EX-99.(4)(E) 7 dex994e.txt FORM OF HIGHEST ANNIVERSARY VALUE DEATH BENEFIT SCHEDULE SUPP. P-SCH-HAV-NY Exhibit (4)(e) PRUCO LIFE INSURANCE COMPANY OF NEW JERSEY [213 WASHINGTON STREET NEWARK, NEW JERSEY 07102] HIGHEST ANNIVERSARY VALUE DEATH BENEFIT SCHEDULE SUPPLEMENT ANNUITY NUMBER: [001-00001] EFFECTIVE DATE OF THE HIGHEST ANNIVERSARY VALUE DEATH BENEFIT RIDER: [Issue Date of the Annuity] DUE PROOF OF DEATH PERIOD: [A period of [1 year], beginning on the decedent's date of death.] HIGHEST ANNIVERSARY VALUE COMPARISON DATES: [Each anniversary of the Issue Date subsequent to the Effective Date] DEATH BENEFIT TARGET DATE: [The Death Benefit Target Date is initially equal to the later of: (1) the anniversary of the Issue Date coinciding with or next following the date the oldest Owner, (the Annuitant, if the Annuity is entity-owned) reaches age [80]; and (2) the [5th] anniversary of the Issue Date. If there is a change of Owner(s) (Annuitant, if the Annuity is owned by an entity) prior to the Death Benefit Target Date, the Death Benefit Target Date will be recalculated using the age of the oldest Owner or Annuitant, once the change is made. If there is a change of Owner(s) (Annuitant) on or after the Death Benefit Target Date, there will be no change in the Death Benefit Target Date.] INSURANCE CHARGE FOR THE RIDER: [Assessed daily at the annualized rate of [0.40]%] P-SCH-HAV(2/10)-NY