Common use of RIGHT TO EXAMINE CONTRACT Clause in Contracts

RIGHT TO EXAMINE CONTRACT. The Owner may cancel this contract by returning it to the Company or one of its authorized representatives within ten days after receipt. If returned, the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposed. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the Company will refund the greater of the above or the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3031-99 TABLE OF CONTENTS SPECIFICATONS DEFINITIONS OWNER, ANNUITANT AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES GENERAL PROVISIONS Form A3031-99

RIGHT TO EXAMINE CONTRACT. The Owner Within 10 days of the date of receipt of this Contract by the Owner, it may cancel this contract be returned by returning delivering or mailing it to the Company or one of at its authorized representatives within ten days after receiptAnnuity Service Center. If returnedWhen this Contract is received by the Company, it will be voided as if it had never been in force. A written request for cancellation must accompany the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposedcontract. If, however, the contract is issued as an Individual Retirement Annuity (IRA)In such event, the Company will refund the greater Contract Value, computed at the end of the above or Valuation Period during which this Contract is received by the gross paymentsCompany at its Annuity Service Center. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity The Company (has reserved the Company) and right to allocate the Owner and is issued in consideration Contribution to the Money Market Sub-Account until the expiration of the Initial Payment shown on the Specifications pageRight to Examine Contract period. Additional Payments are permittedTHIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY George C. Nicholson, Ian K. Whitehead, SECRETARY PRESIDENT INDIVIDUAL VARIABLE SINGLE CONTRIBUTION IMMEDIATE ANNUITY CONTRACT NONPARTICIPATING ANNUITY PAYMENTS PROVIDED BY THIS CONTRACT ARE BASED ON THE INVESTMENT EXPERIENCE OF A SUB-ACCOUNT AND WILL VARY IN ACCORDANCE WITH THE PERFORMANCE OF THE SUB-ACCOUNT. Payments may be allocated to Variable Sub-Accounts, the Fixed DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS ON PAGE ____. {policy #} TABLE OF CONTENTS PAGE CONTRACT SCHEDULE DEFINITIONS CONTRIBUTION PROVISIONS Contribution Allocation of Contribution SEPARATE ACCOUNT PROVISIONS The Separate Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on Separate Account Charge Valuation of Assets VALUATION PROVISIONS Accumulation Units Accumulation Unit Value Annuity Unit Value Net Investment Factor CONTRACT VALUE TRANSFERS Transfers Before the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on Transfers After the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to ANNUITY PROVISIONS Annuity Date Non-Participating Form A3031-99 TABLE Determination of Annuity Payments Frequency and Amount of Annuity Payments SUSPENSION OR DEFERRAL OF CONTENTS SPECIFICATONS DEFINITIONS PAYMENT PROVISIONS OWNER, ANNUITANT AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES GENERAL ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS Form A3031-99Owner Annuitant Assignment Of The Contract

RIGHT TO EXAMINE CONTRACT. The Owner Within 10 days of the date of receipt of this Contract by the Owner, it may cancel this contract be returned by returning delivering or mailing it to the Company or one of at its authorized representatives within ten days after receiptAnnuity Service Center. If returnedWhen the Contract is received by the Company, the Company it will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposedbe voided as if it has never been in force. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the The Company will refund the greater Contract Value, computed at the end of the above or the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This Valuation Period during which this Contract is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, received by the Company agrees to pay annuity benefit payments beginning on the at its Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity DateService Center. THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY George C. Nicholson, Xxx X. Whitehead, Secrexxxx President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3031-99 INDIVIDUAL FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE CONTRIBUTIONS NONPARTICIPATING ANNUITY PAYMENTS, WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. TABLE OF CONTENTS SPECIFICATONS PAGE CONTRACT SCHEDULE DEFINITIONS OWNER, ANNUITANT AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER CONTRIBUTION PROVISIONS Contributions Allocation Of Contributions SEPARATE ACCOUNT PROVISIONS The Separate Account Valuation Of Assets Accumulation Units Accumulation Unit Value Mortality And Expense Risk Charge Distribution Charge Enhanced Death Benefit Charge FIXED ACCOUNT Fixed Account CONTRACT VALUE CONTRACT MAINTENANCE CHARGE Deduction For Contract Maintenance Charge TRANSFERS Transfers During The Accumulation Period Transfers During The Annuity Period WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES GENERAL PROVISIONS Form A3031-99Withdrawals Contingent Deferred Sales Charge

RIGHT TO EXAMINE CONTRACT. The Owner Within 10 days of the date of receipt of this Contract by the Owner, it may cancel this contract be returned by returning delivering or mailing it to the Company or one of at its authorized representatives within ten days after receiptAdministrative Office. If returnedWhen the Contract is received by the Company, the Company it will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposedbe voided as if it had never been in force. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the The Company will refund the greater Contract Value computed at the end of the above or Valuation Period during which the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This Contract is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, received by the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Dateat its Administrative Office. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SECRETARY PRESIDENT INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Non-Participating Form A3031-99 participating WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. NON FORFEITURE VALUES MAY INCREASE OR DECREASE BASED ON THE MARKET VALUE ADJUSTMENT SPECIFIED IN THIS CONTRACT. TABLE OF CONTENTS SPECIFICATONS CONTRACT SCHEDULE DEFINITIONS PURCHASE PAYMENT PROVISIONS PURCHASE PAYMENTS ALLOCATION OF PURCHASE PAYMENTS SEPARATE ACCOUNT PROVISIONS THE SEPARATE ACCOUNTS VALUATION OF ASSETS ACCUMULATION UNITS ACCUMULATION UNIT VALUE MORTALITY AND EXPENSE RISK CHARGE ADMINISTRATIVE CHARGE DISTRIBUTION EXPENSE CHARGE MVA ACCOUNT PROVISIONS MVA ACCOUNT INTEREST TO BE CREDITED GUARANTEE PERIOD MULTIPLE GUARANTEE PERIODS CHANGE IN GUARANTEE PERIOD MARKET VALUE ADJUSTMENT MVA ACCOUNT VALUES FIXED ACCOUNT PROVISIONS FIXED ACCOUNT VALUES INTEREST TO BE CREDITED CONTRACT VALUE CONTRACT MAINTENANCE CHARGE DEDUCTION FOR CONTRACT MAINTENANCE CHARGE TRANSFERS TRANSFERS DURING THE ACCUMULATION PERIOD TRANSFERS DURING THE ANNUITY PERIOD WITHDRAWAL PROVISIONS WITHDRAWALS CONTINGENT DEFERRED SALES CHARGE WITHDRAWAL CHARGE PROCEEDS PAYABLE ON DEATH DEATH OF OWNER DURING THE ACCUMULATION PERIOD DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD DEATH OF OWNER DURING THE ANNUITY PERIOD DEATH OF ANNUITANT PAYMENT OF DEATH BENEFIT BENEFICIARY CHANGE OF BENEFICIARY SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS OWNER JOINT OWNER ANNUITANT ASSIGNMENT OF A CONTRACT ANNUITY PROVISIONS GENERAL ANNUITY DATE SELECTION OF AN ANNUITY OPTION FREQUENCY AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE AMOUNT OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS OPTION 1. LIFETIME ONLY ANNUITY: OPTION 2. LIFETIME ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS WITH GUARANTEED PERIODS OPTION 3. INSTALLMENT REFUND LIFE ANNUITY OPTION 4. PAYMENT FOR A FIXED PERIOD: OPTION 5. JOINT AND SURVIVOR ANNUITY ANNUITY FIXED ANNUITY VARIABLE ANNUITY ANNUITY UNIT MORTALITY TABLES GENERAL PROVISIONS Form A3031THE CONTRACT MISSTATEMENT OF AGE INCONTESTABILITY MODIFICATION NON-99PARTICIPATING EVIDENCE OF SURVIVAL PROOF OF AGE PROTECTION OF PROCEEDS REPORTS TAXES REGULATORY REQUIREMENTS CONTRACT SCHEDULE OWNER: [John Doe] CONTRACT NUMBER: [10000] CONTRACT ISSUE DATE:[January 3, 1995] ANNUITY DATE: [January 3, 2000] PURCHASE PAYMENTS: INITIAL PURCHASE PAYMENT: [$50,000 Non-Qual; $10,000 IRA - 403(b) rollover] MINIMUM SUBSEQUENT PURCHASE PAYMENT: [$1,000; or if the automatic premium check option is elected: $250 monthly] MAXIMUM TOTAL PURCHASE PAYMENT: [$1,000,000, without prior Company approval]

RIGHT TO EXAMINE CONTRACT. The Owner may cancel this contract by returning it to the Company or one of its authorized representatives within ten days after receipt. If returned, the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposed. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the Company will refund the greater of the above or the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3031A3030-99 1 TABLE OF CONTENTS SPECIFICATONS DEFINITIONS OWNER, ANNUITANT AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES GENERAL PROVISIONS Form A3031A3030-9999 2 DEFINITIONS Accumulated Value The aggregate value of all accounts in this contract before the Annuity Date. As long as the Accumulated Value is greater than zero, the contract will stay in effect.

RIGHT TO EXAMINE CONTRACT. The Owner Within 10 days of the date of receipt of this Contract by the Owner, it may cancel this contract be returned by returning delivering or mailing it to the Company or one of at its authorized representatives within ten days after receiptAdministrative Office. If returnedWhen the Contract is received by the Company, the Company it will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposedbe voided as if it had never been in force. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the The Company will refund the greater Contract Value computed at the end of the above or Valuation Period during which the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This Contract is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, received by the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Dateat its Administrative Office. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SECRETARY PRESIDENT INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Non-Participating Form A3031-99 participating WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. NON FORFEITURE VALUES MAY INCREASE OR DECREASE BASED ON THE MARKET VALUE ADJUSTMENT SPECIFIED IN THIS CONTRACT. TABLE OF CONTENTS SPECIFICATONS CONTRACT SCHEDULE DEFINITIONS PURCHASE PAYMENT PROVISIONS PURCHASE PAYMENTS ALLOCATION OF PURCHASE PAYMENTS SEPARATE ACCOUNT PROVISIONS THE SEPARATE ACCOUNTS VARIABLE ACCOUNT VALUATION OF ASSETS ACCUMULATION UNITS ACCUMULATION UNIT VALUE MORTALITY AND EXPENSE RISK CHARGE ADMINISTRATIVE CHARGE DISTRIBUTION EXPENSE CHARGE MVA ACCOUNT PROVISIONS MVA ACCOUNT INTEREST TO BE CREDITED GUARANTEE PERIOD MULTIPLE GUARANTEE PERIODS CHANGE IN GUARANTEE PERIOD MARKET VALUE ADJUSTMENT MVA ACCOUNT VALUES FIXED ACCOUNT PROVISIONS FIXED ACCOUNT VALUES INTEREST TO BE CREDITED CONTRACT VALUE CONTRACT MAINTENANCE CHARGE DEDUCTION FOR CONTRACT MAINTENANCE CHARGE TRANSFERS TRANSFERS DURING THE ACCUMULATION PERIOD TRANSFERS DURING THE ANNUITY PERIOD WITHDRAWAL PROVISIONS WITHDRAWALS CONTINGENT DEFERRED SALES CHARGE WITHDRAWAL CHARGE PROCEEDS PAYABLE ON DEATH DEATH OF OWNER DURING THE ACCUMULATION PERIOD DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD DEATH BENEFIT OPTIONS DURING THE ACCUMULATION PERIOD DEATH OF OWNER DURING THE ANNUITY PERIOD DEATH OF ANNUITANT PAYMENT OF DEATH BENEFIT BENEFICIARY CHANGE OF BENEFICIARY SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION OWNER, ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS OWNER JOINT OWNER ANNUITANT ASSIGNMENT OF A CONTRACT ANNUITY PROVISIONS GENERAL ANNUITY DATE SELECTION OF AN ANNUITY OPTION FREQUENCY AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE AMOUNT OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS OPTION 1. LIFETIME ONLY ANNUITY: OPTION 2. LIFETIME ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS WITH GUARANTEED PERIODS OPTION 3. INSTALLMENT REFUND LIFE ANNUITY OPTION 4. PAYMENT FOR A FIXED PERIOD: OPTION 5. JOINT AND SURVIVOR ANNUITY ANNUITY FIXED ANNUITY VARIABLE ANNUITY ANNUITY UNIT MORTALITY TABLES GENERAL PROVISIONS Form A3031THE CONTRACT MISSTATEMENT OF AGE INCONTESTABILITY MODIFICATION NON-99PARTICIPATING EVIDENCE OF SURVIVAL PROOF OF AGE PROTECTION OF PROCEEDS REPORTS TAXES REGULATORY REQUIREMENTS CONTRACT SCHEDULE OWNER: [John Doe] CONTRACT NUMBER: [10000] CONTRACT ISSUE DATE:[January 3, 1995] ANNUITY DATE: [January 3, 2000] PURCHASE PAYMENTS: INITIAL PURCHASE PAYMENT: [$50,000 Non-Qual; $10,000 IRA - 403(b) rollover] MINIMXX SUBSEQUENT PURCHASE PAYMENT: [$1,000; or if the automatic premium check option is elected: $250 monthly] MAXIMUM TOTAL PURCHASE PAYMENT: [$1,000,000, without prior Company approval]

RIGHT TO EXAMINE CONTRACT. The Owner may cancel this contract by returning it to the Company or one of its authorized representatives within ten days after receipt. If returned, the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposed. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the Company will refund the greater of the above or the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3031A3030-99 1 TABLE OF CONTENTS SPECIFICATONS DEFINITIONS OWNER, ANNUITANT AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES GENERAL PROVISIONS Form A3031-99DEFINITIONS Accumulated Value The aggregate value of all accounts in this contract before the Annuity Date. As long as the Accumulated Value is greater than zero, the contract will stay in effect.

RIGHT TO EXAMINE CONTRACT. [The Contract Owner has the right to return this Contract. This Contract may cancel this contract be returned to the Company for any reason within ten (10) calendar days after its receipt by returning the Contract Owner. It may be returned by delivering or mailing it to the Company or one of at its authorized representatives within ten days after receiptAnnuity Service Center. If returnedWhen this Contract is received by the Company it will be voided as if it had never been in force. Upon its return, the Company will refund an amount equal to the Accumulated Valuerefund, after application of any Market Value Adjustment, plus any fees or other charges imposed. If, howeverwithin seven days, the contract is issued as an Individual Retirement Annuity (IRA), Contract Value next computed after receipt of this Contract by the Company will refund the greater of the above or the gross paymentsat its Annuity Service Center. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accountsmore or less than the Purchase Payment(s).] THIS IS A LEGAL CONTRACT BETWEEN THE CONTRACT OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SECRETARY PRESIDENT INDIVIDUAL VARIABLE DEFERRED ANNUITY CONTRACT WITH FLEXIBLE PURCHASE PAYMENTS Nonparticipating ANNUITY PAYMENTS, the Fixed Account or Guarantee Period AccountsWITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3031-99 TABLE OF CONTENTS SPECIFICATONS CONTRACT SCHEDULE 4 DEFINITIONS OWNER, ANNUITANT 5 PURCHASE PAYMENT PROVISIONS 8 PURCHASE PAYMENTS 8 SUBSEQUENT PURCHASE PAYMENTS 8 ALLOCATION OF PURCHASE PAYMENTS 8 SEPARATE ACCOUNT PROVISIONS 8 THE SEPARATE ACCOUNT 8 VALUATION OF ASSETS 9 ACCUMULATION UNITS 9 ACCUMULATION UNIT VALUE 9 MORTALITY AND BENEFICIARY EXPENSE RISK CHARGE 10 ADMINISTRATIVE CHARGE 10 MORTALITY AND EXPENSE GUARANTEE 10 ANNUAL CONTRACT MAINTENANCE CHARGE. 10 DEDUCTION FOR ANNUAL CONTRACT MAINTENANCE CHARGE 10 TRANSFER PROVISIONS 10 TRANSFERS DURING THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER PERIOD 10 TRANSFERS DURING THE ANNUITY PERIOD 11 WITHDRAWAL PROVISIONS 12 WITHDRAWAL 12 CONTINGENT DEFERRED SALES CHARGE 12 WITHDRAWAL CHARGE 13 PROCEEDS PAYABLE ON DEATH 13 DEATH OF CONTRACT OWNER DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT AMOUNT DURING THE ACCUMULATION PERIOD 13 DEATH BENEFIT PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS OPTIONS DURING THE ACCUMULATION PERIOD 13 DEATH OF CONTRACT OWNER DURING THE ANNUITY PERIOD 14 DEATH OF ANNUITANT ANNUITY 14 PAYMENT OF DEATH BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES 14 BENEFICIARY. 15 CHANGE OF BENEFICIARY 15 SUSPENSION OR DEFERRAL OF PAYMENTS PROVISION 15 ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS 16 ANNUITANT 16 CONTRACT OWNER 16 JOINT CONTRACT OWNERS 16 ASSIGNMENT OF THE CONTRACT 16 GENERAL PROVISIONS Form A303117 THE CONTRACT 17 CONTRACT CHANGES BY THE COMPANY 17 CONTRACT CHANGES BY THE CONTRACT OWNER 17 CONTRACT TERMINATION 18 INCONTESTABILITY 18 MISSTATEMENT OF AGE OR SEX 18 NON-99BUSINESS DAYS 19 NON-PARTICIPATING 19 PROTECTION OF PROCEEDS 19 REGULATORY REQUIREMENTS 19 REPORTS 19 PREMIUM AND OTHER TAXES 19 ANNUITY PROVISIONS 20 ANNUITY GUIDELINES 20 ANNUITY PAYMENTS 20 FIXED ANNUITY 21 VARIABLE ANNUITY 21 ANNUITY UNITS AND PAYMENTS 21 ANNUITY UNIT VALUE 21 ANNUITY OPTIONS 22 Annuity Option A - Life Income 22 Annuity Option B - Life Income with Period Certain 22 Annuity Option C - Joint and Last Survivor Annuity 22 Annuity Option D - Joint and 2/3 Survivor Annuity 22 Annuity Option E - Period Certain Annuity 22 ANNUITY RATES 23 FIXED ANNUITY RATES 23 Fixed Annuity Rates Table 1 24 Fixed Annuity Rates Table 2 25 Fixed Annuity Rates Table 3 26 Fixed Annuity Rates Table 4 27 VARIABLE ANNUITY RATES 28 Variable Annuity Rates Table 5 29 Variable Annuity Rates Table 6 30 Variable Annuity Rates Table 7 31 Variable Annuity Rates Table 8 32 INSERT SCHEDULE PAGES 4A+ HERE

RIGHT TO EXAMINE CONTRACT. The Owner Within 10 days of the date of receipt of this Contract by the Owner, it may cancel this contract be returned by returning delivering or mailing it to the Company or one of at its authorized representatives within ten days after receiptAnnuity Service Center. If returnedWhen this Contract is received by the Company, it will be voided as if it had never been in force. A written request for cancellation must accompany the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposedcontract. If, however, the contract is issued as an Individual Retirement Annuity (IRA)In such event, the Company will refund the greater of the above or the gross paymentsContribution THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY George C. Nicholson, Ian K. Whitehead, SECRETARY PRESIDENT INDIVIDUAL FIXED AND VARIABLE SINGLE CONTRIBUTION IMMEDIATE ANNUITY CONTRACT NONPARTICIPATING ANNUITY PAYMENTS PROVIDED BY THIS CONTRACT ARE BASED ON THE INVESTMENT EXPERIENCE OF A SUB-ACCOUNT AND WILL VARY IN ACCORDANCE WITH THE PERFORMANCE OF THE SUB-ACCOUNT, EXCEPT TO THE EXTENT LIMITED BY THE GUARANTEED MINIMUM ANNUITY PAYMENT FEATURE. ALLMERICA FINANCIAL LIFE INSURANCE AND DETAILS OF THE GUARANTEED MINIMUM ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications pagePAYMENT FEATURE ARE DESCRIBED UNDER ANNUITY PROVISIONS ON PAGE ____. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3031-99 {policy #} TABLE OF CONTENTS SPECIFICATONS PAGE CONTRACT SCHEDULE DEFINITIONS CONTRIBUTION PROVISIONS Contribution Allocation of Contribution SEPARATE ACCOUNT PROVISIONS The Separate Account Separate Account Charge Guaranteed Minimum Annuity Payment Charge Valuation of Assets VALUATION PROVISIONS Annuity Unit Value Net Investment Factor ANNUITY PROVISIONS Annuity Date Determination of Annuity Payments Guaranteed Minimum Annuity Payments SUSPENSION OR DEFERRAL OF PAYMENT PROVISIONS OWNER, ANNUITANT AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES GENERAL ANNUITANT, OWNERSHIP, ASSIGNMENT PROVISIONS Form A3031-99Owner Annuitant Assignment Of The Contract