0001037155-09-000040 Sample Contracts

First Great-West Life & Annuity Insurance Company A Stock Company [50 Main Street White Plains, NY 10606] FLEXIBLE PREMIUM VARIABLE ANNUITY PLEASE READ THIS ANNUITY CONTRACT CAREFULLY.
Flexible Premium Variable Annuity • May 20th, 2009 • Variable Annuity I Ser Acc of Fir GRT West Li & Annu Ins Co

ALL PAYOUTS AND VALUES BASED ON THE INVESTMENT EXPERIENCE OF THE ANNUITY ACCOUNT VALUE ARE VARIABLE, MAY INCREASE OR DECREASE ACCORDINGLY, AND ARE NOT GUARANTEED AS TO AMOUNT. THE ANNUITY ACCOUNT WILL INCREASE OR DECREASE IN VALUE BASED UPON INVESTMENT RESULTS.

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