0000878467-07-000055 Sample Contracts

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EMPIRE FIDELITY INVESTMENTS LIFE INSURANCE COMPANY NEW YORK, NEW YORK DEFERRED VARIABLE ANNUITY
Empire Fidelity Investments Variable Annuity Account A • July 6th, 2007

This Contract has been issued in consideration of the Single Purchase Payment. We assess daily Mortality and Expense Risk Charges at annual rates of [0.85%] against the assets of a Contract issued with a single Annuitant and [1.00%] against the assets of a Contract issued with joint Annuitants. In addition, a daily Administrative Charge at an annual rate of 0.25% is charged against the assets of each Contract.

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