0001104659-11-038621 Sample Contracts

GROUP FLEXIBLE PREMIUM FIXED AND VARIABLE DEFERRED ANNUITY CERTIFICATE Non- Participating

Separate Account I of National Integrity Life Ins Co • July 12th, 2011

• Company
  Separate Account I of National Integrity Life Ins Co
• Filed
  July 12th, 2011

To allocate the Contributions made to this Certificate to the Investment Options available under the Variable or Fixed Accounts offered on the Participation Date;