0001193125-19-105381 Sample Contracts

PLEASE READ THIS ANNUITY CONTRACT CAREFULLY.
Variable Annuity I Ser Acc of GRT West Li & Annu Ins Co of Ny • April 15th, 2019

[DEATH BENEFIT: The Owner has elected Death Benefit Option 1: Return of Annuity Account Value. As described in the Death Benefit provisions, the death benefit payable under this Option 1 will be equal to the Annuity Account Value as of the date the Request for payout is received, less Premium Tax, if any.

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