Separate Account within seven
(7) days of receipt of a Written Request unless the Suspension or Deferral of
Payments provision is in effect.

Each partial withdrawal must be for an amount that is not less than the minimum
amount shown on the contract schedule. The minimum Contract Value that must
remain in a Sub-account and the Fixed Account after a partial withdrawal is
shown on the contract schedule. The maximum amount which may be withdrawn from
the Fixed Account is shown on the contract schedule.

CONTINGENT DEFERRED SALES CHARGE. Upon withdrawal of all or part of the
Contract, a contingent deferred sales charge may be assessed as stated on the
contract schedule.

PROCEEDS PAYABLE AT DEATH PROVISIONS

DEATH OF OWNER DURING ACCUMULATION PERIOD. Upon the death of the Owner, or any
Joint Owner, during the Accumulation Period, the death benefit will be paid to
the beneficiary(ies) designated by the Owner(s). Upon the death of a Joint
Owner, the surviving Owner will be treated as the primary beneficiary. Any other
beneficiary designation on record at the time of death will be treated as a
contingent beneficiary. The death benefit must be paid under one of the death
benefit options below. However, if the beneficiary is the spouse of the Owner,
he or she may elect to continue the contract, at the then current Contract
Value, in his or her own name and exercise all the ownership rights under the
contract.

DEATH BENEFIT AMOUNT. During the Accumulation Period, if death of an Owner
occurs prior to age 80, the death benefit will be the greater of: a) the
Contract Value; or b) total Purchase Payments less any partial withdrawals and
contingent deferred sales charges. If age 80 or older, the death benefit will be
equal to the Contract Value. The Contract Value will be determined as of the
Business Day the Company receives both due proof of death and an election for
the payment method. If Joint Owners are named, the death benefit is determined
based on the age of the oldest Owner.

After the death benefit amount is determined, it remains in the Separate Account
and/or Fixed Account until distribution begins. From the time the death benefit
is determined until complete distribution is made, any amount in the Sub-account
will be subject to investment risk, which is borne by the Beneficiary.

DEATH BENEFIT OPTIONS DURING ACCUMULATION PERIOD. The Owner may designate in
writing that the death benefit be paid under one of the options available below.
If the Owner doesn't designate an option, then the Beneficiary must elect the
death benefit to be paid under one of the following options in the event of the
death of the Owner or a Joint Owner during the Accumulation Period:

- Option 1 - Lump sum payment of the death benefit; or

- Option 2 - Payment of the entire death benefit within five (5)
years of the date of the death of the Owner or any Joint Owner;
or

- Option 3 - Payment of the death benefit under an Annuity Option
over the lifetime of the Beneficiary, or over a period not
extending beyond the life expectancy of the Beneficiary, with
distribution beginning within one (1) year of the date of death
of the Owner or Joint Owner.

Any portion of the death benefit not applied under Option 3, within one (1) year
of the date of the Owner's death, must be distributed within five (5) years of
the date of death.

Unless the Owner has previously designated one of the above payment options, a
Beneficiary who is a spouse of the Owner may elect to: a) continue the contract
in his or her own name at the then current Contract Value; b) elect a lump sum
payment of the death benefit; or c) or apply the death benefit to an Annuity
Option.

If a lump sum payment is requested, the amount will be paid within seven (7)
days of receipt of proof of death and the payment election, unless the
Suspension or Deferral of Payments provision, as set forth on page 14 is in
effect. Payment to the Beneficiary, other than in a lump sum, may only be
elected during the sixty-day (60) period beginning with the date of receipt of
proof of death.

DEATH BENEFIT OPTION DURING THE ANNUITY PERIOD. If the Owner, or any Joint
Owner, who is not the Annuitant, dies during the Annuity Period, any remaining
payments under the Annuity Option elected will continue at least as rapidly as
under the method of distribution in effect at such Owner's or Joint Owner's
death. Upon the death of any Owner during the Annuity Period, the Beneficiary
becomes the Owner. Upon the death of any Joint Owner during the Annuity period,
the surviving owner, if any, will be treated as the primary Beneficiary. Any
other Beneficiary designation on record at the time of death will be treated as
a Contingent Beneficiary.

DEATH OF ANNUITANT. Upon the death of an Xxxxxxxxx, who is not the Owner, during
the Accumulation Period, the Owner automatically becomes the Annuitant. The
Owner may designate a new Annuitant, subject to the Company's underwriting rules
then in effect. If the Owner is a non-natural person, the death of an Annuitant
will be treated as the death of the Owner and a new Annuitant may not be
designated.

Upon the death of an Annuitant during the Annuity Period, the death benefit, if
any, will be as specified in the Annuity Option elected. Death benefits will be
paid at least as rapidly as under the method of distribution in effect at the
Annuitant's death.

PAYMENT OF DEATH BENEFIT: The Company will require due proof of death of the
Annuitant before any death benefit is paid. Due proof of death will be:

1. a certified death certificate; or

2. a certified decree of a court of competent jurisdiction as to the
finding of death; or

3. any other proof satisfactory to the Company

All death benefits will be paid in accordance with applicable law or regulations
governing death benefit payments.

BENEFICIARY. The Beneficiary designation in effect on the Contract Issue Date
will remain in effect until changed. The Beneficiary is entitled to receive the
benefits to be paid at the death of the Owner.

Unless the Owner provides otherwise, the death benefit will be paid in equal
shares to the survivor(s) as follows:

1. the Primary Beneficiary(ies) who survive the Owner's and/or the
Annuitant's death, as applicable; or if none

2. the Contingent Beneficiary(ies) who survive the Owner's and/or
the Annuitant's death, as applicable; or if none

3. the estate of the Owner.

BENEFICIARY CHANGE. Subject to the rights of any irrevocable Beneficiary(ies),
the Owner may change the primary Beneficiary(ies) or contingent
Beneficiary(ies). A change may be made by Written Request. The change will take
effect as of the date the Written Request is signed. The Company will not be
liable for any payment made or action taken before it records the change.

SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION

The Company reserves the right to suspend or postpone payments from the Separate
Account for a withdrawal or transfer for any period listed below, provided that
applicable rules and regulations of the Securities and Exchange Commission will
govern as to whether the conditions described in (2) and (3) below exist. The
Company further reserves the right to postpone payments from the Fixed Account
for a period of up to six (6) months.

1. the New York Stock Exchange is closed (other than customary weekend
and holiday closings); or

2. trading on the New York Stock Exchange is restricted; or

3. an emergency exists as a result of which disposal of securities held
in the Separate Account is not reasonably practicable or it is not
reasonably practicable to determine the value of the Separate
Account's net assets; or

4. during any other period when the Securities and Exchange Commission,
by order, so permits consistent with the protection of Owners.

OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS

OWNER. The Owner has all interest and right to amounts held in this contract.
The Owner is the person designated as such on the Contract Issue Date, unless
changed.

The Owner may change ownership of the contract at any time by Written Request. A
change of ownership will automatically revoke any prior designation of Owner.
The change will become effective as of the date the Written Request is received
by Us. The Company will not be liable for any payment made or action taken
before it records the change.

JOINT OWNER. A contract may be owned by Joint Owners. If Joint Owners are named,
the Joint Owner must be the spouse of the other Owner, unless limited by law.
Upon the death of either Owner, the surviving Joint Owner will be the primary
Beneficiary. Any other Beneficiary designation will be treated as a contingent
Beneficiary unless otherwise indicated in a Written Request.

ANNUITANT/JOINT ANNUITANT. The Annuitant(s) is the person on whose life Annuity
Payments are based. The Annuitant(s) is the person designated by the Owner at
the Contract Issue Date, unless changed prior to the Annuity Date. The Annuitant
may not be changed in a contract that is owned by a non-natural person. Any
change of Annuitant(s) is subject to the Company's underwriting rules in effect
at the time the Written Request is recorded by the Company.

ASSIGNMENT OF CONTRACT. A Written Request specifying the terms of an assignment
of a contract must be provided to Our Administrative Office. The Company will
not be liable for any payment made or action taken before it records the
assignment. The Company will not be responsible for the validity or tax
consequences of any assignment. Any assignment made after the Annuity Date, or
after the death benefit has become payable will be valid only with the Company's
consent. If the contract is assigned, the Owner's rights may only be exercised
with the consent of the assignee of record.

ANNUITIZATION PROVISIONS

GENERAL. On the Annuity Date, the Contract Withdrawal Value will be applied
under the Annuity Option selected by the Owner. The Owner may elect to have the
Contract Withdrawal Value applied to provide a Fixed Annuity, a Variable Annuity
or a combination Fixed and Variable Annuity. The Contract Value may be applied
under the Annuity Option selected if the Annuity Date occurs on or after the
fifth (5) Contract Anniversary and the Annuity Option is life contingency for a
minimum of five (5) years. If an Annuity Option combination is elected, the
Owner must specify what portion of the Contract Withdrawal Value is to be
applied to the fixed and variable options. In addition, the Owner may select a
lump sum payment .

ANNUITY DATE. The Annuity Date is selected by the Owner at the Contract Issue
Date. The Annuity Date must be the first day of a calendar month and must be at
least ninety (90) days after the Contract Issue Date. The Annuity Date may not
be later than the earlier of: a) the date the Annuitant reaches attained age 90;
or b) the maximum date permitted under applicable law.

Prior to the Annuity Date, the Owner, subject to the above, may change the
Annuity Date by Written Request. Any change must be requested at least thirty
(30) days prior to the new Annuity Date.

SELECTION OF AN ANNUITY OPTION: An Annuity Option may be selected by Written
Request of the Owner. If no Annuity Option is selected, Option 2 with 120
monthly payments guaranteed will automatically be applied. Unless specified
otherwise, that portion of the Contract Withdrawal Value allocated to the
Separate Account shall be used to provide a variable annuity, and that portion
of the Contract Withdrawal Value allocated to the Fixed Account will be used to
provide a Fixed Annuity. Prior to the Annuity Date, the Owner can change the
Annuity Option selected by Written Request. Any change must be requested at
least thirty (30) days prior to the Annuity Date.

FREQUENCY AND AMOUNT OF ANNUITY PAYMENTS. Annuity Payments are paid in monthly
installments. The Contract Withdrawal Value is applied to the annuity table for
the Annuity Option selected. If the Contract Withdrawal Value applied under an
Annuity Option is less than $5,000, the Company reserves the right to make a
lump sum payment in lieu of Annuity Payments. If the Annuity Payment is ever
less than $50, the Company reserves the right to reduce the frequency of
payments to an interval which will result in each payment being at least $50.

ANNUITY OPTIONS: The following Annuity Options or any other Annuity Option
acceptable to the Company may be selected:

OPTION 1. INCOME FOR SPECIFIED PERIOD. We will pay an income for a specific
number of years in equal installments. We guarantee these payments to be at
least those shown in Table 1. However, when the Annuitant dies, if We have
made Annuity Payments for less than the specified period elected, We will
continue to make Annuity Payments to the Owner for the rest of the
specified period. If an Owner does not want to receive Annuity Payments, he
or she may ask Us for a single lump sum. A single sum payment will be equal
to the present value of remaining payments as of the date of receipt of
proof of death commuted at the assumed investment rate for a Variable
Annuity Option and at the Fixed Account guaranteed rate for a Fixed Annuity
option.

OPTION 2. LIFE INCOME WITH PERIOD CERTAIN. We will pay equal monthly
payments for a specified period certain and then for the life of the
Annuitant. If the Annuitant dies during period certain, We will continue to
make payments to the Owner (or any person designated by the Owner) for the
rest of the guaranteed specified period. If the Owner does not want to
receive payments after the Annuitant's death, he/she can ask Us for a lump
sum. A single sum payment will be equal to the present value of remaining
payments as of the date of receipt of proof of death commuted at the
assumed investment rate for a Variable Annuity Option and at the Fixed
Account guaranteed rate for a Fixed Annuity option.

OPTION 3. INCOME OF SPECIFIED AMOUNT. We will pay income of a specified
amount until the principal and interest are exhausted. However, when the
Annuitant dies, if We have made annuity payments for less than the
specified amount, We will continue to make annuity payments to the Owner
for the balance of the specified amount. If the Owner does not want to
receive annuity payments, he or she can ask Us for a single lump sum. A
single sum payment will be equal to the present value of remaining payments
as of the date of receipt of proof of death commuted at the assumed
investment rate for a Variable Annuity Option and at the Fixed Account
guaranteed rate for a Fixed Annuity option.

OPTION 4. JOINT AND SURVIVOR INCOME. We will pay equal monthly payments
during the joint lifetime of the Annuitant and the named Joint Annuitant.
We will determine the payment from Table 4 based on the Age of each person.
The Annuitant must be at least 50 years old, and the Joint Annuitant must
be at least 45 years old, at the time of the first monthly payment.

ANNUITY. If the Owner selects a Fixed Annuity, the Contract Withdrawal Value
will be allocated to the General Account and the Annuity paid as a Fixed
Annuity. If the Owner selects a variable annuity, the Contract Withdrawal Value
will be allocated to the Sub-accounts of the Separate Account in accordance with
the selection made by the Owner, and the annuity will be paid as a variable
annuity. If no selection is made, the Contract Withdrawal Value will be applied
in the same proportions, to the same Sub-accounts, as the allocations are at the
time of election. Unless the Owner specifies otherwise, the payee of the Annuity
Payments shall be the Owner. The Contract Withdrawal Value will be applied to
the applicable annuity table contained in this contract based upon the Annuity
Option selected by the Owner. The amount of the first payment for each $1,000 of
Contract Withdrawal Value is shown in the annuity tables.

FIXED ANNUITY. The Owner may elect to have the Contract Withdrawal Value applied
to provide a Fixed Annuity. The dollar amount of each Fixed Annuity Payment
shall be determined in accordance with Annuity tables contained in contract
which are based on the minimum guaranteed interest rate of 3% per year.

VARIABLE ANNUITY. The Owner may elect to have the Contract Withdrawal Value
applied to provide a variable annuity. Variable Annuity Payments reflect the
investment performance of the Separate Account in accordance with the allocation
of the Contract Withdrawal Value to the Sub-accounts during the Annuity Period.
Variable Annuity Payments are not guaranteed as to dollar amount.

The dollar amount of the first Variable Annuity Payment is determined in
accordance with the description above. The dollar amount of the variable Annuity
Payment for each applicable Sub-account after the first variable Annuity Payment
is determined as follows:

1. The dollar amount of the first variable Annuity Payment is divided by
the value of an Annuity Unit for each applicable Sub-account as of the
Annuity Date. This sets the number of Annuity Units for each monthly
payment for the applicable Sub-accounts.

2. The fixed number of Annuity Units per payment in each Sub-account is
multiplied by the Annuity Unit value for that Sub-account for the last
Business Day of the month proceeding the month for which the payment
is due. This result is the dollar amount of the payment for each
applicable Sub-account.

The total dollar amount of each variable Annuity Payment is the sum of all
Sub-account variable Annuity Payments reduced by the applicable portion of the
contract maintenance fee.

ANNUITY UNIT. The value of any Annuity Unit for each Sub-account of the Separate
Account was initially set at $10.

The Sub-account Annuity Unit Value for any subsequent Business Day is determined
as follows:

1. The net investment factor for the current Business Day is multiplied
by the value of the Annuity Unit for the Sub-account for the
immediately preceding Business Day.

2. The result in (1) is then divided by the assumed investment rate
factor, which equals 1.00, plus the assumed investment rate for the
number of days since the preceding Business Day. The Owner can choose
either a 5% or a 3% assumed investment rate.

MORTALITY TABLES. The Annuity 2000 Mortality Table is used in establishing the
annuity table.

The dollar amount of an Annuity Payment for any age or combination of ages not
shown in the tables, or for any other form of Annuity Option agreed to by the
Company, will be provided by the Company upon request.

GENERAL CONTRACT PROVISIONS

THE CONTRACT. The entire contract consists of this contract, the application, if
any, amendments and any riders or endorsements attached to it. This contract may
be changed or altered in writing only, by the President, Senior Vice President
or Secretary of the Company. No agent has the authority to change or waive any
provision of this contract.

EVIDENCE OF SURVIVAL. The Company may require satisfactory evidence of the
continued survival of any person(s) on whose life Annuity Payments are based.

INCONTESTABILITY. This contract will be incontestable from the Contract Issue
Date.

MISSTATEMENT OF AGE OR SEX. If the age or sex of any Annuitant has been
misstated, any annuity benefits payable will be the annuity benefits that would
have been provided at the correct age and sex. After Annuity Payments have
begun, any underpayments will be made up in one sum with the next Annuity
Payment. Any overpayment will be deducted from future Annuity Payments until the
total is repaid.

MODIFICATION. This contract may be modified in order to maintain compliance with
applicable state and/or federal law.

NON-PARTICIPATING. This contract will not share in any distribution of
dividends, profits or income of the Company.

PREMIUM TAXES. Any taxes paid to any governmental entity relating to the
contract will be deducted from the Purchase Payment or Contract Value. The
Company may, at its sole discretion, pay taxes when due and deduct that amount
from the Contract Value at a later date. Payment of taxes at an earlier date
does not waive the rights of the Company to deduct that amount from the Contract
Value at a later date.

PROOF OF AGE AND SEX. The Company may require evidence of age and sex of any
Annuitant and any Owner.

PROTECTION OF PROCEEDS. To the extent permitted by law, death benefits and
Annuity Payments shall be free from legal process and the claim of any creditor
other than the person entitled to them under a valid legal contract. No payment,
nor any amount under this contract, shall be taken or assigned in advance of its
payment date unless the Company receives the Owner's Written Request.

OTHER TAXES. The Company reserves the right to establish a provision for federal
income taxes if it determines, at its sole discretion, that it will incur a tax
as a result of the operation of the Separate Account. The Company will deduct
for any income taxes incurred by it as a result of the operation of the Separate
Account whether or not there was a provision for taxes and whether or not that
provision was sufficient. The Company will deduct any withholding taxes required
by applicable law.

REGULATORY REQUIREMENTS. All values payable under any contract will not be less
than the minimum benefits required by the laws and regulations of the state in
which the contract is delivered.

REPORTS. At least once each calendar year, the Company will furnish each Owner
with an annual report showing the Contract Value and any other information
required by law.

TABLE 1

INCOME FOR SPECIFIED PERIOD FACTORS

Installments shown are for each $1,000 of net proceeds applied. Interest is 3%,
and is subject to change as described in the Interest on Settlement Options
Section.

ANNUAL SEMI
YEARS ANNUAL ANNUAL QUARTERLY MONTHLY
---------------------------------------------------

1 N/A N/A N/A N/A
2 N/A N/A N/A N/A
3 N/A N/A N/A N/A
4 N/A N/A N/A N/A
5 $ 211.99 $ 106.78 $ 53.59 $ 17.91
6 179.22 90.27 45.30 15.14
7 155.83 78.49 39.39 13.16
8 138.31 69.66 34.96 11.68
9 124.69 62.81 31.52 10.53
10 113.82 57.33 28.77 9.61
11 104.93 52.85 26.52 8.86
12 97.54 49.13 24.65 8.24
13 91.29 45.98 23.08 7.71
14 85.95 43.29 21.73 7.26
15 81.33 40.96 20.56 6.87
16 77.29 38.93 19.54 6.53
17 73.24 37.14 18.64 6.23
18 70.59 35.56 17.84 5.96
19 67.78 34.14 17.13 5.73
20 65.26 32.87 16.50 5.51

* Equal monthly payment for the number of years elected, not to exceed 25 years.
Payments will begin on the option date selected.

TABLE 2

MONTHLY INCOME FOR LIFE WITH GUARANTEED PERIOD CERTAIN

Equal monthly payments for a guaranteed period of 10, 15, or 20 years, as
elected, and for life thereafter as shown in the table below. Amount of each
monthly installment per $1,000 net proceeds. Amounts based on Annuity 2000
Mortality Tables and 3% interest.

MALE

AGE OF
PAYEE 10 YEARS 15 YEARS 20 YEARS
---------------------------------------

25 $ 3.08 $ 3.08 $ 3.07
26 3.10 3.10 3.09
27 3.12 3.12 3.11
28 3.15 3.14 3.14
29 3.17 3.17 3.16
30 3.20 3.19 3.19
31 3.22 3.22 3.21
32 3.25 3.25 3.24
33 3.28 3.28 3.27
34 3.31 3.31 3.30
35 3.34 3.34 3.33
36 3.38 3.37 3.36
37 3.41 3.40 3.39
38 3.45 3.44 3.42
39 3.49 3.48 3.46
40 3.53 3.52 3.50
41 3.57 3.56 5.53
42 3.62 3.60 3.57
43 3.66 3.64 3.62
44 3.71 3.69 3.66
45 3.76 3.74 3.70
46 3.81 3.79 3.75
47 3.87 3.84 3.80
48 3.92 3.89 3.85
49 3.98 3.95 3.90
50 4.05 4.01 3.95
51 4.11 4.07 4.00
52 4.18 4.13 4.06
53 $ 4.25 $ 4.20 $ 4.12
54 4.33 4.27 4.18
55 4.41 4.34 4.24
56 4.49 4.42 4.30
57 4.58 4.49 4.36
58 4.68 4.58 4.43
59 4.78 4.66 4.49
60 4.88 4.75 4.56
61 4.99 4.84 4.62
62 5.10 4.93 4.69
63 5.23 5.03 4.75
64 5.35 5.13 4.82
65 5.48 5.22 4.88
66 5.62 5.33 4.94
67 5.77 5.43 5.00
68 5.92 5.53 5.06
69 6.07 5.63 5.11
70 6.23 5.73 5.16
71 6.39 5.83 5.21
72 6.56 5.93 5.25
73 6.73 6.02 5.29
74 6.90 6.11 5.33
75 7.08 6.20 5.36
76 7.25 6.28 5.39
77 7.43 6.35 5.41
78 7.61 6.42 5.43
79 7.78 6.49 5.45
80 7.95 6.55 5.46

FEMALE

AGE OF
PAYEE 10 YEARS 15 YEARS 20 YEARS
---------------------------------------

25 $ 2.99 $ 2.99 $ 2.99
26 3.01 3.01 3.00
27 3.03 3.03 3.02
28 3.05 3.05 3.04
29 3.07 3.07 3.06
30 3.09 3.09 3.09
31 3.11 3.11 3.11
32 3.14 3.14 3.13
33 3.16 3.16 3.15
34 3.19 3.19 3.18
35 3.22 3.21 3.21
36 3.24 3.24 3.23
37 3.27 3.27 3.26
38 3.30 3.30 3.29
39 3.34 3.33 3.32
40 3.37 3.36 3.35
41 3.41 3.40 3.39
42 3.44 3.44 3.42
43 3.48 3.47 3.46
44 3.52 3.51 3.50
45 3.57 3.55 3.54
46 3.61 3.60 3.58
47 3.66 3.64 3.62
48 3.71 3.69 3.66
49 3.76 3.74 3.71
50 3.81 3.79 3.76
51 3.87 3.85 3.81
52 3.93 3.90 3.86
53 $ 3.99 $ 3.96 $ 3.92
54 4.06 4.02 3.97
55 4.13 4.09 4.03
56 4.20 4.16 4.09
57 4.28 4.23 4.15
58 4.36 4.30 4.22
59 4.45 4.38 4.28
60 4.54 4.46 4.35
61 4.63 4.55 4.42
62 4.73 4.64 4.49
63 4.84 4.73 4.57
64 4.95 4.83 4.64
65 5.07 4.93 4.71
66 5.20 5.03 4.78
67 5.33 5.14 4.85
68 5.47 5.25 4.92
69 5.62 5.36 4.99
70 5.78 5.47 5.05
71 5.94 5.58 5.11
72 6.11 5.70 5.17
73 6.29 5.81 5.22
74 6.48 5.92 5.27
75 6.67 6.03 5.31
76 6.86 6.13 5.35
77 7.06 6.22 5.38
78 7.26 6.31 5.40
79 7.46 6.39 5.43
80 7.66 6.47 5.45

TABLE 3

EQUAL PAYMENTS OF A SPECIFIED AMOUNT

Equal monthly payments of at least $4.71 per month for each $1,000 of proceeds.
Payments will begin on the option date and will continue until the proceeds and
interest, at a rate of 3% compounded annually, are exhausted.

TABLE 4

JOINT SURVIVOR INCOME FACTORS

MALE AGE
------------------------------------------------------------------
FEMALE AGE 45 50 55 60 65 70

45 $ 3.34 $ 3.41 $ 3.46 $ 3.50 $ 3.54 $ 3.58

50 3.44 3.54 3.62 3.69 3.74 3.79

55 3.53 3.66 3.79 3.90 3.99 4.06

60 3.60 3.78 3.95 4.12 4.27 4.38

65 3.66 3.87 4.10 4.34 4.57 4.77

70 3.71 3.95 4.22 4.54 4.87 5.19

Installments shown are monthly and are for each $1,000 of net proceeds applied.

Based on Annuity 2000 Tables and 3% interest. Amounts are subject to change as
described in the Interest On Settlement Options Section.

We will furnish values for age combinations not shown in the table upon request.

JEFFERSON NATIONAL LIFE INSURANCE COMPANY
FIXED FUND
ACCUMULATION TABLE FOR FLEXIBLE PREMIUM DEFERRED ANNUITY
$1,000 Annual Premium
Guaranteed Surrender Value*

END OF
POLICY CONTRACT VALUE
YEAR INCREASE CONRACT VALUE SURRENDER VALUE
---------------------------------------------------------

1 1,030.00 1,030.00 958.24
2 1,060.90 2,090.90 1,947.63
3 1,092.73 3,183.63 2,969.10
4 1,125.51 4,309.14 4,023.61
5 1,159.27 5,468.41 5,116.69
6 1,194.05 6,662.46 6,252.44
7 1,229.87 7,892.34 7,431.80
8 1,266.77 9,159.11 8,656.58
9 1,304.77 10,463.88 9,934.34
10 1,343.92 11,807.80 11,267.80
11 1,384.23 13,192.03 12,652.03
12 1,425.76 14,617.79 14,077.79
13 1,468.53 16,086.32 15,546.32
14 1,512.59 17,598.91 17,058.91
15 1,557.97 19,156.88 18,616.88
16 1,604.71 20,761.59 20,221.59
17 1,652.85 22,414.44 21,874.44
18 1,702.43 24,116.87 23,576.87
19 1,753.51 25,870.37 25,330.37
20 1,806.11 27,676.49 27,136.49
21 1,860.29 29,536.78 28,996.78
22 1,916.10 31,452.88 30,912.88
23 1,973.59 33,426.47 32,886.47
24 2,032.79 35,459.26 34,919.26
25 2,093.78 37,553.04 37,013.04
26 2,156.59 39,709.63 39,169.63
27 2,221.29 41,930.92 41,390.92
28 2,287.93 44,218.85 43,678.85
29 2,356.57 46,575.42 46,035.42
30 2,427.26 49,002.68 48,462.68
31 2,500.08 51,502.76 50,962.76
32 2,575.08 54,077.84 53,537.84
33 2,652.34 56,730.18 56,190.18
34 2,731.91 59,462.08 58,922.08
35 2,813.86 62,275.94 61,735.94
36 2,898.28 65,174.22 65,174.22
37 2,985.23 68,159.45 68,159.45
38 3,074.78 71,234.23 71,234.23
39 3,167.03 74,401.26 74,401.26
40 3,262.04 77,663.30 77,663.30

*Values shown are based on an interest rate of 3% for all years.

JEFFERSON NATIONAL LIFE INSURANCE COMPANY
ADMINISTRATIVE OFFICE: 0000 XXXXXXXXX XXXXXX XXXXX, XXXXX 0000
TELEPHONE: (000) 000-0000

A STOCK COMPANY

INDIVIDUAL FLEXIBLE PREMIUM DEFERRED ANNUITY CONTRACT
FIXED AND VARIABLE ACCOUNTS
NON-PARTICIPATING

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INDIVIDUAL FLEXIBLE PREMIUM DEFERRED ANNUITY CONTRACT FIXED AND VARIABLE ACCOUNTS NON-PARTICIPATING

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