Common use of Right to Cancel Clause in Contracts

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract within [ 10 ] days after you receive it by returning it to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return packageContract Date. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Surrender or Withdrawal 8 Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT 8 PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of an Owner 8 Annuitant 19 Death of the Annuitant 8 Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit 8 Payment Proceeds 21 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 22 Adding or Delay in Payment Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 23 Default Annuity Income Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 9 24 Fixed Income Annuity Payments 9 24 Conversion to Current Rates 24 Variable Income Annuity Payments 10 – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Values 10 Selection Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1227 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the postmark date on dollar amount of the properly addressed variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contractall product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 0.90% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would need to be more or less than your Purchase Payments5.05%. THIS IS A LEGALLY BINDING INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 12 Annual Fee 12 Mortality and Expense Risk Charge (“Risk Charge”) 12 Premium Taxes 12 Other Taxes 12 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 13 Free Withdrawals 13 Earnings 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 14 Transfer Limitations and Restrictions 14 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 15 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Transfer Option 15 Portfolio Rebalancing Transfer Option 15 Earnings Sweep Transfer Option 16 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 17 Minimum Withdrawal Amount 17 Amount Available for Withdrawal 17 Pre-authorized Withdrawals 17 Termination of Surrender or Withdrawal 8 Contract 17 CONTRACT LOANS Loans 18 Loan Procedures 18 Loan Account 18 Loan Terms 18 Loan Interest Rate 18 Repayment Terms 18 DEATH BENEFIT 8 PROVISIONS Death Benefit 20 Death Benefit Amount 20 Death of an Owner 8 Annuitant 20 Death of the Annuitant 8 Owner 21 Death of Owner Distribution Rules 21 Interest on Death Benefit 8 Payment Proceeds 22 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 23 Adding or Delay in Payment Changing Your Beneficiary 23 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 23 Default Annuity Income Option 23 Application of Contract Value 24 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 9 24 Fixed Income Annuity Payments 9 25 Conversion to Current Rates 25 Variable Income Annuity Payments 10 — Subaccount Annuity Units 25 Subsequent Variable Payments 25 Annuity Unit Values 10 Selection Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 — Life Only 26 Option 2 — Life with Period Certain 26 Option 3 — Joint and Survivor Life 26 Option 4 — Period Certain Only 27 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1227 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract within [ 10 ] days after you receive it by returning it to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. /s/ Xxxx X. Xxxxx /s/ Xxxxxxx X. Xxxx THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1212 [ PRODUCT A ] SCHEDULE CONTRACT NUMBER ISSUE DATE [ VA00000001 ] [ February 1, 2012 ]

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation No withdrawal charge will be determined by the postmark date on the properly addressed imposed, and postage-paid return package. We we will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value.] Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx Chairman and Chief Executive Officer Secretary ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Fixed and/or Variable Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating ICC12:10-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] 1252 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 SPECIFICATIONS 3A DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 12 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Premium Taxes 13 Other Taxes 13 Withdrawal Charge 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 17 Minimum Withdrawal 8 Amount 17 Amount Available for Withdrawal 17 Full Withdrawal 17 DEATH BENEFIT 8 TERMS AND PROVISIONS Definition of Terms 18 Death Benefit 18 Standard Death Benefit Amount 18 Death of an Owner 8 19 Death of the Annuitant 8 19 Death Benefit 8 Payment of the Death Benefit 9 Suspension Owner Distribution Rules 19 BENEFICIARY PROVISIONS Designation of Beneficiary 21 Adding or Delay in Payment Changing Your Beneficiary 21 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 22 Default Annuity Income Option 22 Application of Contract Value 22 Your Selections 23 Fixed and Variable Annuities 23 Amount of Payments 9 23 Fixed Income Annuity Payments 9 23 Conversion to Current Rates 23 Variable Income Annuity Payments 10 —Subaccount Annuity Units 24 Subsequent Variable Payments 24 Annuity Unit Values 10 Selection Value 24 Periodic Payments 24 ANNUITY OPTIONS Option 1: Life Only 25 Option 2: Life with Period Certain 25 Option 3: Joint and Survivor Life 25 Option 4: Period Certain Only 25 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12Tables 27 ICC12:10-1252 CONTRACT SPECIFICATIONS Contract Data Contract Number: [VA99999999] Contract Date: [01-01-2011] Contract Type: [Non-Qualified]

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract within [ 10 ] days after you receive it by returning it to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California to this Contractbe effective as of the Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 1.50% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would need to be more or less than your Purchase Payments5.75%. THIS IS A LEGALLY BINDING INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282No Dividends are Payable 10-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] 2128 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Surrender or Withdrawal 8 Contract 16 DEATH BENEFIT 8 PROVISIONS Death Benefit 17 Death Benefit Amount 17 Death of an Owner 8 Annuitant 17 Death of the Annuitant 8 Owner 18 Death Benefit 8 Payment of the Death Benefit 9 Suspension Owner Distribution Rules 18 BENEFICIARY PROVISIONS Designation of Beneficiary 20 Adding or Delay in Payment Changing Your Beneficiary 20 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 21 Default Annuity Income Option 21 Application of Contract Value 21 Your Selections 22 Fixed and Variable Annuities 22 Amount of Payments 9 22 Fixed Income Annuity Payments 9 22 Conversion to Current Rates 22 Variable Income Annuity Payments 10 — Subaccount Annuity Units 22 Subsequent Variable Payments 23 Annuity Unit Values 10 Selection Value 23 Periodic Payments 23 ANNUITY OPTIONS Option 1 - Life Only 24 Option 2 - Life with Period Certain 24 Option 3 - Joint and Survivor Life 24 Option 4 - Period Certain Only 24 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1225 Basis of Computations 25 Rates Not Shown 25 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation No withdrawal charge will be determined by the postmark date on the properly addressed imposed, and postage-paid return package. We we will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order,, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary INDIVIDUAL LIMITED PREMIUM DEFERRED FIXED AND VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 FIXED ACCOUNT OPTIONS Fixed Account Options (FAOs) 10 Minimum Allocation Amount 10 Crediting Interest 10 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 11 Separate Account 5 11 CONTRACT VALUES Contract Value 12 FAO Value 12 Variable Account Value 6 Accumulation 12 Subaccount Value 12 Subaccount Unit Values 6 Value 13 Net Investment Factor 7 TRANSFERS 7 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 14 Mortality and Expense Risk Charge (“Risk Charge”) 14 Premium Taxes 14 Other Taxes 14 Transfer Fee 14 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 14 Amount of Withdrawal Charge 15 Free Withdrawals 15 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent 16 Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 between a Variable Investment Option and a FAO 16 Transfers Among the Variable Investment Options 16 Transfer Limitations and Restrictions 16 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 18 Minimum Withdrawal Amount 18 Amount Available for Withdrawal 18 Termination of Surrender or Withdrawal 8 Contract 18 DEATH BENEFIT 8 PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of an Owner 8 Annuitant 19 Death of the Annuitant 8 Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit 8 Payment Proceeds 21 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 22 Adding or Delay in Payment of Death Benefit 9 Changing Your Beneficiary 22 ANNUITY INCOME PAYMENTS 9 PROVISIONS Date Annuity Payments Begin 23 Default Annuity Date 9 and Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection Option 23 Change of Annuity Date and Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase 23 Application of Contract Value 23 Conversion to Current Rates 11 FIXED 23 ANNUITY OPTIONS Option 1 - Life Only 24 Option 2 - Life with Period Certain 24 Option 3 - Joint and Survivor Life 24 Option 4 - Period Certain Only 24 ANNUITY OPTION TABLES 12 VARIABLE ANNUITY TABLES 12Applicability of Rates 25 Basis of Computations 25 Rates Not Shown 25 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of This Contract will then be deemed void from the cancellation will be determined by the postmark date on the properly addressed and postage-paid return packagebeginning. We will promptly return refund the Contract Value plus Value, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Transfer Fee 13 Withdrawal Fee 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 15 Minimum Withdrawal Amount 15 Amount Available for Withdrawal 15 Termination of Surrender or Withdrawal 8 Contract 15 CONTRACT LOANS Loans 16 Loan Procedures 16 Loan Account 16 Loan Terms 16 Loan Interest Rate 16 Repayment Terms 16 DEATH BENEFIT 8 PROVISIONS Death Benefit 18 Death Benefit Amount 18 Death of an Owner 8 Annuitant 18 Death of the Annuitant 8 Owner 19 Death of Owner Distribution Rules 19 Interest on Death Benefit 8 Payment Proceeds 20 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 21 Adding or Delay in Payment Changing Your Beneficiary 21 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 22 Default Annuity Income Option 22 Application of Contract Value 22 Your Selections 23 Fixed and Variable Annuities 23 Amount of Payments 9 23 Fixed Income Annuity Payments 9 23 Conversion to Current Rates 23 Variable Income Annuity Payments 10 – Subaccount Annuity Units 23 Subsequent Variable Payments 23 Annuity Unit Values 10 Selection Value 24 Periodic Payments 24 ANNUITY OPTIONS Option 1 – Life Only 25 Option 2 – Life with Period Certain 25 Option 3 – Joint and Survivor Life 25 Option 4 – Period Certain Only 25 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1226 Basis of Computations 26 Rates Not Shown 26 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return packageContract Date. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Market Value Adjustment Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 GUARANTEED INTEREST OPTIONS Guaranteed Interest Options (GIOs) 10 Minimum Allocation Amount 10 Crediting of Purchase Payments 5 Interest 10 Rollover to New GIO 10 Market Value Adjustment (MVA) 11 Waiver of Market Value Adjustment 11 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 12 Separate Account 5 12 CONTRACT VALUES Contract Value 13 GIO Value 13 Variable Account Value 6 Accumulation 13 Subaccount Value 13 Subaccount Unit Values 6 Value 14 Net Investment Factor 7 TRANSFERS 7 14 Loan Account Value 14 CHARGES, FEES AND DEDUCTIONS Administrative Fee 15 Annual Fee 15 Mortality and Expense Risk Charge (“Risk Charge”) 15 Premium Taxes 15 Other Taxes 15 Transfer Fee 15 Withdrawal Fee 15 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 15 Amount of Withdrawal Charge 16 Free Withdrawals 16 Earnings 16 TRANSFER PROVISIONS Transfers 7 Limitation 17 Transfer Limitations and Restrictions 17 Special Restrictions on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 from the GIOs 18 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 18 Minimum Withdrawal Amount 18 Amount Available for Withdrawal 19 Special Restrictions on Withdrawals from the GIOs 19 Termination of Surrender or Withdrawal 8 Contract 19 CONTRACT LOANS Loans 20 Loan Procedures 20 Loan Account 20 Loan Terms 20 Loan Interest Rate 20 Repayment Terms 20 DEATH BENEFIT 8 PROVISIONS Death Benefit 22 Death Benefit Amount 22 Death of an Owner 8 Annuitant 22 Death of the Annuitant 8 Owner 23 Death of Owner Distribution Rules 23 Interest on Death Benefit 8 Payment Proceeds 24 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 25 Adding or Delay in Payment Changing Your Beneficiary 25 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 26 Default Annuity Income Option 26 Application of Contract Value 26 Your Selections 27 Fixed and Variable Annuities 27 Amount of Payments 9 27 Fixed Income Annuity Payments 9 27 Conversion to Current Rates 27 Variable Income Annuity Payments 10 – Subaccount Annuity Units 27 Subsequent Variable Payments 28 Annuity Unit Values 10 Selection Value 28 Periodic Payments 28 ANNUITY OPTIONS Option 1 – Life Only 29 Option 2 – Life with Period Certain 29 Option 3 – Joint and Survivor Life 29 Option 4 – Period Certain Only 29 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1230 Basis of Computations 30 Rates Not Shown 30 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation No withdrawal charge will be determined by the postmark date on the properly addressed imposed, and postage-paid return package. We we will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating — No Dividends are Payable ICC16:10-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] 1600 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 12 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Premium Taxes 13 Other Taxes 13 Withdrawal Charge 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 16 Minimum Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 16 Amount Available for Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1216

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation No withdrawal charge will be determined by the postmark date on the properly addressed imposed, and postage-paid return package. We we will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value.] Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx Chairman and Chief Executive Officer Secretary ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Fixed and/or Variable Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee DEFINITION OF TERMS 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 6 PURCHASE PAYMENTS 5 Initial Purchase Payment 8 Additional Purchase Payments 5 8 Purchase Payment Allocation of Purchase Payments 5 8 Allocations During the Right to Cancel Period 8 Minimum Investment Option Value 8 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 9 Separate Account 5 9 CONTRACT VALUES Contract Value 10 Variable Account Value 6 Accumulation 10 Subaccount Value 10 Subaccount Unit Values 6 Value 10 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 11 CHARGES, FEES AND DEDUCTIONS Administrative Fee 12 Mortality and Expense Risk Charge (“Risk Charge”) 12 Annual Fee 12 Premium Taxes 12 Other Taxes 12 Withdrawal Charge 12 Amount of Withdrawal Charge 12 Free Withdrawals 13 Earnings 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 16 Minimum Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12Amount 16 Amount Available for Withdrawal 16 Full Withdrawal 16

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract within [ 10 ] days after you receive it by returning it to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ WX 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1212 [ PROTECTIVE VARIABLE ANNUITY INVESTORS SERIES ADV ] SCHEDULE CONTRACT NUMBER ISSUE DATE [ Contract Number ] [ Month Day, Year ] OWNER 1 BIRTH DATE OF OWNER 1 [ Owner 1 Name ] [ Month Day, Year ] OWNER 2 BIRTH DATE OF OWNER 2 [ Owner 2 Name or “None” ] [ Month Day, Year or “Not Applicable” ] ANNUITANT BIRTH DATE OF ANNUITANT [ Annuitant Name ] [ Month Day, Year ] BENEFICIARY ANNUITY DATE As contained in our records [ Month Day, Year ] DEATH BENEFIT [ “Contract Value” or “Return of Purchase Payments” ] AGENT INSURANCE REGULATORY AUTHORITY [ Agent Name ] [ State Department of Insurance Name ] [ Agency Name ] [ State DOI Phone ] [ Agency Street Address ] [ State DOI Email or Website ] [ Agency City State ZIP ] [ Agency Phone ] INITIAL PURCHASE PAYMENT TAX-QUALIFIED STATUS [ $nnn,nnn.nn ] [ Type of Qualified Plan or “Non-Qualified” ]

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract within [ 10 ] days after you receive it by returning it to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1212 Protective Dimensions Schedule CONTRACT NUMBER ISSUE DATE OWNER 1 BIRTH DATE OF OWNER 1

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract within [ 10 ] days after you receive it by returning it to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1212 [PROTECTIVE DIMENSIONS IV VARIABLE ANNUITY SCHEDULE] CONTRACT NUMBER ISSUE DATE OWNER 1 BIRTH DATE OF OWNER 1 OWNER 2 BIRTH DATE OF OWNER 2 ANNUITANT BIRTH DATE OF ANNUITANT BENEFICIARY ANNUITY DATE As contained in our records PROTECTED LIFETIME INCOME OPTION DEATH BENEFIT AGENT INSURANCE REGULATORY AUTHORITY INITIAL PURCHASE PAYMENT TAX-QUALIFIED STATUS INTEREST RATES FOR THE GUARANTEED ACCOUNT Annual Effective Interest Rates for the FIXED ACCOUNT — Guaranteed Account on the Issue Date: DCA ACCOUNT 1 — DCA ACCOUNT 2 — Non-Forfeiture Interest Rate (NFIR) for the Guaranteed Account: The Contract’s NFIR for the Guaranteed Account was established on the Issue Date and will not change. It was determined by taking the 5-Year Constant Maturity Treasury Rate as of the January 31 prior to the May 1 — April 30 annual period during which the Contract was issued, subtracting 1.25%, and rounding the result to the nearest 0.05%. The NFIR cannot be less than 1.00% and will not be more than 3.00%. Interest rates declared by the Company for the Guaranteed Account will be at least equal to the Contract’s NFIR. ICC11-VDA-P-2006SO-1 [DIMENSIONS IV 11/19] [PROTECTIVE DIMENSIONS IV VARIABLE ANNUITY SCHEDULE], continued CONTRACT LIMITATIONS, FEES, AND CHARGES Maximum Issue Date: We will not issue a Contract on or after the oldest Owner’s or Xxxxxxxxx’s 86th birthday.

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. [You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value.] Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx Chairman and Chief Executive Officer Secretary ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating ICC12:10-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] 1225 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 SPECIFICATIONS 3A DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 PAGE WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 16 Minimum Withdrawal 8 Amount 16 Full Withdrawal 16 Amount Available for Withdrawal 16 DEATH BENEFIT 8 PROVISIONS Death Benefit 17 Death Benefit Amount 17 Death of an Owner 8 Annuitant 17 Death of the Annuitant 8 Owner 18 Death Benefit 8 Payment of the Death Benefit 9 Suspension Owner Distribution Rules 18 BENEFICIARY PROVISIONS Designation of Beneficiary 20 Adding or Delay in Payment Changing Your Beneficiary 20 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of 21 Default Annuity Option 10 21 Application of Contract Value 21 Your Selections 22 Fixed Annuities 22 Amount of Payments 22 Fixed Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Payments 22 Conversion to Current Rates 11 FIXED 22 Periodic Payments 22 ANNUITY OPTIONS Option 1 – Life Only 23 Option 2 – Life with Period Certain 23 Option 3 – Joint and Survivor Life 23 Option 4 – Period Certain Only 23 ANNUITY OPTION TABLES 12 VARIABLE ANNUITY TABLES 12Applicability of Rates 24 Basis of Computations 24 Rates Not Shown 24 ICC12:10-1225 2 CONTRACT SPECIFICATIONS Contract Data

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the postmark date on dollar amount of the properly addressed variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contractall product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 1.00% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would be more or less than your Purchase Payments5.15%. THIS IS A LEGALLY BINDING INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 12 Annual Fee 12 Mortality and Expense Risk Charge (“Risk Charge”) 12 Premium Taxes 12 Other Taxes 12 Contingent Deferred Sales Charge (“Withdrawal Charge”) 13 Amount of Withdrawal Charge 13 Free Withdrawals 13 Earnings 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 14 Transfer Limitations and Restrictions 14 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 15 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Transfer Option 15 Portfolio Rebalancing Transfer Option 15 Earnings Sweep Transfer Option 16 PAGE WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 17 Minimum Withdrawal Amount 17 Amount Available for Withdrawal 17 Pre-authorized Withdrawals 17 Termination of Surrender or Withdrawal 8 Contract 17 CONTRACT LOANS Loans 18 Loan Procedures 18 Loan Account 18 Loan Terms 18 Loan Interest Rate 18 Repayment Terms 18 DEATH BENEFIT 8 PROVISIONS Death Benefit 20 Death Benefit Amount 20 Death of an Owner 8 Annuitant 20 Death of the Annuitant 8 Owner 21 Death of Owner Distribution Rules 21 Interest on Death Benefit 8 Payment Proceeds 22 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 23 Adding or Delay in Payment Changing Your Beneficiary 23 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 23 Default Annuity Income Option 23 Application of Contract Value 24 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 9 24 Fixed Income Annuity Payments 9 25 Conversion to Current Rates 25 Variable Income Annuity Payments 10 – Subaccount Annuity Units 25 Subsequent Variable Payments 25 Annuity Unit Values 10 Selection Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 27 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1227 Basis of Computations 27 Rates Not Shown 27 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California to this Contractbe effective as of the Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 0.60% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would need to be more or less than your Purchase Paymentsat least 4.75% (net of fund level expenses). THIS IS A LEGALLY BINDING INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating — No Dividends are Payable 10-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] 2170 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Letter of Intent 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Sales Charge 13 Premium Taxes 13 Other Taxes 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 15 Minimum Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 15 Amount Available for Withdrawal 8 15 DEATH BENEFIT 8 PROVISIONS Death Benefit 16 Death Benefit Amount 16 Death of an Owner 8 Annuitant 16 Death of Owner 17 Death of Owner Distribution Rules 17 BENEFICIARY PROVISIONS Designation of Beneficiary 19 Adding or Changing Your Beneficiary 19 ANNUITY PROVISIONS Choice of Annuity Date 20 Default Annuity Option 20 Application of Contract Value 20 Your Selections 20 Fixed and Variable Annuities 21 Amount of Payments 21 Fixed Annuity Payments 21 Conversion to Current Rates 21 Variable Annuity Payments — Subaccount Annuity Units 21 Subsequent Variable Payments 21 Annuity Unit Value 21 Periodic Payments 22 ANNUITY OPTIONS Option 1 - Life Only 23 Option 2 - Life with Period Certain 23 Option 3 - Joint and Survivor Life 23 Option 4 - Period Certain Only 23 ANNUITY OPTION TABLES Applicability of Rates 24 Basis of Computations 24 Rates Not Shown 24 CONTRACT SPECIFICATIONS Contract Data Contract Number: [VA99999999] Contract Date: [01-01-2009] Contract Type: [Non-Qualified] Initial Purchase Payment: [$500,000] Minimum Purchase Payment Amount: [$10,000] Maximum Purchase Payment Amount Without Home Office Approval: [$1,000,000] Owner(s): [Xxxx Xxx] [Xxxx Xxx] Annuitant(s): [Xxxx Xxx] Annuitant’s Age: [35] [Xxxx Xxx] [35] Annuity Date: [01-01-2027] Annuitant’s Sex: [Male] [Female] Fees & Charges M&E Risk Charge 0.60 % Administrative Fee 0.15 % Annual Fee $ 30.00 Sales Charge Schedule Maximum Sales Charge as a Percentage of Cumulative Value* Purchase Payment [Under $50,000] [5.5%] [$50,000 — $99,999] [4.5%] [$100,000 — $249,999] [3.5%] [$250,000 — $499,999] [2.5%] [$500,000 — $999,999] [2.0%] [$1,000,000 or more] [0.5%] * Cumulative Value means the Annuitant 8 Death Benefit 8 Payment greater of the Death Benefit 9 Suspension or Delay in Payment following as of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed the day we receive the Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12Payment:

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts Sales Charges, charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Letter of Intent 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Sales Charge 13 Premium Taxes 13 Other Taxes 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 16 Minimum Withdrawal 8 Amount 16 Full Withdrawal 16 Amount Available for Withdrawal 16 DEATH BENEFIT 8 PROVISIONS Death Benefit 17 Death Benefit Amount 17 Death of an Owner 8 Annuitant 17 Death of the Annuitant 8 Owner 18 Death of Owner Distribution Rules 18 Interest on Death Benefit 8 Payment Proceeds 19 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 20 Adding or Delay in Payment Changing Your Beneficiary 20 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 21 Default Annuity Income Option 21 Application of Contract Value 21 Your Selections 21 Fixed and Variable Annuities 22 Amount of Payments 9 22 Fixed Income Annuity Payments 9 22 Conversion to Current Rates 22 Variable Income Annuity Payments 10 — Subaccount Annuity Units 22 Subsequent Variable Payments 22 Annuity Unit Values 10 Selection Value 22 Periodic Payments 23 ANNUITY OPTIONS Option 1 — Life Only 24 Option 2 — Life with Period Certain 24 Option 3 — Joint and Survivor Life 24 Option 4 — Period Certain Only 24 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1225 Basis of Computations 25 Rates Not Shown 25 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this end your participation in the Contract within [ 10 ] ten days after you receive it by returning it the Contract and Certificate to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it Return by mailmail is effective on being post-marked, effective date of the cancellation will be determined by the postmark date on the properly addressed and postagepostage pre-paid return packagepaid. We will promptly return the Contract Value plus the sales charge and any premium tax or other amounts deducted from your the Purchase Payments before they were applied to this the Contract. The amount returned we return may be more or less than your Purchase Payments. Xxxx X. Xxxxx President Xxxxxxx X. Xxxx Secretary THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Xxxxx X. X. Box 1928, 10648 Birmingham, Alabama 3528235202-8238 0648 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] This Page Intentionally left blank. INSERT CORRECT DATA PAGE HERE SCHEDULE—if issued to Contractholder CERTIFICATE—if issued to Participant TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Definitions 7 Parties to the Contract 8 Company 2 8 Owner 2 8 Change of Owner 2 8 Beneficiary 2 8 Change of Beneficiary 2 8 Annuitant 2 8 Change of Annuitant 3 8 Payee 3 GENERAL PROVISIONS 3 8 General Provisions 8 Entire Contract 3 8 Modification of the Contract 3 Non-Participating 3 8 Incontestability 3 Application of Law 3 Form Approval 3 9 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 9 Written Notice 9 Error in Age or Gender 4 9 Settlement 4 9 Receipt of Payment 4 9 Protection of Proceeds 9 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 9 Non-Participating 9 Minimum Values 9 Application of Law 9 Reports 10 Purchase Payments 5 10 Purchase Payment 10 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 10 No Default 10 Sales Charge 10 Sales Charge 10 Letter of Intent 10 Variable Account 10 General Description 5 10 Sub-Accounts of the Variable Account 5 11 Variable Account Value 6 11 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 12 Transfers 7 Limitation on Frequent 12 Transfers 7 12 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 12 Surrenders 8 Withdrawals 8 Surrender Value 8 13 Full and Partial Surrenders 13 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 13 5 Death Benefit 13 Death of an Owner 8 13 Death of the Annuitant 8 Death Benefit 8 13 Payment of the Death Benefit 9 14 Suspension or Delay in of Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 14 Annuitization 14 Annuity Commencement Date 9 14 Annuity Income Payments 9 14 Fixed Income Payments 9 14 Variable Income Payments 10 14 Annuity Unit Values 10 15 Selection of Annuity Option 10 15 Annuity Options 11 15 Minimum Amounts 11 16 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1216 Fixed Annuity Tables 17 Variable Annuity Tables 17

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract policy within [ 10 ] 30 days after you receive of receiving it by returning it this policy to our Our administrative office. As soon as You deliver or mail this policy to Us, or it is treated as if it was never issued. Your premium payment will be refunded when We receive this policy. After the 30-day period, You may cancel this policy by notifying Us in writing that You wish to do so. This policy will be cancelled on the date We receive Your written notice unless Your notice specifies a later date. Cancellation of this policy will be without prejudice to any claim made prior to the agent who sold it to you, with a written request for cancellationtermination of this policy. If you return it by mail, effective date of the cancellation will be determined by the postmark date President Assurity Life Insurance Company has signed this policy on the properly addressed and postageIssue Date. Secretary Assurity Life Insurance Company Administrative Office XX Xxx 00000, Xxxxxxx, Xxxxxxxx 00000-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Toll-8238 free (000) 000-0000 DISABILITY INCOME POLICY Guaranteed Renewable to Age [65] ICC11-VDA-P-2006C-WW ● Qualified Right to Renew to Age 75 Company may change premium rates Representative Name: Address: [ 12/11 [ [ ] ] ] [ ] [ ] Telephone: [ ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS Renewal 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change Right to Cancel 1 Policy Schedule 3 Definitions 4 Premiums 6 Premium Payments 6 Grace Period 6 Reinstatement 6 Refund of Owner 2 Unearned Premium 7 Total Disability Benefit 7 Monthly Benefit Payment 7 Total Disability for Part of a Month 7 Partial Disability Benefit 7 Monthly Benefit Payment 7 Partial Disability for Part of a Month 7 Presumptive Disability Benefit 7 Home Modification Benefit 7 Survivor Benefit 7 Survivor Benefit Beneficiary 2 8 Vocational Rehabilitation Benefit 8 Organ Donor Benefit 8 Waiver of Premium 8 Limitations 8 Foreign Travel and Residency 8 Mental/Nervous Disorders; Substance Abuse 8 Pre-existing Condition 8 Exclusions 8 Military Service 9 Termination 9 Claims Procedure 9 Notice of Claim 9 Claim Forms 9 Proof of Loss 9 Time of Payment of Claims 10 Time of Loss 10 Payment of Claims 10 General Provisions 10 Application Statements 10 Assignment 10 Change of Beneficiary 2 Annuitant 2 Change 10 Conformity with State Statutes 10 Entire Contract; Changes 10 Legal Action 11 Misstatement of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification Age and/or Gender 11 Misstatement of Income 11 Periods of Time 11 Physical Examination and Autopsy 11 Time of Coverage 11 Time Limit on Certain Defenses 11 POLICY SCHEDULE INITIAL ANNUAL‌ FORM NO. FORM NAME BENEFIT PREMIUM I H0920 Disability Income Policy $[ ] Total Disability Monthly Benefit [ ] Maximum Benefit Period [ ] Elimination Period [ ] consecutive days Partial Disability Monthly Benefit [ ] Maximum Partial Benefit Period 6 Months [R I0921 [5-Year] Own Occupation Rider $[ ] R I0922 Automatic Benefit Increase Rider $[ ] R I0923 Catastrophic Disability Benefit Rider $[ ] [ [ [ Catastrophic Disability Monthly Benefit ] Maximum Catastrophic Benefit Period ] R I0924 Guaranteed Insurability Rider $[ ] Maximum Increase Amount ] R I0925 Non-Cancelable Rider $[ ] R I0926 Residual Disability Benefit Rider $[ ] Maximum Residual Benefit Period [ ] Elimination Period [ ] consecutive days R I0927 Retroactive Injury Benefit Rider $[ ] R I0928 Return of Premium Benefit Rider $[ ] R I0929 Supplemental Disability Income Rider $[ ] Supplemental Disability Income Monthly Benefit [ ] Maximum Supplemental Benefit Period [ ] I R0721 Critical Illness Benefit Rider $[ ] Benefit Amount [ ] Multi Life Discount -$[ ]] Insured Person: [ ] Policy Number: [ ] Age: [ Gender: [ ] ] Issue Date: [ Initial Premium: $[ ] ] Class: [ ] Premium Period: [ ] Premium Modes: Annual: $[ ] Quarterly: $[ ] Semi-Annual: $[ ] Monthly: $[ ] DEFINITIONS Any Gainful Occupation means an occupation, which fits You by education, training or experience and replaces or is expected to replace 60% or more of Your Prior Monthly Income. Complication of Pregnancy means a condition when the pregnancy is not terminated, with diagnosis which is distinct from pregnancy, adversely affected by pregnancy or caused by pregnancy, and includes, but which is not limited to: acute nephritis, anemia of pregnancy, nephrosis, cardiac decompensation, incompetent cervix, missed abortion, placenta previa, puerperal infection and similar medical and surgical conditions of comparable severity. It also includes emergency Caesarean section delivery, ectopic pregnancy which is surgically terminated, spontaneous termination of pregnancy which occurs during a period of gestation when a viable birth is not possible, hyperemesis gravidarum (pernicious vomiting), pre-eclampsia and eclampsia. Complications of Pregnancy cease upon termination of the Contract 3 Nonpregnancy. Complication of Pregnancy does not include false labor, pre-Participating 3 Incontestability 3 Application term contractions of Law 3 Form Approval 3 Assignment 3 Protection labor, advanced maternal age, occasional spotting, non-emergency Caesarean section delivery, postpartum depression, Physician prescribed rest during the period of Proceeds 4 Minimum Values 4 Reports 4 Error pregnancy, morning sickness and similar conditions which, although associated with the management of a difficult pregnancy and back pain, are not medically classified as a distinct Complication of Pregnancy. Concurrent Disabilities means disabilities caused by more than one Injury or Sickness, whether they are related or not. Covered Accident means an unforeseen event or occurrence which directly, independently and exclusively results in Age an Injury and (a) occurs after this policy’s Issue Date; (b) occurs while this policy is in force; and (c) is not caused by or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death a result of an Owner 8 Death activity or condition listed in the Exclusions section of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12this policy.

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 [ten (10)] days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation No withdrawal charge will be determined by the postmark date on the properly addressed imposed, and postage-paid return package. We we will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating — No Dividends are Payable ICC10:10-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] 1180 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 10 Additional Purchase Payments 10 Purchase Payment Allocation 10 Allocations During the Right to Cancel Period 10 Minimum Investment Option Value 10 VARIABLE INVESTMENT OPTIONS Variable Investment Options 11 Separate Account 11 CONTRACT VALUES Contract Value 12 Variable Account Value 12 Subaccount Value 12 Subaccount Unit Value 12 Net Investment Factor 13 Loan Account Value 13 Persistency Credit 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 14 Mortality and Expense Risk Charge (“Risk Charge”) 14 Annual Fee 14 Premium Taxes 14 Other Taxes 14 Withdrawal Charge 14 Amount of Withdrawal Charge 15 Free Withdrawals 15 Earnings 15 TRANSFER PROVISIONS Transfers 16 Transfer Limitations and Restrictions 16 WITHDRAWAL PROVISIONS Withdrawals 18 Minimum Withdrawal Amount 18 Full Withdrawal 18 Amount Available for Withdrawal 18 DEATH BENEFIT PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of Annuitant 19 Death of Owner 2 Beneficiary 2 Change 20 Death of Owner Distribution Rules 20 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Annuity Date 23 Default Annuity Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 24 Fixed Annuity Payments 24 Conversion to Current Rates 24 Variable Annuity Payments — Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 — Life Only 26 Option 2 Annuitant — Life with Period Certain 26 Option 3 — Joint and Survivor Life 26 Option 4 — Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Rates 27 Basis of Computations 27 Rates Not Shown 27 ICC10:10-1180 CONTRACT SPECIFICATIONS Contract Data Contract Number: [VA99999999] Contract Date: [01-01-2009] Contract Type: [Non-Qualified] Initial Purchase Payment: [$500,000] Minimum Purchase Payment Amount: [$10,000] Maximum Purchase Payment Amount: [$1,000,000] Owner(s): [Xxxx Xxx] [Xxxx Xxx] Annuitant(s): [Xxxx Xxx] [Xxxx Xxx] Annuitant’s Age: [35] [35] Annuity Date: [01-01-2027] Annuitant’s Sex: [Male] [Female] Fees & Charges M&E Risk Charge: 1.15 % Administrative Fee: 0.15 % Annual Fee: $ 30.00 Withdrawal Charges Age of Purchase Payment in Contract Years Withdrawal Charge % 1 7 % 2 Change 7 % 3 6 % 4 6 % 5 5 % 6 3 % 7 1 % 8 and Later 0 % Optional Riders Name Annual Charge % Maximum Annual Charge % [Stepped-Up Death Benefit Rider 0.20%] 0.20 % [Guaranteed Withdrawal Benefit III-B Rider 1.05%] 1.50 % [Core Withdrawal Benefit II-A Rider 0.65%] 1.20 % For a complete description of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification the charges, fees and deductions shown above and other applicable fees and charges, refer to the Charges, Fees and Deductions section of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts the Annual Charge provision of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12Optional Rider(s) shown above, if applicable. ICC10:10-1180

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return packageContract Date. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL LIMITED PREMIUM DEFERRED FIXED AND VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 FIXED ACCOUNT OPTIONS Fixed Account Options (FAOs) 10 Minimum Allocation Amount 10 Crediting Interest 10 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 11 Separate Account 5 11 CONTRACT VALUES Contract Value 12 FAO Value 12 Variable Account Value 6 Accumulation 12 Subaccount Value 12 Subaccount Unit Values 6 Value 13 Net Investment Factor 7 TRANSFERS 7 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 14 Mortality and Expense Risk Charge (“Risk Charge”) 14 Premium Taxes 14 Other Taxes 14 Transfer Fee 14 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 14 Amount of Withdrawal Charge 15 Free Withdrawals 15 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent 16 Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 between a Variable Investment Option and a FAO 16 Transfers Among the Variable Investment Options 16 Transfer Limitations and Restrictions 16 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 18 Minimum Withdrawal Amount 18 Amount Available for Withdrawal 18 Termination of Surrender or Withdrawal 8 Contract 18 DEATH BENEFIT 8 PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of an Owner 8 Annuitant 19 Death of the Annuitant 8 Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit 8 Payment Proceeds 21 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 22 Adding or Delay in Payment of Death Benefit 9 Changing Your Beneficiary 22 ANNUITY INCOME PAYMENTS 9 PROVISIONS Date Annuity Payments Begin 23 Default Annuity Date 9 and Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection Option 23 Change of Annuity Date and Annuity Option. 23 Application of Contract Value 23 Conversion to Current Rates 23 ANNUITY OPTIONS Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase 1 — Life Only 24 Option 2 — Life with Period Certain 24 Option 3 — Joint and Survivor Life 24 Option 4 — Period Certain Only 24 ANNUITY OPTION TABLES Applicability of Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1225 Basis of Computations 25 Rates Not Shown 25 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the postmark date on dollar amount of the properly addressed variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contractall product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 0.85%, the Administrative Fee of 0.15% and the Distribution Fee of 0.25%. Thus, the total gross annual rate of return would need to be more or less than your Purchase Payments5.25%. THIS IS A LEGALLY BINDING INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 CHARGES, FEES AND DEDUCTIONS Administrative Fee 12 Distribution Fee 12 Mortality and Expense Risk Charge (“Risk Charge”) 12 Premium Taxes 12 Other Taxes 12 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 12 Amount of Withdrawal Charge 13 Free Withdrawals 13 Earnings 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 14 Transfer Limitations and Restrictions 14 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 15 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Transfer Option 15 Portfolio Rebalancing Transfer Option 15 Earnings Sweep Transfer Option 16 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 17 Minimum Withdrawal Amount 17 Amount Available for Withdrawal 17 Pre-authorized Withdrawals 17 Termination of Surrender or Withdrawal 8 Contract 17 DEATH BENEFIT 8 PROVISIONS Death Benefit 18 Death Benefit Amount 18 Death of an Owner 8 Annuitant 18 Death of the Annuitant 8 Owner 19 Death of Owner Distribution Rules 19 Interest on Death Benefit 8 Payment Proceeds 20 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 21 Adding or Delay in Payment Changing Your Beneficiary 21 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 22 Default Annuity Income Option 22 Application of Contract Value 22 Your Selections 22 Fixed and Variable Annuities 23 Amount of Payments 9 23 Fixed Income Annuity Payments 9 23 Conversion to Current Rates 23 Variable Income Annuity Payments 10 — Subaccount Annuity Units 23 Subsequent Variable Payments 24 Annuity Unit Values 10 Selection Value 24 Periodic Payments 24 ANNUITY OPTIONS Option 1 – Life Only 25 Option 2 – Life with Period Certain 25 Option 3 – Joint and Survivor Life 25 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1226 Basis of Computations 26 Rates Not Shown 26 Table of Contents CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California to this Contractbe effective as of the Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 0.60% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would need to be more or less than your Purchase Payments4.75%. THIS IS A LEGALLY BINDING INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating – No Dividends are Payable TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Letter of Intent 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Sales Charge 13 Premium Taxes 13 Other Taxes 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 16 Minimum Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 16 Amount Available for Withdrawal 8 16 DEATH BENEFIT 8 PROVISIONS Death Benefit 17 Death Benefit Amount 17 Death of an Owner 8 Annuitant 17 Death of the Annuitant 8 Owner 18 Death of Owner Distribution Rules 18 Interest on Death Benefit 8 Payment Proceeds 19 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 20 Adding or Delay in Payment Changing Your Beneficiary 20 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 21 Default Annuity Income Option 21 Application of Contract Value 21 Your Selections 21 Fixed and Variable Annuities 22 Amount of Payments 9 22 Fixed Income Annuity Payments 9 22 Conversion to Current Rates 22 Variable Income Annuity Payments 10 – Subaccount Annuity Units 22 Subsequent Variable Payments 22 Annuity Unit Values 10 Selection Value 23 Periodic Payments 23 ANNUITY OPTIONS Option 1 – Life Only 24 Option 2 – Life with Period Certain 24 Option 3 – Joint and Survivor Life 24 Option 4 – Period Certain Only 24 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1225 Basis of Computations 25 Rates Not Shown 25 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract policy within [ 10 ] 30 days after you receive of receiving it by returning it the policy to our Our administrative office. As soon as You deliver or mail the policy to Us, or it is treated as if it was never issued. Your premium payment will be refunded when We receive the policy. After the 30-day period, You may cancel this policy by notifying Us in writing that You wish to do so. Your policy will be cancelled on the date We receive Your written notice unless You tell Us a later date. Cancellation of this policy will be without prejudice to any claim made prior to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date termination of the cancellation will be determined by the postmark date contract. Assurity Life Insurance Company has signed this policy on the properly addressed and postageIssue Date. Secretary President Assurity Life Insurance Company Administrative Office XX Xxx 00000 – Xxxxxxx, Xxxxxxxx 00000-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Toll-8238 free (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] DISABILITY INCOME POLICY Guaranteed Renewable to Age 67 – Qualified Right to Renew to Age 70 Company may change premium rates Agent Name: Address: Telephone: TABLE OF CONTENTS RENEWAL PROVISION 1 RIGHT TO CANCEL 1 POLICY SCHEDULE A 3 DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change 4 PREMIUMS 5 Premium Payments 5 Grace Period 5 Reinstatement 5 Refund of Owner 2 Beneficiary 2 Unearned Premium 5 TOTAL DISABILITY BENEFIT 5 Monthly Benefit Payment 5 Total Disability for Part of a Month 6 Maximum Benefit Period When You Attain Age 70 6 PARTIAL DISABILITY BENEFIT 6 Monthly Benefit Payment 6 Partial Disability for Part of a Month 6 WAIVER OF PREMIUM 6 LIMITATIONS 6 Foreign Travel 6 Preexisting Condition 6 EXCLUSIONS 6 TERMINATION 7 CLAIMS PROCEDURE 7 Notice of Claim 7 Claim Forms 7 Proof of Loss 7 Time of Payment of Claims 7 Payment of Claims 7 GENERAL PROVISIONS 8 Assignment 8 Change of Beneficiary 2 Annuitant 2 Change 8 Conformity with State Statutes 8 Entire Contract; Changes 8 Legal Action 8 Misstatement of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification Age 8 Misstatement of Income 8 Periods of Time 8 Physical Examination and Autopsy 8 Time Limit on Certain Defenses 8 Time of Coverage 8 POLICY SCHEDULE FORM NO. BENEFIT INITIAL ANNUAL PREMIUM I D0710 Total Disability Benefits (Accident/Sickness) Monthly Benefit: Maximum Benefit Period: Elimination Period: ADDITIONAL BENEFITS ARE EXPLAINED IN THE POLICY. R I0711 Critical Illness Benefit Rider R I0712 Retroactive Injury Benefit Rider R I0713 Return of Premium Benefit Rider INSURED PERSON: POLICY NUMBER: ISSUE AGE: OCCUPATION CLASS: CLASS: MODAL PREMIUM: ISSUE DATE: PREMIUM MODE: DEFINITIONS Complications of Pregnancy means a condition (when the pregnancy is not terminated) the diagnosis of which is distinct from pregnancy but which is adversely affected by pregnancy or caused by pregnancy, and include, but is not limited to: acute nephritis, nephrosis, cardiac decompensation, caesarean section, missed abortion and similar medical and surgical conditions of comparable severity; an ectopic pregnancy which is surgically terminated or spontaneous termination of pregnancy which occurs during a period of gestation when a viable birth is not possible; and pernicious vomiting (hyperemesis gravidarum), pre-eclampsia and toxemia with convulsions (eclampsia of pregnancy). Complications of Pregnancy cease upon termination of the Contract 3 Nonpregnancy. Complications of Pregnancy does not include false labor, pre-Participating 3 Incontestability 3 Application term contractions or labor, advanced maternal age, occasional spotting, Physician prescribed rest during the period of Law 3 Form Approval 3 Assignment 3 Protection pregnancy, morning sickness and similar conditions which, although associated with the management of Proceeds 4 Minimum Values 4 Reports 4 Error a difficult pregnancy and back pain, are not medically classified as distinct Complications of Pregnancy. Concurrent Total Disability means a disability caused by more than one Injury, whether the Injuries are related or not. Covered Accident means an unforeseen event or occurrence which directly, independently and exclusively results in Age an Injury and (a) occurs after the policy Issue Date; (b) occurs while this policy is in force; and (c) is not caused by or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death a result of an Owner 8 Death activity or condition listed in EXCLUSIONS in this policy. Elimination Period means the number of consecutive days You must be Totally Disabled before You are eligible to receive the Annuitant 8 Death Benefit 8 Payment Monthly Benefit. See the Policy Schedule and Claims Procedure. We do not pay Monthly Benefits during the Elimination Period. Employed on a Full-Time Basis means working for pay at least 30 hours per week for 90 days immediately preceding the renewal date. Immediate Family means the spouse, father, mother, children or siblings of any Insured Person. Injury(ies) means bodily harm that is caused solely by or is the Death Benefit 9 Suspension or Delay result of a Covered Accident. All injuries sustained in Payment any one Covered Accident and all complications and reoccurrences of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12complications are considered to be a single Injury.

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return packageContract Date. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL LIMITED PREMIUM DEFERRED VARIABLE ANNUITY WITH INDEX-8238 (000) 000LINKED INTEREST CONTRACT Investment Experience Reflected in Benefits Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-0000 ] ICC11Participating ICC09:10-VDA-P-2006C-WW [ 12/11 ] 1169 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 FIXED ACCOUNT OPTIONS Fixed Account Options (FAOs) 10 Minimum Allocation Amount 10 Crediting Interest 10 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 12 Separate Account 5 12 CONTRACT VALUES Contract Value 13 FAO Value 13 Variable Account Value 6 Accumulation 13 Subaccount Value 13 Subaccount Unit Values 6 Value 14 Net Investment Factor 7 TRANSFERS 7 14 CHARGES, FEES AND DEDUCTIONS Administrative Fee 15 Mortality and Expense Risk Charge (“Risk Charge”) 15 Premium Taxes 15 Other Taxes 15 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 15 Amount of Withdrawal Charge 16 Free Withdrawals 16 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent 17 Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 between a Variable Investment Option and a Fixed Account Option 17 Transfers Among the Variable Investment Options 17 Transfer Limitations and Restrictions 17 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 19 Minimum Withdrawal Amount 19 Amount Available for Withdrawal 19 Termination of Surrender or Withdrawal 8 Contract 19 DEATH BENEFIT 8 PROVISIONS Death Benefit 20 Death Benefit Amount 20 Death of an Owner 8 Annuitant 20 Death of the Annuitant 8 Owner 21 Death Benefit 8 Payment of the Death Benefit 9 Suspension Owner Distribution Rules 21 BENEFICIARY PROVISIONS Designation of Beneficiary 23 Adding or Delay in Payment of Death Benefit 9 Changing Your Beneficiary 23 ANNUITY INCOME PAYMENTS 9 PROVISIONS Date Annuity Payments Begin 24 Default Annuity Date 9 and Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection Option 24 Change of Annuity Date and Annuity Option 10 Annuity Options 11 24 Application of Contract Value 24 Minimum Amounts 11 Guaranteed Amount 24 Conversion to Current Rates 24 ANNUITY OPTIONS Option 1 – Life Only 25 Option 2 – Life with Period Certain 25 Option 3 – Joint and Survivor Life 25 Option 4 – Period Certain Only 25 ANNUITY OPTION TABLES Applicability of Rates 26 Basis of Computations 26 Rates Not Shown 26 ICC09:10-1169 CONTRACT SPECIFICATIONS CONTRACT DATA Contract Number: [VA999999] Contract Type: [Non-Qualified] Minimum Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12Payment Amount: [$25,000] Minimum Allocation Amount: [$1,000] Maximum Issue Age: [Age 85]

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted minus any Credit Enhancements applied to the Contract. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the postmark date on dollar amount of the properly addressed variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contractall product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 1.55% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would need to be more or less than your Purchase Payments5.80%. THIS IS A LEGALLY BINDING INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 Credit Enhancement 9 Recapture of Purchase Payments 5 Credit Enhancement 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 13 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 15 Transfer Limitations and Restrictions 15 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 16 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Transfer Option 16 Portfolio Rebalancing Transfer Option 16 Earnings Sweep Transfer Option 17 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 18 Minimum Withdrawal Amount 18 Amount Available for Withdrawal 18 Pre-authorized Withdrawals 18 Termination of Surrender or Withdrawal 8 Contract 18 CONTRACT LOANS Loans 19 Loan Procedures 19 Loan Account 19 Loan Terms 19 Loan Interest Rate 19 Repayment Terms 20 DEATH BENEFIT 8 PROVISIONS Death Benefit 21 Death Benefit Amount 21 Death of an Owner 8 Annuitant 21 Death of the Annuitant 8 Owner 21 Death of Owner Distribution Rules 22 Interest on Death Benefit 8 Payment Proceeds 22 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 24 Adding or Delay in Payment Changing Your Beneficiary 24 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 25 Default Annuity Income Option 25 Application of Contract Value 25 Your Selections 25 Fixed and Variable Annuities 26 Amount of Payments 9 26 Fixed Income Annuity Payments 9 26 Conversion to Current Rates 26 Variable Income Annuity Payments 10 – Subaccount Annuity Units 26 Subsequent Variable Payments 26 Annuity Unit Values 10 Selection Value 26 Periodic Payments 27 ANNUITY OPTIONS Option 1 – Life Only 28 Option 2 – Life with Period Certain 28 Option 3 – Joint and Survivor Life 28 Option 4 – Period Certain Only 28 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1230 Basis of Computations 30 Rates Not Shown 30 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACTPlease read this contract carefully. You may cancel this Contract within [ 10 ] days the contract for any reason before midnight of the 10th day after you first receive it it. Do this by returning it (1) mailing or delivering notice of cancellation to our administrative officeService Center or (2) returning the contract to our Service Center or the representative through whom you bought it. Notice given by mail and return of the contract by mail are effective on being postmarked, or to the agent who sold it to you, with a written request for cancellationproperly addressed and postage prepaid. If you return cancel the contract, it by mail, effective date of the cancellation will be determined by deemed void from the postmark date beginning. Within 7 days after we receive notice of cancellation or the returned contract, we will refund the Accumulated Value. Flexible premium deferred variable annuity. Service Center: Annuity Income payable at Annuity Date. Thrivent Financial for Lutherans Standard Death Benefit included. 0000 Xxxxx Xxxxxxx Xxxx Death Proceeds payable at death of Annuitant before Appleton, WI 54919-0001 Annuity Date. Return on the properly addressed and postage-paid return packageinvestments reflected in contract benefits. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 Telephone (000) 000-0000 ] ICC11Waiver of Surrender Charge benefit included. xxx.xxxxxxxx.xxx Annual dividends payable if earned. Signed for the Society President Secretary ANNUITANT: XXXX XXX AGE: 50 SEX: MALE ANNUITANT: XXXX XXX AGE: 50 SEX: FEMALE CONTRACT NUMBER: XX0000000 DATE OF ISSUE: MAY 01, 2017 ICC16 W-VDAWR-P-2006C-WW [ 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS FPVA WR0110IC Contract Number: XX0000000 Table of Contents Contract Schedule, Contract Data 3 Section 1 PARTIES TO THE CONTRACT Definitions 6 Section 2 Company General Provisions 7 Section 3 Membership and Ownership 8 Section 4 Premiums 10 Section 5 Accumulated Value 10 Section 6 Surrender 13 Section 7 Death Proceeds 15 Section 8 Annuity Income 16 Section 9 Variable Account and Accumulation Unit Values 16 Section 10 Fixed Account 18 Section 11 Settlement Provisions 18 Section 12 Beneficiary 21 Section 13 Dividends 22 Riders, Amendments, Endorsements, Application Index Section Accumulated Value 5 Accumulation Unit Value 9 Allocation of Premiums 4 Annual Report 2 Owner 2 Annuitant Exchange 7 Annuity Income 8 Automatic Transfers 5 Asset Rebalancing 5 Dollar Cost Averaging 5 Beneficiary 12 Cash Surrender Value 6 Change of Owner Contract 2 Beneficiary Death Proceeds 7 Delay of Payment 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Dividends 13 Entire Contract 2 Fixed Account 10 Incontestability 2 Maintenance of Solvency 2 Section Membership 3 Modification Misstatement of the Contract Age or Sex 2 Ownership 3 Non-Participating Premiums 4 Settlement Options 11 Standard Death Benefit 7 Successor Owner 3 Incontestability 3 Application Surrender 6 Cash Surrender Value 6 Full Surrender 6 Partial Surrender 6 Surrender Charge 6 Surrender of Law 3 Form Approval 3 Annuity Income 11 Termination 2 Transfer and Assignment 3 Protection Transfer of Proceeds 4 Minimum Accumulated Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 9 Waiver of Surrender or Withdrawal 8 Charge 6 ICC16 W-WR-FPVA page 2 WR0200IC Thrivent Financial for Lutherans 0000 X. Xxxxxxx Road, Appleton, WI 54919-0001 Contract Schedule BASIC BENEFIT FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY PLAN TYPE: NON-QUALIFIED ANNUITY DATE: MAY 01, 2062 FIRST ALLOCATION DATE: MAY 05, 2017 INITIAL PREMIUM: $125,000.00 MINIMUM AMOUNT OF ANY ADDITIONAL PREMIUM PAYMENT: $50 MAXIMUM TOTAL PREMIUM (WITHOUT OUR APPROVAL): $1,000,000 MINIMUM PARTIAL SURRENDER AMOUNT: $200 MINIMUM ACCUMULATED VALUE: $10,000 FIXED ACCOUNT FIXED ACCOUNT GUARANTEED MINIMUM INTEREST RATE: 0.50% FIXED ACCOUNT INITIAL EFFECTIVE INTEREST RATE: 1.00% GUARANTEED FOR 12 MONTHS FROM THE DATE OF ISSUE DCA FIXED ACCOUNT GUARANTEED INTEREST RATE: 2.50% ADDITIONAL BENEFITS DETAILS OF THE FOLLOWING ADDITIONAL BENEFIT RIDER AND ITS CHARGE ARE GIVEN ON SEPARATE SCHEDULE PAGES: FORM ICC16 XX-XX-MADB - MAXIMUM ANNIVERSARY DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 THE FOLLOWING FORM IS INCLUDED AS PART OF THIS CONTRACT: ICC16 XX-XX-FPVA-AMEND ACCUMULATED VALUES IN THE VARIABLE ACCOUNT DEPEND ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT. CASH SURRENDER VALUES AND DEATH PROCEEDS ARE NOT LESS THAN THE MINIMUM BENEFITS REQUIRED BY SECTION 7 OF THE VARIABLE ANNUITY TABLES 12REGULATION, MODEL #250. THE GUARANTEED MINIMUM CASH SURRENDER VALUE FOR THE FIXED ACCOUNT IS EQUAL TO 87.5% OF THE PREMIUM ALLOCATED OR TRANSFERRED TO THAT ACCOUNT; LESS ANY SURRENDERS (EXCLUDING ANY SURRENDER CHARGES) DEDUCTED FROM THE FIXED ACCOUNT; ACCUMULATED AT 1.00% ANNUALLY. THE INSURANCE DEPARTMENT OF THE STATE IN WHICH THIS CONTRACT WAS ISSUED MAY BE CONTACTED BY CALLING (000) 000-0000. ANNUITANT: XXXX XXX AGE: 50 SEX: MALE ANNUITANT: XXXX XXX AGE: 50 SEX: FEMALE CONTRACT NUMBER: XX0000000 DATE OF ISSUE: MAY 01, 2017 ICC16 W-WR-FPVA-CS page 3 WR0370IC Date of Issue: MAY 01, 2017 Contract Number: XX0000000 ANNUITANT: XXXX XXX ANNUITANT: XXXX XXX FLEXIBLE PREMIUM MAXIMUM ANNUAL MORTALITY AND EXPENSE RISK CHARGE AS A PERCENTAGE OF THE DAILY ACCUMULATED VALUE IN EACH SUBACCOUNT: 0.50% SUBACCOUNT FEES THAT REDUCE THE NET INVESTMENT FACTOR (SEE SECTION 9.3(4)) MAXIMUM ANNUAL FUND FACILITATION FEE: 0.50% A FUND FACILITATION FEE MAY BE CHARGED AS A PERCENTAGE OF THE DAILY ACCUMULATED VALUE IN EACH SUBACCOUNT. THE CHARGE MAY CHANGE AT ANY TIME, AND IT MAY VARY BY SUBACCOUNT. TRANSFERS (SEE SECTION 5.2) NUMBER OF TRANSFERS AVAILABLE IN A CONTRACT YEAR WITHOUT CHARGE: 24 CHARGE FOR EACH EXCESS TRANSFER: $25 SURRENDER CHARGES# PREMIUM DURATION PERCENT IN YEARS APPLIED 1 1% 2 1% 3+ 0% # FREE SURRENDER PERCENTAGE: 10%

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the postmark date on dollar amount of the properly addressed variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 3% and postage-paid return package. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contractall product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 0.20% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would need to be more or less than your Purchase Paymentsat least 3.45% (net of fund level expenses). THIS IS A LEGALLY BINDING INDIVIDUAL LIMITED PREMIUM DEFERRED FIXED AND VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable and Fixed Accumulation Before Annuity Date Annuities Payable in Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating 10-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] 2169 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 FIXED ACCOUNT OPTIONS Fixed Account Options (FAOs) 10 Minimum Allocation Amount 10 Crediting Interest 10 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 12 Separate Account 5 12 CONTRACT VALUES Contract Value 13 FAO Value 13 Variable Account Value 6 Accumulation 13 Subaccount Value 13 Subaccount Unit Values 6 Value 14 Net Investment Factor 7 TRANSFERS 7 14 CHARGES, FEES AND DEDUCTIONS Administrative Fee 15 Mortality and Expense Risk Charge (“Risk Charge”) 15 Premium Taxes 15 Other Taxes 15 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 15 Amount of Withdrawal Charge 16 Free Withdrawals 16 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent 17 Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 between a Variable Investment Option and a Fixed Account Option 17 Transfers Among the Variable Investment Options 17 Transfer Limitations and Restrictions 17 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 19 Minimum Withdrawal Amount 19 Amount Available for Withdrawal 19 Termination of Surrender or Withdrawal 8 Contract 19 DEATH BENEFIT 8 PROVISIONS Death Benefit 20 Death Benefit Amount 20 Death of an Owner 8 Annuitant 20 Death of the Annuitant 8 Owner 21 Death Benefit 8 Payment of the Death Benefit 9 Suspension Owner Distribution Rules 21 BENEFICIARY PROVISIONS Designation of Beneficiary 23 Adding or Delay in Payment of Death Benefit 9 Changing Your Beneficiary 23 ANNUITY INCOME PAYMENTS 9 PROVISIONS Date Annuity Payments Begin 24 Default Annuity Date 9 and Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection Option 24 Change of Annuity Date and Annuity Option. 24 Application of Contract Value 24 Minimum Amount 24 Conversion to Current Rates 24 ANNUITY OPTIONS Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase 1 — Life Only 25 Option 2 — Life with Period Certain 25 Option 3 — Joint and Survivor Life 25 Option 4 — Period Certain Only 25 ANNUITY OPTION TABLES Applicability of Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1226 Basis of Computations 26 Rates Not Shown 26 10-2169 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return package. We will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California to this Contractbe effective as of the Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The amount returned may fees and charges would include the Mortality and Expense Risk charge of 1.50% and the Administrative Fee of 0.25%. Thus, the total gross annual rate of return would need to be more or less than your Purchase Payments5.75%. THIS IS A LEGALLY BINDING INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating – No Dividends are Payable TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Transfer Fee 13 Withdrawal Fee 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Surrender or Withdrawal 8 Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT 8 PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of an Owner 8 Annuitant 19 Death of the Annuitant 8 Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit 8 Payment Proceeds 21 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 22 Adding or Delay in Payment Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 23 Default Annuity Income Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 9 24 Fixed Income Annuity Payments 9 24 Conversion to Current Rates 24 Variable Income Annuity Payments 10 – Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Values 10 Selection Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 – Life Only 26 Option 2 – Life with Period Certain 26 Option 3 – Joint and Survivor Life 26 Option 4 – Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1228 Basis of Computations 28 Rates Not Shown 28 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract within [ 10 ] ten days after you receive it by returning it the Contract to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it Return by mailmail is effective on being post-marked, effective date of the cancellation will be determined by the postmark date on the properly addressed and postagepostage pre-paid return packagepaid. We will promptly return the Contract Value plus the sales charge and any premium tax or other amounts deducted from your the Purchase Payments before they were applied to this the Contract. The amount returned we return may be more or less than your Purchase Payments. Xxxx X. Xxxxx President Xxxxxxx X. Xxxx Secretary THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Xxxxx X. X. Box 1928, 10648 Birmingham, Alabama 3528235202-8238 0648 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] This Page Intentionally left blank. INSERT CORRECT SCHEDULE HERE TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Definitions 7 Parties to the Contract 7 Company 2 7 Owner 2 7 Change of Owner 2 8 Beneficiary 2 8 Change of Beneficiary 2 8 Annuitant 2 8 Change of Annuitant 3 8 Payee 3 GENERAL PROVISIONS 3 8 General Provisions 8 Entire Contract 3 8 Modification of the Contract 3 Non-Participating 3 8 Incontestability 3 Application of Law 3 Form Approval 3 8 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 9 Written Notice 9 Error in Age or Gender 4 9 Settlement 4 9 Receipt of Payment 4 9 Protection of Proceeds 9 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 9 Non-Participating 9 Minimum Values 9 Application of Law 9 Reports 9 Purchase Payments 5 10 Purchase Payment 10 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 10 No Default 10 Sales Charge 10 Sales Charge 10 Letter of Intent 10 Variable Account 10 General Description 5 10 Sub-Accounts of the Variable Account 5 10 Variable Account Value 6 11 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 12 Transfers 7 Limitation on Frequent 12 Transfers 7 12 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 12 Surrenders 8 Withdrawals 8 Surrender Value 8 13 Full and Partial Surrenders 13 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 13 5 Death Benefit 13 Death of an Owner 8 13 Death of the Annuitant 8 Death Benefit 8 13 Payment of the Death Benefit 9 13 Suspension or Delay in of Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 14 Annuitization 14 Annuity Commencement Date 9 14 Annuity Income Payments 9 14 Fixed Income Payments 9 14 Variable Income Payments 10 14 Annuity Unit Values 10 15 Selection of Annuity Option 10 15 Annuity Options 11 15 Minimum Amounts 11 15 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1215 Fixed Annuity Tables 17 Variable Annuity Tables 17

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation No withdrawal charge will be determined by the postmark date on the properly addressed imposed, and postage-paid return package. We we will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL LIMITED PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating — No Dividends are Payable ICC16:10-0000 ] ICC111600-VDA-P-2006C-WW [ 12/11 ] L TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 12 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Annual Fee 13 Premium Taxes 13 Other Taxes 13 Withdrawal Charge 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 16 Minimum Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 16 Amount Available for Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1216

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 [ten (10)] days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation No withdrawal charge will be determined by the postmark date on the properly addressed imposed, and postage-paid return package. We we will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL LIMITED PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating — No Dividends are Payable ICC10:10-0000 ] ICC111185-VDA-P-2006C-WW [ 12/11 ] L TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 10 Additional Purchase Payments 5 10 Purchase Payment Allocation of Purchase Payments 5 10 Allocations During the Right to Cancel Period 10 Minimum Investment Option Value 10 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 11 Separate Account 5 11 CONTRACT VALUES Contract Value 12 Variable Account Value 6 Accumulation 12 Subaccount Value 12 Subaccount Unit Values 6 Value 12 Net Investment Factor 7 TRANSFERS 7 13 Loan Account Value 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 14 Mortality and Expense Risk Charge (“Risk Charge”) 14 Annual Fee 14 Premium Taxes 14 Other Taxes 14 Withdrawal Charge 14 Amount of Withdrawal Charge 15 Free Withdrawals 15 Earnings 15 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 16 Transfer Limitations and Restrictions 16 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 18 Minimum Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 18 Amount Available for Withdrawal 8 18 DEATH BENEFIT 8 PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of an Owner 8 Annuitant 19 Death of the Annuitant 8 Owner 20 Death Benefit 8 Payment of the Death Benefit 9 Suspension Owner Distribution Rules 20 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Delay in Payment Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 23 Default Annuity Income Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 9 24 Fixed Income Annuity Payments 9 24 Conversion to Current Rates 24 Variable Income Annuity Payments 10 — Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Values 10 Selection Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 — Life Only 26 Option 2 — Life with Period Certain 26 Option 3 — Joint and Survivor Life 26 Option 4 — Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1227 Basis of Computations 27 Rates Not Shown 27 ICC10:10-1185-L CONTRACT SPECIFICATIONS Contract Data

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of This Contract will then be deemed void from the cancellation will be determined by the postmark date on the properly addressed and postage-paid return packagebeginning. We will promptly return refund the Contract Value plus Value, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 12 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Transfer Fee 13 Withdrawal Fee 13 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 14 Transfer Limitations and Restrictions 14 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 15 Minimum Withdrawal Amount 15 Amount Available for Withdrawal 15 Termination of Surrender or Withdrawal 8 Contract 15 CONTRACT LOANS Loans 16 Loan Procedures 16 Loan Account 16 Loan Terms 16 Loan Interest Rate 16 Repayment Terms 16 DEATH BENEFIT 8 PROVISIONS Death Benefit 18 Death Benefit Amount 18 Death of an Owner 8 Annuitant 18 Death of the Annuitant 8 Owner 19 Death of Owner Distribution Rules 19 Interest on Death Benefit 8 Payment Proceeds 20 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 21 Adding or Delay in Payment Changing Your Beneficiary 21 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 22 Default Annuity Income Option 22 Application of Contract Value 22 Your Selections 23 Fixed and Variable Annuities 23 Amount of Payments 9 23 Fixed Income Annuity Payments 9 23 Conversion to Current Rates 23 Variable Income Annuity Payments 10 — Subaccount Annuity Units 23 Subsequent Variable Payments 23 Annuity Unit Values 10 Selection Value 24 Periodic Payments 24 ANNUITY OPTIONS Option 1 – Life Only 25 Option 2 – Life with Period Certain 25 Option 3 – Joint and Survivor Life 25 Option 4 – Period Certain Only 25 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1226 Basis of Computations 26 Rates Not Shown 26 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return packageContract Date. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Distribution Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 13 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Surrender or Withdrawal 8 Contract 16 DEATH BENEFIT 8 PROVISIONS Death Benefit 17 Death Benefit Amount 17 Death of an Owner 8 Annuitant 17 Death of the Annuitant 8 Owner 18 Death of Owner Distribution Rules 18 Interest on Death Benefit 8 Payment Proceeds 19 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 20 Adding or Delay in Payment Changing Your Beneficiary 20 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 21 Default Annuity Income Option 21 Application of Contract Value 21 Your Selections 21 Fixed and Variable Annuities 22 Amount of Payments 9 22 Fixed Income Annuity Payments 9 22 Conversion to Current Rates 22 Variable Income Annuity Payments 10 — Subaccount Annuity Units 22 Subsequent Variable Payments 22 Annuity Unit Values 10 Selection Value 23 Periodic Payments 23 ANNUITY OPTIONS Option 1 — Life Only 24 Option 2 — Life with Period Certain 24 Option 3 — Joint and Survivor Life 24 Option 4 — Period Certain Only 24 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1225 Basis of Computations 25 Rates Not Shown 25 CONTRACT SPECIFICATIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel this Contract within [ 10 ] ten days after you receive it by returning it the Contract to our administrative office, or to the agent who sold it to you, with a written request for cancellation. If you return it Return by mailmail is effective on being post-marked, effective date of the cancellation will be determined by the postmark date on the properly addressed and postagepostage pre-paid return packagepaid. We will promptly return the Contract Value plus any amounts deducted from your the Purchase Payments before they were applied to this the Contract. The amount returned we return may be more or less than your Purchase Payments. Xxxx X. Xxxxx President Xxxxxxx X. Xxxx Secretary THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxx P. O. Xxx 00000 Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 3528200000-8238 0000 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] This Page Intentionally left blank. TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Definitions 5 Parties to the Contract 5 Company 2 5 Owner 2 5 Change of Owner 2 6 Beneficiary 2 6 Change of Beneficiary 2 6 Annuitant 2 6 Change of Annuitant 3 6 Payee 3 GENERAL PROVISIONS 3 6 General Provisions 6 Entire Contract 3 6 Modification of the Contract 3 Non-Participating 3 6 Incontestability 3 Application of Law 3 Form Approval 3 6 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 7 Written Notice 7 Error in Age or Gender 4 7 Settlement 4 7 Receipt of Payment 4 7 Protection of Proceeds 7 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 7 Non-Participating 7 Minimum Values 7 Application of Law 7 Reports 7 Purchase Payments 5 7 Purchase Payment 7 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 8 No Default 8 Variable Account 8 General Description 5 8 Sub-Accounts of the Variable Account 5 8 Variable Account Value 6 9 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 10 Transfers 7 Limitation on Frequent 10 Transfers 7 10 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 10 Surrenders 8 Withdrawals 8 10 Full and Partial Surrenders 10 {Penalty Free Surrender Value 8 11 } {Determining the Surrender Charge 11 } Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 11 Death Benefit 11 Death of an Owner 8 11 Death of the Annuitant 8 Death Benefit 8 12 Payment of the Death Benefit 9 12 Suspension or Delay in of Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 12 Annuitization 12 Annuity Commencement Date 9 12 Annuity Income Payments 9 12 Fixed Income Payments 9 12 Variable Income Payments 10 13 Annuity Unit Values 10 13 Selection of Annuity Option 10 13 Annuity Options 11 13 Minimum Amounts 11 14 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1214 Fixed Annuity Tables 14 Variable Annuity Tables 15 4 DEFINITIONS

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will Contract Date. PACIFIC LIFE & ANNUITY COMPANY Chairman and Chief Executive Officer Secretary The smallest gross annual rate of return needed for the dollar amount of the variable annuity payments to not decrease is equal to the sum of the assumed interest rate (AIR) of 4% and all product fees and charges. The fees and charges would include the Mortality and Expense Risk charge of 1.25% and the Administrative Fee of 0.15%. Thus, the total gross annual rate of return would be determined by 5.40%. INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-Participating Exhibit 4(a) TABLE OF CONTENTS PAGE CONTRACT SPECIFICATIONS 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 7 PURCHASE PAYMENTS Initial Purchase Payment 9 Additional Purchase Payments 9 Purchase Payment Allocation 9 Allocations During the postmark date Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 10 CONTRACT VALUES Contract Value 11 Variable Account Value 11 Subaccount Value 11 Subaccount Unit Value 11 Net Investment Factor 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Transfer Fee 13 Withdrawal Fee 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 15 Transfer Limitations and Restrictions 15 SYSTEMATIC TRANSFER OPTIONS Systematic Transfer Options 16 Dollar Cost Averaging Transfer Option 16 Portfolio Rebalancing Transfer Option 16 Earnings Sweep Transfer Option 17 WITHDRAWAL PROVISIONS Withdrawals 18 Minimum Withdrawal Amount 18 Amount Available for Withdrawal 18 Pre-authorized Withdrawals 18 Termination of Contract 18 CONTRACT LOANS Loans 19 Loan Procedures 19 Loan Account 19 Loan Terms 19 Loan Interest Rate 19 Repayment Terms 19 DEATH BENEFIT PROVISIONS Death Benefit 21 Death Benefit Amount 21 Death of Annuitant 21 Death of Owner 22 Death of Owner Distribution Rules 22 Interest on the properly addressed Death Benefit Proceeds 23 BENEFICIARY PROVISIONS Designation of Beneficiary 24 Adding or Changing Your Beneficiary 24 ANNUITY PROVISIONS Choice of Annuity Date 25 Default Annuity Option 25 Application of Contract Value 25 Your Selections 26 Fixed and postageVariable Annuities 26 Amount of Payments 26 Fixed Annuity Payments 26 Conversion to Current Rates 26 Variable Annuity Payments – Subaccount Annuity Units 26 Subsequent Variable Payments 27 Annuity Unit Value 27 Periodic Payments 27 ANNUITY OPTIONS Option 1 – Life Only 28 Option 2 – Life with Period Certain 28 Option 3 – Joint and Survivor Life 28 Option 4 – Period Certain Only 29 ANNUITY OPTION TABLES Applicability of Rates 29 Basis of Computations 29 Rates Not Shown 29 Exhibit 4(a) CONTRACT SPECIFICATIONS Service Center: Send Forms and written requests to: Send Payments to: Pacific Life & Annuity Company Pacific Life & Annuity Company P.O. Box 7138 P.O. Box 100517 Pasadena, California 91109-paid return package7138 Pasadena, California 91189-0517 Toll-Free Number: 1-000-000-0000 (between 6:00 a.m. and 5:00 p.m., Pacific Time) Please use our toll-free number to present inquiries or obtain information about your coverage and for us to provide assistance in resolving complaints. We will promptly return Investment Options [Blue Chip] [Research] [Mid-Cap Growth] [Multi-Strategy] [Diversified Research] [Large-Cap Value] [Small-Cap Index] [Growth LT] [I-Net Tollkeeper] [Short Duration Bond] [Managed Bond] [International Value] [Technology] [Aggressive Growth] [Equity] [Global Growth] [Main Street Core] [Small-Cap Equity] [Money Market] [Real Estate] [Focused 30] [Financial Services] [Small-Cap Value] [Equity Income] [Capital Opportunities] [Telecommunications] [Emerging Markets] [Aggressive Equity] [Equity Index] [Strategic Value] [International Large-Cap] [High Yield Bond] [Inflation Managed] [Mid-Cap Value] [Health Services] DCA Plus 6-Month DCA Plus 12-Month Interest Rates (Minimum Guaranteed Interest Rate is 3.00% per year.) Guarantee Terms and Current Rates DCA Plus Fixed Option 6 Mos. [4.00%] 12 Mos. [3.00%] Charges, Fees and Deductions Administration M&E Risk Annual Benefit Description Fee Charge Fee Basic Contract – [Non-Qualified] 0.15% 1.25% $30.00 [Stepped-Up Death Benefit Rider] [0.20%] Age of Withdrawal Age of Withdrawal Purchase Payment in Charge Purchase Payment in Charge Withdrawal Charges Contract Years Percentage Contract Years Percentage 2 7% 6 1% 3 6% 7 and Later 0% 4 5% Annual Charge Optional Riders Percentage [Guaranteed Protection Advantage Rider] [0.10%] FOR A COMPLETE DESCRIPTION OF THE CHARGES, FEES AND DEDUCTIONS SHOWN ABOVE AND OTHER APPLICABLE FEES AND CHARGES, REFER TO THE CHARGES, FEES AND DEDUCTIONS SECTION OF THE CONTRACT OR THE ANNUAL CHARGE PROVISION OF THE OPTIONAL RIDER(S) SHOWN ABOVE, IF ANY. Contract Number: [VA99999999] Owner(s): [JXXX XXX] [JXXX XXX] Annuitant(s): [JXXX XXX] [JXXX XXX] Initial Purchase Payment: [$5,000.00] Maximum Purchase Payment: $1,000,000 Contract Date: [01-01-2004] Age: [35] Sex: [MALE] [35] [FEMALE] Annuity Date: [01-01-2059] Exhibit 4(a) DEFINITION OF TERMS Account Value – The amount of the Contract Value plus allocated to any amounts deducted from your Purchase Payments before they were applied one of the Investment Options. Add-In Amount – The amount added by us, if applicable, to this Contractthe Contract Value on the Notice Date to set the Contract Value equal to the death benefit proceeds that would have been payable to the spouse as the deemed Beneficiary/designated recipient of the death benefit. The amount returned may be more Add-In Amount will only apply if the deceased Owner was also the sole surviving Annuitant. Age – The Owner’s or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 XxxxxAxxxxxxxx’s age, Xxxxxxxxxxas applicable, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant 3 Payee 3 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age at his or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 PURCHASE PAYMENTS 5 Purchase Payments 5 Allocation of Purchase Payments 5 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the Variable Account 5 Variable Account Value 6 Accumulation Unit Values 6 Net Investment Factor 7 TRANSFERS 7 Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or Withdrawal 8 DEATH BENEFIT 8 Death of an Owner 8 Death of the Annuitant 8 Death Benefit 8 Payment of the Death Benefit 9 Suspension or Delay in Payment of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 Annuity Income Payments 9 Fixed Income Payments 9 Variable Income Payments 10 Annuity Unit Values 10 Selection of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 12her last birthday.

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 [ten (10)] days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you, with a written request for cancellation. If you return it by mail, effective date of the cancellation No withdrawal charge will be determined by the postmark date on the properly addressed imposed, and postage-paid return package. We we will promptly return refund the Contract Value plus as of the date the returned Contract is delivered to us in good order, including any amounts fees or charges for premium taxes and/or other taxes that were deducted from your Purchase Payments before they were applied the Contract Value. Signed for the Company at Newport Beach, California, to this Contractbe effective as of the Contract Date. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Withdrawal Charges Waived in Specific Instances Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000Participating — No Dividends are Payable ICC10:10-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] 1185 TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 10 Additional Purchase Payments 5 10 Purchase Payment Allocation of Purchase Payments 5 10 Allocations During the Right to Cancel Period 10 Minimum Investment Option Value 10 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 11 Separate Account 5 11 CONTRACT VALUES Contract Value 12 Variable Account Value 6 Accumulation 12 Subaccount Value 12 Subaccount Unit Values 6 Value 12 Net Investment Factor 7 TRANSFERS 7 13 Loan Account Value 13 CHARGES, FEES AND DEDUCTIONS Administrative Fee 14 Mortality and Expense Risk Charge (“Risk Charge”) 14 Annual Fee 14 Premium Taxes 14 Other Taxes 14 Withdrawal Charge 14 Amount of Withdrawal Charge 15 Free Withdrawals 15 Earnings 15 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 16 Transfer Limitations and Restrictions 16 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment of Surrender or 18 Minimum Xxxxxxxxxx Xxxxxx 00 Xxxx Xxxxxxxxxx 18 Amount Available for Withdrawal 8 18 DEATH BENEFIT 8 PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of an Owner 8 Annuitant 19 Death of the Annuitant 8 Owner 20 Death Benefit 8 Payment of the Death Benefit 9 Suspension Owner Distribution Rules 20 BENEFICIARY PROVISIONS Designation of Beneficiary 22 Adding or Delay in Payment Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 23 Default Annuity Income Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 9 24 Fixed Income Annuity Payments 9 24 Conversion to Current Rates 24 Variable Income Annuity Payments 10 — Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Values 10 Selection Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 — Life Only 26 Option 2 — Life with Period Certain 26 Option 3 — Joint and Survivor Life 26 Option 4 — Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1227 Basis of Computations 27 Rates Not Shown 27 ICC10:10-1185 CONTRACT SPECIFICATIONS Contract Data

Right to Cancel. YOU HAVE THE RIGHT TO RETURN THIS CONTRACT. You may cancel return this Contract within [ 10 ] ten (10) days after you receive it by returning it. To do so, mail it to us at our administrative office, Service Center or to the agent who sold it to you. This Contract will then be deemed void from the beginning. No withdrawal charge will be imposed, with a written request and we will refund the Contract Value, including any fees or charges for cancellationpremium taxes and/or other taxes that were deducted from the Contract Value. If you return it by mailSigned for the Company at Newport Beach, California, to be effective date as of the cancellation will be determined by the postmark date on the properly addressed and postage-paid return packageContract Date. We will promptly return the Contract Value plus any amounts deducted from your Purchase Payments before they were applied to this Contract. The amount returned may be more or less than your Purchase Payments. THIS IS A LEGALLY BINDING CONTRACT - READ IT CAREFULLY Administrative Office: PROTECTIVE PACIFIC LIFE INSURANCE COMPANY [ xxx.Xxxxxxxxxx.xxx ] [ 0000 Xxxxxxx 000 Xxxxx, Xxxxxxxxxx, Xxxxxxx 00000 P. O. Box 1928, Birmingham, Alabama 35282Chairman and Chief Executive Officer Secretary INDIVIDUAL FLEXIBLE PREMIUM DEFERRED VARIABLE ANNUITY CONTRACT Investment Experience Reflected in Benefits Variable Accumulation Before Annuity Date Annuities Payable in Variable and Fixed Dollar Amounts Death Benefit Proceeds Payable Before Annuity Date Non-8238 (000) 000-0000 ] ICC11-VDA-P-2006C-WW [ 12/11 ] Participating TABLE OF CONTENTS SCHEDULE A DEFINITIONS 1 PARTIES TO THE PAGE CONTRACT 2 Company 2 Owner 2 Change of Owner 2 Beneficiary 2 Change of Beneficiary 2 Annuitant 2 Change of Annuitant SPECIFICATIONS 3 Payee 3 DEFINITION OF TERMS 4 GENERAL PROVISIONS 3 Entire Contract 3 Modification of the Contract 3 Non-Participating 3 Incontestability 3 Application of Law 3 Form Approval 3 Assignment 3 Protection of Proceeds 4 Minimum Values 4 Reports 4 Error in Age or Gender 4 Settlement 4 Receipt of Payment 4 Premium Tax 4 Written Notice 4 7 PURCHASE PAYMENTS 5 Initial Purchase Payment 9 Additional Purchase Payments 5 9 Purchase Payment Allocation of Purchase Payments 5 9 Allocations During the Right to Cancel Period 9 Minimum Investment Option Value 9 VARIABLE ACCOUNT 5 General Description 5 Sub-Accounts of the INVESTMENT OPTIONS Variable Investment Options 10 Separate Account 5 10 CONTRACT VALUES Contract Value 11 Variable Account Value 6 Accumulation 11 Subaccount Value 11 Subaccount Unit Values 6 Value 11 Net Investment Factor 7 TRANSFERS 7 11 Loan Account Value 12 CHARGES, FEES AND DEDUCTIONS Administrative Fee 13 Annual Fee 13 Mortality and Expense Risk Charge (“Risk Charge”) 13 Premium Taxes 13 Other Taxes 13 Contingent Deferred Sales Charge (‘Withdrawal Charge”) 13 Amount of Withdrawal Charge 14 Free Withdrawals 14 Earnings 14 TRANSFER PROVISIONS Transfers 7 Limitation on Frequent Transfers 7 Dollar Cost Averaging 7 SURRENDERS AND WITHDRAWALS 8 Surrenders 8 15 Transfer Limitations and Restrictions 15 WITHDRAWAL PROVISIONS Withdrawals 8 Surrender Value 8 Suspension or Delay in Payment 16 Minimum Withdrawal Amount 16 Amount Available for Withdrawal 16 Termination of Surrender or Withdrawal 8 Contract 16 CONTRACT LOANS Loans 17 Loan Procedures 17 Loan Account 17 Loan Terms 17 Loan Interest Rate 17 Repayment Terms 17 DEATH BENEFIT 8 PROVISIONS Death Benefit 19 Death Benefit Amount 19 Death of an Owner 8 Annuitant 19 Death of the Annuitant 8 Owner 20 Death of Owner Distribution Rules 20 Interest on Death Benefit 8 Payment Proceeds 21 BENEFICIARY PROVISIONS Designation of the Death Benefit 9 Suspension Beneficiary 22 Adding or Delay in Payment Changing Your Beneficiary 22 ANNUITY PROVISIONS Choice of Death Benefit 9 ANNUITY INCOME PAYMENTS 9 Annuity Date 9 23 Default Annuity Income Option 23 Application of Contract Value 23 Your Selections 24 Fixed and Variable Annuities 24 Amount of Payments 9 24 Fixed Income Annuity Payments 9 24 Conversion to Current Rates 24 Variable Income Annuity Payments 10 — Subaccount Annuity Units 24 Subsequent Variable Payments 25 Annuity Unit Values 10 Selection Value 25 Periodic Payments 25 ANNUITY OPTIONS Option 1 — Life Only 26 Option 2 — Life with Period Certain 26 Option 3 — Joint and Survivor Life 26 Option 4 — Period Certain Only 26 ANNUITY OPTION TABLES Applicability of Annuity Option 10 Annuity Options 11 Minimum Amounts 11 Guaranteed Purchase Rates 11 FIXED ANNUITY TABLES 12 VARIABLE ANNUITY TABLES 1227 Basis of Computations 27 Rates Not Shown 27 Table of Contents CONTRACT SPECIFICATIONS