Common use of Right to Examine Clause in Contracts

Right to Examine. If, within 10 days of receipt of this Contract, You are not satisfied with it, You may return the Contract to Our Annuity Service Center, or the agent through whom the Contract was purchased. We will refund the Contract Value computed as of the end of the business day we receive the Contract in Our Annuity Service Center. Upon such refund, the Contract shall be void. For Individual Retirement Annuities, a refund of the Purchase Payment(s) may be required. Therefore, We reserve the right to allocate Your Purchase Payment(s) to the Cash Management Portfolio until the end of the Right To Examine period. Thereafter, allocations will be made as shown on the Contract Purchase Payment Allocation page. THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY. /s/ JXX X. XXXXXXX Jxx X. Xxxxxxx President INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Nonparticipating TABLE OF CONTENTS Purchase Payment Allocation Page 4 Purchase Payment Provisions Page 10 Accumulation Provisions Page 10 Contract Data Page Contract Number: P9999999999 Annuity Service Center: P. O. BXX 00000 XXX XXXXXXX, XX 00000-0000 Owner: JXXX XXX Age at Issue: 35 Annuitant: JXXX XXX Initial Purchase Payment: [$10,000.00 ] Specified Annuity Date: July 1, 2031 Contract Date: July 1, 2001 Latest Annuity Date: July 1, 2061 Minimum Guarantee Rate for Fixed Account Options - 3.0% Separate Account Charge: [1.52%] Annual Contract Administration Charge: $30.00 Beneficiary: As named by You Separate Account: [FS Variable Separate Account] Optional Elections Maximum Anniversary Value Death Benefit Elected: Optional Election Charges: 0.20% For Inquiries [Call 1-000-000-0000] PURCHASE PAYMENT ALLOCATION Subaccounts _____% Growth-Income _____% Strategic Growth Portfolio _____% Alliance Growth _____% Real Estate _____% Conservative Growth Portfolio _____% Global Equities _____% Federated Value _____% Balanced Portfolio _____% Nations Capital Growth _____% Telecom Utility _____% Conservative Balanced Portfolio _____% Nations MidCap Growth 75 % Gxxxxxx Sxxxx Research _____% Flexible Income Portfolio _____% Nations Small Company _____% Mxxxxxx Growth _____% Corporate Bond _____% Nations Value Fund _____% MFS Growth & Income _____% Global Bond _____% Nations International Value _____% International Diversified Equities _____% Worldwide High Income _____% Nations Mxxxxxx 21st Century _____% Emerging Markets _____% High-Yield Bond _____% Nations Mxxxxxx Focused Equities _____% International Growth & Income _____% Government and Quality Bond _____% MFS Growth & Income _____% Pxxxxx Growth _____% Nations High Yield Bond _____% MFS Mid-Cap Growth _____% Aggressive Growth _____% Focus Growth Portfolio _____% International Diversified Equities _____% Blue Chip Growth _____% Focus Growth & Income Portfolio _____% Technology _____% “Dogs” of Wall Street _____% Focus TechNet Portfolio _____% Nations Asset Allocation _____% Growth Opportunities _____% Focus Value Portfolio _____% Asset Allocation _____% Growth _____% Equity Income Fund _____% MFS Total Return _____% Natural Resources _____% Growth & Income Fund _____% SunAmerica Balanced _____% Large Cap Growth Portfolio _____% Growth Fund of the Northwest _____% Short Term Income Fund _____% Large Cap Composite Portfolio _____% Growth Fund _____% Government Securities Fund _____% Large Cap Value Portfolio _____% Mid Cap Stock Fund _____% Income Fund _____% Mid Cap Growth Portfolio _____% Small Cap Stock Fund _____% Money Market Fund _____% Mid Cap Value Portfolio _____% International Growth Fund _____% MFS Mid-Cap Growth _____% Small Cap Portfolio _____% Alliance Growth _____% Technology _____% International Equity Portfolio _____% Global Equities _____% Capital Appreciation _____% Diversified Fixed Income Portfolio _____% Dxxxx Venture Value _____% Moderate Growth Strategy _____% Cash Management Portfolio _____% Nations Mxxxxxx Growth & Income _____% Balanced Growth Strategy _____% Growth Strategy _____% Nations Mxxxxxx International Opportunities _____% Conservative Growth Strategy _____% Small & Mid Cap Value _____% Foreign Value _____% Lord Axxxxx Series Fund Fixed Account Options Guarantee Period Initial Interest Rate 25.00% 3-Year Fixed MVA [3.00%] [0.00% 1-Year Fixed Non-MVA ] DCA Fixed Account Options 0.00% 6-Month DCA Fixed Non-MVA 0.00% 1-Year DCA Fixed Non-MVA

Right to Examine. If, within 10 days of receipt of this Contract, Contract (60 days if the Contract replaced any other life insurance or annuity contract(s)) You are not satisfied with it, You may return the this Contract to Our Annuity Service Center, Center or to the agent through whom the Contract was purchased. We The Company will refund the Purchase Payment or the Contract Value Value, whichever is greater, computed as of the end of the business day during which we receive the Contract in Our Annuity Service CenterContract. Upon such refund, the Contract shall be void. For Individual Retirement Annuities, or if a refund of the Purchase Payment(s) may be is otherwise required. Therefore, We reserve the right to allocate Your Purchase Payment(s) to the Cash Management Portfolio until the end of the Right To Examine period. ThereafterWith 30 days advance notice, allocations will be made as we may cease offering Fixed Account Guarantee Period Options and/or Dollar Cost Averaging Fixed Account Options if market conditions are such that we are not able to credit the Minimum Guarantee Rate shown on the Contract Purchase Payment Allocation pageData Page. THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY. /s/ JXX X. XXXXXXX Jxx X. Xxxxxxx President INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Nonparticipating TABLE OF CONTENTS Purchase Payment Allocation Page 4 Purchase Payment Provisions Page 10 Accumulation Provisions Page 10 Contract Data Page Contract Number: P9999999999 Annuity Service Center: P. O. BXX 00000 XXX XXXXXXX, XX 00000-0000 Owner: JXXX XXX Age at Issue: 35 Annuitant: JXXX XXX Initial Purchase Payment¬3 For Inquiries Call: [$10,000.00 ] Specified Annuity Date: July 1, 2031 Contract Date: July 1, 2001 Latest Annuity Date: July 1, 2061 Minimum Guarantee Rate for Fixed Account Options - 3.0% Separate Account Charge: [1.52%] Annual Contract Administration Charge: $30.00 Beneficiary: As named by You Separate Account: [FS Variable Separate Account] Optional Elections Maximum Anniversary Value Death Benefit Elected: Optional Election Charges: 0.20% For Inquiries [Call 10-000-000-0000] PURCHASE PAYMENT ALLOCATION Subaccounts _____% Growth-¬4 INDIVIDUAL FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT Nonparticipating FS-995 (12/10) 1 TABLE OF CONTENTS Definitions Page 5 Purchase Payment Provisions Page 8 Accumulation Provisions Page 8 Charges and Deductions Page 10 Transfer Provisions Page 11 Withdrawal Provisions Page 11 Annuity Provisions Page 16 General Provisions Page 18 Annuity Income _____% Strategic Growth Portfolio _____% Alliance Growth _____% Real Estate _____% Conservative Growth Portfolio _____% Global Equities _____% Federated Value _____% Balanced Portfolio _____% Nations Capital Growth _____% Telecom Utility _____% Conservative Balanced Portfolio _____% Nations MidCap Growth 75 % Gxxxxxx Sxxxx Research _____% Flexible Payment Options Page 21 Fixed Annuity Income Portfolio _____% Nations Small Company _____% Mxxxxxx Growth _____% Corporate Bond _____% Nations Value Fund _____% MFS Growth & Payment Options Table Page 22 Variable Annuity Income _____% Global Bond _____% Nations International Value _____% International Diversified Equities _____% Worldwide High Income _____% Nations Mxxxxxx 21st Century _____% Emerging Markets _____% High-Yield Bond _____% Nations Mxxxxxx Focused Equities _____% International Growth & Income _____% Government and Quality Bond _____% MFS Growth & Income _____% Pxxxxx Growth _____% Nations High Yield Bond _____% MFS Mid-Cap Growth _____% Aggressive Growth _____% Focus Growth Portfolio _____% International Diversified Equities _____% Blue Chip Growth _____% Focus Growth & Income Portfolio _____% Technology _____% “Dogs” of Wall Street _____% Focus TechNet Portfolio _____% Nations Asset Allocation _____% Growth Opportunities _____% Focus Value Portfolio _____% Asset Allocation _____% Growth _____% Equity Income Fund _____% MFS Total Return _____% Natural Resources _____% Growth & Income Fund _____% SunAmerica Balanced _____% Large Cap Growth Portfolio _____% Growth Fund of the Northwest _____% Short Term Income Fund _____% Large Cap Composite Portfolio _____% Growth Fund _____% Government Securities Fund _____% Large Cap Value Portfolio _____% Mid Cap Stock Fund _____% Income Fund _____% Mid Cap Growth Portfolio _____% Small Cap Stock Fund _____% Money Market Fund _____% Mid Cap Value Portfolio _____% International Growth Fund _____% MFS Mid-Cap Growth _____% Small Cap Portfolio _____% Alliance Growth _____% Technology _____% International Equity Portfolio _____% Global Equities _____% Capital Appreciation _____% Diversified Fixed Income Portfolio _____% Dxxxx Venture Value _____% Moderate Growth Strategy _____% Cash Management Portfolio _____% Nations Mxxxxxx Growth & Income _____% Balanced Growth Strategy _____% Growth Strategy _____% Nations Mxxxxxx International Opportunities _____% Conservative Growth Strategy _____% Small & Mid Cap Value _____% Foreign Value _____% Lord Axxxxx Series Fund Fixed Account Payment Options Guarantee Period Initial Interest Rate 25.00% 3-Year Fixed MVA Table Page 25 FS-995 (12/10) 2 CONTRACT DATA PAGE Contract Number: [3.00%P9999999999] ¬1 Contract Date: [0.00% 1-Year Fixed Non-MVA May 2, 2011] DCA Fixed Account Options 0.00% 6-Month DCA Fixed Non-MVA 0.00% 1-Year DCA Fixed Non-MVA¬1

Right to Examine. If, within 10 days of receipt of this Contract, Contract (60 days if the Contract replaced any other life insurance or annuity contract(s)) You are not satisfied with it, You may return the this Contract to Our Annuity Service Center, Center or to the agent through whom the Contract was purchased. We The Company will refund the greater of Purchase Payment(s) or the Contract Value reduced by the lesser of: (a) the value of all Payment Enhancement(s) as of the date on which We receive Your request to cancel Your Contract; or (b) the amount of all Payment Enhancement(s) We allocated to Your Contract Value, computed as of the end of the business day during which we receive the Contract in Our Annuity Service CenterContract. Upon such refund, the Contract shall be void. For Individual Retirement Annuities, or if a refund of the Purchase Payment(s) may be is otherwise required. Therefore, We reserve the right to allocate Your Purchase Payment(s) to the Cash Management Portfolio until the end of the Right To Examine period. ThereafterWith 30 days advance notice, allocations will be made as we may cease offering Fixed Account Guarantee Period Options and/or Dollar Cost Averaging Fixed Account Options if market conditions are such that we are not able to credit the Minimum Guarantee Rate shown on the Contract Purchase Payment Allocation pageData Page. THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY. /s/ JXX X. XXXXXXX Jxx X. Xxxxxxx President INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Nonparticipating TABLE OF CONTENTS Purchase Payment Allocation Page 4 Purchase Payment Provisions Page 10 Accumulation Provisions Page 10 Contract Data Page Contract Number: P9999999999 Annuity Service Center: P. O. BXX 00000 XXX XXXXXXX, XX 00000-0000 Owner: JXXX XXX Age at Issue: 35 Annuitant: JXXX XXX Initial Purchase Payment¬3 For Inquiries Call: [$10,000.00 ] Specified Annuity Date: July 1, 2031 Contract Date: July 1, 2001 Latest Annuity Date: July 1, 2061 Minimum Guarantee Rate for Fixed Account Options - 3.0% Separate Account Charge: [1.52%] Annual Contract Administration Charge: $30.00 Beneficiary: As named by You Separate Account: [FS Variable Separate Account] Optional Elections Maximum Anniversary Value Death Benefit Elected: Optional Election Charges: 0.20% For Inquiries [Call 10-000-000-0000] PURCHASE PAYMENT ALLOCATION Subaccounts _____% Growth¬4 INDIVIDUAL FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT Nonparticipating FS-993-PPS9 (12/10) 1 TABLE OF CONTENTS Definitions Page 5 Purchase Payment Provisions Page 8 Payment Enhancement Provisions Page 9 Accumulation Provisions Page 9 Charges and Deductions Page 10 Transfer Provisions Page 11 Withdrawal Provisions Page 11 Death Provisions Page 13 Annuity Provisions Page 16 General Provisions Page 18 Annuity Income _____% Strategic Growth Portfolio _____% Alliance Growth _____% Real Estate _____% Conservative Growth Portfolio _____% Global Equities _____% Federated Value _____% Balanced Portfolio _____% Nations Capital Growth _____% Telecom Utility _____% Conservative Balanced Portfolio _____% Nations MidCap Growth 75 % Gxxxxxx Sxxxx Research _____% Flexible Payment Options Page 21 Fixed Annuity Income Portfolio _____% Nations Small Company _____% Mxxxxxx Growth _____% Corporate Bond _____% Nations Value Fund _____% MFS Growth & Payment Options Table Page 22 Variable Annuity Income _____% Global Bond _____% Nations International Value _____% International Diversified Equities _____% Worldwide High Income _____% Nations Mxxxxxx 21st Century _____% Emerging Markets _____% HighPayment Options Table Page 25 FS-993-Yield Bond _____% Nations Mxxxxxx Focused Equities _____% International Growth & Income _____% Government and Quality Bond _____% MFS Growth & Income _____% Pxxxxx Growth _____% Nations High Yield Bond _____% MFS Mid-Cap Growth _____% Aggressive Growth _____% Focus Growth Portfolio _____% International Diversified Equities _____% Blue Chip Growth _____% Focus Growth & Income Portfolio _____% Technology _____% “Dogs” of Wall Street _____% Focus TechNet Portfolio _____% Nations Asset Allocation _____% Growth Opportunities _____% Focus Value Portfolio _____% Asset Allocation _____% Growth _____% Equity Income Fund _____% MFS Total Return _____% Natural Resources _____% Growth & Income Fund _____% SunAmerica Balanced _____% Large Cap Growth Portfolio _____% Growth Fund of the Northwest _____% Short Term Income Fund _____% Large Cap Composite Portfolio _____% Growth Fund _____% Government Securities Fund _____% Large Cap Value Portfolio _____% Mid Cap Stock Fund _____% Income Fund _____% Mid Cap Growth Portfolio _____% Small Cap Stock Fund _____% Money Market Fund _____% Mid Cap Value Portfolio _____% International Growth Fund _____% MFS Mid-Cap Growth _____% Small Cap Portfolio _____% Alliance Growth _____% Technology _____% International Equity Portfolio _____% Global Equities _____% Capital Appreciation _____% Diversified Fixed Income Portfolio _____% Dxxxx Venture Value _____% Moderate Growth Strategy _____% Cash Management Portfolio _____% Nations Mxxxxxx Growth & Income _____% Balanced Growth Strategy _____% Growth Strategy _____% Nations Mxxxxxx International Opportunities _____% Conservative Growth Strategy _____% Small & Mid Cap Value _____% Foreign Value _____% Lord Axxxxx Series Fund Fixed Account Options Guarantee Period Initial Interest Rate 25.00% 3-Year Fixed MVA PPS9 (12/10) 2 CONTRACT DATA PAGE Contract Number: [3.00%P9999999999] ¬1 Contract Date: [0.00% 1-Year Fixed Non-MVA May 2, 2011] DCA Fixed Account Options 0.00% 6-Month DCA Fixed Non-MVA 0.00% 1-Year DCA Fixed Non-MVA¬1

Right to Examine. If, within 10 days of receipt of this Contract, Contract (60 days if the Contract replaced any other life insurance or annuity contract(s)) You are not satisfied with it, You may return the this Contract to Our Annuity Service Center, Center or to the agent through whom the Contract was purchased. We The Company will refund the Purchase Payment or the Contract Value Value, whichever is greater, computed as of the end of the business day during which we receive the Contract in Our Annuity Service CenterContract. Upon such refund, the Contract shall be void. For Individual Retirement Annuities, or if a refund of the Purchase Payment(s) may be is otherwise required. Therefore, We reserve the right to allocate Your Purchase Payment(s) to the Cash Management Portfolio until the end of the Right To Examine period. ThereafterWith 30 days advance notice, allocations will be made as we may cease offering Fixed Account Guarantee Period Options and/or Dollar Cost Averaging Fixed Account Options if market conditions are such that we are not able to credit the Minimum Guarantee Rate shown on the Contract Purchase Payment Allocation pageData Page. THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY. /s/ JXX X. XXXXXXX Jxx X. Xxxxxxx President INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Nonparticipating TABLE OF CONTENTS Purchase Payment Allocation Page 4 Purchase Payment Provisions Page 10 Accumulation Provisions Page 10 Contract Data Page Contract Number: P9999999999 Annuity Service Center: P. O. BXX 00000 XXX XXXXXXX, XX 00000-0000 Owner: JXXX XXX Age at Issue: 35 Annuitant: JXXX XXX Initial Purchase Payment¬3 For Inquiries Call: [$10,000.00 ] Specified Annuity Date: July 1, 2031 Contract Date: July 1, 2001 Latest Annuity Date: July 1, 2061 Minimum Guarantee Rate for Fixed Account Options - 3.0% Separate Account Charge: [1.52%] Annual Contract Administration Charge: $30.00 Beneficiary: As named by You Separate Account: [FS Variable Separate Account] Optional Elections Maximum Anniversary Value Death Benefit Elected: Optional Election Charges: 0.20% For Inquiries [Call 10-000-000-0000] PURCHASE PAYMENT ALLOCATION Subaccounts _____% Growth¬4 INDIVIDUAL FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT Nonparticipating FS-993-PPIII (12/10) 1 TABLE OF CONTENTS Definitions Page 5 Purchase Payment Provisions Page 8 Accumulation Provisions Page 8 Charges and Deductions Page 10 Transfer Provisions Page 10 Withdrawal Provisions Page 11 Annuity Provisions Page 16 General Provisions Page 17 Annuity Income _____% Strategic Growth Portfolio _____% Alliance Growth _____% Real Estate _____% Conservative Growth Portfolio _____% Global Equities _____% Federated Value _____% Balanced Portfolio _____% Nations Capital Growth _____% Telecom Utility _____% Conservative Balanced Portfolio _____% Nations MidCap Growth 75 % Gxxxxxx Sxxxx Research _____% Flexible Payment Options Page 20 Fixed Annuity Income Portfolio _____% Nations Small Company _____% Mxxxxxx Growth _____% Corporate Bond _____% Nations Value Fund _____% MFS Growth & Payment Options Table Page 21 Variable Annuity Income _____% Global Bond _____% Nations International Value _____% International Diversified Equities _____% Worldwide High Income _____% Nations Mxxxxxx 21st Century _____% Emerging Markets _____% HighPayment Options Table Page 24 FS-993-Yield Bond _____% Nations Mxxxxxx Focused Equities _____% International Growth & Income _____% Government and Quality Bond _____% MFS Growth & Income _____% Pxxxxx Growth _____% Nations High Yield Bond _____% MFS Mid-Cap Growth _____% Aggressive Growth _____% Focus Growth Portfolio _____% International Diversified Equities _____% Blue Chip Growth _____% Focus Growth & Income Portfolio _____% Technology _____% “Dogs” of Wall Street _____% Focus TechNet Portfolio _____% Nations Asset Allocation _____% Growth Opportunities _____% Focus Value Portfolio _____% Asset Allocation _____% Growth _____% Equity Income Fund _____% MFS Total Return _____% Natural Resources _____% Growth & Income Fund _____% SunAmerica Balanced _____% Large Cap Growth Portfolio _____% Growth Fund of the Northwest _____% Short Term Income Fund _____% Large Cap Composite Portfolio _____% Growth Fund _____% Government Securities Fund _____% Large Cap Value Portfolio _____% Mid Cap Stock Fund _____% Income Fund _____% Mid Cap Growth Portfolio _____% Small Cap Stock Fund _____% Money Market Fund _____% Mid Cap Value Portfolio _____% International Growth Fund _____% MFS Mid-Cap Growth _____% Small Cap Portfolio _____% Alliance Growth _____% Technology _____% International Equity Portfolio _____% Global Equities _____% Capital Appreciation _____% Diversified Fixed Income Portfolio _____% Dxxxx Venture Value _____% Moderate Growth Strategy _____% Cash Management Portfolio _____% Nations Mxxxxxx Growth & Income _____% Balanced Growth Strategy _____% Growth Strategy _____% Nations Mxxxxxx International Opportunities _____% Conservative Growth Strategy _____% Small & Mid Cap Value _____% Foreign Value _____% Lord Axxxxx Series Fund Fixed Account Options Guarantee Period Initial Interest Rate 25.00% 3-Year Fixed MVA PPIII (12/10) 2 CONTRACT DATA PAGE Contract Number: [3.00%P9999999999] ¬1 Contract Date: [0.00% 1-Year Fixed Non-MVA May 2, 2011] DCA Fixed Account Options 0.00% 6-Month DCA Fixed Non-MVA 0.00% 1-Year DCA Fixed Non-MVA¬1

Right to Examine. If, within 10 days of receipt of this Contract, Contract (60 days if the Contract replaced any other life insurance or annuity contract(s)) You are not satisfied with it, You may return the this Contract or Your written request to cancel to Our Annuity Service Center, Center or to the agent through whom the Contract was purchased. We The Company will refund the greater of Purchase Payment(s) or the Contract Value reduced by the amount of all Payment Enhancement(s) We allocated to Your Contract Value, computed as of the end of the business day during which we receive the Contract or Your written request to cancel is received by Us in Our Annuity Service Centergood order. Upon such refund, the Contract shall be void. For Individual Retirement Annuities, or if a refund of the Purchase Payment(s) may be is otherwise required. Therefore, We reserve the right to allocate Your Purchase Payment(s) to the Cash Management Portfolio until the end of the Right To Examine period. ThereafterWith 30 days advance notice, allocations will be made as we may cease offering Fixed Account Guarantee Period Options and/or Dollar Cost Averaging Fixed Account Options if market conditions are such that we are not able to credit the Minimum Guarantee Rate shown on the Contract Purchase Payment Allocation pageData Page. THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY. /s/ JXX X. XXXXXXX Jxx X. Xxxxxxx President INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Nonparticipating TABLE OF CONTENTS Purchase Payment Allocation Page 4 Purchase Payment Provisions Page 10 Accumulation Provisions Page 10 Contract Data Page Contract Number: P9999999999 Annuity Service Center: P. O. BXX 00000 XXX XXXXXXX, XX 00000-0000 Owner: JXXX XXX Age at Issue: 35 Annuitant: JXXX XXX Initial Purchase Payment¬3 For Inquiries Call: [$10,000.00 ] Specified Annuity Date: July 1, 2031 Contract Date: July 1, 2001 Latest Annuity Date: July 1, 2061 Minimum Guarantee Rate for Fixed Account Options - 3.0% Separate Account Charge: [1.52%] Annual Contract Administration Charge: $30.00 Beneficiary: As named by You Separate Account: [FS Variable Separate Account] Optional Elections Maximum Anniversary Value Death Benefit Elected: Optional Election Charges: 0.20% For Inquiries [Call 10-000-000-0000] PURCHASE PAYMENT ALLOCATION Subaccounts _____% GrowthINDIVIDUAL FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT Nonparticipating FS-997-PVGII (5/11) 1 TABLE OF CONTENTS Definitions Page 5 Purchase Payment Provisions Page 8 Payment Enhancement Provisions Page 9 Accumulation Provisions Page 9 Charges and Deductions Page 10 Transfer Provisions Page 11 Withdrawal Provisions Page 11 Annuity Provisions Page 16 General Provisions Page 18 Annuity Income _____% Strategic Growth Portfolio _____% Alliance Growth _____% Real Estate _____% Conservative Growth Portfolio _____% Global Equities _____% Federated Value _____% Balanced Portfolio _____% Nations Capital Growth _____% Telecom Utility _____% Conservative Balanced Portfolio _____% Nations MidCap Growth 75 % Gxxxxxx Sxxxx Research _____% Flexible Payment Options Page 21 Fixed Annuity Income Portfolio _____% Nations Small Company _____% Mxxxxxx Growth _____% Corporate Bond _____% Nations Value Fund _____% MFS Growth & Payment Options Table Page 22 Variable Annuity Income _____% Global Bond _____% Nations International Value _____% International Diversified Equities _____% Worldwide High Income _____% Nations Mxxxxxx 21st Century _____% Emerging Markets _____% HighPayment Options Table Page 25 FS-997-Yield Bond _____% Nations Mxxxxxx Focused Equities _____% International Growth & Income _____% Government and Quality Bond _____% MFS Growth & Income _____% Pxxxxx Growth _____% Nations High Yield Bond _____% MFS Mid-Cap Growth _____% Aggressive Growth _____% Focus Growth Portfolio _____% International Diversified Equities _____% Blue Chip Growth _____% Focus Growth & Income Portfolio _____% Technology _____% “Dogs” of Wall Street _____% Focus TechNet Portfolio _____% Nations Asset Allocation _____% Growth Opportunities _____% Focus Value Portfolio _____% Asset Allocation _____% Growth _____% Equity Income Fund _____% MFS Total Return _____% Natural Resources _____% Growth & Income Fund _____% SunAmerica Balanced _____% Large Cap Growth Portfolio _____% Growth Fund of the Northwest _____% Short Term Income Fund _____% Large Cap Composite Portfolio _____% Growth Fund _____% Government Securities Fund _____% Large Cap Value Portfolio _____% Mid Cap Stock Fund _____% Income Fund _____% Mid Cap Growth Portfolio _____% Small Cap Stock Fund _____% Money Market Fund _____% Mid Cap Value Portfolio _____% International Growth Fund _____% MFS Mid-Cap Growth _____% Small Cap Portfolio _____% Alliance Growth _____% Technology _____% International Equity Portfolio _____% Global Equities _____% Capital Appreciation _____% Diversified Fixed Income Portfolio _____% Dxxxx Venture Value _____% Moderate Growth Strategy _____% Cash Management Portfolio _____% Nations Mxxxxxx Growth & Income _____% Balanced Growth Strategy _____% Growth Strategy _____% Nations Mxxxxxx International Opportunities _____% Conservative Growth Strategy _____% Small & Mid Cap Value _____% Foreign Value _____% Lord Axxxxx Series Fund Fixed Account Options Guarantee Period Initial Interest Rate 25.00% 3-Year Fixed MVA PVGII (5/11) 2 Contract Number: [3.00%P9999999999] ¬1 Contract Date: [0.00% 1-Year Fixed Non-MVA May 2, 2011] DCA Fixed Account Options 0.00% 6-Month DCA Fixed Non-MVA 0.00% 1-Year DCA Fixed Non-MVA¬1

Right to Examine. If, within 10 days of receipt of this Contract, Contract (60 days if the Contract replaced any other life insurance or annuity contract(s)) You are not satisfied with it, You may return the this Contract to Our Annuity Service Center, Center or to the agent through whom the Contract was purchased. We The Company will refund the Purchase Payment or the Contract Value Value, whichever is greater, computed as of the end of the business day during which we receive the Contract in Our Annuity Service CenterContract. Upon such refund, the Contract shall be void. For Individual Retirement Annuities, or if a refund of the Purchase Payment(s) may be is otherwise required. Therefore, We reserve the right to allocate Your Purchase Payment(s) to the Cash Management Portfolio until the end of the Right To Examine period. ThereafterWith 30 days advance notice, allocations will be made as we may cease offering Fixed Account Guarantee Period Options and/or Dollar Cost Averaging Fixed Account Options if market conditions are such that we are not able to credit the Minimum Guarantee Rate shown on the Contract Purchase Payment Allocation pageData Page. THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY. /s/ JXX X. XXXXXXX Jxx X. Xxxxxxx President INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Nonparticipating TABLE OF CONTENTS Purchase Payment Allocation Page 4 Purchase Payment Provisions Page 10 Accumulation Provisions Page 10 Contract Data Page Contract Number: P9999999999 Annuity Service Center: P. O. BXX 00000 XXX XXXXXXX, XX 00000-0000 Owner: JXXX XXX Age at Issue: 35 Annuitant: JXXX XXX Initial Purchase Payment¬3 For Inquiries Call: [$10,000.00 ] Specified Annuity Date: July 1, 2031 Contract Date: July 1, 2001 Latest Annuity Date: July 1, 2061 Minimum Guarantee Rate for Fixed Account Options - 3.0% Separate Account Charge: [1.52%] Annual Contract Administration Charge: $30.00 Beneficiary: As named by You Separate Account: [FS Variable Separate Account] Optional Elections Maximum Anniversary Value Death Benefit Elected: Optional Election Charges: 0.20% For Inquiries [Call 10-000-000-0000] PURCHASE PAYMENT ALLOCATION Subaccounts _____% Growth¬4 INDIVIDUAL FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT Nonparticipating FS-993-PPS7 (12/10) 1 TABLE OF CONTENTS Definitions Page 5 Purchase Payment Provisions Page 8 Accumulation Provisions Page 8 Charges and Deductions Page 10 Transfer Provisions Page 10 Withdrawal Provisions Page 11 Death Provisions Page 12 Annuity Provisions Page 16 General Provisions Page 17 Annuity Income _____% Strategic Growth Portfolio _____% Alliance Growth _____% Real Estate _____% Conservative Growth Portfolio _____% Global Equities _____% Federated Value _____% Balanced Portfolio _____% Nations Capital Growth _____% Telecom Utility _____% Conservative Balanced Portfolio _____% Nations MidCap Growth 75 % Gxxxxxx Sxxxx Research _____% Flexible Payment Options Page 21 Fixed Annuity Income Portfolio _____% Nations Small Company _____% Mxxxxxx Growth _____% Corporate Bond _____% Nations Value Fund _____% MFS Growth & Payment Options Table Page 22 Variable Annuity Income _____% Global Bond _____% Nations International Value _____% International Diversified Equities _____% Worldwide High Income _____% Nations Mxxxxxx 21st Century _____% Emerging Markets _____% HighPayment Options Table Page 25 FS-993-Yield Bond _____% Nations Mxxxxxx Focused Equities _____% International Growth & Income _____% Government and Quality Bond _____% MFS Growth & Income _____% Pxxxxx Growth _____% Nations High Yield Bond _____% MFS Mid-Cap Growth _____% Aggressive Growth _____% Focus Growth Portfolio _____% International Diversified Equities _____% Blue Chip Growth _____% Focus Growth & Income Portfolio _____% Technology _____% “Dogs” of Wall Street _____% Focus TechNet Portfolio _____% Nations Asset Allocation _____% Growth Opportunities _____% Focus Value Portfolio _____% Asset Allocation _____% Growth _____% Equity Income Fund _____% MFS Total Return _____% Natural Resources _____% Growth & Income Fund _____% SunAmerica Balanced _____% Large Cap Growth Portfolio _____% Growth Fund of the Northwest _____% Short Term Income Fund _____% Large Cap Composite Portfolio _____% Growth Fund _____% Government Securities Fund _____% Large Cap Value Portfolio _____% Mid Cap Stock Fund _____% Income Fund _____% Mid Cap Growth Portfolio _____% Small Cap Stock Fund _____% Money Market Fund _____% Mid Cap Value Portfolio _____% International Growth Fund _____% MFS Mid-Cap Growth _____% Small Cap Portfolio _____% Alliance Growth _____% Technology _____% International Equity Portfolio _____% Global Equities _____% Capital Appreciation _____% Diversified Fixed Income Portfolio _____% Dxxxx Venture Value _____% Moderate Growth Strategy _____% Cash Management Portfolio _____% Nations Mxxxxxx Growth & Income _____% Balanced Growth Strategy _____% Growth Strategy _____% Nations Mxxxxxx International Opportunities _____% Conservative Growth Strategy _____% Small & Mid Cap Value _____% Foreign Value _____% Lord Axxxxx Series Fund Fixed Account Options Guarantee Period Initial Interest Rate 25.00% 3-Year Fixed MVA PPS7 (12/10) 2 CONTRACT DATA PAGE Contract Number: [3.00%P9999999999]¬1 Contract Date: [May 2, 2011] [0.00% 1-Year Fixed Non-MVA ] DCA Fixed Account Options 0.00% 6-Month DCA Fixed Non-MVA 0.00% 1-Year DCA Fixed Non-MVA¬1

Right to Examine. If, within 10 days of receipt of this Contract, Contract (60 days if the Contract replaced any other life insurance or annuity contract(s)) You are not satisfied with it, You may return the this Contract to Our Annuity Service Center, Center or to the agent through whom the Contract was purchased. We The Company will refund the Purchase Payment or the Contract Value Value, whichever is greater, computed as of the end of the business day during which we receive the Contract in Our Annuity Service CenterContract. Upon such refund, the Contract shall be void. For Individual Retirement Annuities, or if a refund of the Purchase Payment(s) may be is otherwise required. Therefore, We reserve the right to allocate Your Purchase Payment(s) to the Cash Management Portfolio until the end of the Right To Examine period. ThereafterWith 30 days advance notice, allocations will be made as we may cease offering Fixed Account Guarantee Period Options and/or Dollar Cost Averaging Fixed Account Options if market conditions are such that we are not able to credit the Minimum Guarantee Rate shown on the Contract Purchase Payment Allocation pageData Page. THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY. /s/ JXX X. XXXXXXX Jxx X. Xxxxxxx President INDIVIDUAL FIXED AND VARIABLE ANNUITY CONTRACT Nonparticipating TABLE OF CONTENTS Purchase Payment Allocation Page 4 Purchase Payment Provisions Page 10 Accumulation Provisions Page 10 Contract Data Page Contract Number: P9999999999 Annuity Service Center: P. O. BXX 00000 XXX XXXXXXX, XX 00000-0000 Owner: JXXX XXX Age at Issue: 35 Annuitant: JXXX XXX Initial Purchase Payment¬3 For Inquiries Call: [$10,000.00 ] Specified Annuity Date: July 1, 2031 Contract Date: July 1, 2001 Latest Annuity Date: July 1, 2061 Minimum Guarantee Rate for Fixed Account Options - 3.0% Separate Account Charge: [1.52%] Annual Contract Administration Charge: $30.00 Beneficiary: As named by You Separate Account: [FS Variable Separate Account] Optional Elections Maximum Anniversary Value Death Benefit Elected: Optional Election Charges: 0.20% For Inquiries [Call 10-000-000-0000] PURCHASE PAYMENT ALLOCATION Subaccounts _____% Growth-¬4 INDIVIDUAL FIXED AND VARIABLE DEFERRED ANNUITY CONTRACT Nonparticipating FS-993 (12/10) 1 TABLE OF CONTENTS Definitions Page 5 Purchase Payment Provisions Page 8 Accumulation Provisions Page 8 Charges and Deductions Page 10 Transfer Provisions Page 10 Withdrawal Provisions Page 11 Annuity Provisions Page 16 General Provisions Page 17 Annuity Income _____% Strategic Growth Portfolio _____% Alliance Growth _____% Real Estate _____% Conservative Growth Portfolio _____% Global Equities _____% Federated Value _____% Balanced Portfolio _____% Nations Capital Growth _____% Telecom Utility _____% Conservative Balanced Portfolio _____% Nations MidCap Growth 75 % Gxxxxxx Sxxxx Research _____% Flexible Payment Options Page 20 Fixed Annuity Income Portfolio _____% Nations Small Company _____% Mxxxxxx Growth _____% Corporate Bond _____% Nations Value Fund _____% MFS Growth & Payment Options Table Page 21 Variable Annuity Income _____% Global Bond _____% Nations International Value _____% International Diversified Equities _____% Worldwide High Income _____% Nations Mxxxxxx 21st Century _____% Emerging Markets _____% High-Yield Bond _____% Nations Mxxxxxx Focused Equities _____% International Growth & Income _____% Government and Quality Bond _____% MFS Growth & Income _____% Pxxxxx Growth _____% Nations High Yield Bond _____% MFS Mid-Cap Growth _____% Aggressive Growth _____% Focus Growth Portfolio _____% International Diversified Equities _____% Blue Chip Growth _____% Focus Growth & Income Portfolio _____% Technology _____% “Dogs” of Wall Street _____% Focus TechNet Portfolio _____% Nations Asset Allocation _____% Growth Opportunities _____% Focus Value Portfolio _____% Asset Allocation _____% Growth _____% Equity Income Fund _____% MFS Total Return _____% Natural Resources _____% Growth & Income Fund _____% SunAmerica Balanced _____% Large Cap Growth Portfolio _____% Growth Fund of the Northwest _____% Short Term Income Fund _____% Large Cap Composite Portfolio _____% Growth Fund _____% Government Securities Fund _____% Large Cap Value Portfolio _____% Mid Cap Stock Fund _____% Income Fund _____% Mid Cap Growth Portfolio _____% Small Cap Stock Fund _____% Money Market Fund _____% Mid Cap Value Portfolio _____% International Growth Fund _____% MFS Mid-Cap Growth _____% Small Cap Portfolio _____% Alliance Growth _____% Technology _____% International Equity Portfolio _____% Global Equities _____% Capital Appreciation _____% Diversified Fixed Income Portfolio _____% Dxxxx Venture Value _____% Moderate Growth Strategy _____% Cash Management Portfolio _____% Nations Mxxxxxx Growth & Income _____% Balanced Growth Strategy _____% Growth Strategy _____% Nations Mxxxxxx International Opportunities _____% Conservative Growth Strategy _____% Small & Mid Cap Value _____% Foreign Value _____% Lord Axxxxx Series Fund Fixed Account Payment Options Guarantee Period Initial Interest Rate 25.00% 3-Year Fixed MVA Table Page 24 FS-993 (12/10) 2 Contract Number: [3.00%P9999999999]¬1 Contract Date: [May 2, 2011] [0.00% 1-Year Fixed Non-MVA ] DCA Fixed Account Options 0.00% 6-Month DCA Fixed Non-MVA 0.00% 1-Year DCA Fixed Non-MVA¬1