0001104659-10-001450 Sample Contracts

Form of FUND PARTICIPATION AGREEMENT
Participation Agreement • January 13th, 2010 • Financial Investors Variable Insurance Trust • Colorado

THIS AGREEMENT, made and entered into this day of , 200 (the “Agreement”) by and among , organized under the laws of the State of (the “Company”), on behalf of itself and each separate account of the Company named in Schedule A to this Agreement, as may be amended from time to time (each account referred to as the “Account” and collectively as the “Accounts”); Financial Investors Variable Insurance Trust, an open-end management investment company organized under the laws of the State of Delaware (the “Fund”); ALPS Advisors, Inc., a corporation organized under the laws of the State of Colorado and investment adviser to the Fund (the “Adviser”); and ALPS Distributors, Inc., a corporation organized under the laws of the State of Colorado and principal underwriter/distributor of the Fund (the “Distributor”).

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