Common use of Annuity Purchase Rates Clause in Contracts

Annuity Purchase Rates. 13 [SENTRY LOGO] ANNUITANT: MARK ▇▇▇▇▇▇ ▇▇NTRACT NUMBER: 379723871 CONTRACT OWNER: MARK ▇▇▇▇▇▇ ▇▇FECTIVE DATE: 12/27/1996 INCOME DATE: 10/01/2017 CONTRACT MAINTENANCE CHARGE: $30 EACH YEAR UNLESS CHANGED.* GUARANTEED NEVER TO EXCEED $45 PER YEAR. *PRIOR TO THE INCOME DATE, THE CONTRACT MAINTENANCE CHARGE IS NOT GUARANTEED AND MAY BE CHANGED FOR FUTURE YEARS. AFTER THE INCOME DATE, THE AMOUNT OF THE CONTRACT MAINTENANCE CHARGE WILL NOT BE CHANGED FROM THE AMOUNT OF THE ANNUAL MAINTENANCE CHARGE IN EFFECT DURING THE CONTRACT YEAR IMMEDIATELY PRECEDING THE INCOME DATE. AFTER THE INCOME DATE, THE CONTRACT MAINTENANCE CHARGE WILL BE COLLECTED ON A MONTHLY BASIS. MORTALITY AND EXPENSE RISK PREMIUM: EQUAL ON AN ANNUAL BASIS TO 1.2% OF THE DAILY NET ASSET VALUE OF THE VARIABLE ACCOUNT. TRANSFER FEE: $0 PER TRANSACTION. THIS TRANSFER FEE IS NOT GUARANTEED AND MAY BE CHANGED AT ANY TIME. HOWEVER, IT WILL NEVER EXCEED $20. ELIGIBLE MUTUAL FUNDS: NEUB▇▇▇▇▇ ▇▇▇ BERM▇▇ ▇▇▇ISERS MANAGEMENT TRUST - GROWTH PORTFOLIO - LIMITED MATURITY BOND PORTFOLIO - LIQUID ASSET PORTFOLIO - BALANCED PORTFOLIO VARIABLE ACCOUNT: SENTRY VARIABLE ACCOUNT I ANNUITY SERVICE OFFICE: P.O. BOX 4792, SYRACUSE, NEW YORK 13221 FOR DETERMINATION OF VARIABLE BENEFITS PLEASE SEE THE VARIABLE ACCOUNT PROVISIONS, PAGE 5, AND THE VARIABLE ANNUITY PROVISION, PAGE 8. FOR USE WITH SENTRY VARIABLE ACCOUNT I A SEPARATE INVESTMENT ACCOUNT OF SENTRY LIFE INSURANCE COMPANY OF NEW YORK

Annuity Purchase Rates. 13 [SENTRY LOGO] ANNUITANT: MARK ▇▇▇▇▇▇ ▇▇NTRACT TRY CONTRACT NUMBER: 379723871 378102371 CONTRACT OWNER: MARK ▇▇▇▇▇▇ ▇▇FECTIVE TRY EFFECTIVE DATE: 12/27/1996 06/11/1996 INCOME DATE: 10/01/2017 02/01/2049 CONTRACT MAINTENANCE CHARGE: $30 EACH YEAR UNLESS CHANGED.* GUARANTEED NEVER TO EXCEED $45 PER YEAR. .* *PRIOR TO THE INCOME DATE, THE CONTRACT MAINTENANCE CHARGE IS NOT GUARANTEED AND MAY BE CHANGED FOR FUTURE YEARS. AFTER THE INCOME DATE, THE AMOUNT OF THE CONTRACT MAINTENANCE CHARGE WILL NOT BE CHANGED FROM THE AMOUNT OF THE ANNUAL MAINTENANCE CHARGE IN EFFECT DURING THE CONTRACT YEAR IMMEDIATELY PRECEDING THE INCOME DATE. AFTER THE INCOME DATE, THE CONTRACT MAINTENANCE CHARGE WILL BE COLLECTED ON A MONTHLY BASIS. MORTALITY AND EXPENSE RISK PREMIUM: EQUAL ON AN ANNUAL BASIS TO 1.2% OF THE DAILY NET ASSET VALUE OF THE VARIABLE ACCOUNT. TRANSFER FEE: $0 PER TRANSACTION. THIS TRANSFER FEE IS NOT GUARANTEED AND MAY BE CHANGED AT ANY TIME. HOWEVER, IT WILL NEVER TO EXCEED $20. ELIGIBLE MUTUAL FUNDS: NEUB▇▇▇▇▇ ▇▇▇ BERM▇▇ ▇▇▇ISERS MANAGEMENT TRUST - GROWTH PORTFOLIO - LIMITED MATURITY BOND PORTFOLIO - LIQUID ASSET PORTFOLIO - BALANCED PORTFOLIO VARIABLE ACCOUNT: SENTRY VARIABLE ACCOUNT I II ANNUITY SERVICE OFFICE: P.O. BOX 4792867, SYRACUSESTEVENS POINT, NEW YORK 13221 WISCONSIN 54481 FOR DETERMINATION OF VARIABLE BENEFITS PLEASE SEE THE VARIABLE ACCOUNT PROVISIONS, PAGE 5, AND THE VARIABLE ANNUITY PROVISION, PAGE 8. FOR USE WITH SENTRY VARIABLE ACCOUNT I II A SEPARATE INVESTMENT ACCOUNT OF SENTRY LIFE INSURANCE COMPANY OF NEW YORK4