Common use of Right to Cancel Clause in Contracts

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return cancel this Contract within ten (10) [ 10 ] days after you receive it. To do so, mail it by returning it to us at our Service Center administrative office, or to the agent who sold it to you, with a written request for cancellation. This Contract will then be deemed void from If you return it by mail, effective date of the beginning. No withdrawal charge cancellation will be imposed, determined by the postmark date on the properly addressed and we postage-paid return package. We will refund promptly return the Contract Value, including Value plus any fees or charges for premium taxes and/or other taxes that were amounts deducted from the your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract Value. Signed for the Company at Newport Beach, California, to be effective as 3 Modification of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date 3 Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 GENERAL PROVISIONS 7 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional 5 Purchase Payments 9 5 Allocation of Purchase Payment Allocation 9 Allocations During Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 5 Variable Account Value 11 Subaccount Value 11 Subaccount 6 Accumulation Unit Value 11 Values 6 Net Investment Factor 11 Loan Account 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘8 Suspension or Delay in Payment of Surrender or Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 8 DEATH BENEFIT PROVISIONS 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 19 8 Payment of the Death Benefit Amount 19 Death 9 Suspension or Delay in Payment of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 9 ANNUITY PROVISIONS Choice INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Date 23 Default Option 10 Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 11 FIXED ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 TABLES 12 VARIABLE ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS12

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 0.90% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would need to be 5.05%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 12 Annual Fee 13 12 Mortality and Expense Risk Charge (“Risk Charge”) 13 12 Premium Taxes 13 12 Other Taxes 13 12 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 13 Free Withdrawals 14 13 Earnings 14 13 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 14 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 15 Dollar Cost Averaging Transfer Option 15 Portfolio Rebalancing Transfer Option 15 Earnings Sweep Transfer Option 16 WITHDRAWAL PROVISIONS Withdrawals 16 17 Minimum Withdrawal Amount 16 17 Amount Available for Withdrawal 16 17 Pre-authorized Withdrawals 17 Termination of Contract 16 17 CONTRACT LOANS Loans 17 18 Loan Procedures 17 18 Loan Account 17 18 Loan Terms 17 18 Loan Interest Rate 17 18 Repayment Terms 17 18 DEATH BENEFIT PROVISIONS Death Benefit 19 20 Death Benefit Amount 19 20 Death of Annuitant 19 20 Death of Owner 20 21 Death of Owner Distribution Rules 20 21 Interest on Death Benefit Proceeds 21 22 BENEFICIARY PROVISIONS Designation of Beneficiary 22 23 Adding or Changing Your Beneficiary 22 23 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 24 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 25 Conversion to Current Rates 24 25 Variable Annuity Payments – — Subaccount Annuity Units 24 25 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – — Life Only 26 Option 2 – — Life with Period Certain 26 Option 3 – — Joint and Survivor Life 26 Option 4 – — Period Certain Only 26 27 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Distribution Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 13 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 17 Death Benefit Amount 19 17 Death of Annuitant 19 17 Death of Owner 20 18 Death of Owner Distribution Rules 20 18 Interest on Death Benefit Proceeds 21 19 BENEFICIARY PROVISIONS Designation of Beneficiary 22 20 Adding or Changing Your Beneficiary 22 20 ANNUITY PROVISIONS Choice of Annuity Date 23 21 Default Annuity Option 23 21 Application of Contract Value 23 21 Your Selections 24 21 Fixed and Variable Annuities 24 22 Amount of Payments 24 22 Fixed Annuity Payments 24 22 Conversion to Current Rates 24 22 Variable Annuity Payments – — Subaccount Annuity Units 24 22 Subsequent Variable Payments 25 22 Annuity Unit Value 25 23 Periodic Payments 25 23 ANNUITY OPTIONS Option 1 – — Life Only 26 24 Option 2 – — Life with Period Certain 26 24 Option 3 – — Joint and Survivor Life 26 24 Option 4 – — Period Certain Only 26 24 ANNUITY OPTION TABLES Applicability of Rates 27 25 Basis of Computations 27 25 Rates Not Shown 27 25 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE LIMITED PREMIUM DEFERRED VARIABLE ANNUITY WITH INDEX-LINKED INTEREST CONTRACT Investment Experience Reflected in Benefits Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating ICC09:10-1169 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 FIXED ACCOUNT OPTIONS Fixed Account Options (FAOs) 10 Minimum Allocation Amount 10 Crediting Interest 10 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 12 Separate Account 10 12 CONTRACT VALUES Contract Value 11 13 FAO Value 13 Variable Account Value 11 13 Subaccount Value 11 13 Subaccount Unit Value 11 14 Net Investment Factor 11 Loan Account Value 12 14 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 15 Mortality and Expense Risk Charge (“Risk Charge”) 13 15 Premium Taxes 13 15 Other Taxes 13 15 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 15 Amount of Withdrawal Charge 14 16 Free Withdrawals 14 Earnings 14 16 TRANSFER PROVISIONS Transfers 15 17 Transfers between a Variable Investment Option and a Fixed Account Option 17 Transfers Among the Variable Investment Options 17 Transfer Limitations and Restrictions 15 17 WITHDRAWAL PROVISIONS Withdrawals 16 19 Minimum Withdrawal Amount 16 19 Amount Available for Withdrawal 16 19 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 19 DEATH BENEFIT PROVISIONS Death Benefit 19 20 Death Benefit Amount 19 20 Death of Annuitant 19 20 Death of Owner 20 21 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 23 Adding or Changing Your Beneficiary 22 23 ANNUITY PROVISIONS Choice Date Annuity Payments Begin 24 Default Annuity Date and Annuity Option 24 Change of Annuity Date 23 Default and Annuity Option 23 24 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Minimum Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 25 Option 2 – Life with Period Certain 26 25 Option 3 – Joint and Survivor Life 26 25 Option 4 – Period Certain Only 26 25 ANNUITY OPTION TABLES Applicability of Rates 27 26 Basis of Computations 27 26 Rates Not Shown 27 26 ICC09:10-1169 CONTRACT SPECIFICATIONSSPECIFICATIONS CONTRACT DATA Contract Number: [VA999999] Contract Type: [Non-Qualified] Minimum Purchase Payment Amount: [$25,000] Minimum Allocation Amount: [$1,000] Maximum Issue Age: [Age 85]

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from minus any Credit Enhancements applied to the Contract ValueContract. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 1.55% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would need to be 5.80%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 Credit Enhancement 9 Recapture of Credit Enhancement 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 13 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 16 Dollar Cost Averaging Transfer Option 16 Portfolio Rebalancing Transfer Option 16 Earnings Sweep Transfer Option 17 WITHDRAWAL PROVISIONS Withdrawals 16 18 Minimum Withdrawal Amount 16 18 Amount Available for Withdrawal 16 18 Pre-authorized Withdrawals 18 Termination of Contract 16 18 CONTRACT LOANS Loans 17 19 Loan Procedures 17 19 Loan Account 17 19 Loan Terms 17 19 Loan Interest Rate 17 19 Repayment Terms 17 20 DEATH BENEFIT PROVISIONS Death Benefit 19 21 Death Benefit Amount 19 21 Death of Annuitant 19 21 Death of Owner 20 21 Death of Owner Distribution Rules 20 22 Interest on Death Benefit Proceeds 21 22 BENEFICIARY PROVISIONS Designation of Beneficiary 22 24 Adding or Changing Your Beneficiary 22 24 ANNUITY PROVISIONS Choice of Annuity Date 23 25 Default Annuity Option 23 25 Application of Contract Value 23 25 Your Selections 24 25 Fixed and Variable Annuities 24 26 Amount of Payments 24 26 Fixed Annuity Payments 24 26 Conversion to Current Rates 24 26 Variable Annuity Payments – Subaccount Annuity Units 24 26 Subsequent Variable Payments 25 26 Annuity Unit Value 25 26 Periodic Payments 25 27 ANNUITY OPTIONS Option 1 – Life Only 26 28 Option 2 – Life with Period Certain 26 28 Option 3 – Joint and Survivor Life 26 28 Option 4 – Period Certain Only 26 28 ANNUITY OPTION TABLES Applicability of Rates 27 30 Basis of Computations 27 30 Rates Not Shown 27 30 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we We will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, California to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 0.60% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would need to be 4.75%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating – No Dividends are Payable TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Letter of Intent 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Sales Charge 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 17 Death Benefit Amount 19 17 Death of Annuitant 19 17 Death of Owner 20 18 Death of Owner Distribution Rules 20 18 Interest on Death Benefit Proceeds 21 19 BENEFICIARY PROVISIONS Designation of Beneficiary 22 20 Adding or Changing Your Beneficiary 22 20 ANNUITY PROVISIONS Choice of Annuity Date 23 21 Default Annuity Option 23 21 Application of Contract Value 23 21 Your Selections 24 21 Fixed and Variable Annuities 24 22 Amount of Payments 24 22 Fixed Annuity Payments 24 22 Conversion to Current Rates 24 22 Variable Annuity Payments – Subaccount Annuity Units 24 22 Subsequent Variable Payments 25 22 Annuity Unit Value 25 23 Periodic Payments 25 23 ANNUITY OPTIONS Option 1 – Life Only 26 24 Option 2 – Life with Period Certain 26 24 Option 3 – Joint and Survivor Life 26 24 Option 4 – Period Certain Only 26 24 ANNUITY OPTION TABLES Applicability of Rates 27 25 Basis of Computations 27 25 Rates Not Shown 27 25 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return cancel this Contract within ten (10) [ 10 ] days after you receive it. To do so, mail it by returning it to us at our Service Center administrative office, or to the agent who sold it to you, with a written request for cancellation. This Contract will then be deemed void from If you return it by mail, effective date of the beginning. No withdrawal charge cancellation will be imposed, determined by the postmark date on the properly addressed and we postage-paid return package. We will refund promptly return the Contract Value, including Value plus any fees or charges for premium taxes and/or other taxes that were amounts deducted from the your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. /s/ Xxxx X. Xxxxx /s/ Xxxxxxx X. Xxxx THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract Value. Signed for the Company at Newport Beach, California, to be effective as 3 Modification of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date 3 Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 GENERAL PROVISIONS 7 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional 5 Purchase Payments 9 5 Allocation of Purchase Payment Allocation 9 Allocations During Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 5 Variable Account Value 11 Subaccount Value 11 Subaccount 6 Accumulation Unit Value 11 Values 6 Net Investment Factor 11 Loan Account 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘8 Suspension or Delay in Payment of Surrender or Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 8 DEATH BENEFIT PROVISIONS 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 19 8 Payment of the Death Benefit Amount 19 Death 9 Suspension or Delay in Payment of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 9 ANNUITY PROVISIONS Choice INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Date 23 Default Option 10 Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 11 FIXED ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 TABLES 12 VARIABLE ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 12 [ PRODUCT A ] SCHEDULE CONTRACT SPECIFICATIONSNUMBER ISSUE DATE [ VA00000001 ] [ February 1, 2012 ]

Right to Cancel. You may return this Contract within [ten (10) )] days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE LIMITED PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating — No Dividends are Payable ICC10:10-1185-L TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 10 Additional Purchase Payments 9 10 Purchase Payment Allocation 9 10 Allocations During the Right to Cancel Period 9 10 Minimum Investment Option Value 9 10 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 11 Separate Account 10 11 CONTRACT VALUES Contract Value 11 12 Variable Account Value 11 12 Subaccount Value 11 12 Subaccount Unit Value 11 12 Net Investment Factor 11 13 Loan Account Value 12 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 14 Mortality and Expense Risk Charge (“Risk Charge”) 13 14 Annual Fee 14 Premium Taxes 13 14 Other Taxes 13 Contingent Deferred Sales 14 Withdrawal Charge (‘Withdrawal Charge”) 13 14 Amount of Withdrawal Charge 14 15 Free Withdrawals 14 15 Earnings 14 15 TRANSFER PROVISIONS Transfers 15 16 Transfer Limitations and Restrictions 15 16 WITHDRAWAL PROVISIONS Withdrawals 16 18 Minimum Withdrawal Amount 16 Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 18 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 18 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – — Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – — Life Only 26 Option 2 – — Life with Period Certain 26 Option 3 – — Joint and Survivor Life 26 Option 4 – — Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 ICC10:10-1185-L CONTRACT SPECIFICATIONSSPECIFICATIONS Contract Data

Right to Cancel. You may return cancel this Contract policy within ten (10) 30 days after you of receiving it by returning the policy to Our administrative office. As soon as You deliver or mail the policy to Us, it is treated as if it was never issued. Your premium payment will be refunded when We receive itthe policy. To After the 30-day period, You may cancel this policy by notifying Us in writing that You wish to do so, mail it . Your policy will be cancelled on the date We receive Your written notice unless You tell Us a later date. Cancellation of this policy will be without prejudice to us at our Service Center or any claim made prior to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as termination of the Contract contract. Assurity Life Insurance Company has signed this policy on the Issue Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date NonPresident Assurity Life Insurance Company Administrative Office XX Xxx 00000 – Xxxxxxx, Xxxxxxxx 00000-Participating 0000 Toll-free (000) 000-0000 DISABILITY INCOME POLICY Guaranteed Renewable to Age 67 – Qualified Right to Renew to Age 70 Company may change premium rates Agent Name: Address: Telephone: TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS RENEWAL PROVISION 1 RIGHT TO CANCEL 1 POLICY SCHEDULE 3 DEFINITION DEFINITIONS 4 PREMIUMS 5 Premium Payments 5 Grace Period 5 Reinstatement 5 Refund of Unearned Premium 5 TOTAL DISABILITY BENEFIT 5 Monthly Benefit Payment 5 Total Disability for Part of a Month 6 Maximum Benefit Period When You Attain Age 70 6 PARTIAL DISABILITY BENEFIT 6 Monthly Benefit Payment 6 Partial Disability for Part of a Month 6 WAIVER OF TERMS 4 PREMIUM 6 LIMITATIONS 6 Foreign Travel 6 Preexisting Condition 6 EXCLUSIONS 6 TERMINATION 7 CLAIMS PROCEDURE 7 Notice of Claim 7 Claim Forms 7 Proof of Loss 7 Time of Payment of Claims 7 Payment of Claims 7 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation 8 Assignment 8 Change of Beneficiary 22 Adding 8 Conformity with State Statutes 8 Entire Contract; Changes 8 Legal Action 8 Misstatement of Age 8 Misstatement of Income 8 Periods of Time 8 Physical Examination and Autopsy 8 Time Limit on Certain Defenses 8 Time of Coverage 8 POLICY SCHEDULE FORM NO. BENEFIT INITIAL ANNUAL PREMIUM I D0710 Total Disability Benefits (Accident/Sickness) Monthly Benefit: Maximum Benefit Period: Elimination Period: ADDITIONAL BENEFITS ARE EXPLAINED IN THE POLICY. R I0711 Critical Illness Benefit Rider R I0712 Retroactive Injury Benefit Rider R I0713 Return of Premium Benefit Rider INSURED PERSON: POLICY NUMBER: ISSUE AGE: OCCUPATION CLASS: CLASS: MODAL PREMIUM: ISSUE DATE: PREMIUM MODE: DEFINITIONS Complications of Pregnancy means a condition (when the pregnancy is not terminated) the diagnosis of which is distinct from pregnancy but which is adversely affected by pregnancy or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice caused by pregnancy, and include, but is not limited to: acute nephritis, nephrosis, cardiac decompensation, caesarean section, missed abortion and similar medical and surgical conditions of Annuity Date 23 Default Annuity Option 23 Application comparable severity; an ectopic pregnancy which is surgically terminated or spontaneous termination of Contract Value 23 Your Selections 24 Fixed pregnancy which occurs during a period of gestation when a viable birth is not possible; and Variable Annuities 24 Amount pernicious vomiting (hyperemesis gravidarum), pre-eclampsia and toxemia with convulsions (eclampsia of Payments 24 Fixed Annuity Payments 24 Conversion pregnancy). Complications of Pregnancy cease upon termination of the pregnancy. Complications of Pregnancy does not include false labor, pre-term contractions or labor, advanced maternal age, occasional spotting, Physician prescribed rest during the period of pregnancy, morning sickness and similar conditions which, although associated with the management of a difficult pregnancy and back pain, are not medically classified as distinct Complications of Pregnancy. Concurrent Total Disability means a disability caused by more than one Injury, whether the Injuries are related or not. Covered Accident means an unforeseen event or occurrence which directly, independently and exclusively results in an Injury and (a) occurs after the policy Issue Date; (b) occurs while this policy is in force; and (c) is not caused by or a result of an activity or condition listed in EXCLUSIONS in this policy. Elimination Period means the number of consecutive days You must be Totally Disabled before You are eligible to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint receive the Monthly Benefit. See the Policy Schedule and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability Claims Procedure. We do not pay Monthly Benefits during the Elimination Period. Employed on a Full-Time Basis means working for pay at least 30 hours per week for 90 days immediately preceding the renewal date. Immediate Family means the spouse, father, mother, children or siblings of Rates 27 Basis any Insured Person. Injury(ies) means bodily harm that is caused solely by or is the result of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSa Covered Accident. All injuries sustained in any one Covered Accident and all complications and reoccurrences of complications are considered to be a single Injury.

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE LIMITED PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating — No Dividends are Payable ICC16:10-1600-L TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 12 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Withdrawal Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS16

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we We will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 12 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Transfer Fee 13 Withdrawal Charge”) Fee 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 WITHDRAWAL PROVISIONS Withdrawals 16 15 Minimum Withdrawal Amount 16 15 Amount Available for Withdrawal 16 15 Termination of Contract 16 15 CONTRACT LOANS Loans 17 16 Loan Procedures 17 16 Loan Account 17 16 Loan Terms 17 16 Loan Interest Rate 17 16 Repayment Terms 17 16 DEATH BENEFIT PROVISIONS Death Benefit 19 18 Death Benefit Amount 19 18 Death of Annuitant 19 18 Death of Owner 20 19 Death of Owner Distribution Rules 20 19 Interest on Death Benefit Proceeds 21 20 BENEFICIARY PROVISIONS Designation of Beneficiary 22 21 Adding or Changing Your Beneficiary 22 21 ANNUITY PROVISIONS Choice of Annuity Date 23 22 Default Annuity Option 23 22 Application of Contract Value 23 22 Your Selections 24 23 Fixed and Variable Annuities 24 23 Amount of Payments 24 23 Fixed Annuity Payments 24 23 Conversion to Current Rates 24 23 Variable Annuity Payments – — Subaccount Annuity Units 24 23 Subsequent Variable Payments 25 23 Annuity Unit Value 25 24 Periodic Payments 25 24 ANNUITY OPTIONS Option 1 – Life Only 26 25 Option 2 – Life with Period Certain 26 25 Option 3 – Joint and Survivor Life 26 25 Option 4 – Period Certain Only 26 25 ANNUITY OPTION TABLES Applicability of Rates 27 26 Basis of Computations 27 26 Rates Not Shown 27 26 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 1.25% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would be 5.40%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating Exhibit 4(a) TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Transfer Fee 13 Withdrawal Fee 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 16 Dollar Cost Averaging Transfer Option 16 Portfolio Rebalancing Transfer Option 16 Earnings Sweep Transfer Option 17 WITHDRAWAL PROVISIONS Withdrawals 16 18 Minimum Withdrawal Amount 16 18 Amount Available for Withdrawal 16 18 Pre-authorized Withdrawals 18 Termination of Contract 16 18 CONTRACT LOANS Loans 17 19 Loan Procedures 17 19 Loan Account 17 19 Loan Terms 17 19 Loan Interest Rate 17 19 Repayment Terms 17 19 DEATH BENEFIT PROVISIONS Death Benefit 19 21 Death Benefit Amount 19 21 Death of Annuitant 19 21 Death of Owner 20 22 Death of Owner Distribution Rules 20 22 Interest on Death Benefit Proceeds 21 23 BENEFICIARY PROVISIONS Designation of Beneficiary 22 24 Adding or Changing Your Beneficiary 22 24 ANNUITY PROVISIONS Choice of Annuity Date 23 25 Default Annuity Option 23 25 Application of Contract Value 23 25 Your Selections 24 26 Fixed and Variable Annuities 24 26 Amount of Payments 24 26 Fixed Annuity Payments 24 26 Conversion to Current Rates 24 26 Variable Annuity Payments – Subaccount Annuity Units 24 26 Subsequent Variable Payments 25 27 Annuity Unit Value 25 27 Periodic Payments 25 27 ANNUITY OPTIONS Option 1 – Life Only 26 28 Option 2 – Life with Period Certain 26 28 Option 3 – Joint and Survivor Life 26 28 Option 4 – Period Certain Only 26 29 ANNUITY OPTION TABLES Applicability of Rates 27 29 Basis of Computations 27 29 Rates Not Shown 27 29 Exhibit 4(a) CONTRACT SPECIFICATIONSSPECIFICATIONS Service Center: Send Forms and written requests to: Send Payments to: Pacific Life & Annuity Company Pacific Life & Annuity Company P.O. Box 7138 P.O. Box 100517 Pasadena, California 91109-7138 Pasadena, California 91189-0517 Toll-Free Number: 1-000-000-0000 (between 6:00 a.m. and 5:00 p.m., Pacific Time) Please use our toll-free number to present inquiries or obtain information about your coverage and for us to provide assistance in resolving complaints. Investment Options [Blue Chip] [Research] [Mid-Cap Growth] [Multi-Strategy] [Diversified Research] [Large-Cap Value] [Small-Cap Index] [Growth LT] [I-Net Tollkeeper] [Short Duration Bond] [Managed Bond] [International Value] [Technology] [Aggressive Growth] [Equity] [Global Growth] [Main Street Core] [Small-Cap Equity] [Money Market] [Real Estate] [Focused 30] [Financial Services] [Small-Cap Value] [Equity Income] [Capital Opportunities] [Telecommunications] [Emerging Markets] [Aggressive Equity] [Equity Index] [Strategic Value] [International Large-Cap] [High Yield Bond] [Inflation Managed] [Mid-Cap Value] [Health Services] DCA Plus 6-Month DCA Plus 12-Month Interest Rates (Minimum Guaranteed Interest Rate is 3.00% per year.) Guarantee Terms and Current Rates DCA Plus Fixed Option 6 Mos. [4.00%] 12 Mos. [3.00%] Charges, Fees and Deductions Administration M&E Risk Annual Benefit Description Fee Charge Fee Basic Contract – [Non-Qualified] 0.15% 1.25% $30.00 [Stepped-Up Death Benefit Rider] [0.20%] Age of Withdrawal Age of Withdrawal Purchase Payment in Charge Purchase Payment in Charge Withdrawal Charges Contract Years Percentage Contract Years Percentage 2 7% 6 1% 3 6% 7 and Later 0% 4 5% Annual Charge Optional Riders Percentage [Guaranteed Protection Advantage Rider] [0.10%] FOR A COMPLETE DESCRIPTION OF THE CHARGES, FEES AND DEDUCTIONS SHOWN ABOVE AND OTHER APPLICABLE FEES AND CHARGES, REFER TO THE CHARGES, FEES AND DEDUCTIONS SECTION OF THE CONTRACT OR THE ANNUAL CHARGE PROVISION OF THE OPTIONAL RIDER(S) SHOWN ABOVE, IF ANY. Contract Number: [VA99999999] Owner(s): [JXXX XXX] [JXXX XXX] Annuitant(s): [JXXX XXX] [JXXX XXX] Initial Purchase Payment: [$5,000.00] Maximum Purchase Payment: $1,000,000 Contract Date: [01-01-2004] Age: [35] Sex: [MALE] [35] [FEMALE] Annuity Date: [01-01-2059] Exhibit 4(a) DEFINITION OF TERMS Account Value – The amount of the Contract Value allocated to any one of the Investment Options. Add-In Amount – The amount added by us, if applicable, to the Contract Value on the Notice Date to set the Contract Value equal to the death benefit proceeds that would have been payable to the spouse as the deemed Beneficiary/designated recipient of the death benefit. The Add-In Amount will only apply if the deceased Owner was also the sole surviving Annuitant. Age – The Owner’s or Axxxxxxxx’s age, as applicable, at his or her last birthday.

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE LIMITED PREMIUM DEFERRED FIXED AND VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 FIXED ACCOUNT OPTIONS Fixed Account Options (FAOs) 10 Minimum Allocation Amount 10 Crediting Interest 10 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 11 Separate Account 10 11 CONTRACT VALUES Contract Value 11 12 FAO Value 12 Variable Account Value 11 12 Subaccount Value 11 12 Subaccount Unit Value 11 13 Net Investment Factor 11 Loan Account Value 12 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 14 Mortality and Expense Risk Charge (“Risk Charge”) 13 14 Premium Taxes 13 14 Other Taxes 13 14 Transfer Fee 14 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 14 Amount of Withdrawal Charge 14 15 Free Withdrawals 14 Earnings 14 15 TRANSFER PROVISIONS Transfers 15 16 Transfers between a Variable Investment Option and a FAO 16 Transfers Among the Variable Investment Options 16 Transfer Limitations and Restrictions 15 16 WITHDRAWAL PROVISIONS Withdrawals 16 18 Minimum Withdrawal Amount 16 18 Amount Available for Withdrawal 16 18 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 18 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice Date Annuity Payments Begin 23 Default Annuity Date and Annuity Option 23 Change of Annuity Date 23 Default and Annuity Option Option. 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 23 ANNUITY OPTIONS Option 1 – — Life Only 26 24 Option 2 – — Life with Period Certain 26 24 Option 3 – — Joint and Survivor Life 26 24 Option 4 – — Period Certain Only 26 24 ANNUITY OPTION TABLES Applicability of Rates 27 25 Basis of Computations 27 25 Rates Not Shown 27 25 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we We will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, California to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Transfer Fee 13 Withdrawal Charge”) Fee 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 WITHDRAWAL PROVISIONS Withdrawals 16 15 Minimum Withdrawal Amount 16 15 Amount Available for Withdrawal 16 15 Termination of Contract 16 15 CONTRACT LOANS Loans 17 16 Loan Procedures 17 16 Loan Account 17 16 Loan Terms 17 16 Loan Interest Rate 17 16 Repayment Terms 17 16 DEATH BENEFIT PROVISIONS Death Benefit 19 18 Death Benefit Amount 19 18 Death of Annuitant 19 18 Death of Owner 20 19 Death of Owner Distribution Rules 20 19 Interest on Death Benefit Proceeds 21 20 BENEFICIARY PROVISIONS Designation of Beneficiary 22 21 Adding or Changing Your Beneficiary 22 21 ANNUITY PROVISIONS Choice of Annuity Date 23 22 Default Annuity Option 23 22 Application of Contract Value 23 22 Your Selections 24 23 Fixed and Variable Annuities 24 23 Amount of Payments 24 23 Fixed Annuity Payments 24 23 Conversion to Current Rates 24 23 Variable Annuity Payments – Subaccount Annuity Units 24 23 Subsequent Variable Payments 25 23 Annuity Unit Value 25 24 Periodic Payments 25 24 ANNUITY OPTIONS Option 1 – Life Only 26 25 Option 2 – Life with Period Certain 26 25 Option 3 – Joint and Survivor Life 26 25 Option 4 – Period Certain Only 26 25 ANNUITY OPTION TABLES Applicability of Rates 27 26 Basis of Computations 27 26 Rates Not Shown 27 26 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within [ten (10) )] days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating — No Dividends are Payable ICC10:10-1185 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 10 Additional Purchase Payments 9 10 Purchase Payment Allocation 9 10 Allocations During the Right to Cancel Period 9 10 Minimum Investment Option Value 9 10 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 11 Separate Account 10 11 CONTRACT VALUES Contract Value 11 12 Variable Account Value 11 12 Subaccount Value 11 12 Subaccount Unit Value 11 12 Net Investment Factor 11 13 Loan Account Value 12 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 14 Mortality and Expense Risk Charge (“Risk Charge”) 13 14 Annual Fee 14 Premium Taxes 13 14 Other Taxes 13 Contingent Deferred Sales 14 Withdrawal Charge (‘Withdrawal Charge”) 13 14 Amount of Withdrawal Charge 14 15 Free Withdrawals 14 15 Earnings 14 15 TRANSFER PROVISIONS Transfers 15 16 Transfer Limitations and Restrictions 15 16 WITHDRAWAL PROVISIONS Withdrawals 16 18 Minimum Withdrawal Amount 16 Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 18 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 18 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – — Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – — Life Only 26 Option 2 – — Life with Period Certain 26 Option 3 – — Joint and Survivor Life 26 Option 4 – — Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 ICC10:10-1185 CONTRACT SPECIFICATIONSSPECIFICATIONS Contract Data

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we We will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, California to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 1.50% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would need to be 5.75%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating - No Dividends are Payable 10-2128 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 17 Death Benefit Amount 19 17 Death of Annuitant 19 17 Death of Owner 20 18 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 18 BENEFICIARY PROVISIONS Designation of Beneficiary 22 20 Adding or Changing Your Beneficiary 22 20 ANNUITY PROVISIONS Choice of Annuity Date 23 21 Default Annuity Option 23 21 Application of Contract Value 23 21 Your Selections 24 22 Fixed and Variable Annuities 24 22 Amount of Payments 24 22 Fixed Annuity Payments 24 22 Conversion to Current Rates 24 22 Variable Annuity Payments – — Subaccount Annuity Units 24 22 Subsequent Variable Payments 25 23 Annuity Unit Value 25 23 Periodic Payments 25 23 ANNUITY OPTIONS Option 1 – - Life Only 26 24 Option 2 – - Life with Period Certain 26 24 Option 3 – - Joint and Survivor Life 26 24 Option 4 – - Period Certain Only 26 24 ANNUITY OPTION TABLES Applicability of Rates 27 25 Basis of Computations 27 25 Rates Not Shown 27 25 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order,, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE LIMITED PREMIUM DEFERRED FIXED AND VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 FIXED ACCOUNT OPTIONS Fixed Account Options (FAOs) 10 Minimum Allocation Amount 10 Crediting Interest 10 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 11 Separate Account 10 11 CONTRACT VALUES Contract Value 11 12 FAO Value 12 Variable Account Value 11 12 Subaccount Value 11 12 Subaccount Unit Value 11 13 Net Investment Factor 11 Loan Account Value 12 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 14 Mortality and Expense Risk Charge (“Risk Charge”) 13 14 Premium Taxes 13 14 Other Taxes 13 14 Transfer Fee 14 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 14 Amount of Withdrawal Charge 14 15 Free Withdrawals 14 Earnings 14 15 TRANSFER PROVISIONS Transfers 15 16 Transfers between a Variable Investment Option and a FAO 16 Transfers Among the Variable Investment Options 16 Transfer Limitations and Restrictions 15 16 WITHDRAWAL PROVISIONS Withdrawals 16 18 Minimum Withdrawal Amount 16 18 Amount Available for Withdrawal 16 18 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 18 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice Date Annuity Payments Begin 23 Default Annuity Date and Annuity Option 23 Change of Annuity Date 23 Default and Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 23 ANNUITY OPTIONS Option 1 – - Life Only 26 24 Option 2 – - Life with Period Certain 26 24 Option 3 – - Joint and Survivor Life 26 24 Option 4 – - Period Certain Only 26 24 ANNUITY OPTION TABLES Applicability of Rates 27 25 Basis of Computations 27 25 Rates Not Shown 27 25 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 3% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 0.20% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would need to be at least 3.45% (net of fund level expenses). INDIVIDUAL FLEXIBLE LIMITED PREMIUM DEFERRED FIXED AND VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating 10-2169 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 FIXED ACCOUNT OPTIONS Fixed Account Options (FAOs) 10 Minimum Allocation Amount 10 Crediting Interest 10 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 12 Separate Account 10 12 CONTRACT VALUES Contract Value 11 13 FAO Value 13 Variable Account Value 11 13 Subaccount Value 11 13 Subaccount Unit Value 11 14 Net Investment Factor 11 Loan Account Value 12 14 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 15 Mortality and Expense Risk Charge (“Risk Charge”) 13 15 Premium Taxes 13 15 Other Taxes 13 15 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 15 Amount of Withdrawal Charge 14 16 Free Withdrawals 14 Earnings 14 16 TRANSFER PROVISIONS Transfers 15 17 Transfers between a Variable Investment Option and a Fixed Account Option 17 Transfers Among the Variable Investment Options 17 Transfer Limitations and Restrictions 15 17 WITHDRAWAL PROVISIONS Withdrawals 16 19 Minimum Withdrawal Amount 16 19 Amount Available for Withdrawal 16 19 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 19 DEATH BENEFIT PROVISIONS Death Benefit 19 20 Death Benefit Amount 19 20 Death of Annuitant 19 20 Death of Owner 20 21 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 23 Adding or Changing Your Beneficiary 22 23 ANNUITY PROVISIONS Choice Date Annuity Payments Begin 24 Default Annuity Date and Annuity Option 24 Change of Annuity Date 23 Default and Annuity Option 23 Option. 24 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Minimum Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – — Life Only 26 25 Option 2 – — Life with Period Certain 26 25 Option 3 – — Joint and Survivor Life 26 25 Option 4 – — Period Certain Only 26 25 ANNUITY OPTION TABLES Applicability of Rates 27 26 Basis of Computations 27 26 Rates Not Shown 27 26 10-2169 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return this end your participation in the Contract within ten (10) days after you receive it. To do soit by returning the Contract and Certificate to our administrative office, mail it to us at our Service Center or to the agent who sold it to you, with a written request for cancellation. This Contract Return by mail is effective on being post-marked, properly addressed and postage pre-paid. We will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund promptly return the Contract Value, including Value plus the sales charge and any fees premium tax or charges for premium taxes and/or other taxes that were amounts deducted from the Purchase Payments before they were applied to the Contract. The amount we return may be more or less than your Purchase Payments. Xxxx X. Xxxxx President Xxxxxxx X. Xxxx Secretary THIS IS A LEGALLY BINDING CONTRACT READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY 0000 Xxxxxxx 000 Xxxxx X. X. Box 10648 Birmingham, Alabama 35202-0648 (000) 000-0000 This Page Intentionally left blank. INSERT CORRECT DATA PAGE HERE SCHEDULE—if issued to Contractholder CERTIFICATE—if issued to Participant TABLE OF CONTENTS Definitions 7 Parties to the Contract Value. Signed for the 8 Company at Newport Beach, California, to be effective as 8 Owner 8 Change of Owner 8 Beneficiary 8 Change of Beneficiary 8 Annuitant 8 Change of Annuitant 8 Payee 8 General Provisions 8 Entire Contract 8 Modification of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected 8 Incontestability 9 Assignment 9 Written Notice 9 Error in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Age or Gender 9 Settlement 9 Receipt of Payment 9 Protection of Proceeds Payable Before Annuity Date 9 Premium Tax 9 Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial 9 Minimum Values 9 Application of Law 9 Reports 10 Purchase Payments 10 Purchase Payment 9 Additional 10 Allocation of Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS 10 No Default 10 Sales Charge 10 Sales Charge 10 Letter of Intent 10 Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value General Description 10 Sub-Accounts of the Variable Account 11 Variable Account Value 11 Subaccount Value 11 Subaccount Accumulation Unit Value 11 Net Investment Factor 11 Loan Account Value Values 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee Transfers 12 Transfers 12 Dollar Cost Averaging 12 Surrenders 13 Annual Fee Full and Partial Surrenders 13 Mortality and Expense Risk Charge (“Risk Charge”) Suspension or Delay in Payment of Surrender 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS 5 Death Benefit 19 13 Death of an Owner 13 Death of the Annuitant 13 Payment of the Death Benefit Amount 19 Death 14 Suspension of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice Payment 14 Annuitization 14 Annuity Commencement Date 14 Annuity Income Payments 14 Fixed Income Payments 14 Variable Income Payments 14 Annuity Unit Values 15 Selection of Annuity Date 23 Default Option 15 Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Options 15 Minimum Amounts 16 Guaranteed Purchase Rates 16 Fixed Annuity Payments 24 Conversion to Current Rates 24 Tables 17 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSTables 17

Right to Cancel. You may return this Contract within [ten (10) )] days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating — No Dividends are Payable ICC10:10-1180 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 10 Additional Purchase Payments 9 10 Purchase Payment Allocation 9 10 Allocations During the Right to Cancel Period 9 10 Minimum Investment Option Value 9 10 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 11 Separate Account 10 11 CONTRACT VALUES Contract Value 11 12 Variable Account Value 11 12 Subaccount Value 11 12 Subaccount Unit Value 11 12 Net Investment Factor 11 13 Loan Account Value 12 13 Persistency Credit 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 14 Mortality and Expense Risk Charge (“Risk Charge”) 13 14 Annual Fee 14 Premium Taxes 13 14 Other Taxes 13 Contingent Deferred Sales 14 Withdrawal Charge (‘Withdrawal Charge”) 13 14 Amount of Withdrawal Charge 14 15 Free Withdrawals 14 15 Earnings 14 15 TRANSFER PROVISIONS Transfers 15 16 Transfer Limitations and Restrictions 15 16 WITHDRAWAL PROVISIONS Withdrawals 16 18 Minimum Withdrawal Amount 16 18 Full Withdrawal 18 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 18 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – — Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – — Life Only 26 Option 2 – — Life with Period Certain 26 Option 3 – — Joint and Survivor Life 26 Option 4 – — Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 ICC10:10-1180 CONTRACT SPECIFICATIONSSPECIFICATIONS Contract Data Contract Number: [VA99999999] Contract Date: [01-01-2009] Contract Type: [Non-Qualified] Initial Purchase Payment: [$500,000] Minimum Purchase Payment Amount: [$10,000] Maximum Purchase Payment Amount: [$1,000,000] Owner(s): [Xxxx Xxx] [Xxxx Xxx] Annuitant(s): [Xxxx Xxx] [Xxxx Xxx] Annuitant’s Age: [35] [35] Annuity Date: [01-01-2027] Annuitant’s Sex: [Male] [Female] Fees & Charges M&E Risk Charge: 1.15 % Administrative Fee: 0.15 % Annual Fee: $ 30.00 Withdrawal Charges Age of Purchase Payment in Contract Years Withdrawal Charge % 1 7 % 2 7 % 3 6 % 4 6 % 5 5 % 6 3 % 7 1 % 8 and Later 0 % Optional Riders Name Annual Charge % Maximum Annual Charge % [Stepped-Up Death Benefit Rider 0.20%] 0.20 % [Guaranteed Withdrawal Benefit III-B Rider 1.05%] 1.50 % [Core Withdrawal Benefit II-A Rider 0.65%] 1.20 % For a complete description of the charges, fees and deductions shown above and other applicable fees and charges, refer to the Charges, Fees and Deductions section of the Contract or the Annual Charge provision of the Optional Rider(s) shown above, if applicable. ICC10:10-1180

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return cancel this Contract within ten (10) 10 days after you receive it. To do so, mail it by returning it to us at our Service Center administrative office, or to the agent who sold it to you, with a written request for cancellation. This Contract will then be deemed void from If you return it by mail, effective date of the beginning. No withdrawal charge cancellation will be imposed, determined by the postmark date on the properly addressed and we postage-paid return package. We will refund promptly return the Contract Value, including Value plus any fees or charges for premium taxes and/or other taxes that were amounts deducted from the your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY xxx.Xxxxxxxxxx.xxx 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ICC11-VDA-P-2006C-WW 12/11 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract Value. Signed for the Company at Newport Beach, California, to be effective as 3 Modification of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date 3 Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 GENERAL PROVISIONS 7 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional 5 Purchase Payments 9 5 Allocation of Purchase Payment Allocation 9 Allocations During Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 5 Variable Account Value 11 Subaccount Value 11 Subaccount 6 Accumulation Unit Value 11 Values 6 Net Investment Factor 11 Loan Account 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘8 Suspension or Delay in Payment of Surrender or Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 8 DEATH BENEFIT PROVISIONS 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 19 8 Payment of the Death Benefit Amount 19 Death 9 Suspension or Delay in Payment of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 9 ANNUITY PROVISIONS Choice INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Date 23 Default Option 10 Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 11 FIXED ANNUITY OPTIONS Option TABLES 12 VARIABLE ANNUITY TABLES 12 Protective Dimensions Schedule CONTRACT NUMBER ISSUE DATE OWNER 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSBIRTH DATE OF OWNER 1

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return cancel this Contract within ten (10) days after you receive it. To do so, mail it by returning it to us at our Service Center administrative office, or to the agent who sold it to you, with a written request for cancellation. This Contract will then be deemed void from If you return it by mail, effective date of the beginning. No withdrawal charge cancellation will be imposed, determined by the postmark date on the properly addressed and we postage-paid return package. We will refund promptly return the Contract Value, including Value plus any fees or charges for premium taxes and/or other taxes that were amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY xxx.Xxxxxxxxxx.xxx 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ICC11-VDA-P-2006C-WW 12/11 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract Value. Signed 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12 [PROTECTIVE DIMENSIONS IV VARIABLE ANNUITY SCHEDULE] CONTRACT NUMBER ISSUE DATE OWNER 1 BIRTH DATE OF OWNER 1 OWNER 2 BIRTH DATE OF OWNER 2 ANNUITANT BIRTH DATE OF ANNUITANT BENEFICIARY ANNUITY DATE As contained in our records PROTECTED LIFETIME INCOME OPTION DEATH BENEFIT AGENT INSURANCE REGULATORY AUTHORITY INITIAL PURCHASE PAYMENT TAX-QUALIFIED STATUS INTEREST RATES FOR THE GUARANTEED ACCOUNT Annual Effective Interest Rates for the Company at Newport Beach, California, to be effective FIXED ACCOUNT — Guaranteed Account on the Issue Date: DCA ACCOUNT 1 — DCA ACCOUNT 2 — Non-Forfeiture Interest Rate (NFIR) for the Guaranteed Account: The Contract’s NFIR for the Guaranteed Account was established on the Issue Date and will not change. It was determined by taking the 5-Year Constant Maturity Treasury Rate as of the January 31 prior to the May 1 — April 30 annual period during which the Contract Datewas issued, subtracting 1.25%, and rounding the result to the nearest 0.05%. PACIFIC LIFE INSURANCE COMPANY Chairman The NFIR cannot be less than 1.00% and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED will not be more than 3.00%. Interest rates declared by the Company for the Guaranteed Account will be at least equal to the Contract’s NFIR. ICC11-VDA-P-2006SO-1 [DIMENSIONS IV 11/19] [PROTECTIVE DIMENSIONS IV VARIABLE ANNUITY SCHEDULE], continued CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During LIMITATIONS, FEES, AND CHARGES Maximum Issue Date: We will not issue a Contract on or after the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding oldest Owner’s or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSXxxxxxxxx’s 86th birthday.

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. .] Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY [ Chairman and Chief Executive Officer Secretary ] INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Fixed and/or Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 3 GENERAL PROVISIONS 7 6 PURCHASE PAYMENTS Initial Purchase Payment 9 8 Additional Purchase Payments 9 8 Purchase Payment Allocation 9 8 Allocations During the Right to Cancel Period 9 8 Minimum Investment Option Value 9 8 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 9 Separate Account 10 9 CONTRACT VALUES Contract Value 11 10 Variable Account Value 11 10 Subaccount Value 11 10 Subaccount Unit Value 11 10 Net Investment Factor 11 Loan Account Value 12 11 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 12 Mortality and Expense Risk Charge (“Risk Charge”) 13 12 Annual Fee 12 Premium Taxes 13 12 Other Taxes 13 Contingent Deferred Sales 12 Withdrawal Charge (‘Withdrawal Charge”) 13 12 Amount of Withdrawal Charge 14 12 Free Withdrawals 14 13 Earnings 14 13 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSFull Withdrawal 16

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return cancel this Contract within ten (10) [ 10 ] days after you receive it. To do so, mail it by returning it to us at our Service Center administrative office, or to the agent who sold it to you, with a written request for cancellation. This Contract will then be deemed void from If you return it by mail, effective date of the beginning. No withdrawal charge cancellation will be imposed, determined by the postmark date on the properly addressed and we postage-paid return package. We will refund promptly return the Contract Value, including Value plus any fees or charges for premium taxes and/or other taxes that were amounts deducted from the your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY xxx.Xxxxxxxxxx.xxx 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ICC11-VDA-P-2006C-WX 12/11 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract Value. Signed for the Company at Newport Beach, California, to be effective as 3 Modification of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date 3 Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 GENERAL PROVISIONS 7 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional 5 Purchase Payments 9 5 Allocation of Purchase Payment Allocation 9 Allocations During Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 5 Variable Account Value 11 Subaccount Value 11 Subaccount 6 Accumulation Unit Value 11 Values 6 Net Investment Factor 11 Loan Account 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘8 Suspension or Delay in Payment of Surrender or Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 8 DEATH BENEFIT PROVISIONS 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 19 8 Payment of the Death Benefit Amount 19 Death 9 Suspension or Delay in Payment of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 9 ANNUITY PROVISIONS Choice INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Date 23 Default Option 10 Annuity Option 23 Application Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12 [ PROTECTIVE VARIABLE ANNUITY INVESTORS SERIES ADV ] SCHEDULE CONTRACT NUMBER ISSUE DATE [ Contract Number ] [ Month Day, Year ] OWNER 1 BIRTH DATE OF OWNER 1 [ Owner 1 Name ] [ Month Day, Year ] OWNER 2 BIRTH DATE OF OWNER 2 [ Owner 2 Name or “None” ] [ Month Day, Year or “Not Applicable” ] ANNUITANT BIRTH DATE OF ANNUITANT [ Annuitant Name ] [ Month Day, Year ] BENEFICIARY ANNUITY DATE As contained in our records [ Month Day, Year ] DEATH BENEFIT [ “Contract Value” or “Return of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount Purchase Payments” ] AGENT INSURANCE REGULATORY AUTHORITY [ Agent Name ] [ State Department of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability Insurance Name ] [ Agency Name ] [ State DOI Phone ] [ Agency Street Address ] [ State DOI Email or Website ] [ Agency City State ZIP ] [ Agency Phone ] INITIAL PURCHASE PAYMENT TAX-QUALIFIED STATUS [ $nnn,nnn.nn ] [ Type of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSQualified Plan or “Non-Qualified” ]

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating — No Dividends are Payable ICC16:10-1600 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 12 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Withdrawal Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS16

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we We will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, California to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 1.50% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would need to be 5.75%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating – No Dividends are Payable TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Transfer Fee 13 Withdrawal Charge”) Fee 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 28 Basis of Computations 27 28 Rates Not Shown 27 28 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Market Value Adjustment Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 GUARANTEED INTEREST OPTIONS Guaranteed Interest Options (GIOs) 10 Minimum Allocation Amount 10 Crediting of Interest 10 Rollover to New GIO 10 Market Value Adjustment (MVA) 11 Waiver of Market Value Adjustment 11 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 12 Separate Account 10 12 CONTRACT VALUES Contract Value 11 13 GIO Value 13 Variable Account Value 11 13 Subaccount Value 11 13 Subaccount Unit Value 11 14 Net Investment Factor 11 14 Loan Account Value 12 14 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 15 Annual Fee 13 15 Mortality and Expense Risk Charge (“Risk Charge”) 13 15 Premium Taxes 13 15 Other Taxes 13 15 Transfer Fee 15 Withdrawal Fee 15 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 15 Amount of Withdrawal Charge 14 16 Free Withdrawals 14 16 Earnings 14 16 TRANSFER PROVISIONS Transfers 15 17 Transfer Limitations and Restrictions 15 17 Special Restrictions on Transfers from the GIOs 18 WITHDRAWAL PROVISIONS Withdrawals 16 18 Minimum Withdrawal Amount 16 18 Amount Available for Withdrawal 16 19 Special Restrictions on Withdrawals from the GIOs 19 Termination of Contract 16 19 CONTRACT LOANS Loans 17 20 Loan Procedures 17 20 Loan Account 17 20 Loan Terms 17 20 Loan Interest Rate 17 20 Repayment Terms 17 20 DEATH BENEFIT PROVISIONS Death Benefit 19 22 Death Benefit Amount 19 22 Death of Annuitant 19 22 Death of Owner 20 23 Death of Owner Distribution Rules 20 23 Interest on Death Benefit Proceeds 21 24 BENEFICIARY PROVISIONS Designation of Beneficiary 22 25 Adding or Changing Your Beneficiary 22 25 ANNUITY PROVISIONS Choice of Annuity Date 23 26 Default Annuity Option 23 26 Application of Contract Value 23 26 Your Selections 24 27 Fixed and Variable Annuities 24 27 Amount of Payments 24 27 Fixed Annuity Payments 24 27 Conversion to Current Rates 24 27 Variable Annuity Payments – Subaccount Annuity Units 24 27 Subsequent Variable Payments 25 28 Annuity Unit Value 25 28 Periodic Payments 25 28 ANNUITY OPTIONS Option 1 – Life Only 26 29 Option 2 – Life with Period Certain 26 29 Option 3 – Joint and Survivor Life 26 29 Option 4 – Period Certain Only 26 29 ANNUITY OPTION TABLES Applicability of Rates 27 30 Basis of Computations 27 30 Rates Not Shown 27 30 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – — Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – — Life Only 26 Option 2 – — Life with Period Certain 26 Option 3 – — Joint and Survivor Life 26 Option 4 – — Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 Table of Contents CONTRACT SPECIFICATIONS

Right to Cancel. [You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we We will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. .] Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY [ Chairman and Chief Executive Officer Secretary ] INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating ICC12:10-1225 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 3A DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 PAGE WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Full Withdrawal 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 17 Death Benefit Amount 19 17 Death of Annuitant 19 17 Death of Owner 20 18 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 18 BENEFICIARY PROVISIONS Designation of Beneficiary 22 20 Adding or Changing Your Beneficiary 22 20 ANNUITY PROVISIONS Choice of Annuity Date 23 21 Default Annuity Option 23 21 Application of Contract Value 23 21 Your Selections 24 22 Fixed and Variable Annuities 24 22 Amount of Payments 24 22 Fixed Annuity Payments 24 22 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 22 Periodic Payments 25 22 ANNUITY OPTIONS Option 1 – Life Only 26 23 Option 2 – Life with Period Certain 26 23 Option 3 – Joint and Survivor Life 26 23 Option 4 – Period Certain Only 26 23 ANNUITY OPTION TABLES Applicability of Rates 27 24 Basis of Computations 27 24 Rates Not Shown 27 24 ICC12:10-1225 2 CONTRACT SPECIFICATIONSSPECIFICATIONS Contract Data

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return cancel this Contract within ten (10) days after you receive it. To do soit by returning the Contract to our administrative office, mail it to us at our Service Center or to the agent who sold it to you, with a written request for cancellation. This Contract Return by mail is effective on being post-marked, properly addressed and postage pre-paid. We will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund promptly return the Contract Value, including Value plus any fees or charges for premium taxes and/or other taxes that were amounts deducted from the Purchase Payments before they were applied to the Contract. The amount we return may be more or less than your Purchase Payments. Xxxx X. Xxxxx President Xxxxxxx X. Xxxx Secretary THIS IS A LEGALLY BINDING CONTRACT READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY 0000 Xxxxxxx 000 Xxxxx P. O. Xxx 00000 Xxxxxxxxxx, Xxxxxxx 00000-0000 (000) 000-0000 This Page Intentionally left blank. TABLE OF CONTENTS Definitions 5 Parties to the Contract Value. Signed for the 5 Company at Newport Beach, California, to be effective as 5 Owner 5 Change of Owner 6 Beneficiary 6 Change of Beneficiary 6 Annuitant 6 Change of Annuitant 6 Payee 6 General Provisions 6 Entire Contract 6 Modification of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected 6 Incontestability 6 Assignment 7 Written Notice 7 Error in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Age or Gender 7 Settlement 7 Receipt of Payment 7 Protection of Proceeds Payable Before Annuity Date 7 Premium Tax 7 Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Minimum Values 7 Application of Law 7 Reports 7 Purchase Payments 7 Purchase Payment 9 Additional 7 Allocation of Purchase Payments 9 Purchase Payment Allocation 9 Allocations During 8 No Default 8 Variable Account 8 General Description 8 Sub-Accounts of the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 8 Variable Account Value 9 Accumulation Unit Values 10 Transfers 10 Transfers 10 Dollar Cost Averaging 10 Surrenders 10 Full and Partial Surrenders 10 {Penalty Free Surrender 11 Subaccount Value } {Determining the Surrender Charge 11 Subaccount Unit Value } Suspension or Delay in Payment of Surrender 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 11 Death of an Owner 11 Death of the Annuitant 12 Payment of the Death Benefit Amount 19 Death 12 Suspension of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice Payment 12 Annuitization 12 Annuity Commencement Date 12 Annuity Income Payments 12 Fixed Income Payments 12 Variable Income Payments 13 Annuity Unit Values 13 Selection of Annuity Date 23 Default Option 13 Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Options 13 Minimum Amounts 14 Guaranteed Purchase Rates 14 Fixed Annuity Payments 24 Conversion to Current Rates 24 Tables 14 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option Tables 15 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSDEFINITIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return cancel this Contract within ten (10) days after you receive it. To do soit by returning the Contract to our administrative office, mail it to us at our Service Center or to the agent who sold it to you, with a written request for cancellation. This Contract Return by mail is effective on being post-marked, properly addressed and postage pre-paid. We will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund promptly return the Contract Value, including Value plus the sales charge and any fees premium tax or charges for premium taxes and/or other taxes that were amounts deducted from the Purchase Payments before they were applied to the Contract. The amount we return may be more or less than your Purchase Payments. Xxxx X. Xxxxx President Xxxxxxx X. Xxxx Secretary THIS IS A LEGALLY BINDING CONTRACT READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY 0000 Xxxxxxx 000 Xxxxx X. X. Box 10648 Birmingham, Alabama 35202-0648 (000) 000-0000 This Page Intentionally left blank. INSERT CORRECT SCHEDULE HERE TABLE OF CONTENTS Definitions 7 Parties to the Contract Value. Signed for the 7 Company at Newport Beach, California, to be effective as 7 Owner 7 Change of Owner 8 Beneficiary 8 Change of Beneficiary 8 Annuitant 8 Change of Annuitant 8 Payee 8 General Provisions 8 Entire Contract 8 Modification of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected 8 Incontestability 8 Assignment 9 Written Notice 9 Error in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Age or Gender 9 Settlement 9 Receipt of Payment 9 Protection of Proceeds Payable Before Annuity Date 9 Premium Tax 9 Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial 9 Minimum Values 9 Application of Law 9 Reports 9 Purchase Payments 10 Purchase Payment 9 Additional 10 Allocation of Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS 10 No Default 10 Sales Charge 10 Sales Charge 10 Letter of Intent 10 Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 General Description 10 Sub-Accounts of the Variable Account 10 Variable Account Value 11 Subaccount Value 11 Subaccount Accumulation Unit Value 11 Net Investment Factor 11 Loan Account Value Values 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee Transfers 12 Transfers 12 Dollar Cost Averaging 12 Surrenders 13 Annual Fee Full and Partial Surrenders 13 Mortality and Expense Risk Charge (“Risk Charge”) Suspension or Delay in Payment of Surrender 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS 5 Death Benefit 19 13 Death of an Owner 13 Death of the Annuitant 13 Payment of the Death Benefit Amount 19 Death 13 Suspension of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice Payment 14 Annuitization 14 Annuity Commencement Date 14 Annuity Income Payments 14 Fixed Income Payments 14 Variable Income Payments 14 Annuity Unit Values 15 Selection of Annuity Date 23 Default Option 15 Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Options 15 Minimum Amounts 15 Guaranteed Purchase Rates 15 Fixed Annuity Payments 24 Conversion to Current Rates 24 Tables 17 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSTables 17

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may return cancel this Contract within ten (10) days after you receive it. To do so, mail it by returning it to us at our Service Center administrative office, or to the agent who sold it to you, with a written request for cancellation. This Contract will then be deemed void from If you return it by mail, effective date of the beginning. No withdrawal charge cancellation will be imposed, determined by the postmark date on the properly addressed and we postage-paid return package. We will refund promptly return the Contract Value, including Value plus any fees or charges for premium taxes and/or other taxes that were amounts deducted from the your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY xxx.Xxxxxxxxxx.xxx 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ICC11-VDA-P-2006C-WW 12/11 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract Value. Signed for the Company at Newport Beach, California, to be effective as 3 Modification of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date 3 Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 GENERAL PROVISIONS 7 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional 5 Purchase Payments 9 5 Allocation of Purchase Payment Allocation 9 Allocations During Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 5 Variable Account Value 11 Subaccount Value 11 Subaccount 6 Accumulation Unit Value 11 Values 6 Net Investment Factor 11 Loan Account 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘8 Suspension or Delay in Payment of Surrender or Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 8 DEATH BENEFIT PROVISIONS 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 19 8 Payment of the Death Benefit Amount 19 Death 9 Suspension or Delay in Payment of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 9 ANNUITY PROVISIONS Choice INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Date 23 Default Option 10 Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 11 FIXED ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 TABLES 12 VARIABLE ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS12

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. .] Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY [ Chairman and Chief Executive Officer Secretary ] INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Fixed and/or Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating ICC12:10-1252 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 3A DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 12 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Withdrawal Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 17 Minimum Withdrawal Amount 16 17 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms Full Withdrawal 17 DEATH BENEFIT TERMS AND PROVISIONS Definition of Terms 18 Death Benefit 19 18 Standard Death Benefit Amount 18 Death of Owner 19 Death of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 19 BENEFICIARY PROVISIONS Designation of Beneficiary 22 21 Adding or Changing Your Beneficiary 22 21 ANNUITY PROVISIONS Choice of Annuity Date 23 22 Default Annuity Option 23 22 Application of Contract Value 23 22 Your Selections 24 23 Fixed and Variable Annuities 24 23 Amount of Payments 24 23 Fixed Annuity Payments 24 23 Conversion to Current Rates 24 23 Variable Annuity Payments – —Subaccount Annuity Units 24 Subsequent Variable Payments 25 24 Annuity Unit Value 25 24 Periodic Payments 25 24 ANNUITY OPTIONS Option 1 – 1: Life Only 26 25 Option 2 – 2: Life with Period Certain 26 25 Option 3 – 3: Joint and Survivor Life 26 25 Option 4 – 4: Period Certain Only 26 25 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 Annuity Tables 27 ICC12:10-1252 CONTRACT SPECIFICATIONSSPECIFICATIONS Contract Data Contract Number: [VA99999999] Contract Date: [01-01-2011] Contract Type: [Non-Qualified]

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 1.00% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would be 5.15%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 12 Annual Fee 13 12 Mortality and Expense Risk Charge (“Risk Charge”) 13 12 Premium Taxes 13 12 Other Taxes 13 12 Contingent Deferred Sales Charge (‘“Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 13 Free Withdrawals 14 13 Earnings 14 13 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 14 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 15 Dollar Cost Averaging Transfer Option 15 Portfolio Rebalancing Transfer Option 15 Earnings Sweep Transfer Option 16 PAGE WITHDRAWAL PROVISIONS Withdrawals 16 17 Minimum Withdrawal Amount 16 17 Amount Available for Withdrawal 16 17 Pre-authorized Withdrawals 17 Termination of Contract 16 17 CONTRACT LOANS Loans 17 18 Loan Procedures 17 18 Loan Account 17 18 Loan Terms 17 18 Loan Interest Rate 17 18 Repayment Terms 17 18 DEATH BENEFIT PROVISIONS Death Benefit 19 20 Death Benefit Amount 19 20 Death of Annuitant 19 20 Death of Owner 20 21 Death of Owner Distribution Rules 20 21 Interest on Death Benefit Proceeds 21 22 BENEFICIARY PROVISIONS Designation of Beneficiary 22 23 Adding or Changing Your Beneficiary 22 23 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 24 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 25 Conversion to Current Rates 24 25 Variable Annuity Payments – Subaccount Annuity Units 24 25 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 27 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we We will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or Sales Charges, charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Letter of Intent 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Sales Charge 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Full Withdrawal 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 17 Death Benefit Amount 19 17 Death of Annuitant 19 17 Death of Owner 20 18 Death of Owner Distribution Rules 20 18 Interest on Death Benefit Proceeds 21 19 BENEFICIARY PROVISIONS Designation of Beneficiary 22 20 Adding or Changing Your Beneficiary 22 20 ANNUITY PROVISIONS Choice of Annuity Date 23 21 Default Annuity Option 23 21 Application of Contract Value 23 21 Your Selections 24 21 Fixed and Variable Annuities 24 22 Amount of Payments 24 22 Fixed Annuity Payments 24 22 Conversion to Current Rates 24 22 Variable Annuity Payments – — Subaccount Annuity Units 24 22 Subsequent Variable Payments 25 22 Annuity Unit Value 25 22 Periodic Payments 25 23 ANNUITY OPTIONS Option 1 – — Life Only 26 24 Option 2 – — Life with Period Certain 26 24 Option 3 – — Joint and Survivor Life 26 24 Option 4 – — Period Certain Only 26 24 ANNUITY OPTION TABLES Applicability of Rates 27 25 Basis of Computations 27 25 Rates Not Shown 27 25 CONTRACT SPECIFICATIONS

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 0.85%, the Administrative Fee of 0.15% and the Distribution Fee of 0.25%. Thus, the total gross annual rate of return would need to be 5.25%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual 12 Distribution Fee 13 12 Mortality and Expense Risk Charge (“Risk Charge”) 13 12 Premium Taxes 13 12 Other Taxes 13 12 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 12 Amount of Withdrawal Charge 14 13 Free Withdrawals 14 13 Earnings 14 13 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 14 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 15 Dollar Cost Averaging Transfer Option 15 Portfolio Rebalancing Transfer Option 15 Earnings Sweep Transfer Option 16 WITHDRAWAL PROVISIONS Withdrawals 16 17 Minimum Withdrawal Amount 16 17 Amount Available for Withdrawal 16 17 Pre-authorized Withdrawals 17 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 18 Death Benefit Amount 19 18 Death of Annuitant 19 18 Death of Owner 20 19 Death of Owner Distribution Rules 20 19 Interest on Death Benefit Proceeds 21 20 BENEFICIARY PROVISIONS Designation of Beneficiary 22 21 Adding or Changing Your Beneficiary 22 21 ANNUITY PROVISIONS Choice of Annuity Date 23 22 Default Annuity Option 23 22 Application of Contract Value 23 22 Your Selections 24 22 Fixed and Variable Annuities 24 23 Amount of Payments 24 23 Fixed Annuity Payments 24 23 Conversion to Current Rates 24 23 Variable Annuity Payments – — Subaccount Annuity Units 24 23 Subsequent Variable Payments 25 24 Annuity Unit Value 25 24 Periodic Payments 25 24 ANNUITY OPTIONS Option 1 – Life Only 26 25 Option 2 – Life with Period Certain 26 25 Option 3 – Joint and Survivor Life 26 25 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 26 Basis of Computations 27 26 Rates Not Shown 27 26 Table of Contents CONTRACT SPECIFICATIONS

Right to Cancel. Please read this contract carefully. You may return this Contract within ten (10) days cancel the contract for any reason before midnight of the 10th day after you first receive it. To do so, mail it Do this by (1) mailing or delivering notice of cancellation to us at our Service Center or (2) returning the contract to our Service Center or the agent who sold representative through whom you bought it. Notice given by mail and return of the contract by mail are effective on being postmarked, properly addressed and postage prepaid. If you cancel the contract, it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposedWithin 7 days after we receive notice of cancellation or the returned contract, and we will refund the Contract Accumulated Value. Flexible premium deferred variable annuity. Service Center: Annuity Income payable at Annuity Date. Thrivent Financial for Lutherans Standard Death Benefit included. 0000 Xxxxx Xxxxxxx Xxxx Death Proceeds payable at death of Annuitant before Appleton, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract ValueWI 54919-0001 Annuity Date. Return on investments reflected in contract benefits. Telephone (000) 000-0000 Waiver of Surrender Charge benefit included. xxx.xxxxxxxx.xxx Annual dividends payable if earned. Signed for the Company at Newport BeachSociety President Secretary ANNUITANT: XXXX XXX AGE: 50 SEX: MALE ANNUITANT: XXXX XXX AGE: 50 SEX: FEMALE CONTRACT NUMBER: XX0000000 DATE OF ISSUE: MAY 01, California2017 ICC16 W-WR-FPVA WR0110IC Contract Number: XX0000000 Table of Contents Contract Schedule, to be effective as Contract Data 3 Section 1 Definitions 6 Section 2 General Provisions 7 Section 3 Membership and Ownership 8 Section 4 Premiums 10 Section 5 Accumulated Value 10 Section 6 Surrender 13 Section 7 Death Proceeds 15 Section 8 Annuity Income 16 Section 9 Variable Account and Accumulation Unit Values 16 Section 10 Fixed Account 18 Section 11 Settlement Provisions 18 Section 12 Beneficiary 21 Section 13 Dividends 22 Riders, Amendments, Endorsements, Application Index Section Accumulated Value 5 Accumulation Unit Value 9 Allocation of the Premiums 4 Annual Report 2 Annuitant Exchange 7 Annuity Income 8 Automatic Transfers 5 Asset Rebalancing 5 Dollar Cost Averaging 5 Beneficiary 12 Cash Surrender Value 6 Change of Contract Date. PACIFIC LIFE INSURANCE COMPANY Chairman 2 Death Proceeds 7 Delay of Payment 2 Dividends 13 Entire Contract 2 Fixed Account 10 Incontestability 2 Maintenance of Solvency 2 Section Membership 3 Misstatement of Age or Sex 2 Ownership 3 Premiums 4 Settlement Options 11 Standard Death Benefit 7 Successor Owner 3 Surrender 6 Cash Surrender Value 6 Full Surrender 6 Partial Surrender 6 Surrender Charge 6 Surrender of Annuity Income 11 Termination 2 Transfer and Chief Executive Officer Secretary INDIVIDUAL Assignment 3 Transfer of Accumulated Values 5 Variable Account 9 Waiver of Surrender Charge 6 ICC16 W-WR-FPVA page 2 WR0200IC Thrivent Financial for Lutherans 0000 X. Xxxxxxx Road, Appleton, WI 54919-0001 Contract Schedule BASIC BENEFIT FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date NonPLAN TYPE: NON-Participating TABLE QUALIFIED ANNUITY DATE: MAY 01, 2062 FIRST ALLOCATION DATE: MAY 05, 2017 INITIAL PREMIUM: $125,000.00 MINIMUM AMOUNT OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION ANY ADDITIONAL PREMIUM PAYMENT: $50 MAXIMUM TOTAL PREMIUM (WITHOUT OUR APPROVAL): $1,000,000 MINIMUM PARTIAL SURRENDER AMOUNT: $200 MINIMUM ACCUMULATED VALUE: $10,000 FIXED ACCOUNT FIXED ACCOUNT GUARANTEED MINIMUM INTEREST RATE: 0.50% FIXED ACCOUNT INITIAL EFFECTIVE INTEREST RATE: 1.00% GUARANTEED FOR 12 MONTHS FROM THE DATE OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES ISSUE DCA FIXED ACCOUNT GUARANTEED INTEREST RATE: 2.50% ADDITIONAL BENEFITS DETAILS OF THE FOLLOWING ADDITIONAL BENEFIT RIDER AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 ITS CHARGE ARE GIVEN ON SEPARATE SCHEDULE PAGES: FORM ICC16 XX-XX-MADB - MAXIMUM ANNIVERSARY DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death THE FOLLOWING FORM IS INCLUDED AS PART OF THIS CONTRACT: ICC16 XX-XX-FPVA-AMEND ACCUMULATED VALUES IN THE VARIABLE ACCOUNT DEPEND ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT. CASH SURRENDER VALUES AND DEATH PROCEEDS ARE NOT LESS THAN THE MINIMUM BENEFITS REQUIRED BY SECTION 7 OF THE VARIABLE ANNUITY REGULATION, MODEL #250. THE GUARANTEED MINIMUM CASH SURRENDER VALUE FOR THE FIXED ACCOUNT IS EQUAL TO 87.5% OF THE PREMIUM ALLOCATED OR TRANSFERRED TO THAT ACCOUNT; LESS ANY SURRENDERS (EXCLUDING ANY SURRENDER CHARGES) DEDUCTED FROM THE FIXED ACCOUNT; ACCUMULATED AT 1.00% ANNUALLY. THE INSURANCE DEPARTMENT OF THE STATE IN WHICH THIS CONTRACT WAS ISSUED MAY BE CONTACTED BY CALLING (000) 000-0000. ANNUITANT: XXXX XXX AGE: 50 SEX: MALE ANNUITANT: XXXX XXX AGE: 50 SEX: FEMALE CONTRACT NUMBER: XX0000000 DATE OF ISSUE: MAY 01, 2017 ICC16 W-WR-FPVA-CS page 3 WR0370IC Date of Annuitant 19 Death of Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Issue: MAY 01, 2017 Contract Value 23 Your Selections Number: XX0000000 ANNUITANT: XXXX XXX ANNUITANT: XXXX XXX FLEXIBLE PREMIUM MAXIMUM ANNUAL MORTALITY AND EXPENSE RISK CHARGE AS A PERCENTAGE OF THE DAILY ACCUMULATED VALUE IN EACH SUBACCOUNT: 0.50% SUBACCOUNT FEES THAT REDUCE THE NET INVESTMENT FACTOR (SEE SECTION 9.3(4)) MAXIMUM ANNUAL FUND FACILITATION FEE: 0.50% A FUND FACILITATION FEE MAY BE CHARGED AS A PERCENTAGE OF THE DAILY ACCUMULATED VALUE IN EACH SUBACCOUNT. THE CHARGE MAY CHANGE AT ANY TIME, AND IT MAY VARY BY SUBACCOUNT. TRANSFERS (SEE SECTION 5.2) NUMBER OF TRANSFERS AVAILABLE IN A CONTRACT YEAR WITHOUT CHARGE: 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments CHARGE FOR EACH EXCESS TRANSFER: $25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option SURRENDER CHARGES# PREMIUM DURATION PERCENT IN YEARS APPLIED 1 – Life Only 26 Option 1% 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS1% 3+ 0% # FREE SURRENDER PERCENTAGE: 10%

Right to Cancel. You may return cancel this Contract policy within ten (10) 30 days after you of receiving it by returning this policy to Our administrative office. As soon as You deliver or mail this policy to Us, it is treated as if it was never issued. Your premium payment will be refunded when We receive itthis policy. To After the 30-day period, You may cancel this policy by notifying Us in writing that You wish to do so, mail it . This policy will be cancelled on the date We receive Your written notice unless Your notice specifies a later date. Cancellation of this policy will be without prejudice to us at our Service Center or any claim made prior to the agent who sold it to youtermination of this policy. This Contract will then be deemed void from President Assurity Life Insurance Company has signed this policy on the beginning. No withdrawal charge will be imposed, and we will refund the Contract Value, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, to be effective as of the Contract Issue Date. PACIFIC LIFE INSURANCE COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date NonAssurity Life Insurance Company Administrative Office XX Xxx 00000, Xxxxxxx, Xxxxxxxx 00000-Participating 0000 Toll-free (000) 000-0000 DISABILITY INCOME POLICY Guaranteed Renewable to Age [65] ● Qualified Right to Renew to Age 75 Company may change premium rates Representative Name: Address: [ [ [ ] ] ] [ ] [ ] Telephone: [ ] TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the Renewal 1 Right to Cancel 1 Policy Schedule 3 Definitions 4 Premiums 6 Premium Payments 6 Grace Period 6 Reinstatement 6 Refund of Unearned Premium 7 Total Disability Benefit 7 Monthly Benefit Payment 7 Total Disability for Part of a Month 7 Partial Disability Benefit 7 Monthly Benefit Payment 7 Partial Disability for Part of a Month 7 Presumptive Disability Benefit 7 Home Modification Benefit 7 Survivor Benefit 7 Survivor Benefit Beneficiary 8 Vocational Rehabilitation Benefit 8 Organ Donor Benefit 8 Waiver of Premium 8 Limitations 8 Foreign Travel and Residency 8 Mental/Nervous Disorders; Substance Abuse 8 Pre-existing Condition 8 Exclusions 8 Military Service 9 Minimum Investment Option Value Termination 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options Claims Procedure 9 Notice of Claim 9 Claim Forms 9 Proof of Loss 9 Time of Payment of Claims 10 Separate Account Time of Loss 10 CONTRACT VALUES Contract Value Payment of Claims 10 General Provisions 10 Application Statements 10 Assignment 10 Change of Beneficiary 10 Conformity with State Statutes 10 Entire Contract; Changes 10 Legal Action 11 Variable Account Value Misstatement of Age and/or Gender 11 Subaccount Value Misstatement of Income 11 Subaccount Unit Value Periods of Time 11 Net Investment Factor Physical Examination and Autopsy 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Time of Coverage 11 Time Limit on Certain Defenses 11 POLICY SCHEDULE INITIAL ANNUAL‌ FORM NO. FORM NAME BENEFIT PREMIUM I H0920 Disability Income Policy $[ ] Total Disability Monthly Benefit [ ] Maximum Benefit Period [ ] Elimination Period [ ] consecutive days Partial Disability Monthly Benefit [ ] Maximum Partial Benefit Period 6 Months [R I0921 [5-Year] Own Occupation Rider $[ ] R I0922 Automatic Benefit Increase Rider $[ ] R I0923 Catastrophic Disability Benefit Rider $[ ] [ [ [ Catastrophic Disability Monthly Benefit ] Maximum Catastrophic Benefit Period ] R I0924 Guaranteed Insurability Rider $[ ] Maximum Increase Amount ] R I0925 Non-Cancelable Rider $[ ] R I0926 Residual Disability Benefit Rider $[ ] Maximum Residual Benefit Period [ ] Elimination Period [ ] consecutive days R I0927 Retroactive Injury Benefit Rider $[ ] R I0928 Return of Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Rider $[ ] R I0929 Supplemental Disability Income Rider $[ ] Supplemental Disability Income Monthly Benefit [ ] Maximum Supplemental Benefit Period [ ] I R0721 Critical Illness Benefit Rider $[ ] Benefit Amount 19 Death [ ] Multi Life Discount -$[ ]] Insured Person: [ ] Policy Number: [ ] Age: [ Gender: [ ] ] Issue Date: [ Initial Premium: $[ ] ] Class: [ ] Premium Period: [ ] Premium Modes: Annual: $[ ] Quarterly: $[ ] Semi-Annual: $[ ] Monthly: $[ ] DEFINITIONS Any Gainful Occupation means an occupation, which fits You by education, training or experience and replaces or is expected to replace 60% or more of Annuitant 19 Death Your Prior Monthly Income. Complication of Owner 20 Death Pregnancy means a condition when the pregnancy is not terminated, with diagnosis which is distinct from pregnancy, adversely affected by pregnancy or caused by pregnancy, and includes, but which is not limited to: acute nephritis, anemia of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 BENEFICIARY PROVISIONS Designation pregnancy, nephrosis, cardiac decompensation, incompetent cervix, missed abortion, placenta previa, puerperal infection and similar medical and surgical conditions of Beneficiary 22 Adding comparable severity. It also includes emergency Caesarean section delivery, ectopic pregnancy which is surgically terminated, spontaneous termination of pregnancy which occurs during a period of gestation when a viable birth is not possible, hyperemesis gravidarum (pernicious vomiting), pre-eclampsia and eclampsia. Complications of Pregnancy cease upon termination of the pregnancy. Complication of Pregnancy does not include false labor, pre-term contractions of labor, advanced maternal age, occasional spotting, non-emergency Caesarean section delivery, postpartum depression, Physician prescribed rest during the period of pregnancy, morning sickness and similar conditions which, although associated with the management of a difficult pregnancy and back pain, are not medically classified as a distinct Complication of Pregnancy. Concurrent Disabilities means disabilities caused by more than one Injury or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice Sickness, whether they are related or not. Covered Accident means an unforeseen event or occurrence which directly, independently and exclusively results in an Injury and (a) occurs after this policy’s Issue Date; (b) occurs while this policy is in force; and (c) is not caused by or a result of Annuity Date 23 Default Annuity Option 23 Application an activity or condition listed in the Exclusions section of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONSthis policy.

Right to Cancel. You may return this Contract within ten (10) days after you receive it. To do so, mail it to us at our Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, and we We will refund the Contract ValueValue as of the date the returned Contract is delivered to us in good order, including any fees or charges for premium taxes and/or other taxes that were deducted from the Contract Value. Signed for the Company at Newport Beach, California, California to be effective as of the Contract Date. PACIFIC LIFE INSURANCE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 0.60% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would need to be at least 4.75% (net of fund level expenses). INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating — No Dividends are Payable 10-2170 TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Letter of Intent 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Sales Charge 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 14 Transfer Limitations and Restrictions 15 14 WITHDRAWAL PROVISIONS Withdrawals 16 15 Minimum Withdrawal Amount 16 Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 15 Amount Available for Withdrawal 16 Termination of Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 15 DEATH BENEFIT PROVISIONS Death Benefit 19 16 Death Benefit Amount 19 16 Death of Annuitant 19 16 Death of Owner 20 17 Death of Owner Distribution Rules 20 Interest on Death Benefit Proceeds 21 17 BENEFICIARY PROVISIONS Designation of Beneficiary 22 19 Adding or Changing Your Beneficiary 22 19 ANNUITY PROVISIONS Choice of Annuity Date 23 20 Default Annuity Option 23 20 Application of Contract Value 23 20 Your Selections 24 20 Fixed and Variable Annuities 24 21 Amount of Payments 24 21 Fixed Annuity Payments 24 21 Conversion to Current Rates 24 21 Variable Annuity Payments – — Subaccount Annuity Units 24 21 Subsequent Variable Payments 25 21 Annuity Unit Value 25 21 Periodic Payments 25 22 ANNUITY OPTIONS Option 1 – - Life Only 26 23 Option 2 – - Life with Period Certain 26 23 Option 3 – - Joint and Survivor Life 26 23 Option 4 – - Period Certain Only 26 23 ANNUITY OPTION TABLES Applicability of Rates 27 24 Basis of Computations 27 24 Rates Not Shown 27 24 CONTRACT SPECIFICATIONSSPECIFICATIONS Contract Data Contract Number: [VA99999999] Contract Date: [01-01-2009] Contract Type: [Non-Qualified] Initial Purchase Payment: [$500,000] Minimum Purchase Payment Amount: [$10,000] Maximum Purchase Payment Amount Without Home Office Approval: [$1,000,000] Owner(s): [Xxxx Xxx] [Xxxx Xxx] Annuitant(s): [Xxxx Xxx] Annuitant’s Age: [35] [Xxxx Xxx] [35] Annuity Date: [01-01-2027] Annuitant’s Sex: [Male] [Female] Fees & Charges M&E Risk Charge 0.60 % Administrative Fee 0.15 % Annual Fee $ 30.00 Sales Charge Schedule Maximum Sales Charge as a Percentage of Cumulative Value* Purchase Payment [Under $50,000] [5.5%] [$50,000 — $99,999] [4.5%] [$100,000 — $249,999] [3.5%] [$250,000 — $499,999] [2.5%] [$500,000 — $999,999] [2.0%] [$1,000,000 or more] [0.5%] * Cumulative Value means the greater of the following as of the day we receive the Purchase Payment: