<SEC-DOCUMENT>0000950123-11-067864.txt : 20110725
<SEC-HEADER>0000950123-11-067864.hdr.sgml : 20110725
<ACCEPTANCE-DATETIME>20110725154815
ACCESSION NUMBER:		0000950123-11-067864
CONFORMED SUBMISSION TYPE:	6-K
PUBLIC DOCUMENT COUNT:		26
CONFORMED PERIOD OF REPORT:	20110725
FILED AS OF DATE:		20110725
DATE AS OF CHANGE:		20110725

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			MANULIFE FINANCIAL CORP
		CENTRAL INDEX KEY:			0001086888
		STANDARD INDUSTRIAL CLASSIFICATION:	LIFE INSURANCE [6311]
		IRS NUMBER:				000000000
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		6-K
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	001-14942
		FILM NUMBER:		11984628

	BUSINESS ADDRESS:	
		STREET 1:		200 BLOOR ST EAST
		STREET 2:		NORTH TOWER 11
		CITY:			TORONTO ONTARIO CANA
		STATE:			A6
		ZIP:			00000
		BUSINESS PHONE:		4169263500

	MAIL ADDRESS:	
		STREET 1:		200 BLOOR ST EAST
		STREET 2:		NORTH TOWER 11
		CITY:			TORONTO ONTARIO CANA
</SEC-HEADER>
<DOCUMENT>
<TYPE>6-K
<SEQUENCE>1
<FILENAME>b87363a1e6vk.htm
<DESCRIPTION>MAULIFE FINANCIAL CORPORATION
<TEXT>
<HTML>
<HEAD>
<TITLE>e6vk</TITLE>
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<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV style="width: 100%; border-bottom: 2pt solid black; font-size: 1pt">&nbsp;</DIV>
<DIV style="width: 100%; border-bottom: 1pt solid black; font-size: 1pt">&nbsp;</DIV>




<DIV align="center" style="font-size: 14pt; margin-top: 12pt"><B>UNITED STATES<BR>
SECURITIES AND EXCHANGE COMMISSION</B>
</DIV>

<DIV align="center" style="font-size: 12pt"><B>Washington, D.C. 20549</B>
</DIV>


<DIV align="Center" style="font-size: 10pt; margin-top: 6pt"><DIV style="width: 100%; border-bottom: 1px solid #000000; FONT-size: 1px">&nbsp;</DIV>
</DIV>
<DIV align="center" style="font-size: 18pt; margin-top: 12pt"><B>Form&nbsp;6-K</B>
</DIV>


<DIV align="Center" style="font-size: 10pt; margin-top: 6pt"><DIV style="width: 100%; border-bottom: 1px solid #000000; FONT-size: 1px">&nbsp;</DIV>
</DIV>

<DIV align="Center" style="font-size: 12pt; margin-top: 6pt"><B>REPORT OF FOREIGN PRIVATE ISSUER<BR>
PURSUANT TO RULE 13a-16 OR 15d-16 OF THE SECURITIES EXCHANGE ACT OF 1934</B>
</DIV>

<!-- xbrl,dc -->
<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>For the month of <U>July, 2011.</U></B>
</DIV>
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<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>Commission File Number <U>1-14942</U></B>
</DIV>

<DIV align="center" style="font-size: 24pt; margin-top: 12pt"><B>MANULIFE FINANCIAL CORPORATION</B>
</DIV>

<DIV align="center" style="font-size: 10pt">(Translation of registrant&#146;s name into English)</DIV>



<DIV align="Center" style="font-size: 10pt; margin-top: 6pt"><B>200 Bloor Street East,<BR>
North Tower 10<BR>
Toronto, Ontario, Canada M4W 1E5<BR>
(416)&nbsp;926-3000</B>
</DIV>
<DIV align="center" style="font-size: 10pt"><DIV style="width: 100%; border-bottom: 1px solid #000000; FONT-size: 1px">&nbsp;</DIV></DIV>


<DIV align="center" style="font-size: 10pt">(Address of principal executive office)</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Indicate by check mark whether the registrant files or will file annual reports under cover of
Form 20-F or Form 40-F.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="47%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="right" valign="top">Form&nbsp;20-F&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<FONT style="font-family: Wingdings">&#111;</FONT>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Form&nbsp;40-F&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<FONT style="font-family: Wingdings">&#254;</FONT></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Indicate by check mark if the registrant is submitting the Form 6-K in paper as permitted by
Regulation&nbsp;S-T Rule&nbsp;101(b)(1): <FONT style="font-family: Wingdings">&#111;</FONT>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Indicate by check mark if the registrant is submitting the Form 6-K in paper as permitted by
Regulation&nbsp;S-T Rule&nbsp;101(b)(7): <FONT style="font-family: Wingdings">&#111;</FONT>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Indicate by check mark whether the registrant by furnishing the information contained in this Form
is also thereby furnishing the information to the Commission pursuant to Rule&nbsp;12g3-2(b) under the
Securities Exchange Act of 1934.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="47%">&nbsp;</TD>
</TR>
<TR></TR>
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<TR valign="bottom">
    <TD align="right" valign="top">Yes&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<FONT style="font-family: Wingdings">&#111;</FONT>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">No&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<FONT style="font-family: Wingdings">&#254;</FONT></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If &#147;Yes&#148; is marked, indicate below the file number assigned to the registrant in connection with
Rule&nbsp;12g3-2(b): 82- &#95;&#95;&#95;&#95;&#95;&#95;&#95;&#95;.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This Report on Form 6-K, including all exhibits hereto, is incorporated by reference in the joint Registration Statement
filed with the Securities and Exchange Commission by the registrant and John Hancock Life Insurance
Company (U.S.A.) on Form F-3 (Registration Nos. 333-159101-01 and 333-159101,
respectively) as such Registration Statement may be amended or supplemented from time to time.
</DIV>



<DIV style="width: 100%; border-bottom: 1pt solid black; margin-top: 10pt; font-size: 1pt">&nbsp;</DIV>
<DIV style="width: 100%; border-bottom: 2pt solid black; font-size: 1pt">&nbsp;</DIV>








<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

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<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<!-- TOC -->
<A name="toc"><DIV align="CENTER"><U><B>TABLE OF CONTENTS</B></U></DIV></A>

<P><CENTER>
<TABLE border="0" width="90%" cellpadding="0" cellspacing="0">
<TR>
	<TD width="3%"></TD>
	<TD width="3%"></TD>
	<TD width="3%"></TD>
	<TD width="3%"></TD>
	<TD width="3%"></TD>
	<TD width="3%"></TD>
	<TD width="3%"></TD>
	<TD width="3%"></TD>
	<TD width="76%"></TD>
</TR>
<TR><TD colspan="9"><A HREF="#000">SIGNATURES</A></TD></TR>
<TR><TD colspan="9"><A HREF="#001">EXHIBIT INDEX</A></TD></TR>
</TABLE>
</CENTER>
<!-- /TOC -->









<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>DOCUMENTS FILED AS PART OF THIS FORM 6-K</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The following documents, filed as exhibits to this Form 6-K, are incorporated by
reference as part of this Form 6-K:
</DIV>
<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="7%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="88%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center" style="border-bottom: 1px solid #000000">Exhibit</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" style="border-bottom: 1px solid #000000">Description of Exhibit</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.1</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Individual Contract &#150; Specimen Single Payment Modified Guaranteed
Deferred Annuity Contract &#150; Individual &#150; 10MVA-CPI-1.1</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.2</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Individual Specifications Page &#150; Specimen Single Payment Modified
Guaranteed Deferred Annuity Contract Specifications Page &#150;
Individual &#150; SPEC-CPI10.2</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.3</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Group Certificate &#150; Specimen Single Payment Modified Guaranteed
Deferred Annuity Certificate &#150; 10MVAGRP-CPI.1</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.4</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Group Specifications Page &#150; Specimen Single Payment Modified
Guaranteed Deferred Annuity Contract Specifications Page &#151;  Group
&#150; SPEC-CPI10-1.2</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.5</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Individual Application &#150; &#091;JH Choice&#093; Individual Single Payment
Modified Guaranteed Deferred Annuity Application&#150; ICC10MVAAPP</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.6</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Master Contract for Group Annuity &#150; Specimen Single Payment
Modified Guaranteed Deferred Annuity Contract &#150; Group &#150; 09GRPMAST</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.7</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Master Application for Group Annuity &#150; Specimen Single Payment
Modified Guaranteed Deferred Annuity Application (Group) &#150;
156-GRPMAST-09</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.8</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Generic Roth Individual Retirement Annuity Endorsement &#150; 10ROTH</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.9</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Generic Simple Individual Retirement Annuity Endorsement &#150; 10SIMPLE</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.10</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Generic Individual Retirement Annuity Endorsement &#150; 10TRADIRA</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.11</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Individual Specifications Page &#150; FL only &#150; SPEC-MVA09_ed.LC (ed 4/11) </DIV></TD>
</TR>

<!-- End Table Body -->
</TABLE>
</DIV>

<!-- link1 "SIGNATURES" -->
<DIV align="left"><A NAME="000"></A></DIV>

<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>SIGNATURES</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has
duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
</DIV>

<TABLE width="100%" border="0" cellspacing="0" cellpadding="0" style="font-size: 10pt">
<TR>
    <TD width="48%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="35%">&nbsp;</TD>
    <TD width="15%">&nbsp;</TD>
</TR>
<TR>
    <TD valign="top" align="left">&nbsp;</TD>
    <TD colspan="3" align="left">MANULIFE FINANCIAL CORPORATION<BR>
&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR><TR>
    <TD align="left">&nbsp;</TD>
    <TD valign="top">By:&nbsp;&nbsp;</TD>
    <TD colspan="2" style="border-bottom: 1px solid #000000" align="left"><I>/s/ David Kerr</I>
&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR><TR>
    <TD align="left">&nbsp;</TD>
    <TD valign="top">Name:&nbsp;&nbsp;</TD>
    <TD align="left" colspan="2">David Kerr&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR><TR>
    <TD align="left">&nbsp;</TD>
    <TD valign="top">Title:&nbsp;&nbsp;</TD>
    <TD nowrap align="left" colspan="2">AVP, Senior Counsel &#038; Assistant Corporate Secretary&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR>
    <TD colspan="5">&nbsp;</TD>
</TR>
</TABLE>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Date: July&nbsp;25, 2011
</DIV>








<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

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<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">



<!-- link1 "EXHIBIT INDEX" -->
<DIV align="left"><A NAME="001"></A></DIV>

<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>EXHIBIT INDEX</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="7%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="88%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center" style="border-bottom: 1px solid #000000">Exhibit</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" style="border-bottom: 1px solid #000000">Description of Exhibit</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.1</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Individual Contract &#150; Specimen Single Payment Modified Guaranteed
Deferred Annuity Contract &#150; Individual &#150; 10MVA-CPI-1.1</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.2</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Individual Specifications Page &#150; Specimen Single Payment Modified
Guaranteed Deferred Annuity Contract Specifications Page &#150;
Individual &#150; SPEC-CPI10.2</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.3</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Group Certificate &#150; Specimen Single Payment Modified Guaranteed
Deferred Annuity Certificate &#150; 10MVAGRP-CPI.1</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.4</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Group Specifications Page &#150; Specimen Single Payment Modified
Guaranteed Deferred Annuity Contract Specifications Page &#151;  Group
&#150; SPEC-CPI10-1.2</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.5</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Individual Application &#150; &#091;JH Choice&#093; Individual Single Payment
Modified Guaranteed Deferred Annuity Application&#150; ICC10MVAAPP</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.6</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Master Contract for Group Annuity &#150; Specimen Single Payment
Modified Guaranteed Deferred Annuity Contract &#150; Group &#150; 09GRPMAST</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.7</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Master Application for Group Annuity &#150; Specimen Single Payment
Modified Guaranteed Deferred Annuity Application (Group) &#150;
156-GRPMAST-09</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.8</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Generic Roth Individual Retirement Annuity Endorsement &#150; 10ROTH</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.9</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Generic Simple Individual Retirement Annuity Endorsement &#150; 10SIMPLE</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.10</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Generic Individual Retirement Annuity Endorsement &#150; 10TRADIRA</DIV></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">99.11</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:0px; text-indent:-0px">Individual Specifications Page &#150; FL only &#150; SPEC-MVA09_ed.LC (ed 4/11) </DIV></TD>
</TR>
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</TABLE>
</DIV>



<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>



</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.1
<SEQUENCE>2
<FILENAME>b87363a1exv99w1.htm
<DESCRIPTION>INDIVIDUAL CONTRACT - 10MVA-CPI-1.1
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w1</TITLE>
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<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>Exhibit&nbsp;99.1</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
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<TR valign="bottom">
    <TD width="47%"></TD>
    <TD width="5%"></TD>
    <TD width="47%"></TD>
</TR>
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<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top"><B>JOHN HANCOCK LIFE INSURANCE COMPANY<BR>
 (U.S.A.)<br>
Bloomfield Hills, Michigan</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top"><IMG src="b87363a1b8736300.gif" alt="(JOHNHANCOCK LOGO)"></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="70%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="25%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>Overnight Mailing Address:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>Annuity Service Office:</B></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&#091;164 Corporate Drive
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;P.O. Box 9505</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Portsmouth, NH 03801-6815&#093;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Portsmouth, NH 03802-9505</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">For Inquiries or Assistance in</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Resolving Complaints:</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">1-800-344-1029</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">www.jhannuities.com&#093;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>This is a legal Contract &#151; read it carefully.</B>
</DIV>


<DIV align="Center" style="font-size: 10pt; margin-top: 6pt"><B>We agree </B>to pay the benefits of this Contract in accordance with its terms.
</DIV>

<DIV align="Center" style="font-size: 10pt; margin-top: 6pt"><B>This Contract </B>is issued in consideration of the Payment.
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">John Hancock Life Insurance Company (U.S.A.) (&#147;the Company&#148;) will pay an annuity benefit commencing
on the Maturity Date to the Payee as directed by the Owner, in accordance with the Annuity Payments
provision of this Contract. Unless another available option under this Contract is elected,
Annuity Payments will be payable for a period of 10&nbsp;years and as long thereafter as the Annuitant
lives. If the Owner dies while this Contract is in effect prior to the Maturity Date, we will pay
a Death Benefit to the Beneficiary upon receipt of all required claim forms and proof of death of
the Owner at the Annuity Service Office.
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>FIFTEEN DAY RIGHT TO REVIEW</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>The Owner may cancel the Contract by returning it to our Annuity Service Office or the agent at any
time within 15&nbsp;days after receipt of the Contract. Within 7&nbsp;days of receipt of the Contract by us,
we will pay the Account Value to the Owner, adjusted by any Market Value Adjustment, if applicable,
computed on the Date the Contract is received by us. The Market Value Adjustment will only be
applied where the change in the Guaranteed Margin, as determined in accordance with the formula in
the Specifications Page, is greater than or equal to 0.25%. If the purchase of this Contract
involves the replacement of any existing life insurance or annuity, then the right to review
provision is extended to 30&nbsp;days.</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>When the Contract is issued as an individual retirement annuity under Section&nbsp;408 or Section&nbsp;408A
of the Code, or as otherwise required by applicable law, during the first 7&nbsp;days of the Right to
Review period, we will return the amount equal to the Payment made for the Contract, if greater
than the Account Value described above.</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We hold reserves for our guarantees under this Contract in a non-unitized &#091;CPI MVA&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
Separate Account established within the General Account. The assets of the &#091;CPI MVA&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
Separate Account are subject to the liabilities that arise out of the other business that we
conduct. General Account assets are also available to meet the guarantees under this Contract as
well as our other general obligations.
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>Signed for us </B>at Boston, Massachusetts, on the Contract Date.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="47%">&nbsp;</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="center" valign="top"><IMG src="b87363a1b8736301.gif" alt="(signature)">
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top"><IMG src="b87363a1b8736302.gif" alt="(signature)"></TD>
</TR>
<TR valign="bottom">
    <TD align="center" valign="top">President
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Secretary</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>SINGLE PREMIUM MODIFIED GUARANTEE INFLATION INDEXED DEFERRED ANNUITY<BR>
NON-PARTICIPATING</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>AMOUNTS PAYABLE UNDER THIS CONTRACT MAY BE SUBJECT TO AN UPWARD OR DOWNWARD MARKET VALUE ADJUSTMENT
(SEE PART 6, PAGE 7 and Specifications Page S.2). AMOUNTS WITHDRAWN UNDER THIS CONTRACT MAY BE
SUBJECT TO AN EARLY WITHDRAWAL CHARGE (SEE PART 8, PAGE 8 and Specifications Page S.3). THIS
CONTRACT MAY CONTAIN A BENEFIT THAT WAIVES WITHDRAWAL CHARGES.</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

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<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>INTRODUCTION</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This is a Single Payment Modified Guarantee Inflation Indexed Deferred Annuity. It is effective
when we receive your Payment at our Annuity Service Office or such other place as we may designate.
We determine Account Value during the first year of the Initial Term based on the Payment and the
Declared Interest Rate as shown on the Specifications Page. We determine Account Value during the
first year of any Subsequent Term based on the Account Value upon the completion of the previous
Term and the new Declared Interest Rate for that Subsequent Term. After the first year of the
Initial Term or the first year of any Subsequent Term, and prior to the Maturity Date while you are
still living, the Account Value will accumulate based on the Indexed Crediting Rate, which is a
rate (as described in Part&nbsp;7) that we determine based on: 1) the year over year change in the All
Items Consumer Price Index for All Urban Consumers (&#147;CPI-U&#148;) for the U.S. City Average, plus 2) the
Guaranteed Margin. Amounts withdrawn, excluding the Free Withdrawal Amount, prior to the end of
any Term are subject to a Market Value Adjustment and Withdrawal Charges, which could reduce the
withdrawal amount and any remaining Account Value below the Payment.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You must allocate the Payment to one Initial Term.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">On the Maturity Date, if the Annuitant and Owner are still living, the Contract will provide for
Annuity Payments to the Payee based upon the Annuity Option selected. Fixed annuity dollar amounts
are guaranteed by the Company.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="88%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left"><B>TABLE OF CONTENTS</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="2"><B>PAGE</B></TD>
    <TD>&nbsp;</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR style="font-size: 1px">
    <TD colspan="5" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 1 - DEFINITIONS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 2 - GENERAL PROVISIONS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 3 &#150; OWNER, BENEFICIARY</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 4 - PAYMENT</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 5 &#150; INITIAL AND SUBSEQUENT TERM</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 6 &#150; MARKET VALUE ADJUSTMENT (MVA)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 7 &#150; INTEREST ON ACCOUNT VALUE</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 8 &#150; WITHDRAWAL(S)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 9 &#150; FEES AND DEDUCTIONS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>9</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 10 &#150; DEATH BENEFITS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>10</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 11 &#150; ANNUITY PAYMENTS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>11</B></TD>
    <TD>&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 1: DEFINITIONS</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="25%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="70%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>WE AND YOU</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#147;We&#148;, &#147;us&#148; and &#147;our&#148; means the Company. &#147;You&#148; or &#147;your&#148; means the Owner of this Contract.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ACCOUNT VALUE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The amount we hold under this Contract for you at any given time. On the Contract Date,
the Account Value is equal to the Payment. Thereafter, we determine the Account Value
as specified in the Contract, &#147;Part 7: Interest on Account Value.&#148;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITANT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Any individual person or persons whose life is used to determine the duration of Annuity
Payments involving life contingencies. The Annuitant is as designated on the
Specifications Page, unless changed prior to the Maturity Date.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITY OPTION</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The method selected by you for Annuity Payments made by us.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITY PAYMENT(S)</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Periodic payment(s) by us to you or your designated Payee, which generally commence on
or after the Maturity Date and are in accordance with the Annuity Option elected under
the terms of this Contract.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITY SERVICE OFFICE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Any office designated by us for the receipt of Payment and processing of Owner requests.
The Annuity Service Office is shown on the Contract Cover Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>BENEFICIARY</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The person, persons or entity to whom certain benefits are payable following the death
of an Owner, or if the Owner is a non natural person, an Annuitant.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CONTRACT ANNIVERSARY</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The anniversary of the Contract beginning twelve consecutive months from the Contract
Date and each year thereafter.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CONTRACT DATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The date of issue of this Contract as designated on the Specifications Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CONTRACT YEAR</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The period of time measured twelve consecutive months from the Contract Date or any
Contract Anniversary thereafter.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CONTINGENT BENEFICIARY</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The person, persons or entity, who becomes the Beneficiary if the Beneficiary is not
alive when a benefit is due and payable.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>&#091;CPI MVA&#093;</B><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP> <B>SEPARATE ACCOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A non-registered separate account that we established within the General Account and in
which we hold reserves for our guarantees under the Contract. Our other General Account
assets are also available to meet the guarantees under the Contract and our other
general obligations. The assets of the &#091;CPI MVA&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP> Separate Account are
subject to the liabilities that arise out of the other business that we conduct.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CPI-U</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">As used in this Contract, the CPI-U is referring to the broadest and most comprehensive
CPI-U which is called the All Items Consumer Price Index for All Urban Consumers (CPI-U)
for the U.S. City Average. It is published monthly by the Department of Labor and
reflects spending patterns of almost all residents of urban or metropolitan areas. If
this index is discontinued or if the calculation is changed substantially the Company
may substitute a comparable index.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>DECLARED INTEREST RATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The interest credited on any given day will be at a rate that, if compounded daily for
one year, would equal the rate we declare for the first year of any selected Term under
the terms of the Contract, as shown on the Specifications Page of the Contract.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">10MVA-CPI-1.1</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<P align="right" style="font-size: 10pt"><!-- Folio -->Page 3 <!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="25%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="70%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ENDORSEMENT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">An Endorsement modifies the Contract to which it is attached. Endorsements must be
signed by an officer of the Company in order to be effective.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>FLOOR RATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The minimum rate of interest the Company will credit to the Contract regardless of the
year-over-year movement in the CPI-U. The Floor Rate applicable to you will appear on
the Specifications Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>FREE WITHDRAWAL AMOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The amount of the Account Value not subject to withdrawal charges or a MVA as described
in <BR>
Part 8.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>GENERAL ACCOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">All of the Company&#146;s assets, other than the assets in segregated asset accounts, which
are maintained as &#147;insulated&#148; separate accounts under applicable law.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>GROSS WITHDRAWAL AMOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The amount deducted from the Account Value for a full or partial withdrawal. For a full
withdrawal such amount is the Account Value. For a partial withdrawal, the Gross
Withdrawal Amount is the amount you request plus any applicable Withdrawal Charge and
adjusted by any applicable Market Value Adjustment.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>GUARANTEED MARGIN</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A rate that is used to determine the Indexed Crediting Rate and the Market Value
Adjustment factor. This rate remains constant for the Term. This rate will be shown on
the Specifications Page of the Contract.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>INDEXED CREDITING RATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The crediting rate that is based on annual changes in the CPI-U adjusted by the
Guaranteed Margin which starts in the second year of each Term. If the crediting rate
is limited, the limit(s) will be noted in the Specifications Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>IN WRITING</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Unless otherwise stated, means a notice provided in a format acceptable to us based on
the type of request, which is received at our Annuity Servicing Office.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>INTERNAL REVENUE CODE (CODE)</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The Internal Revenue Code of 1986, as amended from time to time, and any successor
statute of similar purposes.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>INITIAL TERM</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The period of time that you select on the application form, beginning on the Contract
Date. The Initial Term continues for the period shown on the Specifications Page of the
Contract.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>MATURITY DATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The date on which Annuity Payments are scheduled to commence. It is the date specified
on the Specifications Page, unless changed.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>OWNER(S)</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The person, persons or entity entitled to the ownership rights under this Contract. The
Owner is as designated on the Specifications Page, unless changed.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>PAYEE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Any of the person(s) or entity to whom Annuity Payments are to be made.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>PAYMENT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">An amount paid to us by you that we accept as consideration for the benefits provided by
this Contract. The Payment may consist of multiple components that we might receive on
different dates if your purchase is part of a tax-free exchange pursuant to Code Section
1035 or a trustee-to-trustee transfer of Qualified Plan funds. The single Payment may
only be received by us within the first sixty days from the Contract Date.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>QUALIFIED CONTRACT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A Contract issued under a Qualified Plan.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>QUALIFIED PLAN</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A retirement plan, which receives favorable tax treatment under sections 401, 403, 408,
408A, 414 or 457, of the Internal Revenue Code of 1986, as amended.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">10MVA-CPI-1.1</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<P align="right" style="font-size: 10pt"><!-- Folio -->Page 4 <!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="25%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="70%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>RATE CAP</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The maximum Indexed Crediting Rate we will credit to the Contract regardless of the
year-over-year movement in the CPI-U. The Rate Cap may vary by Term and premium band.
The Rate Cap, if applicable, will appear on the Specifications Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>SUBSEQUENT TERM</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A period of time beginning on the day following expiry of the immediately preceding Term.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>TERM</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The Initial Term or a Subsequent Term.</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 2: GENERAL PROVISIONS</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ENTIRE CONTRACT

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This Contract is an agreement between the Owner(s) and the Company. The entire Contract consists
of this Contract, any Riders, Endorsements, and Specifications Pages. This Contract is
incontestable from its Contract Date.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The benefits and values available under this Contract are not less than the minimum required by any
statute of the state in which this Contract is delivered. We have filed a detailed statement of the
method used to calculate the benefits and values with the Department of Insurance in the state in
which this Contract is delivered, if required by law.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may also have access to (i)&nbsp;information for you or a member of your family, regarding elder
care needs and questions, either directly or through a third party arrangement, and (ii)&nbsp;assistance
that may help you identify various elder care service agencies available in your community.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">MODIFICATION
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Only the President, a Vice President, or the Secretary of the Company has authority to agree on our
behalf to any alteration of the Contract or to any waiver of our rights or requirements. The
alteration or waiver must be in writing. We will not change or modify this Contract without your
consent except as may be required to make it conform to any applicable law or regulation or any
ruling issued by a government agency; or unless we have reserved the right to change the terms
herein.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">CHANGE IN MATURITY DATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Prior to the Maturity Date, an Owner may request in writing a change of the Maturity Date. Any
extension of the Maturity Date will be subject to our approval.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">ASSIGNMENT
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may assign this Contract, except as otherwise provided, at any time prior to the Maturity Date.
Your interest, any interest of the Annuitant and of any revocable Beneficiary shall be subject to
the terms of the assignment. We will not be on notice of any assignment unless it is in writing.
An assignment, unless otherwise specified by the Owner, shall take effect on the date the notice of
assignment is signed, subject to any payments made or actions taken by the Company prior to receipt
of this notice. We will not be liable for any payments made or actions we take before the
assignment is accepted by us. An absolute assignment will revoke the interest of any revocable
Beneficiary. We assume no responsibility for the validity or sufficiency of any assignment.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If this Contract is issued to a Qualified Plan, this Contract is subject to assignment restrictions
for federal income tax purposes. In such event, this Contract shall not be sold, assigned,
discounted, or pledged as collateral for a loan or as security for the performance of an obligation
or for any other purpose, to any person other than us.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">CLAIMS OF CREDITORS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">All benefits and payments under this Contract shall be exempt from the claims of creditors of the
Contract Owner to the extent permitted by law.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>




<P align="right" style="font-size: 10pt"><!-- Folio -->Page 5 <!-- /Folio -->
</DIV>

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<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt">MISSTATEMENT AND PROOF OF AGE, SEX OR SURVIVAL
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We may require proof of age, sex or survival of any person upon whose age, sex or survival an
Annuity Payment depends. If the age or sex of the Annuitant has been misstated, the benefits will
be those which the Annuity Payment would have provided for the correct age and sex. If we have
made incorrect Annuity Payments, the amount of any underpayment will be paid immediately. The
amount of any overpayment will be deducted from future Annuity Payments. We will uniformly charge
or credit interest in accordance with state law, as applicable.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">NON-PARTICIPATING
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Your Contract is non-participating and will not share in our profits or surplus earnings. We will
pay no dividends on your Contract.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">CANCELLATION FOR MINIMUM ACCOUNT VALUE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If, as a result of any partial withdrawal, the Account Value would be reduced to less than the
Minimum Account Value, indicated on the Specifications Page, we may cancel this Contract and pay
you the amount equal to that which would be paid as a result of a Total Withdrawal, as described in
Part&nbsp;8, &#147;Withdrawals&#148;.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">REPORTS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will send you a report at least annually. The report will at least contain a notification of
the Account Value prior to the application of any MVA formula, and the MVA amount used to determine
the cash surrender value.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">CURRENCY AND PLACE OF PAYMENTS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">All payments made to or by us shall be made in the lawful currency of the United States of America
at the Annuity Service Office or elsewhere if we consent.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">NOTICES AND ELECTIONS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">To be effective, all notices and elections you make under this Contract must be in writing, signed
by you and received by us at the Annuity Service Office. Unless otherwise provided in this
Contract, all notices, requests and elections will be effective when received by us at our Annuity
Service Office, complete with all necessary information and your signature.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">ISSUE STATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This Contract will be governed by the laws of the jurisdiction indicated on the Specifications
Page.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">SECTION 72(s)
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The provisions of this Contract shall be interpreted so as to comply with the requirements of
Section 72(s) of the Internal Revenue Code.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 3: OWNER, BENEFICIARY</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">OWNER

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Owner of this Contract shall be the person, persons or entity designated on the Specifications
Page unless otherwise changed by you in writing. If amounts become payable to the Beneficiary under
this Contract, the Beneficiary becomes the Owner of this Contract.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>



<P align="right" style="font-size: 10pt"><!-- Folio -->Page 6 <!-- /Folio -->
</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt">BENEFICIARY
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Upon the death of the Owner, any surviving Owner will become the Beneficiary. If there is no
surviving Owner, the Beneficiary will be as designated on the Specifications Page, unless otherwise
changed during the Owner&#146;s lifetime. If no such Beneficiary is living, the Beneficiary is the
&#147;Contingent Beneficiary&#148;. If no Beneficiary or Contingent Beneficiary is living, the Beneficiary
is the estate of the deceased Owner.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">CHANGE OF OWNER, ANNUITANT, BENEFICIARY
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Subject to the rights of an irrevocable Beneficiary, you may request to change the Owner,
Annuitant, or Beneficiary by sending us notice in writing. Any such request must be received at
our Annuity Service Office and approved by us. If we approved a change of Beneficiary, it will
take effect on the date the request is signed. If an irrevocable Beneficiary is named in this
Contract, the Beneficiary cannot be changed without the consent of the irrevocable Beneficiary. If
we approve a change of Owner or Annuitant, it will take effect on the date we received the request
at the Annuity Service Office. The Annuitant may not be changed after the Maturity Date. You need
not send us the Contract unless we request it. We will not be liable for any payments or actions
we take before we approve the change.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If any Annuitant is changed and any Owner is not an individual, the entire interest in the Contract
must be distributed to the Owner within five years of the change.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 4: PAYMENT</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Contract is not effective until Payment is received by us at our Annuity Service Office or
such other place as we may designate. The Payment deposited into the Contract can not be less than
the Minimum Payment nor exceed the Maximum Payment shown on the Specifications Page. Upon request,
we will consider applying nondiscriminatory financial factors waiving the Payment limits.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">ALLOCATION OF PAYMENT
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">When we receive the Payment, it will be allocated to the Initial Term as shown on the
Specifications Page.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 5: INITIAL AND SUBSEQUENT TERM</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">TERM

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Term means the Initial Term or the Subsequent Term. We allocate the Payment to the Initial
Term elected as shown on the Specifications Page. Thereafter, any allocation of your Account Value
will be in a Subsequent Term then available under this Contract. The Initial Term is measured from
the Contract Date. All Subsequent Terms are measured from the first day following the last day of
the immediately preceding Term.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">SUBSEQUENT TERM
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">At the end of your Initial Term you may elect a Subsequent Term. You will have a period of 30&nbsp;days
commencing with the expiration of a Term to elect in writing a Subsequent Term from among those
that are available. At least 15&nbsp;days, but not more than 45&nbsp;days prior to the expiration of the
Initial Term and any Subsequent Term, we will provide you with a written notice of the expiry of
the Term and notice of the Subsequent Terms available. Unless we receive written instructions from
you selecting a Subsequent Term from those then available, upon expiration of any Term, your
Account Value will be placed in the shortest available Term. Any Subsequent Term will begin the
day after the expiration of the immediately preceding Term. We do not subject your Account Value
to a Market Value Adjustment when it is applied to a Subsequent Term. Once the Subsequent Term has
been in effect for 30&nbsp;days, the MVA formula may be applicable to any withdrawal.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If your Subsequent Term extends beyond the Maturity Date shown on the Specifications Page, your
Maturity Date will be extended to the last day of that Subsequent Term. In no event will you be
permitted to elect a Subsequent Term longer than the shortest Term ending on or after the Maximum
Maturity Date shown on the Specifications Page.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>



<P align="right" style="font-size: 10pt"><!-- Folio -->Page 7 <!-- /Folio -->
</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 6: MARKET VALUE ADJUSTMENT (MVA)</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Any amounts withdrawn or converted to Annuity Payments on any date other than the period 30
days after the expiration of a Term may be adjusted upward or downward by the application of a
Market Value Adjustment Factor described in the Specifications Page.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The operation of the Market Value Adjustment factor upon withdrawal is set forth in Part&nbsp;8,
&#147;Withdrawals.&#148;
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 7: INTEREST ON ACCOUNT VALUE</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">In the first year of each Term only, the credited interest rate received on the Contract will
be the Declared Interest Rate that is not linked to the CPI-U. The interest credited on any given
day will be at a rate that, if compounded daily for one year, would equal the Declared Interest
Rate as determined by us, as shown on the Specifications Page. Beginning on the first Contract
Anniversary within the Initial Term, and repeating on each first Contract Anniversary within any
Subsequent Term, the Indexed Crediting Rate will be linked to the CPI-U and will be adjusted
(upward or downward) by the Guaranteed Margin. The Indexed Crediting Rate will be reset annually,
at each Contract Anniversary. We will look back to the CPI-U value published three months earlier
than the Contract Anniversary to calculate the Indexed Crediting Rate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The formula is shown in the Specifications Page.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 8: WITHDRAWALS</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may withdraw part or all of the Account Value at any time before the earlier of the death
of an Owner, or Annuitant if the Owner is a non natural person, or the Maturity Date by sending us
a notice in writing.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will not defer payment more than six months beyond the date we receive such notice. If we defer
payment for more than 30&nbsp;days, the amount deferred will earn interest at a rate not less than the
minimum required by law.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">FREE WITHDRAWAL AMOUNT
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Free Withdrawal Amount will equal the greater of; a) the annual Required Minimum Distribution
amount for Owners of Qualified Contracts aged 70 <FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT> or more; or b) the amount of any interest
credited to the Account Value during the 12&nbsp;months prior to the date of your request, less any
Gross Withdrawal Amount(s) taken during this 12&nbsp;month period.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">30 DAY WINDOW
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will not apply a Market Value Adjustment factor or assess Withdrawal Charges if you request a
withdrawal or annuitize any amount during the 30&nbsp;day period after the expiration of any Term. We
must receive your written request for withdrawal after the end of a Term and during the 30&nbsp;day
period following the end of that Term.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">WITHDRAWAL CHARGE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If a withdrawal is made from the Contract prior to the Maturity Date, a Withdrawal Charge may be
assessed against the portion of the Account Value being withdrawn. The amount of the Withdrawal
Charge and when it is assessed is discussed below
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">1)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Free Withdrawal Amount is defined above and may be withdrawn free of a Withdrawal
Charge and is not subject to a Market Value Adjustment.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">2)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Any amounts withdrawn in excess of the Free Withdrawal Amount will be subject to a
Withdrawal Charge, if any. The Withdrawal Charge is determined by multiplying the Gross
Withdrawal Amount, less any annual administration fee and Free Withdrawal Amount, by the
applicable Withdrawal Charge percentage shown on the Specifications Page.</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>




<P align="right" style="font-size: 10pt"><!-- Folio -->Page 8 <!-- /Folio -->
</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">3)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>No Withdrawal Charge will apply to withdrawals made at the end of a Term as described
in &#147;Part&nbsp;5: Initial Term and Subsequent Term&#148;. A request for withdrawal at the end of a
Term must be received in writing during the 30&nbsp;day period immediately following the end of
that Term in order to avoid the application of a Withdrawal Charge.</TD>
</TR>

</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt">TOTAL WITHDRAWAL
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Upon receipt of your request to withdraw all of your Account Value, we will terminate the Contract
and we will pay you an amount determined by the following formula:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">F &#043; &#091;(A-F) x Z&#093; &#150; &#091;(A-F) x W&#093;, WHERE:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">F = the Free Withdrawal Amount;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">A = the Account Value, reduced by any applicable Annual Fee;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Z = the Market Value Adjustment Factor, as shown on the Specifications Page;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">W = the Withdrawal Charge Percentage.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">PARTIAL WITHDRAWAL(S)
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may withdraw less than your entire Account Value. However, requests for amounts in excess of
the Free Withdrawal Amount are subject to a Withdrawal Charge, a Market Value Adjustment and will
be determined using the following calculation:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">F &#043; &#091;(G -F) x Z&#093; &#150; &#091;(G-F) x W&#093;, where:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">F = the Free Withdrawal Amount;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">G = the Gross Withdrawal Amount;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Z = the Market Value Adjustment Factor, as shown on the Specifications Page;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">W = the Withdrawal Charge Percentage.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We do not restrict the frequency of withdrawals. However, the Gross Withdrawal Amount withdrawn
must be no less than the Minimum Partial Withdrawal Amount shown on the Contract&#146;s Specifications
Pages. Any withdrawal which would reduce the Account Value to less than the Minimum Account Value,
indicated on the Specifications Page, may be treated as a request for a Total Withdrawal of your
Account Value.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 9: FEES AND DEDUCTIONS</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ANNUAL FEE

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">To compensate us for assuming certain administrative expenses, we may charge an Annual Fee as set
forth on the Specifications Page. Prior to the Maturity Date, the Annual Fee is deducted from the
Account Value on each Contract Anniversary. If the Account Value is totally withdrawn on any date
other than the Contract Anniversary, we will deduct the total amount of the Annual Fee from the
Account Value before the amount to be paid is calculated.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">TAXES
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We may charge certain taxes against your Payment, Account Value, payment of death benefit, or
Annuity Payments when appropriate. Such taxes may include premium taxes, personal income taxes, or
other taxes levied on the Payment, Account Value, death benefit or Annuity Payments by any
government entity which we determine have resulted from the establishment or maintenance of the
&#091;CPI MVA&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>Separate Account, or from the receipt by us of Payments, or from the issuance
of this Contract, or from the commencement or continuance of Annuity Payments under this Contract.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">
<P align="right" style="font-size: 10pt"><!-- Folio -->Page 9 <!-- /Folio -->
</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">

</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 10: DEATH BENEFITS</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">DEATH BEFORE MATURITY DATE

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">A death benefit will be paid if any Owner dies prior to the date Annuity Payments begin. The Death
Benefit will be equal to the Account Value, as of the date on which written notice and proof of
death and all required claim forms are received in good order at the Company&#146;s Annuity Service
Office. Interest on any death benefit, if applicable, will be paid in accordance with state law.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">On the death of the last surviving Annuitant, the Owner becomes the new Annuitant, if the Owner is
an individual. If any Owner is a non natural person, the death of an Annuitant is treated as the
death of an Owner.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If the co-Owner predeceases the Owner, the Owner will be treated as the Beneficiary.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Beneficiary may continue the Contract as the Owner, subject to the requirements of Section
72(s) of the Internal Revenue Code. If the Contract cannot continue under Section&nbsp;72(s), or if the
Beneficiary elects not to continue the Contract, the Death Benefit will be distributed under one of
the following provisions:
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(i)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>as an Annuity Option as described within Part&nbsp;11: &#147;Annuity Payments&#148;; or</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(ii)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>over the life of the Beneficiary, or over a period not to extend beyond the life
expectancy of the Beneficiary, with all such distributions beginning within one year from
the date of the Owner&#146;s Death; or</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(iii)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>the entire interest in the Contract must be distributed within five (5)&nbsp;years of the
Owner&#146;s Death; or</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(iv)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>in one lump sum.</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Withdrawal Charges will be waived and a Market Value Adjustment will not apply on any of the
distributions shown above. If the Beneficiary dies before distributions under (ii)&nbsp;or (iii)&nbsp;are
complete, the remaining Death Benefit must be distributed in a lump sum immediately. If there is
more than one Beneficiary, the foregoing provisions will independently apply to each Beneficiary.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Contract will terminate if the Death Benefit is taken in one sum.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If the Beneficiary decides to continue the Contract as the Owner, subject to Section&nbsp;72(s),
the new Owner must carry out the current Term and thereafter, applicable charges and adjustments
will apply to amounts withdrawn as described under the Contract. Such amounts may be adjusted
upward or downward by the application of a Market Value Adjustment Factor. Subject to the rights
of an irrevocable Beneficiary, the new Owner in such instance may name a new Beneficiary and, if no
Beneficiary is so named, the decedent Beneficiary&#146;s estate will be the Beneficiary.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If the Contract is held as part of a Qualified Plan, the terms of your Qualified Plan Endorsement
form will control.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will permit the Owner to limit the Death Benefit option(s) to be offered to any named
Beneficiary, if the Owner provides notice in writing to the Company prior to death and the desired
option(s) is one provided for in this Contract.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">DEATH BENEFIT ON OR AFTER MATURITY DATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">On or after the date Annuity Payments begin, if the Annuitant dies, the Death Benefit will depend
on the Annuity Option selected in accordance with Part&nbsp;11: &#147;Annuity Payments&#148;.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">PROOF OF DEATH
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Proof of death is required upon the death of the Annuitant or the Owner. Proof of death is one of
the following received at the Annuity Service Office:
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">a)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>A certified copy of a death certificate.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">b)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>A certified copy of a decree of a court of competent jurisdiction as to the finding of
death.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">c)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Any other proof satisfactory to us.</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>






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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 11: ANNUITY PAYMENTS</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">GENERAL

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Any amounts payable under this Contract may be converted to Annuity Payments in accordance with one
or more of the Annuity Options described below, subject to any restrictions of Internal Revenue
Code section 72(s). Once Annuity Payments commence, the Annuity Option and the Annuitant may not
be changed.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will pay annuity benefits in the form of Annuity Payment(s) on the life of the Annuitant, to the
Payee, if living, on the Maturity Date. Annuity Payments will commence on or after the Maturity
Date and continue for the period of time provided for under the Annuity Option you elect.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">MATURITY DATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">On the Maturity Date or other date elected to commence Annuity Payments, we will convert the
Account Value adjusted by any Market Value Adjustment as described in Part&nbsp;6 of this Contract and
the Specifications Page, into Annuity Payments. The amount used to determine the first Annuity
Payment will be measured as of a date not more than 10 business days prior to the Maturity Date or
other date elected to commence Annuity Payments.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Only an Account Value of $5,000 or more may be applied to one of the Annuity Payment options
offered. If the amount of the first Annuity Payment would be less than our minimum requirements
then in effect, we may make a single payment, adjusted by any Market Value Adjustment as described
in Part&nbsp;6 of this Contract, on the date the first payment is payable. This single payment is in
place of all other benefits provided by this Contract.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">CALCULATION USED TO DETERMINE ANNUITY PAYMENT(S)
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The amount of each Annuity Payment is determined by applying the amounts which will be converted to
Annuity Payment(s) to the appropriate table(s) identified by this Contract. We guarantee the
dollar amount of each Annuity Payment. Annuity Payments will never be less than that available by
applying the Account Value adjusted by any
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Market Value Adjustment as described in Part&nbsp;6 of this Contract, to buy a single premium immediate
annuity then offered by us, or by one of our affiliated companies if we do not offer a single
premium immediate annuity.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">DESCRIPTION OF ANNUITY OPTIONS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The following Annuity Options are available under this contract for a single life:
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">a.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Life Annuity with a guarantee of Annuity Payments for a Period of 5, 10, or 20
Years. Under this option we will make payments for the period elected, and as long
thereafter as the Annuitant lives.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">b.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Non-Refund Life Annuity. Under this option, we will make payments throughout the
lifetime of the Annuitant. No further payments will be made after the death of the
Annuitant.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">c.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Any other option which we may make available including joint lives.</TD>
</TR>

</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt">ALTERNATIVE ANNUITY OPTIONS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Instead of settlement in accordance with the Annuity Options described above, you may choose an
alternate form of settlement acceptable to us. Once Annuity Payments commence, the form of
settlement may not be changed.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">ANNUITY PAYMENT INTERVALS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may elect to receive your Annuity Payments monthly, quarterly, semi-annually or annually.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>





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<DIV style="font-family: Helvetica,Arial,sans-serif">



<DIV align="left" style="font-size: 10pt; margin-top: 6pt">TABLE OF PAYMENT RATES
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The rates shown below are guaranteed minimum rates. The actual rates that we will apply will be
the greater of these guaranteed minimum rates and the current rates in effect at the time Annuity
Payments begin. Information regarding our current rates will be available to any Owner upon
request.
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>MONTHLY ANNUITY PAYMENT RATE TABLE</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="5%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center" style="border-bottom: 1px solid #000000"><B>Age of Annuitant&#146;s</B></TD>
    <TD>&nbsp;</TD>
     <TD rowspan="2" nowrap align="center" colspan="15"><B>Life Annuity with a Guaranteed <div style="border-bottom: 1px solid #000000; font-size: 1pt">&nbsp;</div>
Period</B><BR>
<BR>
</TD>

</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center"><B><B>Birthday</B><BR>Nearest Date</B>     </TD>
    <TD>&nbsp;</TD>
   </TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center" style="border-bottom: 1px solid #000000"><B>of First Payment</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>5 Years</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>10 Years</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>20 Years</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>Life Annuity</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">55</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.07</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.05</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.00</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.07</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">56</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.14</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.13</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.07</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.14</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">57</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.21</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.20</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.13</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.22</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">58</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.29</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.28</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.20</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.30</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">59</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.38</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.36</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.27</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.39</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">60</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.47</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.45</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.34</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.48</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">61</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.57</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.54</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.42</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.58</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">62</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.67</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.64</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.50</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.68</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">63</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.78</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.74</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.58</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.79</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">64</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.89</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.85</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.66</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.91</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">65</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.02</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.97</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.74</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.03</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">66</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.15</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.09</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.83</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.17</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">67</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.29</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.22</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.31</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">68</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.44</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.36</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.00</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.46</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">69</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.60</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.50</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.08</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.63</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">70</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.78</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.66</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.17</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.81</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">71</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.96</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.82</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.25</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.00</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">72</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.16</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.99</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.32</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.21</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">73</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.38</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.17</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.40</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.44</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">74</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.61</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.36</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.47</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.69</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">75</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.83</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.56</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.53</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.95</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">76</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.13</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.76</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.59</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.24</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">77</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.41</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.97</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.64</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.55</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">78</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.71</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.18</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.69</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.89</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">79</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.03</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.40</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.73</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.25</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">80</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.38</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.62</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.77</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.65</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">81</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.74</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.83</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.80</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.08</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">82</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.13</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.04</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.82</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.55</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">83</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.54</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.25</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.84</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">9.06</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">84</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.97</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.45</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.86</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">9.61</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">85</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">9.41</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.63</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.87</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">10.21</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">86</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">9.87</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.80</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.88</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">10.86</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">87</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">10.33</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.96</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.89</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">11.57</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">88</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">10.80</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.10</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.90</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">12.32</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">89</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">11.26</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.23</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.90</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">13.12</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">90</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">11.71</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.35</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">13.96</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">91</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">12.15</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.45</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">14.84</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">92</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">12.57</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.54</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">15.75</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">93</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">12.97</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.62</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">16.69</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:30px; text-indent:-15px">94</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">13.35</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.69</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">17.66</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:30px; text-indent:-15px">95 and over</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">13.73</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.75</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">18.67</TD>
    <TD>&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">These rates are based on the Annuity 2000 mortality table for Females projected for improvement
using projection scale G. Interest is at an annual effective rate of 1.5%.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>





<P align="right" style="font-size: 10pt"><!-- Folio -->Page 12 <!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">



<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Communications about this annuity Contract may be sent to the Company at its Servicing Office.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Single Payment Modified Guarantee Inflation Indexed Deferred Annuity
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Non-Participating
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Amounts withdrawn under this Contract may be subject to a Withdrawal Charge and a Market Value
Adjustment
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%"></TD>
    <TD width="5%"></TD>
    <TD width="47%"></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top"><B>JOHN HANCOCK LIFE INSURANCE COMPANY <BR>
(U.S.A.)</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top"><IMG src="b87363a1b8736300.gif" alt="(JOHNHANCOCK LOGO)"></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVA-CPI-1.1
</DIV>



<P align="right" style="font-size: 10pt"><!-- Folio -->Page 13 <!-- /Folio -->
</DIV>



</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.2
<SEQUENCE>3
<FILENAME>b87363a1exv99w2.htm
<DESCRIPTION>INDIVIDUAL SPECIFICATIONS PAGE - SPEC-CPI10.2
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w2</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
<!-- PAGEBREAK -->

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Exhibit&nbsp;99.2</B>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>SPECIFICATIONS PAGE</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="31%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="21%">&nbsp;</TD>
    <TD width="12%">&nbsp;</TD>
    <TD width="31%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="31%">&nbsp;</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>TYPE OF CONTRACT/CERTIFICATE:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top"><B>&#091;</B>QUALIFIED&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>MATURITY DATE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2032&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CONTRACT/CERTIFICATE DATE:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2009&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>MAXIMUM MATURITY DATE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2052&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>PAYMENT:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;$250,000&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" valign="top"><B>CONTRACT/CERTIFICATE NUMBER</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;000111&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>OWNER:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right" valign="top">&#091;DOROTHY HANCOCK&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>ISSUE STATE:</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;MA&#093;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CO-OWNER:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;JAMES DOE&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>OWNER&#146;S AGE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;52&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITANT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;JOHN HANCOCK&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>ANNUITANT&#146;S AGE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;52&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CO-ANNUITANT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;NON APPLICABLE&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="76%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="5%">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #ffffff">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" colspan="2"><B>Declared Interest Rate</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" colspan="3"><B>Initial Term</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #ffffff"><B>Initial Term</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" colspan="2"><B>(Applicable to the first Contract/Certificate Year)</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" colspan="3"><B>Expiration Date</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px">&#091;3 Years&#093;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" align="center">&#091;3.95%&#093;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;8/1/2012&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>GUARANTEED MARGIN (Applicable to the Initial Term)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;   &#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>CPI-U Value on Contract/Certificate Date</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;    &#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>RATE CAP (Applicable to the Initial Term)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;8%&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>FLOOR RATE (Applicable to the Initial Term)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;0%&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>ANNUAL FEE</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$50&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PARTIAL WITHDRAWAL LIMITATIONS:</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>MINIMUM PARTIAL WITHDRAWAL AMOUNT</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$1000&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD colspan="5" align="left"><B>MINIMUM ACCOUNT VALUE AFTER PARTIAL WITHDRAWAL</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$5000&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PAYMENT LIMITATIONS:</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>MINIMUM PAYMENT</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$10,000&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>MAXIMUM PAYMENT</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$1,000,000&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">&#091;THIS CONTRACT/CERTIFICATE IS INTENDED FOR ISSUES AS TO A TAX-QUALIFIED RETIREMENT PLAN
UNDER THE INTERNAL REVENUE CODE FOR TAX-FAVORED STATUS. UNLESS OTHERWISE REQUIRED
TO QUALIFY FOR SUCH STATUS, LANGUAGE IN THIS CONTRACT/CERTIFICATE REFERRING TO FEDERAL
TAX STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. SUCH LANGUAGE IS NOT SUBJECT
TO APPROVAL OR DISAPPROVAL BY THE STATE IN WHICH THE CONTRACT/CERTIFICATE IS ISSUED
FOR DELIVERY. PLEASE SEEK THE ADVICE OF YOUR OWN TAX ADVISOR REGARDING YOUR
INDIVIDUAL TAX TREATMENT.&#093;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SPEC-CPI10.2
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->S.1<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>MVA FORMULA</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Market Value Adjustment factor is determined by the following formula:
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><IMG src="b87363a1b8736303.gif" alt="(FORMULA)">

</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="100%">Where k, M<SUB style="FONT-size: 85%; vertical-align: text-bottom">issue, </SUB>M<SUB style="FONT-size: 85%; vertical-align: text-bottom">withdrawal</SUB> and n are defined as follows:</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">M<SUB style="FONT-size: 85%; vertical-align: text-bottom">issue</SUB> = the Guaranteed Margin in effect for the current Term for this
Contract/Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">M<SUB style="FONT-size: 85%; vertical-align: text-bottom">withdrawal</SUB> = the Guaranteed Margin (expressed as a decimal) offered on a Term equal to
the number of months remaining in the current Term, as of the date the withdrawal or annuitization
request is processed. For purposes of this calculation, months remaining will be rounded up to the
next nearest whole month. If a Guaranteed Margin for this duration is not available for new
purchases, we will declare a Guaranteed Margin solely for this purpose that is consistent with the
Guaranteed Margin for durations that are currently available.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B><I>k </I></B>= Adjustment Factor is &#091;0.25%&#093;. This Adjustment Factor effectively reduces the amount paid and
functions as an additional withdrawal charge.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B><I>n </I></B>= number of months from the date that any amounts withdrawn or converted to Annuity Payments are
processed to the end of your current Term. In the case of partial months, n is rounded up to the
next month.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Market Value Adjustment is equal to A x (B-1) where A is the amount subject to adjustment, and
B is the Market Value Adjustment factor above. The Market Value Adjustment may be positive or
negative.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>INDEXED CREDITING RATE FORMULA</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The following formula represents that at the beginning of each Contract Anniversary within any
selected Term, the Indexed Crediting Rate (R<SUB style="FONT-size: 85%; vertical-align: text-bottom">t</SUB>) for each year of the Term (<SUB style="FONT-size: 85%; vertical-align: text-bottom"><I>t</I></SUB>)
would be the greater of the Indexed Crediting Rate as determined using the CPI-U plus the
Guaranteed Margin (M), or the Floor Rate, and the lesser of the Indexed Credit Rate or the Rate
Cap.
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><IMG src="b87363a1b8736304.gif" alt="(FORMULA)">
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Where:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">R<SUB style="FONT-size: 85%; vertical-align: text-bottom">t</SUB> = Indexed Crediting Rate at time <SUB style="FONT-size: 85%; vertical-align: text-bottom">t</SUB> applicable for the following year.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CPI<SUB style="FONT-size: 85%; vertical-align: text-bottom">t </SUB>= the CPI-U value from 3&nbsp;months prior to the rate determination date.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CPI<SUB style="FONT-size: 85%; vertical-align: text-bottom">t-1 </SUB>= the CPI-U value 1&nbsp;year prior to CPI<SUB style="FONT-size: 85%; vertical-align: text-bottom">t</SUB>.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><I>M = </I>the Guaranteed Margin which is set at the beginning of the Contract/Certificate and remains
constant throughout the Term. M may be a negative value.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Indexed Crediting Rate will never be less than a Floor Rate of &#091;0%&#093;nor greater than a Rate Cap
of &#091;10%&#093;.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SPEC-CPI10.2
</DIV>




<P align="center" style="font-size: 10pt"><!-- Folio -->S.2<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>TABLES OF WITHDRAWAL CHARGE PERCENTAGES:</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>&#091;APPLICABLE TO ACCOUNT VALUE DURING THE INITIAL TERM:</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="20%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="39" style="border-bottom: 1px solid #000000"><B>CONTRACT/CERTIFICATE YEAR AT TIME OF WITHDRAWAL</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #000000"><B>TERM</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>1</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>2</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>3</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>4</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>5</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>6</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>7</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>8</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>9</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>10</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>1 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>2 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>3 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>4 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>5 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>6 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>7 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>8 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>9 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>10 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="right" style="font-size: 10pt; margin-top: 12pt"><B>&#093;</B><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>APPLICABLE TO ACCOUNT VALUE DURING ANY SUBSEQUENT TERM:</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>&#091;</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="20%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="39"><B>NUMBER OF COMPLETE CONTRACT/CERTIFICATE YEARS SINCE THE COMMENCEMENT</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="39" style="border-bottom: 1px solid #000000"><B>OF ANY SUBSEQUENT TERM AT THE TIME OF WITHDRAWAL</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #000000"><B>TERM</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>0</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>1</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>2</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>3</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>4</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>5</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>6</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>7</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>8</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>9</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>1 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>2 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>3 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>4 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>5 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>6 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>7 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>8 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>9 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>10 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="right" style="font-size: 10pt; margin-top: 12pt"><B>&#093;</B><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SPEC-CPI10.2
</DIV>




<P align="center" style="font-size: 10pt"><!-- Folio -->S.3<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>BENEFICIARY INFORMATION</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Beneficiary(ies) is as designated by you as of the Contract/Certificate Date, unless otherwise
changed per the provisions of the Contract/Certificate.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="40%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="58%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Beneficiary(s)
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;John Doe&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Contingent Beneficiary(s)
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;Jane Doe.&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SPEC-CPI10.2
</DIV>



<P align="center" style="font-size: 10pt"><!-- Folio -->S.4<!-- /Folio -->
</DIV>



</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.3
<SEQUENCE>4
<FILENAME>b87363a1exv99w3.htm
<DESCRIPTION>GROUP CERTIFICATE
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w3</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
<!-- PAGEBREAK -->

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Exhibit&nbsp;99.3</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%"></TD>
    <TD width="5%"></TD>
    <TD width="47%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top"><B>JOHN HANCOCK LIFE INSURANCE COMPANY <BR>
(U.S.A.)</B> <br><B>Bloomfield Hills, Michigan</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top"><IMG src="b87363a1b8736300.gif" alt="(JOHN HANCOCK LOGO)"></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="70%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="28%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>Overnight Mailing Address:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>Annuity Service Office:</B></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&#091;164 Corporate Drive
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;P.O. Box 9505</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Portsmouth, NH 03801-6815&#093;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Portsmouth, NH 03802-9505</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">For Inquiries or Assistance in</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Resolving Complaints:</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">1-800-344-1029</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">www.jhannuities.com&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>This is a legal Certificate &#151; read it carefully.</B>
</DIV>


<DIV align="Center" style="font-size: 10pt; margin-top: 6pt"><B>We agree </B>to pay the benefits of this Certificate in accordance with its terms.
</DIV>

<DIV align="Center" style="font-size: 10pt; margin-top: 6pt"><B>This Certificate </B>is issued in consideration of the Payment.
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">John Hancock Life Insurance Company (U.S.A.) (&#147;the Company&#148;) will pay an annuity benefit commencing
on the Maturity Date to the Payee as directed by the Owner, in accordance with the Annuity Payments
provision of this Certificate. Unless another available option under this Certificate is elected,
Annuity Payments will be payable for a period of 10&nbsp;years and as long thereafter as the Annuitant
lives. If the Owner dies while this Certificate is in effect prior to the Maturity Date, we will
pay a Death Benefit to the Beneficiary upon receipt of all required claim forms and proof of death
of the Owner at the Annuity Service Office.
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>FIFTEEN DAY RIGHT TO REVIEW</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>The Owner may cancel the Certificate by returning it to our Annuity Service Office or the agent at
any time within 15&nbsp;days after receipt of the Certificate. Within 7&nbsp;days of receipt of the
Certificate by us, we will pay the Account Value to the Owner, adjusted by any Market Value
Adjustment, if applicable, computed on the Date the Certificate is received by us. The Market
Value Adjustment will only be applied where the change in the Guaranteed Margin, as determined in
accordance with the formula in the Specifications Page, is greater than or equal to 0.25%. If the
purchase of this Certificate involves the replacement of any existing life insurance or annuity,
then the right to review provision is extended to 30&nbsp;days.</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>When the Certificate is issued as an individual retirement annuity under Section&nbsp;408 or Section
408A of the Code, or as otherwise required by applicable law, during the first 7&nbsp;days of the Right
to Review period, we will return the amount equal to the Payment made for the Certificate, if
greater than the Account Value described above.</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We hold reserves for our guarantees under this Certificate in a non-unitized CPI MVA<SUP style="FONT-size: 85%; vertical-align: text-top">
</SUP>Separate Account established within the General Account. The assets of the CPI MVA<SUP style="FONT-size: 85%; vertical-align: text-top">
</SUP>Separate Account are subject to the liabilities that arise out of the other business that we
conduct. General Account assets are also available to meet the guarantees under this Certificate
as well as our other general obligations.
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>Signed for us </B>at Boston, Massachusetts, on the Certificate Date.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="47%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="center" valign="top"><IMG src="b87363a1b8736301a.gif" alt="(SIGNATURE)">
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top"><IMG src="b87363a1b8736302b.gif" alt="(SIGNATURE)"></TD>
</TR>
<TR valign="bottom">
    <TD align="center" valign="top">President
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">Secretary</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>SINGLE PREMIUM MODIFIED GUARANTEE INFLATION INDEXED DEFERRED ANNUITY
<BR>NON-PARTICIPATING</B></div>
<DIV align="left" style="font-size: 10pt; margin-top: 0pt"><B>
AMOUNTS PAYABLE UNDER THIS CERTIFICATE MAY BE SUBJECT TO AN UPWARD OR DOWNWARD MARKET
VALUE ADJUSTMENT (SEE PART 6, PAGE 7 and Specifications Page S.2). AMOUNTS WITHDRAWN UNDER THIS
CERTIFICATE MAY BE SUBJECT TO AN EARLY WITHDRAWAL CHARGE (SEE PART 8, PAGE 8 and Specifications
Page S.3). THIS CERTIFICATE MAY CONTAIN A BENEFIT THAT WAIVES WITHDRAWAL CHARGES.</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>







<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>INTRODUCTION</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This is a Single Payment Modified Guarantee Inflation Indexed Deferred Annuity. It is effective
when we receive your Payment at our Annuity Service Office or such other place as we may designate.
We determine Account Value during the first year of the Initial Term based on the Payment and the
Declared Interest Rate as shown on the Specifications Page. We determine Account Value during the
first year of any Subsequent Term based on the Account Value upon the completion of the previous
Term and the new Declared Interest Rate for that Subsequent Term. After the first year of the
Initial Term or the first year of any Subsequent Term, and prior to the Maturity Date while you are
still living, the Account Value will accumulate based on the Indexed Crediting Rate, which is a
rate (as described in Part&nbsp;7) that we determine based on: 1) the year over year change in the All
Items Consumer Price Index for All Urban Consumers (&#147;CPI-U&#148;) for the U.S. City Average, plus 2) the
Guaranteed Margin. Amounts withdrawn, excluding the Free Withdrawal Amount, prior to the end of
any Term are subject to a Market Value Adjustment and Withdrawal Charges, which could reduce the
withdrawal amount and any remaining Account Value below the Payment.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You must allocate the Payment to one Initial Term.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">On the Maturity Date, if the Annuitant and Owner are still living, the Certificate will provide for
Annuity Payments to the Payee based upon the Annuity Option selected. Fixed annuity dollar amounts
are guaranteed by the Company.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="88%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left"><B>TABLE OF CONTENTS</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3"><B>PAGE</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR style="font-size: 1px">
    <TD colspan="5" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 1 - DEFINITIONS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 2 - GENERAL PROVISIONS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 3 &#151; OWNER, BENEFICIARY</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 4 - PAYMENT</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 5 &#151; INITIAL AND SUBSEQUENT TERM</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 6 &#151; MARKET VALUE ADJUSTMENT (MVA)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 7 &#151; INTEREST ON ACCOUNT VALUE</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 8 &#151; WITHDRAWAL(S)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 9 &#151; FEES AND DEDUCTIONS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>9</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 10 &#151; DEATH BENEFITS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>10</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PART 11 &#151; ANNUITY PAYMENTS</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>11</B></TD>
    <TD>&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>







<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 1: DEFINITIONS</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="35%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="60%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>WE AND YOU</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#147;We&#148;, &#147;us&#148; and &#147;our&#148; means the Company. &#147;You&#148; or &#147;your&#148; means the Owner of this Certificate.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ACCOUNT VALUE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The amount we hold under this Certificate for you at any given time. On the Certificate
Date, the Account Value is equal to the Payment. Thereafter, we determine the Account
Value as specified in the Certificate, &#147;Part 7: Interest on Account Value.&#148;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITANT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Any individual person or persons whose life is used to determine the duration of Annuity
Payments involving life contingencies. The Annuitant is as designated on the
Specifications Page, unless changed prior to the Maturity Date.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITY OPTION</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The method selected by you for Annuity Payments made by us.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITY PAYMENT(S)</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Periodic payment(s) by us to you or your designated Payee, which generally commence on or
after the Maturity Date and are in accordance with the Annuity Option elected under the
terms of this Certificate.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITY SERVICE OFFICE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Any office designated by us for the receipt of Payment and processing of Owner requests.
The Annuity Service Office is shown on the Certificate Cover Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>BENEFICIARY</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The person, persons or entity to whom certain benefits are payable following the death of
an Owner, or if the Owner is a non natural person, an Annuitant.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CERTIFICATE ANNIVERSARY</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The anniversary of the Certificate beginning twelve consecutive months from the Certificate
Date and each year thereafter.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CERTIFICATE DATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The date of issue of this Certificate as designated on the Specifications Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CERTIFICATE YEAR</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The period of time measured twelve consecutive months from the Certificate Date or any
Certificate Anniversary thereafter.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CONTINGENT BENEFICIARY</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The person, persons or entity, who becomes the Beneficiary if the Beneficiary is not alive
when a benefit is due and payable.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CPI MVA SEPARATE</B><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP><B>ACCOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A non-registered separate account that we established within the General Account and in
which we hold reserves for our guarantees under the Certificate. Our other General Account
assets are also available to meet the guarantees under the Certificate and our other
general obligations. The assets of the&#091;CPI MVA Separate Account are subject to the
liabilities that arise out of the other business that we conduct.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CPI-U</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">As used in this Certificate, the CPI-U is referring to the broadest and most comprehensive
CPI-U which is called the All Items Consumer Price Index for All Urban Consumers (CPI-U)
for the U.S. City Average. It is published monthly by the Department of Labor and reflects
spending patterns of almost all residents of urban or metropolitan areas. If this index is
discontinued or if the calculation is changed substantially the Company may substitute a
comparable index.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>DECLARED INTEREST RATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The interest credited on any given day will be at a rate that, if compounded daily for one
year, would equal the rate we declare for the first year of any selected Term under the
terms of the Certificate, as shown on the Specifications Page of the Certificate.</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">10MVAGRP-CPI.1
</DIV>


<P align="right" style="font-size: 10pt"><!-- Folio -->Page 3<!-- /Folio -->
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<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">
<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="35%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="60%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ENDORSEMENT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">An Endorsement modifies the Certificate to which it is attached. Endorsements must be
signed by an officer of the Company in order to be effective.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>FLOOR RATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The minimum rate of interest the Company will credit to the Certificate regardless of the
year-over-year movement in the CPI-U. The Floor Rate applicable to you will appear on the
Specifications Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>FREE WITHDRAWAL AMOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The amount of the Account Value not subject to withdrawal charges or a MVA as described in
Part 8.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>GENERAL ACCOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">All of the Company&#146;s assets, other than the assets in segregated asset accounts, which are
maintained as &#147;insulated&#148; separate accounts under applicable law.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>GROSS WITHDRAWAL AMOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The amount deducted from the Account Value for a full or partial withdrawal. For a full
withdrawal such amount is the Account Value. For a partial withdrawal, the Gross
Withdrawal Amount is the amount you request plus any applicable Withdrawal Charge and
adjusted by any applicable Market Value Adjustment.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>GUARANTEED MARGIN</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A rate that is used to determine the Indexed Crediting Rate and the Market Value Adjustment
factor. This rate remains constant for the Term. This rate will be shown on the
Specifications Page of the Certificate.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>INDEXED CREDITING RATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The crediting rate that is based on annual changes in the CPI-U adjusted by the Guaranteed
Margin which starts in the second year of each Term. If the crediting rate is limited, the
limit(s) will be noted in the Specifications Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>IN WRITING</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Unless otherwise stated, means a notice provided in a format acceptable to us based on the
type of request, which is received at our Annuity Servicing Office.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>INTERNAL REVENUE CODE (CODE)</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The Internal Revenue Code of 1986, as amended from time to time, and any successor statute
of similar purposes.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>INITIAL TERM</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The period of time that you select on the application form, beginning on the Certificate
Date. The Initial Term continues for the period shown on the Specifications Page of the
Certificate.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>MATURITY DATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The date on which Annuity Payments are scheduled to commence. It is the date specified on
the Specifications Page, unless changed.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>OWNER(S)</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The person, persons or entity entitled to the ownership rights under this Certificate. The
Owner is as designated on the Specifications Page, unless changed.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>PAYEE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Any of the person(s) or entity to whom Annuity Payments are to be made.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>PAYMENT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">An amount paid to us by you that we accept as consideration for the benefits provided by
this Certificate. The Payment may consist of multiple components that we might receive on
different dates if your purchase is part of a tax-free exchange pursuant to Code Section
1035 or a trustee-to-trustee transfer of Qualified Plan funds. The single Payment may only
be received by us within the first sixty days from the Certificate Date.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>QUALIFIED CERTIFICATE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A Certificate issued under a Qualified Plan.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>QUALIFIED PLAN</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A retirement plan, which receives favorable tax treatment under sections 401, 403, 408,
408A, 414 or 457, of the Internal Revenue Code of 1986, as amended.</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">10MVAGRP-CPI.1
</DIV>


<P align="right" style="font-size: 10pt"><!-- Folio -->Page 4<!-- /Folio -->
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<DIV style="font-family: Helvetica,Arial,sans-serif">
<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="35%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="60%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>RATE CAP</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The maximum Indexed Crediting Rate we will credit to the Certificate regardless of the
year-over-year movement in the CPI-U. The Rate Cap may vary by Term and premium band. The
Rate Cap, if applicable, will appear on the Specifications Page.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>SUBSEQUENT TERM</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">A period of time beginning on the day following expiry of the immediately preceding Term.</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>TERM</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">The Initial Term or a Subsequent Term.</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 2: GENERAL PROVISIONS</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ENTIRE CERTIFICATE

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This Certificate is an agreement between the Owner(s) and the Company. The entire Certificate
consists of this Certificate, any Riders, Endorsements, and Specifications Pages. This Certificate
is incontestable from its Certificate Date.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The benefits and values available under this Certificate are not less than the minimum required by
any statute of the state in which this Certificate is delivered. We have filed a detailed statement
of the method used to calculate the benefits and values with the Department of Insurance in the
state in which this Certificate is delivered, if required by law.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may also have access to (i)&nbsp;information for you or a member of your family, regarding elder
care needs and questions, either directly or through a third party arrangement, and (ii)&nbsp;assistance
that may help you identify various elder care service agencies available in your community.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">MODIFICATION
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Only the President, a Vice President, or the Secretary of the Company has authority to agree on our
behalf to any alteration of the Certificate or to any waiver of our rights or requirements. The
alteration or waiver must be in writing. We will not change or modify this Certificate without
your consent except as may be required to make it conform to any applicable law or regulation or
any ruling issued by a government agency; or unless we have reserved the right to change the terms
herein.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CHANGE IN MATURITY DATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Prior to the Maturity Date, an Owner may request in writing a change of the Maturity Date. Any
extension of the Maturity Date will be subject to our approval.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ASSIGNMENT
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may assign this Certificate, except as otherwise provided, at any time prior to the Maturity
Date. Your interest, any interest of the Annuitant and of any revocable Beneficiary shall be
subject to the terms of the assignment. We will not be on notice of any assignment unless it is in
writing. An assignment, unless otherwise specified by the Owner, shall take effect on the date the
notice of assignment is signed, subject to any payments made or actions taken by the Company prior
to receipt of this notice. We will not be liable for any payments made or actions we take before
the assignment is accepted by us. An absolute assignment will revoke the interest of any revocable
Beneficiary. We assume no responsibility for the validity or sufficiency of any assignment.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If this Certificate is issued to a Qualified Plan, this Certificate is subject to assignment
restrictions for federal income tax purposes. In such event, this Certificate shall not be sold,
assigned, discounted, or pledged as collateral for a loan or as security for the performance of an
obligation or for any other purpose, to any person other than us.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CLAIMS OF CREDITORS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">All benefits and payments under this Certificate shall be exempt from the claims of creditors of
the Certificate Owner to the extent permitted by law.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>







<P align="right" style="font-size: 10pt"><!-- Folio -->Page 5<!-- /Folio -->
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<DIV style="font-family: Helvetica,Arial,sans-serif">



<DIV align="left" style="font-size: 10pt; margin-top: 6pt">MISSTATEMENT AND PROOF OF AGE, SEX OR SURVIVAL
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We may require proof of age, sex or survival of any person upon whose age, sex or survival an
Annuity Payment depends. If the age or sex of the Annuitant has been misstated, the benefits will
be those which the Annuity Payment would have provided for the correct age and sex. If we have
made incorrect Annuity Payments, the amount of any underpayment will be paid immediately. The
amount of any overpayment will be deducted from future Annuity Payments. We will uniformly charge
or credit interest in accordance with state law, as applicable.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">NON-PARTICIPATING
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Your Certificate is non-participating and will not share in our profits or surplus earnings. We
will pay no dividends on your Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CANCELLATION FOR MINIMUM ACCOUNT VALUE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If, as a result of any partial withdrawal, the Account Value would be reduced to less than the
Minimum Account Value, indicated on the Specifications Page, we may cancel this Certificate and pay
you the amount equal to that which would be paid as a result of a Total Withdrawal, as described in
Part&nbsp;8, &#147;Withdrawals&#148;.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">REPORTS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will send you a report at least annually. The report will at least contain a notification of
the Account Value prior to the application of any MVA formula, and the MVA amount used to determine
the cash surrender value.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CURRENCY AND PLACE OF PAYMENTS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">All payments made to or by us shall be made in the lawful currency of the United States of America
at the Annuity Service Office or elsewhere if we consent.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">NOTICES AND ELECTIONS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">To be effective, all notices and elections you make under this Certificate must be in writing,
signed by you and received by us at the Annuity Service Office. Unless otherwise provided in this
Certificate, all notices, requests and elections will be effective when received by us at our
Annuity Service Office, complete with all necessary information and your signature.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ISSUE STATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This Certificate will be governed by the laws of the jurisdiction indicated on the Specifications
Page.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SECTION 72(s)
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The provisions of this Certificate shall be interpreted so as to comply with the requirements of
Section 72(s) of the Internal Revenue Code.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 3: OWNER, BENEFICIARY</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">OWNER
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Owner of this Certificate shall be the person, persons or entity designated on the
Specifications Page unless otherwise changed by you in writing. If amounts become payable to the
Beneficiary under this Certificate, the Beneficiary becomes the Owner of this Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>







<P align="right" style="font-size: 10pt"><!-- Folio -->Page 6<!-- /Folio -->
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<DIV style="font-family: Helvetica,Arial,sans-serif">



<DIV align="left" style="font-size: 10pt; margin-top: 6pt">BENEFICIARY
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Upon the death of the Owner, any surviving Owner will become the Beneficiary. If there is no
surviving Owner, the Beneficiary will be as designated on the Specifications Page, unless otherwise
changed during the Owner&#146;s lifetime. If no such Beneficiary is living, the Beneficiary is the
&#147;Contingent Beneficiary&#148;. If no Beneficiary or Contingent Beneficiary is living, the Beneficiary
is the estate of the deceased Owner.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CHANGE OF OWNER, ANNUITANT, BENEFICIARY
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Subject to the rights of an irrevocable Beneficiary, you may request to change the Owner,
Annuitant, or Beneficiary by sending us notice in writing. Any such request must be received at
our Annuity Service Office and approved by us. If we approved a change of Beneficiary, it will
take effect on the date the request is signed. If an irrevocable Beneficiary is named in this
Certificate, the Beneficiary cannot be changed without the consent of the irrevocable Beneficiary.
If we approve a change of Owner or Annuitant, it will take effect on the date we received the
request at the Annuity Service Office. The Annuitant may not be changed after the Maturity Date.
You need not send us the Certificate unless we request it. We will not be liable for any payments
or actions we take before we approve the change.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If any Annuitant is changed and any Owner is not an individual, the entire interest in the
Certificate must be distributed to the Owner within five years of the change.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 4: PAYMENT</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Certificate is not effective until Payment is received by us at our Annuity Service Office
or such other place as we may designate. The Payment deposited into the Certificate can not be
less than the Minimum Payment nor exceed the Maximum Payment shown on the Specifications Page.
Upon request, we will consider applying nondiscriminatory financial factors waiving the Payment
limits.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ALLOCATION OF PAYMENT
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">When we receive the Payment, it will be allocated to the Initial Term as shown on the
Specifications Page.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 5: INITIAL AND SUBSEQUENT TERM</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">TERM
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Term means the Initial Term or the Subsequent Term. We allocate the Payment to the Initial
Term elected as shown on the Specifications Page. Thereafter, any allocation of your Account Value
will be in a Subsequent Term then available under this Certificate. The Initial Term is measured
from the Certificate Date. All Subsequent Terms are measured from the first day following the last
day of the immediately preceding Term.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SUBSEQUENT TERM
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">At the end of your Initial Term you may elect a Subsequent Term. You will have a period of 30&nbsp;days
commencing with the expiration of a Term to elect in writing a Subsequent Term from among those
that are available. At least 15&nbsp;days, but not more than 45&nbsp;days prior to the expiration of the
Initial Term and any Subsequent Term, we will provide you with a written notice of the expiry of
the Term and notice of the Subsequent Terms available. Unless we receive written instructions from
you selecting a Subsequent Term from those then available, upon expiration of any Term, your
Account Value will be placed in the shortest available Term. Any Subsequent Term will begin the
day after the expiration of the immediately preceding Term. We do not subject your Account Value
to a Market Value Adjustment when it is applied to a Subsequent Term. Once the Subsequent Term has
been in effect for 30&nbsp;days, the MVA formula may be applicable to any withdrawal.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If your Subsequent Term extends beyond the Maturity Date shown on the Specifications Page, your
Maturity Date will be extended to the last day of that Subsequent Term. In no event will you be
permitted to elect a Subsequent Term longer than the shortest Term ending on or after the Maximum
Maturity Date shown on the Specifications Page.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>





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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 6: MARKET VALUE ADJUSTMENT (MVA)</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Any amounts withdrawn or converted to Annuity Payments on any date other than the period 30
days after the expiration of a Term may be adjusted upward or downward by the application of a
Market Value Adjustment Factor described in the Specifications Page.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The operation of the Market Value Adjustment factor upon withdrawal is set forth in Part&nbsp;8,
&#147;Withdrawals.&#148;
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 7: INTEREST ON ACCOUNT VALUE</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">In the first year of each Term only, the credited interest rate received on the Certificate
will be the Declared Interest Rate that is not linked to the CPI-U. The interest credited on any
given day will be at a rate that, if compounded daily for one year, would equal the Declared
Interest Rate as determined by us, as shown on the Specifications Page. Beginning on the first
Certificate Anniversary within the Initial Term, and repeating on each first Certificate
Anniversary within any Subsequent Term, the Indexed Crediting Rate will be linked to the CPI-U and
will be adjusted (upward or downward) by the Guaranteed Margin. The Indexed Crediting Rate will be
reset annually, at each Certificate Anniversary. We will look back to the CPI-U value published
three months earlier than the Certificate Anniversary to calculate the Indexed Crediting Rate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The formula is shown in the Specifications Page.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 8: WITHDRAWALS</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may withdraw part or all of the Account Value at any time before the earlier of the death
of an Owner, or Annuitant if the Owner is a non natural person, or the Maturity Date by sending us
a notice in writing.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will not defer payment more than six months beyond the date we receive such notice. If we defer
payment for more than 30&nbsp;days, the amount deferred will earn interest at a rate not less than the
minimum required by law.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">FREE WITHDRAWAL AMOUNT
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Free Withdrawal Amount will equal the greater of; a) the annual Required Minimum Distribution
amount for Owners of Qualified Certificates aged 70 <FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT> or more; or b) the amount of any interest
credited to the Account Value during the 12&nbsp;months prior to the date of your request, less any
Gross Withdrawal Amount(s) taken during this 12&nbsp;month period.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">30 DAY WINDOW
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will not apply a Market Value Adjustment factor or assess Withdrawal Charges if you request a
withdrawal or annuitize any amount during the 30&nbsp;day period after the expiration of any Term. We
must receive your written request for withdrawal after the end of a Term and during the 30&nbsp;day
period following the end of that Term.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">WITHDRAWAL CHARGE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If a withdrawal is made from the Certificate prior to the Maturity Date, a Withdrawal Charge may be
assessed against the portion of the Account Value being withdrawn. The amount of the Withdrawal
Charge and when it is assessed is discussed below
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">1)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Free Withdrawal Amount is defined above and may be withdrawn free of a Withdrawal
Charge and is not subject to a Market Value Adjustment.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">2)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Any amounts withdrawn in excess of the Free Withdrawal Amount will be subject to a
Withdrawal Charge, if any. The Withdrawal Charge is determined by multiplying the Gross
Withdrawal Amount, less any annual administration fee and Free Withdrawal Amount, by the
applicable Withdrawal Charge percentage shown on the Specifications Page.</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>




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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">3)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>No Withdrawal Charge will apply to withdrawals made at the end of a Term as described
in &#147;Part&nbsp;5: Initial Term and Subsequent Term&#148;. A request for withdrawal at the end of a
Term must be received in writing during the 30&nbsp;day period immediately following the end of
that Term in order to avoid the application of a Withdrawal Charge.</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">TOTAL WITHDRAWAL
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Upon receipt of your request to withdraw all of your Account Value, we will terminate the
Certificate and we will pay you an amount determined by the following formula:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">F &#043; &#091;(A-F) x Z&#093; &#150; &#091;(A-F) x W&#093;, WHERE:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">F = the Free Withdrawal Amount;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">A = the Account Value, reduced by any applicable Annual Fee;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Z = the Market Value Adjustment Factor, as shown on the Specifications Page;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">W = the Withdrawal Charge Percentage.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">PARTIAL WITHDRAWAL(S)
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may withdraw less than your entire Account Value. However, requests for amounts in excess of
the Free Withdrawal Amount are subject to a Withdrawal Charge, a Market Value Adjustment and will
be determined using the following calculation:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">F &#043; &#091;(G -F) x Z&#093; &#150; &#091;(G-F) x W&#093;, where:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">F = the Free Withdrawal Amount;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">G = the Gross Withdrawal Amount;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Z = the Market Value Adjustment Factor, as shown on the Specifications Page;
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">W = the Withdrawal Charge Percentage.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We do not restrict the frequency of withdrawals. However, the Gross Withdrawal Amount withdrawn
must be no less than the Minimum Partial Withdrawal Amount shown on the Certificate&#146;s
Specifications Pages. Any withdrawal which would reduce the Account Value to less than the Minimum
Account Value, indicated on the Specifications Page, may be treated as a request for a Total
Withdrawal of your Account Value.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 9: FEES AND DEDUCTIONS</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ANNUAL FEE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">To compensate us for assuming certain administrative expenses, we may charge an Annual Fee as set
forth on the Specifications Page. Prior to the Maturity Date, the Annual Fee is deducted from the
Account Value on each Certificate Anniversary. If the Account Value is totally withdrawn on any
date other than the Certificate Anniversary, we will deduct the total amount of the Annual Fee from
the Account Value before the amount to be paid is calculated.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">TAXES
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We may charge certain taxes against your Payment, Account Value, payment of death benefit, or
Annuity Payments when appropriate. Such taxes may include premium taxes, personal income taxes, or
other taxes levied on the Payment, Account Value, death benefit or Annuity Payments by any
government entity which we determine have resulted from the establishment or maintenance of the CPI
MVA<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>Separate Account, or from the receipt by us of Payments, or from the issuance of
this Certificate, or from the commencement or continuance of Annuity Payments under this
Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>






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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 10: DEATH BENEFITS</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">DEATH BEFORE MATURITY DATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">A death benefit will be paid if any Owner dies prior to the date Annuity Payments begin. The Death
Benefit will be equal to the Account Value, as of the date on which written notice and proof of
death and all required claim forms are received in good order at the Company&#146;s Annuity Service
Office. Interest on any death benefit, if applicable, will be paid in accordance with state law.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">On the death of the last surviving Annuitant, the Owner becomes the new Annuitant, if the Owner is
an individual. If any Owner is a non natural person, the death of an Annuitant is treated as the
death of an Owner.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If the co-Owner predeceases the Owner, the Owner will be treated as the Beneficiary.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Beneficiary may continue the Certificate as the Owner, subject to the requirements of Section
72(s) of the Internal Revenue Code. If the Certificate cannot continue under Section&nbsp;72(s), or if
the Beneficiary elects not to continue the Certificate, the Death Benefit will be distributed under
one of the following provisions:
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(i)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>as an Annuity Option as described within Part&nbsp;11: &#147;Annuity Payments&#148;; or</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(ii)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>over the life of the Beneficiary, or over a period not to extend beyond the life
expectancy of the Beneficiary, with all such distributions beginning within one year from
the date of the Owner&#146;s Death; or</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(iii)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>the entire interest in the Certificate must be distributed within five (5)&nbsp;years of
the Owner&#146;s Death; or</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(iv)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>in one lump sum.</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Withdrawal Charges will be waived and a Market Value Adjustment will not apply on any of the
distributions shown above. If the Beneficiary dies before distributions under (ii)&nbsp;or (iii)&nbsp;are
complete, the remaining Death Benefit must be distributed in a lump sum immediately. If there is
more than one Beneficiary, the foregoing provisions will independently apply to each Beneficiary.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Certificate will terminate if the Death Benefit is taken in one sum.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If the Beneficiary decides to continue the Certificate as the Owner, subject to Section&nbsp;72(s),
the new Owner must carry out the current Term and thereafter, applicable charges and adjustments
will apply to amounts withdrawn as described under the Certificate. Such amounts may be adjusted
upward or downward by the application of a Market Value Adjustment Factor. Subject to the rights
of an irrevocable Beneficiary, the new Owner in such instance may name a new Beneficiary and, if no
Beneficiary is so named, the decedent Beneficiary&#146;s estate will be the Beneficiary.
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If the Certificate is held as part of a Qualified Plan, the terms of your Qualified Plan
Endorsement form will control.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will permit the Owner to limit the Death Benefit option(s) to be offered to any named
Beneficiary, if the Owner provides notice in writing to the Company prior to death and the desired
option(s) is one provided for in this Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">DEATH BENEFIT ON OR AFTER MATURITY DATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">On or after the date Annuity Payments begin, if the Annuitant dies, the Death Benefit will depend
on the Annuity Option selected in accordance with Part&nbsp;11: &#147;Annuity Payments&#148;.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">PROOF OF DEATH
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Proof of death is required upon the death of the Annuitant or the Owner. Proof of death is one of
the following received at the Annuity Service Office:
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">a)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>A certified copy of a death certificate.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">b)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>A certified copy of a decree of a court of competent jurisdiction as to the finding of
death.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">c)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Any other proof satisfactory to us.</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>







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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>PART 11: ANNUITY PAYMENTS</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">GENERAL
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Any amounts payable under this Certificate may be converted to Annuity Payments in accordance with
one or more of the Annuity Options described below, subject to any restrictions of Internal Revenue
Code section 72(s). Once Annuity Payments commence, the Annuity Option and the Annuitant may not
be changed.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will pay annuity benefits in the form of Annuity Payment(s) on the life of the Annuitant, to the
Payee, if living, on the Maturity Date. Annuity Payments will commence on or after the Maturity
Date and continue for the period of time provided for under the Annuity Option you elect.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">MATURITY DATE
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">On the Maturity Date or other date elected to commence Annuity Payments, we will convert the
Account Value adjusted by any Market Value Adjustment as described in Part&nbsp;6 of this Certificate
and the Specifications Page, into Annuity Payments. The amount used to determine the first Annuity
Payment will be measured as of a date not more than 10 business days prior to the Maturity Date or
other date elected to commence Annuity Payments.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Only an Account Value of $5,000 or more may be applied to one of the Annuity Payment options
offered. If the amount of the first Annuity Payment would be less than our minimum requirements
then in effect, we may make a single payment, adjusted by any Market Value Adjustment as described
in Part&nbsp;6 of this Certificate, on the date the first payment is payable. This single payment is in
place of all other benefits provided by this Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CALCULATION USED TO DETERMINE ANNUITY PAYMENT(S)
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The amount of each Annuity Payment is determined by applying the amounts which will be converted to
Annuity Payment(s) to the appropriate table(s) identified by this Certificate. We guarantee the
dollar amount of each Annuity Payment. Annuity Payments will never be less than that available by
applying the Account Value adjusted by any
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Market Value Adjustment as described in Part&nbsp;6 of this Certificate, to buy a single premium
immediate annuity then offered by us, or by one of our affiliated companies if we do not offer a
single premium immediate annuity.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">DESCRIPTION OF ANNUITY OPTIONS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The following Annuity Options are available under this Certificate for a single life:
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">a.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Life Annuity with a guarantee of Annuity Payments for a Period of 5, 10, or 20
Years. Under this option we will make payments for the period elected, and as long
thereafter as the Annuitant lives.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">b.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Non-Refund Life Annuity. Under this option, we will make payments throughout the
lifetime of the Annuitant. No further payments will be made after the death of the
Annuitant.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">c.</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Any other option which we may make available including joint lives.</TD>
</TR>

</TABLE>
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ALTERNATIVE ANNUITY OPTIONS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Instead of settlement in accordance with the Annuity Options described above, you may choose an
alternate form of settlement acceptable to us. Once Annuity Payments commence, the form of
settlement may not be changed.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">ANNUITY PAYMENT INTERVALS
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">You may elect to receive your Annuity Payments monthly, quarterly, semi-annually or annually.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>




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<DIV align="left" style="font-size: 10pt; margin-top: 6pt">TABLE OF PAYMENT RATES
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The rates shown below are guaranteed minimum rates. The actual rates that we will apply will be
the greater of these guaranteed minimum rates and the current rates in effect at the time Annuity
Payments begin. Information regarding our current rates will be available to any Owner upon
request.
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>MONTHLY ANNUITY PAYMENT RATE TABLE</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" colspan="3" style="border-bottom: 1px solid #000000"><B>Age of Annuitant&#146;s</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="15" style="border-bottom: 1px solid #000000"><B>Life Annuity with a Guaranteed</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center" colspan="3"><B>Birthday</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="15" style="border-bottom: 0px solid #000000"><B>Period</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center" colspan="3"><B>Nearest Date</B>  </TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>of First Payment</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>5 Years</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>10 Years</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>20 Years</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>Life Annuity</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">55</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.07</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.05</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.00</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.07</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">56</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.14</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.13</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.07</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.14</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">57</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.21</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.20</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.13</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.22</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">58</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.29</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.28</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.20</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.30</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">59</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.38</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.36</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.27</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.39</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">60</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.47</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.45</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.34</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.48</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">61</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.57</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.54</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.42</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.58</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">62</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.67</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.64</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.50</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.68</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">63</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.78</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.74</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.58</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.79</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">64</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.89</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.85</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.66</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.91</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">65</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.02</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.97</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.74</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.03</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">66</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.15</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.09</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.83</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.17</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">67</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.29</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.22</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">3.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.31</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">68</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.44</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.36</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.00</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.46</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">69</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.60</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.50</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.08</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.63</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">70</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.78</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.66</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.17</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.81</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">71</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.96</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.82</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.25</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.00</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">72</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.16</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.99</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.32</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.21</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">73</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.38</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.17</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.40</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.44</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">74</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.61</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.36</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.47</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.69</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">75</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.83</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.56</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.53</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.95</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">76</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.13</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.76</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.59</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.24</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">77</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.41</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">5.97</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.64</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.55</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">78</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.71</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.18</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.69</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.89</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">79</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.03</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.40</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.73</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.25</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">80</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.38</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.62</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.77</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.65</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">81</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.74</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">6.83</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.80</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.08</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">82</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.13</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.04</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.82</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.55</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">83</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.54</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.25</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.84</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">9.06</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">84</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.97</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.45</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.86</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">9.61</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">85</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">9.41</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.63</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.87</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">10.21</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">86</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">9.87</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.80</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.88</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">10.86</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">87</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">10.33</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">7.96</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.89</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">11.57</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">88</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">10.80</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.10</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.90</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">12.32</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">89</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">11.26</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.23</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.90</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">13.12</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">90</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">11.71</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.35</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">13.96</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">91</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">12.15</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.45</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">14.84</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">92</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">12.57</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.54</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">15.75</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">93</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">12.97</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.62</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">16.69</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">94</TD>
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">13.35</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.69</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">17.66</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top" align="right">&nbsp;</TD>
    <TD valign="top" align="right">95</TD>
    <TD nowrap>&nbsp;and over</TD>
    <TD>&nbsp;</TD>
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">13.73</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">8.75</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">4.91</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right">18.67</TD>
    <TD>&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">These rates are based on the Annuity 2000 mortality table for Females projected for improvement
using projection scale G. Interest is at an annual effective rate of 1.5%.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>







<P align="right" style="font-size: 10pt"><!-- Folio -->Page 12<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">



<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Communications about this annuity Certificate may be sent to the Company at its Servicing Office.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Single Payment Modified Guarantee Inflation Indexed Deferred Annuity
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Non-Participating
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Amounts withdrawn under this Certificate may be subject to a Withdrawal Charge and a Market Value
Adjustment
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%"></TD>
    <TD width="5%"></TD>
    <TD width="47%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top"><B>JOHN HANCOCK LIFE INSURANCE COMPANY </B><br><B>(U.S.A.)</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top"><IMG src="b87363a1b8736300.gif" alt="(JOHN HANCOCK LOGO)"></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">10MVAGRP-CPI.1
</DIV>




<P align="right" style="font-size: 10pt"><!-- Folio -->Page 13<!-- /Folio -->
</DIV>

</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.4
<SEQUENCE>5
<FILENAME>b87363a1exv99w4.htm
<DESCRIPTION>GROUP SPECIFICATIONS PAGE - SPEC-CPI10-1.2
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w4</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
<!-- PAGEBREAK -->
<DIV style="font-family: Helvetica,Arial,sans-serif">

 <DIV align="left" style="font-size: 10pt; margin-top: 18pt"><B>Exhibit 99.4</B>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>SPECIFICATIONS PAGE</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="25%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="25%">&nbsp;</TD>
    <TD width="10%">&nbsp;</TD>
    <TD width="31%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="31%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top" nowrap><DIV style="margin-left:0px; text-indent:-0px"><B>TYPE OF CONTRACT/CERTIFICATE:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top"><B>&#091;</B>QUALIFIED&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>MATURITY DATE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2032&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CONTRACT/CERTIFICATE DATE:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2009&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>MAXIMUM MATURITY DATE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2052&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>PAYMENT:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;$250,000&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" valign="top"><B>CONTRACT/CERTIFICATE NUMBER</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;000111&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>OWNER:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;DOROTHY HANCOCK&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>ISSUE STATE:</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;MA&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CO-OWNER:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;JAMES DOE&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>OWNER&#146;S AGE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;52&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITANT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;JOHN HANCOCK&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>ANNUITANT&#146;S AGE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;52&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CO-ANNUITANT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;NON APPLICABLE&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="84%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="10%">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #ffffff">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" colspan="2"><B>Declared Interest Rate</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" colspan="3"><B>Initial Term</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #ffffff"><B>Initial Term</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" colspan="2"><B>(Applicable to the first Contract/Certificate Year)</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" colspan="3"><B>Expiration Date</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px">&#091;3 Years&#093;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" align="center">&#091;3.95%&#093;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;8/1/2012&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>GUARANTEED MARGIN (Applicable to the Initial Term)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;   &#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>CPI-U Value on Contract/Certificate Date</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;    &#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>RATE CAP (Applicable to the Initial Term)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;8%&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>FLOOR RATE (Applicable to the Initial Term)</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;0%&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>ANNUAL FEE</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$50&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PARTIAL WITHDRAWAL LIMITATIONS:</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>MINIMUM PARTIAL WITHDRAWAL AMOUNT</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$1000&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD colspan="5" align="left"><B>MINIMUM ACCOUNT VALUE AFTER PARTIAL WITHDRAWAL</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$5000&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>PAYMENT LIMITATIONS:</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>MINIMUM PAYMENT</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$10,000&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD><DIV style="margin-left:15px; text-indent:-15px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>MAXIMUM PAYMENT</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right">&#091;$1,000,000&#093;</TD>
    <TD nowrap><SUP style="FONT-size: 85%; vertical-align: text-top"></SUP></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">&#091;THIS CONTRACT/CERTIFICATE IS INTENDED FOR ISSUES AS TO A TAX-QUALIFIED RETIREMENT PLAN
UNDER THE INTERNAL REVENUE CODE FOR TAX-FAVORED STATUS. UNLESS OTHERWISE REQUIRED
TO QUALIFY FOR SUCH STATUS, LANGUAGE IN THIS CONTRACT/CERTIFICATE REFERRING TO FEDERAL
TAX STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. SUCH LANGUAGE IS NOT SUBJECT
TO APPROVAL OR DISAPPROVAL BY THE STATE IN WHICH THE CONTRACT/CERTIFICATE IS ISSUED
FOR DELIVERY. PLEASE SEEK THE ADVICE OF YOUR OWN TAX ADVISOR REGARDING YOUR
INDIVIDUAL TAX TREATMENT.&#093;
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt">SPEC-CPI10-1.2
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->S.1<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>MVA FORMULA</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Market Value Adjustment factor is determined by the following formula:
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><IMG src="b87363a1b8736303.gif" alt="(FORMULA)">
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Where k, M<SUB style="FONT-size: 85%; vertical-align: text-bottom">issue, </SUB>M<SUB style="FONT-size: 85%; vertical-align: text-bottom">withdrawal</SUB> and n are defined as follows:

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">M<SUB style="FONT-size: 85%; vertical-align: text-bottom">issue</SUB> = the Guaranteed Margin in effect for the current Term for this
Contract/Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">M<SUB style="FONT-size: 85%; vertical-align: text-bottom">withdrawal</SUB> = the Guaranteed Margin (expressed as a decimal) offered on a Term equal to
the number of months remaining in the current Term, as of the date the withdrawal or annuitization
request is processed. For purposes of this calculation, months remaining will be rounded up to the
next nearest whole month. If a Guaranteed Margin for this duration is not available for new
purchases, we will declare a Guaranteed Margin solely for this purpose that is consistent with the
Guaranteed Margin for durations that are currently available.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B><I>k </I></B>= Adjustment Factor is &#091;0.25%&#093;. This Adjustment Factor effectively reduces the amount paid and
functions as an additional withdrawal charge.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B><I>n </I></B>= number of months from the date that any amounts withdrawn or converted to Annuity Payments are
processed to the end of your current Term. In the case of partial months, n is rounded up to the
next month.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Market Value Adjustment is equal to A x (B-1) where A is the amount subject to adjustment, and
B is the Market Value Adjustment factor above. The Market Value Adjustment may be positive or
negative.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>INDEXED CREDITING RATE FORMULA</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The following formula represents that at the beginning of each Contract Anniversary within any
selected Term, the Indexed Crediting Rate (R<SUB style="FONT-size: 85%; vertical-align: text-bottom">t</SUB>) for each year of the Term (<SUB style="FONT-size: 85%; vertical-align: text-bottom"><I>t</I></SUB>)
would be the greater of the Indexed Crediting Rate as determined using the CPI-U plus the
Guaranteed Margin (M), or the Floor Rate, and the lesser of the Indexed Credit Rate or the Rate
Cap.
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 12pt"><IMG src="b87363a1b8736304.gif" alt="(FORMULA)">
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Where:
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">R<SUB style="FONT-size: 85%; vertical-align: text-bottom">t</SUB> = Indexed Crediting Rate at time <SUB style="FONT-size: 85%; vertical-align: text-bottom">t</SUB> applicable for the following year.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CPI<SUB style="FONT-size: 85%; vertical-align: text-bottom">t </SUB>= the CPI-U value from 3&nbsp;months prior to the rate determination date.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">CPI<SUB style="FONT-size: 85%; vertical-align: text-bottom">t-1 </SUB>= the CPI-U value 1&nbsp;year prior to CPI<SUB style="FONT-size: 85%; vertical-align: text-bottom">t</SUB>.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><I>M = </I>the Guaranteed Margin which is set at the beginning of the Contract/Certificate and remains
constant throughout the Term. M may be a negative value.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The Indexed Crediting Rate will never be less than a Floor Rate of &#091;0%&#093;nor greater than a Rate Cap
of &#091;10%&#093;.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SPEC-CPI10-1.2
</DIV>




<P align="center" style="font-size: 10pt"><!-- Folio -->S.2<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>TABLES OF WITHDRAWAL CHARGE PERCENTAGES:</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>&#091;APPLICABLE TO ACCOUNT VALUE DURING THE INITIAL TERM:</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="20%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="39" style="border-bottom: 1px solid #000000"><B>CONTRACT/CERTIFICATE YEAR AT TIME OF WITHDRAWAL</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #000000"><B>TERM</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>1</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>2</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>3</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>4</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>5</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>6</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>7</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>8</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>9</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>10</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>1 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>2 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>3 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>4 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>5 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>6 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>7 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>8 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>9 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>10 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="right" style="font-size: 10pt; margin-top: 12pt"><B>&#093;</B><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>APPLICABLE TO ACCOUNT VALUE DURING ANY SUBSEQUENT TERM:</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>&#091;</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="20%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="39"><B>NUMBER OF COMPLETE CONTRACT/CERTIFICATE YEARS SINCE THE COMMENCEMENT</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="39" style="border-bottom: 1px solid #000000"><B>OF ANY SUBSEQUENT TERM AT THE TIME OF WITHDRAWAL</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #000000"><B>TERM</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>0</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>1</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>2</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>3</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>4</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>5</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>6</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>7</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>8</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>9</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>1 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>2 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>3 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>4 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>5 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>6 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>7 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>8 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>9 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>10 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="right">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="right" style="font-size: 10pt; margin-top: 12pt"><B>&#093;</B><SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SPEC-CPI10-1.2
</DIV>




<P align="center" style="font-size: 10pt"><!-- Folio -->S.3<!-- /Folio -->
</DIV>

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<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>BENEFICIARY INFORMATION</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Beneficiary(ies) is as designated by you as of the Contract/Certificate Date, unless otherwise
changed per the provisions of the Contract/Certificate.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="40%">&nbsp;</TD>
    <TD width="10%">&nbsp;</TD>
    <TD width="50%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Beneficiary(s)
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;John Doe&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Contingent Beneficiary(s)
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;Jane Doe.&#093;<SUP style="FONT-size: 85%; vertical-align: text-top"> </SUP></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">SPEC-CPI10-1.2
</DIV>




<P align="center" style="font-size: 10pt"><!-- Folio -->S.4<!-- /Folio -->
</DIV>

</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.5
<SEQUENCE>6
<FILENAME>b87363a1exv99w5.htm
<DESCRIPTION>INDIVIDUAL APPLICATION - ICC10MVAAPP
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w5</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
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<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Exhibit&nbsp;99.5</B>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><IMG src="b87363a1b8736308.gif" alt="(GRAPHICS)">
</DIV>

<TABLE width="90%">
<TR><TD style="font-size: 1pt; color: #FFFFFF">Exhibit&nbsp;99.5 NOT FOR USE IN NEW YORK John Hancock Life Insurance Company (U.S.A.) P.O. Box
9505, Portsmouth, NH 03802-9505 Overnight mail: 164 Corporate Drive, Portsmouth, NH 03801-6815
800-344-1029 www.jhannuities.com Home Office: Bloomfield Hills, MI JH Choice Application
Individual&#151;Single Payment Modified Guaranteed Deferred Annuity 1 Expected Premium Expected Premium
Expected premium includes any assets coming from another financial institution (i.e., 1035
exchange, qualified plan rollover, etc.) Amount of actual premium $&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;received will appear in the
delivered contract. 2 Owner (oldest)&nbsp;Male Female Trust/Entity Name (First, Middle, Last or Name of
Trust/Entity) Date of Birth (mm/dd/yyyy) Social Security Number/Tax Identification Number Email
Address Mailing Address City, State, Zip Residential Address (required if different from mailing or
address is PO Box) Client Brokerage Account Number Co-owner Male Female Trust/Entity Name (First,
Middle, Last or Name of Trust/Entity) Date of Birth (mm/dd/yyyy) Social Security/Tax Identification
Number Email Address Mailing Address City, State, Zip Residential Address (required if different
from mailing or address is PO Box) 3 Annuitant (Applicable for Non-natural Owners and Nonqualified
plans if different from Owner) Male Female Name (First, Middle, Last) Date of Birth (mm/dd/yyyy)
Social Security Number Email Address Mailing Address City, State, Zip Residential Address (required
if different from mailing or address is PO Box) Co-annuitant (if different from co-owner) Male
Female Name (First, Middle, Last) Date of Birth (mm/dd/yyyy) Social Security Number Email Address
Mailing Address City, State, Zip Residential Address (required if different from mailing or address
is PO Box) ICC10MVAAPP Page 1 of 3 0711 CHCMVA</TD>
</TR>
</TABLE>



<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><IMG src="b87363a1b8736306.gif" alt="(GRAPHICS)">
</DIV>

<TABLE width="90%">
<TR><TD style="font-size: 1pt; color: #FFFFFF">JH Choice Application 4 Beneficiaries The primary If a co-owner was selected in Section&nbsp;2, and is
living, that person will take precedence beneficiaries and contingent over the primary beneficiary.
Contingent beneficiaries receive proceeds only if all primary beneficiaries must EACH equal
beneficiaries pre-decease the owner. If you wish to restrict the death payment options for 100% of
proceeds. Please use any of the beneficiaries listed below, please complete the Restricted
Beneficiary Payout whole percentages only. form located on www.jhannuities.com. Role Beneficiary&#146;s
Name % of Proceeds Relationship to owner Note: To name additional beneficiaries, please use the
space in Special Instructions (Section&nbsp;7). 5 Type of Annuity Plan type: Tax-qualified plans:
Qualified Nonqualified IRA (Tax Year) Roth IRA (Tax Year) IRA Rollover IRA Transfer Other 6
Guaranteed Period (Please check one. Check availability, not all guarantee periods may be
available.) 4-Year 5-Year 6-Year 7 Special Instructions (write in) or Optional Riders 8 Disclosures
Any person who knowingly presents a false statement in an application for insurance may be guilty
of a criminal offense and subject to penalties under state law. A sales representative does not
have the company&#146;s authorization to accept risk, pass on insurability or make, void, waiver or
change conditions or provisions of the application, contract or receipt. 9 Military Sales Is the
annuitant or owner an active member of the U.S. Armed Forces? Yes* No (default) * If you answered
&#147;Yes&#148;, please complete and attach a &#147;Military Personnel Financial Services Disclosure&#148; form
(available on www.jhannuities.com). This product is not specifically designed for or marketed to
active duty military personnel. Applications not complying with our military sales procedures will
not be accepted. Page 2 of 3 0711 CHCMVA</TD>
</TR>
</TABLE>



<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><IMG src="b87363a1b8736307.gif" alt="(GRAPHICS)">
</DIV>

<TABLE width="90%">
<TR><TD style="font-size: 1pt; color: #FFFFFF">JH Choice Application 10 Acknowledgments/Signatures Statement of Applicant: I/We agree that the
contract I/we have applied for shall not take effect until the later of: (1)&nbsp;the issuance of the
contract, or (2)&nbsp;receipt by the company at its Annuity Service Office of the first payment required
under the contract. The information herein is true and complete to the best of my/our knowledge and
belief and is correctly recorded. Yes* No Does the annuitant or owner have existing individual life
insurance policies or annuity contracts? Yes* No Will this contract replace or change any existing
life insurance or annuity in this or any other company? *If you answered &#147;YES&#148; to either question,
please complete below and attach a state replacement form (if applicable). Please see reference
guide in the forms booklet. Annuity Life Insurance Issuing Company Contract Number I/We understand
that unless I/we elect otherwise, the Maturity Date will be the Annuitant&#146;s 95th birthday Alternate
Maturity Date I/We acknowledge receipt of the current prospectus and understand that because of the
market value adjustment provision of the contract the amount I receive upon withdrawal or
annuitization may vary from the reported Account Value. I/We confirm a review of my/our investment
objectives, tax, liquidity, and financial statuses was offered to me/us. I/We have read the
applicable fraud statement contained in the State Disclosures Section. To the best of my knowledge
and belief, the statements in this application are true and complete. I/We am/are either a citizen
or resident alien of the United States of America. SIGN HERE Owner: Signature City, State (signed
in) Date SIGN HERE Title of Officer: Title Signing for SIGN HERE Co-owner: Signature City, State
(signed in) Date HERE SIGN Annuitant: (If different from owner) Signature City, State (signed in)
Date SIGN Co-annuitant: HERE (If co-owner) different from Signature City, State (signed in) Date 11
Financial Advisor Information A. Certification: I have truly and accurately recorded the
information provided by the applicant and I have determined that the annuity contract/certificate
applied for is a suitable investment for the applicant. YES NO Does the annuitant or owner have
existing individual life insurance policies or annuity contracts? YES NO Will this contract replace
or change any existing life insurance or annuity in this or any other company? If yes, complete
applicable state replacement forms. Printed name Telephone Number State License ID Broker/Dealer
Firm Broker/Dealer Rep Number Email Address HERE SIGN Signature Page 3 of 3 0711 CHCMVA</TD>
</TR>
</TABLE>




<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>



</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.6
<SEQUENCE>7
<FILENAME>b87363a1exv99w6.htm
<DESCRIPTION>MASTER CONTRACT FOR GROUP ANNUITY - 09GRPMAST
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w6</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
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<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><b>Exhibit 99.6</b>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><IMG src="b87363a1b8736305.gif" alt="(JOHN HANCOCK LOGO)">
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="middle">Life Insurance Company (U.S.A.)
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="middle">&#091;Bloomfield Hills, Michigan&#093;<SUP style="FONT-size: 85%; vertical-align: text-top">1</SUP></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="18%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="80%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">CONTRACTHOLDER
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>&#091;Financial Institution&#093;</B><SUP style="FONT-size: 85%; vertical-align: text-top"><B>2</B></SUP></TD>
</TR>
<TR style="font-size: 6pt">
<TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">CONTRACT NUMBER
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>&#091;12345&#093;</B><SUP style="FONT-size: 85%; vertical-align: text-top"><B>3</B></SUP></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>GROUP ANNUITY</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The John Hancock Life Insurance Company (U.S.A.) (&#147;the Company&#148;, &#147;we&#148;, &#147;our&#148;) agrees, subject to
the conditions and provisions of the certificate, to provide the benefits, rights and privileges as
stated in the certificate. A certificate evidencing participation under this contract will be
issued to each member of the eligible group from which we received the required premium
contribution.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This contract is issued in consideration of the master application for this contract.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Signed for the Company at Boston, Massachusetts:
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="7%"></TD>
    <TD width="85%"></TD>
    <TD width="7%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top"><IMG src="b87363a1b8736310.gif" alt="-s- Jon E. Boyl">
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top"><IMG src="b87363a1b8736311.gif" alt="-s- Emanuel Alves"></TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">President
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Secretary</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Group Annuity<BR>
Nonparticipating &#151; Not eligible for dividends

</DIV>

<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>Administrative Office</B><BR>
&#091;601 Congress Street<BR>
Boston, Massachusetts 02210&#093;<SUP style="FONT-size: 85%; vertical-align: text-top">4</SUP>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%"></TD>
    <TD width="5%"></TD>
    <TD width="47%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">09GRPMAST
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">GP0101</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
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<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>Contract Provisions</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="6%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="93%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left"><B>Section</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">1.
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Eligibility/Cessation of Participation</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">2.
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Certificates</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">3.
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Incorporation</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">4.
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Termination</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%"></TD>
    <TD width="5%"></TD>
    <TD width="47%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">2
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">GP0201</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt">09GRPMAST</div>

<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

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<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>1. ELIGIBILITY/CESSATION OF PARTICIPATION</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">A person who is a customer of the contractholder to which this contract is issued may become a
Certificate Owner upon Our approval and receipt of the required premium contribution.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>2. CERTIFICATES</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">We will issue an individual certificate to each Certificate Owner. The certificate will state
the terms, conditions, and benefits of this contract. We may credit interest to Certificate Owners
at rates that vary by certificate issue date, premium amount, or eligible class.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>3. INCORPORATION</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">A sample certificate attached hereto is made a part of this contract. Any provisions of this
contract which are inconsistent with provisions of the certificate are waived and superseded by the
certificate provisions.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>4. TERMINATION</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This contract will terminate when the contractholder requests termination in writing to us or
when no Certificate Owners hold any certificate issued under this contract.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Any certificates in force when the contract terminates will continue to be in force in accordance
with our administrative rules in effect, until terminated by the Certificate Owner.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="47%"></TD>
    <TD width="5%"></TD>
    <TD width="47%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">3
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">GP0301</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt">09GRPMAST</div>

<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>



</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.7
<SEQUENCE>8
<FILENAME>b87363a1exv99w7.htm
<DESCRIPTION>MASTER APPLICATION FOR GROUP ANNUITY - 156-GRPMAST-09
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w7</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
<!-- PAGEBREAK -->
<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Exhibit&nbsp;99.7</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt">&nbsp;&#091;&nbsp;
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><IMG src="b87363a1b8736305.gif" alt="(JOHN HANCOCK LOGO)">
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Life Insurance Company (U.S.A.)
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;Bloomfield Hills, Michigan&#093; <SUP style="FONT-size: 85%; vertical-align: text-top">1</SUP></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="right" style="font-size: 10pt; margin-top: 12pt">Administrative Office<BR>
&#091;601 Congress Street<BR>
Boston, Massachusetts 02210&#093;<SUP style="FONT-size: 85%; vertical-align: text-top">2</SUP>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>MASTER APPLICATION FOR GROUP ANNUITY</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Application is made for group master policy form &#091;09GRPMAST&#093;<SUP style="FONT-size: 85%; vertical-align: text-top">3</SUP> to which this application
shall be attached and made a part. The terms and conditions of the annuity applied for will be
subject to and in accordance with the group master policy issued by John Hancock Life Insurance
Company (U.S.A.).
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="11%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="4%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="75%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD colspan="3" valign="top" align="left">Applicant Corporation:</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR style="font-size: 1px">
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" valign="top" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD colspan="3" valign="top" align="left" nowrap>Address of Corporation:</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR style="font-size: 1px">
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" valign="top" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR style="font-size: 10pt">
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" valign="bottom" align="left" style="border-bottom: 1px solid #000000">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD colspan="3" valign="top" align="left">Name and Title of</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD colspan="3" valign="top" align="left">Corporate Officer:</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR style="font-size: 1px">
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" valign="top" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD colspan="3" valign="top" align="left">Tax ID Number:</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR style="font-size: 1px">
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" valign="top" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD colspan="3" valign="top" align="left">Applicant&#146;s Signature:</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR style="font-size: 1px">
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" valign="top" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD colspan="3" valign="top" align="left">Print Name:</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR style="font-size: 1px">
    <TD valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="3" valign="top" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Date:
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;&nbsp;&nbsp;&nbsp;&#091;Witness:
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top" nowrap>&#093;<SUP style="FONT-size: 85%; vertical-align: text-top">4</SUP></TD>
</TR>
<TR style="font-size: 1px">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top" style="border-top: 1px solid #000000">&nbsp;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top" style="border-top: 1px solid #000000">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt">156-GRPMAST-09
</DIV>



<P align="center" style="font-size: 10pt"><!-- Folio --><!-- /Folio -->
</DIV>



</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.8
<SEQUENCE>9
<FILENAME>b87363a1exv99w8.htm
<DESCRIPTION>GENERIC ROTH INDIVIDUAL RETIREMENT ANNUITY ENDORSEMENT - 10ROTH
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w8</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
<!-- PAGEBREAK -->
<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Exhibit&nbsp;99.8</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="65%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><IMG src="b87363a1b8736305.gif" alt="(JOHN HANCOCK LOGO)">
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Life Insurance Company (U.S.A.)</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>ROTH INDIVIDUAL RETIREMENT ANNUITY ENDORSEMENT<BR>
(Under section 408A of the Internal Revenue Code)</B>

</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Check if this endorsement supersedes a prior Roth IRA endorsement.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This endorsement is made a part of the annuity contract to which it is attached, and the following
provisions apply in lieu of any provisions in the contract to the contrary.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The annuitant is establishing a Roth individual retirement annuity (Roth IRA) under section 408A to
provide for his or her retirement and for the support of his or her beneficiaries after death.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;I</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Except in the case of a rollover contribution described in section 408A(e), a recharacterized
contribution described in section 408A(d)(6), or qualified rollover contributions (as defined in
Article&nbsp;II below), the issuer will accept only cash contributions up to $3,000 per year for tax
years 2002 through 2004. That contribution limit is increased to $4,000 for tax years 2005 through
2007; and $5,000 for 2008 and thereafter. For annuitants who have reached the age of 50 before the
close of the tax year, the contribution limit is increased to $3,500 per year for tax years 2002
through 2004; $4,500 for 2005; $5,000 for 2006 and 2007; and $6,000 for 2008 and thereafter. For
tax years after 2008, the above limits will be adjusted by the Secretary of the Treasury to reflect
a cost-of-living adjustment, if any, under section 219(b)(5)(D)(d)(6). Such adjustments will be in
multiples of $500.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If the annuitant was a participant in a &#167; 401(k) plan of a certain employer in bankruptcy described
in Code
&#167; 219(b)(5)(C), then the contribution limit is increased to $7,000 for tax years 2006 and 2007; and
$8,000 for 2008 and 2009 only. An annuitant who makes such contributions may not also make
contributions under any other section of the Code.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Notwithstanding the preceding limits on contributions, however, an annuitant may make additional
contributions specifically authorized by statute, such as repayments of qualified reservist
distributions, repayments of certain plan distributions made on account of a federally declared
disaster and certain amounts received in connection with the Exxon Valdez litigation.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;II</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>1. </B>The maximum regular contribution that can be made to all of an annuitant&#146;s Roth IRAs for a
taxable year is the smaller amount determined under (i)&nbsp;or (ii)&nbsp;below.
</DIV>



<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">(i)&nbsp;The maximum regular contribution is phased out ratably between certain levels of
modified adjusted gross income in accordance with the following table:
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%">&nbsp;</TD>
    <TD width="1%">&nbsp;&nbsp;&nbsp;&nbsp;</TD>
    <TD width="9%">&nbsp;</TD>
    <TD width="1%">&nbsp;&nbsp;&nbsp;&nbsp;</TD>
    <TD width="10%">&nbsp;</TD>
    <TD width="1%">&nbsp;&nbsp;&nbsp;&nbsp;</TD>
    <TD width="20%">&nbsp;</TD>
    <TD width="1%">&nbsp;&nbsp;&nbsp;&nbsp;</TD>
    <TD width="20%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3"><B>Full</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="center" style="border-bottom: 1px solid #000000"><B>Filing Status</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="3" style="border-bottom: 1px solid #000000"><B>Contribution</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" style="border-bottom: 1px solid #000000"><B>Phase-out Range</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" style="border-bottom: 1px solid #000000"><B>No Contribution</B></TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="7" style="border-bottom: 1px solid #000000"><B>Modified AGI</B></TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Single or Head of Household
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap colspan="3" align="left" valign="top">$95,000 or less
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top" nowrap>Between $105,000 and
$120,000
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top" nowrap>$120,000 or more</TD>
</TR>
<TR valign="bottom">
    <TD valign="top" nowrap><DIV style="margin-left:0px; text-indent:-0px">Joint Return or Qualifying Widow(er)
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap colspan="3" align="left" valign="top">$150,000 or less
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Between $167,000 and
$177,000
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">$177,000 or more</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Married-Separate Return
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" valign="top">$0</TD>
    <TD>&nbsp;</TD>
    <TD nowrap valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Between $0 and $10,000
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">$10,000 or more</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10ROTH</B>
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->1<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">An annuitant&#146;s modified adjusted gross income (&#147;modified AGI&#148;) for a taxable year is defined
in Code &#167; 408A(c)(3) and does not include any amount included in adjusted gross income as a
result of a qualified rollover contribution. If the annuitant&#146;s modified AGI for a taxable
year is in the phase-out range, the maximum regular contribution determined for that taxable
year is rounded up to the next multiple of $10 and is not reduced below $200. For tax years
after 2010, the above limits will be adjusted by the Secretary of the Treasury to reflect a
cost-of-living adjustment, if any, under Code &#167; 408A(c)(3). Such adjustments will be in
multiples of $1,000.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">(ii)&nbsp;If the annuitant makes regular contributions to both Roth and non Roth IRAs for a
taxable year, the maximum regular contribution that can be made to all of an annuitant&#146;s
Roth IRAs for that taxable year is reduced by the regular contributions made to the
annuitant&#146;s non Roth IRAs for the taxable year.
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>2. </B>In the case of a joint return, the AGI limits in the table above apply to the combined AGI of
the annuitant and his or her spouse.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>3. </B>No contributions will be accepted under a SIMPLE IRA plan established by any employer pursuant
to &#167; 408(p). Also, no transfer or rollover of funds attributable to contributions made by a
particular employer under its SIMPLE IRA plan will be accepted from a SIMPLE IRA, that is, an IRA
used in conjunction with a SIMPLE IRA plan, prior to the expiration of the 2-year period beginning
on the date the annuitant first participated in that employer&#146;s SIMPLE IRA plan.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>4. </B>If this is an inherited IRA within the meaning of &#167; 408(d)(3)(C), no contributions will be
accepted.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>5. </B>A regular contribution to a non Roth IRA may be recharacterized pursuant to the rules in &#167;
1.408A-5 of the regulations as a regular contribution to this IRA, subject to the limits in section
<B>1</B>. of this Article.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>6. </B>A &#147;qualified rollover contribution&#148; is a rollover contribution of a distribution from an
eligible retirement plan described in &#167; 402(c)(8)(B). If the distribution is from an IRA, the
rollover must meet the requirements of Code &#167; 408(d)(3), except the one-rollover-per year rule of &#167;
408(d)(3)(B) does not apply if the distribution is from a non Roth IRA. If the distribution is from
an eligible retirement plan other than an IRA, the rollover must meet the requirements of Code &#167;
402(c), 402(e)(6), 403(a)(4), 403(b)(8), 403(b)(10), 408(d)(3) or 457(e)(16), as applicable. A
qualified rollover contribution also includes (i)&nbsp;and (ii)&nbsp;below.
</DIV>



<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">(i)&nbsp;All or part of a military death gratuity or Service members&#146; group life insurance
(&#147;SGLI&#148;) payment may be contributed if the contribution is made within 1&nbsp;year of receiving
the gratuity or payment. Such contributions are disregarded for purposes of the
one-rollover-per-year rule under &#167; 408(d)(3)(B).
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">(ii)&nbsp;All or part of an airline payment (as defined in &#167; 125 of the Worker, Retiree, and
Employer Recovery Act of 2008 (&#147;WRERA&#148;), Pub. L. 110-458) received by certain airline
employees may be contributed if the contribution is made within 180&nbsp;days of receiving the
payment.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;III</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The annuitant&#146;s interest in the contract is nonforfeitable and nontransferable.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;IV</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>1. </B>The contract does not require fixed contributions.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>2. </B>Any dividends (refund of contributions other than those attributable to excess contributions)
arising under the contract will be applied (before the close of the calendar year following the
year of the dividend) as contributions toward the contract.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;V</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>1. </B>Notwithstanding any provision of this IRA to the contrary, the distribution of the annuitant&#146;s
interest in the
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10ROTH</B>
</DIV>




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</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">



<DIV align="left" style="font-size: 10pt; margin-top: 6pt">account shall be made in accordance with the requirements of Code &#167; 408(a)(6), as modified by &#167;
408A(c)(5), and the regulations thereunder, the provisions of which are herein incorporated by
reference. If distributions are made from an annuity contract purchased from an insurance company,
distributions thereunder must satisfy the requirements of &#167; 1.401(a)(9)-6 of the Income Tax
Regulations (taking into account Code &#167; 408A(c)(5)), rather than the distribution rules in
paragraphs 2., 3., and 4., below.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>2. </B>Upon the death of the annuitant, his or her entire interest will be distributed at least as
rapidly as follows:
</DIV>



<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">(i)&nbsp;If the designated beneficiary is someone other than the annuitant&#146;s surviving spouse,
the entire interest will be distributed, starting by the end of the calendar year following
the calendar year of the annuitant&#146;s death, over the remaining life expectancy of the
designated beneficiary, with such life expectancy determined using the age of the
beneficiary as of his or her birthday in the year following the year of the annuitant&#146;s
death, or, if elected, in accordance with paragraph 2. (iii)&nbsp;below. If this is an inherited
IRA within the meaning of Code &#167; 408(d)(3)(C) established for the benefit of a nonspouse
designated beneficiary by a direct trustee-to-trustee transfer from a retirement plan of a
deceased annuitant under
&#167; 402(c)(11), then, notwithstanding any election made by the deceased annuitant pursuant to
the preceding sentence, the nonspouse designated beneficiary may elect to have distributions
made under this paragraph 2. (i)&nbsp;if the transfer is made no later than the end of the year
following the year of death.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">(ii)&nbsp;If the annuitant&#146;s sole designated beneficiary is the annuitant&#146;s surviving spouse, the
entire interest will be distributed, starting by the end of the calendar year following the
calendar year of the annuitant&#146;s death (or by the end of the calendar year in which the
annuitant would have attained age 70<FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT>, if later), over such spouse&#146;s life expectancy, or, if
elected, in accordance with paragraph 2. (iii)&nbsp;below. If the surviving spouse dies before
distributions are required to begin, the remaining interest will be distributed, starting by
the end of the calendar year following the calendar year of the spouse&#146;s death, over the
spouse&#146;s designated beneficiary&#146;s remaining life expectancy determined using such
beneficiary&#146;s age as of his or her birthday in the year following the death of the spouse,
or, if elected, will be distributed in accordance with paragraph 2. (iii)&nbsp;below. If the
surviving spouse dies after distributions are required to begin, any remaining interest will
be distributed over the spouse&#146;s remaining life expectancy determined using the spouse&#146;s age
as of his or her birthday in the year of the spouse&#146;s death. If the annuitant&#146;s surviving
spouse is the designated beneficiary, such spouse, at his or her option, will then be
treated as the annuitant
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">(iii)&nbsp;If there is no designated beneficiary, or if applicable by operation of paragraph 2.
(i)&nbsp;or (ii)&nbsp;above, the entire interest will be distributed by the end of the calendar year
containing the fifth anniversary of the annuitant&#146;s death (or of the spouse&#146;s death in the
case of the surviving spouse&#146;s death before distributions are required to begin under
paragraph 2. (ii)&nbsp;above).
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 2%">(iv)&nbsp;The amount to be distributed each year under paragraph 2. (i)&nbsp;or (ii)&nbsp;is the quotient
obtained by dividing the value of the IRA as of the end of the preceding year by the
remaining life expectancy specified in such paragraph. Life expectancy is determined using
the Single Life Table in Q&#038;A-1 of &#167; 1.401(a)(9)-9 of the Income Tax Regulations. If
distributions are being made to a surviving spouse as the sole designated beneficiary, such
spouse&#146;s remaining life expectancy for a year is the number in the Single Life Table
corresponding to such spouse&#146;s age in the year. In all other cases, remaining life
expectancy for a year is the number in the Single Life Table corresponding to the
beneficiary&#146;s age in the year specified in paragraph (b)(i) or (ii)&nbsp;and reduced by 1 for
each subsequent year.
</DIV>
<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>3. </B>The &#147;value&#148; of the IRA includes the amount of any outstanding rollover, transfer and
recharacterization under Q&#038;As-7 and -8 of &#167; 1.408-8 of the Income Tax Regulations.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>4. </B>If the sole designated beneficiary is the annuitant&#146;s surviving spouse, the spouse may elect to
treat the IRA as his or her own IRA. This election will be deemed to have been made if such
surviving spouse makes a contribution to the IRA or fails to take required distributions as a
beneficiary.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>5</B>. The required minimum distributions payable to a designated beneficiary from this IRA may be
withdrawn from another IRA the beneficiary holds from the same decedent in accordance with Q&#038;A-9 of
&#167; 1.408-8 of the Income Tax Regulations.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10ROTH</B>
</DIV>



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</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">




<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;VI</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>1. </B>The annuitant agrees to provide the issuer with all information necessary to prepare any reports
required by sections 408(i) and 408A(d)(3)(E), Regulations sections 1.408-5 and 1.408-6, or other
guidance published by the Internal Revenue Service (IRS).
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>2. </B>The issuer agrees to submit to the IRS and annuitant the reports prescribed by the IRS.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>3. </B>The issuer shall furnish annual calendar year reports concerning the status of the annuity and
such information concerning requirement minimum distributions as is prescribed by the Commissioner
of the Internal Revenue Service.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;VII</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Notwithstanding any other articles which may be added or incorporated, the provisions of Article&nbsp;I
through VI and this sentence will be controlling. Any additional articles inconsistent with section
408A, the related regulations, or other published guidance will be invalid.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;VIII</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This endorsement will be amended as necessary to comply with the provisions of the Code, the
related regulations, and other published guidance. Only the President, a Vice President, the
Secretary, or an Assistant Secretary of the Company has authority to amend, waive or modify any of
the provisions of this endorsement of the contract which is attached.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><U><B>Article&nbsp;IX</B></U>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>1. </B>If this Endorsement is issued as part of an individual annuity contract, (i)&nbsp;the term
&#147;annuitant&#148; as used in this Endorsement shall have the same meaning as the term &#147;Owner&#148; as used in
the individual annuity contract and (ii)&nbsp;the term &#147;contract&#148; as used in this Endorsement shall have
the same meaning as the term &#147;Contract&#148; as used in the individual annuity contract. If this
Endorsement is issued in connection with a group annuity contract, the term &#147;contract&#148; as used in
this Endorsement shall refer to the Certificate and the term &#147;annuitant&#148; shall refer to the owner
of the Certificate. If this is an inherited IRA within the meaning of Code &#167; 408(d)(3)(C)
maintained for the benefit of a designated beneficiary of a deceased annuitant, references in this
document to the &#147;annuitant&#148; are to the deceased annuitant.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>2. </B>The General Instructions and Specific Instructions set forth below are intended to provide an
explanation of certain aspects of the endorsement. They do not add, modify, or negate any
provisions of this endorsement or the annuity contract to which this endorsement is attached.
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Signed for the Company at Boston, Massachusetts.</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 50%"><IMG src="b87363a1b8736302.gif" alt="-s- Emanuel Alves">

</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 50%">/s/ Emanuel Alves

</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 50%">Secretary

</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10ROTH</B>
</DIV>


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<DIV style="font-family: Helvetica,Arial,sans-serif">
<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD nowrap align="left" style="border-bottom: 1px solid #000000"><B>General Instructions</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" style="border-bottom: 1px solid #000000"><B>Definitions</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" style="border-bottom: 1px solid #000000">&nbsp;</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><I>Section references are to the
Internal Revenue Code unless
otherwise noted.</I><BR><BR>
This Form is a model annuity
endorsement that meets the
requirements of section 408A
and has been pre-approved by
the IRS. A Roth individual
retirement annuity (Roth IRA) is
established after the contract,
which includes this endorsement,
is fully executed by both the
individual (annuitant)&nbsp;and the
issuer. The contract must be for
the exclusive benefit of the
annuitant and his or her
beneficiaries.<BR><BR>
<B>Do not </B>file this Form with the
IRS. Instead, keep it with your
records.<BR><BR>
Unlike contributions to traditional
individual retirement
arrangements, contributions to a
Roth IRA are not deductible from
the annuitant&#146;s gross income;
and distributions after 5&nbsp;years
that are made when the
annuitant is 59<FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT> years of age
or older <B>or </B>on account of death,
disability, or the purchase of a
home by a first-time homebuyer
(limited to $10,000), are not
includible in gross income. For
more information on Roth IRAs,
including the required disclosures
the issuer must give the
annuitant, see <B>Pub. 590</B>,
Individual Retirement
Arrangements (IRAs).
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>Issuer. </B>The issuer
is the insurance
company providing
the annuity
contract. The
insurance company
may use other terms
besides &#147;issuer&#148; to
refer to itself,
such as, &#147;company,&#148;
&#147;insurer,&#148; or &#147;us.&#148;<BR><BR>
<B>Annuitant. </B>The
annuitant is the
person who
establishes the
annuity contract.
The insurance
company may use
other terms besides
&#147;annuitant&#148; to refer
to the person who
establishes the
annuity contract,
such as, &#147;owner,&#148;
&#147;applicant,&#148;
&#147;insured,&#148; or you.&#148;<BR>
<BR>
<B>Specific Instructions</B><BR>
<BR><B>Article&nbsp;I. </B>The
annuitant may be
subject to a 6% tax
on excess
contributions if <B>(1)</B>
contributions to
other individual
retirement
arrangements of the
annuitant that have
been made for the
same tax year, <B>(2)</B>
the annuitant&#146;s
adjusted gross
income exceeds the
applicable limits in
Article&nbsp;II for the
tax year, or <B>(3) </B>the
annuitant&#146;s and
spouse&#146;s
compensation is less
than the amount
contributed by or on
behalf of them for
the tax year. <BR><BR>
The annuitant should
see the disclosure
statement or Pub.
590 for more
information.
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>Article&nbsp;V. </B>This
article describes
how distributions
will be made from
the Roth IRA after
the annuitant&#146;s
death. Elections
made pursuant to
this article should
be reviewed
periodically to
ensure they
correspond to the
annuitant&#146;s intent.
Under paragraph 4
of Article&nbsp;V, the
annuitant&#146;s spouse,
if s/he so elects,
is treated as the
owner of the Roth
IRA upon the death
of the annuitant,
rather than as the
beneficiary. If the
spouse is to be
treated as the
beneficiary, and
not the owner, an
overriding
provision should be
added to Article
IX.<BR><BR>
<B>Article&nbsp;IX. </B>Article
IX and any that
follow it may
incorporate
additional
provisions that are
agreed to by the
annuitant and
issuer to complete
the contract. They
may include, for
example,
definitions,
investment powers,
voting rights,
exculpatory
provisions,
amendment and
termination,
removal of the
issuer, issuer&#146;s
fees, state law
requirements,
beginning date of
distributions,
accepting only
cash, treatment of
excess
contributions,
prohibited
transactions with
the annuitant, etc.
Attach additional
pages if necessary.</TD>
</TR>
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</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10ROTH</B>
</DIV>



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</DIV>



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</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.9
<SEQUENCE>10
<FILENAME>b87363a1exv99w9.htm
<DESCRIPTION>GENERIC SIMPLE INDIVIDUAL RETIREMENT ANNUITY ENDORSEMENT - 10SIMPLE
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w9</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
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<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Exhibit&nbsp;99.9</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="65%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><IMG src="b87363a1b8736305.gif" alt="(JOHN HANCOCK LOGO)">
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Life Insurance Company (U.S.A.)</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>ENDORSEMENT</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">This Contract shall be a Simple IRA.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">The term &#147;Code&#148; as used in this Endorsement means the Internal Revenue Code of 1986 as amended.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If this Endorsement is issued as part of an individual annuity contract, the terms &#147;Owner&#148; and
&#147;Contract&#148; as used in this Endorsement shall have the same meaning as such terms are used in the
individual annuity contract. If this is an inherited IRA within the meaning of Code &#167; 408(d)(3)(C)
maintained for the benefit of a designated beneficiary of a deceased Owner, references in this
document to the &#147;Owner&#148; are to the deceased Owner. If this Endorsement is issued in connection
with a group annuity contract, the term &#147;Contract&#148; as used in this Endorsement shall refer to the
Certificate and the term &#147;Owner&#148; as used in this Endorsement shall refer to the owner of the
Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">As requested by the Owner to satisfy Section&nbsp;408 of the Code, as in effect on the Date of Issue of
your Contract, it is agreed by the Owner and the Company that:
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(1)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Your Contract is not transferable by the Owner and shall not be: (a)&nbsp;sold, (b)&nbsp;assigned, (c)
discounted, or (d)&nbsp;pledged as collateral for a loan or for any other purpose, except to the
Company, unless as part of a divorce settlement of which the Owner is a party.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(2)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>All provisions of your Contract dealing with acceptable contributions (from any source) are
hereby deleted and the following paragraph substituted therefore:</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>This Contract as a SIMPLE IRA will accept only cash contributions made by an employer on
behalf of the Owner pursuant to the terms of a SIMPLE IRA Plan described in Section 408(p)
of the Internal Revenue Code. A rollover contribution or a transfer of assets from another
SIMPLE IRA of the Owner will also be accepted. No other contributions will be accepted.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(3)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The following paragraphs are added to your Contract:</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(a)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If contributions made on behalf of the Owner pursuant to a SIMPLE IRA Plan
maintained by the Owner&#146;s employer are received directly by the Company from the
employer, the Company will provide the employer with the summary description required
by Section&nbsp;408(l)(2)(B) of the Code.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(b)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Notwithstanding anything in this Endorsement to the contrary, prior to the
expiration of the 2-year period beginning on the date the Owner first participated in
any SIMPLE IRA Plan maintained by the Owner&#146;s employer, any rollover or transfer by the
Owner of funds from this SIMPLE IRA must be made to another SIMPLE IRA of the Owner.
Any distribution of funds to the Owner during this 2-year period may be subject to a
25-percent additional tax if the Owner does not roll over the amount distributed into a
SIMPLE IRA. After the expiration of this 2-year period, the Owner may roll over or
transfer funds to any IRA of the Owner that is qualified under Section&nbsp;408(a), (b)&nbsp;or
(p)&nbsp;of the Code or to another eligible retirement plan described in section
402(c)(8)(B) of the Code.</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(4)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Notwithstanding any provision of this Contract to the contrary, the distribution of the
Owner&#146;s interest (value of the annuity) shall be made in accordance with the requirements of
Section&nbsp;408(b)(3) of the Code and the regulations thereunder, the provisions of which are
herein incorporated by reference. If distributions are not made in the form of an annuity on
an irrevocable basis (except for acceleration), then</TD>
</TR>


</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10SIMPLE</B>
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->1<!-- /Folio -->
</DIV>

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<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV style="margin-top: 6pt"><TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">


<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>distribution of the interest in the Contract (see paragraph 5(c) below) must satisfy section
408(a)(6) and the regulations thereunder.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The entire interest of the Owner will be distributed or commence to be distributed, no later
than the first day of April following the calendar year in which the Owner attains age 70<FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT>
(required beginning date), over: (a)&nbsp;the life of the Owner, or the lives of the Owner and
his or her designated beneficiary; or (b)&nbsp;a period certain not extending beyond the life
expectancy of the Owner, or the joint and the last survivor expectancy of the Owner and his
or her designated beneficiary. Payments must be made in periodic payments at intervals of no
longer than one year. In addition, payments must be either nonincreasing or they may
increase only as provided in Q&#038;As-1 and -4 of Section&nbsp;1.401(a)(9)-6 of the Income Tax
Regulations. In addition, any payment must satisfy the incidental benefit requirements
specified in Q&#038;A-2 of section 1.401(a)(9)-6. The distribution periods described above cannot
exceed the periods specified in section 1.401(a)(9)-6. The first required payment can be
made as late as April 1 of the calendar year following the calendar year in which the Owner
attains age 70<FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT> and must be the payment that is required for one payment interval. The
second payment need not be made until the end of the next payment interval.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The preceding paragraph does not apply to inherited IRAs within the meaning of &#167;
408(d)(3)(C).</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(5)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If the Owner dies before the entire interest is distributed, the following distribution
provisions shall apply:</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(a)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Distributions Beginning Before Death. If the Owner dies on or after required
distributions of his or her interest have commenced, the remaining portion of such
interest will continue to be distributed under the settlement option chosen.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(b)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Distributions Beginning After Death. If the Owner dies before required
distribution of his or her interest begins, his or her entire interest shall be
distributed at least as rapidly as follows:</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="6%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(i)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If the designated beneficiary is someone other than the Owner&#146;s
surviving spouse, the entire interest will be distributed under an available
settlement option, starting by the end of the calendar year following the
calendar year of the Owner&#146;s death, over the remaining life expectancy of the
designated beneficiary, with such life expectancy determined using the age of
the beneficiary as of his or her birthday in the year following the year of the
Owner&#146;s death, or, if elected, in accordance with paragraph (b)(iii) below.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="6%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(ii)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If the Owner&#146;s sole designated beneficiary is the Owner&#146;s
surviving spouse, the entire interest will be distributed under an available
settlement option, starting by the end of the calendar year following the
calendar year of the Owner&#146;s death (or by the end of the calendar year in which
the Owner would have attained age 70<FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT>, if later), over such spouse&#146;s life
expectancy, or, if elected, in accordance with paragraph (b)(iii) below. If the
surviving spouse dies before required distributions commence to him or her, the
remaining interest will be distributed, starting by the end of the calendar
year following the calendar year of the spouse&#146;s death, over the spouse&#146;s
designated beneficiary&#146;s remaining life expectancy determined using such
beneficiary&#146;s age as of his or her birthday in the year following the death of
the spouse, or, if elected, will be distributed in accordance with paragraph
(b)(iii) below. If the surviving spouse dies after required distributions
commence to him or her, any remaining interest will continue to be distributed
under the contract option chosen.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="6%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(iii)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If there is no designated beneficiary, or if applicable by
operation of paragraph (b)(i) or (b)(ii) above, the entire interest will be
distributed under an available settlement option by the end of the calendar
year containing the fifth anniversary of the Owner&#146;s death (or of the spouse&#146;s
death in the case of the surviving spouse&#146;s death before distributions are
required to begin under paragraph (b)(ii) above).</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="6%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(iv)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Life expectancy is determined using the Single Life Table in
Q&#038;A-1 of &#167;1.401(a)(9)-9 of the Income Tax Regulations. If distributions are
being made to a surviving spouse as the</TD>
</TR>


</TABLE>
</DIV>



<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10SIMPLE</B>
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->2<!-- /Folio -->
</DIV>

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<DIV style="margin-top: 6pt"><TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">


<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="6%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>sole designated beneficiary, such spouse&#146;s remaining life expectancy for a
year is the number in the Single Life Table corresponding to such spouse&#146;s
age in the year. In all other cases, remaining life expectancy for a year is
the number in the Single Life Table corresponding to the beneficiary&#146;s age
in the year specified in paragraph (b)(i) or (ii)&nbsp;and reduced by 1 for each
subsequent year.</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(c)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The &#147;interest&#148; in the Contract includes the amount of any outstanding rollover,
transfer and recharacterization under Q&#038;As-7 and -8 of &#167;1.408-8 of the Income Tax
Regulations and the actuarial value of any other benefits provided under the Contract,
such as guaranteed death benefits.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(d)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>For purposes of paragraphs 5(a) and 5(b) of this Endorsement, required
distributions are considered to commence on the Owner&#146;s required beginning date or, if
applicable, on the date distributions are required to begin to the surviving spouse
under paragraph (b)(ii) above. However, if distributions start prior to the applicable
date in the preceding sentence, on an irrevocable basis (except for acceleration) under
an annuity contract meeting the requirements of &#167;1.401(a)(9)-6 of the Income Tax
Regulations, then required distributions are considered to commence on the annuity
starting date.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(e)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If the sole designated beneficiary is the Owner&#146;s surviving spouse, the spouse
may elect to treat the Contract as his or her own. This election will be deemed to have
been made if such surviving spouse makes a contribution to the Contract or fails to
take required distributions as a beneficiary.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="2%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(f)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The required minimum distributions payable to a designated beneficiary from
this IRA may be withdrawn from another IRA the beneficiary holds from the same decedent
in accordance with Q&#038;A9 of &#167; 1.408-8 of the Income Tax Regulations.</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(6)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Owner and Annuitant under your Contract are and will continue to be as shown in the
application.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(7)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The interest of the Owner in the Contract is nonforfeitable. The Contract is established for
the exclusive benefit of the Owner and his or her beneficiaries.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(8)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Owner may satisfy the minimum distribution requirements under Section&nbsp;408(a)(6) and
408(b)(3) of the Code by receiving a distribution from one IRA that is equal to the amount
required to satisfy the minimum distribution requirements for two or more IRAs. For this
purpose, the Owner of two or more IRAs may use the &#145;alternative method&#146; described in Notice
88-38, 1988-1 C.B. 524, to satisfy the minimum distribution requirements described above. This
section does not apply to Roth IRAs.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(9)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Company shall furnish annual calendar year reports concerning the status of your Contract
and such information concerning required minimum distributions as is prescribed by the
Commissioner of the Internal Revenue.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(10)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Any definition of compensation set forth in the Contract is hereby deleted.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(11)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Contract with this Endorsement may not be used by a designated financial institution
within the meaning of section 408(p)(7) of the Code.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(12)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>In the event of any conflict between the terms of this Endorsement and the provisions of your
Contract, the terms of this Endorsement shall control.</TD>
</TR>




</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10SIMPLE</B>
</DIV>


<P align="center" style="font-size: 10pt"><!-- Folio -->3<!-- /Folio -->
</DIV>

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<DIV style="margin-top: 6pt"><TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">


<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="1%" nowrap align="left">(13)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>This Endorsement may be amended as necessary to comply with the provisions of the Code and
the related regulations.</TD>
</TR>

</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Signed for the Company at Boston, Massachusetts.</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt; margin-left: 50%"><IMG src="b87363a1b8736302.gif" alt="-s- Emanuel Alves"><BR>
/s/ Emanuel Alves<BR>
Secretary

</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10SIMPLE</B>
</DIV>



<P align="center" style="font-size: 10pt"><!-- Folio -->4<!-- /Folio -->
</DIV>



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</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.10
<SEQUENCE>11
<FILENAME>b87363a1exv99w10.htm
<DESCRIPTION>GENERIC INDIVIDUAL RETIREMENT ANNUITY ENDORSEMENT - 10TRADIRA
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w10</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
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<DIV style="font-family: 'Times New Roman',Times,serif">

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Exhibit&nbsp;99.10
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="20%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
    <TD width="35%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">

<TD valign="top" rowspan="2"><DIV style="margin-left:0px; text-indent:-0px"><IMG src="b87363a1b8736309.gif" alt="(JOHN HANCOCK LOGO)">
</DIV></TD>

    <TD align="left" valign="middle">Life Insurance Company (U.S.A.)</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>ENDORSEMENT</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">&#147;The Code&#148; means the Internal Revenue Code of 1986 as amended.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">If this Endorsement is issued as part of an individual annuity contract, the terms &#147;Owner&#148; and
&#147;Contract&#148; as used in this Endorsement shall have the same meaning as such terms are used in the
individual annuity contract. If this is an inherited IRA within the meaning of Code &#167; 408(d)(3)(C)
maintained for the benefit of a designated beneficiary of a deceased Owner, references in this
document to the &#147;Owner&#148; are to the deceased Owner. If this Endorsement is issued in connection
with a group annuity contract, the term &#147;Contract&#148; as used in this Endorsement shall refer to the
Certificate and the term &#147;Owner&#148; as used in this Endorsement shall refer to the owner of the
Certificate.
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">As requested by the Owner to satisfy Section&nbsp;408 of the Code, it is agreed by the Owner and the
Company that:
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(1)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Your Contract is not transferable by the Owner and shall not be: (a)&nbsp;sold, (b)&nbsp;assigned, (c)
discounted, or (d)&nbsp;pledged as collateral for a loan or for any other purpose, except to the
Company, unless as part of a divorce settlement of which the Owner is a party.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(2)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The interest of the Owner in the Contract is nonforfeitable at all times. The Contract is
established for the exclusive benefit of the Owner or his or her beneficiaries.</TD>
</TR>



</TABLE>
</DIV>



<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">(3)</TD>
    <TD width="3%" nowrap align="left">(a)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Except in the case of a rollover contribution (as permitted by Internal Revenue Code &#167;&#167;
402(c), 402(e) (6), 403(a) (4), 403(b) (8), 403(b) (10), 408 (d) (3)&nbsp;and 457 (e) (16)&nbsp;or a
contribution made in accordance with the terms of a Simplified Employee Pension (SEP)&nbsp;as described
in &#167;408(k), no contributions will be accepted unless they are in cash, and the total of such
contributions shall not exceed $5,000 for any taxable year beginning in 2008 and years thereafter.</TD>
</TR>
</table>
</div>




<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>After 2008, the limit will be adjusted by the Secretary of the Treasury for
cost-of-living increases under Code &#167;219(b) (5) (D). Such adjustments will be in
multiples of $500.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>No contributions may be made to your Contract once annuity payments have begun.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(b)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>In the case of an individual who is 50 or older, the annual cash contribution
limit is increased by $1,000 for the year 2010 and years thereafter.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(c)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>In addition to the amounts described in paragraphs (a)&nbsp;and (b)&nbsp;above, an individual may
make additional contributions specifically authorized by statute &#151; such as repayments of
qualified reservist distributions, repayments of certain plan distributions made on account
of a federally declared disaster and certain amounts received in connection with the Exxon
Valdez litigation.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(d)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>No contributions will be accepted under a SIMPLE IRA plan established by any employer
pursuant to a &#167; 408(p). Also, no transfer or rollover of funds attributable to
contributions made by a particular employer under its SIMPLE IRA plan will be accepted from
a SIMPLE IRA, that is, an IRA used in conjunction with a SIMPLE IRA plan, prior to the
expiration of the 2-year period beginning on the date the individual first participated in
that employer&#146;s SIMPLE IRA plan.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(e)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If this is an inherited IRA within the meaning of &#167; 408(d)(3)(C), no contributions will
be accepted.</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(4)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Notwithstanding any provision of this Contract to the contrary, the distribution of the Owner&#146;s
interest (value of the annuity) shall be made in accordance with the requirements of Section
408(b)(3) of the Code and the regulations thereunder, the provisions of which are herein
incorporated by reference.</TD>
</TR>

</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10TRAD IRA</B>
</DIV>





<P align="center" style="font-size: 10pt"><!-- Folio -->1<!-- /Folio -->
</DIV>

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<DIV style="font-family: 'Times New Roman',Times,serif">



<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Exhibit&nbsp;99.10
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The entire interest of the Owner will be distributed or commence to be distributed, no
later than the first day of April following the calendar year in which the Owner attains
age 70<FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT> (required beginning date), over: (a)&nbsp;the life of the Owner, or the lives of the
Owner and his or her designated beneficiary; or (b)&nbsp;a period certain not extending beyond
the life expectancy of the Owner, or the joint and last survivor expectancy of the Owner
and his or her designated beneficiary. Payments must be made in periodic payments at
intervals of no longer than one year. In addition, payments must be either nonincreasing or
they may increase only as provided in Q&#038;As-1 and -4 of section 1.401(a)(9)-6 of the Income
Tax Regulations. In addition, any payment must satisfy the incidental benefit requirements
specified in Q&#038;A-2 of section 1.401(a)(9)-6. The distribution periods described above
cannot exceed the periods specified in section 1.401(a)(9)-6. The first required payment
can be made as late as April 1 of the calendar year following the calendar year in which
the Owner attains age 70<FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT> and must be the payment that is required for one payment
interval. The second payment need not be made until the end of the next payment interval.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The preceding paragraph does not apply to inherited IRAs within the meaning of &#167;
408(d)(3)(C).</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(5)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If the Owner dies before the entire interest is distributed, the following distribution
provisions shall apply:</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(a)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Distributions Beginning Before Death. If the Owner dies on or after required
distributions of his or her interest have commenced, the remaining portion of such interest
will continue to be distributed under the settlement option chosen.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(b)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Distributions Beginning After Death. If the Owner dies before required distribution of
his or her interest begins, his or her entire interest shall be distributed at least as
rapidly as follows:</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="8%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(i)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If the designated beneficiary is someone other than the Owner&#146;s surviving
spouse, the entire interest will be distributed under an available settlement
option, starting by the end of the calendar year following the calendar year of the
Owner&#146;s death, over the remaining life expectancy of the designated beneficiary,
with such life expectancy determined using the age of the beneficiary as of his or
her birthday in the year following the year of the Owner&#146;s death, or, if elected,
in accordance with paragraph (b) (iii)&nbsp;below. If this is an inherited IRA within
the meaning of Code &#167; 408(d)(3)(C) established for the benefit of a nonspouse
designated beneficiary by a direct trustee-to-trustee transfer from a retirement
plan of a deceased individual under &#167; 402(c)(11), then, notwithstanding any
election made by the deceased individual pursuant to the preceding sentence, the
nonspouse designated beneficiary may elect to have distributions made under this
paragraph (b)(1) if the transfer is made no later than the end of the year
following the year of death.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="8%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(ii)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>the Owner&#146;s sole designated beneficiary is the Owner&#146;s surviving spouse, the
entire interest will be distributed under an available settlement option, starting
by the end of the calendar year following the calendar year of the Owner&#146;s death
(or by the end of the calendar year in which the Owner would have attained age 70<FONT style="FONT-size: 70%"><SUP>1</SUP></FONT>/<FONT style="FONT-size: 60%">2</FONT>,
if later), over such spouse&#146;s life expectancy, or, if elected, in accordance with
paragraph (b) (iii)&nbsp;below. If the surviving spouse dies before required
distributions commence to him or her, the remaining interest will be distributed,
starting by the end of the calendar year following the calendar year of the
spouse&#146;s death, over the spouse&#146;s designated beneficiary&#146;s remaining life
expectancy determined using such beneficiary&#146;s age as of his or her birthday in the
year following the death of the spouse, or, if elected, will be distributed in
accordance with paragraph (b) (iii)&nbsp;below. If the surviving spouse dies after
required distributions commence to him or her, any remaining interest will continue
to be distributed under the contract option chosen.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="8%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(iii)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If there is no designated beneficiary, or if applicable by operation of
paragraph (b) (i)&nbsp;or (b) (ii)&nbsp;above, the entire interest will be distributed under
an available settlement option by the end of the calendar year containing the fifth
anniversary of the Owner&#146;s death (or of the spouse&#146;s death in the case of the
surviving spouse&#146;s death before distributions are required to begin under paragraph
(b) (ii)&nbsp;above).</TD>
</TR>

</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10TRAD IRA</B>
</DIV>





<P align="center" style="font-size: 10pt"><!-- Folio -->2<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: 'Times New Roman',Times,serif">



<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Exhibit&nbsp;99.10
</DIV>


<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="8%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(iv)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>Life expectancy is determined using the Single Life Table in Q&#038;A-1 of
&#167;1.401(a)(9)-9 of the Income Tax Regulations. If distributions are being made to a
surviving spouse as the sole designated beneficiary, such spouse&#146;s remaining life
expectancy for a year is the number in the Single Life Table corresponding to such
spouse&#146;s age in the year. In all other cases, remaining life expectancy for a year
is the number in the Single Life Table corresponding to the beneficiary&#146;s age in
the year specified in paragraph (b)) (i)&nbsp;or (ii)&nbsp;and reduced by 1 for each
subsequent year.</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(c)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The &#147;interest&#148; in the Contract includes the amount of any outstanding rollover,
transfer and recharacterization under Q&#038;As-7 and -8 of &#167;1.408-8 of the Income Tax
Regulations and the actuarial value of any other benefits provided under the Contract, such
as guaranteed death benefits.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(d)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>For purposes of paragraphs 5(a) and 5(b) of this Endorsement, required distributions
are considered to commence on the Owner&#146;s required beginning date or, if applicable, on the
date distributions are required to begin to the surviving spouse under paragraph (b) (ii)
above.
However, if distributions start prior to the applicable date in the preceding
sentence, on an irrevocable basis (except for acceleration) under an annuity
contract meeting the requirements of &#167;1.401(a)(9)-6 of the Income Tax Regulations,
then required distributions are considered to commence on the annuity starting
date.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(e)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>If the sole designated beneficiary is the Owner&#146;s surviving spouse, the spouse may
elect to treat the Contract as his or her own. This election will be deemed to have been
made if such surviving spouse makes a contribution to the Contract or fails to take
required distributions as a beneficiary.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="4%" style="background: transparent">&nbsp;</TD>
    <TD width="3%" nowrap align="left">(f)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The required minimum distributions payable to a designated beneficiary from this IRA
may be withdrawn from another IRA the beneficiary holds from the same decedent in
accordance with Q&#038;A-9 of &#167; 1.408-8 of the Income Tax Regulations.</TD>
</TR>

</TABLE>
</DIV>

<DIV style="margin-top: 6pt">
<TABLE width="100%" border="0" cellpadding="0" cellspacing="0" style="font-size: 10pt">

<TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(6)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Owner and Annuitant under your Contract are and will continue to be as shown in the
application.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(7)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Owner may satisfy the minimum distribution requirements under section 408(a)(6) and
408(b)(3) of the Code by receiving a distribution from one IRA that is equal to the amount required
to satisfy the minimum distribution requirements for two or more IRAs. For this purpose, the owner
of two or more IRAs may use the &#145;alternative method&#146; described in Notice 88-38, 1988-1 C.B. 524, to
satisfy the minimum distribution requirements described above. This section does not apply to Roth
IRAs.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(8)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>The Company shall furnish annual calendar year reports concerning the status of your Contract
and such information concerning required minimum distributions as is prescribed by the Commissioner
of the Internal Revenue.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(9)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>In the event of any conflict between the terms of this endorsement and the provisions of your
Contract, the terms of this endorsement shall control.</TD>
</TR>

<TR>
    <TD style="font-size: 6pt">&nbsp;</TD>
</TR><TR valign="top" style="font-size: 10pt; color: #000000; background: transparent">
    <TD width="3%" nowrap align="left">(10)</TD>
    <TD width="1%">&nbsp;</TD>
    <TD>This endorsement may be amended as necessary to comply with the provisions of the Code and the
related regulations.</TD>
</TR>

</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Signed for the Company at Boston, Massachusetts.</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="48%">&nbsp;</TD>
    <TD width="2%">&nbsp;</TD>
    <TD width="35%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">/s/&nbsp;Emanuel Alves
<DIV style="font-size: 1pt; border-top: 1px solid #000000">&nbsp;</DIV>Emanuel Alves</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">Secretary</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>10TRAD IRA</B>
</DIV>



<P align="center" style="font-size: 10pt"><!-- Folio -->3<!-- /Folio -->
</DIV>




</BODY>
</HTML>
</TEXT>
</DOCUMENT>
<DOCUMENT>
<TYPE>EX-99.11
<SEQUENCE>12
<FILENAME>b87363a1exv99w11.htm
<DESCRIPTION>INDIVIDUAL SPECIFICATIONS PAGE - FL ONLY - SPEC-MVA09 ED.LC (ED. 4/11)
<TEXT>
<HTML>
<HEAD>
<TITLE>exv99w11</TITLE>
</HEAD>
<BODY bgcolor="#FFFFFF">
<!-- PAGEBREAK -->
<DIV style="font-family: Helvetica,Arial,sans-serif">


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>Exhibit&nbsp;99.11</B>
</DIV>


<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>SPECIFICATIONS PAGE</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="21%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="21%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="21%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="21%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD nowrap  valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>TYPE OF CONTRACT/CERTIFICATE:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top"><B>&#091;</B>QUALIFIED&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>MATURITY DATE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2032&#093;</TD>
</TR>

<TR style="font-size: 6pt">
<td>&nbsp;</td>
</TR>

<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CONTRACT/CERTIFICATE DATE:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2009&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left" valign="top"><B>MAXIMUM MATURITY DATE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2052&#093;</TD>
</TR>
<TR style="font-size: 6pt">
<td>&nbsp;</td>
</TR>

<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>PAYMENT:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;$250,000&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" nowrap valign="top"><B>CONTRACT/CERTIFICATE NUMBER</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;000111&#093;</TD>
</TR>
<TR style="font-size: 6pt">
<td>&nbsp;</td>
</TR>

<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>OWNER:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" NOWRAP valign="top">&#091;DOROTHY HANCOCK&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>ISSUE STATE:</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;MA&#093;</TD>
</TR>
<TR style="font-size: 6pt">
<td>&nbsp;</td>
</TR>

<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CO-OWNER:</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;JAMES DOE&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>OWNER&#146;S AGE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;52&#093;</TD>
</TR>
<TR style="font-size: 6pt">
<td>&nbsp;</td>
</TR>

<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUITANT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;JOHN HANCOCK&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top"><B>ANNUITANT&#146;S AGE</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;52&#093;</TD>
</TR>
<TR style="font-size: 6pt">
<td>&nbsp;</td>
</TR>

<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>CO-ANNUITANT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;NON APPLICABLE&#093;</TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="30%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD align="LEFT" valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>Initial Guarantee Period</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD NOWRAP  align="CENTER" valign="top"><B>Initial Guaranteed Interest Rate</B>
</TD>
    <TD>&nbsp;</TD>
    <TD align="rIGHT" valign="top"><B>Initial Guarantee Period</B></TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="rIGHT" valign="top"><B>Expiration Date</B>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="LEFT" valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&#091;3 Years&#093;
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&#091;3.95%&#093;
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;8/1/2012&#093;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ADJUSTMENT FACTOR</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;0.25%&#093;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>ANNUAL FEE</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;$50&#093;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>PARTIAL WITHDRAWAL LIMITATIONS:</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD nowrap  valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>MINIMUM PARTIAL WITHDRAWAL AMOUNT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;$1000&#093;</TD>
</TR>
<TR valign="bottom">
    <TD nowrap valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>MINIMUM ACCOUNT VALUE AFTER PARTIAL WITHDRAWAL</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;$5000&#093;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">PAYMENT LIMITATIONS:</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">MINIMUM PAYMENT
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;$10,000&#093;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px"><B>MAXIMUM PAYMENT</B>
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&#091;$1,000,000&#093;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">&#091;THIS CONTRACT/CERTIFICATE IS INTENDED FOR ISSUES AS TO A TAX-QUALIFIED RETIREMENT PLAN
UNDER THE INTERNAL REVENUE CODE FOR TAX-FAVORED STATUS. UNLESS OTHERWISE REQUIRED
TO QUALIFY FOR SUCH STATUS, LANGUAGE IN THIS CONTRACT/CERTIFICATE REFERRING TO FEDERAL
TAX STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. SUCH LANGUAGE IS NOT SUBJECT
TO APPROVAL OR DISAPPROVAL BY THE STATE IN WHICH THE CONTRACT/CERTIFICATE IS ISSUED
FOR DELIVERY. PLEASE SEEK THE ADVICE OF YOUR OWN TAX ADVISOR REGARDING YOUR
INDIVIDUAL TAX TREATMENT.&#093;
</DIV>







<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top">SPEC-MVA09 ed.LC (ed. 4/11)
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">S.1
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">FL</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>







<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>

<DIV style="font-family: Helvetica,Arial,sans-serif">

<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>TABLES OF WITHDRAWAL CHARGE PERCENTAGES:</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>APPLICABLE TO ACCOUNT VALUE DURING THE INITIAL GUARANTEE PERIOD:</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="20%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="38"><B>CONTRACT/CERTIFICATE YEAR AT TIME OF WITHDRAWAL</B></TD>
    <TD>&nbsp;</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR style="font-size: 1px">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="39" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD><DIV style="margin-left:15px; text-indent:-15px"><B>GUARANTEE PERIOD</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>9</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>10</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>&#091;1 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>2 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>3 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>4 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>5 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>6 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>7 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>8 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>9 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>10 Year&#093;</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt"><B>SECTION 627.4554(9), OF THE FLORIDA STATUTES RESTRICTS THE MAXIMUM PERIOD THAT A WITHDRAWAL
CHARGE MAY APPLY UNDER ANY CONTRACT ISSUED TO A CONSUMER AGED 65 YEARS OR OLDER TO TEN CONTRACT
YEARS. THEREFORE THE APPLICATION OF THE WITHDRAWAL CHARGES TO 1) THE INITIAL GUARANTEE PERIOD
(FROM THE CHART ABOVE), AND 2) ANY SUBSEQUENT GUARANTEE PERIOD(S) SELECTED (FROM THE CHART BELOW),
WHEN COMBINED, WILL NOT EXCEED TEN CONTRACT YEARS.</B>
</DIV>


<DIV align="left" style="font-size: 10pt; margin-top: 12pt"><B>APPLICABLE TO ACCOUNT VALUE DURING ANY SUBSEQUENT GUARANTEE PERIOD:</B>
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="20%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
    <TD width="3%">&nbsp;</TD>
    <TD width="1%">&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="38"><B>NUMBER OF COMPLETE CONTRACT/CERTIFICATE YEARS SINCE THE COMMENCEMENT OF ANY</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR style="font-size: 8pt" valign="bottom">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="center" colspan="38"><B>SUBSEQUENT GUARANTEE PERIOD AT THE TIME OF WITHDRAWAL</B></TD>
    <TD>&nbsp;</TD>
</TR>

<!-- End Table Head -->
<!-- Begin Table Body -->
<TR style="font-size: 1px">
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD colspan="39" align="left" style="border-top: 1px solid #000000">&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>GUARANTEE PERIOD</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>6</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>7</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>8</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right"><B>9</B></TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>1 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>2 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>3 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>4 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>5 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>6 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>7 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>8 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>9 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
</TR>
<TR valign="bottom" style="background: #cceeff">
    <TD align="center"><DIV style="margin-left:15px; text-indent:-15px"><B>10 Year</B></DIV></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>5</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>4</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>3</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>2</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>1</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
    <TD>&nbsp;</TD>
    <TD nowrap align="left">&nbsp;</TD>
    <TD align="right"><B>0</B></TD>
    <TD nowrap><B>%</B></TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>




<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top" nowrap>SPEC-MVA09 ed.LC (ed. 4/11)
</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">S.2
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">FL</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>




<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>

<!-- PAGEBREAK -->
<P><HR noshade><P>
<H5 align="left" style="page-break-before:always">&nbsp;</H5><P>


<DIV style="font-family: Helvetica,Arial,sans-serif">



<DIV align="center" style="font-size: 10pt; margin-top: 18pt"><B>BENEFICIARY INFORMATION</B>
</DIV>

<DIV align="left" style="font-size: 10pt; margin-top: 6pt">Beneficiary(ies) is as designated by you as of the Contract/Certificate Date, unless otherwise
changed per the provisions of the Contract/Certificate.
</DIV>

<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="40%">&nbsp;</TD>
    <TD width="5%">&nbsp;</TD>
    <TD width="55%">&nbsp;</TD>
</TR>
<TR></TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Beneficiary(s)
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;John Doe&#093;</TD>
</TR>
<TR valign="bottom"><!-- Blank Space -->
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">&nbsp;</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD valign="top"><DIV style="margin-left:0px; text-indent:-0px">Contingent Beneficiary(s)
</DIV></TD>
    <TD>&nbsp;</TD>
    <TD align="left" valign="top">&#091;Jane Doe.&#093;</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>



<DIV align="center">
<TABLE style="font-size: 10pt" cellspacing="0" border="0" cellpadding="0" width="100%">
<!-- Begin Table Head -->
<TR valign="bottom">
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
    <TD width="5%"></TD>
    <TD width="30%"></TD>
</TR>
<!-- End Table Head -->
<!-- Begin Table Body -->
<TR valign="bottom"><!-- Blank Space -->
    <TD align="left" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">&nbsp;</TD>
</TR>
<TR valign="bottom">
    <TD align="left" valign="top" nowrap>SPEC-MVA09 ed.LC (ed. 4/11)</TD>
    <TD>&nbsp;</TD>
    <TD align="center" valign="top">S.3
</TD>
    <TD>&nbsp;</TD>
    <TD align="right" valign="top">FL</TD>
</TR>
<!-- End Table Body -->
</TABLE>
</DIV>




<P align="center" style="font-size: 10pt"><!-- Folio -->&nbsp;<!-- /Folio -->
</DIV>




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