0000950123-11-063393 Sample Contracts

Pacific Life & Annuity Company [700 Newport Center Drive Newport Beach, CA 92660 (800) 748-6907]
Separate Account a of Pacific Life & Annuity Co • July 1st, 2011

Add-In Amount — The amount added by us, if applicable, to the Contract Value on the Notice Date to set the Contract Value equal to the death benefit proceeds that would have been payable to the spouse as the deemed Beneficiary/designated recipient of the death benefit.

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