Annuitant Owner [Thomas J. Doe] [John Q. Public] Initial Premium Annuity Option Annuity Commencement Date [$10,000] [Life 10 Year Certain] [January 1, 2053] Separate Account(s) Contract Number [Separate Account B ] [123456]Your Contract Benefits • February 2nd, 2018 • VOYA INSURANCE & ANNUITY Co • Life insurance
This is a legal Contract between its Owner and us. Please read it carefully. In this Contract you or your refers to the Owner shown above. We, our or us refers to Golden American Life Insurance Company. You may allocate this Contract's Accumulation Value among the Separate Account Divisions shown in the Schedule.
