Common use of CONTRACT INFORMATION Clause in Contracts

CONTRACT INFORMATION. This Contract Data Page reflects the information with which your Contract has been established as of the Effective Date. If any information on this page needs to be changed or corrected, please contact the Annuity Service Center as identified in the prospectus. Table of Contents Page Section 1 DEFINITIONS 3 Section 2 OWNERSHIP AND BENEFICIARY PROVISIONS 6 Section 3 CONTRIBUTIONS 7 Section 4 ANNUITY ACCOUNT VALUE PROVISIONS 8 Section 5 TRANSFER PROVISIONS 9 Section 6 DEATH BENEFFIT PROVISIONS 10 Section 7 SURRENDERS AND PARTIAL WITHDRAWALS 11 Section 8 GENERAL PROVISIONS 12 Section 9 PAYOUT OPTIONS 14 Section 1:Definitions Accumulation Period - the time period between the Effective Date and the earlier of the Annuity Commencement Date or Payout Election Date Accumulation Unit - an accounting measure used to determine the Annuity Account Value before the date annuity payouts commence. Annuitant - the person named in the application and in the Contract Data Page upon whose life the payout of an annuity is based and who will receive annuity payouts. If a Contingent Annuitant is named, then the Annuitant will be considered the primary Annuitant. Annuity Account - an account that reflects the Owner’s Sub-Accounts in both the Investment Segment and Income Segment. Annuity Account Value - the total value of all the Owner’s Sub-Accounts in both the Investment Segment and Income Segment. The Annuity Account Value is credited with a return based upon investment experience of the Sub-Account(s) selected by the Owner and will increase and decrease accordingly. Annuity Commencement Date - the date annuity payouts begin, which is either the Payout Election Date or the Annuitant’s 90th birthday if no Payout Election Date has been established. The Annuity Commencement Date may be changed by the Owner prior to the Annuity Commencement Date or it may be changed by the Beneficiary upon death of an Owner only if the Beneficiary is the Owner’s surviving Spouse and elects to continue the Contract. Annuity Payout Period - the period beginning on the Annuity Commencement Date and continuing until all annuity payouts have been made under this Contract.

CONTRACT INFORMATION. This Contract Data Page Page, together with the Initial Applicable Allocation Confirmation, reflects the information with which your Contract has been established as of the Effective Date. If any information on this page needs to be changed or corrected, please contact the Annuity Service Center as identified in the prospectus. J555 Table of Contents Page Section 1 DEFINITIONS 3 Section 2 OWNERSHIP AND BENEFICIARY PROVISIONS 6 Section 3 CONTRIBUTIONS 7 Section 4 ANNUITY ACCOUNT VALUE PROVISIONS 8 Section 5 TRANSFER PROVISIONS 9 Section 6 DEATH BENEFFIT BENEFIT PROVISIONS 10 Section 7 SURRENDERS AND PARTIAL WITHDRAWALS 11 Section 8 GENERAL PROVISIONS 12 Section 9 PAYOUT OPTIONS 14 Section 1:: Definitions Accumulation Period - the time period between the Effective Date and the earlier of the Annuity Commencement Date or Payout Election Date Accumulation Unit - an accounting measure used to determine the Annuity Account Value before the date annuity payouts commence. Annuitant - the person named in the application and in the Contract Data Page upon whose life the payout of an annuity is based and who will receive annuity payouts. If a Contingent Annuitant is named, then the Annuitant will be considered the primary Annuitant. Annuity Account - an account that reflects the Owner’s Sub-Accounts in both the Investment Segment and Income Segment. Annuity Account Value - –the total value of all the Owner’s Sub-Accounts in both the Investment Segment and Income Segment. The Annuity Account Value is credited with a return based upon investment experience of the Sub-Account(s) selected by the Owner and will increase and decrease accordingly. Annuity Commencement Date - – the date annuity payouts begin, which is either the Payout Election Date or the Annuitant’s 90th 91st birthday if no Payout Election Date has been established. The Annuity Commencement Date may be changed by the Owner prior to the Annuity Commencement Date or it may be changed by the Beneficiary upon death of an Owner only if the Beneficiary is the Owner’s surviving Spouse and elects to continue the Contract. Annuity Payout Period - the period beginning on the Annuity Commencement Date and continuing until all annuity payouts have been made under this Contract.. J555

CONTRACT INFORMATION. This Contract Data Page Page, together with the Initial Applicable Allocation Confirmation, reflects the information with which your Contract has been established as of the Effective Date. If any information on this page needs to be changed or corrected, please contact the Annuity Service Center as identified in the prospectusRetirement Resource Operations Center. Table of Contents ICC16-J100 2 TABLE OF CONTENTS Page CONTRACT DATA 1 Section 1 DEFINITIONS 3 Section 2 OWNERSHIP AND BENEFICIARY PROVISIONS 6 Section 3 CONTRIBUTIONS 7 Section 4 ANNUITY ACCOUNT VALUE PROVISIONS 8 Section 5 TRANSFER PROVISIONS 9 Section 6 DEATH BENEFFIT BENEFIT PROVISIONS 10 Section 7 SURRENDERS AND PARTIAL WITHDRAWALS 11 Section 8 GENERAL PROVISIONS 12 13 Section 9 PAYOUT OPTIONS 14 Section SECTION 1:Definitions : DEFINITIONS Accumulation Period - the The time period between the Effective Date and the earlier of the Annuity Commencement Date Annuitant’s 99th birthday or the Payout Election Date Accumulation Unit - an An accounting measure used to determine the Annuity Account Value before the date annuity payouts commence. Annuitant (Joint Annuitant) - the The person named in the application and in the Contract Data Page upon whose life the payout of an annuity is based and who will receive annuity payouts. The Annuitant will be the Owner unless otherwise indicated in the application. Joint Annuitants may be named in the application or any time before the Annuity Commencement Date, and must be one another’s Spouse as of the Effective Date. If you select a Joint Annuitant, ‘Annuitant’ means the older Joint Annuitant or the sole surviving Joint Annuitant. If you name a Contingent Annuitant is namedAnnuitant, then the Annuitant will be considered the primary ‘Primary Annuitant’. If an IRA custodian or trustee owns the Contract, the Underlying IRA Holxxx xxxx xe the Annuitant and if there are two Annuitants, the Joint Annuitant must be the Underlying IRA Holxxx’x Xxxxxx and the designated beneficiary of the custodial or trusteed account. Annuity Account - an An account that reflects the Owner’s interests in the Sub-Accounts in both the Investment Segment Strategy and Income SegmentStrategy. Annuity Account Value - the The total value of all the Owner’s interests in the Sub-Accounts in both the Investment Segment Strategy and Income SegmentStrategy. The Annuity Account Value is credited with a return based upon investment experience of the Sub-Account(s) selected by the Owner and will increase and decrease accordingly. Annuity Commencement Date - the The date annuity payouts begin, as shown on the Contract Data Page, which is either the Payout Election Date or no later than the Annuitant’s 90th 99th birthday if no Payout Election Date has been established. The Annuity Commencement Date Owner may be changed by the Owner prior to change the Annuity Commencement Date or it may be changed by if annuity payouts have not already begun. Upon death of the Owner, the Beneficiary upon death of an Owner may change the Annuity Commencement Date only if the Beneficiary is the Owner’s surviving Spouse spouse and elects to continue the Contract. In all cases, the Annuity Commencement Date must occur no later than the Annuitant’s 99th birthday. Annuity Payout Period - the The period beginning on the Annuity Commencement Date and continuing until all annuity payouts have been made under this Contract.

CONTRACT INFORMATION. This Contract Data Page Page, together with the Initial Premium Allocation Confirmation, reflects the information with which your Contract has been established as of the Effective Date. If any information on this page needs to be changed or corrected, please contact the Annuity Service Center as identified in the prospectus. Table of Contents Page Section 1 DEFINITIONS 3 Section 2 OWNERSHIP AND BENEFICIARY PROVISIONS 6 5 Section 3 CONTRIBUTIONS 7 Section 4 ANNUITY ACCOUNT VALUE PROVISIONS 8 Section 5 TRANSFER TRANSFERS PROVISIONS 9 Section 6 DEATH BENEFFIT BENEFIT PROVISIONS 10 Section 7 SURRENDERS AND PARTIAL WITHDRAWALS 11 12 Section 8 GENERAL PROVISIONS 12 13 Section 9 PAYOUT OPTIONS 14 15 Section 1:: Definitions Accumulation Period - the time period between the Effective Date and the earlier of the Annuity Commencement Date or Payout Election Date Date. Accumulation Unit - an accounting measure used to determine the Annuity Account Value before the date annuity payouts commence. Annuitant - the person named in the application and in the Contract Data Page upon whose life the payout of an annuity is based and who will receive annuity payouts. If a Contingent Annuitant is named, then the Annuitant will be considered the primary Annuitant. Annuity Account - an account that reflects the total value of the Owner’s Sub-Accounts in both the Investment Segment and Income SegmentAccounts. Annuity Account Value - the total value sum of all the Owner’s values of the Sub-Accounts in both credited to the Investment Segment and Income SegmentOwner under the Annuity Account. The Annuity Account Value is credited with a return based upon the investment experience of the Sub-Account(sInvestment Division(s) selected by the Owner and will increase and or decrease accordingly. Annuity Commencement Date - – the date annuity payouts begin, which is either the Payout Election Date or the Annuitant’s 90th birthday if no Payout Election Date has been established. The Annuity Commencement Date may be changed by the Owner prior to the Annuity Commencement Date or it may be changed by the Beneficiary upon death of an Owner only if the Beneficiary is the Owner’s surviving Spouse and elects to continue the Contract. Annuity Payout Period - the period beginning on the Annuity Commencement Date and continuing until all annuity payouts have been made under this Contract. Annuity Service Center – P.O. Box 173920, Denver, CO, 80217-3920. The toll-free telephone number is 1-000-000-0000. The Annuity Service Center may also be contacted via e-mail and the internet as identified in the prospectus. Annuity Unit - an accounting measure used to determine the dollar value of any variable annuity payout after the first annuity payout is made. J444NY Page 3 Automatic Bank Draft Plan - a plan provided to the Owner to allow for automatic payment of Contributions. The Contribution amount will be withdrawn from a pre-authorized account and automatically credited to the Annuity Account. Beneficiary - the person(s) designated by the Owner to receive death proceeds which may become payable upon the death of an Owner or the Annuitant. If the surviving spouse of an Owner is the surviving Joint Owner, the surviving spouse will be deemed to be the Beneficiary upon such Owner’s death and may take the death benefit or elect to continue this Contract in force. The Beneficiary is shown on the Contract Data Page unless later changed by the Owner. Contingent Annuitant - the person named in the application who will become the Annuitant upon the death of the primary Annuitant. The Contingent Annuitant is the person named in the Contract Data Page, unless later changed by Request while the primary Annuitant is alive and before annuity payouts have commenced. Contingent Beneficiary - the person designated by the Owner to become the Beneficiary when the primary Beneficiary dies. Contract - the document issued to the Owner which specifies the rights and obligations of the Owner. Contributions - purchase amounts received and allocated to the Owner’s annuity prior to any Premium Tax or other deductions. Effective Date - the date on which the first Contribution is credited to the Annuity Account. First Great-West Life & Annuity Insurance Company (FGWL&A) - the issuer and underwriter of this Contract. The Home Office is located at 50 Xxxx Xxxxxx, Xxxxx Xxxxxx, XX, 00000. The Administrative Service Office is located at P.O. Box 173921, Denver, CO, 80217-3921. Home Office – The principal office of GWL&A located at 8000 Xxxx Xxxxxxx Xxxx, Xxxxxxxxx, Xxxxxxxx, 00000, or an institution designated by GWL&A. Non-qualified Annuity Contract - an annuity Contract which is not intended to be a part of a qualified retirement plan and is not intended to satisfy the requirements of Section 408 of the Internal Revenue Code of 1986, as amended. This Contract may only be issued as a Non-qualified Annuity Contract. Owner (Joint Owners) - the person or persons named on the Contract Data Page. The Owner is entitled to exercise all rights and privileges under the Contract while the Annuitant is living. Joint Owners must be one another’s spouse as of the Effective Date. The Annuitant will be the Owner unless otherwise indicated in the application. Payout Commencement Date - the date on which annuity payouts or periodic withdrawals begin under a payout option. If a Payout Commencement Date is not shown on the Contract Data Page, annuity payouts will begin on the Annuitant’s 90th birthday. The Payout Commencement Date may be changed by the Owner prior to commencement of annuity payouts or it may be changed by the Beneficiary upon death of an Owner. Portfolio - a registered management investment company, or portfolio thereof, in which the assets of the Series Account may be invested. Premium Tax - the amount of tax, if any, charged by a state or other governmental authority. Premium Tax will be deducted from Contributions or the Annuity Account Value when incurred by FGWL&A or at another time of FGWL&A’s choosing. Proportional Withdrawals – a partial or periodic withdrawal made by the Owner that reduces the Annuity Account Value measured as a percentage of each prior withdrawal against the Annuity Account Value on the Transaction Date the partial or periodic withdrawal is taken. A Proportional Withdrawal is determined by calculating the percentage the withdrawal represents of the Annuity Account Value at the time the withdrawal was made. This percentage is applied to the total Contributions less any adjustments for prior Proportional Withdrawals. For example, a partial withdrawal of 75% of the Annuity Account Value represents a Proportional Withdrawal of 75% of the total Contributions for purposes of calculating the Death Benefit. Request - any instruction in a form, written, telephoned, electronic or computerized, satisfactory to FGWL&A and received at the Annuity Service Center (or other service center subsequently named) from the Owner or the Owner’s designee (as specified in a form acceptable to FGWL&A) or the Beneficiary, (as applicable) as required by any provision of this Contract or as required by FGWL&A. The Request is subject to any action taken or payout made by FGWL&A before it was processed. Series Account - the segregated investment account established by FGWL&A under New York law and registered as a unit investment trust under the Investment Company Act of 1940, as amended. Sub-Account - a division of the Series Account containing the shares of a Portfolio. There is a Sub-Account for each Portfolio. Surrender Value - will be equal to the Annuity Account Value on the Transaction Date of the surrender less Premium Tax, if any. Transaction Date - the date on which any Contribution, Transfer or other Request from the Owner will be processed. Contributions and Requests received after 4:00 p.m. EST/EDT will be deemed to have been received on the next business day. Requests will be processed and the Annuity Account Value will be valued on each day that the New York Stock Exchange is open for trading. Transfer - the moving of money from and among the Sub- Account(s). Valuation Date - the date on which the net asset value of each Portfolio is determined. Valuation Period - the period between two successive Valuation Dates.

CONTRACT INFORMATION. This Contract Data Page Page, together with the Initial Applicable Allocation Confirmation, reflects the information with which your Contract has been established as of the Effective Date. If any information on this page needs to be changed or corrected, please contact the Annuity Service Center as identified in the prospectusRetirement Resource Operations Center. Table of Contents J100-ny 2 TABLE OF CONTENTS Page CONTRACT DATA 1 Section 1 DEFINITIONS 3 Section 2 OWNERSHIP AND BENEFICIARY PROVISIONS 6 Section 3 CONTRIBUTIONS 7 Section 4 ANNUITY ACCOUNT VALUE PROVISIONS 8 Section 5 TRANSFER PROVISIONS 9 Section 6 DEATH BENEFFIT BENEFIT PROVISIONS 10 Section 7 SURRENDERS AND PARTIAL WITHDRAWALS 11 Section 8 GENERAL PROVISIONS 12 13 Section 9 PAYOUT OPTIONS 14 Section SECTION 1:Definitions : DEFINITIONS Accumulation Period - the The time period between the Effective Date and the earlier of the Annuity Commencement Date Annuitant’s 99th birthday or the Payout Election Date Accumulation Unit - an An accounting measure used to determine the Annuity Account Value before the date annuity payouts commence. Annuitant (Joint Annuitant) - the The person named in the application and in the Contract Data Page upon whose life the payout of an annuity is based and who will receive annuity payouts. The Annuitant will be the Owner unless otherwise indicated in the application. Joint Annuitants may be named in the application or any time before the Annuity Commencement Date, and must be one another’s Spouse as of the Effective Date. If you select a Joint Annuitant, ‘Annuitant’ means the older Joint Annuitant or the sole surviving Joint Annuitant. If you name a Contingent Annuitant is namedAnnuitant, then the Annuitant will be considered the primary ‘Primary Annuitant’. If an IRA custodian or trustee owns the Contract, the Underlying IRA Hxxxxx xxxx be the Annuitant and if there are two Annuitants, the Joint Annuitant must be the Underlying IRA Hxxxxx’x Xxxxse and the designated beneficiary of the custodial or trusteed account.” Annuity Account - an An account that reflects the Owner’s interests in the Sub-Accounts in both the Investment Segment Strategy and Income SegmentStrategy. Annuity Account Value - the The total value of all the Owner’s interests in the Sub-Accounts in both the Investment Segment Strategy and Income SegmentStrategy. The Annuity Account Value is credited with a return based upon investment experience of the Sub-Account(s) selected by the Owner and will increase and decrease accordingly. Annuity Commencement Date - the The date annuity payouts begin, as shown on the Contract Data Page, which is either the Payout Election Date or no later than the Annuitant’s 90th 99th birthday if no Payout Election Date has been established. The Annuity Commencement Date Owner may be changed by the Owner prior to change the Annuity Commencement Date or it may be changed by if annuity payouts have not already begun. Upon death of the Owner, the Beneficiary upon death of an Owner may change the Annuity Commencement Date only if the Beneficiary is the Owner’s surviving Spouse spouse and elects to continue the Contract. In all cases, the Annuity Commencement Date must occur no later than the Annuitant’s 99th birthday. Annuity Payout Period - the The period beginning on the Annuity Commencement Date and continuing until all annuity payouts have been made under this Contract.

CONTRACT INFORMATION. This Contract Data Page Page, together with the Initial Applicable Allocation Confirmation, reflects the information with which your Contract has been established as of the Effective Date. If any information on this page needs to be changed or corrected, please contact the Annuity Service Retirement Resource Operations Center as identified in the prospectus. Table of Contents Page Section 1 DEFINITIONS 3 Section 2 OWNERSHIP AND BENEFICIARY PROVISIONS 6 Section 3 CONTRIBUTIONS 7 Section 4 ANNUITY ACCOUNT VALUE PROVISIONS 8 Section 5 TRANSFER PROVISIONS 9 Section 6 DEATH BENEFFIT PROVISIONS 10 Section 7 SURRENDERS AND PARTIAL WITHDRAWALS 11 Section 8 GENERAL PROVISIONS 12 Section 9 PAYOUT OPTIONS 14 Section 1:: Definitions Accumulation Period - the time period between the Effective Date and the earlier of the Annuity Commencement Date or Payout Election Date Accumulation Unit - an accounting measure used to determine the Annuity Account Value before the date annuity payouts commence. Annuitant - the person named in the application and in the Contract Data Page upon whose life the payout of an annuity is based and who will receive annuity payouts. If a Contingent Annuitant is named, then the Annuitant will be considered the primary Annuitant. Annuity Account - an account that reflects the Owner’s Sub-Accounts in both the Investment Segment and Income Segment. Annuity Account Value - the total value of all the Owner’s Sub-Accounts in both the Investment Segment and Income Segment. The Annuity Account Value is credited with a return based upon investment experience of the Sub-Account(s) selected by the Owner and will increase and decrease accordingly. Annuity Commencement Date - the date annuity payouts begin, which is either the Payout Election Date or the Annuitant’s 90th 91st birthday if no Payout Election Date has been established. The Annuity Commencement Date may be changed by the Owner prior to the Annuity Commencement Date or it may be changed by the Beneficiary upon death of an Owner only if the Beneficiary is the Owner’s surviving Spouse and elects to continue the Contract. Annuity Payout Period - the period beginning on the Annuity Commencement Date and continuing until all annuity payouts have been made under this Contract. ICC11-J555 3 Annuity Unit - an accounting measure used to determine the dollar value of any variable annuity payout after the first annuity payout is made. Automatic Bank Draft Plan - a plan provided to the Owner to allow for automatic payment of Contributions. The Contribution amount will be withdrawn from a pre-authorized account and automatically credited to the Annuity Account. Beneficiary - the person(s) designated by the Owner to receive death proceeds which may become payable upon the death of an Owner. If the surviving Spouse of an Owner is the surviving Joint Owner, the surviving Spouse will be deemed to be the Beneficiary upon such Owner’s death and may take the death benefit or elect to continue this Contract in force. The Beneficiary is shown on the Contract Data Page unless later changed by the Owner. Business Day - Any day, and during the hours, on which the New York Stock Exchange is open for trading. In the event that a date falls on a non-Business Day, the date of the succeeding Business Day will be used, except as otherwise provided, Code - the Internal Revenue Code of 1986, as amended, and all related laws and regulations which are in effect during the term of this Contract.

CONTRACT INFORMATION. This Contract Data Page reflects the information with which your Contract has been established as of the Effective Date. If any information on this page needs to be changed or corrected, please contact the Annuity Service Center as identified in the prospectus. J555-NY Table of Contents Page Section 1 DEFINITIONS 3 Section 2 OWNERSHIP AND BENEFICIARY PROVISIONS 6 Section 3 CONTRIBUTIONS 7 Section 4 ANNUITY ACCOUNT VALUE PROVISIONS 8 Section 5 TRANSFER PROVISIONS 9 Section 6 DEATH BENEFFIT BENEFIT PROVISIONS 10 9 Section 7 SURRENDERS AND PARTIAL WITHDRAWALS 11 10 Section 8 GENERAL PROVISIONS 12 11 Section 9 PAYOUT OPTIONS 14 13 Section 1:: Definitions Accumulation Period - the time period between the Effective Date and the earlier of the Annuity Commencement Date or Payout Election Date Accumulation Unit - an accounting measure used to determine the Annuity Account Value before the date annuity payouts commence. Annuitant - the person named in the application and in the Contract Data Page upon whose life the payout of an annuity is based and who will receive annuity payouts. If a Contingent Annuitant is named, then the Annuitant will be considered the primary Annuitant. Annuity Account - an account that reflects the Owner’s Sub-Accounts in both the Investment Segment and Income Segment. Annuity Account Value - –the total value of all the Owner’s Sub-Accounts in both the Investment Segment and Income Segment. The Annuity Account Value is credited with a return based upon investment experience of the Sub-Account(s) selected by the Owner and will increase and decrease accordingly. Annuity Commencement Date - – the date annuity payouts begin, which is either the Payout Election Date or the Annuitant’s 90th birthday if no Payout Election Date has been established. The Annuity Commencement Date may be changed by the Owner prior to the Annuity Commencement Date or it may be changed by the Beneficiary upon death of an Owner only if the Beneficiary is the Owner’s surviving Spouse and elects to continue the Contract. Annuity Payout Period - the period beginning on the Annuity Commencement Date and continuing until all annuity payouts have been made under this Contract. Annuity Service Center – [P. O. Box 173920 Denver, CO 80217-3920]. The toll-free telephone number is [1-888-xxx-xxxx]. Annuity Unit - an accounting measure used to determine the dollar value of any variable annuity payout after the first annuity payout is made. Automatic Bank Draft Plan - a plan provided to the Owner to allow for automatic payment of Contributions. The Contribution amount will be withdrawn from a pre-authorized account and automatically credited to the Annuity Account. Beneficiary - the person(s) designated by the Owner to receive death proceeds which may become payable upon the death of an Owner. If the surviving Spouse of an Owner is the surviving Joint Owner, the surviving Spouse will be deemed to be the Beneficiary upon such Owner’s death and may take the death benefit or elect to continue this Contract in force. The Beneficiary is shown on the Contract Data Page unless later changed by the Owner. Business Day – Any day, and during the hours, on which the New York Stock Exchange is open for trading. In the event that a date falls on a non-Business Day, the date of the succeeding Business Day will be used, except as otherwise provided, Code – the Internal Revenue Code of 1986, as amended, and all related laws and regulations which are in effect during the term of this Contract.