0001047469-99-021876 Sample Contracts

MINNESOTA LIFE ENDORSEMENT _______________________________________________________________________________ This endorsement, when attached to the contract, modifies certain contract provisions so as to change the contract to a Single Payment Immediate...
Endorsement • May 21st, 1999 • Variable Annuity Account

This endorsement, when attached to the contract, modifies certain contract provisions so as to change the contract to a Single Payment Immediate Annuity.

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CITY, STATE, ZIP -------------------------------------------------------------- --------------------------------------------------------------------- BENEFICIARY CLASS NAME RELATIONSHIP DATE OF BIRTH SEX SOCIAL SECURITY NUMBER / /M / /F...
Variable Annuity Application • May 21st, 1999 • Variable Annuity Account

---------------------------------------------------------------------------------------------------------------- # of Dependents RISK TOLERANCE: (CHECK ONE) TIME HORIZON / / 9-11yrs / / Conservative / / Moderate / / Aggressive / / < 3 yrs / / 4-8 yrs / / 12+ yrs ---------------------------------------------------------------------------------------------------------------- PRIOR INVESTMENT EXPERIENCE / / Mutual Funds / / Limited Partnerships / / Bonds / / Years of Experience / / Annuities / / Stocks / / Options/Futures ----------------------------------------------------------------------------------------------------------------------------------- OWNER/ANNUITANT - I/we represent that the statements and answers in this application are full, complete and true to the SIGNATURES best of my/our knowledge. I/we agree that they are to be considered the basis of any contract issued to me/us. I/we have read and agree with applicable statements.

DEALER SELLING AGREEMENT (VARIABLE CONTRACTS)
Dealer Selling Agreement • May 21st, 1999 • Variable Annuity Account • Minnesota
WITNESSETH:
Distribution Agreement • May 21st, 1999 • Variable Annuity Account • Minnesota
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