CONTRACT SPECIFICATIONS

Contract Number:                  [XX-0123456]

Annuitant:                        [Abraham Lincoln]

Age at Issue:                     [35]

Contract Date:                    [May 1, 2001]

Initial Purchase Payment:         [$150,000]

Maturity Date:                    [May 1, 2056]

Owner(s):                         [Abraham Lincoln]
                                  [Mary Lincoln]

Beneficiary Designation:          [Refer to the Client Information Profile]

Death Benefit on Contract Date:   [Enhanced Guaranteed Minimum Death Benefit]

PURCHASE PAYMENT AND ALLOCATION REQUIREMENTS:

     Minimum Subsequent Purchase Payment Transmitted Electronically: $25

     Minimum Subsequent Purchase Payment Transmitted Other Than Electronically:
     $100

     Minimum Allocation to Any One Variable Subaccount: $20

ACCOUNT FEE:

     The Account Fee is $30 per Contract Year. The Account Fee will be deducted
     on the first Valuation Date following the last day of each Contract Year.
     If the Contract is surrendered prior to the last day of a Contract Year,
     the full Account Fee will be deducted upon the surrender. The Account Fee
     will be deducted from each Variable Subaccount on a pro-rata basis. The
     Account Fee will be waived for any Contract Year in which the Contract
     Value equals or exceeds $50,000.00 as of the Valuation Date on which the
     Account Fee would otherwise be deducted. The Account Fee will be waived
     after 15 Contract Years. The Account Fee will also be waived on and after
     the Annuity Commencement Date.

VARIABLE ACCOUNT:

     The Variable Account for this Contract is the "Lincoln New York Separate
     Account H for Variable Annuities". There are currently 13 Variable
     Subaccounts in the Variable Account available to the Owner. The Owner may
     direct Net Purchase Payments under the Contract to any of the available
     Variable Subaccounts, subject to limitations. The amounts allocated to each
     Variable Subaccount will be invested in net asset value in the shares of
     one of the Funds. The Variable Subaccounts are:

     Global Discovery Fund
     Global Growth Fund
     Global Small Capitalization Fund
     Growth Fund
     International Fund
     New World Fund
     Blue-Chip Income and Growth Fund
     Growth-Income Fund
     Asset Allocation Fund
     Bond Fund

                                       3.1



     High-Income Bond Fund
     U.S. Govt./AAA-Rated Securities Fund
     Cash Management Fund

     See Section 4.01 for provisions governing any limitations, substitution or
elimination of Funds.

VARIABLE ACCOUNT REQUIREMENTS:

     MORTALITY AND EXPENSE RISK AND ADMINISTRATIVE CHARGE PRIOR TO THE ANNUITY
     COMMENCEMENT DATE:

     We assess a daily charge equal on an annual basis to the percentages shown
     of the average daily net asset value of each Variable Subaccount. The daily
     charge will not exceed the percentages shown. If on the Contract Date, one
     of the below listed Death Benefit Option(s) has been selected, the
     Mortality and Expense Risk and Administrative Charge will be as indicated
     for the Death Benefit Option selected.

          Death Benefit Option(s):                      Charges:

          . Contract Value Death Benefit                  1.65%
          . Guarantee of Principal Death Benefit          1.70%
          . Enhanced Guaranteed Minimum Death Benefit     1.95%

     After the Contract Date, the Owner (or a spouse who continues the Contract
     as the Owner) may change at any time to a Death Benefit Option with a lower
     charge than the Death Benefit Option in effect, but may never change to a
     Death Benefit Option with a higher charge (see the Death Benefit Option
     charges above). If the Death Benefit Option is changed after the Contract
     Date, the change will be effective as of the Valuation Date the Notice to
     change the Death Benefit option is received.

     MORTALITY AND EXPENSE RISK AND ADMINISTRATIVE CHARGE ON OR AFTER THE
     ANNUITY COMMENCEMENT DATE: 1.40%

     The daily charge will not exceed the percentage shown.

PERSISTENCY CREDIT:

     The amount of the Persistency Credit is calculated by multiplying the
     Contract Value, less any Purchase Payments that have not been invested in
     this Contract for a minimum of 7 years, by the quarterly Persistency Credit
     percentage of 0.10%. The amount of any Persistency Credit will never be
     less than zero.

TRANSFER REQUIREMENTS PRIOR TO THE ANNUITY COMMENCEMENT DATE:

     Transfers cannot be made during the first 30 days.

     LNY reserves the right to require a 30 day minimum time period between each
     transfer.

     Maximum Number of Transfers: 12 per Contract Year, excluding automatic DCA
     transfers. There will be no fee imposed for these twelve (12) transfers.
     Transfers in excess of 12 per Contract Year must be authorized by LNY. LNY
     reserves the right to impose a fee for any transfer in excess of 12 per
     Contract Year. This fee will not exceed $25.

     Variable Account:

          Minimum Single Transfer Amount From a Variable Subaccount: The lesser
          of 1) $300; or 2) the remaining amount in the Variable Subaccount.

          Minimum Transfer Amount To a Variable Subaccount: $300

                                       3.2



WITHDRAWAL AND SURRENDER REQUIREMENTS:

     Minimum Partial Withdrawal Amount: $300

     Contingent Deferred Sales Charge (CDSC): None

DEATH BENEFIT REQUIREMENTS PRIOR TO THE ANNUITY COMMENCEMENT DATE:

     The Owner may select a Death Benefit Option(s) to be effective as of the
     Contract Date. If no Death Benefit Option is selected, the Guarantee of
     Principal Death Benefit will be the Death Benefit effective as of the
     Contract Date.

ANNUITY PAYMENT REQUIREMENTS:

     Determination of the First Annuity Payment Date:

          For 100% Fixed Annuity Payment, the Annuity Payment Date must be at
          least 30 days after the Annuity Commencement Date. If any portion of
          the annuity payment will be on a variable basis, the Annuity Payment
          Date will be 14 days after the Annuity Commencement Date. The Annuity
          Unit value, if applicable, and Contract Value used to effect annuity
          payments will be determined as of the Annuity Commencement Date.

     Minimum Annuity Payment Amount: $50

     Minimum Guaranteed Interest Rate for the Fixed Annuity Payment: 1.50%

     Assumed Investment Rate for the Variable Annuity Payment: Between 3.0% -
     5.0%

     WITH A MORTALITY AND EXPENSE RISK AND ADMINSTRATIVE CHARGE OF 1.40%, THE
     SMALLEST RATE OF INVESTMENT RETURN REQUIRED TO ENSURE THAT THE DOLLAR
     AMOUNT OF VARIABLE ANNUITY PAYMENTS DOES NOT DECREASE IS:

     4.40% FOR VARIABLE ANNUITY OPTIONS BASED ON AN ASSUMED RATE OF RETURN OF
     3.0% PER YEAR; OR
     5.40% FOR VARABLE ANNUITY OPTIONS BASED ON AN ASSUMED RATE OF RETURN OF
     4.0% PER YEAR; OR
     6.40% FOR VARIABLE ANNUITY OPTIONS BASED ON AN ASSUMED RATE OF RETURN OF
     5.0% PER YEAR.

                                       3.3