Annuity Date of Starting Date of Contract Issue Date Birth Number mo day yr mo day yr mo day yr Annuitant [ John J. Jones 12 20 1952 ] Owner [ Jane J. Doe 11 15 1950 ]Annuity Contract • April 30th, 2004 • Tiaa Separate Account Va 1 • New York
Contract Type FiledApril 30th, 2004 Company JurisdictionThis is a contract between you, the Owner, and TEACHERS INSURANCE AND ANNUITY ASSOCIATION OF AMERICA (“TIAA”). This page refers briefly to some of the features of this Contract. The next pages set forth in detail the rights and obligations of both TIAA and you under the Contract.