0000950123-13-002976 Sample Contracts

CONTRACT NUMBER [P9999999999] ¬1 OWNER [JOHN DOE] ¬1
Life Insurance Contract • April 29th, 2013 • Fs Variable Separate Account

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (“We”, “Us”, the “Company”, or “US Life”) agrees to provide benefits to the Owner in accordance with the provisions set forth in this Contract and in consideration of the Application and/or confirmation thereof and Purchase Payments We receive.

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