Exhibit (27)(d)(30)
DATA PAGES
The Data Pages consist of Parts A, B and C and are part of your Contract. Definitions set forth in your Contract apply to capitalized terms used in the Data Pages. The benefits described in the Data Pages are subject to all the terms and conditions in your Contract, except as modified below.
PART A — This part lists your personal data.
| Owner: |
[JOHN DOE] |
Age: [60] |
Sex: [Male] | |||
| [Available toNon-Qualified Contracts:] |
||||||
| [Joint Owner: [JANE DOE] |
Age: [55] | Sex: [Female] ] | ||||
| Annuitant: |
[JOHN DOE] |
Age: [60] |
Sex: [Male] | |||
[Applicable to Non-Qualified Contracts:]
[Joint Annuitant: [JANE DOE] Age: [55] Sex: [Female] ]
| [Applicable to Inherited IRA, Inherited Roth IRA, Inherited Non-Qualified Contracts:] | ||
| [Deceased Owner of Original [Traditional IRA]: | [John Doe, Sr.] | |
| Date of Death of Original [Traditional IRA] Owner: | [xx/xx/xx] ] | |
[Applicable to Non-Spousal Beneficiary Continuation Option to Traditional IRA Contracts:]
| [Deceased Participant of Original Applicable Plan: | [John Doe, Sr.] | |
| Date of Death of Deceased Participant of Original Applicable Plan: | [xx/xx/xx] ] |
[Applicable to Qualified Plan and SEP-IRA Contracts:]
[Employer: [ABC Company] ]
[Applicable to Qualified Plan Contracts:]
[Plan: [ABC Company Plan] ]
Beneficiary(ies): [JANE DOE]
Contract Number: [00000]
Endorsements Attached:
[Endorsement Applicable to Contract Continuation and Its Effect on a Death Benefit Rider
Endorsement Applicable to Non-Qualified Contracts
Endorsement Applicable to Qualified Defined Contribution Plans
Endorsement Applicable to Qualified Defined Benefit Plans
Endorsement Applicable to Roth IRA Contracts
Endorsement Applicable to SEP-IRA Contracts
Endorsement Applicable to Traditional IRA Contracts
Inherited Non-Qualified Payout Endorsement
Inherited Roth IRA Beneficiary Continuation Option (BCO) Endorsement
Inherited Traditional IRA Beneficiary Continuation Option (BCO) Endorsement
Endorsement Applicable to Dollar Cap Averaging
MSCI Disclosure Endorsement ]
| ICC26-DPCSCSPR | Data Page [1] |
Rider(s) Attached:
[Greater of Roll-Up or Highest Anniversary Value Guaranteed Minimum Death Benefit Rider
Highest Anniversary Value Guaranteed Minimum Death Benefit Rider
Return of Premium Guaranteed Minimum Death Benefit Rider
Standard Segment Option Rider for Bitcoin Segment(s)
Best Entry Segment Option Rider
Dual Direction Segment Option Rider
Dual Direction Downside Advantage Segment Option Rider
Dual Step Up Segment Option Rider
Dual Step Tier Segment Option Rider
Enhanced Upside Segment Option Rider
Optimal Mix Segment Option Rider
Standard Segment Option Rider
Step Up Segment Option Rider ]
| Contract Date: |
[January 1, 2025] | |
| [Applicable to Non-Qualified, Traditional IRA, Roth IRA, SEP-IRA, and Qualified Plan Contracts:] | ||
| [Contract Maturity Date: |
[December 31, 2062] | |
Except as described below, the Contract Maturity Date is based on the age of the Annuitant, and is the Contract Date Anniversary that occurs on or after the Annuitant’s [98th] birthday. The Contract Maturity Date will not change under the Contract, except as described in Section 8.02 and the next paragraphs below.
Applicable to Non-Qualified Contracts with Joint Annuitants: The age of the older Annuitant determines the Contract Maturity Date except as described below.
Applicable to Contracts with a Death Benefit Rider: For Contracts with a Death Benefit Rider in effect, the age of the Owner (or Joint Owner, whoever is older) or in the event of a Non-Natural Owner, the Annuitant (or Joint Annuitant, whoever is older) determines the Contract Maturity Date.
Applicable to Traditional IRA, Roth IRA, and SEP-IRA Contracts:
If you die and your spouse elects to continue this Contract (“Spousal Continuation”), your surviving spouse must be age [98] or younger as of the Contract Date Anniversary following the Benefit Transaction Date. Your spouse then becomes the Annuitant under the Contract and his/her date of birth will determine the Contract Maturity Date.
Applicable to Non-Qualified Contracts
If you die and your spouse elects to continue this Contract (“Spousal Continuation”), your surviving spouse must be age [98] or younger as of the Contract Date Anniversary following the Benefit Transaction Date. If you were also the sole Annuitant under the Contract, your spouse then becomes the Annuitant under the Contract and his/her date of birth will determine the Contract Maturity Date. However, if you were not the Annuitant or Joint Annuitant, your spouse becomes the Annuitant, superseding any named Annuitant and your spouse’s date of birth will determine the Contract Maturity Date.]
[Applicable to Inherited Traditional IRA and Inherited Roth IRA Contracts:]
[BCO Distribution Commencement Date : [xx/xx/xx] ]
[Applicable to Inherited Non-Qualified Contracts:]
| [Required | Payment Starting Date: [xx/xx/xx] ] |
| ICC26-DPCSCSPR | Data Page [2] |
PART B - This part describes certain provisions of your Contract.
| Initial Contribution Received: | [$100,000.00] |
Default Investment Option: [Guaranteed Interest Option].
[Dollar Cap Averaging (“DCA”) Program:
DCA Investment Option: [Guaranteed Interest Option]
DCA Minimum Amounts:
| • | Initial Contribution : [$25,000] (if elected on your Contract Date) |
| • | Subsequent Contributions and Transfers: [$5,000] (if elected after your Contract Date) |
DCA Period: [three or six months]
DCA Transfer Frequency: [monthly]]
[GENERAL DOLLAR CAP AVERAGING (“GDCA”)
| General Dollar Cap Averaging: |
[$0.00] | |
| General Dollar Cap Averaging Rate: |
[1.00%] through the duration of the GDCA ] |
PART II - STRUCTURED INVESTMENT OPTION
Segment Start Date: (see Section 2.01(o) and Section 2.07 of the Contract) The Segment Start Date is generally [a Thursday]. If the Segment Start Date falls on a non-Business Day, the Segment Start Date will be the prior Business Day.
Segment Maturity Date: (see Section 2.01(j) and Section 2.07 of the Contract) The Segment Maturity Date is generally [the Thursday] (as determined by the Segment Start Date and the Segment Duration) of the same month and week as the Segment Start Date in the calendar year in which the Segment Duration ends. If the Segment Maturity Date is scheduled to fall on a non- Business Day, the Segment Maturity Date will be the prior Business Day. We will notify you at least [45] days prior to a Segment Maturity Date. You may not allocate amounts to a Segment Type with a Segment Maturity Date after your Contract Maturity Date.
Segment Transaction Date: (see Section 2.01(q) of the Contract) Segment Transaction Dates are generally [every Thursday]. If the Segment Transaction Date falls on a non-Business Day, the Segment Transaction Date will be the prior Business Day.
Segment Type Holding Account: (See Section 2.01(s) of the Contract): The Segment Type Holding Account is currently the [Guaranteed Interest Option].
[Separate Account(s): (see Section 2.09 of the Qualified Plan Endorsement or SEP-IRA Endorsement, as applicable) [No. 68] ]
Guaranteed Minimum Performance Cap Rate: [2%] multiplied by the Segment Duration, with the Segment Duration measured in years.
Guaranteed Minimum Participation Rate: [50%], unless otherwise stated.
| ICC26-DPCSCSPR | Data Page [3] |
| • | STRUCTURED INVESTMENT OPTION |
| Segment Type |
Segment Duration |
Segment Buffer |
Initial Performance Cap Rate |
Initial Participation Rate |
Percentage Allocated |
Amount Allocated |
||||||||||||||||||
| [S&P 500 Standard |
[3-Month | [-5 | % | [6.00 | % | [100 | % | |||||||||||||||||
| S&P 500 Standard |
3-Month | -10 | % | 5.25 | % | 100 | % | |||||||||||||||||
| S&P 500 Standard |
3-Month | -15 | % | 4.00 | % | 100 | % | |||||||||||||||||
| Russell 2000 Standard |
3-Month | -5 | % | 7.75 | % | 100 | % | |||||||||||||||||
| Russell 2000 Standard |
3-Month | -10 | % | 7.00 | % | 100 | % | |||||||||||||||||
| Russell 2000 Standard |
3-Month | -15 | % | 5.50 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Standard |
3-Month | -5 | % | 9.25 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Standard |
3-Month | -10 | % | 8.75 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Standard |
3-Month | -15 | % | 5.25 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Standard |
3-Month | -5 | % | 6.25 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Standard |
3-Month | -10 | % | 5.75 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Standard |
3-Month | -15 | % | 4,75 | % | 100 | % | |||||||||||||||||
| S&P 500 Standard |
1 Year | -10 | % | 21.0 | % | 100 | % | [50 | %] | [$ | 50,000 | ] | ||||||||||||
| S&P 500 Standard |
1 Year | -15 | % | 16.0 | % | 100 | % | |||||||||||||||||
| S&P 500 Standard |
1 Year | -20 | % | 13.5 | % | 100 | % | |||||||||||||||||
| S&P 500 Standard |
1 Year | -40 | % | 9.5 | % | 100 | % | |||||||||||||||||
| S&P 500 Standard |
1 Year | -100 | % | 5.0 | % | 100 | % | |||||||||||||||||
| Russell 2000 Standard |
1 Year | -10 | % | 29.5 | % | 100 | % | |||||||||||||||||
| Russell 2000 Standard |
1 Year | -15 | % | 22.0 | % | 100 | % | |||||||||||||||||
| Russell 2000 Standard |
1 Year | -20 | % | 18.0 | % | 100 | % | |||||||||||||||||
| Russell 2000 Standard |
1 Year | -40 | % | 11.5 | % | 100 | % | |||||||||||||||||
| Russell 2000 Standard |
1 Year | -100 | % | 7.5 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Standard |
1 Year | -10 | % | 35.0 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Standard |
1 Year | -15 | % | 21.0 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Standard |
1 Year | -20 | % | 16.5 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Standard |
1 Year | -40 | % | 11.0 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Standard |
1 Year | -100 | % | 9.0 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Standard |
1 Year | -10 | % | 23.0 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Standard |
1 Year | -15 | % | 18.5 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Standard |
1 Year | -20 | % | 15.5 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Standard |
1 Year | -40 | % | 10.5 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Standard |
1 Year | -100 | % | 7.0 | % | 100 | % | |||||||||||||||||
| iShares Bitcoin Trust ETF Standard* |
1 year | -10 | % | 40.0 | % | 100 | % | |||||||||||||||||
| iShares Bitcoin Trust ETF Standard* |
1 Year | -15 | % | 35.0 | % | 100 | % | |||||||||||||||||
| iShares Bitcoin Trust ETF Standard* |
1 Year | -20 | % | 30.0 | % | 100 | % | |||||||||||||||||
| iShares Bitcoin Trust ETF Standard* |
1 year | -40 | % | 20.0 | % | 100 | % | |||||||||||||||||
| S&P 500 Step Up |
1 Year | -10 | % | 12.8 | % | 100 | % | |||||||||||||||||
| S&P 500 Step Up |
1 Year | -15 | % | 11.5 | % | 100 | % | |||||||||||||||||
| S&P 500 Step Up |
1 Year | -20 | % | 9.5 | % | 100 | % | |||||||||||||||||
| S&P 500 Step Up |
1 Year | -40 | % | 8.0 | % | 100 | % | |||||||||||||||||
| Russell 2000 Step Up |
1 Year | -10 | % | 16.5 | % | 100 | % | |||||||||||||||||
| Russell 2000 Step Up |
1 Year | -15 | % | 14.5 | % | 100 | % | |||||||||||||||||
| Russell 2000 Step Up |
1 Year | -20 | % | 13.0 | % | 100 | % | |||||||||||||||||
| Russell 2000 Step Up |
1 Year | -40 | % | 9.5 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Step Up |
1 Year | -10 | % | 13.5 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Step Up |
1 Year | -15 | % | 12.0 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Step Up |
1 Year | -20 | % | 10.5 | % | 100 | % | |||||||||||||||||
| MSCI EAFE Step Up |
1 Year | -40 | % | 8.5 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Step Up |
1 Year | -10 | % | 15.0 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Step Up |
1 Year | -15 | % | 13.5 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Step Up |
1 Year | -20 | % | 12.0 | % | 100 | % | |||||||||||||||||
| NASDAQ 100 Step Up |
1 Year | -40 | % | 9.0 | % | 100 | % | |||||||||||||||||
| ICC26-DPCSCSPR | Data Page [4] |
| S&P 500 Enhanced Upside 125% |
1 Year | -10 | % | 16.0 | % | 100 | % | |||||||||
| S&P 500 Dual Direction |
1 Year | -10 | % | 16.0 | % | 100 | % | |||||||||
| S&P 500 Dual Direction |
1 Year | -15 | % | 11.5 | % | 100 | % | |||||||||
| S&P 500 Dual Direction |
1 Year | -20 | % | 8.5 | % | 100 | % | |||||||||
| Russell 2000 Dual Direction |
1 Year | -10 | % | 22.0 | % | 100 | % | |||||||||
| Russell 2000 Dual Direction |
1 Year | -15 | % | 15.0 | % | 100 | % | |||||||||
| Russell 2000 Dual Direction |
1 Year | -20 | % | 10.0 | % | 100 | % | |||||||||
| MSCI EAFE Dual Direction |
1 Year | -10 | % | 18.5 | % | 100 | % | |||||||||
| MSCI EAFE Dual Direction |
1 Year | -15 | % | 12.0 | % | 100 | % | |||||||||
| MSCI EAFE Dual Direction |
1 Year | -20 | % | 8.0 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Direction |
1 Year | -10 | % | 18.5 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Direction |
1 Year | -15 | % | 13.5 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Direction |
1 Year | -20 | % | 10.0 | % | 100 | % | |||||||||
| S&P 500 Dual Direction Downside Advantage |
1 Year | -10 | % | 13,5 | % | 100 | % | |||||||||
| S&P 500 Dual Direction Downside Advantage |
1 Year | -15 | % | 8.2 | % | 100 | % | |||||||||
| Russell 2000 Dual Direction Downside Advantage |
1 Year | -10 | % | 17.6 | % | 100 | % | |||||||||
| Russell 2000 Dual Direction Downside Advantage |
1 Year | -15 | % | 9.8 | % | 100 | % | |||||||||
| MSCI EAFE Dual Direction Downside Advantage |
1 Year | -10 | % | 11.0 | % | 100 | % | |||||||||
| MSCI EAFE Dual Direction Downside Advantage |
1 Year | -15 | % | 4.75 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Direction Downside Advantage |
1 Year | -10 | % | 16.3 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Direction Downside Advantage |
1 Year | -15 | % | 9.85 | % | 100 | % | |||||||||
| S&P 500 Dual Step Up |
1 Year | -10 | % | 10.5 | % | 100 | % | |||||||||
| S&P 500 Dual Step Up |
1 Year | -15 | % | 9.0 | % | 100 | % | |||||||||
| S&P 500 Dual Step Up |
1 Year | -20 | % | 8.0 | % | 100 | % | |||||||||
| S&P 500 Dual Step Up |
1 Year | -40 | % | 5.5 | % | 100 | % | |||||||||
| Russell 2000 Dual Step Up |
1 Year | -10 | % | 13.0 | % | 100 | % | |||||||||
| Russell 2000 Dual Step Up |
1 Year | -15 | % | 10.5 | % | 100 | % | |||||||||
| Russell 2000 Dual Step Up |
1 Year | -20 | % | 9.0 | % | 100 | % | |||||||||
| Russell 2000 Dual Step Up |
1 Year | -40 | % | 5.5 | % | 100 | % | |||||||||
| MSCI EAFE Dual Step Up |
1 Year | -10 | % | 10.5 | % | 100 | % | |||||||||
| MSCI EAFE Dual Step Up |
1 Year | -15 | % | 8.5 | % | 100 | % | |||||||||
| MSCI EAFE Dual Step Up |
1 Year | -20 | % | 7.5 | % | 100 | % | |||||||||
| MSCI EAFE Dual Step Up |
1 Year | -40 | % | 5.5 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Step Up |
1 Year | -10 | % | 12.5 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Step Up |
1 Year | -15 | % | 10.0 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Step Up |
1 Year | -20 | % | 8.5 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Step Up |
1 Year | -40 | % | 5.5 | % | 100 | % | |||||||||
| S&P 500 Standard |
6 Year | -10 | % | Uncapped | 117 | % | ||||||||||
| S&P 500 Standard |
6 Year | -15 | % | 300.0 | % | 112 | % | |||||||||
| S&P 500 Standard |
6 Year | -20 | % | 150.0 | % | 110 | % | |||||||||
| S&P 500 Standard |
6 Year | -40 | % | 90.0 | % | 105 | % | |||||||||
| S&P 500 Standard |
6 Year | -100 | % | 30.0 | % | 100 | % | |||||||||
| Russell 2000 Standard |
6 Year | -10 | % | Uncapped | 118 | % | ||||||||||
| Russell 2000 Standard |
6 Year | -15 | % | 250.0 | % | 115 | % | |||||||||
| Russell 2000 Standard |
6 Year | -20 | % | 155.0 | % | 115 | % | |||||||||
| Russell 2000 Standard |
6 Year | -40 | % | 100.0 | % | 105 | % | |||||||||
| Russell 2000 Standard |
6 Year | -100 | % | 30.0 | % | 100 | % | |||||||||
| MSCI EAFE Standard |
6 Year | -10 | % | Uncapped | 135 | % | ||||||||||
| MSCI EAFE Standard |
6 Year | -15 | % | Uncapped | 130 | % | ||||||||||
| MSCI EAFE Standard |
6 Year | -20 | % | Uncapped | 125 | % | ||||||||||
| MSCI EAFE Standard |
6 Year | -40 | % | 150.0 | % | 115 | % | |||||||||
| MSCI EAFE Standard |
6 Year | -100 | % | 30.0 | % | 100 | % | |||||||||
| NASDAQ 100 Standard |
6 Year | -10 | % | 130.0 | % | 120 | % | |||||||||
| NASDAQ 100 Standard |
6 Year | -15 | % | 120.0 | % | 115 | % | |||||||||
| NASDAQ 100 Standard |
6 Year | -20 | % | 110.0 | % | 115 | % | |||||||||
| NASDAQ 100 Standard |
6 Year | -40 | % | 85.0 | % | 105 | % | |||||||||
| NASDAQ 100 Standard |
6 Year | -100 | % | 30.0 | % | 100 | % | |||||||||
| ICC26-DPCSCSPR | Data Page [5] |
| S&P 500 Step Up |
6 Year | -10 | % | 65.0 | % | 100 | % | |||||||||
| S&P 500 Step Up |
6 Year | -20 | % | 60.0 | % | 100 | % | |||||||||
| S&P 500 Step Up |
6 Year | -40 | % | 50.0 | % | 100 | % | |||||||||
| S&P 500 Dual Step Up |
6 Year | -10 | % | 60.0 | % | 100 | % | |||||||||
| S&P 500 Dual Step Up |
6 Year | -20 | % | 50.0 | % | 100 | % | |||||||||
| S&P 500 Dual Step Up |
6 Year | -40 | % | 40.0 | % | 100 | % | |||||||||
| Russell 2000 Dual Step Up |
6 Year | -10 | % | 60.0 | % | 100 | % | |||||||||
| Russell 2000 Dual Step Up |
6 Year | -20 | % | 50.0 | % | 100 | % | |||||||||
| Russell 2000 Dual Step Up |
6 Year | -40 | % | 40.0 | % | 100 | % | |||||||||
| MSCI EAFE Dual Step Up |
6 Year | -10 | % | 55.0 | % | 100 | % | |||||||||
| MSCI EAFE Dual Step Up |
6 Year | -20 | % | 45.0 | % | 100 | % | |||||||||
| MSCI EAFE Dual Step Up |
6 Year | -40 | % | 35.0 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Step Up |
6 Year | -10 | % | 60.0 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Step Up |
6 Year | -20 | % | 50.0 | % | 100 | % | |||||||||
| NASDAQ 100 Dual Step Up |
6 Year | -40 | % | 40.0 | % | 100 | % | |||||||||
| S&P 500 Dual Direction |
6 Year | -10 | % | Uncapped | 115 | % | ||||||||||
| S&P 500 Dual Direction |
6 Year | -15 | % | 110.0 | % | 115 | % | |||||||||
| S&P 500 Dual Direction |
6 Year | -20 | % | 90.0 | % | 115 | % | |||||||||
| S&P 500 Dual Direction |
6 Year | -40 | % | 60.0 | % | 105 | % | |||||||||
| Russell 2000 Dual Direction |
6 Year | -10 | % | Uncapped | 116 | % | ||||||||||
| Russell 2000 Dual Direction |
6 Year | -15 | % | 150.0 | % | 115 | % | |||||||||
| Russell 2000 Dual Direction |
6 Year | -20 | % | 130.0 | % | 115 | % | |||||||||
| Russell 2000 Dual Direction |
6 Year | -40 | % | 75.0 | % | 105 | % | |||||||||
| MSCI EAFE Dual Direction |
6 Year | -10 | % | 500.0 | % | 120 | % | |||||||||
| MSCI EAFE Dual Direction |
6 Year | -15 | % | 400.0 | % | 115 | % | |||||||||
| MSCI EAFE Dual Direction |
6 Year | -20 | % | 350.0 | % | 110 | % | |||||||||
| MSCI EAFE Dual Direction |
6 Year | -40 | % | 110.0 | % | 105 | % | |||||||||
| NASDAQ 100 Dual Direction |
6 Year | -10 | % | 120.0 | % | 118 | % | |||||||||
| NASDAQ 100 Dual Direction |
6 Year | -15 | % | 110.0 | % | 115 | % | |||||||||
| NASDAQ 100 Dual Direction |
6 Year | -20 | % | 100.0 | % | 115 | % | |||||||||
| NASDAQ 100 Dual Direction] |
6 Year | ] | -40 | %] | 65.0 | %] | 105 | %] | ||||||||
[*iShares is a registered trademark of BlackRock, Inc. or its affiliates.]
| ICC26-DPCSCSPR | Data Page [6] |
[DUAL STEP TIER SEGMENTS:
| Segment Type |
Segment Duration |
Segment Buffer |
Initial Performance Cap Rate |
Initial Step Rate |
Initial Participation Rate |
Percentage Allocated |
Amount Allocated |
|||||||||||||||||||||
| [S&P 500 Dual Step Tier |
[1 Year | [-10 | % | [15.5 | % | [4.50 | % | [100 | % | |||||||||||||||||||
| Russell 2000 Dual Step Tier |
1 Year | -10 | % | 18.5 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| MSCI EAFE Dual Step Tier |
1 Year | -10 | % | 13.5 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| NASDAQ 100 Dual Step Tier |
1 Year | -10 | % | 17.5 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| S&P 500 Dual Step Tier |
6 Year | -10 | % | 80.0 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| S&P 500 Dual Step Tier |
6 Year | -20 | % | 70.0 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| Russell 2000 Dual Step Tier |
6 Year | -10 | % | 80.0 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| Russell 2000 Dual Step Tier |
6 Year | -20 | % | 70.0 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| MSCI EAFE Dual Step Tier |
6 Year | -10 | % | 65.0 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| MSCI EAFE Dual Step Tier |
6 Year | -20 | % | 55.0 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| NASDAQ 100 Dual Step Tier |
6 Year | -10 | % | 80.0 | % | 4.50 | % | 100 | % | |||||||||||||||||||
| NASDAQ 100 Dual Step Tier] |
6 Year | ] | -20 | %] | 70.0 | %] | 4.50 | %] | 100 | %] | ||||||||||||||||||
Guaranteed Minimum Step Rate: [1.00%] ]
[BEST ENTRY SEGMENTS:
| Segment Type |
Segment Duration |
Segment Buffer |
Initial Performance Cap Rate |
Initial Participation Rate |
Best Entry Reset Limit |
Percentage Allocated |
Amount Allocated |
|||||||||||||||||||||
| [S&P 500 Best Entry Segment] |
[6 Year | ] | [-10 | %] | [Uncapped | ] | [100 | %] | [80 | %] | ||||||||||||||||||
Observation Day(s): [each of the] [first] [four] [monthiversaries] ]
[OPTIMAL MIX SEGMENTS:
| Segment Type |
Segment Duration |
Segment Buffer |
Initial Performance Cap Rate |
Initial Participation Rate |
Percentage Allocated |
Amount Allocated |
||||||||||||||||||
| [Optimal Mix US Segment |
[1 Year | [-10 | % | [14.25 | % | [100 | % | |||||||||||||||||
| Optimal Mix Global Segment |
1 Year | -10 | % | 12.0 | % | 100 | % | |||||||||||||||||
| Optimal Mix US Segment |
6 Year | -10 | % | 100 | % | 100 | % | |||||||||||||||||
| Optimal Mix Global Segment] |
6 Year | ] | -10 | %] | 100 | %] | 100 | %] | ||||||||||||||||
The following Indices apply to the Segment Types shown above:
[Optimal Mix US Indices: [S&P 500 Price Return Index, Russell 2000 Price Return Index, NASDAQ 100 Price Return Index] ]
[Optimal Mix Global Indices: [S&P 500 Price Return Index, Russell 2000 Price Return Index, MSCI EAFE Index, NASDAQ 100 Price Return Index] ]
The following weights apply to the Segment Types shown above:
[Optimal Mix US Weights: [50%, 30%, 20%] (applied from highest to lowest Index performance rank) ]
[Optimal Mix Global Weights: [40%, 30%, 20%, 10%] (applied from highest to lowest Index performance rank) ] ]
| ICC26-DPCSCSPR | Data Page [7] |
| • | [GUARANTEED INTEREST OPTION] (See Part III of the Contract) |
|
Percentage |
Amount Allocated |
|||||||
| [Guaranteed Interest Option] |
[50%] | [$ | 50,000] | |||||
| Initial Crediting Rate: |
[1.00%] through [January 01, 2026] | |||||||
| Initial Non-Forfeiture Rate: |
[0.15%] | |||||||
| Minimum Non-Forfeiture Rate |
[0.15%] | |||||||
Nonforfeiture Rate:
The Nonforfeiture Rate for the first Contract Year is stated above under “Initial Nonforfeiture Rate.”
For each subsequent Contract Year, the Nonforfeiture Rate will be redetermined using the daily five-year Constant Maturity Treasury (“CMT”) Rate, reported by the Federal Reserve, rounded to the nearest [0.05%], less [1.25%]. We will use the average of the daily 5-year CMT Rates for a 60-calendar day period, beginning on the 1st day of the first month in the quarter prior to the calendar quarter of the Contract Date. The resulting interest rate will never be less than [0.15%], which is the “Minimum Nonforfeiture Rate” stated above, or greater than [3.00%].
Total: [$100,000.00]
Allocations must be in whole numbers and must total 100%. The total maximum number of Segments that you can invest in, and/or provide Segment allocation instructions for, at any time is [167]. If (i) a Contribution into a Segment or a Segment Type Holding Account, or (ii) a transfer from a Segment Type Holding Account into a Segment, or (iii) a transfer from the [Guaranteed Interest Option] into a Segment or a Segment Type Holding Account, or (iv) on a Segment Maturity Date, a transfer from a Segment to a Segment or a Segment Type Holding Account, would ultimately cause your Contract to exceed this limit, amounts will be transferred to the [Guaranteed Interest Option] as described in the next sentence. If at the close of business on a Segment Start Date the total number of Segments scheduled to be established on that Segment Start Date would cause the Contract to exceed the [167] limit, then new Segments will be established starting with the largest Segment Investment to the smallest until the maximum number of active Segments is reached and the remaining amounts will be transferred to the [Guaranteed Interest Option]. We will notify you if this maximum number changes. Any such change will not affect the Segments in which you currently invest.
| ICC26-DPCSCSPR | Data Page [8] |
PART IV - CONTRIBUTIONS AND ALLOCATIONS
LIMITS ON CONTRIBUTIONS (See Section 4.02 of the Contract)
Initial Contribution minimum: [$25,000]
[Subsequent Contribution minimum: [$500]
[Applicable to Contracts Without a Death Benefit Rider in Effect:
If your Contract does not have a Death Benefit Rider in effect, subsequent Contributions can be made through the Owner’s age [85] (or, if applicable, the older Joint Owner’s age [85]), or if later, the first Contract Date Anniversary. In the event of a Non-Natural Owner, the subsequent Contributions can be made through the Annuitant’s age [85] (or, if applicable, the older Joint Annuitant’s age [85]), or if later, the first Contract Date Anniversary.
Applicable to Contracts With a Death Benefit Rider in Effect:
If your Contract does have a Death Benefit Rider in effect, subsequent Contributions can be made through the Owner’s age [75] (or, if applicable, the older Joint Owner’s age [75]), or if later, the first Contract Date Anniversary. In the event of a Non-Natural Owner, subsequent Contributions can be made through the Annuitant’s age [75] (or, if applicable, the older Joint Annuitant’s age [75]), or if later, the first Contract Date Anniversary.]
You may allocate amounts to a Segment on a date other than a Segment Start Date. Such amounts are first applied to the Segment Type Holding Account and then are subsequently transferred automatically to the Segment on the next Segment Start Date if Segment Participation Requirements have been met.
You may allocate amounts to a Segment on a Segment Transaction Date.
We may refuse to accept any Contribution if the sum of all Contributions under all [Structured Capital Strategies Series] Contracts with the same Annuitant or Owner would then total more than [$2,500,000].
We may also refuse to accept any Contribution if the sum of all Contributions under all Equitable annuity accumulation Contracts/Certificates of which you are Owner or of which you are the Annuitant would total [$5,000,000.] ]
| ICC26-DPCSCSPR | Data Page [9] |
PART V – TRANSFERS AMONG INVESTMENT OPTIONS
TRANSFER REQUESTS (See Section 5.01 of the Contract)
[There is currently no minimum transfer amount.]
TRANSFER RULES (See Section 5.02 of the Contract):
Transfer Rules – General
We reserve the right to:
| a) | limit transfers among or to the [Guaranteed Interest Option], Segments and the Segment Type Holding Accounts to no more than once every [30] days, |
| b) | require a minimum time period between each transfer into or out of one or more specified [Guaranteed Interest Option], Segments and the Segment Type Holding Account, |
| c) | establish a maximum dollar amount that may be transferred on any Transaction Date among [Guaranteed Interest Option], Segments and the Segment Type Holding Accounts, |
| d) | reject transfer requests from a person acting on behalf of multiple contract owners unless pursuant to a trading authorization agreement that we have accepted. |
| e) | impose conditions or limitations on transfer rights, restrict transfers or refuse any particular transfer if we are concerned that market timing, excessive trading or other trading strategies may disrupt operation of the [Guaranteed Interest Option] or may have a detrimental effect on the value of any Segment or determine that you have engaged in any such strategy. |
Communications services may be restricted or denied if we determine that you used such services for market
timing or other trading strategies that may disrupt operation of an Investment Option.
Transfer Rules Applicable to the Structured Investment Option
| a) | Amounts allocated to a Segment on a date other than a Segment Start Date are first applied to the Segment Type Holding Account and then are subsequently transferred automatically to the Segment on the next Segment Start Date. |
| b) | You may transfer amounts to a Segment on a Segment Transaction Date. |
| c) | You may not transfer amounts to an active Segment after its Segment Start Date. |
| ICC26-DPCSCSPR | Data Page [10] |
PART VI – WITHDRAWALS AND TERMINATION
WITHDRAWALS (See Section 6.01 of the Contract):
Generally, withdrawals will be processed from your Annuity Account Value from the [Guaranteed Interest Option]. If there is insufficient value or no value in the [Guaranteed Interest Option], any additional amount required or the total amount of the withdrawal, as applicable, will be withdrawn from the Segment Type Holding Accounts on a pro-rata basis. If there is insufficient value in the Segment Type Holding Accounts, any additional amount required or the total amount of the withdrawal, as applicable, will be withdrawn from the Segments on a pro-rata basis. [Applicable to Traditional IRA and SEP-IRA Contracts:] [Withdrawals under our Automatic Required Minimum Distribution (“RMD”) Withdrawal Service will be made in the same manner as described above.]
Alternatively, you may provide specific instructions for how you wish withdrawals to be processed. You may provide specific withdrawal instructions for the [Guaranteed Interest Option] or Segment Type Holding Account(s) or Segment(s). A specific dollar amount or percentage, or percentage of the Segment Interim Value (as applicable) must be provided for the [Guaranteed Interest Option] or Segment Type Holding Account or Segment. Withdrawals cannot be taken on a pro-rata basis for the specified [Guaranteed Interest Option] or Segment Type Holding Accounts or Segments.
The minimum lump sum withdrawal amount is [$300].
[Applicable to Traditional IRA and SEP-IRA Contracts:] [Automatic Required Minimum Distribution Withdrawals: The Automatic Required Minimum Distribution Withdrawal minimum initial amount is [$250]. See Endorsement Applicable to [Traditional IRA] Contracts.]
[Applicable to Qualified Plan Contracts:] [Amounts withdrawn to pay Third Party Administrator (TPA) fees are not subject to this minimum withdrawal amount.]
CONTRACT TERMINATION (See Section 6.02 of the Contract):
Requests for a withdrawal must be for either (a) 90% or less of the Cash Value or (b) 100% of the Cash Value (surrender of the Contract). A request for more than 90% of the Cash Value will be considered a request to withdraw 100% of the Cash Value and this Contract will terminate.
If a withdrawal is made that would result in a Cash Value less than [$500], we will so advise you and have the right to pay you such Value. In that case, this Contract will terminate.
| ICC26-DPCSCSPR | Data Page [11] |
[The following Part VIII will not appear for Inherited Traditional IRA, Inherited Roth IRA, and Inherited Non-Qualified Contracts:]
[PART VIII – ANNUITY BENEFITS
NORMAL FORM OF ANNUITY BENEFIT (See Section 8.04 of the Contract): Life Annuity with Period Certain
For annuity commencement date ages [80] and greater, the “Period Certain” is as follows:
| Annuitization Age |
Length of Period Certain | |
| Up to age [80 |
[10 | |
| 81 |
9 | |
| 82 |
8 | |
| 83 |
7 | |
| 84 |
6 | |
| 85 |
5 | |
| 86 |
4 | |
| 87 |
3 | |
| 88 |
2 | |
| 89 |
1 | |
| 90 through 98] |
0] |
AMOUNT OF ANNUITY BENEFIT (See Section 8.05 of the Contract): The amount applied to provide the Annuity Benefit will be (1) the Annuity Account Value for any life annuity form or (2) the Cash Value for any annuity certain (an annuity form which does not guarantee payments for a person’s lifetime) except that, if the period certain is more than five years, the amount applied will be no less than 95% if available, of the Annuity Account Value.
CONDITIONS FOR PAYMENT (MINIMUM AMOUNT TO BE APPLIED TO AN ANNUITY) (See Section 8.06 of the Contract): [$2,000], as well as minimum of $20 for initial monthly annuity payment.
MISSTATEMENT OF AGE OR SEX (INTEREST RATE TO BE APPLIED IN ADJUSTING FOR MISSTATEMENT OF AGE OR SEX) (See Section 10.09 of the Contract):
[6%] per year ]
| ICC26-DPCSCSPR | Data Page [12] |
PART C – This part describes certain charges in your Contract.
PART IX – CHARGES
Transfer Charges (See Section 9.02 of the Contract):
Currently, the number of free transfers is [unlimited], subject to the terms of Sections 6.01 and 9.02. However, we reserve the right to limit the number of free transfers to [12] transfers per Contract Year.
[For each additional transfer in excess of the free transfers, we will charge the lesser of [$25] or [2%] of each transaction amount at the time each transfer is processed. The Charge is deducted from the Investment Options from which each transfer is made on a pro-rata basis. This charge may change, subject to a maximum of $35 for each transaction. Automatic transfers between a Segment Type Holding Account and to a Segment are not included for purposes of this charge.]
Third Party Transfer Charge (see Section 9.04 of the Contract):
We reserve the right to deduct a charge from the amounts withdrawn, which is no greater than $55 per occurrence for a direct rollover, direct transfer, or 1035 exchange from this Contract and transferred to a third party, or to another company, or in connection with an exchange of this Contract for a Contract issued by another company. The current charge is [$0.00].
This charge will be deducted from the Annuity Account Value in the [Guaranteed Interest Option]. If there is insufficient value or no value in the [Guaranteed Interest Option], any additional amount required or the total amount of the withdrawal, as applicable, will be withdrawn from the Segment Type Holding Accounts on a pro-rata basis. If there is insufficient value in the Segment Type Holding Accounts, any additional amount required or the total amount of the withdrawal, as applicable, will be withdrawn from the Segments on a pro-rata basis.
Contract Fee (see Section 9.05 of the Contract):
Contract Fee as applied to the Structured Investment Option only:
The Contract Fee is equal to an Annual Rate of [1.50%] (equivalent to a daily rate of [0.004110%] of the Segment Investment of each Segment for the Segment Duration.
On the Segment Maturity Date, we determine the Segment Maturity Value which reflects the deduction of the Contract Fee in the Segment Rate of Return.
On dates other than the Segment Maturity Date a deduction of the Contract Fee corresponding to the elapsed portion of the Segment Duration is deducted from the Segment Interim Value. This means your Contract Fee is determined by multiplying the number of calendar days elapsed in your Segment by the Contract Fee expressed as a daily rate and multiplying that by your Segment Investment. This determines your Contract Fee, which is deducted from the Segment Interim Value.
The Segment Investment is adjusted on a pro-rata basis for withdrawals and transfers of the Segment Investment out of the Structured Investment Option and the portion of the Contract Fee that is attributable to the amount withdrawn and transferred.
| ICC26-DPCSCSPR | Data Page [13] |
Check Preparation Charge (see Section 10.06 of the Contract): Alternate Payment Method
We will pay all amounts due under this Contract by direct deposit to a bank account that accepts such deposits provided that you have given us authorization, and the information we need to initiate the deposit, in a form acceptable to us. If you have not provided such authorization and information, we will make the payment by check drawn on a bank located in the United States (subject to any check preparation charge specified herein) or by any other method to which you and we agree. All payments will be made in U.S. Dollars. Any Check Preparation Charge will not exceed $85. The current charge is [$0.00].
| ICC26-DPCSCSPR | Data Page [14] |