Schedule Page to DVA Plus NY Contract for Mark Harmon – Separate Account B Investment Allocation

Summary

This document is a schedule page to the DVA Plus NY annuity contract for Mark Harmon, who is both the annuitant and owner. It confirms an initial premium of $120,000, with a life annuity option guaranteed for 10 years, commencing August 1, 2049. The contract involves investment in Separate Account B, which allocates funds across various mutual fund portfolios managed by different investment firms. The schedule details the specific accounts and investment options available under the contract.

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EX-4.D 10 schpage.txt SCHEDULE PAGE TO THE DVA PLUS NY CONTRACT THE SCHEDULE THE VARIABLE SEPARATE ACCOUNTS |-----------------------------------------------------------------------| |-----------------------------------------------------------------------| | Annuitant Owner | | MARK HARMON MARK HARMON | |-----------------------------------------------------------------------| | | | Initial Premium Annuity Option Annuity | | Commencement Date | | | | $120,000.00 LIFE 10 YEAR AUGUST 1, 2049 | | CERTAIN | |-----------------------------------------------------------------------| | Separate Account(s) Contract Number | | SEPARATE ACCOUNT B I000001-FP (Q) | |-----------------------------------------------------------------------| DIVISIONS INVESTING IN SHARES OF A MUTUAL FUND Separate Account B (the "Account") is a unit investment trust Separate Account, organized in and governed by the laws of the State of Delaware, our state of domicile. The Account is divided into Divisions. Each Division listed below invests in shares of the mutual fund portfolio (the "Series") designated. Each portfolio is a part of The GCG Trust managed by Directed Services, Inc. SERIES SERIES ------ ------ Equity Income Real Estate Fully Managed Hard Assets Value Equity Limited Maturity Bond Small Cap Liquid Asset Capital Appreciation Strategic Equity Rising Dividends Managed Global Mid-Cap Growth Research Total Return Growth Capital Growth Global Fixed Income Emerging Markets Developing World The Division listed below invests in shares of the mutual fund portfolio (the "Portfolio") designated. The portfolios are a part of the PIMCO Trust managed by Pacific Investment Managment Company. PORTFOLIO --------- High Yield Bond StocksPlus Growth and Income The Divisions below invests in shares of the mutual fund portfolio (the "Portfolio") designated. Each portfolio is a part of The Galaxy VIP fund, managed by Fleet Investment Advisors, Inc. PORTFOLIO --------- Equity Small Company Growth Asset Allocation Growth & Income High Quality Bond GA-IA-1037-02/97 3B