0001104659-12-028133 Sample Contracts

FLEXIBLE PREMIUM DEFERRED FIXED AND VARIABLE ANNUITY CONTRACT Non-Participating
Separate Account I of National Integrity Life Ins Co • April 25th, 2012

This Contract creates a legal agreement between you, as Owner, and National Integrity Life Insurance Company (Company, we or us). We have issued this Contract to you based on the information you gave us and in consideration of the Initial Premium shown on your Specifications Pages. We agree to provide benefits to you as stated in this Contract.

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