0000927730-11-000146 Sample Contracts

EX-c(3) This Agreement, dated ______________, 20___ is by and among ___________ ______________________________________________________________________
Jnlny Separate Account Iv • April 29th, 2011 • New York

JACKSON NATIONAL LIFE INSURANCE COMPANY OF NEW YORK®, on its own behalf and on behalf of its separate accounts, through which Contracts may be issued, (“Insurer”); and JACKSON NATIONAL LIFE DISTRIBUTORS LLC. (member FINRA formerly known as the NASD), a registered broker/dealer (“Distributor”). This Agreement is for the purpose of arranging for the distribution of certain life and annuity contracts (“Contracts”) issued by Insurer through sales people who are licensed insurance producers and/or registered representatives (collectively referred to as “Producer” or “Producers”) of the Broker/Dealer and any licensed insurance Agency, where applicable, and duly-appointed with the Insurer.

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