0001193125-23-301259 Sample Contracts

SCHEDULE A SEPARATE ACCOUNTS AND ASSOCIATED CONTRACTS
Pia Variable Life Account I • December 21st, 2023

This Schedule A to the Participation Agreement dated June 8,2021 by and among the parties identified below is updated and effective as of August 18, 2023 and replaces all prior versions of this Schedule A.

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Insured: WILLIAM PENN $50,000.00 Specified Amount Level Death Benefit Option Policy Number: 8888888 Policy Date: January 1, 2024 Date of Issue: January 1, 2024
Pia Variable Life Account I • December 21st, 2023

This contract is made in consideration of the payment of premiums as provided in this policy. The provisions on this and the following pages are part of this policy.

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