0001193125-23-301258 Sample Contracts

SCHEDULE A SEPARATE ACCOUNTS AND ASSOCIATED CONTRACTS
Pia Variable Annuity Account I • December 21st, 2023

This Schedule A to the Participation Agreement dated June 8,2021 by and among the parties identified below is updated and effective as of August 18, 2023 and replaces all prior versions of this Schedule A.

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Contract Owner: WILLIAM PENN Contract Number: 8888888 Joint Contract HANNAH PENN Owner: Contract Date: January 1, 2024 Annuity Date: January 1, 2079 Annuitant: WILLIAM PENN Age of Annuitant: 45 Joint Annuitant: HANNAH PENN Age of Joint 45 Annuitant:
Pia Variable Annuity Account I • December 21st, 2023

This is a legal Contract between the Contract Owner and The Penn Insurance and Annuity Company. Please read the Contract carefully.

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