Exhibit 99.(d)(3)
[ MARKETING NAME ] SCHEDULE
| CONTRACT NUMBER | ISSUE DATE |
| [ VA0000001 ] | [ June 1, 2025 ] |
| OWNER 1 | BIRTH DATE OF OWNER 1 |
| [ John Doe ] | [ January 1, 1950 ] |
| OWNER 2 | BIRTH DATE OF OWNER 2 |
| [ None ] | [ Not Applicable ] |
| ANNUITANT | BIRTH DATE OF ANNUITANT |
| [ John Doe ] | [ January 1, 1950 ] |
| BENEFICIARY | ANNUITY DATE |
| As contained in our records | [ January 1, 2045 ] |
| PROTECTED LIFETIME INCOME OPTION | DEATH BENEFIT |
| [ Marketing Name ] | [ Contract Value ] |
| AGENT | INSURANCE REGULATORY AUTHORITY |
| [ Allen Agent ] | [ Anystate Department of Insurance ] |
| [ Brisk Financial Services ] | [ 123-456-7890 ] |
| [ 5678 High Street ] | [ contact.doi@anystate.gov ] |
| [ Anycity, Anystate 12345 ] | |
| [ 987-654-3210 ] | |
| INITIAL PURCHASE PAYMENT | TAX-QUALIFIED STATUS |
| [ $100,000.00 ] | [ Non-Qualified ] |
INTEREST RATES FOR THE GUARANTEED ACCOUNT
|
Annual Effective Interest Rates for the Guaranteed Account on the Issue Date:
|
FIXED ACCOUNT – [1.00 %] |
| DCA ACCOUNT 1 – [2.00 %] | |
| DCA ACCOUNT 2 – [3.00 %] | |
|
Non-Forfeiture Interest Rate (NFIR) for the Guaranteed Account: |
[1.00% ] |
[ The Contract's NFIR for the Guaranteed Account was established on the Issue Date and will not change. It was determined by taking the 5-Year Constant Maturity Treasury Rate as of the January 31 prior to the May 1 – April 30 annual period during which the Contract was issued, subtracting 1.25%, and rounding the result to the nearest 0.05%. The NFIR will be no lower than the minimum rate prescribed in the law of the state where the policy is delivered or issued for delivery. Interest rates declared by the Company for the Guaranteed Account will be at least equal to the Contract's NFIR. ]
| ICC25-VDA-P-2006SF-2 | [ A ] | [ Marketing Name 6/25 ] |
[ MARKETING NAME ] SCHEDULE, continued
CONTRACT LIMITATIONS
| Maximum Issue Date: | We will not issue a Contract on or after the oldest Owner's or Annuitant's [ 86th ] birthday. |
| Maximum Annuity Date: | The oldest Owner's or Annuitant's [ 95th ] birthday. |
| Additional Purchase Payments: | Not permitted on or after the oldest Owner's or Annuitant's [ 86th ] birthday or within 3 years of the Annuity Date |
| Minimum Additional Purchase Payment: | $100.00, $50 if EFT |
| Maximum Aggregate Purchase Payments: | [$1,000,000.00] |
| CONTRACT FEES AND CHARGES | |
| Administration Charge: | [ 0.15% ] per year |
| The Administration Charge was established on the Issue Date and will not change. | |
| Transfer Fee for Transfers in Excess of Limit: | $25 for each transfer in excess of 12 per Contract Year. |
| The Transfer Fee was established on the Issue Date and will not change. | |
| [ Contract Maintenance Fee: | [$35.00 ] |
|
The Contract Maintenance Fee was established on the Issue Date and will not change. It is deducted prior to the Annuity Date on each Contract Anniversary, and on any day that the Contract is surrendered other than a Contract Anniversary. The Contract Maintenance Fee will be deducted from the Investment Options in the same proportion as their values are to the Contract Value. The Contract Maintenance Fee will be waived by the Company in the event either the Contract Value, or the aggregate Purchase Payments reduced by aggregate withdrawals, equals or exceeds [ $100,000.00 ] on the date the Fee is to be deducted. ]
| |
| Mortality & Expense Risk Charge: | |
|
The Mortality & Expense Risk Charge is assessed daily at an annual rate against assets held in the Variable Sub Accounts. This charge is based on the initial Purchase Payment as of the Issue Date and the Contract Value on the last day of each Contract quarter following the Issue Date.
In order to assess the Mortality & Expense Risk Charge, we must first assign the initial Purchase Payment to a Mortality and Expense Risk Tier. Additional Purchase Payments received during the first Contract quarter, which place the Contract into a new Mortality and Expense Risk Tier, will not result in a cost reduction until the first quarterly Contract Anniversary. If the Contract Value crosses a Mortality and Expense Risk Tier threshold, the Mortality & Expense Risk Charge will be adjusted – either reduced or increased - and will become effective in the next full Contract quarter.
The Mortality and Expense Risk Charge will stop at the Annuity Date (the Mortality and Expense Risk Charge will be assessed on the Annuity Date then discontinue thereafter) if fixed annuity payments are selected. The Mortality and Expense Risk Charge (excluding any increase for optional benefits) will continue after the Annuity Date if variable annuity payments are selected, using the Mortality and Expense Risk Tier in effect at the time of annuitization. Reductions of the Risk Charge are not applicable upon annuitization.
| |
| Mortality and Expense Risk Tiers | Mortality & Expense Risk Charge |
| Less than [$500,000] | [ 0.30% ] |
| [$500,000] - [$999,999.99] | [ 0.25% ] |
| [$1,000,000] or greater | [ 0.20% ] |
| ICC25-VDA-P-2006SF-2 | [ B ] | [ Marketing Name 6/25 ] |
[ MARKETING NAME ] SCHEDULE, continued
CONTRACT FEES AND CHARGES, continued
| [ Advisory Fee Deductions |
| You purchased this Contract through a financial intermediary that manages your Contract Value for a fee (“Advisory Fee”). This Advisory Fee is covered in a separate agreement between you and the financial intermediary, and is in addition to the contract fees and charges described in this schedule. You may instruct us to deduct the Advisory Fee from the Contract Value. The Advisory Fee will be deducted from the Investment Options in the same proportion as their values are to the Contract Value, unless you instruct us otherwise. |
| [ The maximum amount we will deduct from the Contract for Advisory Fees is [ 1.50% ] per year, reduced to [ 1.00% ] per year if the contract includes a protected lifetime income option, an optional death benefit, or both. ] ] |
INVESTMENT OPTIONS AVAILABLE ON THE ISSUE DATE
| Protective Life Guaranteed Account | |
| Fixed Account DCA Account 1 DCA Account 2 | |
| Sub-Accounts of PLICO Variable Annuity Account S | |
| [AllianceBernstein | Fidelity Investments |
| AB VPS Discovery Value B | Fidelity® VIP Asset Manager 50% Portfolio Service 2 |
| AB VPS Large Cap Growth B | Fidelity® VIP Asset Manager 70% Portfolio Service 2 |
| AB VPS Relative Value B | Fidelity® VIP Balanced Portfolio Service 2 |
| AB VPS Small Cap Growth B | Fidelity® VIP Bond Index Portfolio Service 2 |
| American Funds | Fidelity® VIP Contrafund Portfolio Service 2 |
| American Funds® IS - Asset Allocation Fund (4) | Fidelity® VIP Energy Portfolio Service 2 |
| American Funds® IS - Capital Income Builder (4) | Fidelity® VIP Extended Market Index Portfolio Service 2 |
| American Funds® IS - Capital World Bond Fund (4) | Fidelity® VIP FundsManager® 20% Portfolio Service 2 |
| American Funds® IS - Capital World Growth & Income Fund (4) | Fidelity® VIP FundsManager® 60% Portfolio Service 2 |
| American Funds® IS - Global Balanced Fund (4) | Fidelity® VIP FundsManager® 85% Portfolio Service 2 |
| American Funds® IS - Global Growth Fund (4) | Fidelity® VIP Growth Opportunities Portfolio Service 2 |
| American Funds® IS - Global Small Cap Fund (4) | Fidelity® VIP Growth Portfolio Service 2 |
| American Funds® IS - Growth Fund (4) | Fidelity® VIP Health Care Portfolio Service 2 |
| American Funds® IS - Growth-Income Fund (4) | Fidelity® VIP International Capital Appreciation Portfolio Service 2 |
| American Funds® IS - International Fund (4) | Fidelity® VIP International Index Portfolio Service 2 |
| American Funds® IS - New World Fund (4) | Fidelity® VIP Investment Grade Bond Portfolio Service 2 |
| American Funds® IS - The Bond Fund of America Fund (4) | Fidelity® VIP Mid Cap Portfolio Service 2 |
| American Funds® IS - US Government Securities Fund (4) | Fidelity® VIP Target Volatility Portfolio Service 2 |
| American Funds® IS - Washington Mutual Investors Fund (4) | Fidelity® VIP Technology Portfolio Initial |
| BlackRock | Fidelity® VIP Total Market Index Portfolio Service 2 |
| BlackRock 60/40 Trgt Allc ETF V.I. III | Fidelity® VIP Utilities Portfolio Initial |
| BlackRock Global Allocation V.I. III | Fidelity® VIP Value Strategies Portfolio Service 2 |
| BlackRock International V.I. I | First Trust |
| Clayton Street (Managed by Janus Capital Management, LLC) | First Trust Dow Jones Dividend & Income Allocation Portfolio I |
| Protective Life Dynamic Allc Ser Cnsrv | First Trust Multi Income Allocation Portfolio I |
| Protective Life Dynamic Allc Ser Gr | Franklin Templeton Investments |
| Protective Life Dynamic Allc Ser Mod | ClearBridge Variable Dividend Strat II |
| Columbia Threadneedle | ClearBridge Variable Large Cap Growth II |
| Columbia VP Balanced 2 | ClearBridge Variable Mid Cap II |
| Columbia VP Emerging Markets Bond 2 | ClearBridge Variable Small Cap Growth II |
| Columbia VP Intermediate Bond 2 | Franklin DynaTech VIP 2 |
| Columbia VP Limited Duration Credit 2 | Franklin Income VIP 2 |
| Columbia VP Select Mid Cap Value 2 | Franklin Rising Dividends VIP 2 |
| Columbia VP Strategic Income 2 | Franklin Small Cap Value VIP 2 |
| Franklin Small Mid Cap Growth VIP 2 | |
| Templeton Developing Markets VIP 2 | |
| Templeton Global Bond VIP 2 | |
| Western Asset Core Plus VIT II |
| ICC25-VDA-P-2006SF-2 | [ C ] | [ Marketing Name 6/25 ] |
[ MARKETING NAME ] SCHEDULE, continued
INVESTMENT OPTIONS AVAILABLE ON THE ISSUE DATE, continued
| Sub-Accounts of PLICO Variable Annuity Account S (continued) | |
| Goldman Sachs | MFS |
| Goldman Sachs VIT Core Fixed Income Svc | MFS® VIT Growth Svc |
| Goldman Sachs VIT Mid Cap Growth Svc | MFS® VIT Mid Cap Growth Svc |
| Goldman Sachs VIT Sm Cp Eq Insghts Svc | MFS® VIT New Discovery Svc |
| Goldman Sachs VIT Strategic Growth Svc | MFS® VIT Total Return Svc |
| Goldman Sachs VIT Trd Driv Alloc Svc | MFS® VIT II Core Equity Svc |
| Invesco | MFS® VIT II International Growth Svc |
| Invesco V.I. Balanced-Risk Fund – Series II | MFS® VIT II International Intrs Val Svc |
| Invesco V.I. Comstock Fund – Series II | MFS® VIT II MA Investors Growth Stk Svc |
| Invesco V.I. Equity and Income Fund – Series II | MFS® VIT II Research International Svc |
| Invesco V.I. Global Fund – Series II | MFS® VIT III Blended Rsrch Sm Cp Eq Svc |
| Invesco V.I. Global Real Estate Fund – Series II | MFS® VIT III Global Real Estate Svc |
| Invesco V.I. Government Securities Fund – Series II | MFS® VIT III Mid Cap Value Svc |
| Invesco V.I. Growth and Income Fund – Series II | Morgan Stanley |
| Invesco V.I. Main Street Small Cap Fund – Series II | Morgan Stanley VIF Discovery II |
| Invesco® V.I. S&P 500 Buffer December Fund – Series II | Morgan Stanley VIF Global Strategist II |
| Invesco® V.I. S&P 500 Buffer June Fund – Series II | Morgan Stanley VIF Growth II |
| Invesco® V.I. S&P 500 Buffer March Fund – Series II | PIMCO |
| Invesco® V.I. S&P 500 Buffer September Fund – Series II | PIMCO VIT All Asset Adv |
| Invesco V.I. U.S. Government Money Portfolio – Series I | PIMCO VIT CommodityRealReturn® Strat Adv |
| Janus Henderson | PIMCO VIT Emerging Markets Bond Adv |
| Janus Henderson VIT Balanced Svc | PIMCO VIT Global Diversified Alloc Adv |
| Janus Henderson VIT Forty Svc | PIMCO VIT High Yield Adv |
| Janus Henderson VIT Glb Tech&Innvt Svc | PIMCO VIT Income Advisor |
| Janus Henderson VIT Global Sust Eq Svc | PIMCO VIT Long-Term US Govt Adv |
| Janus Henderson VIT Overseas Svc | PIMCO VIT Low Duration Adv |
| Lord Abbett | PIMCO VIT Real Return Adv |
| Lord Abbett Series Fund Bond-Debenture Portfolio | PIMCO VIT Short-Term Adv |
| Lord Abbett Series Fund Dividend Growth Portfolio | PIMCO VIT Total Return Adv |
| Lord Abbett Series Fund Fundamental Equity Portfolio | Schwab Funds |
| Lord Abbett Series Fund Growth Opportunities Portfolio | Schwab® Government Money Market Portfolio |
| Lord Abbett Series Fund Short Duration Income Portfolio | Schwab® S&P 500 Index Portfolio |
| Schwab VIT Balanced Portfolio | |
| Schwab VIT Balanced with Growth Portfolio | |
| Schwab VIT Growth Portfolio | |
| T. Rowe Price | |
| T. Rowe Price All-Cap Opportunities Port I | |
| T. Rowe Price Blue Chip Growth Port II | |
| T. Rowe Price Health Sciences Port II | |
| T. Rowe Price Moderate Allocation I ] | |
| ICC25-VDA-P-2006SF-2 | [ D ] | [ Marketing Name 6/25 ] |