EX-99.(4)(E)(I) 10 d61207dex994ei.htm FORM OF ADDITIONAL BENEFIT SPECIFICATIONS HAV DEATH BENEFIT RIDER Form of Additional Benefit Specifications HAV Death Benefit Rider

Exhibit (4)(e)(i)

ADDITIONAL BENEFITS SPECIFICATIONS

HIGHEST ANNIVERSARY VALUE (“HAV”) DEATH BENEFIT RIDER

 

Covered Person:    [John Doe]
Joint Covered Person:    [Jane Doe]
Effective Date:    [Issue Date]
Maximum HAV Age:    [80]
Annual Rider Fee Rate:    [.40]%

 

 

ICC20-VATRAD-ABPHAV-01    [3-E]