|||GOLDEN
|||||AMERICAN
|||||||LIFE INSURANCE PREMIUM CREDIT RIDER
||||COMPANY
Golden American is a stock company domiciled in Delaware
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The Contract to which this Rider is attached is hereby modified by the
provisions of this Rider. This Rider's provisions control where there is a
conflict between this Rider and the Contract. This Rider is effective as of the
Contract Date.
Where used in this Rider, the term Contract shall mean Certificate when this
Rider is attached to a Certificate. The term Credit is as defined in the
Contract.
CREDIT ADDED TO PREMIUM
A Credit will be added to each Premium Payment applied to the Accumulation Value
within the first Contract Year. The Credit will be applied pro rata to each
Variable Separate Account Division or Fixed Allocation in the same ratio as the
applicable Premium Payment. The Credit is equal to [4%] of the Premium Payment
applied to the Accumulation Value.
FORFEITURE OF CREDIT
The amount of the Credit, but not the earnings thereon, will be forfeited if:
1. The "Right to Examine" provision is exercised, as stated in the Contract;
2. The Owner (or Annuitant if the Owner is a non-natural person) dies within
12 months of the Credit being applied; provided however, this provision
will not impact credits applied prior to the death of the Owner (the first
Owner to die, if there are Joint Owners) if the Contract is continued on
the life of a surviving spouse; or
3. All or part of a Premium Payment for which a Credit is applied is withdrawn
during the first seven Contract Years. For each withdrawal, the percentage
of the Credit to be forfeited will be calculated by multiplying the
percentage of the premium withdrawn which represents Premium Payments made
in the first Contract Year by the appropriate percentage shown below; or
4. The Contract is surrendered within the first seven Contract Years. The
percentage of the Credit to be forfeited will equal the amount shown below.
Complete Years Elapsed
At Time of Withdrawal
Or Full Surrender 01 2 3 4 5 6 7+
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Amount of Credit 100% 100% 75% 75% 50% 50% 25% 0%
Forfeited
Not withstanding 3. and 4. above:
(1) If the Contract is continued on the life of the surviving spouse, this
provision will not impact credits applied prior to the death of the Owner
(the first Owner to die, if there are Joint Owners) if a Partial Withdrawal
is made or the Contract is surrendered (a) after the death of the Owner;
and (b) such death occurs after the first Contract Year; or
(2) If a non-spouse beneficiary elects to continue the Contract as their own
for purposes of taking distributions as permitted under the Contract, this
provision will not impact credits applied prior to the death of the Owner
(the first Owner to die, if there are Joint Owners) if a Partial Withdrawal
is made or the Contract is surrendered after the death of the Owner.
Free Amounts, as described in the Contract, are not treated as withdrawals of
Premium Payments for purposes of 3. above. Any forfeited amounts will be
deducted on a pro rata basis from all Divisions in which the Accumulation Value
is allocated at the time of withdrawal.
GA-RA-1069 1
RIDER CHARGE
The charge for this Rider is equal to a maximum annual rate of [0.50%] of the
Contract's Accumulation Value, deducted daily at a rate of [0.001373]%, on a pro
rata basis from each Division in the Variable Separate Account and from
Accumulation Value in the Fixed or General Account, as applicable. It is
assessed for a [seven]-year period following the Contract Date. Any due and
unpaid Rider Charges existing at the time payments begin under an income option
will continue to be deducted, or, if a fixed Annuity Income Option is elected,
reflected in the payment rates.
Signed: /s/ ▇▇▇▇▇ ▇▇▇▇▇▇
President
GA-RA-1069 2
