Contract Data Page Sample Contracts

CONTRACT NUMBER [P9999999999] ¬1 OWNER [JOHN DOE] ¬1

Contract Data Page • April 29th, 2013 • Fs Variable Separate Account

• Contract Type
  Contract Data Page
• Filed
  April 29th, 2013
• Company
  Fs Variable Separate Account

THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (“We”, “Us”, the “Company”, or “US Life”) agrees to provide benefits to the Owner in accordance with the provisions set forth in this Contract and in consideration of the Application and/or confirmation thereof and Purchase Payments We receive.