0000950123-11-040077 Sample Contracts

OWNER [JOHN DOE]

Annuity Contract • April 27th, 2011 • Variable Separate Account

• Contract Type
  Annuity Contract
• Filed
  April 27th, 2011
• Company
  Variable Separate Account

DEFERRED VARIABLE ANNUITY APPLICATION/ENROLLMENT FORM ("APPLICATION")

Deferred Variable Annuity Application/Enrollment Form • April 27th, 2011 • Variable Separate Account

• Contract Type
  Deferred Variable Annuity Application/Enrollment Form
• Filed
  April 27th, 2011
• Company
  Variable Separate Account