SAGE VARIABLE ANNUITY ACCOUNT A
N-4, 1998-01-22
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<PAGE>   1
    As filed with the Securities and Exchange Commission on January 22, 1998

                                                             File No. 333-______
                                                               File No. 811-8581

                       SECURITIES AND EXCHANGE COMMISSION
                             Washington, D.C. 20549

                                    FORM N-4

           REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933   [X]
              Pre-Effective Amendment No.                            [ ]
                                           ---
              Post-Effective Amendment No.                           [ ]
                                           ---

                          REGISTRATION STATEMENT UNDER
                     THE INVESTMENT COMPANY ACT OF 1940              [X]

                               Amendment No.  1                      [X]
                                             ---

                       THE SAGE VARIABLE ANNUITY ACCOUNT A
                           (Exact Name of Registrant)

                      SAGE LIFE ASSURANCE OF AMERICA, INC.
                               (Name of Depositor)

                               300 Atlantic Street
                               Stamford, CT 06901
              (Address of Depositor's Principal Executive Offices)

                  Depositor' s Telephone Number: (203) 324-6338

                                James F. Bronsdon
                      Sage Life Assurance of America, Inc.
                               300 Atlantic Street
                               Stamford, CT 06901

               (Name and Address of Agent for Service of Process)

                                    Copy to:
                                 Stephen E. Roth
                        Sutherland, Asbill & Brennan LLP
                         1275 Pennsylvania Avenue, N.W.
                           Washington, D.C. 20004-2404


<PAGE>   2



APPROXIMATE DATE OF PROPOSED PUBLIC OFFERING:

As soon as practicable after the effective date of the Registration Statement.

Title of Securities: Interests in a separate account under flexible payment
deferred combination fixed and variable annuity contracts.

The Registrant hereby amends this Registration Statement on such date or dates
as may be necessary to delay its effective date until the Registrant files a
further amendment which specifically states that this Registration Statement
shall thereafter become effective in accordance with Section 8(a) of the
Securities Act of 1933 or until the Registration Statement shall become
effective on such date as the Commission, acting pursuant to said Section 8(a),
may determine.


<PAGE>   3



                              CROSS REFERENCE SHEET
                       PURSUANT TO RULE 481(a) AND 495(a)

Showing location in Part A (Prospectus) and Part B (Statement of Additional
Information) of Registration Statement of Information required by Form N-4


                                     PART A

<TABLE>
<CAPTION>
ITEM OF FORM N-4                                                                 PROSPECTUS CAPTION
- ----------------                                                                 ------------------


<S>                                                                              <C>
    1.    Cover Page ........................................................... Cover Page

    2.    Definitions .......................................................... Index of Terms

    3.    Synopsis ............................................................. Fee Table; Profile

    4.    Condensed Financial Information ...................................... How is Contract Performance
                                                                                 Presented?
    5.    General           ...................................................

          (a) Depositor ........................................................ What other information should I
                                                                                 know?

          (b) Registrant ....................................................... What other information should I
                                                                                 know?

          (c) Portfolio Company ................................................ What are my investment options?

          (d) Fund Prospectus .................................................. Cover Page

          (e) Voting Rights .................................................... What other information should I
                                                                                 know?

          (f) Administrators ................................................... What other information should I
                                                                                 know?
    6.    Deductions and Expenses

          (a) General .......................................................... What are the expenses under the
                                                                                 Contract?

          (b) Sales Load % ..................................................... Fee Table; Example
</TABLE>



<PAGE>   4



<TABLE>
<S>                                                                              <C>
          (c) Special Purchase Plan ...........................................  What are the expenses under the
                                                                                 Contract?

          (d) Commissions .....................................................  What other information should I
                                                                                 know?

          (e) Fund Expenses ...................................................  Fee Table; Example

          (f) Expenses - Registrant ...........................................  Fee Table; What are the expenses
                                                                                 under the Contract?

          (g) Organizational Expenses .........................................  N/A

    7.    Contracts

          (a) Persons with Rights .............................................  What are the Contracts?; What are my
                                                                                 income payment options?; How do I
                                                                                 purchase a Contract?; How do I
                                                                                 access my money?; What other
                                                                                 information should I know?

          (b) (i) Allocation of Purchase Payments .............................  What are my investment options?

              (ii) Transfers ..................................................  What are my investment options?

              (iii) Exchanges .................................................  N/A

          (c) Changes .........................................................  What other information should  I
                                                                                 know?

          (d) Inquiries .......................................................  What are my investment options?;
                                                                                 What other information should I
                                                                                 know?

    8.    Annuity Period ......................................................  What are my income payment
                                                                                 options?

    9.    Death Benefit .......................................................  Does the Contract have a death
                                                                                 benefit?
    10.   Purchase and Contract Value

          (a) Purchases .......................................................  How do I purchase a Contract?

          (b) Valuation .......................................................  What are my investment options?

          (c) Daily Calculation ...............................................  What are my investment options?
</TABLE>


<PAGE>   5



<TABLE>
<S>                                                                              <C>
          (d) Underwriter .....................................................  What other information should I
                                                                                 know?

    11.   Redemptions.....................................................................................

          (a) By Owners .......................................................  How do I access my money?

              By Annuitant ....................................................  What are my income payment
                                                                                 options?

          (b) Texas ORP .......................................................  N/A

          (c) Check Delay .....................................................  How do I access my money?

          (d) Lapse ...........................................................  N/A

          (e) Free Look .......................................................  What other information should I
                                                                                 know?

    12.   Taxes. . . . . . . ..................................................  How will my investment in the
                                                                                 Contract be taxed?

    13.   Legal Proceedings ...................................................  What other information should I
                                                                                 know?

    14.   Table of Contents for the Statement of
          Additional Information ..............................................  Table of Contents of the Statement of
                                                                                 Additional Information
</TABLE>



<PAGE>   6



                                     PART B


<TABLE>
<CAPTION>
ITEM OF FORM N-4                                                                 PART B CAPTION
- ----------------                                                                 --------------

<S>                                                                              <C>
    15.   Cover Page ..........................................................  Cover Page

    16.   Table of Contents ...................................................  Table of Contents

    17.   General Information and History .....................................  N/A

    18.   Services
          (a) Fees and Expenses of Registrant .................................  N/A
          (b) Management Contracts ............................................  N/A
          (c) Custodian .......................................................  N/A
              Independent Accountant ..........................................  Experts
          (d) Assets of Registrant ............................................  N/A
          (e) Affiliated Person ...............................................  N/A
          (f) Principal Underwriter ...........................................  Distribution of the Contracts

    19.   Purchase of Securities Being Offered ................................  Distribution of the Contracts
          Offering Sales Load                                                    N/A

    20.   Underwriters ........................................................  Distribution of the Contracts

    21.   Calculation of Performance Data .....................................  Calculation of Historical Performance
                                                                                 Data

    22.   Annuity Payments ....................................................  Income Payment Provisions

    23.   Financial Statements ................................................  Financial Statements
</TABLE>


                           PART C - OTHER INFORMATION

<TABLE>
<CAPTION>
ITEM OF FORM N-4                                                                 PART C CAPTION
- ----------------                                                                 --------------


<S>                                                                              <C>
    24.   Financial Statements and Exhibits ...................................  Financial Statements and Exhibits
          (a) Financial Statements ............................................  (a) Financial Statements
          (b) Exhibits ........................................................  (b) Exhibits

    25.   Directors and Officers of the Depositor .............................  Directors and Officers of the
                                                                                 Depositor
</TABLE>


<PAGE>   7



<TABLE>
<S>                                                                              <C>
    26.   Persons Controlled By or Under Common ...............................  Persons Controlled By or Under
          Control with the Depositor or Registrant                               Common Control with the Depositor
                                                                                 or Registrant

    27.   Number of Contract Owners ...........................................  Number of Contract Owners

    28.   Indemnification .....................................................  Indemnification

    29.   Principal Underwriters ..............................................  Principal Underwriter

    30.   Location of Accounts and Records ....................................  Location of Books and Records

    31.   Management Services .................................................  Management Services

    32.   Undertakings ........................................................  Undertakings and Representations

          Signature Page ......................................................  Signatures
</TABLE>


<PAGE>   8



                  PROFILE DATED _________________________, 1998
        FLEXIBLE PAYMENT DEFERRED COMBINATION FIXED AND VARIABLE ANNUITY
                                    CONTRACTS
                                    Issued By
                     THE SAGE VARIABLE ANNUITY ACCOUNT A AND
                      SAGE LIFE ASSURANCE OF AMERICA, INC.



       THIS PROFILE IS A SUMMARY OF SOME IMPORTANT POINTS THAT YOU SHOULD
         KNOW AND CONSIDER BEFORE PURCHASING A CONTRACT. THE CONTRACT IS
        MORE FULLY DESCRIBED IN THE FULL PROSPECTUS THAT ACCOMPANIES THIS
                 PROFILE. PLEASE READ THAT PROSPECTUS CAREFULLY.

 "We," "us," "our", "Sage Life" or the "Company" refer to Sage Life Assurance of
        America, Inc. "You" and "your" refer to the Owner of a Contract.

1.         WHAT ARE THE CONTRACTS?

       The fixed and variable annuity Contract offered by Sage Life Assurance of
America, Inc., is a contract between you, the Owner, and us, Sage Life, an
insurance company.

       The Contract is designed for use in your long-term financial and
retirement planning. It provides a means for allocating amounts on a tax
deferred basis to our Variable Account and Fixed Account.

       Through our Variable Account you can invest in up to __ different
investment portfolios (each a "Fund"). These Funds, listed in Section 4, are
professionally managed and allow for a broad range of investment strategies
(growth and income, aggressive growth, etc.), styles (growth, value, etc.) and
asset classes (stocks, bonds, international, etc.). You can select a mix of
Funds to meet your financial and retirement needs and objectives, tolerance for
risk and view of the market. Amounts you invest in these Funds will fluctuate
daily based on underlying investment performance. So, the value of your
investment may increase or decrease.

       Through our Fixed Account, we guarantee rates of interest for periods of
1, 2, 3, 4, 5, 7 and 10 years. We also guarantee your principal while it remains
in our Fixed Account. However, if you decide to surrender your Contract or
access amounts in the Fixed Account before the end of a guarantee period you
have chosen, we may apply a Market Value Adjustment. This Adjustment reflects
the differences between the guaranteed interest rates in effect at the time of
your allocation to the Fixed Account and the time you make a premature surrender
or withdrawal. The Market Value Adjustment may result in an increase or decrease
in the amounts surrendered or accessed.

          As your needs or financial or retirement goals change, your investment
mix can change with them. After the Free-Look Period, you may transfer funds
among any of the investment choices in our Fixed or Variable Accounts while
continuing to defer current income taxes.


<PAGE>   9




       Very importantly, both the Fixed and Variable Accounts are considered
separate investment accounts of Sage Life. As a result, assets supporting your
allocations to these Accounts have an important safety feature. They cannot be
charged with liabilities arising out of any other business we may conduct.

       The Contract also provides your beneficiary with a death benefit.

       In addition, the Contract provides you with various options to access
your Account Value through income payments that are guaranteed, or income
payments that vary with underlying investment performance, or a combination of
both.

       Like all deferred annuity contracts, this Contract has two phases: the
savings, or accumulation phase; and the payout, or income phase.

       During the accumulation phase, earnings grow tax-free until withdrawn.
Once withdrawn they are taxed as income. If you withdraw money before you are 59
1/2 years old, you may have to pay an additional 10% IRS tax penalty.

       The income phase begins when you inform us you want to start receiving
regular income payments under the various income plans we offer.

2.     WHAT ARE MY INCOME PAYMENT OPTIONS?

       Once the income phase of your Contract begins, we apply your Account
Value to provide you regular income payments.

       You can choose from five different income plans:

       Income Plan 1 - Life Annuity: You will receive payments for your life.

       Income Plan 2 - Life Annuity with 10 or 20 Years Certain: You will
            receive payments for your life. However, if you die before the end
            of the guaranteed certain period you select (10 or 20 years), your
            beneficiary will receive the payments for the remainder of that
            period.

       Income Plan 3 - Joint and Last Survivor Life Annuity: Payments will be
            made as long as either you or a second person you select (such as
            your spouse) is alive.

       Income Plan 4 - Payments for a Specified Period Certain: You will receive
            payments for the number of years you select. However, if you die
            before the end of that period, your beneficiary will receive the
            payments for the remainder of the guaranteed certain period.


                                        2

<PAGE>   10



       Income Plan 5 - Annuity Plan: You can use your Account Value to purchase
            any other income plan we offer at the time you want to begin
            receiving income payments for which you and the Annuitant are
            eligible.

       In explaining the income plans we are assuming that you designate
yourself as the Annuitant. Of course, you can designate someone other than
yourself as Annuitant.

       You tell us how much of your Account Value to apply to fixed income
payments and to variable income payments. During the income phase you still have
all of the investment choices you had prior to beginning income payments.
However, transfers among your investment choices will be limited.

       The amount of Account Value you apply to provide fixed income payments
will be allocated to the Fixed Account. The amount of each income payment is
guaranteed and remains level throughout the payment period.

       The amount of Account Value you apply to provide variable income payments
will be allocated to the Variable Account and invested in the investment
portfolios you select. The amount of each income payment will vary according to
the investment performance of those portfolios.

3.     HOW DO I PURCHASE A CONTRACT?

       In most cases you may purchase a Contract with $5,000 or more through one
of our authorized agents.

       For tax-qualified Contracts (like IRAs) we require only $2,000, but, of
course, for rollovers you always have the flexibility to invest more.

       In addition, you can add $250 or more to your Contract at any time during
the accumulation phase.

4.     WHAT ARE MY INVESTMENT OPTIONS?

       There are __ investment options under the Contracts. These choices are
professionally managed and allow for a broad range of investment strategies,
styles and asset classes.
Additional investment options may be available in the future.

       Through our Variable Account you can choose to have your money invested
in one or more of the following ___ investment portfolios that are described in
the prospectuses for the funds:

      -    The Alger American Fund
           *     Income & Growth
           *     Growth
           *     Small Capitalization



                                        3

<PAGE>   11



       These investment portfolios do not provide any performance guarantees and
therefore their value can increase or decrease depending upon investment
performance.

       Through our Fixed Account, you can choose to have your money invested in
one or more of 7 periods for which we will guarantee your principal and a rate
of interest when your investment is left in the Fixed Account for the entire
period of the guarantee. You can choose periods of 1, 2, 3, 4, 5, 7 and 10
years. However, if you decide to surrender your Contract or access amounts
before the end of a period you have chosen, we may apply a Market Value
Adjustment.

5.     WHAT ARE THE EXPENSES UNDER THE CONTRACT?

       The Contract has insurance and investment features. Each has related
costs. Below is a brief summary of the Contract's charges:

       Surrender Charges - None! There are no surrender charges under the
Contract.

        Administration Charge - During the first seven Contract Years, if, at
the time of deduction, your Account Value is less than $50,000, we will deduct a
$40 administration charge.

          Asset-Based Charges - Asset-Based Charges for mortality and expense
risks and for certain administrative costs are deducted monthly from the amount
allocated to the Variable Account. These charges are equal on an annual basis to
1.40%, decreasing to 1.25% after the seventh Contract Year.

       Purchase Payment Tax Charge - During the first seven Contract Years we
will deduct any state premium tax that we incur if you surrender your Contract
or begin receiving regular income payments. This tax charge ranges from 0% -
___% depending upon the state. We currently do not deduct this charge on or
after the eighth Contract Year.

       Fund Charges - There are also Fund charges that are based on the average
daily value of your money invested in the investment portfolios. These charges
range on an annual basis from 0.____% to 0.____%, depending upon the Fund.

       Sage Life's business strategy is to reward our long-term customers. So,
as you can see, after the seventh Contract Year we

       eliminate the administration charge;

       eliminate the purchase payment tax charge; and

       reduce Asset-Based Charges.

This means more of your investment is working for you!

                                        4

<PAGE>   12



       The following chart is designed to help you understand expenses under the
Contract.


<TABLE>
<CAPTION>
                                                                                                      Examples of Total Expenses
                           Total Annual          Total Annual Fund          Total Annual                  Paid at the End of:   
         Fund            Insurance Charges            Charges                  Charges                    -------------------

Alger American Fund                                                                                  One Year             Ten Years
- -------------------                                                                                  --------             ---------
<S>                            <C>                     <C>                      <C>                    <C>                  <C>  
Income and Growth              1.40%                   .81%                     2.21%                  $____                $____

Small Capitalization           1.40%                   .88%                     2.28%                  $____                $____

Growth                         1.40%                   .79%                     2.19%                  $____                $____

___________________            ____%                   ____%                    ____%                  $____                $____

___________________            ____%                   ____%                    ____%                  $____                $____

___________________            ____%                   ____%                    ____%                  $____                $____
</TABLE>

       Below is an explanation of what is included in each column of the chart:

       The column "Total Annual Insurance Charges" shows the total of the
            annual administration charge (for purposes of the chart it is
            assumed to be 0.___% of the value of an average Contract) and the
            Asset-Based Charges.

       The column "Total Annual Fund Charges" shows the charges for each Fund.
            The charges shown for [each] Fund reflect the fact that the
            investment adviser to [each] Fund has agreed to bear the expenses
            incurred by the ______________, other than the investment advisory
            fee, that exceed 0.___% of that Fund's average daily net assets.
            These expense limitations are voluntary and may be terminated by an
            adviser at any time.

       The column "Total Annual Charges" shows the total of "Total Annual
            Insurance Charges" and "Total Annual Fund Charges."

       The next two columns show you examples of the charges, in dollars, you
            could pay under a Contract for each $1,000 you invest when you
            purchased the Contract. The examples assume the average Account
            Value is $30,000 and that your Contract earns 5% annually before
            charges.

       For more information about expenses under the Contract, please refer to
the "Fee Table" in the full prospectus that accompanies this Profile.

6.     HOW WILL MY INVESTMENT IN THE CONTRACT BE TAXED?

       During the accumulation phase, your earnings are not taxed until you take
them out. If you take money out, earnings come out first and are taxed as
income. If you are younger than 59 1/2 when you take money out, you may be
charged a 10% federal tax penalty on the withdrawn earnings.

        Income payments during the income phase are considered partly a return
of your original investment. That part of each payment is not taxable as income.

                                        5

<PAGE>   13



       Special tax rules apply to withdrawals from a new type of IRA called the
Roth IRA.

7.     HOW DO I ACCESS MY MONEY?

       During the accumulation phase, if you want to take money out of your
Contract, you can choose among several different options.

       You can withdraw some of your money.

       You can surrender the Contract and take the proceeds as a single lump
            sum payment or apply the proceeds to an income plan.

       You can take withdrawals using our systematic partial withdrawal option.

       Keep in mind that amounts you surrender or withdraw may be subject to a
Market Value Adjustment if the amounts are taken from the Fixed Account. If you
are younger than 59 1/2 when
you take money out, you may be charged a 10% tax penalty.

       Once you start receiving regular income payments and if you selected the
"payments for a specified period certain" income plan, you may request a full
withdrawal.

8.     HOW IS CONTRACT PERFORMANCE PRESENTED?

       As of the date of this Profile, the Variable Account had not commenced
operations. However, certain of the Funds had commenced operations prior to the
date of this Profile. For those Funds, non-standard performance data is shown.

       Non-standard performance data is data that reflects the past performance
of the Funds as adjusted for the Contract expenses and deductions discussed
above, except for the purchase payment tax charge. If applied, this charge would
reduce the performance figures shown.

       Please remember that past performance is not a guarantee of future
results.

                                        6

<PAGE>   14






<TABLE>
<CAPTION>
Fund      1997     1996        1995        1994     1993      1992        1991        1990      1989      1988     1987
- ----      ----     ----        ----        ----     ----      ----        ----        ----      ----      ----     ----
<S>       <C>      <C>         <C>         <C>       <C>      <C>         <C>         <C>       <C>       <C>       <C>

















</TABLE>


9.     DOES THE CONTRACT HAVE A DEATH BENEFIT?

   If you die during the accumulation phase, we will pay a death benefit to your
designated beneficiary. The amount of the death benefit will be the greatest of
the following:

           the current Account Value on the date we receive due proof of death;

           100% of the sum of all purchase payments you have invested in your
                Contract, less any withdrawals you have made (including any
                Market Value Adjustment incurred); or

           the highest anniversary value on or before you reach age 80.

The anniversary value is equal to the Account Value of your Contract on a
Contract Anniversary, increased by the dollar amount of any additional purchase
payments you have invested since that Contract Anniversary and reduced
proportionately by any withdrawals (including any associated Market Value
Adjustments incurred) you have taken since that anniversary.

10.        WHAT OTHER INFORMATION SHOULD I KNOW?

           The Contract has several additional features:

           FREE-LOOK RIGHT: You have the right to return the Contract to us at
our Customer Service Center or to the agent who sold it to you, and have us
cancel the Contract within a certain number of days (usually 10 days from the
date you receive the Contract, but some states require
different periods).


                                        7

<PAGE>   15



           If you exercise this right, we will cancel the Contract as of the day
we receive it and send you a refund equal to your Account Value plus any charges
we have deducted on or before the date we received the returned Contract, or if
greater and required by the law of your state, your initial purchase payment
(less any withdraws previously taken). In some states, if you allocated amounts
to the Variable Account, those amounts will be allocated to the Money Market
Fund until the Period expires.

           DOLLAR-COST AVERAGING PROGRAM: An optional Dollar-Cost Averaging
Program permits you to transfer a set dollar amount systematically from the
Money Market Fund and/or the Fixed Account to any other investment portfolio,
subject to certain limitations. By investing the same dollar amount on a regular
basis, you don't have to worry about timing the market. Since you invest the
same amount each period, you automatically acquire more units when market values
fall and fewer units when they rise. The potential benefit is to lower your
average cost per unit. This proven investment technique does not guarantee that
any investment portfolio will gain in value. It also will not protect against a
decline in value if market prices fall. However, if you can continue to invest
regularly throughout changing market conditions, this program can be an
effective strategy to help meet your long-term or retirement goals.

           ASSET ALLOCATION PROGRAM: An optional Asset Allocation Program helps
if you do not wish to make your own particular investment decisions. This
investment planning tool is designed to find an optimal asset mix that attempts
to achieve the highest expected return based upon your tolerance for risk, and
consistent with your needs and objectives. This program was designed in
conjunction with Ibbotson and Associates, one of the nation's premier providers
of asset allocation consulting services.

           AUTOMATIC PORTFOLIO REBALANCING PROGRAM: An optional Automatic
Portfolio Rebalancing Program can help prevent a sensible well-conceived
investment strategy from becoming diluted over time. Investment performance will
likely cause your investment percentages to shift. With this program, you can
instruct us to automatically rebalance your Contract to your original
percentages on a quarterly basis. Money invested in the Fixed Account is not
part of this program.

11.        HOW CAN I MAKE INQUIRIES?

           If you need further information about the Contracts, please write or
call us at our Customer Service Center (888) 502-7243, or contact an authorized
agent. The address of our Customer Service Center office is P.O. Box ____,
Wethersfield, CT____.

                                        8

<PAGE>   16



                       PROSPECTUS DATED ___________, 1998
                      SAGE LIFE ASSURANCE OF AMERICA, INC.
        FLEXIBLE PAYMENT DEFERRED COMBINATION FIXED AND VARIABLE ANNUITY
                                    CONTRACTS
                                    Issued by
                     THE SAGE VARIABLE ANNUITY ACCOUNT A and
                      SAGE LIFE ASSURANCE OF AMERICA, INC.


Executive Office:                                      Customer Service Center:
300 Atlantic Street                                    P.O. Box _____
Stamford, CT  06901                                    Wethersfield, CT ____
                                          Telephone: (888) 502-7243 (Toll Free)


           UNLESS OTHERWISE INDICATED, THIS PROSPECTUS DESCRIBES THE OPERATION 
OF THE CONTRACTS BEFORE THE INCOME DATE.  DEFINITIONS OF CERTAIN TERMS USED IN 
THIS PROSPECTUS MAY BE FOUND BY REFERRING TO THE INDEX OF TERMS.

           This prospectus describes flexible payment deferred combination fixed
and variable annuity contracts (the "Contracts") offered by Sage Life Assurance
of America, Inc. ("we," "us," "our," or the "Company"). The Contracts are
designed for use in your long-term financial and retirement planning. They
provide a means for investing on a tax-deferred basis in our Variable Account
and our Fixed Account. You can purchase a Contract by making a minimum initial
purchase payment. After purchase, an Owner of a Contract determines the amount
and timing of additional purchase payments.

           An Owner may allocate purchase payments and transfer Account Value to
The Sage Variable Annuity Account A (the "Variable Account") and also to The
Sage Fixed Interest Account A (the "Fixed Account") within certain limits. The
Variable Account is divided into ___Sub-Accounts (each, a "Variable
Sub-Account").

           Each Variable Sub-Account invests in a corresponding investment
portfolio (each, a "Fund") of The Alger American Fund, ____, ____, or ___
(collectively, the "Trusts"). The accompanying prospectuses describe each of the
Funds, including the risks of investing in each Fund, and provide other
information about the Trusts. These prospectuses should be read in conjunction
with this prospectus.

           The Account Value will vary daily as a function of the investment
performance of the Variable Sub-Accounts and any interest credited under our
Fixed Account. The Company does not guarantee any minimum Account Value for
amounts allocated to the Variable Account. Amounts allocated to the Fixed
Account are guaranteed a minimum fixed rate of interest for specified periods of
time. However, amounts withdrawn, surrendered, transferred, or applied to an
income plan from the Fixed Account may be subject to a Market Value Adjustment,
the operation of which may increase or decrease such amounts. The Contracts
provide additional benefits, including five income plan options, a death benefit
upon any Owner's death before the


<PAGE>   17



Income Date, and optional programs including dollar-cost averaging, asset
allocation, automatic portfolio rebalancing, and systematic partial withdrawals.

           This prospectus sets forth basic information about the Contracts, the
Variable Account, and the Fixed Account that a prospective purchaser ought to
know before purchasing a Contract. This prospectus should be read carefully and
retained for future reference.

           Additional information about the Contracts and the Variable Account
is contained in the Statement of Additional Information, which has been filed
with the Securities and Exchange Commission. The Statement of Additional
Information is dated the same as this prospectus and is incorporated herein by
reference. The Table of Contents for the Statement of Additional Information is
on page ____ of this prospectus. You may obtain a copy of the Statement of
Additional Information free of charge by writing to or calling us at our
Customer Service Center at the address or phone number shown above.

PLEASE READ THIS PROSPECTUS CAREFULLY AND KEEP IT FOR FUTURE
REFERENCE.  THIS PROSPECTUS MUST BE ACCOMPANIED BY THE CURRENT
PROSPECTUS FOR EACH OF THE FUNDS.

THESE SECURITIES HAVE NOT BEEN APPROVED OR DISAPPROVED BY THE SECURITIES AND
EXCHANGE COMMISSION NOR HAS THE SECURITIES AND EXCHANGE COMMISSION PASSED UPON
THE ACCURACY OR ADEQUACY OF THIS PROSPECTUS. ANY REPRESENTATION TO THE CONTRARY
IS A CRIMINAL OFFENSE.

VARIABLE ANNUITY CONTRACTS ARE NOT DEPOSITS OR OBLIGATIONS OF, OR ENDORSED OR
GUARANTEED BY, ANY BANK, NOR ARE THEY FEDERALLY INSURED OR OTHERWISE PROTECTED
BY THE FDIC, THE FEDERAL RESERVE BOARD, OR ANY OTHER AGENCY; THEY ARE SUBJECT TO
INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF PRINCIPAL.


                                        2

<PAGE>   18



                                TABLE OF CONTENTS




<TABLE>
<S>                                                                                                 <C>
INDEX OF TERMS ......................................................................................

FEE TABLE............................................................................................

EXAMPLE..............................................................................................
1.         What are the Contracts?...................................................................
2.         What are my Income Payment Options?.......................................................
3.         How do I purchase a Contract?.............................................................
                     Initial Purchase Payment........................................................
                     Issuance of a Contract..........................................................
                     Free-Look Right to Cancel Contract..............................................
                     Making Additional Purchase Payments.............................................
4.         What are my Investment Options?
                     Purchase Payments Allocations...................................................
                     Variable Sub-Account Investment Options.........................................
                     Fixed Account Investment Options................................................
                     Market Value Adjustment.........................................................
                     Transfers.......................................................................
                     Dollar-Cost Averaging Program...................................................
                     Asset Allocation Program........................................................
                     Automatic Portfolio Rebalancing Program.........................................
                     Account Value...................................................................
                     Surrender Value.................................................................
                     Variable Account Value..........................................................
                     Accumulation Unit Value.........................................................
                     Net Investment Factor...........................................................
                     Fixed Account Value.............................................................
5.         What are the expenses under the Contract?
                     Surrender Charges...............................................................
                     Annual Administration Charge....................................................
                     Transfer Charge ................................................................
                     Asset-Based Charges.............................................................
                     Fund Expenses...................................................................
6.         How will my investment in the Contract be taxed?
                     Introduction....................................................................
                     Tax Status of the Contracts.....................................................
                               Diversification Requirements..........................................
                               Required Distribution.................................................
                     Tax Treatment of Annuities......................................................
                               In General............................................................
                     Taxation of Non-Qualified Contracts.............................................
</TABLE>

                                        i

<PAGE>   19



<TABLE>
<S>                                                                                                 <C>
                               Non-Natural Person....................................................
                               Withdrawals...........................................................
                               Penalty Tax on Certain Withdrawals....................................
                               Income Payments.......................................................
                               Taxation of Death Benefit Proceeds....................................
                               Transfers, Assignments of a Contract..................................
                               Withholding...........................................................
                               Multiple Contracts....................................................
                     Taxation Of Qualified Contracts.................................................
                               Withdrawals...........................................................
                               Individual Retirement Annuities.......................................
                               Simple IRAs...........................................................
                               Roth IRAs.............................................................
                     Other Tax Consequences..........................................................
7.         How do I access my Money?
                     Withdrawals.....................................................................
                     Surrenders......................................................................
                     Systematic Partial Withdrawal Program...........................................
                     IRA Partial Withdrawal Option...................................................
                     Requesting Payments.............................................................
8.         How is Contract Performance Presented?
9.         Does the Contract have a Death Benefit?
                     Death Benefit...................................................................
           Proof of Death............................................................................
10.        What other Information should I know?
                     Sage Life Assurance of America, Inc.............................................
                     The Sage Variable Annuity Account A.............................................
                     The Sage Fixed Interest Account A...............................................
                     Voting of Fund Shares...........................................................
                     Modification....................................................................
                     Distribution of the Contacts....................................................
                     Experts.........................................................................
                     Legal Matters...................................................................
                     Legal Proceedings...............................................................
                     Reports to Contract Owners......................................................
                     Assignment......................................................................
                     Change of Owner, Beneficiary, or Annuitant......................................
                     Misstatement and Proof of Age,
                     Sex, or Survival................................................................
                     Incontestability................................................................
                     Participation...................................................................
                     Authority to Make Agreements....................................................
                     Financial Statements............................................................
11.        How can I make Inquiries?
</TABLE>


                                       ii

<PAGE>   20



ADDITIONAL INFORMATION ABOUT SAGE LIFE ASSURANCE OF AMERICA, INC.

<TABLE>
<S>                                                                                                 <C>
           History and Business......................................................................
                     Selected Financial Data.........................................................
                     Management's Discussion and Analysis of Financial Condition and Results of
           Operations................................................................................
                     Competition.....................................................................
                     Transactions with Sage Insurance Group..........................................
           Employees.................................................................................
           Properties................................................................................
           State Regulation..........................................................................
           Directors and Executive Officers..........................................................
</TABLE>

FINANCIAL STATEMENTS OF SAGE LIFE ASSURANCE OF AMERICA, INC.

STATEMENT OF ADDITIONAL INFORMATION

APPENDIX A

THIS PROSPECTUS DOES NOT CONSTITUTE AN OFFERING IN ANY JURISDICTION IN WHICH
SUCH OFFERING MAY NOT LAWFULLY BE MADE.


                                       iii

<PAGE>   21



                                 INDEX OF TERMS
- --------------------------------------------------------------------------------



Account Value - The Account Value is the entire amount we hold under your
Contract. It is equal to the sum of the Variable Account Value and Fixed Account
Value.

Accumulation Period - The Accumulation Period is the period during which you
accumulate savings under your Contract.

Accumulation Unit - An Accumulation Unit is the unit of measure we use before
the Income Date to keep track of the value of each Variable Sub-Account.

Annuitant - The Annuitant is the natural person whose age determines the maximum
Income Date and the amount and duration of income payments involving life
contingencies. The Annuitant may also be the person to whom any payment will be
made starting on the Income Date.

Asset-Based Charges - The Asset-Based Charges are charges for mortality and
expense risks and for administrative costs assessed monthly against the assets
of the Variable Account. After the Income Date, these charges are called
Variable Sub-Account Charges and are deducted daily from the assets of the
Variable Account.

Beneficiary - The person or persons to whom we pay a death benefit if any Owner
dies before the Income Date.

Business Day - A Business Day is any day the New York Stock Exchange ("NYSE") is
open for trading and we are open for business, exclusive of Federal holidays,
and any day on which the Securities and Exchange Commission ("SEC") requires
that mutual funds, unit investment trusts or other investment portfolios be
valued.

Code - The Code is the Internal Revenue Code of 1986, as amended.

Contracts - The Contracts are flexible payment deferred combination fixed and
variable annuity contract offered by us, Sage Life Assurance of America, Inc. In
some jurisdictions, the Contracts are issued directly to individuals. In most
jurisdictions, however, the Contracts are only available as a group contract. A
group Contract is issued to or on behalf of a group. Individuals who are part of
a group for which a Contract is issued receive a certificate that recites
substantially all of the provisions of the group Contract. Throughout this
prospectus and unless otherwise stated, the term "Contract" refers to individual
contracts, group Contracts, and certificates for Group Contracts.

Contract Anniversary - A Contract Anniversary is each anniversary of the
Contract Date.

Contract Date - The Contract Date is the date an individual Contract or a
certificate for a group Contract is issued at our Customer Service Center.

Contract Year - A Contract Year is each and every consecutive twelve month
period beginning on the Contract Date and the anniversaries thereof.

                                        1

<PAGE>   22



Customer Service Center - The Customer Service Center is where we provide
service to you. The administrator of our center is Financial Administration
Services, Inc. The mailing address and telephone number of the Customer Service
Center are shown on the first page of this prospectus.

Executive Office - The Executive Office is our main office. The mailing address
of our Executive Office is shown on the first page of this prospectus.

Expiry Date - The Expiry Date is the last day in a Guarantee Period.

Fixed Account - The Fixed Account is The Sage Fixed Interest Account A. It is a
separate investment account of ours under state insurance law (but not under
federal securities laws) into which purchase payments may be allocated or
Account Value may be transferred.

Fixed Account Value - The Fixed Account Value is the sum of the value of each
Fixed Sub-Account on any particular date.

Fixed Sub-Account - A Fixed Sub-Account is established when a purchase payment
is invested or an amount is transferred to the Fixed Account. Each Fixed
Sub-Account is credited with a Guaranteed Interest Rate for a specified
Guarantee Period.

Fund - A Fund is an investment portfolio in which a Variable Sub-Account
invests.

General Account - The General Account consists of all our assets other than
those held in any separate investment accounts.

Guaranteed Interest Rate - The Guaranteed Interest Rate is the effective annual
interest rate that we will credit for a specified Guarantee Period for amounts
allocated to a Fixed Sub-Account. The Guaranteed Interest Rate will never be
less than the minimum shown in your Contract.

Guarantee Period - A Guarantee Period is a period of years for which a specified
effective annual interest rate is guaranteed by us. Interest is credited daily
at a rate to yield the declared annual Guaranteed Interest Rate.

Income Date - The Income Date is the date the Owner selects for income payments
under a Contract to commence.

Income Unit - An Income Unit is the unit of measure we use to calculate the
amount of income payments under a variable income plan option.

Market Value Adjustment - A Market Value Adjustment is a positive or negative
adjustment that may apply to withdrawals or transfers, whether in whole or in
part, or amounts applied to an income plan, from a Fixed Sub-Account before the
end of a Guarantee Period.

Net Asset Value - Net Asset Value is the price of one share of an investment
portfolio.


                                        2

<PAGE>   23



Owner - The person or persons who owns (or own) a Contract. Provisions relating
to action by the Owner mean, in the case of joint Owners, both Owners acting
jointly. In the context of a Contract issued on a group basis, Owners refer to
holders of certificates under a group Contract.

Satisfactory Notice - Satisfactory Notice is a notice or request authorized by
you, in a form satisfactory to us, received at our Customer Service Center.

Surrender Value - The Surrender Value is the amount you receive upon surrender
of your Contract before the Income Date.

Valuation Period - The Valuation Period is the period between one calculation of
an Accumulation Unit value and the next calculation. Normally, we calculate
Accumulation Units once each Business Day, but we can delay this determination
if an emergency exists, making disposal of or fair valuation of assets in the
Variable Account not reasonably practicable, or the SEC permits such deferral.

Variable Account - The Variable Account is The Sage Variable Annuity Account A.
It is a separate investment account of ours under the federal securities laws
into which purchase payments may be invested or Account Value maybe transferred.

Variable Account Value - Variable Sub-Account Value is the sum of the value of
each Variable Sub- Account.

Variable Sub-Account - A Variable Sub-Account is a division of the Variable
Account which invests in shares of a particular investment portfolio.

Variable Sub-Account Charges - Variable Account Charges are Asset-Based Charges
that are deducted daily from the assets of the Variable Account after the Income
Date.

"We", "us", "our", "Sage Life" or the "Company" is Sage Life Assurance of
America, Inc.

"You" or "your" is the Owner of a Contract. You are entitled to exercise all
rights under a Contract. However, if you designate an irrevocable beneficiary,
you may need the consent of that beneficiary before you exercise your rights
under your Contract. Your death before the Income Date initiates payment of the
Death Benefit.


                                        3

<PAGE>   24



                                    FEE TABLE

The purpose of this Fee Table is to assist you in understanding the expenses
that you will pay directly or indirectly when you invest in the Contract.

TRANSACTION EXPENSES

<TABLE>
<S>                                                                                                                 <C>
           Sales Load Imposed on Purchases (as a percentage of purchase payments)...................................None

           Surrender Charge.........................................................................................None

           Transfer Charge(1)........................................................................................$ 0

           Annual Administration Charge(2)...........................................................................$40
</TABLE>

In addition, the amount of any state and local taxes levied by any governmental
entity on purchase payments may be deducted from Account Value when such taxes
are incurred. We reserve the right to defer the collection of this charge and
deduct it against your Account Value on the surrender of a Contract or on
application of Account Value to provide income payments. We refer to this as a
purchase payment tax charge.


VARIABLE ACCOUNT MONTHLY EXPENSES(3) (as a percentage of the Variable Account
Value)

<TABLE>
<CAPTION>
                                                                               Contract Years
                                                                       -----------------------------
<S>                                                                     <C>                   <C>
                                                                        1 - 7                  8 +
                                                                        -----                  -----
          Mortality and Expense Risk Charge                             1.25%                  1.10%
          Asset-Based Administrative Charge                             0.15%                  0.15%
          ---------------------------------                             -----                  -----
          Total Asset-Based Charges                                     1.40%                  1.25%
</TABLE>



- --------

1/ There is no transfer charge. However, we reserve the right to charge $25 per
transfer after - the first 12 transfers in a Contract Year.

2/ The Annual Administration Charge is waived on and after the eighth Contract
Anniversary, or if the Account Value is at least $50,000 on the date of
deduction. 

3/ The Asset-Based Charges are called Variable Sub-Account Charges and are
deducted on a daily basis after the Income Date. See "What are the Expenses
under the Contract?" on page __.


                                        4

<PAGE>   25



FUND ANNUAL EXPENSES (as a percentage of average daily net assets)

<TABLE>
<CAPTION>
                                          Management          Other Expenses (after                    Total Annual
                                          Fee                 expense limitation)(4)                   Expenses

<S>                                       <C>                           <C>                            <C>  
The Alger American Fund
- -----------------------
Income and Growth                         0.__%                         0.__%                          0.__%
Small Capitalization                      0.__%                         0.__%                          0.__%
Growth                                    0.__%                         0.__%                          0.__%

                                          0.__%                         0.__%                          0.__%
________________
                                          0.__%                         0.__%                          0.__%
________________
                                          0.__%                         0.__%                          0.__%
________________
</TABLE>


EXAMPLE

           The purpose of the following Example is to demonstrate the expenses
that you would pay on a $1,000 investment in the Variable Account. The Example
is calculated based on the fees and charges shown in the tables above. For a
more complete description of these expenses, see "What are the expenses under
the Contract?" beginning on page __ of this prospectus, and see the prospectuses
for the Trusts. The Example assumes that the average Account Value is $30,000.
The Example assumes you have invested all your money in the Variable Account.

<TABLE>
<CAPTION>
You would pay the following
expenses on a $1,000 initial purchase
payment, assuming a 5% annual                       1. If you surrender or annuitize         2. If you do not surrender
return on assets and the charges                       your Contract at                         or annuitize your Contract at
listed in the Fee Table above                          the end of each time period              the end of each time period


                                                              1 Year    3 Years                        1 Year     3 Years
The Alger American Fund
- -----------------------
<S>                                                           <C>       <C>                            <C>        <C> 
Income and Growth                                             $___      $___                           $___       $___
Small Capitalization                                          $___      $___                           $___       $___
Growth                                                        $___      $___                           $___       $___


_________________                                             $___      $___                           $___       $___
_________________                                             $___      $___                           $___       $___
_________________                                             $___      $___                           $___       $___
</TABLE>


- --------

4/ Absent this expense limitation, estimated Other Expenses for the
_________________, would be _________________, respectively. Other Expenses for
the ___, ___, and ___ [new funds] are based on estimated amounts for the current
fiscal year. Other Expenses for the ___, ___, and ___ [old funds] are based on
amounts actually incurred for the prior fiscal year. Other Expenses also reflect
the fact that the investment adviser to the ___, ___, ___, ___ [Funds] have
agreed to bear the expenses incurred by each Fund, other than the investment
advisory fee, that exceed ____% of such Fund's average daily net assets. These
expense limitation arrangements are voluntary and can be eliminated by the
investment adviser at any time.

                                        5

<PAGE>   26



The Example should not be considered a representation of past or future
expenses. Actual expenses may be greater or less than those shown. In addition,
purchase payment tax charges are not reflected. These taxes may apply depending
on the state where the Contract is sold. You might also incur transfer fees if
you make more than twelve transfers in a Contract Year. See "Transfer Charge,"
page _. The assumed 5% annual rate of return is hypothetical and should not be
considered a representation of past or future annual returns, which may be
greater or less than this assumed rate.

1.        WHAT ARE THE CONTRACTS?

          The Contracts are flexible payment deferred combination fixed and
variable annuity Contracts offered by us, Sage Life Assurance of America, Inc.
Throughout this prospectus, the term "Contracts" refers to individual Contracts,
group Contracts, and certificates for group Contracts. The Contracts are
designed for use in long-term financial and retirement planning. They provide a
means for investing on a tax-deferred basis in our Variable Account and our
Fixed Account.

          Under the terms of the Contracts, we promise to pay you (or the
Annuitant, if the Owner is other than an individual) income payments after the
Income Date. Until the Income Date, you may pay additional purchase payments
under the Contracts, and will generally not be taxed on increases in the value
of your Contract as long as you do not take distributions. When you use the
Contracts in connection with tax-qualified retirement plans, federal income
taxes may be deferred on your purchase payments, as well as on increases in the
value of your Contract. See "How will my investment in the Contracts be taxed?"
on page _. The Contracts may not be available in all states.

          When you make purchase payments, you can allocate those purchase
payments to one or more of the ___ subdivisions of the Variable Account, known
as "Variable Sub-Accounts." Purchase payments allocated to a Variable
Sub-Account will be invested solely in a Fund, as you direct. Your Account Value
in a Variable Sub-Account will vary according to the investment performance of
the corresponding Fund. Depending on market conditions, your value in each
Variable Sub-Account could increase or decrease. The total of the values in each
Variable Sub-Account is called the Variable Account Value.

           You can also allocate purchase payments to our Fixed Account. See
"Fixed Account Option, " page ___. The Fixed Account includes Fixed Sub-Accounts
that we credit fixed rates of interest for the Guarantee Periods you select. We
currently offer Guarantee Periods with durations of 1, 2, 3, 4, 5, 7 and 10
years. If any amount allocated or transferred remains in a Guarantee Period
until the Expiry Date, its value will be equal to the amount originally
allocated or transferred, multiplied, on an annually compounded basis, by its
Guaranteed Interest Rate. Any surrender, withdrawal, transfer, or amount applied
to an income plan from a Fixed Sub-Account before its Expiry Date may be subject
to a Market Value Adjustment that may increase or decrease the value of the
Fixed Sub-Account (or portion thereof) being surrendered, withdrawn,
transferred, or applied to an income plan. See "Market Value Adjustment" page
_____.

          You can request that we transfer Account Value from one Variable
Sub-Account to another, and from a Fixed Sub-Account to a Variable Sub-Account
and from a Variable Sub-Account to a Fixed Sub-Account, subject to certain
conditions. See "Transfers," page __.


                                        6

<PAGE>   27



          Sage Life offers other variable annuity contracts which also invest in
the same Funds offered under the Contracts. These contracts may have different
charges that could affect Variable Sub- Account performance, and they may offer
different benefits.

2 .       WHAT ARE MY INCOME PAYMENT OPTIONS?

          You choose the Income Date or other agreed upon date when you want
regular income payments to begin. The Income Date you choose must be on or
before the first calendar month following the Annuitant's 95th birthday. We
reserve the right to require that your Income Date be at least two years after
the Contract Date. After you choose the Income Date, you select an income plan
from the list below, and indicate whether you want your income payments to be
fixed or variable or a combination of fixed and variable. You must give
Satisfactory Notice of your choices at least 30 days prior to the Income Date,
and you must have at least $5,000 of value to apply to a variable or fixed
income option.

          On the Income Date, the Account Value under the Contract will be used
to provide income payments. Unless you request otherwise, any money that you
have invested in the Variable Sub- Accounts will be used to provide variable
annuity income payments, and any money that you have invested in the Fixed
Sub-Accounts will be used to provide fixed annuity income payments. If you have
not chosen an income plan by the Income Date, a "life annuity with 10 years
certain" (described below) will be used.

          The available income plans are:

          -  INCOME PLAN 1 - LIFE ANNUITY. An income payment during the lifetime
           of the Annuitant terminating with the last payment preceding the
           death of the Annuitant.

          -  INCOME PLAN 2 - LIFE ANNUITY WITH 10 OR 20 YEARS CERTAIN.  An 
           income payable during the lifetime of the Annuitant with the 
           provisions that payments be made for a minimum of 10 or 20 years, 
           as elected.

          -  INCOME PLAN 3 - JOINT AND LAST SURVIVOR LIFE ANNUITY.  An income
           payable during the joint lifetime of the Annuitant and a designated
           second person, and thereafter during the remaining lifetime of the
           survivor, ceasing with the last payment prior to the death of the
           survivor.

          -  INCOME PLAN 4 - PAYMENTS FOR A SPECIFIED PERIOD CERTAIN. An amount
           payable for the number of years selected which may be from 5 to 30
           years.

          -  INCOME PLAN 5 - ANNUITY PLAN. An amount can be used to purchase any
           other income plan we offer on the Income Date for which you and the
           Annuitant are eligible.

          Your first income payment, whether fixed or variable, will be based on
the amount of proceeds applied under the income plan you have selected and on
the "annuity purchase rates" based on the

                                        7

<PAGE>   28



Annuitant's age and sex, and if applicable upon the age and sex of a second
designated person. The annuity purchase rate we apply will never be lower than
the rate shown in your Contract.

          If you have told us you want fixed income payments, the amount of each
income payment is guaranteed and remains level throughout the payment period. If
you told us you want variable income payments, the amount of variable income
payments will vary according to the investment performance of the Funds you have
selected to support your variable annuity income payments.

          Your income payments will be made monthly, unless you choose
quarterly, semi-annual or annual payments by giving us Satisfactory Notice at
least 30 days prior to the Income Date. Payments start on the Income Date. If
any payment would be less than $100, we may change the payment frequency to the
next longer interval, but in no event less frequent than annual. Also, if on the
Income Date, the Account Value is less than $5,000, we may pay the Surrender
Value on that date in one sum.

3.        HOW DO I PURCHASE A CONTRACT?

          INITIAL PURCHASE PAYMENT. The Contract may be purchased for use in
connection with tax-qualified plans, or it may be purchased on a non-tax
qualified basis. To purchase a non-tax qualified Contract, you may not be more
than 85 years old on the Contract Date. (You may not be more than 75 years old
in Pennsylvania.) To purchase a tax-qualified Contract, you must not be older
than 70 1/2 years old on the Contract Date. A minimum initial purchase payment
is required depending on whether you are purchasing a tax-qualified or non-tax
qualified Contract, as shown in the following table:

<TABLE>
<CAPTION>
                                                                            Minimum Initial Purchase Payment Required

<S>                                                                                      <C>   
          Non-Tax Qualified Contract                                                     $5,000
          Tax Qualified Contract                                                         $2,000
</TABLE>

          ISSUANCE OF A CONTRACT. Once we receive your initial purchase payment
and your application at our Customer Service Center, we will usually issue your
Contract within two Business Days. However, if you did not give us all the
information we need, we will try to contact you to get the additional needed
information. If we cannot complete the application within five Business Days, we
will either send your money back or obtain your permission to keep your money
until we receive the necessary information. Your Contract Date will be the date
your Contract is issued at our Customer Service Center.

          FREE-LOOK RIGHT TO CANCEL CONTRACT. During your "Free-Look" Period,
you may cancel your Contract. The Free-Look Period expires 10 days after you
receive your Contract. Some states may require a longer period. If you decide to
cancel the Contract, you must return it to our Customer Service Center or to one
of our authorized agents. You will receive a refund of your Account Value plus
any annual administration charge, transaction charge and Asset-Based Charge we
have deducted on or before the date we receive your returned Contract, or if
greater and required by the law of your state, your initial purchase payment
(less any withdraws previously taken). In certain states, amounts you allocate
to the Variable Account will be allocated to the Money Market Sub- Account until
the Free-Look Period expires.

                                        8

<PAGE>   29



          MAKING ADDITIONAL PURCHASE PAYMENTS. You may make additional purchase
payments of $250 or more at any time before the Income Date, subject to
following conditions. We will accept additional purchase payments under a
non-qualified plan until the earlier of the year in which you attain age 85 or
the year in which the Annuitant attains age 85. We will accept additional
purchase payments under a qualified plan until the year in which you attain
701/2, except rollover contributions may be made until the year in which you
attain age 85. You must obtain our prior approval before you make a purchase
payment that causes the Account Value of all annuities that you maintain with us
to exceed $1,000,000. Any purchase payment received after the Contract Date will
be credited to the Contract as of the Business Day on which it is received at
our Customer Service Center. Purchase payments received on other than a Business
Day will be deemed received on the next following Business Day.

          In addition, if you have not made a purchase payment for more than two
years and your Account Value is less than $2,000 on a Contract Anniversary, we
may cancel your Contract and pay you the Surrender Value as though you had made
a full withdrawal by giving you written notice at your address of record.
However, you will be allowed 61 days from the date of that notice to submit an
additional purchase payment in an amount sufficient to maintain your Account
Value at $2,000 or more. If we have not received the required additional
purchase payment by the end of this period, we may cancel your Contract.

4.        WHAT ARE MY INVESTMENT OPTIONS?

          PURCHASE PAYMENT ALLOCATIONS. When you apply for a Contract, you
specify the percentage of your purchase payment to be allocated to each Variable
Sub-Account and/or to each Fixed Sub-Account. You can change the allocation
percentages at any time by sending Satisfactory Notice to our Customer Service
Center. The change will apply to all purchase payments we receive on or after we
receive your request. [Purchase payment allocations must be in percentages
totaling 100%, and each allocation percentage must be a whole number.]

          We may, however, require that an initial purchase payment allocated to
a Variable Account be invested in the Money Market Fund during the Free-Look
Period. We may require this if the law of your state requires us to refund your
full initial purchase payment should you cancel your Contract during the
Free-Look Period. At the end of the Free-Look Period, if your initial purchase
payment was allocated to the Money Market Fund by us, we will transfer the value
of what is in the Money Market Fund to the Variable Sub-Account(s) you specified
in your application. Solely for the purpose of processing transfers from the
Money Market Fund, we will deem the Free-Look Period to end 15 days after the
Contract Date. The transfer from the Money Market Fund to the Variable
Sub-Accounts upon the expiration of the Free-Look Period does not count as a
transfer for any other purposes under the Contract.

          VARIABLE SUB-ACCOUNT INVESTMENT OPTIONS. The Variable Account has ___
Sub-Accounts, each investing in a specific Fund. Each of the Funds is either an
open-end diversified management investment company or a separate investment
portfolio of such a company and is managed by a registered investment adviser.
The Funds as well as brief descriptions of their investment objectives are
provided below. There is no assurance that these objectives will be met.


                                        9

<PAGE>   30



                             The Alger American Fund

       ALGER AMERICAN INCOME AND GROWTH PORTFOLIO. This portfolio seeks to
provide a high level of dividend income through investing in equity securities.
Capital appreciation is a secondary objective of this portfolio.

       ALGER AMERICAN SMALL CAPITALIZATION PORTFOLIO. This portfolio seeks long-
term capital appreciation through investment primarily in equity securities
that, at the time of purchase, have total market capitalization within the range
of companies included in the Russell 2000 Growth Index or the S&P SmallCap 600
Index.

       ALGER AMERICAN GROWTH PORTFOLIO. This portfolio seeks long-term capital
appreciation by investing primarily in equity securities of companies that, at
the time of purchase, have total market capitalization of $1 billion or greater.

The Alger American Fund is advised by Fred Alger Management, Inc.

       The ____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________




       The ____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________




       The ____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________



       The MONEY MARKET FUND seeks to maximize current income to the extent
consistent with the preservation of capital and maintenance of liquidity. This
Fund will pursue its objective by investing exclusively in high quality money
market instruments. AN INVESTMENT IN THE MONEY MARKET FUND IS NEITHER INSURED
NOR GUARANTEED BY THE U.S. GOVERNMENT. This Fund will attempt to maintain a
stable net asset value of $1.00 per share, BUT THERE CAN BE NO ASSURANCE THAT
THE FUND WILL BE ABLE TO DO SO.

       The MONEY MARKET FUND is advised by __________.

       Shares of the Funds are sold to separate accounts of insurance companies
that are not affiliated with us or each other, a practice known as "shared
funding." They are also sold to separate accounts to serve as the underlying
investment for both variable annuity contracts and variable life insurance
contracts, a practice known as "mixed funding." As a result, there is a
possibility that a material conflict may arise between the interests of Owners
whose Account Values are allocated to the Variable

                                       10

<PAGE>   31



Account, and owners of other contracts whose contract values are allocated to
one or more other separate accounts investing in any of the Funds. Shares of
some of the Funds may also be sold directly to certain qualified pension and
retirement plans qualifying under Section 401 of the Code. As a result, there is
a possibility that a material conflict may arise between the interest of Owners
or owners of other contracts (including contracts issued by other companies),
and such retirement plans or participants in such retirement plans. In the event
of any such material conflicts, we will consider what action may be appropriate,
including removing a Fund from the Variable Account or replacing the Fund with
another Fund. There are certain risks associated with mixed and shared funding
and with the sale of shares to qualified pension and retirement plans, as
disclosed in each Fund's prospectus.

          More detailed information concerning the investment objectives,
policies, and restriction of the Funds, the expenses of the Funds, the risks
attendant to investing in the Funds and other aspects or their operations can be
found in the current prospectus for each Fund which accompanies this prospectus.
The Funds' prospectuses should be read carefully before any decision is made
concerning the allocation of amounts to the Variable Sub-Accounts.

          FIXED ACCOUNT INVESTMENT OPTIONS. The Fixed Account is a separate
investment account under state insurance law, and is not required to be
registered as an investment company under the 1940 Act. It is maintained
separate from our general account and any other separate investment account we
may have.

          Each time you allocate purchase payments or transfer funds to the
Fixed Account, we establish a Fixed Sub-Account. Each Fixed Sub-Account is
guaranteed an interest rate (the "Guaranteed Interest Rate") for a period of
time (a "Guarantee Period"). We have no specific formula for establishing the
Guaranteed Interest Rates for the different Guarantee Periods. The determination
made will be influenced by, but not necessarily correspond to, interest rates
available on fixed income investments which we may acquire with the amounts we
receive as purchase payments or transfers of Account Value under the Contracts.
These amounts will be invested primarily in investment-grade fixed income
securities including: securities issued by the United States Government or its
agencies or instrumentalities, which issues may or may not be guaranteed by the
United States Government; debt securities that have an investment grade, at the
time of purchase, within the four highest grades assigned by Moody's Investor
Services, Inc., Standard & Poor's Corporation, or any other nationally
recognized rating service; mortgage-backed securities collateralized by real
estate mortgage loans, or securities collateralized by other assets, that are
insured or guaranteed by the Federal Home Loan Mortgage Association, the Federal
National Mortgage Association, or the Government National Mortgage Association,
or that have an investment grade at the time of purchase within the four highest
grades described above; other debt instruments; commercial paper; cash or cash
equivalents. You will have no direct or indirect interest in these investments.
We will also consider other factors in determining the Guaranteed Interest
Rates, including regulatory and tax requirements, sales commissions, and
administrative expenses borne by us, general economic trends, and competitive
factors. THE COMPANY'S MANAGEMENT WILL MAKE THE FINAL DETERMINATION OF THE
GUARANTEED INTEREST RATES IT DECLARES. WE CANNOT PREDICT OR GUARANTEE THE LEVEL
OF FUTURE INTEREST RATES, HOWEVER, OUR GUARANTEE INTEREST RATES WILL BE AT LEAST
3% PER YEAR.


                                       11

<PAGE>   32



          The length of a Guarantee Period is measured from the end of the
calendar month in which the amount is allocated to the Fixed Sub-Account. The
currently available Guarantee Periods are 1, 2, 3, 4, 5, 7, and 10 years.

          We will notify you at least thirty days prior to an Expiry Date of
your options for renewal which include (i) electing a new Guarantee Period from
among those then offered by us, but excluding any which extend beyond your
Income Date, or (ii) transferring the value of the Fixed Sub-Account to one or
more Variable Sub-Accounts. If we do not receive Satisfactory Notice prior to
the Expiry Date, we will transfer the value of the expiring Fixed Sub-Account to
the Money Market Sub-Account.

          A Market Value Adjustment may apply to amounts allocated to a Fixed
Sub-Account in certain situations. See "Market Value Adjustment" below.

          MARKET VALUE ADJUSTMENT. A Market Value Adjustment reflects the
relationship between: (i) the current Guaranteed Interest Rate that we are
crediting for a Guarantee Period approximately equal to the time remaining in
the Fixed Sub-Account's Guarantee Period from which the amount is surrendered,
withdrawn, transferred, or annuitized; and (ii) the Guaranteed Interest Rate
being applied to the Fixed Sub-Account's Guarantee Period from which the amount
will be surrendered, withdrawn, transferred, or annuitized. Any surrender,
withdrawal, transfer, or application to an income plan of an amount allocated to
a Fixed Sub-Account is subject to a Market Value Adjustment that may be positive
or negative, unless the effective date of the surrender, withdrawal, transfer,
or application to an income plan is on or after the Expiry Date of the Guarantee
Period.

          Generally, if the Guaranteed Interest Rate for the selected Guarantee
Period is lower than the Guaranteed Interest Rate currently being offered for
new Guarantee Periods of a duration approximately equal to the balance of the
selected Guarantee Period as of the date that the Market Value Adjustment is
applied, then the application of the Market Value Adjustment will (i) reduce the
amount of the payment upon surrender or application to an income plan (this
amount may be reduced below the amount of the purchase payments or portion of
amounts transferred to the Guarantee Period), and (ii) will reduce the remaining
Account Value on the amount transferred or withdrawn. Similarly, if the
Guaranteed Interest Rate for the selected Guarantee Period is higher than the
Guaranteed Interest Rate currently being offered for new Guarantee Periods of a
duration approximately equal to the balance of the selected Guarantee Period as
of the date that the Market Value Adjustment is applied, then the application of
the Market Value Adjustment will result in the payment, upon surrender,
withdrawal, transfer, or application of amounts to an income plan, of an amount
greater than the amount (or portion thereof) being surrendered, withdrawn,
transferred, or applied to an income plan.

          The Market Value Adjustment is computed by multiplying the amount
being surrendered, withdrawn, transferred, or applied to an income plan, by the
following factor:
                                             N/365
                          [(1+I)/(1+J+.0025)]      - 1

Where

           I is the Index Rate for a maturity equal to the Fixed Sub-Account's
Guarantee Period;


                                       12

<PAGE>   33



          J is the Index Rate for a maturity equal to the time remaining
          (rounded up to the next full year) in the Fixed Sub-Account's
          Guarantee Period; and

          N is the remaining number of days in the Guarantee Period at the time
          of calculation.

The Index Rate is the U.S. Treasury Constant Maturity Series as reported in
Federal Reserve Bulletin Release H.15. We currently base the Index Rate for a
calendar week on the reported rate for the preceding calendar week. We reserve
the right to set it less frequently than weekly but in no event less often than
monthly. If there is no Index Rate for the maturity needed to calculate I or J,
straight line interpolation between the Index Rate for the next highest and next
lowest maturities will be used to determine that Index Rate. If the maturity is
one year or less, we will use the Index Rate for a one-year maturity.

          In the states of _________________________________________, state
insurance law requires that the Market Value Adjustment be computed by
multiplying the amount being surrendered, withdrawn, transferred, or applied to
an income plan, by the greater of the factor above and the following factor:
[(1.03)/(1+K)](G-N)/365 - 1, where N is as defined above, K = the Guaranteed
Interest Rate for the Guaranteed Period and G = the initial number of days in
the Guarantee Period. In these states, the Fixed Account is called the Interest
Account in the Contract.

          Market Value Adjustments will be applied as follows:

          For a partial withdrawal or partial transfer, the Market Value
               Adjustment will be calculated on the total amount that must be
               withdrawn or transferred in order to provide the amount
               requested.

          If the Market Value Adjustment is negative, it is deducted from any
               remaining value in the Fixed Sub-Account. Any remaining Market
               Value Adjustment is deducted from the amount withdrawn,
               transferred, or applied to an income plan.

          If the Market Value Adjustment is positive, it is added to any
               remaining value in the Fixed Sub-Account. In the case of
               surrender or full transfer, or if the full amount of the Fixed
               Sub-Account is applied to an annuity option, the Market Value
               Adjustment is added to the amount withdrawn, transferred, or
               applied to an income plan.

Examples of how the Market Value Adjustment will work are shown in Appendix A.

          TRANSFERS. Prior to the Income Date and while the Annuitant is living,
you may transfer Account Value from and among the Variable and Fixed
Sub-Accounts at any time after the end of the Free-Look Period. The minimum
amount of Account Value that may be transferred from a Variable Sub-Account or a
Fixed Sub-Account is $250, or, if less, the entire remaining Account Value held
in that Sub-Account. You must give us Satisfactory Notice of the Variable
Sub-Accounts and/or Fixed Sub-Accounts from which and to which transfers are to
be made. Otherwise we will not transfer your Account Value. A transfer from a
Fixed Sub-Account may be subject to a Market Value Adjustment. There is
currently no limit on the number of transfers from and among the Variable or
Fixed Sub-Accounts.

                                       13

<PAGE>   34




          A transfer generally will take effect on the Business Day Satisfactory
Notice is received at our Customer Service Center. Requests received on other
than a non-Business Day will be deemed received on the next following Business
Day. We may, however, defer transfers to, from, and among the Variable
Sub-Accounts under the same conditions that we may delay paying proceeds. See
"Requesting Payments," page _.

          We also reserve the right to impose a $25 transfer fee on each
transfer in a Contract Year in excess of twelve, and to limit, upon notice, the
maximum number of transfers you may make per calendar month or per Contract
Year. For purposes of assessing any transfer charge, each transfer request is
considered one transfer, regardless of the number of Variable or Fixed
Sub-Accounts affected by the transfer.

           After the Income Date, you must have our prior consent to transfer
value from the Fixed Account to the Variable Account or from the Variable
Account to the Fixed Account. We reserve the right to limit the number of
transfers among the Variable Sub-Accounts to one transfer per Contract Year
after the Income Date.

          Subject to any required regulatory approvals, we reserve the right to
transfer assets of a Variable Sub-Account that we determine to be associated
with the class of Contracts to which the Contract belongs, to another variable
account or to another variable sub-account.

          DOLLAR-COST AVERAGING PROGRAM. The dollar-cost averaging program
permits you to systematically transfer on a monthly basis, or as frequently as
we authorize, a set dollar amount from either the Money Market Sub-Account or a
Fixed Sub-Account to any combination of Variable Sub-Accounts. The dollar-cost
averaging method of investment is designed to reduce the risk of making
purchases only when the price of Accumulation Units is high. However, you should
carefully consider your financial ability to continue the program over a long
enough period of time to purchase units when their value is low as well as when
it is high. Dollar-cost averaging does not assure a profit or protect against a
loss.

          You may elect to participate in the dollar-cost averaging program at
any time before the Income Date by sending us Satisfactory Notice. The minimum
transfer amount is $250 from the Money Market Sub-Account, or from the 1, 2, 3,
4, or 5 year Guaranteed Period of the Fixed Account, as applicable. All
dollar-cost averaging transfers will be made on the day of each month that
corresponds to your Contract Date unless that date is not a Business Day.
Otherwise, the transfer will be made on the next following Business Day. Once
elected, it remains in effect from the date we receive your request until the
Income Date or until the value of the Sub-Account from which transfers are being
made is depleted or until you cancel the program by written request. You can
request changes by writing us at our Customer Service Center. There is no
additional charge for dollar-cost averaging. A transfer under this program is
not considered a transfer for purposes of assessing a transfer charge. We
reserve the right to discontinue offering the dollar-cost averaging program at
any time and for any reason. Dollar-cost averaging is not available while you
are participating in the automatic portfolio rebalancing program.


                                       14

<PAGE>   35



       ASSET ALLOCATION PROGRAM. You may select from four asset allocation model
portfolios designed by Ibbotson and Associates. These models are as follows:

<TABLE>
<CAPTION>
          Model                                       Investment and Risk Profile
          -----                                       ---------------------------
           <S>                                         <C> 
             1                                             Capital Preservation
             2                                             Moderate Growth
             3                                             Growth
             4                                             Aggressive Growth
</TABLE>

If you elect to participate in the asset allocation program, initial and
additional purchase payments will automatically be allocated among the Variable
Sub-Accounts indicated by the model you select. Although you may only use one
model at a time, you may elect to change your selection as your tolerance for
risk, and/or your needs and objectives change. You may use a questionnaire that
we offer to determine the model that best meets your risk tolerance and time
horizons.

          From time to time Ibbotson and Associates reviews the models and may
find that allocation percentages among the Variable Sub-Accounts or even some of
the Variable Sub-Accounts within a particular model may need to be changed. We
will send you notice at least 30 days before any such change is made.

          None of the models include the Fixed Account. However, you may
allocate a portion of your initial or additional purchase payments, or transfer
Account Value between an asset allocation model and the Fixed Account.

          If you participate in the asset allocation program, the transfers made
under the program are not taken into account in determining any transfer charge.
There is no additional charge for this option. We reserve the right to
discontinue offering this program at any time and for any reason.

          AUTOMATIC PORTFOLIO REBALANCING PROGRAM. Once your money has been
allocated among the Variable Sub-Accounts, the investment performance of each
Variable Sub-Account may cause your allocation to shift. Prior to the Income
Date, you may instruct us to automatically rebalance (on a calendar quarter,
semi-annual, or annual basis) Variable Account Value to return to your original
percentage allocations. Your request will be effective on the Business Day on
which we receive your request at our Customer Service Center. Requests received
on other than a Business Day will be deemed received on the next following
Business Day. Your percentage allocations must be in whole percentages. You may
start and stop automatic portfolio rebalancing at any time and make changes to
your allocation percentages by written request. There is no additional charge
for using this option. A transfer under this option is not considered a transfer
for purposes of assessing any transfer charge. We reserve the right to
discontinue offering this program at any time and for any reason. Any money
allocated to the Fixed Account will not be included in the rebalancing. [The
automatic portfolio rebalancing program is not available while you are
participating in the dollar-cost averaging program].

          ACCOUNT VALUE. The Account Value serves as a starting point for
calculating certain values under a Contract. It is the aggregate of the Variable
Account Value and the Fixed Account Value credited to the Contract. The Account
Value is determined first on the Contract Date and

                                       15

<PAGE>   36



thereafter on each Business Day. The Account Value will vary to reflect the
performance of the Variable Sub-Accounts to which purchase payments have been
allocated, interest credited on amounts allocated to the Fixed Account, charges,
transfers, withdrawals, and full surrenders. It may be more or less than
purchase payments paid.

          SURRENDER VALUE. The Surrender Value on a Business Day before the
Income Date, is the Account Value, adjusted by any applicable Market Value
Adjustment that would be applicable if the Contract were surrendered that day,
and reduced by any applicable annual administration charge.

          VARIABLE ACCOUNT VALUE. On any Business Day, the Variable Account
Value is equal to sum of the value in each Variable Sub-Account. The value in
each Variable Sub-Account is equal to the number of Accumulation Units
attributable to that Variable Sub-Account multiplied by the Accumulation Unit
Value for that Variable Sub-Account for that Business Day. When you allocate a
purchase payment or transfer Account Value to a Variable Sub-Account, your
Contract is credited with Accumulation Units in that Variable Sub-Account. The
number of Accumulation Units is determined by dividing the dollar amount
allocated or transferred to the Variable Sub-Account by the Sub-Account's
Accumulation Unit value for that Business Day. Similarly, when an amount is
transferred, withdrawn, or surrendered from a Variable Sub-Account, the number
of Accumulation Units is determined by dividing the dollar amount transferred,
withdrawn, or surrendered by the Variable Sub-Account's Accumulation Unit value
for that Business Day.

          ACCUMULATION UNIT VALUE. Accumulation Unit value varies to reflect the
investment experience of the underlying Fund, and may increase or decrease from
one Business Day to the next. [The Accumulation Unit value for each Variable
Sub-Account was arbitrarily set at $___ when the Sub-Account was established.]
For each Valuation Period [after the date of establishment], the Accumulation
Unit value is determined by multiplying the Accumulation Unit value for a
Sub-Account for the prior Valuation Period by the net investment factor for the
Variable Sub-Account for the Valuation Period.

          NET INVESTMENT FACTOR. The net investment factor is an index used to
measure the investment performance of a Variable Sub-Account from one Valuation
Period to the next during the Accumulation Period. The net investment factor for
any Valuation Period is determined by dividing (a) by (b) where:

          (a)   is the result of:

                   (i)   the Net Asset Value per share of the investment
                         portfolio share in which the Variable Sub-Account
                         invests determined at the end of the current Valuation
                         Period, plus

                   (ii)  the per share amount of any dividend or capital gain
                         distributions made by the investment portfolio on
                         shares held in the Variable Sub-Account if the
                         "ex-dividend" date occurs during the current Valuation
                         Period, and plus or minus

                   (iii) a per share charge or credit for any taxes reserved
                         for, which is determined by us to have resulted from
                         the operations of the Variable Sub-Account; and


                                       16

<PAGE>   37



          (b)   is the Net Asset Value per share of the investment portfolio
                share in which the Variable Sub-Account invests determined at
                the end of the immediately preceding Valuation Period;

          The net investment factor may be more or less than, or equal to, one.

          FIXED ACCOUNT VALUE. The Fixed Account Value is the sum of the value
of each Fixed Sub-Account on any particular date. The value of a Fixed
Sub-Account is equal to: (1) the sum of the following amounts: purchase payment
allocations and transfers of Account Value to a Fixed Sub-Account and accrued
interest; minus (2) the sum of any withdrawals and transfers from the Fixed Sub-
Account including any charges assessed against a Fixed Sub-Account.

5.        WHAT ARE THE EXPENSES UNDER THE CONTRACT?

          We deduct the charges described below. The charges are for the service
and benefits we provide, costs and expenses we incur, and risks we assume under
the Contracts. Services and benefits we provide include: the ability for Owners
to make withdrawals and surrenders under the Contracts; the death benefit paid
on the death of the Owner; the available investment options, including
dollar-cost averaging, asset allocation, automatic portfolio rebalancing, and
systematic partial withdrawal programs; administration of the income plan
options available under the Contracts; and the distribution of various reports
to Owners. Costs and expenses we incur include those associated with various
overhead and other expenses associated with providing the services and benefits
provided by the Contracts, sales and marketing expenses, and other costs of
doing business. Risks we assume include the risks that Annuitants may live
longer than estimated when the annuity factors under the Contracts were
established, that the amount of the death benefit will be greater than Account
Value, and that the costs of providing the services and benefits under the
Contracts will exceed the charges deducted. We may also deduct a charge for
taxes. See "Fee Table," page ___.

          Unless otherwise specified, charges are deducted proportionately from
all Variable Sub-Accounts and Fixed Sub-Accounts in which you are invested.

          Charges under a Contract may be reduced or eliminated when certain
sales or administration of the Contract result in savings or reduction of
expenses and/or risks.

SURRENDER CHARGES

          None!  There are no surrender charges under the Contracts.

ANNUAL ADMINISTRATION CHARGE

          We will deduct an annual administration charge during the first seven
Contract Years (i) on each Contract Anniversary, and (ii) on the day of any
surrender if the surrender is not on the Contract Anniversary. We will waive
this fee on and after the eighth Contract Anniversary, or if the Account Value
is at least $50,000 when the annual administration charge would have otherwise
been deducted. The charge will be deducted from each Variable or Fixed
Sub-Account proportionately.


                                       17

<PAGE>   38



TRANSFER CHARGE

          We currently do not deduct this charge However, we reserve the right
to deduct a transfer charge of $25 for the 13th and each subsequent transfer
during a Contract Year. For the purpose of assessing the transfer charge, each
written request is considered to be one transfer, regardless of the number of
Variable Sub-Accounts or Fixed Sub-Accounts affected by the transfer. In the
event that the transfer charge becomes applicable, it will be deducted
proportionately from the Variable Sub-Account(s) or the Fixed Sub-Account(s)
from which the transfer is made.

ASSET-BASED CHARGES

          We deduct Asset-Based Charges for mortality and expense risks and
administrative costs assumed by us. Prior to the Income Date, Asset-Based
Charges are deducted monthly and calculated as a percentage of the Variable
Account Value on the date of deduction. On the Contract Date, and monthly
thereafter, the Asset-Based Charges are deducted proportionately from the
Variable Sub-Accounts in which you are invested. After the Income Date,
however, these charges are called Variable Sub-Account Charges and are deducted
daily from the assets of such Variable Sub-Accounts.
The maximum charges are:

<TABLE>
<CAPTION>
                                       Combined Asset-Based Charges     
                                       ----------------------------     
                                                                
                       Annual Charge         Monthly Charge           Daily Charge
                       -------------         --------------           ------------
                                                                
<S>                          <C>               <C>                      <C>      
Contract Years 1-7           1.40%             .116667%                 .0038626%
Contract Years 8+            1.25%             .104167%                 .0034462%
</TABLE>

Asset-Based Charges also are deducted on the effective date of any transfer from
the Fixed Account, or allocation of purchase payment to the Variable Account,
based on the amount transferred or allocated and based on the number of days
remaining until the next date of deduction. These charges do not apply to Fixed
Account Value attributable to a Contract.

FUND EXPENSES

          Because the Variable Account purchases shares of the various Funds,
the net assets of the Variable Account will reflect the investment advisory fees
and other operating expenses incurred by the Funds. A table of each Fund's
advisory fees and other expenses can be found in the front of this prospectus in
the Fee Table. For a description of each Fund's expenses, advisory fees, and
other expenses, see the attached Funds' prospectuses.


                                       18

<PAGE>   39



6.         HOW WILL MY INVESTMENT IN THE CONTRACT BE TAXED?

           THE FOLLOWING DISCUSSION IS GENERAL AND IS NOT INTENDED AS TAX
           ADVICE.

INTRODUCTION

           The following summary provides a general description of the federal
income tax considerations associated with the Contracts and does not purport to
be complete or to cover all tax situations. THIS DISCUSSION IS NOT INTENDED AS
TAX ADVICE. COUNSEL OR OTHER COMPETENT TAX ADVISERS SHOULD BE CONSULTED FOR MORE
COMPLETE INFORMATION. This discussion is based upon our understanding of the
present federal income tax laws. No representation is made as to the likelihood
of continuation of the present federal income tax laws or as to how they may be
interpreted by the Internal Revenue Service (the "IRS").

           The Contracts may be purchased on a non-tax-qualified basis
("Non-Qualified Contract") or purchased on a tax-qualified basis ("Qualified
Contract"). Qualified Contracts are designed for use by individuals whose
purchase payments are comprised solely of proceeds from and/or contributions
under retirement plans that are intended to qualify as plans entitled to special
income tax treatment under Sections 408 or 408A of the Code. The ultimate effect
of federal income taxes on the amounts held under a Contract, or income
payments, depends on the type of retirement plan, on the tax and employment
status of the individual concerned, and on our [and your] tax status. In
addition, certain requirements must be satisfied in purchasing a Qualified
Contract with proceeds from a tax-qualified plan and receiving distributions
from a Qualified Contract in order to continue receiving favorable tax
treatment. Some retirement plans are subject to distribution and other
requirements that are not incorporated into our Contract administration
procedures. Owners, participants, and Beneficiaries are responsible for
determining whether contributions, distributions and other transactions with
respect to the Contracts comply with applicable law. Therefore, purchasers of
Qualified Contracts should seek competent legal and tax advice regarding the
suitability of a Contract for their situation. The following discussion assumes
that Qualified Contracts are purchased with proceeds from and/or contributions
under retirement plans that qualify for the intended special federal income tax
treatment.

TAX STATUS OF THE CONTRACTS

           DIVERSIFICATION REQUIREMENTS. The Code requires that the investments
of the Variable Account be "adequately diversified" in order for the Contracts
to be treated as annuity contracts for federal income tax purposes. It is
intended that the Variable Account, through the Funds, will satisfy these
diversification requirements.

           In certain circumstances, owners of variable annuity contracts have
been considered for federal income tax purposes to be the owners of the assets
of the Variable Account supporting their contracts due to their ability to
exercise investment control over those assets. When this is the case, the
contract owners have been currently taxed on income and gains attributable to
the Variable Account assets. There is little guidance in this area, and some
features of the Contracts, such as the flexibility of an Owner to allocate
purchase payments and transfer Account Values, have not been explicitly
addressed in published rulings. While we believe that the Contracts do not give
Owners investment control over

                                       19

<PAGE>   40



Variable Account assets, we reserve the right to modify the Contracts as
necessary to prevent an Owner from being treated as the owner of the Variable
Account assets supporting the Contract.

           REQUIRED DISTRIBUTIONS. To be treated as an annuity contract for
federal income tax purposes, the Code requires a Non-Qualified Contract to
contain certain provisions specifying how your interest in the Contract will be
distributed in the event of your death. The Non-Qualified Contracts contain
provisions that are intended to comply with these Code requirements, although no
regulations interpreting these requirements have yet been issued. We intend to
review such provisions and modify them if necessary to assure that they comply
with the applicable requirements when such requirements are clarified by
regulation or otherwise.

           Other rules may apply to Qualified Contracts.

           The following discussion assumes that the Contracts will qualify as
annuity contracts for federal income tax purposes.

TAX TREATMENT OF ANNUITIES

           IN GENERAL. We believe that if you are a natural person you will not
be taxed on increases in the value of a Contract until a distribution occurs or
until income payments begin. (An agreement to assign or pledge any portion of
the Account Value, and, in the case of a Qualified Contract, any portion of an
interest in the qualified plan, generally will be treated as a distribution.)

TAXATION OF NON-QUALIFIED CONTRACTS

           NON-NATURAL PERSON. The Owner of any annuity contract who is not a
natural person generally must include in income any increase in the excess of
the Account Value over the "investment in the contract" (generally, the purchase
payments or other consideration paid for the contract) during the taxable year.
There are some exceptions to this rule and a prospective Owner that is not a
natural person may wish to discuss these with a tax adviser.

           The following discussion generally applies to Contracts owned by
natural persons.

           WITHDRAWALS. When a withdrawal from a Non-Qualified Contract occurs,
the amount received will be treated as ordinary income subject to tax up to an
amount equal to the excess (if any) of the Account Value immediately before the
distribution over the Owner's investment in the Contract at that time.

           In the case of a surrender under a Non-Qualified Contract, the amount
received generally will be taxable only to the extent it exceeds the Owner's
investment in the Contract.

           PENALTY TAX ON CERTAIN WITHDRAWALS. In the case of a distribution
from a Non-Qualified Contract, there may be imposed a federal tax penalty equal
to 10% of the amount treated as income. In general, however, there is no penalty
on distributions:


                                       20

<PAGE>   41



           -         made on or after the taxpayer reaches age 59 1/2;
           -         made on or after the death of an Owner;
           -         attributable to the taxpayer's becoming disabled; or
           -         made as part of a series of substantially equal periodic 
                     payments for the life (or life expectancy) of the taxpayer.

           Other exceptions may be applicable under certain circumstances and
special rules may be applicable in connection with the exceptions enumerated
above. A tax adviser should be consulted regarding exceptions from the penalty
tax.

           INCOME PAYMENTS. Although tax consequences may vary depending on the
payment option elected under an annuity contract, a portion of each income
payment is generally not taxed and the remainder is taxed as ordinary income.
The non-taxable portion of an income payment is generally determined in a manner
that is designed to allow you to recover your investment in the Contract ratably
on a tax-free basis over the expected stream of income payments, as determined
when income payments start. Once your investment in the Contract has been fully
recovered, however, the full amount of each income payment is subject to tax as
ordinary income.

           TAXATION OF DEATH BENEFIT PROCEEDS. Amounts may be distributed from a
Contract because of your death or the death of the Annuitant. Generally, such
amounts are includible in the income of the recipient as follows: (i) if
distributed in a lump sum, they are taxed in the same manner as a surrender of
the contract, or (ii) if distributed under a payment option, they are taxed in
the same way as income payments.

           TRANSFERS, ASSIGNMENTS OF A CONTRACT. A transfer or assignment of
ownership of a Contract, the designation of an Annuitant, the designation of a
payee other than yourself, the selection of certain Income Dates, [or the
exchange of a Contract] may result in certain tax consequences to you that are
not discussed herein. An Owner contemplating any such transfer or assignment
should consult a tax advisor as to the tax consequences.

           WITHHOLDING. Annuity distributions are generally subject to 
withholding for the recipient's federal income tax liability. Recipients can
generally elect, however, not to have tax withheld from distributions.

           MULTIPLE CONTRACTS. All annuity contracts that we or our affiliates
issue to the same Owner during any calendar year are treated as one annuity
contract for purposes of determining the amount includible in such Owner's
income when a taxable distribution occurs.

TAXATION OF QUALIFIED CONTRACTS

           The Contracts are designed for use with several types of qualified
plans. The tax rules applicable to participants in these qualified plans vary
according to the type of plan and the terms and conditions of the plan itself.
Special favorable tax treatment may be available for certain types of
contributions and distributions. Adverse tax consequences may result from
contributions in excess of specified limited distributions prior to age 59 1/2
(subject to certain exceptions); distributions that do not conform to specified
commencement and minimum distribution rules; aggregate distributions in excess

                                       21

<PAGE>   42



of a specified annual amount; and in other specified circumstances. Therefore,
no attempt is made to provide more than general information about the use of the
Contracts with the various types of qualified retirement plans. Contract Owners,
Annuitants, and Beneficiaries are cautioned that the rights of any person to any
benefits under these qualified retirement plans may be subject to the terms and
conditions of the plans themselves, regardless of the terms and conditions of
the Contract, but we shall not be bound by the terms and conditions of such
plans to the extent such terms contradict the Contract, unless the Company
consents.

           WITHDRAWALS. When a withdrawal from a Qualified Contract occurs, a
pro rata portion of the amount received is taxable, generally based on the ratio
of the owner's investment in the contract (generally, the purchase payments or
other consideration paid for the contract) to the participant's total accrued
benefit balance under the retirement plan. For Qualified Contracts, the
investment in the contract can be zero. Distributions from certain qualified
plans are generally subject to mandatory withholding. Special tax rules apply to
withdrawals from Roth IRAs (see below).

           Brief descriptions follow of the various types of qualified
retirement plans in connection with a Contract. We will endorse the Contract as
necessary to conform it to the requirements of such plan.

           INDIVIDUAL RETIREMENT ANNUITIES. Section 408 of the Code permits
eligible individuals to contribute to an individual retirement program known as
an "Individual Retirement Annuity" or "IRA." These IRAs are subject to limits on
the amount that may be contributed, the persons who may be eligible, and on the
time when distributions may commence. Also, distributions from certain other
types of qualified retirement plans may be rolled over on a tax-deferred basis
into an IRA. Sales of the Contract for use with IRAs may be subject to special
requirements of the IRS. The Internal Revenue Service has not reviewed the
Contract for qualification as an IRA, and has not generally ruled whether death
benefit provisions such as the provisions in the Contract comport with IRA
qualification requirements.

           SIMPLE IRAs. Beginning in January 1, 1997, certain small employers
may establish SIMPLE plans as provided by Section 408(p) of the Code, under
which employees may elect to defer to a SIMPLE IRA a percentage of compensation
up to $6,000 (as increased for cost of living adjustments). The sponsoring
employer is required to make matching or non-elective contributions on behalf of
employees. Distributions from SIMPLE IRAs are subject to the same restrictions
that apply to IRA distributions and are taxed as ordinary income. Subject to
certain exceptions, premature distributions prior to age 59 1/2 are subject to a
10% penalty tax, which is increased to 25% if the distribution occurs within the
first two years after the commencement of the employee's participation in the
plan. The failure of the SIMPLE IRA to meet Code requirements may result in
adverse tax consequences.

           ROTH IRAs. Effective January 1, 1998, Section 408A of the Code
permits certain eligible individuals to contribute to a Roth IRA. Contributions
to a Roth IRA, which are subject to certain limitations, are not deductible and
must be made in cash or as a rollover or transfer from another Roth IRA or other
IRA. A conversion of an IRA to a Roth IRA may be subject to tax and other
special rules may apply. You should consult a tax adviser before combining any
converted amounts with any other Roth IRA contributions, including any other
conversion amounts from other tax years. Distributions from a Roth IRA generally
are not taxed, except that, once aggregate distributions exceed contributions to
the Roth IRA, income tax and a 10% penalty tax may apply to distributions made
(1) before age

                                       22

<PAGE>   43



59 1/2 (subject to certain exceptions) or (2) during five taxable years starting
with the year in which the first contribution is made to the Roth IRA.

OTHER TAX CONSEQUENCES

           As noted above, the foregoing comments about the federal tax
consequences under the Contracts are not exhaustive, and special rules are
provided with respect to other tax situations not discussed in this prospectus.
Further, the federal income tax consequences discussed herein reflect our
understanding of current law, and the law may change. Federal estate and state
and local estate, inheritance and other tax consequences of ownership or receipt
of distributions under a Contract depend on the individual circumstances of each
Owner or recipient of the distribution. A competent tax adviser should be
consulted for further information.

7.         HOW DO I ACCESS MY MONEY?

           You may make partial withdrawals or a full surrender under the 
Contracts. When you surrender your Contract you can request that the proceeds be
paid under an income plan. See "What are my Income Payment Options?," page __.

WITHDRAWALS

           You may request to withdraw part of the Surrender Value at any time
before the Income Date. (If you have elected the "payments for a specified
period certain" income plan option, you may request a full withdrawal after the
Income Date. See "What are my Income Payment Options?," page _ .) Requests for
withdrawals may be made in writing. See "Requesting Payments," page __. Any
withdrawal must be at least $250. We will pay you the withdrawal amount in one
sum. Under certain circumstances, payments of proceeds from a withdrawal may be
delayed. See "Requesting Payments," page __ .

           When you request a withdrawal, you can direct how the withdrawal will
be deducted from your Account Value. If you provide no directions, the
withdrawal will be deducted from your Account Value in the Variable and Fixed
Sub-Accounts on a pro-rata basis.

SURRENDERS

           You may request surrender of the Contract at any time before the
Income Date. (If you have elected the "payments for a specified period certain"
income plan option, you may request a surrender after the Income Date. See "What
are my Income Payment Options?," page __ .) The Contract will terminate on the
date we receive your request or such later date as you might request. We will
pay you the Surrender Value in one sum unless you choose an income plan. Under
certain circumstances, payments of proceeds from a surrender may be delayed. See
"Requesting Payments," page _ .

SYSTEMATIC PARTIAL WITHDRAWAL PROGRAM

           The systematic partial withdrawal program provides automatic monthly,
quarterly, semi-annual, or annual payments to you from the amounts you have
accumulated in the Variable Sub-Accounts

                                       23

<PAGE>   44



and/or the Fixed Sub-Accounts. You select the day withdrawals will be taken, but
this day can be no later than the 28th day of the month. If a day is not
selected, the month anniversary of the Contract Date will be used. The minimum
payment is $100. The maximum payment amount is the free withdrawal amount as
defined in your Contract. However, any amount in excess of interest earned on a
Fixed Sub-Account in the prior period (for example, prior month for monthly
withdrawals or prior quarter for quarterly withdrawals), may be subject to a
Market Value Adjustment (see "Market Value Adjustment," page __). You may elect
to participate in the systematic partial withdrawal program at any time before
the Income Date by providing Satisfactory Notice. Once we have received your
request, the program will begin and will remain in effect until your Account
Value drops to zero. You may cancel or make changes in the program at any time
by providing us with Satisfactory Notice. Unless you specify otherwise,
withdrawals under the systematic partial withdrawal option will be deducted from
your Account Value in the Variable and Fixed Sub-Accounts on a pro-rata basis.
We do not deduct any other charges for this option. We reserve the right to
discontinue offering the systematic partial withdrawal option at any time and
for any reason.

IRA PARTIAL WITHDRAWAL OPTION

           If your Contract is an IRA Contract and you will attain age 70 1/2 in
the current calendar year, distribution may be made to satisfy requirements
imposed by federal tax law. An IRA Partial Withdrawal provides payout of amounts
required to be distributed by the IRS rules governing mandatory distributions
under qualified plans. A notice before distributions commence will be sent, and
you may elect this option at that time, or at a later date. The IRA Partial
Withdrawal option may not be elected while you are participating in the
systematic partial withdrawal program. IRA Partial Withdrawals may be taken on a
monthly, quarterly, or annual basis. A minimum withdrawal of $100 is required.
You select the day withdrawals will be taken, but this day can be no later than
the 28th day of the month. If a day is not elected, the month anniversary of the
Contract Date will be used. An IRA Partial Withdrawal in excess of the maximum
withdrawal amount for systematic partial withdrawals may be subject to a Market
Value Adjustment.

REQUESTING PAYMENTS

           You must provide us with Satisfactory Notice of your request for
payment. We will ordinarily pay any death benefit, withdrawal, or surrender
proceeds within seven days after receipt at our Customer Service Center of all
the requirements for such a payment. The amount will be determined as of the
date our Customer Service Center receives all such requirements.

           We may delay making a payment, applying Account Value to an income
plan, or processing a transfer request if: (1) the disposal or valuation of the
Variable Account's assets is not reasonably practicable because the New York
Stock Exchange is closed for other than a regular holiday or weekend, trading is
restricted by the SEC, or the SEC declares that an emergency exists; or (2) the
SEC, by order, permits postponement of payment to protect our Contract Owners.
We also may defer making payments attributable to a check that has not cleared
(which may take up to 15 days), and we may defer payment of proceeds from the
Fixed Account for a withdrawal or surrender request for up to six months from
the date we receive the request. If payment is deferred 30 days or more, the
amount deferred will earn interest at a rate not less than the minimum required
in any jurisdiction in which the Contract is delivered.

                                       24

<PAGE>   45



8.         HOW IS CONTRACT PERFORMANCE PRESENTED?

           We may advertise or include in sales literature yields, effective
yields, and total returns for the Variable Sub-Accounts. Effective yields and
total returns for the Variable Sub-Accounts are based on the investment
performance of the corresponding portfolio of the Funds. THESE FIGURES ARE BASED
ON HISTORICAL EARNINGS AND DO NOT INDICATE OR PROJECT FUTURE PERFORMANCE. We may
also advertise or include in sales literature a Variable Sub-Account's
performance compared to certain performance rankings and indexes compiled by
independent organizations, and we may present performance rankings and indexes
without such a comparison.

           The yield of the Money Market Sub-Account refers to the annualized
income generated by an investment in the Sub-Account over a specified seven-day
period. The yield is calculated by assuming that the income generated for that
seven-day period is generated each seven-day period over a 52-week period. The
effective yield is calculated similarly but, when annualized, the income earned
by an investment in the Money Market Sub-Account is assumed to be reinvested.
The effective yield will be slightly higher than the yield because of the
compounding effect of this assumed reinvestment.

           The yield of a Variable Sub-Account (except the Money Market
Sub-Account) refers to the annualized income generated by an investment in the
Variable Sub-Account over a specified 30-day or one-month period. The yield is
calculated by assuming that the income generated by the investment during that
30-day or one-month period is generated each period over a 12-month period.

           The total return of a Variable Sub-Account refers to return
quotations assuming an investment under a Contract has been held in the Variable
Sub-Account for various periods of time. Average annual total return of a
Variable Sub-Account tells you the return you would have experienced if you
allocated a $1,000 purchase payment to a Variable Sub-Account for the specified
period. Standardized average annual total return reflects all historical
investment results, less all charges and deductions applied against the Variable
Sub-Account, including any surrender charge that would apply if you terminated a
Contract at the end of each period indicated, but excluding any deductions for
purchase payment taxes. "Non-Standard" average annual total return information
may be presented, computed on the same basis as described above, except that
deductions will not include the Surrender Charge. In addition, we may from time
to time disclose average annual total return in non-standard periods and
cumulative total return for a Variable Sub-Account.

           We may, from time to time, also disclose yield, standard total
returns, and non-standard total returns for the Funds. We may also disclose
yield, standard total returns, and non-standard total returns of funds or other
accounts managed [by the Adviser or Subadviser with investment objectives
similar to those of the Funds], and Variable Sub-Account performance based on
that performance data. Non-standard performance will be accompanied by standard
performance.

           In advertising and sales literature, the performance of each Variable
Sub-Account may be compared to the performance of other variable annuity issuers
in general or to the performance of particular types of variable annuities
investing in mutual funds, or investment series of mutual funds with investment
objectives similar to each of the Variable Sub-Accounts. Advertising and sales
literature may also compare the performance of a Variable Sub-Account to the
Standard & Poor's Index of 500 Common Stocks, a widely used measure of stock
performance. This unmanaged index assumes

                                       25

<PAGE>   46



the reinvestment of dividends but does not reflect any deduction for the
expense of operating or managing an investment portfolio. Other independent
ranking services and indexes may also be used as a source of performance
comparison. We may also report other information, including the effect of tax
deferred compounding on a Variable Sub-Account's investment returns, or returns
in general, which may be illustrated by tables, graphs, or charts.

9.         DOES THE CONTRACT HAVE A DEATH BENEFIT?

           DEATH BENEFIT. If any Owner dies before the Income Date, we will pay
the Beneficiary the greatest of:

           (i) the Account Value determined as of the day we receive proof of
           death;

           (ii) 100% of the sum of all purchase payments made under your
           Contract, reduced by any prior withdrawals (including any associated
           surrender charge and Market Value Adjustment incurred); or

           (iii) the highest anniversary value (the "Highest Anniversary
           Value"). 

           The Highest Anniversary Value is equal to the greatest anniversary 
value attained in the following manner. Upon our receipt of due proof of death,
we will calculate an anniversary value for each Contract Anniversary prior to
the date of death, but not beyond the deceased's attained age 80. The
anniversary value is equal to the Account Value on a Contract Anniversary and
reduced proportionately by the amount of any withdrawals (including any
associated surrender charge and Market Value Adjustment incurred) taken since
that anniversary, and increased by the dollar amount of additional purchase
payments made since that anniversary. (By reduced proportionately we mean
decreased by the same percentage as the decrease in your Account Value that
results from the withdrawal.)

           If there are multiple Owners, the age of the oldest Owner will be
used to determine the applicable death benefit. If there is no Owner who is a
natural person (that is, an individual), we will treat the Annuitant as Owner
for the purpose of determining when the Owner dies and the Annuitant's age will
determine the applicable death benefit payable to the Beneficiary.

           The death benefit may be paid immediately in one lump sum, or an
income plan may be chosen. See "What are my Income Payment Options?" page ___.
An income plan may be chosen subject to the following conditions:

           (1)       the Beneficiary becomes the new Owner;

           (2)       the excess, if any, of the death benefit over the Account
                     Value will be allocated among the Variable Sub-Accounts and
                     Fixed Sub-Accounts in proportion to their values as of the
                     date on which the death benefit is determined;

           (3)       no additional purchase payments may be applied to the
                     Contract; and


                                       26

<PAGE>   47



           (4)       if the new Owner is not the deceased Owner's spouse, the
                     entire interest in the Contract, must be distributed in one
                     of following ways:

                     a.        The entire interest in the Contract must be
                               distributed over the life of the new Owner, or
                               over a period not extending beyond the life
                               expectancy of the new Owner, with distributions
                               beginning within one year of the Owner's death;
                               or

                     b.        The entire interest in the Contract must be
                               distributed within five years of the Owner's
                               death.

           (5)       If the Beneficiary is the deceased Owner's spouse, the 
Contract will continue with the surviving spouse as the new Owner. The surviving
spouse may name a new Beneficiary (and, if no Beneficiary is so named, the
surviving spouse's estate will be the Beneficiary). Upon the death of the
surviving spouse, the death benefit will equal the Account Value as of the date
we receive proof of death at the time of the surviving spouse's death, and the
entire interest in the Contract must be distributed to the new Beneficiary in
accordance with the provisions of 4(a) or 4(b) above.

           If there is more than one Beneficiary, the foregoing provisions will
apply independently to each Beneficiary.

           If the death benefit is payable and an income plan is chosen, the
Income Date will be the date we receive due proof of the Owner's death. The
Beneficiary must choose the income plan as well as whether the income payments
are to be fixed or variable or a combination of fixed and variable. See "What
are my Income Payment Options?" page ____.

           If the Annuitant dies on or after the Income Date, and income
payments have been selected based on an income plan providing for payments for a
guaranteed period, we will make the remaining guaranteed payments to the
Beneficiary.

           PROOF OF DEATH. Proof of death must be received at our Customer
Service Center before we will pay any death benefit. We will accept one of the
following items:

                    1.   An original certified copy of an official death
                         certificate; or

                    2.   An original certified copy of a decree of a court of
                         competent jurisdiction as to the finding of death; or

                    3.   Any other proof satisfactory to us.


                                       27

<PAGE>   48



10.        WHAT OTHER INFORMATION SHOULD I KNOW?

SAGE LIFE ASSURANCE OF AMERICA, INC. We are a Delaware stock life insurance
company that is wholly owned by Sage Insurance Group, Inc. Our Executive Office
is located at 300 Atlantic Street, Stamford, CT 06901. We were incorporated in
1981 and have been continuously engaged in the life insurance business since
that year. We are subject to regulation by the Insurance Department of the State
of Delaware as well as by the insurance departments of all other states and
jurisdictions in which we do business. We sell insurance in 49 states and the
District of Columbia. We submit annual statements on our operations and finance
to insurance officials in such states and jurisdictions. The Contracts described
in this prospectus have been filed with and, where required, approved by,
insurance officials in those jurisdictions where they are sold.

           THE SAGE VARIABLE ANNUITY ACCOUNT A. We established the Variable
Account as a separate investment account under Delaware law on December 3, 1997.
The Variable Account may invest in mutual funds, unit investment trusts, and
other investment portfolios. We own the assets in the Variable Account and are
obligated to pay all benefits under the Contracts. The Variable Account is used
to support the Contracts as well as for other purposes permitted by law. The
Variable Account is registered with the SEC as a unit investment trust under the
1940 Act and qualifies as a "separate account" within the meaning of the federal
securities laws. Such registration does not involve any supervision by the SEC
of the management of the Variable Account or Sage Life Assurance of America,
Inc.

           The Variable Account is divided into Variable Sub-Accounts, each of
which currently invests in shares of a specific Fund of The Alger American Fund,
____, or ____. Variable Sub-Accounts buy and redeem Fund shares at net asset
value without any sales charge. Any dividend from net investment income and
distribution from realized gains from security transactions of a Fund are
reinvested at net asset value in shares of the same Fund. Income, gains and
losses, realized or unrealized, of a Variable Sub-Account are credited to or
charged against that Variable Sub-Account without regard to any other income,
gains or losses of Sage Life Assurance of America, Inc. Assets equal to the
reserves and other Contract liabilities with respect to each Variable
Sub-Account are not chargeable with liabilities arising out of any other
business or account of ours. If the assets exceed the required reserves and
other liabilities, we may transfer the excess to our general account.

           The Variable Account may include other Variable Sub-Accounts that are
not available under the Contract and are not otherwise discussed in this
prospectus. We may substitute another Variable Sub-Account or insurance company
separate account under the Contracts, if, in our judgment, investment in a
Variable Sub-Account should no longer be possible or becomes inappropriate to
the purposes of the Contracts, or if investment in another variable sub-account
or insurance company separate account is in the best interest of Owners. No
substitution may take place without notice to Owners and prior approval of the
SEC and insurance regulatory authorities, to the extent required by the 1940 Act
and applicable law.

           THE SAGE FIXED INTEREST ACCOUNT A. The Fixed Account is a separate
investment account under state insurance law. It is maintained separate from our
general account and separate from any other separate account that we may have.
We own the assets in the Fixed Account. The Fixed Account will not be charged
with liabilities that arise from any other business that we conduct.

                                       28

<PAGE>   49



We may transfer to our general account assets which exceed the reserves and
other liabilities of the Fixed Account. Notwithstanding the foregoing, our
obligations under (and values and benefits under) the Fixed Account option of
the Contracts do not vary as function of the investment performance of the Fixed
Account. Owners and Beneficiaries with rights under the Contracts do not
participate in the investment gains or losses of the assets of the Fixed
Account. Such gains or losses accrue solely to us. We retain the risk that the
value of the assets in the Fixed Account may fall below the reserves and other
liabilities that we must maintain in connection with our obligations under the
Fixed Account option of the Contracts. In such an event, we will transfer assets
from our general account to the Fixed Account to make up the difference. The
Fixed Account is not required to be registered as an investment company under
the 1940 Act.

           VOTING OF FUND SHARES. We are the legal owner of shares held by the
Variable Sub-Accounts and as such, have the right to vote on all matters
submitted to shareholders of the Funds. However, as required by law, we will
vote shares held in the Variable Sub-Accounts at regular and special meetings of
shareholders of the Funds in accordance with instructions received from Owners
with Account Value in the Variable Sub-Accounts. To obtain voting instructions
from Owners, before a meeting of shareholders of the Funds, we will send Owners
voting instruction materials, a voting instruction form, and any other related
material. Shares held by a Variable Sub-Account for which no timely instructions
are received will be voted by us in the same proportion as those shares for
which voting instructions are received. Should the applicable federal securities
laws, regulations, or interpretations thereof change so as to permit us to vote
shares of the Funds in our own right, we may elect to do so.

MODIFICATION

           When permitted by applicable law, we may modify the Contracts as
follows: (1) deregister the Variable Account under the 1940 Act; (2) operate the
Variable Account as a management company under the 1940 Act if it is operating
as a unit investment trust; (3) operate the Variable Account as a unit
investment trust under the 1940 Act if it is operating as a managed separate
account; (4) restrict or eliminate any voting rights of Owners, or other persons
who have voting rights as to the Variable Account; (5) combine the Variable
Account with other separate accounts; and (6) combine a Variable Sub-Account
with another Variable Sub-Account. If the actions we take result in a material
change in the underlying investments of a Variable Sub-Account in which you are
invested, we will notify you of the change. You may then make a new choice of
Variable Sub-Accounts.

DISTRIBUTION OF THE CONTRACTS

           Finplan of America, Inc. ("Finplan"), acts as the distributor
(principal underwriter) of the Contracts. Finplan is a corporation organized
under the laws of the state of Delaware in 1997, is registered as a
broker-dealer under the Securities Exchange Act of 1934, and is a member of the
National Association of Securities Dealers, Inc. (the "NASD"). Finplan is a
wholly owned subsidiary of Sage Insurance Group, Inc., the Company's parent
corporation. The Company compensates Finplan for acting a principal underwriter
under a distribution agreement. The Contracts are offered on a continuous basis
and the Company does not anticipate discontinuing the offer. The Contracts may
not be available in all states.


                                       29

<PAGE>   50



           The Contracts are sold by broker-dealers through registered
representatives of such broker-dealers who are also appointed and licensed as
insurance agents. These broker-dealers receive commissions for selling Contracts
calculated as a percentage of purchase payments (up to a maximum of 6%).
Broker-dealers who meet certain productivity and profitability standards may be
eligible for additional compensation.

EXPERTS

           The statutory basis statements of admitted assets, liabilities and
surplus of Sage Life Assurance of America, Inc. as of [December 31, 1997], and
the related statutory basis statements of income and changes in surplus, and
cash flows for the years then ended, [appearing in the prospectus] have been
audited by [Ernst & Young LLP], independent accountants, whose report thereon is
set forth elsewhere herein, and are included in reliance upon the authority of
such firm as experts in accounting and auditing.

LEGAL PROCEEDINGS

           There are no legal proceedings to which the Variable Account is a
party or the assets of the Variable Account are subject. We are not involved in
any litigation that is of material importance in relation to our total assets or
that relates to the Variable Account.

REPORTS TO CONTRACT OWNERS

           We maintain the records and accounts of all transactions involving
the Contract, the Variable Account, and the Fixed Account. We will send you a
report at least once each calendar quarter within 31 days of the end of each
calendar quarter showing information about your Contract for the period covered
by the report. We will send you an annual and a semi-annual report for each Fund
underlying a Variable Sub-Account to which you have allocated Account Value, as
required by the 1940 Act. In addition, when you make purchase payments, or if
you make transfers or withdrawals, you will receive a confirmation of these
transactions.

ASSIGNMENT

           You may assign your Contract at any time prior to the Income Date. No
assignment will be binding on us unless we receive Satisfactory Notice. We will
not be liable for any payments made or actions we take before the assignment is
accepted by us. An absolute assignment will revoke the interest of any revocable
Beneficiary. We are not responsible for the validity of any assignment. An
assignment may be a taxable event.

CHANGE OF OWNER, BENEFICIARY, OR ANNUITANT

           During your lifetime and while your Contract is in force, you can
transfer ownership of this Contract or change the Beneficiary, or change the
Annuitant. However, the Annuitant cannot be changed after the Income Date. To
make any of these changes, you must send us Satisfactory Notice. If accepted,
any change in Owner, Beneficiary, or Annuitant will take effect on the date you
signed the notice. Any of these changes will not affect any payment made or
action taken by us before our

                                       30

<PAGE>   51



acceptance. A change in Owner may be a taxable event and may also effect the
amount of death benefit payable under this Contract.

MISSTATEMENT AND PROOF OF AGE, SEX, OR SURVIVAL

           We may require proof of age, sex, or survival of any person whose
age, sex, or survival any payments depend. If the age or sex of the Annuitant
has been misstated, or if the age of the Owner has been misstated, the benefits
will be those which the Account Value applied would have provided for the
correct age and sex. If we have made incorrect income payments, the amount of
any underpayment will be paid immediately. The amount of any overpayment will be
deducted from future income payments.

INCONTESTABILITY

           Your Contract is incontestable from its Contract Date.

AUTHORITY TO MAKE AGREEMENTS

           All agreements made by us must be signed by one of our officers. No
other person, including an insurance agent or broker, can change the terms of a
Contract or make changes to your Contract without our consent.

FINANCIAL STATEMENTS

           The audited statutory basis statements of admitted assets,
liabilities and surplus for the Sage Life Assurance Company of America, Inc. as
of _______, ____ , and the related statutory basis statements of income and
changes in surplus, and cash flows for the years then ended, as well as the
Report of the Independent Accountants, are contained in the Statement of
Additional Information. The financial statements of the Company should be
considered only as bearing on our ability to meet our obligations under the
Contracts. They should not be considered as bearing on the investment
performance of the assets held in the Variable Account.

           No financial statements are presented for the Variable Account
because it has yet to commence operations.

11.        HOW CAN I MAKE INQUIRIES?

           Inquiries regarding a Contract may be made by writing to us at our
Customer Service Center, by calling us at ____________ (Toll Free), or by
contacting one of our authorized agents.

ADDITIONAL INFORMATION ABOUT SAGE LIFE ASSURANCE OF AMERICA INC.

HISTORY AND BUSINESS

           Ownership: Sage Life Assurance of America, Inc ("Company") is
incorporated under the laws of the state of Delaware. The Company is registered
to write general life assurance and fixed and

                                       31

<PAGE>   52



variable annuity contracts in all states except New York, and also is registered
for variable life assurance business in 29 states.

           The Company's formation was sponsored in 1981 by Fidelity Mutual Life
Insurance Company, a Pennsylvania insurer, under the name of Fidelity Standard
Life Insurance Company ("Fidelity Life"). The Company was acquired by Security
First Life Insurance Company ("Security First") of Los Angeles, California in
December 1984. In January 1997, Fidelity Life was acquired by Sage Insurance
Group Inc. ("Sage Insurance Group") (formerly Finplan Investments Inc.), a
Delaware corporation and a subsidiary of Sage Group Limited, which is the
Company's ultimate parent. The Company's name was changed to its present name in
September 1997.

           Prior Business Operations: As a Security First subsidiary, the
Company specialized in the marketing of annuities qualifying under Section
403(b) of the Internal Revenue Code. Under the Assumption Reinsurance Agreement,
Fidelity Life's annuity business was irrevocably transferred to Security First
except to the extent that an annuity contract could not be assumption reinsured
as a result of contract holder rejection or failure to consent, where required,
to the assumption reinsurance. As of December 31,1997, the total value of the
contracts not yet assumed by Security Life was less than $300,000. Security
First is now a subsidiary of The Metropolitan Life Insurance Company.

           Holding Company Structure and Background: The Company is a wholly
owned subsidiary of Sage Insurance Group which is a holding company for the
Company and affiliated entities connected with the conduct of life and annuity
insurance business in the United States of America. The Company is also an
indirect wholly owned subsidiary of Sage Group Limited, a South African
corporation quoted on the Johannesburg Stock Exchange. Sage Group Limited is a
holding company with a thirty-year history of extensive operating experience in
mutual funds, life assurance, investment management and real estate development.
Sage Group has directly and indirectly engaged in insurance marketing activities
in the United States since 1977, through its financial interests in Independent
Financial Marketing Group Inc., a financial planning and bank insurance
marketing company. Sage Group sold its interest in Independent Financial
Marketing Group in March 1996 to the Liberty Financial Companies of Boston.

SELECTED FINANCIAL DATA

           The historical financial results of the Company for the calendar year
1996 and all prior years are not comparable to the results for the year 1997 due
to the substantial change in the business operations of the Company. The Company
effectively disposed of all in-force business existing as at December 31,1996
and, therefore, on January 1,1997, had no insurance liabilities under any policy
contracts of the Company other than contracts that were 100% reinsured to the
Company's former parent company. Effectively therefore, since January 1997, the
Company became comparable to a new company that had not yet commenced business
activities.

           The information summarized below is extracted from the statutory
statements filed with the insurance regulatory authorities, and should be read
in conjunction with the financial statements and notes thereto included in this
prospectus.

                                       32

<PAGE>   53



                         Selected Financial Information
                   For the Fiscal Year Ended December 31, 1997
                                                                  (In Thousands)



CAPITAL AND SURPLUS

INCOME:



Investment Income

BENEFITS AND EXPENSES:

TAXES



MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND
RESULTS OF OPERATIONS

INTRODUCTION

           The following discussion highlights significant factors influencing
the results of operation of the Company. It should be read in conjunction with
the financial statements and the related notes.

HISTORY AND BUSINESS OVERVIEW

           Beginning _______ 1998, the Company plans to commence marketing of
new variable annuity and variable life insurance products for the first time
since all new business production and marketing was ceased in October 1996. The
Company was acquired by Sage Insurance Group on January 16, 1997, and since that
date has been preparing for the recommencement of insurance underwriting and
marketing activities. There has been a total reengineering of the Company's
products, systems and administration since the change of ownership in January
1997 when the Company was acquired by Sage Insurance Group. All of the Company's
current senior management are experienced in the insurance industry and most
have been recruited since January 1997. The ongoing business strategy of the
Company is to confine its activities to the manufacturing and marketing of
variable life insurance and annuity products where the obligations of the
Company under policy contracts are determined by the value of investments held
in separate accounts that are held solely for the purpose of the policy
contracts to which they relate, and may not be used to pay any other obligations
or creditors of the Company.



                                       33

<PAGE>   54



RESULTS OF OPERATIONS

           Owing to the total reorganization of the company's operations
following the cessation of all marketing and other activities in October 1996,
none of the comparable figures for prior years are meaningful in relation to the
Company's ongoing operations and prospects.

           Realized net earnings of $___ million for the year ending December
31, 1997.

LIQUIDITY AND CAPITAL RESOURCES

           Total Capital and Surplus of the Company at end of 1997 was $
compared to $ 9,500,000 on January 16, 1997. Sage Insurance Group, the new
parent company, increased the available capital and surplus to $25,000,000
during 1997.

SEGMENT INFORMATION

           The Company plans to conduct business under the following main 
           product segments:


                    -    Marketing of variable and fixed deferred annuities sold
                         on a single premium and flexible premium basis.

                    -    Marketing of variable and fixed immediate annuities

                    -    Marketing of variable life insurance products sold on a
                         single premium or flexible premium basis.

           During 1997 the Company did not conduct any active marketing. Its
main activity during this period was to revise products and re-engineer the
Company's systems and procedures in preparation for the commencement of
marketing during 1998.

REINSURANCE

           The Company has entered into a reinsurance agreement on a modified
coinsurance basis with Security First involving insurance in-force on the
purchase date of the Company. The Company also reinsures its mortality risk
associated with the Contract's guaranteed death benefit with one or more
appropriately licensed insurance companies.

RESERVES

           In accordance with the life insurance laws and regulations under
which it operates, the Company is obligated to carry on its books, as
liabilities, actuarially determined reserves to meet its obligations on
outstanding contracts. Reserves involving life contingencies, are based on
mortality tables in general use in the United States, and where applicable, are
computed to equal amounts which, together with interest on such reserves
computed annually at certain assumed rates, will be sufficient to meet our
contract obligations at their maturities, or the event of the insured's death.
In the financial statements included in this Prospectus all reserves are
determined in accordance with generally accepted accounting and actuarial
principles.


                                       34

<PAGE>   55



INVESTMENTS

           At December 31, 1997, invested assets totaling $_____ million
consisted of $_____ short-term securities and $_____ million of bonds and other
long-term investments. 100% of the portfolio was held in investment grade
securities. It is the stated policy of the Company to refrain from investing in
securities having speculative characteristics.

COMPETITION

           The Company is engaged in a business that is highly competitive due
to the large number of stock and mutual life insurance companies as well as
other entities marketing insurance products comparable to those being offered by
the Company. There are approximately 2,350 stock, mutual and other types of
insurers in the life insurance business in the United States, a substantial
number of which are significantly larger than the Company. The Company is unique
in that it is one of the few life insurers that confines its activities to the
marketing solely of separate account variable annuity and variable life
insurance products.

TRANSACTIONS WITH SAGE INSURANCE GROUP

           On November 19, 1997, the Company entered into a Cost Sharing
Agreement (the "Agreement") with Sage Insurance Group. Under this Agreement, the
Company agrees to be charged by Sage Insurance Group for the use of certain
office space and certain office equipment. In addition, the parties agree to
share the cost of certain management, clerical, administrative, technical, or
other services performed for the benefit of the other party.

           Pursuant to the foregoing, the Company recorded expenses in 1997 of
_____.

           Inter Group indebtedness arising in the normal course of business are
settled quarterly.

           Sage Insurance Group has also incurred expenditure in connection with
the costs of establishing new systems, new products and premises for the
Company. Sage Group regards these expenditures as being of a development nature
and does not intend to recover these expenditures from the Company.

EMPLOYEES

           Due to the company's business strategy of outsourcing its primary
administrative functions and investment functions to specialist organizations
with expertise in these areas, the number of full-time personnel employed by the
Company will be limited.

           As of [February 1, 1998], the Company had [12] employees.



                                       35

<PAGE>   56



PROPERTIES

           The executive office is located at 300 Atlantic Street, in Stamford,
Connecticut, where the Company's primary records are maintained. This office
space is leased by Sage Insurance Group. The Company reimburses Sage Insurance
Group for the office space under the Cost Sharing Agreement that is described
above.

STATE REGULATION

           The Company is subject to the laws of the State of Delaware governing
insurance companies and to the regulations of the Delaware Department of
Insurance (the "Insurance Department"). A detailed financial statement in the
prescribed form (the "Statement") is filed with the Insurance Department each
year covering the Company's operations for the preceding year and its financial
condition as of the end of that year. Regulation by the Insurance Department
includes periodic examination to determine contract liabilities and reserves
that the Insurance Department may certify that these items are correct. The
Company's books and accounts are subject to review by the Insurance Department
at all times. A full examination of the Company's operations is conducted
periodically by the Insurance Department and under the auspices of the NAIC.

           In addition, the Company is subject to regulation under the insurance
laws of all jurisdictions in which it operates. The laws of the various
jurisdictions establish supervisory agencies with broad administrative powers
with respect to various matters, including licensing to transact business,
overseeing trade practices, licensing agents, approving contract forms,
establishing reserve requirements, fixing maximum interest rates on life
insurance contract loans and minimum rates for accumulation of surrender values,
prescribing the form and content of required financial statements and regulating
the type and amounts of investments permitted. The Company is required to file
the Statement with supervisory agencies in each of the jurisdictions in which it
does business, and its operations and accounts are subject to examination by
these agencies at regular intervals.

           The NAIC has adopted several regulatory initiatives designed to
improve the surveillance and financial analysis regarding the solvency of
insurance companies in general. These initiatives include the development and
implementation of a risk-based capital formula for determining adequate levels
of capital and surplus. Insurance companies are required to calculate their
risk-based capital in accordance with this formula and to include the results in
their Statement. It is anticipated that these standards will have no significant
effect upon the Company.

           Further, many states regulate affiliated groups of insurers, such as
the Company and its affiliates, under insurance holding company legislation.
Under such laws, inter-company transfers of assets and dividend payments from
insurance subsidiaries may be subject to prior notice or approval, depending on
the size of the transfers and payments in relation to the financial positions of
the companies involved.



                                       36

<PAGE>   57



           Under insurance guaranty fund laws in most states, insurers doing
business therein can be assessed (up to prescribed limits) for contract owner
losses incurred when other insurance companies have become insolvent. Most of
these laws provide that an assessment may be excused or deferred if it would
threaten an insurer's own financial strength.

           Although the federal government generally does not directly regulate
the business of insurance, federal initiatives often have an impact on the
business in a variety of ways. Certain insurance products of the Company are
subject to various federal securities laws and regulations. In addition, current
and proposed federal measures that may significantly affect the insurance
business include regulation of insurance company solvency, employee benefit
regulation, removal of barriers preventing banks from engaging in the insurance
business, tax law changes affecting the taxation of insurance companies, and the
tax treatment of insurance products and its impact on the relative desirability
of various personal investment vehicles.


                                       37

<PAGE>   58



DIRECTORS AND EXECUTIVE OFFICERS

<TABLE>
<CAPTION>
                                          Position held with the                    Other Principal Positions
Name (Age)                                Company/Year Commenced                    During Past Five Years
- ----------                                ----------------------                    ----------------------


<S>                                       <C>                                        <C>                                   
Ronald S. Scowby 1/ 2/                    Director, President,                       Director, Finplan of America, Inc.    
Age 59                                    Chief Executive                            9/97 to present; President, Director  
                                          Officer, 1/97 to                           Sage Insurance Group, Inc. 7/97 to    
                                          present                                    present; President, Chief Executive   
                                                                                     Officer, Director Sage Management     
                                                                                     Services (USA), Inc. 6/96 to present; 
                                                                                     President, Chief Executive Officer    
                                                                                     Sage Holdings (USA), Inc. 12/95 to    
                                                                                     present; Owner, Sheldon Scowby        
                                                                                     Resources 7/95-6/96; Executive Vice   
                                                                                     President, Mutual of America Life     
                                                                                     Insurance Group 6/91-7/95; President, 
                                                                                     Mutual of America Financial Services  
                                                                                     6/91-7/95                             
                                                                                     


Robin I. Marsden 1/ 2/                    Director, 1/97 to                          Investments Director, Sage Life      
Age 32                                    present                                    Holdings, Ltd. 11/94 to present;     
                                                                                     Executive-Strategic Developments     
                                                                                     Sage Group Ltd. 11/94 to present;    
                                                                                     Partner, Deloitte & Touche 1/89-10/94
                                                                                     


H. Louis Shill 3/ 2/                      Chairman,    
Age 67                                    1/97 to present                            Founder, Chairman, Sage Group  
                                                                                     Limited 1965 to present.      
                                                                                     



Paul C. Meyer 4/                          Director,                                  Partner, Rogers & Wells
Age 44                                    1/97 to present                            
                                          


Richard D. Starr 5/                       Director,                                  Chairman & Chief Executive Officer, 
Age 53                                    1/97 to present                            Financial Institutions Group, Inc.   
                                                                                     10/78 to present; President, First  
                                                                                     Interstate Securities 1/95-12/95    
                                                                                     

Mitchell R. Katcher 1/                    Director, 12/97 to                         Chief Financial Officer, Finplan of   
Age 44                                    present, Senior                            America, Inc. 9/97 to present;        
                                          Executive Vice                             Treasurer, Sage Insurance Group, Inc. 
                                          President, Chief                           7/97 to present; Executive Vice       
                                          Financial Officer,                         President, Golden American Life       
                                          Chief Actuary                              Insurance Company 7/93-2/97;          
                                          5/97 to present                            Consultant, Tillinghast Towers &      
                                                                                     Perrin 6/91-7/93.                     
                                                                                     
</TABLE>


                                       38

<PAGE>   59



1/   The principal business address of these persons is 300 Atlantic Street,
Stamford, CT 06901.

2/   As of February 1, 1998, Mr. Marsden will become the President and Chief
Executive Officer of the Company and Mr. Scowby will become the company's
Chairman. Messrs. Shill, Marsden, and Scowby will remain as directors of the
Company.

3/   Mr. Shill's principal business address is P.O. Box 2255, Johannesburg,
South Africa 2000.

4/   Mr. Meyer's principal business address is 200 Park Avenue, New York,
N.Y. 10166.

5/   Mr. Starr's principal business address is 22507 SE 47th Place, Issaquah,
WA 98029.


COMPENSATION

Executive officers of the Company also serve as officers of its parent and of
certain affiliated companies. Allocations have been made as to each individual's
time devoted to their duties with the Company. No allocation was made during
1997 nor will any be made for 1998 for the services of Messrs. Shill, Scowby,
and Marsden.

The following table includes compensation paid by the _______________________
and its subsidiaries for services rendered in all capacities for the years
indicated for the Chief Executive Officer and the next four most highly
compensated Executive Officers as of December 31, 1997.

                               Annual Compensation

<TABLE>
<CAPTION>
                                                                          All Other
Name and Principal Position     Year         Salary         Bonus       Compensation
<S>                            <C>          <C>            <C>         <C> 







</TABLE>






EMPLOYMENT CONTRACTS

The following persons have employment agreements with the Company or with Sage
Insurance Group Inc.: Ronald S. Scowby (Chairman); Robin I. Marsden (President
and CEO)5; Mitchell R. Katcher (Senior Executive Vice President)

- ----------

5/   As of February 1, 1998, Mr. Scowby will become Chairman and Mr. Marsden 
will become President and CEO of the Company.

                                       39

<PAGE>   60



RETIREMENT PLANS

           Sage Life will introduce benefit plans to provide funded, tax
qualified, non-contributory retirement plans for all salaried employees,
including executive officers (the "Retirement Plans") and an unfunded,
non-qualified, non-contributory benefits equalization plan (the "Supplemental
Retirement Plan") which provides for the accrual and payment of benefits which
are not available under tax qualified plans such as the Retirement Plans.

           The Retirement Plans provide for retirement benefits based upon the
accumulated value of defined contributions (expressed as a % of Compensation)
paid by the company into the Retirement Plan. The current contribution rate is %
of compensation and all contributions are accumulated in an individual account
maintained for each employee. Compensation under the Retirement Plans consists
of salary paid by ________ and its subsidiaries included under "Salary" and
"Bonus" in the Summary. The amount available at the retirement date to purchase
any form of single or joint life annuity will depend upon the number of years
for which contributions have been made, the rate of growth achieved by the
underlying investments of the individual account of each employee. There is no
guarantee that a minimum amount will be available at the retirement date.

           The "Supplemental Retirement Plan", which is not qualified under
ERISA, provides for similar contributions as the Retirement Plan for that
portion of Compensation which is in excess of the maximum permitted from time to
time for ERISA qualified plans.

                                       40

<PAGE>   61



                           INDEPENDENT AUDITORS REPORT

                                       41

<PAGE>   62



                            TABLE OF CONTENTS OF THE
                       STATEMENT OF ADDITIONAL INFORMATION

           Additional information about the Contracts and The Sage Variable
Annuity Account A is contained in the Statement of Additional Information. You
can obtain a free copy of the Statement of Additional Information by writing to
us at the address shown on the front cover or by calling ________________(Toll
Free). The following is the Table of Contents for the Statement of Additional
Information.

                                       42

<PAGE>   63



                       STATEMENT OF ADDITIONAL INFORMATION
                                TABLE OF CONTENTS

<TABLE>
<CAPTION>
                                                                                                         Page
                                                                                                         ----
<S>                                                                                                     <C>
PARTICIPATION................................................................................................
BENEFICIARY DESIGNATION......................................................................................
CALCULATION OF HISTORICAL PERFORMANCE DATA
           Money Market Sub-Account Yields ..................................................................
           Other Sub-Account Yields ............... .........................................................
           Average Annual Total Returns......................................................................
           Other Total Returns            ...................................................................
           Effect of the Annual Administration Charge on Performance Data....................................
           Use of Indexes....................................................................................
           Other Information.................................................................................
INCOME PAYMENT PROVISIONS....................................................................................
           Amount of Fixed Income Payments...................................................................
           Amount of Variable Income Payments................................................................
           Income Units......................................................................................
           Income Unit Value.................................................................................
           Exchange of Income Units..........................................................................
SAFEKEEPING OF ACCOUNT ASSETS................................................................................
LEGAL MATTERS................................................................................................
OTHER INFORMATION............................................................................................
FINANCIAL STATEMENTS.........................................................................................
</TABLE>


                                       43

<PAGE>   64



                                   APPENDIX A


                             Market Value Adjustment


           A Market Value Adjustment will be applied to withdrawals, transfers
or amounts applied to an income plan when taken from a Fixed Sub-Account prior
to its Expiry Date. A Market Value Adjustment is applied separately to each
Fixed Sub-Account.

           A Market Value Adjustment is determined by multiplying the amount
withdrawn, transferred or applied to an income plan by the following factor.

                                             N/365
                          [(1+I)/(1+J+.0025)]      - 1

Where

          -    I is the Index Rate for a maturity equal to the Fixed
               Sub-Account's Guarantee Period;

          -    J is the Index Rate for a maturity equal to the time remaining
               (rounded up to the next full year) in the Fixed Sub-Account's
               Guarantee Period; and

          -    N is the remaining number of days in the Guarantee Period at the
               time of calculation.

MVA EXAMPLES

Example #1: Full Surrender -- Example of a Negative Market Value Adjustment
Assume $100,000 is invested in a Fixed Sub-Account with a Guarantee Period of
ten years, with a Guaranteed Interest Rate of 7.5% and an Index Rate ("I") of
7.00% based on the U.S. Treasury Constant Maturity Series. A full surrender is
requested three years into the Guarantee Period and the Index Rate based on the
U.S. Treasury Constant Maturity Series for a seven-year Guarantee Period ("J")
is 8.0% and that no prior transfers or partial withdrawal affecting this Fixed
Sub-Account have been made.

CALCULATE THE MARKET VALUE ADJUSTMENT

          1.   The Account Value of the Fixed Sub-Account on the date of
                                                      3
               surrender is $124,300 ($100,000 x 1.075 )
          2.   N = 2,555 (365 x 7)
          3.   Market Value Adjustment = $124,300 x
                                 2555/365
               {[(1.07)/(1.0825)]        -1} = - $9,700
          Therefore, the amount paid on full surrender is $114,530 ($124,230 -
          $9,700)


                                        1

<PAGE>   65




Example #2: Full Surrender -- Example of a Positive Market Value Adjustment
Assume $100,000 is invested in a Fixed Sub-Account with a Guarantee Period of
ten years, with a Guaranteed Interest Rate of 7.5% and an Index Rate ("I") of
7.00% based on the U.S., Treasury Constant Maturity Series. A full surrender is
requested three years into the Guarantee Period and the Index Rate based on the
U.S. Treasury Constant Maturity Series for a seven-year Guarantee Period ("J")
is 6.0% and that no prior transfers or partial withdrawal affecting this Fixed
Sub-Account have been made.

CALCULATE THE MARKET VALUE ADJUSTMENT

          1.   The Account Value of the Fixed Sub-Account on the date of
                                                      3
               surrender is $124,300 ($100,000 x 1.075 )

          2.   N = 2,555 (365 x 7)

          3.   Market Value Adjustment = $124,300 x
                                 2555/365
               {[(1.07)/(1.0625)]        -1} = + $6,270
          Therefore, the amount paid on full surrender is $130,500 ($124,230 +
          $6,270)


Example #3:  Partial Withdrawal -- Example of a Negative Market Value
Assume $200,000 is invested in a Fixed Sub-Account with a Guarantee Period of
ten years, with a Guaranteed Interest Rate of 7.5% and an Index Rate ("I") of
7.00% based on the U.S. Treasury Constant Maturity Series. A partial withdrawal
of $114,530 is requested three years into the Guarantee Period and the Index
Rate based on the U.S. Treasury Constant Maturity Series for a seven-year
Guarantee Period ("J") is 8.0% and that no prior transfers or partial withdrawal
affecting this Fixed Sub-Account have been made.

First calculate the amount that must be withdrawn from the Fixed Sub-Account to
provide the amount requested.

          1.   The Account Value of the Fixed Sub-Account on the date of
                                                      3
               surrender is $248,459 ($200,000 x 1.075 )
          2.   N = 2,555 (365 x 7)

          3.   Amount that must be withdrawn = $114,530 /
                           2555/365
          [(1.07)/(1.0825)]         = $124,230 Then calculate the Market Value
          Adjustment on that amount
                                                                    2555/365
          4. Market Value Adjustment = $124,230 x {[(1.07)/(1.0825)]         -1}
= - $9,700 Therefore, the amount of the partial withdrawal paid is $114,530, as
requested. The Fixed Sub- Account will be reduced by the amount of the partial
withdrawal, $114,530, and also reduced by the Market Value Adjustment of $9,700,
for a total reduction in the Fixed Sub-Account of $124,230.



                                        2

<PAGE>   66


Example #4: Partial Withdrawal -- Example of a Positive Market Value Adjustment
Assume $200,000 is invested in a Fixed Sub-Account with a Guarantee Period of
ten years, with a Guaranteed Interest Rate of 7.5% and an initial Index Rate
("I") of 7.00% based on the U.S. Treasury Constant Maturity Series. A partial
withdrawal of $130,500 is requested three years into the Guarantee Period and
the Index Rate based on the U.S. Treasury Constant Maturity Series for a
seven-year Guarantee Period ("J") is 6.0% and that no prior transfers or partial
withdrawal affecting this Fixed Sub-Account have been made.

First calculate the amount that must be withdrawn from the Fixed Sub-Account to
provide the amount requested.

          1.   The Account Value of the Fixed Sub-Account on the date of
                                                      3
               surrender is $248,459 ($200,000 x 1.075 )
          2.   N = 2,555 (365 x 7)

          3.   Amount that must be withdrawn = $130,500 /
                           2555/365
          [(1.07)/(1.0625)]         = $124,230 Then calculate the Market Value
          Adjustment on that amount
                                                                    2555/365
          4. Market Value Adjustment = $124,230 x {[(1.07)/(1.0625)]        
- -1} = + $6,270 Therefore, the amount of the partial withdrawal paid is $130,500,
as requested. The Fixed Sub- Account will be reduced by the amount of the
partial withdrawal, $130,500, but increased by the Market Value Adjustment of
$6,270, for a total reduction in the Fixed Sub-Account of $124,230.


                                        3



<PAGE>   67
                       STATEMENT OF ADDITIONAL INFORMATION
                         DATED _____________ ____, 1998

        FLEXIBLE PAYMENT DEFERRED COMBINATION FIXED AND VARIABLE ANNUITY
                                    CONTRACTS

                                    issued by

         THE SAGE VARIABLE ANNUITY ACCOUNT A and SAGE LIFE ASSURANCE OF
                                  AMERICA, INC.



                                                        Customer Service Center:
                                                        P.O. Box _________
                                                        Wethersfield, CT _____
                                           Telephone: (888) 502-7243 (Toll Free)

- --------------------------------------------------------------------------------

This Statement of Additional Information expands upon subjects discussed in the
current Prospectus for the Flexible Deferred Combination Fixed and Variable
Annuity Contracts (the Contracts) offered by Sage Life Assurance of America,
Inc. ("we," "us," "our," "Sage Life," or the "Company"). You may obtain a copy
of the prospectus dated ___________, by calling 1- ____-____-____ (Toll Free) or
by writing to our Customer Service Center at the above. Terms used in the
current Prospectus for the Contracts are incorporated into and made a part of
this Statement of Additional Information.


        THIS STATEMENT OF ADDITIONAL INFORMATION IS NOT A PROSPECTUS AND
        SHOULD BE READ ONLY IN CONJUNCTION WITH THE PROSPECTUSES FOR THE
                            CONTRACTS AND THE FUNDS.




<PAGE>   68



                       STATEMENT OF ADDITIONAL INFORMATION
                                TABLE OF CONTENTS


<TABLE>
<CAPTION>
                                                                                                         Page
                                                                                                         ----

<S>                                                                                                      <C>
PARTICIPATION................................................................................................

BENEFICIARY DESIGNATION......................................................................................

CALCULATION OF HISTORICAL PERFORMANCE DATA...................................................................
           Money Market Sub-Account Yields...................................................................
           Other Sub-Account Yields..........................................................................
           Average Annual Total Returns......................................................................
           Other Total Returns...............................................................................
           Effect of the Annual Administration Charge on Performance Data....................................
           Use of Indexes....................................................................................
           Other Information.................................................................................

INCOME PAYMENT PROVISIONS....................................................................................
           Amount of Fixed Income Payments...................................................................
           Amount of Variable Income Payments................................................................
           Income Units......................................................................................
           Income Unit Value.................................................................................
           Exchange of Income Units .........................................................................

SAFEKEEPING OF ACCOUNT ASSETS................................................................................

LEGAL MATTERS................................................................................................

OTHER INFORMATION............................................................................................

FINANCIAL STATEMENTS.........................................................................................
</TABLE>




<PAGE>   69



                                  PARTICIPATION

           The Contract does not participate in the surplus or profits of the
Company, and the Company does not pay dividends on the Contracts.

                             BENEFICIARY DESIGNATION

           This is as shown in the application. It includes the name of the
Beneficiary and the order and method of payment. If you name "estate" as a
Beneficiary, it means the executors or administrators of the last survivor of
you and all beneficiaries. If you name "children" of a person as a Beneficiary,
only children born to or legally adopted by that person as of an Owner's date of
death will be included.

           We may rely on an affidavit as to the ages, names, and other facts
about all Beneficiaries. We will incur no liability if we act on such affidavit.

                   CALCULATION OF HISTORICAL PERFORMANCE DATA

           From time to time, we may disclose yields, total returns, and other
performance data of the Variable Sub-Accounts and the Funds. Such performance
data will be computed, or accompanied by performance data computed, in
accordance with the standards defined by the SEC.

MONEY MARKET SUB-ACCOUNT YIELDS

           From time to time, advertisements and sales literature may quote the
current annualized yield of the Variable Sub-Account investing in the Money
Market Fund of the ______________________ for a seven-day period in a manner
that does not take into consideration any realized or unrealized gains or losses
on shares of the Money Market Fund (the "Money Market Sub-Account").

           This current annualized yield is computed by determining the net
change (exclusive of realized gains and losses on the sale of securities and
unrealized appreciation and depreciation) at the end of the seven-day period in
the value of a hypothetical account under a Contract having a balance of one
Accumulation Unit of the Money Market Sub-Account at the beginning of the
period, dividing such net change in Account Value by the value of the
hypothetical account at the beginning of the period to determine the base period
return, and annualizing this quotient on a 365-day basis. The net change in
account value reflects (i) net income from the Money Market Fund attributable to
the hypothetical account; and (ii) charges and deductions imposed under a
Contract which are attributable to the hypothetical account. The charges and
deductions include the per unit charges for the hypothetical account for the
annual administration charge and the Asset-Based Charges. For purposes of
calculating current yields for a Contract, an average per unit annual
administration charge is used based on the $40 annual administration charge.
Current yield is calculated according to the following formula:

                                        1

<PAGE>   70



Current Yield = ((NCS - ES)/UV) (365/7)

Where:

NCS =                          the net change in the value of the Money Market
                               Fund (exclusive of realized gains or losses on
                               the sale of securities and unrealized
                               appreciation and depreciation) for the seven-day
                               period attributable to a hypothetical account
                               having a balance of one Accumulation Unit.

ES =                           per unit expenses attributable to the
                               hypothetical account for the seven-day period.

UV =                           the unit value for the first day of the seven-day
                               period.
                                                   365/7-1
Effective yield =              (1+((NCS - ES)/UV))      

Where:

NCS =                          the net change in the value of the Money Market
                               Fund (exclusive of realized gains or losses on
                               the sale of securities and unrealized
                               appreciation and depreciation) for the seven-day
                               period attributable to a hypothetical account
                               having a balance of one Accumulation Unit.

ES =                           per unit expenses attributable to the
                               hypothetical account for the seven-day period.

UV =                           the unit value for the first day of the seven-day
                               period.

           Because of the charges and deductions imposed under the Contracts,
the yield for the Money Market Sub-Account is lower than the yield for the Money
Market Fund.

           The current and effective yields on amounts held in the Money Market
Sub-Account normally fluctuate on a daily basis. THEREFORE, THE DISCLOSED YIELD
FOR ANY GIVEN PAST PERIOD IS NOT AN INDICATION OR REPRESENTATION OF FUTURE
YIELDS OR RATES OF RETURN. The Money Market Sub-Account's actual yield is
affected by changes in interest rates on money market securities, average
portfolio maturity of the Money Market Fund, the types and quality of portfolio
securities held by the Money Market Fund and the Money Market Fund's operating
expenses. Yields on amounts held in the Money Market Sub-Account may also be
presented for periods other than a seven-day period.


                                        2

<PAGE>   71



OTHER VARIABLE SUB-ACCOUNT YIELDS

           The yield is a computed by: 1) dividing the net investment income of
the Fund attributable to the Variable Sub-Account units less Variable
Sub-Account expenses for the period; by 2) the maximum offering price per unit
on the last day of the period times the daily average number of Accumulation
Units outstanding for the period; and then 3) compounding that yield for a
six-month period; and then 4) multiplying that result by two (2). Expenses
attributable to a Variable Sub-Account include the annual administration charge
and the Asset-Based Charges. The yield calculation assumes an annual
administration charge of $40 per Contract deducted at the end of each Contract
Year as of the Contract Anniversary. For purposes of calculating the 30-day or
one-month yield, an average administrative cost charge based on the average
Account Value in the Variable Sub-Account is used to determine the amount of the
charge attributable to the Variable Sub-Account for the 30-day or one-month
period. The 30-day or one-month yield is calculated according to the following
formula:

                                          6-1)
Yield =    2 x (((NI - ES)/(U x UV)) + 1)  
           
Where:     
           
NI =       net income of the portfolio for the 30-day or
           one-month period attributable to the Variable
           Sub-Account's units.
           
ES =       expenses of the Variable Sub-Account for the
           30-day or one-month period.
           
U =        the average number of units outstanding.
           
UV =       the unit value at the close (highest) of the last
           day in the 30-day or one-month period.

           Because of the charges and deductions imposed under the Contracts,
the yield for the Variable Sub-Account is lower than the yield for the
corresponding Fund.

           The yield on the amounts held in the Variable Sub-Accounts normally
fluctuates over time. THEREFORE, THE DISCLOSED YIELD FOR ANY GIVEN PAST PERIOD
IS NOT AN INDICATION OR REPRESENTATION OF FUTURE YIELDS OR RATES OF RETURN. A
Variable Sub-Account's actual yield is affected by the types and quality of
portfolio securities held by the corresponding Fund and that Fund's operating
expenses.

           AVERAGE ANNUAL TOTAL RETURNS

           From time to time, sales literature or advertisements may also quote
average annual total returns for one or more of the Variable Sub-Accounts for
various periods of time.


                                        3

<PAGE>   72



           When a Variable Sub-Account or Fund has been in operation for 1, 5,
and 10 years, respectively, the average annual total return for these periods
will be provided. Average annual total returns for other periods of time may,
from time to time, also be disclosed.

           Standard average annual total returns represent the average annual
compounded rates of return that would equate an initial investment of $1,000
under a Contract to the redemption value of that investment as of the last day
of each of the periods. The ending date for each period for which total return
quotations are provided will be for the most recent calendar quarter-end
practicable, considering the type of the communication and the media through
which it is communicated.

           Standard average annual total returns are calculated using Variable
Sub-Account unit values which we calculate on each Business Day based on the
performance of the Variable Sub-Account's underlying Fund. The calculation
assumes that annual Asset-Based Charges of 1.40% during the first seven Contract
Years (decreasing to 1.25% during Contract Years 8 and later) are deducted
monthly beginning on the Contract Date. The calculation also assumes that the
annual administration charge is $40 per year per Contract deducted at the end of
each Contract Year. For purposes of calculating average annual total return, an
average per-dollar per-day annual administration charge attributable to the
hypothetical account for the period is used. The calculation also assumes
surrender of Account Value at the end of the period for the return quotation.
The total return is calculated according to the following formula:

                   1/N)
TR =       ((ERV/P)    -1
           
Where:     
           
TR =       the average annual total return net of Variable
           Sub-Account recurring charges.
           
ERV =      the ending redeemable value of the hypothetical
           account at the end of the period.
           
P =        a hypothetical initial payment of $1,000.
           
N =        the number of years in the period.

           From time to time, sales literature or advertisements may quote
average annual total returns for periods prior to the date the Variable
Sub-Accounts commenced operations. Such performance information for the Variable
Sub-Accounts is calculated based on the performance of the various Funds and the
assumption that the Variable Sub-Accounts were in existence for the same periods
as those indicated for the Funds, with the level of Contract charges that were
in effect at the inception of the Variable Sub-Accounts.


                                        4

<PAGE>   73



           Fund total return information used to calculate the average annual
total returns of the Variable Sub-Accounts for periods prior to the inception of
the Variable Sub-Accounts has been provided by the Funds. Certain Funds are not
affiliated with the Company. While the Company has no reason to doubt the
accuracy of figures provided by the Funds, the Company has not independently
verified the accuracy of these figures.

OTHER TOTAL RETURNS

            Other total returns are calculated in exactly the same way as
average annual total returns described above, except that the ending redeemable
value of the hypothetical account for the period is replaced with an ending
value for the period that does not take into account any charges on amounts
surrendered. From time to time, sales literature or advertisements may quote
other total returns.

           The Company also may disclose cumulative total returns in conjunction
with the standard formats described above. The cumulative total returns will be
calculated using the following formula:

CTR =      (ERV/P) - 1
           
Where:     
           
CTR =      The cumulative total return net of Variable
           Sub-Account recurring charges for the period.
           
ERV =      The ending redeemable value of the hypothetical
           investment at the end of the period.
           
P =        A hypothetical single payment of $1,000.

EFFECT OF THE ANNUAL ADMINISTRATION CHARGE ON PERFORMANCE DATA

           The Contracts provide for a $40 annual administration charge (waived
for Contacts with Account Value of at least $50,000, or beginning on or after
the eight Contract Year) that is deducted from the Variable Sub-Accounts and the
Fixed Sub-Accounts proportionately. For purposes of reflecting the annual
administration charge in yield and total return quotations, the average Account
Value is assumed to be $30,000, so that the annual administration charge is
..1333%.


                                        5

<PAGE>   74



USE OF INDEXES

           From time to time, the performance of certain historical indexes may
be presented in advertisements or sales literature. The performance of these
indexes may be compared to the performance of certain Variable Sub-Accounts or
Funds, or may be presented without such a comparison.

OTHER INFORMATION

           The following is a partial list of those publications which may be
noted in the Funds' sales literature and/or shareholder materials which contain
articles describing investment results or other data relative to one or more of
the Variable Sub-Accounts. Other publications may also be cited.

<TABLE>
<S>                                                 <C>
Broker World                                          Financial World
Across the Board                                      Advertising Age
American Banker                                       Barron's
Best's Review                                         Business Insurance
Business Month                                        Business Week
Changing Times                                        Consumer Reports
The Economist                                         Financial Planning
Forbes                                                Fortune
Inc.                                                  Institutional Investor
Insurance Forum                                       Insurance Sales
Insurance Week                                        Journal of Accountancy
Journal of the American Society of CLU & ChFC         Journal of Commerce
Life Insurance Selling                                Life Association News
MarketFacts                                           Manager's Magazine
National Underwriter                                  Money
Morningstar, Inc.                                     Nation's Business
New Choices (formerly 50 Plus)                        The New York Times
Pension World                                         Pensions & Investments
Rough Notes                                           Round the Table
U.S. Banker                                           VARDs
The Wall Street Journal                               Working Woman
</TABLE>                                                

                            INCOME PAYMENT PROVISIONS

           AMOUNT OF FIXED INCOME PAYMENTS. On the Income Date, the amount you
have chosen to apply to provide fixed income payments will be applied under the
income plan you have chosen. The monthly income payment factor in effect on the
Income Date times that amount and then divided by $1,000 will be the dollar
amount of each monthly payment. Each of these payments are guaranteed and remain
level throughout the payment period.


                                        6

<PAGE>   75



           The monthly income payment factor used to determine the amount of the
fixed annuity income payments will not be less than the guaranteed minimum
monthly income payment factors shown in the Contracts.

           AMOUNT OF VARIABLE INCOME PAYMENTS. These payments will vary in
amount. The dollar amount of each payment attributable to each Variable
Sub-Account is the number of Income Units for each Variable Sub-Account times
the Income Unit Value of that Sub-Account. The sum of the dollar amounts for
each Variable Sub-Account is the amount of the total variable annuity income
payment. The Income Unit value for each payment will be determined no earlier
than five Business Days preceding the due date of the variable income payment.
We guarantee the payment will not vary due to changes in mortality or expenses.

           INCOME UNITS. On the Income Date, the number of Income Units for an
applicable Variable Sub-Account is determined by multiplying (1) by (2) and
dividing the result by (3) where:

           (1)       is the part of the Account Value or death benefit on that
                     date applied under that Variable Sub-Account;

           (2)       is the guaranteed minimum monthly income payment factor for
                     the income plan chosen; and

           (3)       is the Income Unit value for the Variable Sub-Account for
                     the Valuation Period ending on that date.

           INCOME UNIT VALUE. The value of an Income Unit is calculated at the
same time that the value of an Accumulation Unit is calculated and is based on
the same values for Fund shares and other assets and liabilities. The Income
Unit value for a Variable Sub-Account's first Business Day was set at $10.
Thereafter, the Income Unit value for every Business Day is determined by
multiplying (a) by (b), and then dividing by (c) where:

           (a)       is the Accumulation Unit value for the immediately 
                     preceding Valuation Period;
           (b)       is the "net investment factor" for the Variable Sub-Account
                     for the Valuation Period for which the value is being 
                     determined; and
           (c)       is the daily equivalent of the assumed investment rate for
                     the number of days in the Valuation Period.

           After the Income Date the net investment factor is calculated
slightly different than before the Income Date. Before the Income Date
Asset-Based Charges are calculated as a percentage of the Variable Account Value
on the date of deduction. These charges are equal on an annual basis to 1.40%
decreasing to 1.25% after the seventh Contract Year. However, on and after the
Income Date, we call these charges Variable Sub-Account Charges and deduct them
from the assets in each Variable Sub-Account on a daily basis. Therefore, the
"net investment factor" in (b), above, is determined by dividing (a) by (b), and
then subtracting (c) where:


                                        7

<PAGE>   76



           (a)       is the Accumulation Unit value for the current Valuation
                     Period;
           (b)       is the Accumulation Unit value for the immediately 
                     preceding Valuation Period; and
           (c)       is the daily Variable Sub-Account Charges (adjusted for the
                     number of days in the Valuation Period).

                ILLUSTRATION OF CALCULATION OF INCOME UNIT VALUE

<TABLE>
<S>                                                                                                         <C>        
1.         Accumulation Unit value for current Valuation Period..............................................10.0026116

2.         Accumulation Unit value for immediately preceding Valuation Period ...............................10.0000000

3.         Net Investment Factor prior to the Income date (1)/(2) ...........................................1.00026116

4.         Adjustment for Variable Sub-Account Charges......................................................0.000038626

5.         Net Investment Factor on and after the Income Date (3)-(4)........................................1.00022253

6.         Income Unit value for the immediately preceding Valuation Period.................................10.00000000

7.         Daily equivalent of the assumed investment rate for the number of days in the
                                                           1/365
           Valuation Period (assuming you select 3%)=((1.03     )............................................1.00008099

8.         Income Unit value for current Valuation Period [(5) x (6)]/(7)...................................10.00141533


                ILLUSTRATION OF VARIABLE ANNUITY INCOME PAYMENTS

1.         Number of Accumulation Units...........................................................................1,000

2.         Accumulation Unit value...........................................................................10.0026116

3.         Account Value (1) x (2)............................................................................10,002.61

4.         Monthly income payment factor per $1,000 applied.......................................................10.50

5.         First monthly variable income payment [(3) x (4)]/$1,000..............................................105.03

6.         Income Unit Value................................................................................10.00141533

7.         Number of Income Units (5)/(6)......................................................................10.50151

8.         Assume Income Unit value at the end of the second month is.............................................10.05


</TABLE>


                                        8

<PAGE>   77

<TABLE>
<S>                                                                                                             <C>    
9.         Second monthly variable income payment (7) x (10).....................................................105.54

10.        Assume Income Unit value at the end of the third month is..............................................10.10

11.        Third monthly variable income payment (7) x (12)......................................................106.07
</TABLE>

           EXCHANGE OF INCOME UNITS. After the Income Date, if there is an
exchange of value of a designated number of Income Units of particular Variable
Sub-Accounts into other Income Units, the value will be such that the dollar
amount of income payment made on the date of exchange will be unaffected by the
exchange.

                          SAFEKEEPING OF ACCOUNT ASSETS

           The Company holds the title to the assets of the Variable
Sub-Account. The assets are kept physically segregated and held separate and
apart from the Company's general account assets and from the assets in any other
separate account.

           Records are maintained of all purchases and redemptions of Fund
shares held by each of the Variable Sub-Accounts.

           A fidelity bond in the amount of approximately $10 million per
occurrence covering the Company's directors, officers, and employees has been
issued by Lloyd's of London.

                                  LEGAL MATTERS

           All matters relating to Delaware law pertaining to the Contracts,
including the validity of the Contracts and the Company's authority to issue the
Contracts, have been passed upon by James F. Bronsdon, the Company's Vice
President, Legal and Compliance. Sutherland, Asbill & Brennan LLP has provided
advice on certain matters relating to the federal securities laws.

                                OTHER INFORMATION

           A registration statement has been filed with the SEC under the
Securities Act of 1933, as amended, with respect to the Contracts discussed in
this Statement of Additional Information. Not all the information set forth in
the registration statement, amendments and exhibits thereto has been included in
this Statement of Additional Information. Statements contained in this Statement
of Additional Information concerning the content of the Contracts and other
legal instruments are intended to be summaries. For a complete statement of the
terms of these documents, reference should be made to the instruments filed with
the SEC.


                                       9
<PAGE>   78
                              FINANCIAL STATEMENTS

           The Statement of Additional Information contains no financial
statements for the Variable Account because the Variable Account had not
commenced operations as of the date of this Statement of Additional Information.
Financial statements of the Company are presented in the prospectus.


                                        10

<PAGE>   79



                                     PART C

                                OTHER INFORMATION

ITEM 24.             FINANCIAL STATEMENTS AND EXHIBITS

(a)        Financial Statements

           All required financial statements are included in Part A. Financial
statements for The Sage Variable Annuity Account A (the "Variable Account") are
not included in Part B because the Variable Account had not yet commenced
operations as of the date of this Registration Statement.

(b)        Exhibits

           (1)(a)  Resolutions of the Board of Directors of Sage Life 
                   Assurance of America, Inc. establishing The Sage Variable 
                   Annuity Account A.*

           (2)     Not Applicable.

           (3)     Form of Distribution Agreement with Finplan of America,
                   Inc.**

           (4)(a)(i)      Form of Individual Contract.

                 (ii)     Form of Individual Contract with Interest Account.

                 (iii)    Form of Group Contract***

                 (iv)     Form of Group Certificate***

              (b)(i)      Form of Individual IRA Rider.***

                 (ii)     Form of Group IRA Rider.***

                 (iii)    Form of Individual SIMPLE IRA Rider.***

                 (iv)     Form of Group SIMPLE IRA Rider.***

                 (v)      Form of Individual Roth IRA Rider.***

                 (vi)     Form of Group Roth IRA Rider.***

           (5)   (i)      Form of Individual Contract Application.**



                                       11
<PAGE>   80
                 (ii)     Form of Group Certificate Application.


           (6)(a)  Articles of Incorporation of the Company.****

              (b)  By-Laws of the Company.****

           (7)     Not Applicable.

           (8)(a)(i)      Form of Participation Agreement with The Alger 
                          American Fund.**

              (b)(i)      Form of Services Agreement with Financial 
                          Administration Services, Inc.**

           (9)   (i)      Opinion and Consent of James F. Bronsdon.**

                 (ii)     Consent of Sutherland, Asbill & Brennan LLP.**

           (10)    Consent of Ernst & Young LLP.**

           (11)    Not Applicable.

           (12)    Not Applicable.

           (13)    Not Applicable.

           (14)    Financial Data Schedule.**

*          Incorporated herein by reference to Exhibit No. 1 to the Registration
           Statement on Form N-4 (File No. 333-43329) filed on December 24, 
           1997.

**         To be filed by pre-effective amendment.

***        Incorporated herein by reference to Exhibit No. 4 to the Registration
           Statement on Form N-4 (File No. 333-43329) filed on December 24,
           1997.

****       Incorporated herein by reference to Exhibit No. 6 to the Registration
           Statement on Form N-4 (File No. 333-43329) filed on December 24,
           1997.

 ITEM 25.            DIRECTORS AND OFFICERS OF THE DEPOSITOR

           Incorporated herein by reference to the section titled "Directors and
Executive Officers" of the Prospectus filed as Part A of this Registration
Statement.


                                       12
<PAGE>   81



ITEM 26.             PERSONS CONTROLLED BY OR UNDER COMMON CONTROL WITH
                     THE DEPOSITOR OR REGISTRANT

           The registrant is a segregated asset account of the Company and
therefore is owned and controlled by the Company. The Company is a stock life
insurance company of which all the voting securities are owned by Sage Insurance
Group, Inc., a Delaware corporation. All the voting securities of Sage Insurance
Group, Inc. are owned by Finplan of America, Inc, a Texas corporation. Finplan
of America, Inc. is a wholly owned subsidiary of Sage Holdings (USA), Inc., a
Virginia corporation. Sage Holdings (USA), Inc. is a wholly owned subsidiary of
Sage Life Holdings Limited, a South African corporation. The nature of the
business of the companies listed above is insurance and financial services. Sage
Life Holdings is 100% owned by Sage Group Limited, a South African corporation
which is the ultimate holding company. Sage Group Limited is a controlling
company operating in life insurance, mutual funds, real estate and investment
management. Various companies and other entities controlled by Sage Group
Limited may be considered to be under common control with the registrant or the
Company. Such other companies and entities and the nature of their businesses
are set forth below. These companies are incorporated in South Africa and are
wholly owned subsidiaries unless otherwise noted.

           TO BE FILED BY PRE-EFFECTIVE AMENDMENT

ITEM 27.             NUMBER OF CONTRACT OWNERS

           Not applicable.

ITEM 28.             INDEMNIFICATION

           Sage Life's Articles of Incorporation provide that a director of the
Company shall not be personally liable to the Company or its stockholders for
monetary damages for breach of fiduciary duty as a director, except that (i) for
any breach of the director's duty of loyalty to the Company or its stockholders,
(ii) for acts or omissions not in good faith or which would involve intentional
misconduct or a knowing violation of law, (iii) under Section 174 of the
Delaware General Corporation Law, or (iv) for any transaction from which the
director derived any personal benefit. Notwithstanding the foregoing, the
Articles provide that if the Delaware General Corporation Law is amended to
authorize further limitations of the liability of a director or a corporation,
then a director of the Company, in addition to circumstances in which a director
is not personally liable as set forth in the preceding sentence, shall be held
free from liability to the fullest extent permitted by the Delaware General
Corporation Law as amended.

           Sage Life's Bylaws provide that the Company shall indemnify its
officers, directors, employees and agents to the extent permitted by the General
Corporation Law of Delaware.



                                       13
<PAGE>   82
           Further, Section 145 of Delaware General Corporation Law provides
that a corporation shall have power to indemnify any person who was or is a
party or is threatened to be made a party to any threatened, pending or
completed action, suit, or proceeding, whether civil, criminal,
administrative or investigative (other than an action by or in the right of the
corporation) by reason of the fact that he is or was a director, officer,
employee or agent of the corporation, or is or was serving at the request of the
corporation as a director, officer, employee or agent of another corporation as
a director, officer, employee or agent of another corporation, partnership,
joint venture, trust, or other enterprise, against expenses (including
attorneys' fees), judgments, fines and amounts paid in settlement actually and
reasonably incurred by him in connection with such action, suit, or proceeding
if he acted in good faith and in a manner he reasonably believed to be in or not
opposed to the best interests of the corporation, and, with respect to any
criminal action or proceeding, had no reasonable cause to believe his conduct
was unlawful. The termination of any action, suit or proceeding by judgment,
order, settlement, conviction, or upon a plea of nolo contendere or its
equivalent, shall not, of itself, create a presumption that the person did not
act in good faith and in a manner which he reasonably believed to be in or not
opposed to the best interests of the corporation, and, with respect to any
criminal action or proceeding, had a reasonable cause to believe that his
conduct was not unlawful.

           Insofar as indemnification for liability arising under the Securities
Act of 1933 may be permitted to directors, officers and controlling persons of
the registrant pursuant to the foregoing provisions, or otherwise, the
registrant has been advised that in the opinion of the Securities and Exchange
Commission such indemnification is against public policy as expressed in the Act
and is, therefore, unenforceable. In the event that a claim for indemnification
against such liabilities (other than the payment by the registrant of expenses
incurred or paid by a director, officer or controlling person of the registrant
in the successful defense of any action, suit or proceeding) is asserted by such
director, officer or controlling person in connection with the securities being
registered, the registrant will, unless in the opinion of its counsel the matter
has been settled by controlling precedent, submit to a court of appropriate
jurisdiction the question whether such indemnification by it is against public
policy as expressed in the Act and will be governed by the final adjudication of
such issue.

ITEM 29.             PRINCIPAL UNDERWRITER

           (a)       Finplan of America, Inc. ("Finplan") is the registrant's
                     principal underwriter.

           (b)       Officers and Directors of Finplan.

<TABLE>
<CAPTION>
Name and Principal Business Address*                                    Positions and Offices With the Underwriter
- -------------------------------------------------------                 -----------------------------------------------------
<S>                                                                    <C>
Ronald S. Scowby                                                        Director
James F. Bronsdon                                                       President, Chief Executive Officer, Chief
                                                                        Legal Officer
Mitchell R. Katcher                                                     Chief Financial Officer
</TABLE>



                                       14
<PAGE>   83
<TABLE>
<S>                                                                    <C>
James F. Renz                                                           Treasurer
</TABLE>




*          The principal business address of all of the persons listed above is
           300 Atlantic Street, Stamford, CT 06901.

ITEM 30.             LOCATION OF BOOKS AND RECORDS

           All of the accounts, books, records or other documents required to be
kept by Section 31(a) of the Investment Company Act of 1940 and rules
thereunder, are maintained at our Customer Service Center at P.O. Box ______,
Wethersfield, CT _____.

ITEM 31.             MANAGEMENT SERVICES

           [All management contracts are discussed in Part A or Part B of this
registration statement.]

ITEM 32.             UNDERTAKINGS AND REPRESENTATIONS

           (a)       The registrant undertakes that it will file a
                     post-effective amendment to this registration statement as
                     frequently as is necessary to ensure that the audited
                     financial statements in the registration statement are
                     never more than 16 months old for as long as purchase
                     payments under the Contracts offered herein are being
                     accepted.

           (b)       The registrant undertakes that it will include either (1)
                     as part of any application to purchase a Contract offered
                     by the prospectus, a space that an applicant can check to
                     request a Statement of Additional Information, or (2) a
                     post card or similar written communication affixed to or
                     included in the prospectus that the applicant can remove
                     and send to the Company for a Statement of Additional
                     Information.

           (c)       The registrant undertakes to deliver any Statement of
                     Additional Information and any financial statements
                     required to be made available under this Form N-4 promptly
                     upon written or oral request to the Company at the address
                     or phone number listed in the prospectus.

           (d)       The Company represents that the fees and charges under the
                     Contracts, in the aggregate, are reasonable in relation to
                     the services rendered, the expenses expected to be
                     incurred, and the risks assumed by the Company.


                                       15
<PAGE>   84



                                   SIGNATURES

           As required by the Securities Act of 1933 and the Investment Company
Act of 1940, the registrant has caused this registration statement to be signed
on its behalf, in the City of Stamford, and the State of Connecticut, on this
13th day of January, 1998.



                                  The Sage Variable Annuity Account A
                                  (Registrant)

                                  By:  Sage Life Assurance of America, Inc.

Attest:



/s/ James F. Bronsdon             By: /s/ Ronald S. Scowby
- --------------------                  -------------------
James F. Bronsdon                       Ronald S. Scowby
                                        Director, President, Chief Executive
                                        Officer, Sage Life Assurance of America,
                                        Inc.

                                  By:   Sage Life Assurance of America, Inc.
                                        (Depositor)

Attest:

/s/ James F. Bronsdon             By: /s/ Ronald S. Scowby
- --------------------                  -------------------
James F. Bronsdon                       Ronald S. Scowby
                                        Director, President, Chief Executive
                                        Officer



<PAGE>   85



           As required by the Securities Act of 1933, this Registration
Statement has been signed by the following persons in the capacities and on the
dates indicated.


<TABLE>
<CAPTION>
Signature                                                                     Title                                     Date
- ---------                                                                     -----                                     ----


<S>                                                             <C>                                               <C>
/s/ Robin I. Marsden                                                        Director                              January 14, 1998
- -------------------
Robin I. Marsden

/s/ H. Louis Shill                                                          Chairman                              January 15, 1998
- -----------------
H. Louis Shill


/s/ Paul C. Meyer                                                           Director                              January 16, 1998
- ----------------
Paul C. Meyer


/s/ Richard D. Starr                                                        Director                              January 15, 1998
- -------------------
Richard D. Starr


/s/ Mitchell R. Katcher                                          Director, Senior Executive Vice                  January 13, 1998
- ----------------------                                             President, Chief Financial 
Mitchell R. Katcher                                                         Officer,          
                                                                          Chief Actuary       
</TABLE>










<PAGE>   86



<PAGE>   1
                                                              EXHIBIT (4)(a)(i)



        [LOGO] SAGE LIFE ASSURANCE OF AMERICA, INC.

              Member of Sage Insurance Group

                                 A Stock Company

Home Office                                             Customer Service Center
300 Atlantic Street                                             [P. O. Box 1234
Stamford, CT 06901                                  Wethersfield, CT 06109-1234
                                                                1-888-502-7243]

PLEASE READ THIS CONTRACT CAREFULLY. This Contract is a legal contract between
the Contractholder (you) and Sage Life Assurance of America, Inc. You have the
rights described in the Contract. We will make Income Payments beginning on the
Income Date shown in the Schedule if the Annuitant is living on that date.

RIGHT TO EXAMINE THIS CONTRACT:

IF FOR ANY REASON YOU ARE NOT SATISFIED WITH THIS CONTRACT, YOU MAY RETURN IT TO
US OR THE AGENT WHO SOLD IT TO YOU WITHIN 10 DAYS AFTER YOU RECEIVE IT (THE FREE
LOOK PERIOD). WHEN WE RECEIVE IT, WE WILL PROMPTLY REFUND YOU THE ACCOUNT VALUE
PLUS ANY CHARGES SHOWN IN THE SCHEDULE THAT WE HAVE DEDUCTED FROM THE ACCOUNT
VALUE ON OR BEFORE THE DATE THE RETURNED CONTRACT WAS RECEIVED BY US, OR IF
GREATER AND REQUIRED BY THE LAW OF YOUR STATE, THE INITIAL PURCHASE PAYMENT.

ALL PAYMENTS AND VALUES, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE VARIABLE
ACCOUNT, MAY INCREASE OR DECREASE, DEPENDING ON THIS CONTRACT'S INVESTMENT
RESULTS AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. ALL PAYMENTS AND VALUES
BASED ON THE FIXED ACCOUNT MAY BE SUBJECT TO A MARKET VALUE ADJUSTMENT, THE
OPERATION OF WHICH MAY CAUSE SUCH PAYMENTS AND VALUES TO INCREASE OR DECREASE.

                                    /s/ RONALD S. SCOWBY

                                    Chairman

   FLEXIBLE PAYMENT DEFERRED COMBINATION FIXED AND VARIABLE ANNUITY CONTRACT
       Surrender Values while you are living and prior to the Income Date.
                    Income Payments begin on the Income Date
                                Nonparticipating





DVAZ-9712
<PAGE>   2




                                TABLE OF CONTENTS

DEFINITIONS...................................................................3

MAKING PURCHASE PAYMENTS......................................................5

VARIABLE ACCOUNT..............................................................5

FIXED ACCOUNT.................................................................7

TRANSFERS AMONG ACCOUNTS......................................................9

WITHDRAWING ALL OR PART OF YOUR ACCOUNT VALUE.................................9

CHARGES.......................................................................9

OWNER, ANNUITANT AND BENEFICIARY.............................................10

DEATH BENEFITS...............................................................10

GENERAL PROVISIONS...........................................................12

ANNUITY INCOME BENEFITS......................................................13

SCHEDULE.....................................................................17




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DEFINITIONS
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"ACCOUNT VALUE" is the entire amount we hold under this Contract for you before
the Income Date. It is equal to the sum of the Variable Account Value and the
Fixed Account Value.

"ACCUMULATION UNIT" is the unit of measure we use before the Income Date to keep
track of the value of each Variable Sub-Account.

"ANNUITANT" is the natural person whose age determines the Maximum Income Date
and the amount and duration of income payments involving life contingencies. The
Annuitant may also be the person to whom any payment will be made starting on
the Income Date. The Annuitant's name appears in the Schedule.

"BENEFICIARY" is the person or persons to whom we pay a death benefit if any
Owner dies prior to the Income Date.

"CONTRACT DATE" is the date this Contract is issued at our Customer Service
Center. This Contract Date is shown in the Schedule. While this Contract is in
force, every anniversary of this Contract Date is the CONTRACT ANNIVERSARY, and
each and every consecutive twelve-month period beginning on this Contract Date
and each Contract Anniversary is the CONTRACT YEAR.

"CONTINGENT ANNUITANT" is the natural person who becomes the Annuitant if the
Annuitant dies prior to the Income Date.

"CONTINGENT BENEFICIARY" is the person that becomes the Beneficiary if the named
Beneficiary dies prior to the Income Date.

"CUSTOMER SERVICE CENTER" is where we provide service to you. The mailing
address and telephone number of the Customer Service Center are shown on the
first page of this Contract.

"EXCESS WITHDRAWAL" is a withdrawal of Account Value that exceeds the Free
Withdrawal Amount.

"EXPIRY DATE" is the last day in a Guarantee Period.

"FIXED ACCOUNT" is a separate investment account of ours into which purchase
payments may be invested or Account Value may be transferred.

"FIXED ACCOUNT VALUE" is the sum of the value of each Fixed Sub-Account on any
particular day.

A "FIXED SUB-ACCOUNT" is established when purchase payments are invested or
amounts are transferred to the Fixed Account. The value of each Fixed
Sub-Account is equal to the amount invested, increased by interest and reduced
by any withdrawals or transfers from, or charges assessed against the Fixed
Sub-Account.

"FREE WITHDRAWAL AMOUNT" is the maximum amount that can be withdrawn in the
Contract Year without being subject to a surrender charge. This amount is
described in the Schedule.

"GENERAL ACCOUNT" consists of all our assets other than those held in any
separate investment accounts.

"GUARANTEED INTEREST RATE" is the effective annual interest rate we will credit
for a specified Guarantee Period. The Guaranteed Interest Rate will never be
less than the minimum shown in the Schedule.

"GUARANTEE PERIOD" is a period of years for which a specified effective annual
interest rate is guaranteed by us. Interest is credited daily at a rate to yield
the declared annual Guaranteed Interest Rate.

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<PAGE>   4

"HOME OFFICE" is our main office. The mailing address is shown on the first page
of this Contract.

"INCOME DATE" is the date when income payments under this Contract commence.
This date is shown in the Schedule.

"INCOME UNIT" is the unit of measure we use to calculate the amount of income
payments under the Variable Income Annuity.

"MARKET VALUE ADJUSTMENT" is a positive or negative adjustment that may apply to
withdrawals or transfers, whether in whole or in part, and amounts applied to an
income plan, from a Fixed Sub-Account before the end of a Guarantee Period.

"NET ASSET VALUE" is the price of one share of an investment portfolio.

"SATISFACTORY NOTICE" is a notice or request authorized by you, in a form
satisfactory to us, received at our Customer Service Center.

"SUB-ACCOUNT" includes both Variable Sub-Accounts and Fixed Sub-Accounts, unless
the context indicates otherwise.

"SURRENDER VALUE" is the amount you receive upon surrender of this Contract
before the Income Date. It is your Account Value, plus or minus any applicable
Market Value Adjustment, and less any applicable surrender charges or other
charges shown in the Schedule.

"VALUATION DATE" is the date at the end of a Valuation Period when each Variable
Sub-Account is valued.

"VALUATION PERIOD" is the period between one calculation of an Accumulation Unit
value and the next calculation. Normally, we calculate Accumulation Units daily
when the New York Stock Exchange is open for trading and we are open for
business. We can delay this calculation if an emergency exists, making disposal
or fair valuation of assets in the Variable Account not reasonably practicable,
or the Securities and Exchange Commission (SEC) permits the delay. We may change
when we calculate the Accumulation Unit value by giving you 30 days notice, or
such notice as may be required by law.

"VARIABLE ACCOUNT" is a separate investment account of ours into which purchase
payments may be invested or Account Value may be transferred. The Variable
Account is shown in the Schedule.

"VARIABLE ACCOUNT VALUE" is the sum of the value of each Variable Sub-Account on
a Valuation Date.

"VARIABLE SUB-ACCOUNT" is a division of the Variable Account that invests in
shares of a particular investment portfolio. The value of a Variable Sub-Account
is determined by multiplying (a) times (b) where:

       (a) equals the number of Accumulation Units held in the Variable Sub-
           Account; and
       (b) equals the value of the Accumulation Unit for the Variable
           Sub-Account.

"WE", "US" OR "OUR" is Sage Life Assurance of America, Inc.

"YOU" OR "YOUR" is the Owner of this Contract. Your name appears in the
Schedule. You are entitled to exercise all rights under this Contract. However,
if you designate an irrevocable beneficiary, you may need that beneficiary's
consent before you exercise your rights under this Contract. The death of any
Owner before the Income Date initiates payment of the death benefit.

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MAKING PURCHASE PAYMENTS
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INITIAL PURCHASE PAYMENT - You must make the initial purchase payment in order
to put this Contract in force. The amount of your initial purchase payment is
shown in the Schedule.

ADDITIONAL PURCHASE PAYMENTS - After the initial purchase payment, additional
purchase payments may be made at any time while this Contract is in force and
before the Income Date. The amount of any additional purchase payments may vary
but are subject to limits described in the Schedule.

ALLOCATION OF PURCHASE PAYMENTS AMONG THE VARIABLE AND FIXED ACCOUNTS - Subject
to limits described in the Schedule, you tell us how to allocate your purchase
payment, less any applicable taxes, by notifying us of your choices. You
specified how to allocate your initial purchase payment in your application for
this Contract. Initial purchase payments allocated to the Fixed Account will be
invested in Fixed Sub-Accounts with the Guarantee Periods that you specified in
your application. We may, however, require that an initial purchase payment
allocated to a Variable Sub-Account be invested in the Designated Sub-Account
shown in the Schedule during the Free Look Period. At the end of the Free Look
Period, if your initial purchase payment was allocated to the Designated
Sub-Account by us, we will transfer the value of the Designated Sub-Account to
the Sub-Account(s) you specified in your application. For the purpose of
processing transfers from the Designated Sub-Account, the Free Look Period will
end 15 days after this Contract Date.

Subject to our rules, you may tell us how to allocate any additional purchase
payments. If you do not tell us, they will be allocated in the same manner as
your most recent purchase payment.

CANCELLATION OF CONTRACT - If you have not made a purchase payment for more than
2 years and your Account Value is less than $2,000 on a Contract Anniversary, we
may cancel this Contract and pay you the Surrender Value as though you had made
a full withdrawal. We will send you written notice at your address of record.
You will be allowed 61 days from the date we mail you the notice to submit an
additional purchase payment to us in an amount not less than the difference
between $2,000 and the Account Value on the last Contract Anniversary. The
additional purchase payment is subject to the limits and minimums shown in the
Schedule.

VARIABLE ACCOUNT
- --------------------------------------------------------------------------------
VARIABLE ACCOUNT - A variable account is an investment account we maintain
separate from our General Account and any other separate investment accounts we
may have. We own the assets in a variable account. A variable account will not
be charged with liabilities that arise from any other business that we conduct.
We may transfer to our General Account assets that exceed the reserves and other
liabilities of a variable account.

A variable account may invest in mutual funds, unit investment trusts and other
investment portfolios. Such a variable account is treated as a unit investment
trust under Federal securities laws and is registered with the SEC under the
Investment Company Act of 1940.

We may offer certain series or variable accounts that may not be registered with
the SEC under the Securities Act of 1933. Any such series or variable account,
if offered, will be described in the applicable offering document.

The Variable Account for this Contract is shown in the Schedule. The laws of our
state of domicile govern this Variable Account.

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VARIABLE SUB-ACCOUNTS - A unit investment trust variable account includes
variable sub-accounts, each investing in a designated investment portfolio. The
sub-accounts and the investment portfolios in which they invest are specified in
the prospectus or offering document. Income, gains or losses, realized and
unrealized from assets in each variable sub-account are credited to or charged
against that variable sub-account without regard to other income, gains or
losses in the other sub-accounts or our other income, gains or losses.

CHANGES WITHIN THE VARIABLE ACCOUNT - We may, from time to time, make additional
Variable Sub-Accounts available to you. These Sub-Accounts will invest in
investment portfolios we find suitable for this Contract. We also have the right
to eliminate Sub-Accounts, to combine two or more Sub-Accounts or to substitute
a new investment portfolio for the portfolio in which a Sub-Account invests.
Such an action may become necessary if, in our judgment, a portfolio or
Sub-Account no longer suits the purposes of this Contract. This may happen due
to a change in laws or regulations, or a change in a portfolio's or
Sub-Account's investment objectives or restrictions, or because the portfolio or
Sub-Account is no longer available for investment, or for some other reason. We
will get prior approval from the insurance department of our state of domicile
before taking such action. If required, this approval process will be on file
with the insurance department of the jurisdiction in which this Contract is
delivered. We will also get any required approval from the SEC and any other
required approvals before taking such an action.

Subject to any required regulatory approvals, we reserve the right to transfer
assets of the Variable Sub-Accounts that we determine to be associated with the
class of contracts to which this Contract belongs, to another variable account
or variable sub-account.

When permitted by law, we reserve the right to:

         1. Deregister the Variable Account under the Investment Company Act of
            1940;

         2. Operate the Variable Account as a management company under the
            Investment Company Act of 1940, if it is operating as a unit 
            investment trust;

         3. Operate the Variable Account as a unit investment trust under the
            Investment Company Act of 1940, if it is operating as a Managed 
            Separate Account;

         4. Restrict or eliminate any voting rights of Owners, or other persons
            who have voting rights as to the Variable Account;

         5. Combine the Variable Account with other separate investment
            accounts; and

         6. Combine a Variable Sub-Account with another Variable Sub-Account.

If any actions we take result in a material change in the underlying investments
of a Variable Sub-Account in which you are invested, we will notify you of the
change. You may then choose a new Sub-Account.

ACCUMULATION UNITS - We keep track of the value of each of your Variable
Sub-Accounts by crediting you with Accumulation Units for each Sub-Account. The
number of Accumulation Units credited to you for each Sub-Account is determined
by dividing (a) by (b) where:

         (a) is the dollar amount allocated to that Sub-Account; and

         (b) is the value of the Accumulation Unit for that Sub-Account for the
             Valuation Date on which the purchase payment or transferred amount
             is invested in that Sub-Account.

Accumulation Units will be adjusted for any transfers and will be canceled on
payment of a death benefit, a withdrawal, a surrender, the application of
Account Value to an income plan on the Income Date, or assessment of charges
shown in the Schedule (other than the variable sub-account charges) based on
their value for the Valuation Period in which the transaction occurs.

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<PAGE>   7

VALUE OF ACCUMULATION UNITS - The Accumulation Unit value for any Valuation
Period is determined by multiplying (a) by (b) where:

         (a) is the Accumulation Unit value for the immediately preceding
             Valuation Period; and

         (b) is the "net investment factor" for the Variable Sub-Account for the
             Valuation Period for which the value is being determined.

The value of an Accumulation Unit may increase, decrease or remain the same from
one Valuation Period to the next.

NET INVESTMENT FACTOR - The net investment factor for a Variable Sub-Account is
an index that measures the investment performance of that Sub-Account from one
Valuation Period to the next. The net investment factor for any Valuation Period
is determined by dividing (a) by (b), and then subtracting (c) where:

         (a) is the net result of:

             (i)   the Net Asset Value per share of the investment portfolio 
                   share in which the Sub-Account invests determined at the end 
                   of the current Valuation Period; plus

             (ii)  the per share amount of any dividend or capital gains
                   distribution made by that investment portfolio on shares held
                   in the Sub-Account if the "ex-dividend" date occurs during 
                   the current Valuation Period; and plus or minus

             (iii) a per share charge or credit for any taxes reserved for,
                   which is determined by us to have resulted from the 
                   operations of that Sub-Account;

         (b) is the Net Asset Value per share of the investment portfolio
             share in which the Sub-Account invests determined at the end of the
             immediately preceding Valuation Period; and

         (c) is the daily variable sub-account charges shown in the Schedule
             (adjusted for the number of days in the Valuation Period).

The net investment factor may be more or less than, or equal to, one.

FIXED ACCOUNT
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FIXED ACCOUNT - The Fixed Account is a separate investment account under state
insurance law. It is maintained separate from our General Account and separate
from any other separate investment account that we may have. We own the assets
in the Fixed Account. Notwithstanding the foregoing, our obligations under (and
the values and benefits under) the Fixed Account option of this Contract do not
vary as a function of the investment performance of the Fixed Account. Owners
and Beneficiaries with rights under this Contract do not participate in the
investment gains or losses of the assets of the Fixed Account. Such gains or
losses accrue solely to us. We retain the risk that the value of the assets in
the Fixed Account may fall below the reserves and other liabilities that we must
maintain in connection with our obligations under the Fixed Account option of
this Contract. In such event, we will transfer assets from our General Account
to the Fixed Account to make up the difference. The Fixed Account will not be
charged with liabilities that arise from any other business that we conduct. We
may transfer to our General Account assets that exceed the reserves and other
liabilities of the Fixed Account. The Fixed Account is not required to be
registered with the SEC as an investment company under the Investment Company
Act of 1940.

FIXED SUB-ACCOUNT - We will establish a separate Fixed Sub-Account for you each
time you allocate amounts to the Fixed Account. Amounts invested in these Fixed
Sub-Accounts earn interest at the Guaranteed Interest Rate in effect on the date
the amounts are allocated.

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GUARANTEE PERIODS - Each Fixed Sub-Account is guaranteed an interest rate for a
period we refer to as a Guarantee Period. The Guaranteed Interest Rate for a
Fixed Sub-Account is effective for the entire Guarantee Period. The length of a
Guarantee Period is measured from the end of the calendar month in which the
amount is allocated to the Fixed Sub-Account. The last day of the Guarantee
Period is its Expiry Date. Withdrawals or transfers from all or part of a Fixed
Sub-Account, and amounts applied to an income plan, made prior to the Expiry
Date of a Guarantee Period may be subject to a Market Value Adjustment.

We will notify you at least thirty days prior to an Expiry Date of your options
for renewal, which include:

             1.  electing a new Guarantee Period from among those then offered
                 by us, but excluding any that extend beyond your Income Date;
                 or

             2.  transferring the value of the Fixed Sub-Account to one or more
                 Variable Sub-Accounts.

If we do not receive Satisfactory Notice prior to the Expiry Date, we will
transfer the value of the expiring Fixed Sub-Account to the Designated
Sub-Account shown in the Schedule.

GUARANTEED INTEREST RATES - Periodically, we will declare Guaranteed Interest
Rates for then available Guarantee Periods. These rates will be guaranteed for
the duration of the respective Guarantee Periods. Guaranteed Interest Rates will
never be less than the Minimum Guaranteed Interest Rate shown in the Schedule.

MARKET VALUE ADJUSTMENT - A Market Value Adjustment may be applied to
withdrawals, transfers or amounts applied to an income plan when taken from a
Fixed Sub-Account prior to its Expiry Date. A Market Value Adjustment is applied
separately to each Fixed Sub-Account.

A Market Value Adjustment is determined by multiplying the amount withdrawn,
transferred or applied to an income plan by the following factor:

                                             N/365
                          [(1+I)/(1+J+.0025)]      - 1

Where:

             -   I is the Index Rate for a maturity equal to the Fixed
                 Sub-Account's Guarantee Period;
               
             -   J is the Index Rate for a maturity equal to the time remaining
                 (rounded up to the next full year) in the Fixed Sub-Account's
                 Guarantee Period; and

             -   N is the remaining number of days in the Guarantee Period at 
                 the time of calculation.

If there is no Index Rate for the maturity needed to calculate I or J, straight
line interpolation between the Index Rate of the next highest and next lowest
maturities will be used to determine that Index Rate. If the maturity is one
year or less, we will use the Index Rate for a one-year maturity.

Market Value Adjustments will be applied as follows:

             1.  The Market Value Adjustment will be applied to the amount
                 withdrawn, transferred or applied to an income plan before
                 deduction of any applicable surrender charge.

             2.  For a partial withdrawal or partial transfer, the Market Value
                 Adjustment will be calculated on the total amount that must be
                 withdrawn or transferred in order to provide the amount
                 requested.

             3.  If the Market Value Adjustment is negative, it is deducted from
                 any remaining value in the Fixed Sub-Account. Any remaining
                 Market Value Adjustment is deducted from the amount 
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<PAGE>   9
                 withdrawn, transferred or applied to an income plan.

             4.  If the Market Value Adjustment is positive, it is added to any
                 remaining value in the Fixed Sub-Account. In the case of
                 surrender or full transfer, or if the full amount of the Fixed
                 Sub-Account is applied to an income plan, the Market Value
                 Adjustment is added to the amount withdrawn, transferred or
                 applied to an income plan.

TRANSFERS AMONG ACCOUNTS
- --------------------------------------------------------------------------------
Prior to the Income Date and while the Annuitant is living, you may transfer
Account Value among Sub-Accounts. Certain restrictions may apply during the Free
Look Period. To make a transfer, you must give us Satisfactory Notice. Transfers
generally take effect when we receive the notice. The number of free transfers
that we allow each Contract Year is shown in the Charges section of the
Schedule. Restrictions for transfers are shown in the Schedule. A transfer from
a Fixed Sub-Account may be subject to a Market Value Adjustment.

WITHDRAWING ALL OR PART OF YOUR ACCOUNT VALUE
- --------------------------------------------------------------------------------
Prior to the Income Date and while the Annuitant is living, you may withdraw all
or part of your Account Value by giving us Satisfactory Notice. The minimum
withdrawal is shown in the Schedule. 

If you request a withdrawal of all of your Account Value, we will terminate this
Contract and pay you the Surrender Value. This amount may also be applied to the
income plans subject to any restrictions described in this Contract. Unless
specified otherwise, we will make partial withdrawals as described in the
Schedule. Withdrawals generally take effect on the date we receive Satisfactory
Notice.

If you make a withdrawal from this Contract in excess of the Free Withdrawal
Amount described in the Schedule, a surrender charge may be assessed. Surrender
charges are described in the Schedule. A withdrawal from the Fixed Account may
also be subject to a Market Value Adjustment.

EXCESS WITHDRAWALS - If a withdrawal is made for an amount greater than the Free
Withdrawal Amount, a surrender charge may be applicable. For purposes of
calculating the surrender charge only, purchase payments will be liquidated in
whole or in part on a "first-in-first-out-basis." This means we liquidate
purchase payments in the order they were made: the oldest unliquidated purchase
payment first, the next oldest unliquidated purchase payment second, etc., until
all purchase payments have been liquidated.

The surrender charge as to any liquidated purchase payment is determined by
multiplying the amount of the purchase payment being liquidated by the
applicable percentage shown in the Schedule. The total surrender charge will be
the sum of the surrender charges for each purchase payment being liquidated.

In a partial withdrawal, the surrender charge is deducted from the Account Value
remaining after you are paid the amount requested. The amount requested from a
Sub-Account may not exceed the value of that Sub-Account less any applicable
surrender charge. In a complete withdrawal (or surrender of this Contract), it
is deducted from the amount otherwise payable.

CHARGES
- --------------------------------------------------------------------------------
The types and amounts of charges and when and how they are deducted are
described in the Schedule.
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OWNER, ANNUITANT AND BENEFICIARY
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THE OWNER - You are the Owner of this Contract. You have the rights and options
described in this Contract, including but not limited to the right to receive
the income payments beginning on the Income Date. One or more people may own
this Contract.

THE ANNUITANT - Unless another Annuitant is shown in the Schedule, you are also
the Annuitant. You may name a Contingent Annuitant. You will be the Contingent
Annuitant unless you name someone else. If there are joint Owners, we will treat
the youngest Owner as the Contingent Annuitant, unless you elect otherwise.

If you are not the Annuitant and the Annuitant dies before the Income Date, the
Contingent Annuitant becomes the Annuitant. If the Annuitant dies and no
Contingent Annuitant has been named, we will allow you sixty days to designate
someone other than yourself as Annuitant.

THE BENEFICIARY - We pay the death benefit to the primary Beneficiary (unless
there are joint Owners in which case proceeds are payable to the surviving
Owner). If the primary Beneficiary dies before the Owner, the death benefit is
paid to the Contingent Beneficiary, if any. If there is no surviving
Beneficiary, we pay the death benefit to the Owner's estate.

One or more persons may be named as primary Beneficiary or Contingent
Beneficiary. We will assume any death benefit is to be paid in equal shares to
the multiple surviving Beneficiaries unless you specify otherwise.

You have the right to change Beneficiaries. However, if you designate the
primary Beneficiary as irrevocable, you may need the consent of that irrevocable
Beneficiary to exercise the rights and options under this Contract.

CHANGE OF OWNER, BENEFICIARY OR ANNUITANT - During your lifetime and while this
Contract is in force you can transfer ownership of this Contract or change the
Beneficiary, or change the Annuitant. (However, the Annuitant cannot be changed
after the Income Date.) To make any of these changes, you must send us
Satisfactory Notice. If accepted, any change in Owner, Beneficiary or Annuitant
will take effect on the date you signed the notice. Any of these changes will
not affect any payment made or action taken by us before our acceptance. A
CHANGE OF OWNER MAY BE A TAXABLE EVENT and may also affect the amount of death
benefit payable under this Contract.

DEATH BENEFITS
- --------------------------------------------------------------------------------
DEATH BENEFIT BEFORE THE INCOME DATE - If any Owner dies before the Income Date,
we will pay the Beneficiary the greatest of the following:

        (a) the Account Value determined as of the day we receive proof of
            death; or

        (b) 100% of the sum of all purchase payments made to this Contract,
            reduced by any prior withdrawals (including any associated surrender
            charge and Market Value Adjustment incurred); or

        (c) the Highest Anniversary Value.

HIGHEST ANNIVERSARY VALUE - The Highest Anniversary Value is equal to the
greatest anniversary value attained from the following:

        Upon our receipt of proof of death, we will calculate an anniversary
        value for each Contract Anniversary before the Owner's death excluding,
        however, Contract Anniversaries that come after the Owner attains age
        80. An anniversary value is equal to the Account Value on this Contract

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<PAGE>   11
        Anniversary, increased by the dollar amount of any purchase payments
        made since that Contract Anniversary and reduced for any withdrawals
        (including any associated surrender charge and Market Value Adjustment
        incurred) taken since that anniversary. This reduction will be made in
        proportion to the reduction in the Account Value that results from a
        withdrawal.

MULTIPLE OWNERS - If there are multiple Owners, the age of the oldest Owner will
be used to determine the death benefit.

DEATH BENEFIT WHEN NO NATURAL OWNERS - If there is no Owner who is a natural
person, we will treat the Annuitant as Owner for the purpose of paying the death
benefit, and the Annuitant's age will determine the death benefit payable to the
Beneficiary.

REQUIRED DISTRIBUTION OF PROCEEDS ON THE DEATH OF THE OWNER - The three
sub-sections indented below are required to qualify this Contract as an annuity
contract under Section 72(s) of the Internal Revenue Code of 1986, as amended.
Where the terms of these three sub-sections are in conflict with any other
sections or sub-sections of this Contract, these three sub-sections will
control. We reserve the right to amend or administer this Contract as necessary
to comply with the applicable tax requirements. These three sub-sections and
this Contract should be construed so that they comply with the applicable tax
requirements.

        DEATH BENEFIT OPTIONS BEFORE INCOME DATE - In the event any Owner dies
        before the Income Date, the death benefit may be taken in one sum, in
        which case this Contract will terminate. Such sum shall be paid within
        five years of the Owner's death unless one of the options for
        continuation of this Contract below is elected by the person entitled to
        make that election.

        CONTRACT CONTINUATION OPTION - If the death benefit is not taken in one
        sum immediately, this Contract will continue subject to the following
        provisions:

           1. If there are joint Owners, the surviving Owner becomes the new
              Owner. Otherwise, the Beneficiary becomes the new Owner.

           2. Unless specified otherwise, any excess of the death benefit over
              the Account Value will be allocated to and among the Variable and
              Fixed Accounts in proportion to their values as of the date on
              which the death benefit is determined. We will establish a new
              Fixed Sub-Account for any allocation to the Fixed Account based on
              the Guarantee Period you then elect.

           3. No additional purchase payments may be applied to this Contract.

           4. If the new Owner is not the deceased Owner's spouse, the entire
              interest in this Contract must be distributed under one of the
              following options:

              a. The entire interest in this Contract must be distributed over 
                 the life of the new Owner, or over a period not extending
                 beyond the life expectancy of the new Owner, with 
                 distributions beginning within one year of the Owner's death; 
                 or

              b. The entire interest in this Contract must be distributed 
                 within 5 years of the Owner's death.

           5. If the new Owner is the deceased Owner's spouse, this Contract
              will continue with the surviving spouse as the new Owner. The
              surviving spouse may name a new Beneficiary. If no Beneficiary is
              so named, the surviving spouse's estate will be the Beneficiary.
              Upon the death of the surviving spouse, the death benefit will
              equal the Account Value as of the date we receive proof of the
              spouse's death, and the entire interest in this Contract must be
              distributed to the new Beneficiary in accordance with the
              provisions of 4 (a) or 4 (b) above.

           If there is more than one Beneficiary, the foregoing provisions will
           independently apply to each Beneficiary. 

                                                                         Page 11
<PAGE>   12

        DEATH BENEFIT ON OR AFTER THE INCOME DATE - If any Owner dies on or
        after the Income Date but before the time the entire interest in this
        Contract has been distributed, the remaining portion will be distributed
        at least as rapidly as under the method of distribution being used as of
        the date of the Owner's death.

        If income payments have been selected based on an income plan providing
        for payments for a guaranteed period, and the Annuitant dies on or after
        the Income Date, we will make the remaining guaranteed payments to the
        Beneficiary. Any remaining payments will be made as rapidly as under the
        method of distribution being used as of the date of the Annuitant's
        death. If no Beneficiary is living, we will commute any unpaid
        guaranteed payments to a single sum (on the basis of the interest rate
        used in determining the payments) and pay that single sum to the estate
        of the last to die of the Annuitant or the Beneficiary.

PROOF OF DEATH - Proof of death must be received at our Customer  Service Center
before we will pay any death  benefit.  We will accept one of the following
items:

        1. An original certified copy of an official death Contract; or

        2. An original certified copy of a decree of a court of competent
           jurisdiction as to the finding of death; or

        3. Any other proof satisfactory to us.

GENERAL PROVISIONS
- --------------------------------------------------------------------------------
ENTIRE CONTRACT - This Contract including any attached riders, endorsements,
amendments and the application constitutes the entire contract between you and
us. All statements made by you, or any Owner, or any Annuitant will be deemed
representations and not warranties.

ASSIGNMENT - You may assign this Contract at any time prior to the Income Date.
No assignment will be binding on us unless we receive Satisfactory Notice. We
will not be liable for any payments made or actions we take before the
assignment is accepted by us. An absolute assignment will revoke the interest of
any revocable Beneficiary. We will not be responsible for the validity of any
assignment. AN ASSIGNMENT MAY BE A TAXABLE EVENT.

CLAIMS OF CREDITORS - To the extent permitted by law, no benefits payable under
this Contract will be subject to the claims of your, the Beneficiary's, or the
Annuitant's creditors.

MISSTATEMENT AND PROOF OF AGE, SEX OR SURVIVAL - We may require proof of age,
sex or survival of any person upon whose age, sex or survival any payments
depend. If the age or sex of the Annuitant has been misstated, or if the age of
the Owner has been misstated, the benefits will be those that the Account Value
applied would have provided for the correct age and sex. If we have made
incorrect income payments, the amount of any underpayment will be paid
immediately. The amount of any overpayment will be deducted from future income
payments.

NO DIVIDENDS PAYABLE - This Contract is non-participating and does not share in 
any distribution of our surplus.  We will not pay any dividends.

INCONTESTABILITY - This Contract is incontestable from its Contract Date.

REQUIRED REPORTS - We will furnish a report to you as often as required by law,
but at least once each Contract Year before the Income Date. The report will
show the number of Accumulation Units credited to each Variable Sub-Account in
which you are invested and the corresponding Accumulation Unit value as of the
date of the report. It will also show your Fixed Account Value.

                                                                         Page 12
<PAGE>   13


MORTALITY  AND  EXPENSES - Our actual  mortality  and expense  experience  will 
not affect the amount of any income  payments or any other values under this
Contract.

TAXES BASED UPON PURCHASE PAYMENT OR VALUE - If there is a law or change in law
assessing taxes against us based upon purchase payments or value of this
Contract, we reserve the right to charge you and all similarly situated Owners
proportionately for that tax. This would include a tax based upon our realized
net capital gains in the Variable Sub-Accounts and on earnings in the Fixed
Account, on which we are not currently taxed.

PAYMENTS WE MAY DEFER - We may not be able to determine the value of the assets
of the Variable Sub-Accounts because:

        1. The New York Stock Exchange is closed for trading;
        2. The SEC determines that a state of emergency exists;
        3. An order or pronouncement of the SEC permits a delay for the
           protection of Owners; or
        4. The check used to pay the purchase payment has not cleared through
           the banking system. This may take up to 15 days.

If this happens, we may delay:

        1. Determination and payment of the Surrender Value;
        2. Determination and payment of any death benefit if death occurs before
           the Income Date;
        3. Transfers of the Account Value; or
        4. Application of the Account Value under an income plan.

We reserve the right to delay payment of amounts from the Fixed Account for up
to six months. If deferred 30 days or more, the amount deferred will earn
interest at a rate not less than the Minimum Deferral Interest Rate shown in the
Fixed Account section of the Schedule.

AUTHORITY TO MAKE AGREEMENTS - All agreements made by us must be signed by one
of our officers. No other person, including an insurance agent or broker, can
change the terms of this Contract or make any agreement binding on us.

REQUIRED NOTE ON OUR COMPUTATIONS - We have filed a detailed statement of our
computations with the insurance supervisory officials in the appropriate
jurisdictions. The values are not less than those required by the laws of those
states or jurisdictions. Any benefit provided by an attached rider will not
increase these values unless otherwise stated in that rider.

ANNUITY INCOME BENEFITS
- --------------------------------------------------------------------------------
CHOOSING AN INCOME DATE AND INCOME PLAN - On the Income Date, if the Annuitant
is alive and this Contract is in force, income payments will begin under the
income plan you have chosen. If you have not chosen an income plan, the option
shown in the Schedule will automatically apply. If you have not selected an
Income Date, the Maximum Income Date shown in the Schedule will automatically
apply.

You may choose or change an income plan or the Income Date by giving us  
Satisfactory  Notice at least 30 days before the Income Date. However, any 
Income Date must meet the restrictions described in the Schedule.

Once income payments have begun, we reserve the right to disallow further
changes without our prior approval.


                                                                         Page 13
<PAGE>   14


MINIMUM AMOUNTS - If the amount available to apply under any variable or fixed
option is less than the minimum amount shown in the Schedule, we reserve the
right to pay such amount in a lump sum in lieu of the payment otherwise provided
for.

Income payments will be made monthly unless quarterly, semi-annual or annual
payments are chosen by giving us Satisfactory Notice at least 30 days before the
Income Date. However, if at any time the payment becomes less than the minimum
income payment shown in the Schedule, we reserve the right to reduce the
frequency of payment to an interval that results in each payment being at least
equal to the minimum income payment. In no event will the interval be less
frequent than annual.

ALLOCATION OF ANNUITY - At the time you elect the income plan, you may also
elect to have the Account Value applied to provide a Variable Income Annuity, a
Fixed Income Annuity, or a combination of both. Unless you specify otherwise, we
will provide either variable or fixed, or a combination of variable and fixed
income payments in proportion to the Sub-Accounts in which you are invested as
of a date not more than 5 Valuation Days before the due date of the first income
payment. If any applicable purchase payment taxes are then due us, we will also
deduct them proportionately.

VARIABLE INCOME ANNUITY

AMOUNT OF FIRST VARIABLE PAYMENT - The Income Tables shown in the Schedule are
used to determine the first monthly variable income payment for an assumed
investment rate of 3%. The Income Tables show the dollar amount of the first
monthly variable income payment that can be purchased with each $1,000 applied.
The assumed investment rates we currently allow are shown on the Schedule.

VALUE OF INCOME UNITS - The Income Unit value for any Valuation Period is
determined by multiplying (a) by (b), and then dividing by (c) where:

        (a) is the Income Unit value for the immediately preceding Valuation
            Period;

        (b) is the "net investment factor" for the Variable Sub-Account for the
            Valuation Period for which the value is being determined; and

        (c) is the daily equivalent of the assumed investment rate for the
            number of days in the Valuation Period.

The value of an Income Unit may increase, decrease or remain the same from one
Valuation Period to the next.

NUMBER OF INCOME UNITS - We determine the number of Income Units in each
Variable Sub-Account by dividing the first monthly variable income payment
attributable to that Sub-Account by its Income Unit value as of a date not more
than 5 Valuation Days before the due date of the first variable income payment.

AMOUNT OF SECOND AND SUBSEQUENT VARIABLE PAYMENTS - The dollar amount of the
second and subsequent variable income payments may change with the investment
performance of the Variable Sub-Accounts. The total amount of each variable
income payment will be equal to the sum of the variable income payments in each
Variable Sub-Account. The dollar amount of each payment for a Variable
Sub-Account is determined by multiplying the number of Income Units by the
Income Unit value for the Variable Sub-Account for the Valuation Period which
ends on a consistently applied date not more than 5 Valuation Days before the
payment is due.

We guarantee that the dollar amount of each payment after the first will not be
affected by variations in our expenses or mortality experience.

                                                                         Page 14

<PAGE>   15
EXCHANGE OF INCOME UNITS - After the Income Date, if there is an exchange of
value of a designated number of Income Units of particular Variable Sub-Accounts
into other Income Units, the value will be such that the dollar amount of income
payment made on the date of exchange would be unaffected by the exchange.

FIXED INCOME ANNUITY

A Fixed Income Annuity is an annuity with income payments that remain fixed as
to dollar amount throughout the payment period. The Income Tables shown in the
Schedule are used to determine the monthly fixed income payment. The Income
Tables show the dollar amount of the monthly fixed income payment that can be
purchased with each $1,000 applied.

INCOME PLANS

The following is a list of income plans we guarantee to make available.

INCOME PLAN 1. LIFE ANNUITY - An annuity  payable  during the lifetime of the 
Annuitant  and  terminating  with the last payment  preceding the death of the
Annuitant.

INCOME PLAN 2. LIFE ANNUITY WITH 10 OR 20 YEARS CERTAIN - An annuity payable
during the lifetime of the Annuitant with the provision that payments will be
made for a minimum of 10 or 20 years, as elected.

INCOME PLAN 3. JOINT AND LAST SURVIVOR ANNUITY - An annuity payable during the
joint lifetime of the Annuitant and a designated second person, and thereafter
during the remaining lifetime of the survivor, ceasing with the last payment
prior to the death of the survivor.

INCOME PLAN 4. PAYMENTS FOR A SPECIFIED PERIOD CERTAIN - An amount payable for
the number of years selected which may be from 5 to 30 years.

INCOME PLAN 5. ANNUITY PLAN - An amount can be used to purchase any single  
premium annuity we offer on the Income Date for which you and the Annuitant are
eligible.

                                                                         Page 15

<PAGE>   16









                       THIS PAGE INTENTIONALLY LEFT BLANK

                                                                         Page 16


<PAGE>   17



                                    SCHEDULE

           Contract No.:   123456789

                  Owner:   JOHN DOE
          Issue Age/Sex:   35/MALE             Contract Date: 1/1/1998

              Annuitant:   JOHN DOE
          Issue Age/Sex:   35/MALE               Income Date: 1/1/2038

        Initial Purchase 
                Payment:   $[10,000]                        :

This Schedule sets forth additional information that relates to the provisions
in this Contract with the corresponding headings.

MAKING PURCHASE PAYMENTS
The Designated Sub-Account is the [Money Market Sub-Account].

No purchase payment, whether initial or additional, may be allocated such that
any Sub-Account would have a value less than $250.

Additional purchase payments are subject to the following limits:

        1. [Non-qualified plan: Additional purchase payments may be made until
           the earlier of the year in which you attain age 85 or the year in
           which the Annuitant attains age 85.]

        2. [Qualified plan: Additional purchase payments may be made until the
           year in which you attain age 70 1/2, except rollover contributions 
           may be made until the year in which you attain age 85.]

        3. The minimum additional purchase payment we will accept is $250.

        4. Our prior approval is required before you make a purchase payment
           that causes the Account Value of all annuities that you maintain with
           us to exceed $1,000,000.

VARIABLE ACCOUNT
The Variable Account for this Contract is [The Sage Variable Annuity Account 
A]. [It is a unit investment trust variable account.]

FIXED ACCOUNT
The Fixed Account for this Contract is [The Sage Fixed Interest Account A.]

The Minimum Guaranteed Interest Rate is 3%.

The Minimum Deferral Interest Rate is 3%.

The Designated Sub-Account is the [Money Market Sub-Account]. It is not part of
the Fixed Account.

Index Rate: The Index Rate is the U.S. Treasury Constant Maturity Series as
reported in Federal Reserve Bulletin Release H.15. We currently base the Index
Rate for a calendar week on the reported rate for the preceding calendar week.
We reserve the right to set it less frequently but in no event less often than
monthly.

                                                                         Page 17

<PAGE>   18

TRANSFERS AMONG ACCOUNTS
The minimum amount that can be transferred is $250. However, if less remains in
a Sub-Account, that amount may be transferred. If a transfer request would
reduce the Account Value remaining in a Sub-Account below $250, we will treat
the transfer request as a request to transfer the entire amount.

Your transfer request must clearly state the Sub-Accounts from which and to
which transfers are to be made.

We reserve the right to limit, upon notice, the maximum number of transfers you
may make to one per calendar month or 12 per Contract Year.

After the Income Date, we reserve the right to:

        1. disallow transfers from the Fixed Account to the Variable Account, or
           from the Variable Account to the Fixed Account; and

        2. limit the maximum number of transfers between Variable Sub-Accounts
           to 1 per Contract Year.

WITHDRAWING ALL OR PART OF YOUR ACCOUNT VALUE 
The Free Withdrawal Amount is the greater of (a) and (b) where:

       (a) is the excess of 10% of the total purchase payments over 100% of all 
           prior withdrawals in that Contract Year; and

       (b) is the excess of the Account Value on the date of withdrawal over the
           unliquidated purchase payments.

The minimum amount that can be withdrawn is $250. If a withdrawal request would
reduce the Account Value remaining in a Sub-Account below $250, we will treat
the withdrawal request as a request to withdraw the entire amount.

If a requested withdrawal would reduce the Account Value below $2,000, we
reserve the right to treat the request as a withdrawal of only the excess over
$2,000.

Unless you specify otherwise, we will make withdrawals proportionately from all
Sub-Accounts in which you are invested.

                                                                         Page 18

<PAGE>   19


CHARGES

SURRENDER CHARGE - A surrender charge may be imposed upon surrender of this
Contract or when an Excess Withdrawal is made. A Market Value Adjustment, if
any, is applied before calculating the surrender charge. The surrender charge is
applied to each purchase payment and is a percentage of each purchase payment as
follows:

                   The maximum surrender charge percentage is
                   0% for all Certificate Years.

TRANSFER CHARGE - We reserve the right to charge a maximum of $25 for each
transfer after the 12th in a Contract Year. Each request is considered to be one
transfer regardless of the number of Sub-Accounts affected by the transfer. The
transfer charge will be deducted proportionately from all Sub-Accounts from
which the transfer is made.

ADMINISTRATION CHARGE - $40 a year. This charge is incurred at the beginning of
each Contract Year and deducted on each Contract Anniversary or upon surrender.
The charge will be waived:

        1.  if the Account Value is at least $50,000 at the time of deduction;
            or

        2.  beginning on and after the 8th Contract Anniversary.

PURCHASE PAYMENT TAX CHARGE - The amount of any state and local taxes levied by
any governmental entity on purchase payments may be deducted from the Account
Value when such taxes are incurred. We reserve the right to defer the collection
of this charge and deduct it against your Account Value on the surrender of this
Contract, or Excess Withdrawal, or application of the Account Value to provide
income payments.

ASSET-BASED CHARGES - We deduct asset-based charges to compensate us for
assuming mortality and expense risks, and certain administrative expenses. Prior
to the Income Date asset-based charges are calculated as a percentage of the
Variable Account Value on the date of deduction. On this Contract Date, and
monthly thereafter, the asset-based charges are deducted in proportion to the
Variable Sub-Accounts in which you are invested. The maximum charges are:

<TABLE>
<CAPTION>

     Asset-Based Charges        Annual Charge       Monthly Charge
     -------------------        -------------       --------------
<S>                               <C>                <C>     
     Contract Years 1-7             1.40%             .116667%
     Contract Years 8+              1.25%             .104167%
</TABLE>

We also deduct asset-based charges on the effective date of any transfer from
the Fixed Account, or allocation of purchase payment to the Variable Account,
based on the amount transferred or allocated, and based on the number of days
remaining until the next date of deduction.

VARIABLE SUB-ACCOUNT CHARGES - On and after the Income Date we deduct the
asset-based charges above from the assets in each Variable Sub-Account on a
daily basis. The maximum charges are:

<TABLE>
<CAPTION>
      Variable Sub-Account Charges     Annual Charge         Daily Charge
      ----------------------------     -------------         ------------
<S>                                        <C>                <C>      
      Contract Years 1-7                   1.40%              .0038626%
      Contract Years 8+                    1.25%              .0034462%
</TABLE>

CHARGE DEDUCTION RULES - Unless otherwise specified above, charges are deducted
from the Account Value proportionately from all Sub-Accounts in which you are
invested.
                                                                         Page 19

<PAGE>   20

ANNUITY INCOME BENEFITS

If you have not chosen an income plan, Life Annuity with 10 Years Certain will
automatically apply.

The Maximum Income Date is the first day of the first calendar month following
the Annuitant's 95th birthday.

We reserve the right to require that the Income Date be at least 2 years after
this Contract Date.

The minimum amount that can be applied under any Variable or Fixed Income
Annuity is $5,000.

The minimum income payment is $100.

We currently allow assumed  investment  rates of 3% and 5%. If you do not 
specify one of these rates when you choose an income plan, the assumed 
investment rate will be 3%.

Values for other ages, and for other payment periods, joint life combinations,
or assumed investment rates that we offer (Tables below assume 3%) are available
on request. Monthly income payments are shown for each $1,000 applied.

                                                                         Page 20

<PAGE>   21




                         INCOME TABLE FOR A FIXED PERIOD


<TABLE>
<CAPTION>
               Monthly                   Monthly                 Monthly
Fixed Period   Income     Fixed Period   Income    Fixed Period  Income
 of Years      Payment     of Years      Payment    of Years     Payment
 --------      -------     --------      -------    --------      ------
<S>            <C>           <C>          <C>         <C>         <C> 
               $             11           $8.88        21         $5.33
                             12            8.26        22          5.16
                             13            7.73        23          5.00
                             14            7.28        24          4.85
   5            17.95        15            6.89        25          4.72
   6            15.18        16            6.54        26          4.60
   7            13.20        17            6.24        27          4.49
   8            11.71        18            5.98        28          4.38
   9            10.56        19            5.74        29          4.28
  10             9.64        20            5.53        30          4.19
</TABLE>



                              INCOME TABLE FOR LIFE

<TABLE>
<CAPTION>
                   Male/Female             Male/Female         Male/Female
     Age            Life Only           10 Years Certain    20 Years Certain
     ---            ---------           ----------------    ----------------
<S>             <C>                       <C>                <C> 
      50          $4.28 / 3.92            $4.24 / 3.90        $4.10 / 3.84
      55           4.72 / 4.27             4.64 / 4.24         4.40 / 4.12
      60           5.31 / 4.74             5.17 / 4.68         4.73 / 4.45
      65           6.13 / 5.38             5.84 / 5.25         5.04 / 4.81
      70           7.28 / 6.29             6.65 / 6.00         5.29 / 5.14
      75           8.90 / 7.62             7.53 / 6.92         5.43 / 5.37
      80          11.19 / 9.62             8.37 / 7.93         5.50 / 5.48
      85         14.36 / 12.63             9.00 / 8.77         5.52 / 5.52
</TABLE>


RIDERS
Accidental Death Benefit Rider

        The Maximum Accidental Death Benefit is $250,000.

                                                                         Page 21

<PAGE>   22


      [LOGO]  SAGE LIFE ASSURANCE OF AMERICA, INC. 

            Member of Sage Insurance Group






















   FLEXIBLE PAYMENT DEFERRED COMBINATION FIXED AND VARIABLE ANNUITY CONTRACT
       Surrender Values while you are living and prior to the Income Date.
                    Income Payments begin on the Income Date
                                Nonparticipating





<PAGE>   1
                                                            EXHIBIT (4)(a)(ii)


       [LOGO]       SAGE LIFE ASSURANCE OF AMERICA, INC. 
         Member of Sage Insurance Group

                                 A Stock Company

Home Office                                              Customer Service Center
300 Atlantic Street                                              [P. O. Box 1234
Stamford, CT 06901                                   Wethersfield, CT 06109-1234
                                                                 1-888-502-7243]

PLEASE READ THIS CONTRACT CAREFULLY. This Contract is a legal contract between
the Contractholder (you) and Sage Life Assurance of America, Inc. You have the
rights described in the Contract. We will make Income Payments beginning on the
Income Date shown in the Schedule if the Annuitant is living on that date.

RIGHT TO EXAMINE THIS CONTRACT:

IF FOR ANY REASON YOU ARE NOT SATISFIED WITH THIS CONTRACT, YOU MAY RETURN IT TO
US OR THE AGENT WHO SOLD IT TO YOU WITHIN 10 DAYS AFTER YOU RECEIVE IT (THE FREE
LOOK PERIOD). WHEN WE RECEIVE IT, WE WILL PROMPTLY REFUND YOU THE ACCOUNT VALUE
PLUS ANY CHARGES SHOWN IN THE SCHEDULE THAT WE HAVE DEDUCTED FROM THE ACCOUNT
VALUE ON OR BEFORE THE DATE THE RETURNED CONTRACT WAS RECEIVED BY US, OR IF
GREATER AND REQUIRED BY THE LAW OF YOUR STATE, THE INITIAL PURCHASE PAYMENT.

ALL PAYMENTS AND VALUES, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE VARIABLE
ACCOUNT, MAY INCREASE OR DECREASE, DEPENDING ON THIS CONTRACT'S INVESTMENT
RESULTS AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. ALL PAYMENTS AND VALUES
BASED ON THE INTEREST ACCOUNT MAY BE SUBJECT TO A MARKET VALUE ADJUSTMENT, THE
OPERATION OF WHICH MAY CAUSE SUCH PAYMENTS AND VALUES TO INCREASE OR DECREASE.

                                    /s/ RONALD S. SCOWBY

                                    Chairman

               FLEXIBLE PAYMENT DEFERRED VARIABLE ANNUITY CONTRACT
       Surrender Values while you are living and prior to the Income Date.
                    Income Payments begin on the Income Date
                                Nonparticipating




DVAZ-9712 VT
<PAGE>   2




                                TABLE OF CONTENTS

DEFINITIONS...................................................................3

MAKING PURCHASE PAYMENTS......................................................5

VARIABLE ACCOUNT..............................................................5

INTEREST ACCOUNT..............................................................7

TRANSFERS AMONG ACCOUNTS......................................................9

WITHDRAWING ALL OR PART OF YOUR ACCOUNT VALUE.................................9

CHARGES.......................................................................9

OWNER, ANNUITANT AND BENEFICIARY.............................................10

DEATH BENEFITS...............................................................10

GENERAL PROVISIONS...........................................................12

ANNUITY INCOME BENEFITS......................................................13

SCHEDULE.....................................................................17


                                                                         Page 2
<PAGE>   3






DEFINITIONS
- --------------------------------------------------------------------------------
"ACCOUNT  VALUE" is the entire amount we hold under this  Contract for you 
before the Income Date. It is equal to the sum of the Variable  Account Value 
and the Interest Account Value.

"ACCUMULATION UNIT" is the unit of measure we use before the Income Date to keep
track of the value of each Variable Sub-Account.

"ANNUITANT" is the natural person whose age determines the Maximum Income Date
and the amount and duration of income payments involving life contingencies. The
Annuitant may also be the person to whom any payment will be made starting on
the Income Date. The Annuitant's name appears in the Schedule.

"BENEFICIARY" is the person or persons to whom we pay a death benefit if any
Owner dies prior to the Income Date.

"CONTRACT DATE" is the date this Contract is issued at our Customer Service
Center. This Contract Date is shown in the Schedule. While this Contract is in
force, every anniversary of this Contract Date is the CONTRACT ANNIVERSARY, and
each and every consecutive twelve-month period beginning on this Contract Date
and each Contract Anniversary is the CONTRACT YEAR.

"CONTINGENT ANNUITANT" is the natural person who becomes the Annuitant if the
Annuitant dies prior to the Income Date.

"CONTINGENT BENEFICIARY" is the person that becomes the Beneficiary if the named
Beneficiary dies prior to the Income Date.

"CUSTOMER SERVICE CENTER" is where we provide service to you. The mailing
address and telephone number of the Customer Service Center are shown on the
first page of this Contract.

"EXCESS WITHDRAWAL" is a withdrawal of Account Value that exceeds the Free
Withdrawal Amount.

"EXPIRY DATE" is the last day in a Guarantee Period.

"INTEREST ACCOUNT" is a separate investment account of ours into which purchase
payments may be invested or Account Value may be transferred.

"INTEREST ACCOUNT VALUE" is the sum of the value of each Interest Sub-Account on
any particular day.

"INTEREST SUB-ACCOUNT" is established when purchase payments are invested or
amounts are transferred to the Interest Account. The value of each Interest
Sub-Account is equal to the amount invested, increased by interest and reduced
by any withdrawals or transfers from, or charges assessed against the Interest
Sub-Account.

"FREE WITHDRAWAL AMOUNT" is the maximum amount that can be withdrawn in the
Contract Year without being subject to a surrender charge. This amount is
described in the Schedule.

"GENERAL ACCOUNT" consists of all our assets other than those held in any
separate investment accounts.

"GUARANTEED INTEREST RATE" is the effective annual interest rate we will credit
for a specified Guarantee Period. The Guaranteed Interest Rate will never be
less than the minimum shown in the Schedule.

"GUARANTEE PERIOD" is a period of years for which a specified effective annual
interest rate is guaranteed by us. Interest is credited daily at a rate to yield
the declared annual Guaranteed Interest Rate.


                                                                          Page 3
<PAGE>   4

"HOME OFFICE" is our main office.  The mailing address is shown on the first 
page of this Contract.

"INCOME DATE" is the date when income payments under this Contract commence.
This date is shown in the Schedule.

"INCOME UNIT" is the unit of measure we use to calculate the amount of income
payments under the Variable Income Annuity.

"MARKET VALUE ADJUSTMENT" is a positive or negative adjustment that may apply to
withdrawals or transfers, whether in whole or in part, and amounts applied to an
income plan, from an Interest Sub-Account before the end of a Guarantee Period.

"NET ASSET VALUE" is the price of one share of an investment portfolio.

"SATISFACTORY NOTICE" is a notice or request authorized by you, in a form
satisfactory to us, received at our Customer Service Center.

"SUB-ACCOUNT" includes both Variable Sub-Accounts and Interest Sub-Accounts,
unless the context indicates otherwise.

"SURRENDER VALUE" is the amount you receive upon surrender of this Contract
before the Income Date. It is your Account Value, plus or minus any applicable
Market Value Adjustment, and less any applicable surrender charges or other
charges shown in the Schedule.

"VALUATION DATE" is the date at the end of a Valuation Period when each Variable
Sub-Account is valued.

"VALUATION PERIOD" is the period between one calculation of an Accumulation Unit
value and the next calculation. Normally, we calculate Accumulation Units daily
when the New York Stock Exchange is open for trading and we are open for
business. We can delay this calculation if an emergency exists, making disposal
or fair valuation of assets in the Variable Account not reasonably practicable,
or the Securities and Exchange Commission (SEC) permits the delay. We may change
when we calculate the Accumulation Unit value by giving you 30 days notice, or
such notice as may be required by law.

"VARIABLE ACCOUNT" is a separate investment account of ours into which purchase
payments may be invested or Account Value may be transferred. The Variable
Account is shown in the Schedule.

"VARIABLE ACCOUNT VALUE" is the sum of the value of each Variable Sub-Account on
a Valuation Date.

"VARIABLE SUB-ACCOUNT" is a division of the Variable Account that invests in
shares of a particular investment portfolio. The value of a Variable Sub-Account
is determined by multiplying (a) times (b) where:

        (a) equals the number of Accumulation Units held in the Variable
            Sub-Account; and

        (b) equals the value of the Accumulation Unit for the Variable
            Sub-Account.

"WE", "US" OR "OUR" is Sage Life Assurance of America, Inc.

"YOU" OR "YOUR" is the Owner of this Contract. Your name appears in the
Schedule. You are entitled to exercise all rights under this Contract. However,
if you designate an irrevocable beneficiary, you may need that beneficiary's
consent before you exercise your rights under this Contract. The death of any
Owner before the Income Date initiates payment of the death benefit.


                                                                          Page 4
<PAGE>   5



MAKING PURCHASE PAYMENTS
- --------------------------------------------------------------------------------
INITIAL  PURCHASE  PAYMENT - You must make the initial  purchase payment in 
order to put this Contract in force. The amount of your initial purchase payment
is shown in the Schedule.

ADDITIONAL PURCHASE PAYMENTS - After the initial purchase payment, additional
purchase payments may be made at any time while this Contract is in force and
before the Income Date. The amount of any additional purchase payments may vary
but are subject to limits described in the Schedule.

ALLOCATION OF PURCHASE PAYMENTS AMONG THE VARIABLE AND INTEREST ACCOUNTS -
Subject to limits described in the Schedule, you tell us how to allocate your
purchase payment, less any applicable taxes, by notifying us of your choices.
You specified how to allocate your initial purchase payment in your application
for this Contract. Initial purchase payments allocated to the Interest Account
will be invested in Interest Sub-Accounts with the Guarantee Periods that you
specified in your application. We may, however, require that an initial purchase
payment allocated to a Variable Sub-Account be invested in the Designated
Sub-Account shown in the Schedule during the Free Look Period. At the end of the
Free Look Period, if your initial purchase payment was allocated to the
Designated Sub-Account by us, we will transfer the value of the Designated
Sub-Account to the Sub-Account(s) you specified in your application. For the
purpose of processing transfers from the Designated Sub-Account, the Free Look
Period will end 15 days after this Contract Date.

Subject to our rules, you may tell us how to allocate any additional purchase
payments. If you do not tell us, they will be allocated in the same manner as
your most recent purchase payment.

CANCELLATION OF CONTRACT - If you have not made a purchase payment for more than
2 years and your Account Value is less than $2,000 on a Contract Anniversary, we
may cancel this Contract and pay you the Surrender Value as though you had made
a full withdrawal. We will send you written notice at your address of record.
You will be allowed 61 days from the date we mail you the notice to submit an
additional purchase payment to us in an amount not less than the difference
between $2,000 and the Account Value on the last Contract Anniversary. The
additional purchase payment is subject to the limits and minimums shown in the
Schedule.

VARIABLE ACCOUNT
- --------------------------------------------------------------------------------
VARIABLE ACCOUNT - A variable account is an investment account we maintain
separate from our General Account and any other separate investment accounts we
may have. We own the assets in a variable account. A variable account will not
be charged with liabilities that arise from any other business that we conduct.
We may transfer to our General Account assets that exceed the reserves and other
liabilities of a variable account.

A variable account may invest in mutual funds, unit investment trusts and other
investment portfolios. Such a variable account is treated as a unit investment
trust under Federal securities laws and is registered with the SEC under the
Investment Company Act of 1940.

We may offer certain series or variable accounts that may not be registered with
the SEC under the Securities Act of 1933. Any such series or variable account,
if offered, will be described in the applicable offering document.

The Variable Account for this Contract is shown in the Schedule. The laws of our
state of domicile govern this Variable Account.


                                                                          Page 5
<PAGE>   6



VARIABLE SUB-ACCOUNTS - A unit investment trust variable account includes
variable sub-accounts, each investing in a designated investment portfolio. The
sub-accounts and the investment portfolios in which they invest are specified in
the prospectus or offering document. Income, gains or losses, realized and
unrealized from assets in each variable sub-account are credited to or charged
against that variable sub-account without regard to other income, gains or
losses in the other sub-accounts or our other income, gains or losses.

CHANGES WITHIN THE VARIABLE ACCOUNT - We may, from time to time, make additional
Variable Sub-Accounts available to you. These Sub-Accounts will invest in
investment portfolios we find suitable for this Contract. We also have the right
to eliminate Sub-Accounts, to combine two or more Sub-Accounts or to substitute
a new investment portfolio for the portfolio in which a Sub-Account invests.
Such an action may become necessary if, in our judgment, a portfolio or
Sub-Account no longer suits the purposes of this Contract. This may happen due
to a change in laws or regulations, or a change in a portfolio's or
Sub-Account's investment objectives or restrictions, or because the portfolio or
Sub-Account is no longer available for investment, or for some other reason. We
will get prior approval from the insurance department of our state of domicile
before taking such action. If required, this approval process will be on file
with the insurance department of the jurisdiction in which this Contract is
delivered. We will also get any required approval from the SEC and any other
required approvals before taking such an action.

Subject to any required regulatory approvals, we reserve the right to transfer
assets of the Variable Sub-Accounts that we determine to be associated with the
class of contracts to which this Contract belongs, to another variable account
or variable sub-account.

When permitted by law, we reserve the right to:

        1.  Deregister the Variable Account under the Investment Company Act of
            1940;

        2.  Operate the Variable Account as a management company under the
            Investment Company Act of 1940, if it is operating as a unit
            investment trust; 

        3.  Operate the Variable Account as a unit investment trust under the
            Investment Company Act of 1940, if it is operating as a Managed
            Separate Account;

        4.  Restrict or eliminate any voting rights of Owners, or other persons
            who have voting rights as to the Variable Account; 

        5.  Combine the Variable Account with other separate investment
            accounts; and

        6.  Combine a Variable Sub-Account with another Variable Sub-Account.

If any actions we take result in a material change in the underlying investments
of a Variable Sub-Account in which you are invested, we will notify you of the
change. You may then choose a new Sub-Account.

ACCUMULATION UNITS - We keep track of the value of each of your Variable
Sub-Accounts by crediting you with Accumulation Units for each Sub-Account. The
number of Accumulation Units credited to you for each Sub-Account is determined
by dividing (a) by (b) where:

        (a) is the dollar amount allocated to that Sub-Account; and

        (b) is the value of the Accumulation Unit for that Sub-Account for the
            Valuation Date on which the purchase payment or transferred amount
            is invested in that Sub-Account.

Accumulation Units will be adjusted for any transfers and will be canceled on
payment of a death benefit, a withdrawal, a surrender, the application of
Account Value to an income plan on the Income Date, or assessment of charges
shown in the Schedule (other than the variable sub-account charges) based on
their value for the Valuation Period in which the transaction occurs.

                                                                          Page 6
<PAGE>   7

VALUE OF ACCUMULATION UNITS - The Accumulation Unit value for any Valuation
Period is determined by multiplying (a) by (b) where:

        (a) is the Accumulation Unit value for the immediately preceding
            Valuation Period; and

        (b) is the "net investment factor" for the Variable Sub-Account for the
            Valuation Period for which the value is being determined.

The value of an Accumulation Unit may increase, decrease or remain the same from
one Valuation Period to the next.

NET INVESTMENT FACTOR - The net investment factor for a Variable Sub-Account is
an index that measures the investment performance of that Sub-Account from one
Valuation Period to the next. The net investment factor for any Valuation Period
is determined by dividing (a) by (b), and then subtracting (c) where:

        (a) is the net result of:

            (i)   the Net Asset Value per share of the investment portfolio
                  share in which the Sub-Account invests determined at the end
                  of the current Valuation Period; plus

            (ii)  the per share amount of any dividend or capital gains
                  distribution made by that investment portfolio on shares held
                  in the Sub-Account if the "ex-dividend" date occurs during the
                  current Valuation Period; and plus or minus

            (iii) a per share charge or credit for any taxes reserved for, which
                  is determined by us to have resulted from the operations of
                  that Sub-Account;

        (b) is the Net Asset Value per share of the investment portfolio share
            in which the Sub-Account invests determined at the end of the
            immediately preceding Valuation Period; and

        (c) is the daily variable sub-account charges shown in the Schedule
            (adjusted for the number of days in the Valuation Period).

The net investment factor may be more or less than, or equal to, one.

INTEREST ACCOUNT
- --------------------------------------------------------------------------------
INTEREST ACCOUNT - The Interest Account is a separate investment account under
state insurance law. It is maintained separate from our General Account and
separate from any other separate investment account that we may have. We own the
assets in the Interest Account. Notwithstanding the foregoing, our obligations
under (and the values and benefits under) the Interest Account option of this
Contract do not vary as a function of the investment performance of the Interest
Account. Owners and Beneficiaries with rights under this Contract do not
participate in the investment gains or losses of the assets of the Interest
Account. Such gains or losses accrue solely to us. We retain the risk that the
value of the assets in the Interest Account may fall below the reserves and
other liabilities that we must maintain in connection with our obligations under
the Interest Account option of this Contract. In such event, we will transfer
assets from our General Account to the Interest Account to make up the
difference. The Interest Account will not be charged with liabilities that arise
from any other business that we conduct. We may transfer to our General Account
assets that exceed the reserves and other liabilities of the Interest Account.
The Interest Account is not required to be registered with the SEC as an
investment company under the Investment Company Act of 1940.

INTEREST SUB-ACCOUNT - We will establish a separate Interest Sub-Account for you
each time you allocate amounts to the Interest Account. Amounts invested in
these Interest Sub-Accounts earn interest at the Guaranteed Interest Rate in
effect on the date the amounts are allocated.

                                                                          Page 7
<PAGE>   8

GUARANTEE PERIODS - Each Interest Sub-Account is guaranteed an interest rate for
a period we refer to as a Guarantee Period. The Guaranteed Interest Rate for an
Interest Sub-Account is effective for the entire Guarantee Period. The length of
a Guarantee Period is measured from the end of the calendar month in which the
amount is allocated to the Interest Sub-Account. The last day of the Guarantee
Period is its Expiry Date. Withdrawals or transfers from all or part of an
Interest Sub-Account, and amounts applied to an income plan, made prior to the
Expiry Date of a Guarantee Period may be subject to a Market Value Adjustment.

We will notify you at least thirty days prior to an Expiry Date of your options
for renewal, which include:

        1.  electing a new Guarantee Period from among those then offered by us,
            but excluding any that extend beyond your Income Date; or

        2.  transferring the value of the Interest Sub-Account to one or more
            Variable Sub-Accounts.

If we do not receive Satisfactory Notice prior to the Expiry Date, we will
transfer the value of the expiring Interest Sub-Account to the Designated
Sub-Account shown in the Schedule.

GUARANTEED INTEREST RATES - Periodically, we will declare Guaranteed Interest
Rates for then available Guarantee Periods. These rates will be guaranteed for
the duration of the respective Guarantee Periods. Guaranteed Interest Rates will
never be less than the Minimum Guaranteed Interest Rate shown in the Schedule.

MARKET VALUE ADJUSTMENT - A Market Value Adjustment may be applied to
withdrawals, transfers or amounts applied to an income plan when taken from an
Interest Sub-Account prior to its Expiry Date. A Market Value Adjustment is
applied separately to each Interest Sub-Account.

A Market Value Adjustment is determined by multiplying the amount withdrawn,
transferred or applied to an income plan by the following factor:

                                             N/365
                          [(1+I)/(1+J+.0025)]      - 1

Where:

        -   I is the Index Rate for a maturity equal to the Interest 
            Sub-Account's Guarantee Period;

        -   J is the Index Rate for a maturity equal to the time remaining
            (rounded up to the next full year) in the Interest Sub-Account's
            Guarantee Period; and

        -   N is the remaining number of days in the Guarantee Period at the 
            time of calculation.

If there is no Index Rate for the maturity needed to calculate I or J, straight
line interpolation between the Index Rate of the next highest and next lowest
maturities will be used to determine that Index Rate. If the maturity is one
year or less, we will use the Index Rate for a one-year maturity.

Market Value Adjustments will be applied as follows:

        1.  The Market Value Adjustment will be applied to the amount withdrawn,
            transferred or applied to an income plan before deduction of any
            applicable surrender charge.

        2.  For a partial withdrawal or partial transfer, the Market Value
            Adjustment will be calculated on the total amount that must be
            withdrawn or transferred in order to provide the amount requested.

        3.  If the Market Value Adjustment is negative, it is deducted from any
            remaining value in the Interest Sub-Account. Any remaining Market
            Value Adjustment is deducted from the amount 


                                                                          Page 8
<PAGE>   9

            withdrawn, transferred or applied to an income plan.

        4.  If the Market Value Adjustment is positive, it is added to any
            remaining value in the Interest Sub-Account. In the case of
            surrender or full transfer, or if the full amount of the Interest
            Sub-Account is applied to an income plan, the Market Value
            Adjustment is added to the amount withdrawn, transferred or applied
            to an income plan.

TRANSFERS AMONG ACCOUNTS
- --------------------------------------------------------------------------------
Prior to the Income Date and while the Annuitant is living, you may transfer
Account Value among Sub-Accounts. Certain restrictions may apply during the Free
Look Period. To make a transfer, you must give us Satisfactory Notice. Transfers
generally take effect when we receive the notice. The number of free transfers
that we allow each Contract Year is shown in the Charges section of the
Schedule. Restrictions for transfers are shown in the Schedule. A transfer from
an Interest Sub-Account may be subject to a Market Value Adjustment.

WITHDRAWING ALL OR PART OF YOUR ACCOUNT VALUE
- --------------------------------------------------------------------------------
Prior to the Income Date and while the Annuitant is living, you may withdraw all
or part of your Account Value by giving us Satisfactory Notice. The minimum
withdrawal is shown in the Schedule. 

If you request a withdrawal of all of your Account Value, we will terminate this
Contract and pay you the Surrender Value. This amount may also be applied to the
income plans subject to any restrictions described in this Contract. Unless
specified otherwise, we will make partial withdrawals as described in the
Schedule. Withdrawals generally take effect on the date we receive Satisfactory
Notice.

If you make a withdrawal from this Contract in excess of the Free Withdrawal
Amount described in the Schedule, a surrender charge may be assessed. Surrender
charges are described in the Schedule. A withdrawal from the Interest Account
may also be subject to a Market Value Adjustment.

EXCESS WITHDRAWALS - If a withdrawal is made for an amount greater than the Free
Withdrawal Amount, a surrender charge may be applicable. For purposes of
calculating the surrender charge only, purchase payments will be liquidated in
whole or in part on a "first-in-first-out-basis." This means we liquidate
purchase payments in the order they were made: the oldest unliquidated purchase
payment first, the next oldest unliquidated purchase payment second, etc., until
all purchase payments have been liquidated.

The surrender charge as to any liquidated purchase payment is determined by
multiplying the amount of the purchase payment being liquidated by the
applicable percentage shown in the Schedule. The total surrender charge will be
the sum of the surrender charges for each purchase payment being liquidated.

In a partial withdrawal, the surrender charge is deducted from the Account Value
remaining after you are paid the amount requested. The amount requested from a
Sub-Account may not exceed the value of that Sub-Account less any applicable
surrender charge. In a complete withdrawal (or surrender of this Contract), it
is deducted from the amount otherwise payable.

CHARGES
- --------------------------------------------------------------------------------
The types and amounts of charges and when and how they are deducted are
described in the Schedule.

                                                                          Page 9
<PAGE>   10

OWNER, ANNUITANT AND BENEFICIARY
- --------------------------------------------------------------------------------
THE OWNER - You are the Owner of this Contract. You have the rights and options
described in this Contract, including but not limited to the right to receive
the income payments beginning on the Income Date. One or more people may own
this Contract.

THE ANNUITANT - Unless another Annuitant is shown in the Schedule, you are also
the Annuitant. You may name a Contingent Annuitant. You will be the Contingent
Annuitant unless you name someone else. If there are joint Owners, we will treat
the youngest Owner as the Contingent Annuitant, unless you elect otherwise.

If you are not the Annuitant and the Annuitant dies before the Income Date, the
Contingent Annuitant becomes the Annuitant. If the Annuitant dies and no
Contingent Annuitant has been named, we will allow you sixty days to designate
someone other than yourself as Annuitant.

THE BENEFICIARY - We pay the death benefit to the primary Beneficiary (unless
there are joint Owners in which case proceeds are payable to the surviving
Owner). If the primary Beneficiary dies before the Owner, the death benefit is
paid to the Contingent Beneficiary, if any. If there is no surviving
Beneficiary, we pay the death benefit to the Owner's estate. 

One or more persons may be named as primary Beneficiary or Contingent
Beneficiary. We will assume any death benefit is to be paid in equal shares to
the multiple surviving Beneficiaries unless you specify otherwise.

You have the right to change Beneficiaries. However, if you designate the
primary Beneficiary as irrevocable, you may need the consent of that irrevocable
Beneficiary to exercise the rights and options under this Contract.

CHANGE OF OWNER, BENEFICIARY OR ANNUITANT - During your lifetime and while this
Contract is in force you can transfer ownership of this Contract or change the
Beneficiary, or change the Annuitant. (However, the Annuitant cannot be changed
after the Income Date.) To make any of these changes, you must send us
Satisfactory Notice. If accepted, any change in Owner, Beneficiary or Annuitant
will take effect on the date you signed the notice. Any of these changes will
not affect any payment made or action taken by us before our acceptance. A
CHANGE OF OWNER MAY BE A TAXABLE EVENT and may also affect the amount of death
benefit payable under this Contract.

DEATH BENEFITS
- --------------------------------------------------------------------------------
DEATH BENEFIT BEFORE THE INCOME DATE - If any Owner dies before the Income Date,
we will pay the Beneficiary the greatest of the following:

        (a) the Account Value determined as of the day we receive proof of
            death; or

        (b) 100% of the sum of all purchase payments made to this Contract,
            reduced by any prior withdrawals (including any associated surrender
            charge and Market Value Adjustment incurred); or

        (c) the Highest Anniversary Value.

HIGHEST ANNIVERSARY VALUE - The Highest Anniversary Value is equal to the
greatest anniversary value attained from the following:

        Upon our receipt of proof of death, we will calculate an anniversary
        value for each Contract Anniversary before the Owner's death excluding,
        however, Contract Anniversaries that come after the Owner attains age
        80. An anniversary value is equal to the Account Value on this Contract


                                                                         Page 10
<PAGE>   11


        Anniversary, increased by the dollar amount of any purchase payments
        made since that Contract Anniversary and reduced for any withdrawals
        (including any associated surrender charge and Market Value Adjustment
        incurred) taken since that anniversary. This reduction will be made in
        proportion to the reduction in the Account Value that results from a
        withdrawal.

MULTIPLE OWNERS - If there are multiple Owners, the age of the oldest Owner will
be used to determine the death benefit.

DEATH BENEFIT WHEN NO NATURAL OWNERS - If there is no Owner who is a natural
person, we will treat the Annuitant as Owner for the purpose of paying the death
benefit, and the Annuitant's age will determine the death benefit payable to the
Beneficiary.

REQUIRED DISTRIBUTION OF PROCEEDS ON THE DEATH OF THE OWNER - The three
sub-sections indented below are required to qualify this Contract as an annuity
contract under Section 72(s) of the Internal Revenue Code of 1986, as amended.
Where the terms of these three sub-sections are in conflict with any other
sections or sub-sections of this Contract, these three sub-sections will
control. We reserve the right to amend or administer this Contract as necessary
to comply with the applicable tax requirements. These three sub-sections and
this Contract should be construed so that they comply with the applicable tax
requirements.

        DEATH BENEFIT OPTIONS BEFORE INCOME DATE - In the event any Owner dies
        before the Income Date, the death benefit may be taken in one sum, in
        which case this Contract will terminate. Such sum shall be paid within
        five years of the Owner's death unless one of the options for
        continuation of this Contract below is elected by the person entitled to
        make that election.

        CONTRACT CONTINUATION OPTION - If the death benefit is not taken in one
        sum immediately, this Contract will continue subject to the following
        provisions:

           1. If there are joint Owners, the surviving Owner becomes the new
              Owner. Otherwise, the Beneficiary becomes the new Owner.

           2. Unless specified otherwise, any excess of the death benefit over
              the Account Value will be allocated to and among the Variable and
              Interest Accounts in proportion to their values as of the date on
              which the death benefit is determined. We will establish a new
              Interest Sub-Account for any allocation to the Interest Account
              based on the Guarantee Period you then elect.

           3. No additional purchase payments may be applied to this Contract.

           4. If the new Owner is not the deceased Owner's spouse, the entire
              interest in this Contract must be distributed under one of the
              following options:

              a. The entire interest in this Contract must be distributed over 
                 the life of the new Owner, or over a period not extending 
                 beyond the life expectancy of the new Owner, with distributions
                 beginning within one year of the Owner's death; or

              b. The entire interest in this Contract must be distributed within
                 5 years of the Owner's death.

           5. If the new Owner is the deceased Owner's spouse, this Contract
              will continue with the surviving spouse as the new Owner. The
              surviving spouse may name a new Beneficiary. If no Beneficiary is
              so named, the surviving spouse's estate will be the Beneficiary.
              Upon the death of the surviving spouse, the death benefit will
              equal the Account Value as of the date we receive proof of the
              spouse's death, and the entire interest in this Contract must be
              distributed to the new Beneficiary in accordance with the
              provisions of 4 (a) or 4 (b) above.

           If there is more than one Beneficiary, the foregoing provisions will
           independently apply to each Beneficiary.

                                                                         Page 11
<PAGE>   12

           DEATH BENEFIT ON OR AFTER THE INCOME DATE - If any Owner dies on or
           after the Income Date but before the time the entire interest in this
           Contract has been distributed, the remaining portion will be
           distributed at least as rapidly as under the method of distribution
           being used as of the date of the Owner's death.

           If income payments have been selected based on an income plan
           providing for payments for a guaranteed period, and the Annuitant
           dies on or after the Income Date, we will make the remaining
           guaranteed payments to the Beneficiary. Any remaining payments will
           be made as rapidly as under the method of distribution being used as
           of the date of the Annuitant's death. If no Beneficiary is living, we
           will commute any unpaid guaranteed payments to a single sum (on the
           basis of the interest rate used in determining the payments) and pay
           that single sum to the estate of the last to die of the Annuitant or
           the Beneficiary.

PROOF OF DEATH - Proof of death must be received at our Customer  Service Center
before we will pay any death  benefit.  We will accept one of the following
items:

           1. An original certified copy of an official death Contract; or

           2. An original certified copy of a decree of a court of competent
              jurisdiction as to the finding of death; or

           3. Any other proof satisfactory to us.

GENERAL PROVISIONS
- --------------------------------------------------------------------------------
ENTIRE CONTRACT - This Contract including any attached riders, endorsements,
amendments and the application constitutes the entire contract between you and
us. All statements made by you, or any Owner, or any Annuitant will be deemed
representations and not warranties.

ASSIGNMENT - You may assign this Contract at any time prior to the Income Date.
No assignment will be binding on us unless we receive Satisfactory Notice. We
will not be liable for any payments made or actions we take before the
assignment is accepted by us. An absolute assignment will revoke the interest of
any revocable Beneficiary. We will not be responsible for the validity of any
assignment. AN ASSIGNMENT MAY BE A TAXABLE EVENT.

CLAIMS OF CREDITORS - To the extent permitted by law, no benefits payable under
this Contract will be subject to the claims of your, the Beneficiary's, or the
Annuitant's creditors.

MISSTATEMENT AND PROOF OF AGE, SEX OR SURVIVAL - We may require proof of age,
sex or survival of any person upon whose age, sex or survival any payments
depend. If the age or sex of the Annuitant has been misstated, or if the age of
the Owner has been misstated, the benefits will be those that the Account Value
applied would have provided for the correct age and sex. If we have made
incorrect income payments, the amount of any underpayment will be paid
immediately. The amount of any overpayment will be deducted from future income
payments.

NO DIVIDENDS PAYABLE - This Contract is non-participating and does not share in 
any distribution of our surplus.  We will not pay any dividends.

INCONTESTABILITY - This Contract is incontestable from its Contract Date.

REQUIRED REPORTS - We will furnish a report to you as often as required by law,
but at least once each Contract Year before the Income Date. The report will
show the number of Accumulation Units credited to each Variable Sub-Account in
which you are invested and the corresponding Accumulation Unit value as of the
date of the report. It will also show your Interest Account Value.

                                                                         Page 12
<PAGE>   13

MORTALITY AND EXPENSES - Our actual mortality and expense experience will not 
affect the amount of any income  payments or any other values under this
Contract.

TAXES BASED UPON PURCHASE PAYMENT OR VALUE - If there is a law or change in law
assessing taxes against us based upon purchase payments or value of this
Contract, we reserve the right to charge you and all similarly situated Owners
proportionately for that tax. This would include a tax based upon our realized
net capital gains in the Variable Sub-Accounts and on earnings in the Interest
Account, on which we are not currently taxed.

PAYMENTS WE MAY DEFER - We may not be able to determine the value of the assets
of the Variable Sub-Accounts because:

           1. The New York Stock Exchange is closed for trading; 
           2. The SEC determines that a state of emergency exists;
           3. An order or pronouncement of the SEC permits a delay for the
              protection of Owners; or
           4. The check used to pay the purchase payment has not cleared through
              the banking system. This may take up to 15 days.

If this happens, we may delay:

           1. Determination and payment of the Surrender Value;
           2. Determination and payment of any death benefit if death occurs
              before the Income Date;
           3. Transfers of the Account Value; or
           4. Application of the Account Value under an income plan.

We reserve the right to delay payment of amounts from the Interest Account for
up to six months. If deferred 30 days or more, the amount deferred will earn
interest at a rate not less than the Minimum Deferral Interest Rate shown in the
Interest Account section of the Schedule.

AUTHORITY TO MAKE AGREEMENTS - All agreements made by us must be signed by one
of our officers. No other person, including an insurance agent or broker, can
change the terms of this Contract or make any agreement binding on us.

REQUIRED NOTE ON OUR COMPUTATIONS - We have filed a detailed statement of our
computations with the insurance supervisory officials in the appropriate
jurisdictions. The values are not less than those required by the laws of those
states or jurisdictions. Any benefit provided by an attached rider will not
increase these values unless otherwise stated in that rider.

ANNUITY INCOME BENEFITS
- --------------------------------------------------------------------------------
CHOOSING AN INCOME DATE AND INCOME PLAN - On the Income Date, if the Annuitant
is alive and this Contract is in force, income payments will begin under the
income plan you have chosen. If you have not chosen an income plan, the option
shown in the Schedule will automatically apply. If you have not selected an
Income Date, the Maximum Income Date shown in the Schedule will automatically
apply.

You may choose or change an income plan or the Income Date by giving us  
Satisfactory  Notice at least 30 days before the Income Date.  However, any 
Income Date must meet the restrictions described in the Schedule.

Once income payments have begun, we reserve the right to disallow further
changes without our prior approval.

                                                                         Page 13
<PAGE>   14

MINIMUM AMOUNTS - If the amount available to apply under any variable or fixed
option is less than the minimum amount shown in the Schedule, we reserve the
right to pay such amount in a lump sum in lieu of the payment otherwise provided
for.

Income payments will be made monthly unless quarterly, semi-annual or annual
payments are chosen by giving us Satisfactory Notice at least 30 days before the
Income Date. However, if at any time the payment becomes less than the minimum
income payment shown in the Schedule, we reserve the right to reduce the
frequency of payment to an interval that results in each payment being at least
equal to the minimum income payment. In no event will the interval be less
frequent than annual.

ALLOCATION OF ANNUITY - At the time you elect the income plan, you may also
elect to have the Account Value applied to provide a Variable Income Annuity, a
Fixed Income Annuity, or a combination of both. Unless you specify otherwise, we
will provide either variable or fixed, or a combination of variable and fixed
income payments in proportion to the Sub-Accounts in which you are invested as
of a date not more than 5 Valuation Days before the due date of the first income
payment. If any applicable purchase payment taxes are then due us, we will also
deduct them proportionately.

VARIABLE INCOME ANNUITY

AMOUNT OF FIRST VARIABLE PAYMENT - The Income Tables shown in the Schedule are
used to determine the first monthly variable income payment for an assumed
investment rate of 3%. The Income Tables show the dollar amount of the first
monthly variable income payment that can be purchased with each $1,000 applied.
The assumed investment rates we currently allow are shown on the Schedule.

VALUE OF INCOME UNITS - The Income Unit value for any Valuation Period is
determined by multiplying (a) by (b), and then dividing by (c) where:

       (a) is the Income Unit value for the immediately preceding Valuation
           Period;

       (b) is the "net investment factor" for the Variable Sub-Account for the
           Valuation Period for which the value is being determined; and

       (c) is the daily equivalent of the assumed investment rate for the number
           of days in the Valuation Period.

The value of an Income Unit may increase, decrease or remain the same from one
Valuation Period to the next.

NUMBER OF INCOME UNITS - We determine the number of Income Units in each
Variable Sub-Account by dividing the first monthly variable income payment
attributable to that Sub-Account by its Income Unit value as of a date not more
than 5 Valuation Days before the due date of the first variable income payment.

AMOUNT OF SECOND AND SUBSEQUENT VARIABLE PAYMENTS - The dollar amount of the
second and subsequent variable income payments may change with the investment
performance of the Variable Sub-Accounts. The total amount of each variable
income payment will be equal to the sum of the variable income payments in each
Variable Sub-Account. The dollar amount of each payment for a Variable
Sub-Account is determined by multiplying the number of Income Units by the
Income Unit value for the Variable Sub-Account for the Valuation Period which
ends on a consistently applied date not more than 5 Valuation Days before the
payment is due.

We guarantee that the dollar amount of each payment after the first will not be
affected by variations in our expenses or mortality experience.

                                                                         Page 14
<PAGE>   15

EXCHANGE OF INCOME UNITS - After the Income Date, if there is an exchange of
value of a designated number of Income Units of particular Variable Sub-Accounts
into other Income Units, the value will be such that the dollar amount of income
payment made on the date of exchange would be unaffected by the exchange.

FIXED INCOME ANNUITY

A Fixed Income Annuity is an annuity with income payments that remain fixed as
to dollar amount throughout the payment period. The Income Tables shown in the
Schedule are used to determine the monthly fixed income payment. The Income
Tables show the dollar amount of the monthly fixed income payment that can be
purchased with each $1,000 applied.

INCOME PLANS

The following is a list of income plans we guarantee to make available.

INCOME PLAN 1. LIFE ANNUITY - An annuity payable during the lifetime of the
Annuitant and terminating with the last payment preceding the death of the
Annuitant.

INCOME PLAN 2. LIFE ANNUITY WITH 10 OR 20 YEARS CERTAIN - An annuity payable
during the lifetime of the Annuitant with the provision that payments will be
made for a minimum of 10 or 20 years, as elected.

INCOME PLAN 3. JOINT AND LAST SURVIVOR ANNUITY - An annuity payable during the
joint lifetime of the Annuitant and a designated second person, and thereafter
during the remaining lifetime of the survivor, ceasing with the last payment
prior to the death of the survivor.

INCOME PLAN 4. PAYMENTS FOR A SPECIFIED PERIOD CERTAIN - An amount payable for
the number of years selected which may be from 5 to 30 years.

INCOME PLAN 5. ANNUITY PLAN - An amount can be used to purchase any single 
premium annuity we offer on the Income Date for which you and the Annuitant are
eligible.


                                                                         Page 15
<PAGE>   16



























                       THIS PAGE INTENTIONALLY LEFT BLANK




                                                                         Page 16
<PAGE>   17






                                    SCHEDULE

                   Contract No.:  123456789

                          Owner:  JOHN DOE
                  Issue Age/Sex:  35/MALE              Contract Date:  1/1/1998

                      Annuitant:  JOHN DOE
                  Issue Age/Sex:  35/MALE                Income Date:  1/1/2038

               Initial Purchase                                     :
                        Payment:  $[10,000]

This Schedule sets forth additional information that relates to the provisions
in this Contract with the corresponding headings.

MAKING PURCHASE PAYMENTS
The Designated Sub-Account is the [Money Market Sub-Account].

No purchase payment, whether initial or additional, may be allocated such that
any Sub-Account would have a value less than $250.

Additional purchase payments are subject to the following limits:

       1.  [Non-qualified plan: Additional purchase payments may be made until
           the earlier of the year in which you attain age 85 or the year in
           which the Annuitant attains age 85.]

       2.  [Qualified plan: Additional purchase payments may be made until the
           year in which you attain age 70 1/2, except rollover contributions 
           may be made until the year in which you attain age 85.]

       3.  The minimum additional purchase payment we will accept is $250.

       4.  Our prior approval is required before you make a purchase payment
           that causes the Account Value of all annuities that you maintain with
           us to exceed $1,000,000.

VARIABLE ACCOUNT
The Variable Account for this Contract is [The Sage Variable Annuity Account A].
[It is a unit investment trust variable account.]

INTEREST ACCOUNT
The Interest Account for this Contract is [The Sage Fixed Interest Account A.]

The Minimum Guaranteed Interest Rate is 3%.

The Minimum Deferral Interest Rate is 3%.

The Designated Sub-Account is the [Money Market Sub-Account].  It is not part of
the Interest Account.

Index Rate: The Index Rate is the U.S. Treasury Constant Maturity Series as
reported in Federal Reserve Bulletin Release H.15. We currently base the Index
Rate for a calendar week on the reported rate for the preceding calendar week.
We reserve the right to set it less frequently but in no event less often than
monthly.


                                                                         Page 17
<PAGE>   18


TRANSFERS AMONG ACCOUNTS
The minimum amount that can be transferred is $250. However, if less remains in
a Sub-Account, that amount may be transferred. If a transfer request would
reduce the Account Value remaining in a Sub-Account below $250, we will treat
the transfer request as a request to transfer the entire amount.

Your transfer request must clearly state the Sub-Accounts from which and to
which transfers are to be made.

We reserve the right to limit, upon notice, the maximum number of transfers you
may make to one per calendar month or 12 per Contract Year.

After the Income Date, we reserve the right to:

       1.  disallow transfers from the Interest Account to the Variable Account,
           or from the Variable Account to the Interest Account; and

       2.  limit the maximum number of transfers between Variable Sub-Accounts
           to 1 per Contract Year.

WITHDRAWING ALL OR PART OF YOUR ACCOUNT VALUE 
The Free Withdrawal Amount is the greater of (a) and (b) where:

       (a) is the excess of 10% of the total purchase payments over 100% of all
           prior withdrawals in that Contract Year; and

       (b) is the excess of the Account Value on the date of withdrawal over the
           unliquidated purchase payments.

The minimum amount that can be withdrawn is $250. If a withdrawal request 
would reduce the Account Value remaining in a Sub-Account below $250, we will
treat the withdrawal request as a request to withdraw the entire amount.

If a requested withdrawal would reduce the Account Value below $2,000, we 
reserve the right to treat the request as a withdrawal of only the excess over
$2,000.

Unless you specify otherwise, we will make withdrawals proportionately from all
Sub-Accounts in which you are invested.


                                                                         Page 18
<PAGE>   19




CHARGES
SURRENDER CHARGE - A surrender charge may be imposed upon surrender of this
Contract or when an Excess Withdrawal is made. A Market Value Adjustment, if
any, is applied before calculating the surrender charge. The surrender charge is
applied to each purchase payment and is a percentage of each purchase payment as
follows:

    The maximum surrender charge percentage is 0% for all Certificate Years.

TRANSFER CHARGE - We reserve the right to charge a maximum of $25 for each
transfer after the 12th in a Contract Year. Each request is considered to be one
transfer regardless of the number of Sub-Accounts affected by the transfer. The
transfer charge will be deducted proportionately from all Sub-Accounts from
which the transfer is made.

ADMINISTRATION CHARGE - $40 a year. This charge is incurred at the beginning of
each Contract Year and deducted on each Contract Anniversary or upon surrender.
The charge will be waived:

       1.  if the Account Value is at least $50,000 at the time of deduction; or

       2.  beginning on and after the 8th Contract Anniversary.

PURCHASE PAYMENT TAX CHARGE - The amount of any state and local taxes levied by
any governmental entity on purchase payments may be deducted from the Account
Value when such taxes are incurred. We reserve the right to defer the collection
of this charge and deduct it against your Account Value on the surrender of this
Contract, or Excess Withdrawal, or application of the Account Value to provide
income payments.

ASSET-BASED CHARGES - We deduct asset-based charges to compensate us for
assuming mortality and expense risks, and certain administrative expenses. Prior
to the Income Date asset-based charges are calculated as a percentage of the
Variable Account Value on the date of deduction. On this Contract Date, and
monthly thereafter, the asset-based charges are deducted in proportion to the
Variable Sub-Accounts in which you are invested. The maximum charges are:

<TABLE>
<CAPTION>
           Asset-Based Charges      Annual Charge         Monthly Charge
           -------------------      -------------         --------------
<S>                                    <C>                 <C>     
            Contract Years 1-7           1.40%               .116667%
            Contract Years 8+            1.25%               .104167%
</TABLE>

We also deduct asset-based charges on the effective date of any transfer from
the Interest Account, or allocation of purchase payment to the Variable Account,
based on the amount transferred or allocated, and based on the number of days
remaining until the next date of deduction.

VARIABLE SUB-ACCOUNT CHARGES - On and after the Income Date we deduct the
asset-based charges above from the assets in each Variable Sub-Account on a
daily basis. The maximum charges are:

<TABLE>
<CAPTION>
            Variable Sub-Account Charges    Annual Charge     Daily Charge
            ----------------------------    -------------     ------------
<S>                                           <C>            <C>      
            Contract Years 1-7                  1.40%          .0038626%
            Contract Years 8+                   1.25%          .0034462%
</TABLE>

CHARGE DEDUCTION RULES - Unless otherwise specified above, charges are deducted
from the Account Value proportionately from all Sub-Accounts in which you are
invested.

                                                                         Page 19
<PAGE>   20

ANNUITY INCOME BENEFITS

If you have not chosen an income plan, Life Annuity with 10 Years Certain will
automatically apply.

The Maximum Income Date is the first day of the first calendar month following
the Annuitant's 95th birthday.

We reserve the right to require that the Income Date be at least 2 years after
this Contract Date.

The minimum amount that can be applied under any Variable or Fixed Income
Annuity is $5,000.

The minimum income payment is $100.

We currently allow assumed investment rates of 3% and 5%. If you do not specify 
one of these rates when you choose an income plan, the assumed investment rate 
will be 3%.

Values for other ages, and for other payment periods, joint life combinations,
or assumed investment rates that we offer (Tables below assume 3%) are available
on request. Monthly income payments are shown for each $1,000 applied.


                                                                         Page 20
<PAGE>   21




                         INCOME TABLE FOR A FIXED PERIOD


<TABLE>
<CAPTION>
                            Monthly                         Monthly                      Monthly
      Fixed Period          Income       Fixed Period       Income       Fixed Period    Income
        of Years            Payment        of Years         Payment        of Years      Payment
        --------            -------        --------         -------        --------      -------
<S>                        <C>             <C>             <C>             <C>           <C> 
                            $                11             $8.88            21           $5.33
                                             12              8.26            22            5.16
                                             13              7.73            23            5.00
                                             14              7.28            24            4.85
            5                17.95           15              6.89            25            4.72
            6                15.18           16              6.54            26            4.60
            7                13.20           17              6.24            27            4.49
            8                11.71           18              5.98            28            4.38
            9                10.56           19              5.74            29            4.28
           10                 9.64           20              5.53            30            4.19
</TABLE>



                              INCOME TABLE FOR LIFE
<TABLE>
<CAPTION>
                   Male/Female            Male/Female          Male/Female
        Age         Life Only          10 Years Certain     20 Years Certain
        ---         ---------          ----------------     ----------------

<S>               <C>                  <C>                  <C>      
         50        $4.28 / 3.92         $4.24 / 3.90        $4.10 / 3.84
         55         4.72 / 4.27          4.64 / 4.24         4.40 / 4.12
         60         5.31 / 4.74          5.17 / 4.68         4.73 / 4.45
         65         6.13 / 5.38          5.84 / 5.25         5.04 / 4.81
         70         7.28 / 6.29          6.65 / 6.00         5.29 / 5.14
         75         8.90 / 7.62          7.53 / 6.92         5.43 / 5.37
         80        11.19 / 9.62          8.37 / 7.93         5.50 / 5.48
         85       14.36 / 12.63          9.00 / 8.77         5.52 / 5.52
</TABLE>


RIDERS 
Accidental Death Benefit Rider 
       The Maximum Accidental Death Benefit is $250,000.


                                                                         Page 21
<PAGE>   22





        [LOGO]      SAGE LIFE ASSURANCE OF AMERICA, INC. 
         Member of Sage Insurance Group









               FLEXIBLE PAYMENT DEFERRED VARIABLE ANNUITY CONTRACT
       Surrender Values while you are living and prior to the Income Date.
                    Income Payments begin on the Income Date
                                Nonparticipating

<PAGE>   1
                                                                 EXHIBIT (5)(ii)
Sage Life Assurance                                             APPLICATION FOR
of America, Inc.                          DEFERRED VARIABLE ANNUITY CERTIFICATE
Member of Sage Insurance Group   Mail to: Sage Life Assurance of America, Inc.,
                                   [P.O. Box 1234, Wethersfield, CT 06109-1234]

- -------------------------------------------------------------------------------
                         1.  PRIMARY OWNER                                     
- -------------------------------------------------------------------------------
 First                       Middle                            Last

- -------------------------------------------------------------------------------
 Street Address

- -------------------------------------------------------------------------------
 City                        State                             Zip

- -------------------------------------------------------------------------------
 Birthdate (Mo/Day/Yr)     [ ] M      [ ] F   [ ] SS#      [ ] TIN#
                           [ ] Trustee

- -------------------------------------------------------------------------------
 Phone                            E-Mail Address

- -------------------------------------------------------------------------------
                    2.  ANNUITANT (SKIP IF SAME AS OWNER)                      
- -------------------------------------------------------------------------------
 First                       Middle                            Last

- -------------------------------------------------------------------------------
 Street Address

- -------------------------------------------------------------------------------
 City                        State                             Zip

- -------------------------------------------------------------------------------
 Birthdate (Mo/Day/Yr)     [ ] M      [ ] F   [ ] SS#

- -------------------------------------------------------------------------------
 Phone                                Relationship to Primary Owner            

- -------------------------------------------------------------------------------
                     2.A.  CONTINGENT ANNUITANT (OPTIONAL)                     
- -------------------------------------------------------------------------------
  Name                                Relationship to Owner                    

- -------------------------------------------------------------------------------
                         3.  JOINT OWNER (SKIP IF NONE)                        
- -------------------------------------------------------------------------------
 First                       Middle                            Last

- -------------------------------------------------------------------------------
 Street Address

- -------------------------------------------------------------------------------
 City                        State                             Zip

- -------------------------------------------------------------------------------
 Birthdate (Mo/Day/Yr)     [ ] M      [ ] F   [ ] SS#

- -------------------------------------------------------------------------------
 Phone                                Relationship to Primary Owner            

- -------------------------------------------------------------------------------
                                4.  BENEFICIARY                                
- -------------------------------------------------------------------------------
 Primary: Name(s)            Relationship to Owner               Percentage

- -------------------------------------------------------------------------------
 Street Address

- -------------------------------------------------------------------------------
 City                        State                                      Zip

- -------------------------------------------------------------------------------
 Contingent: Name(s)         Relationship to Owner               Percentage

- -------------------------------------------------------------------------------
 Street Address

- -------------------------------------------------------------------------------
 City                        State                       Zip

- -------------------------------------------------------------------------------
                                5.  TYPE OF PLAN                               
- -------------------------------------------------------------------------------

 5a.   [ ] Non-Qualified     [ ]  IRA       [ ]  Other
                                                      --------------
 15b.  If IRA: [ ] Regular   Tax Year            Amount $ 
                                      ------              ----------
                             Tax Year            Amount $ 
                                      ------              ----------
               [ ] Rollover                      Amount $ 
                                                          ----------
               [ ] Trustee to Trustee Transfer   Amount $ 
                                                          ----------
 5c.  Payment Via:  [ ] Check  [ ] Wire [ ] 1035 [ ] Qualified Transfer

 5d.  Optional Riders 
                      ----------------------------------------
- -------------------------------------------------------------------------------
                       6.  ALLOCATION (COMPLETE 6a OR 6b)                      
- -------------------------------------------------------------------------------
Initial purchase payment $ 
                           ----------------
6a.   [ ]  Allocate my purchase payment based on one of the following
           Asset Allocation model portfolios (check box and skip to
           6c.):
           [[ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7  [ ] 8 [ ] 9]
6b.   [ ]  Allocate my purchase payment as follows:

                        VARIABLE SUB-ACCOUNTS
                        ---------------------

       ALGER
       -----
       % Income & Growth
- -------
       % Growth
- -------
       % Small Cap
- -------

                         FIXED SUB-ACCOUNTS
                         ------------------
       % 1 year                       % 5 year
- -------                        -------
       % 2 year                       % 7 year
- -------                        -------
       % 3 year                       % 10 year
- -------                        -------
       % 4 year
- -------

- -------------------------------------------------------------------------------
6c.   [ ] [Optional] Dollar Cost Averaging (DCA %):  _______% (also
          complete 7.).  The sum of the Variable and Fixed Sub-Accounts, and
          DCA% allocations must equal 100%.                                    
- -------------------------------------------------------------------------------
6d.   [ ] [Optional] Rebalance my Variable Sub-Account values each calendar
          quarter based on 6a. or 6b.

- -------------------------------------------------------------------------------
                   7.  DOLLAR COST AVERAGING (% FROM 6c)                       
- -------------------------------------------------------------------------------
Transfer From: Check the box (onlyone) that you want us to allocate the
DCA% you designated in 6c.

No. of Months: We will make level monthly transfers for the number of
months shown.  Unless specified otherwise, such transfers from the Sage Money
Market will be made over a 12-month period.

Transfer To: Unless specified other wise, monthly transfers will be
made in the same % and to the same Sub-Accounts as shown in 6b.

      Transfer From          No. of Months     Transfer To
     ---------------         -------------     -----------
[ ]  Sage Money Market                              %
                              --------       ------- --------
[ ]  Fixed - 1 Year              12                 %
                                             ------- --------
[ ]  Fixed - 2 Year              24                 %
                                             ------- --------
[ ]  Fixed - 3 Year              36                 %
                                             ------- --------
[ ]  Fixed - 4 Year              48                 %
                                             ------- --------
[ ]  Fixed - 5 Year              60                 %
                                             ------- --------

- -------------------------------------------------------------------------------
AP-DVAZ-C-9712  Sage Group Contract No.           Sage Certificate No. 
                                        ---------                     ---------


<PAGE>   2

- -------------------------------------------------------------------------------
                    8.  AUTHORITY FOR TELEPHONE INSTRUCTIONS
- -------------------------------------------------------------------------------
 Telephone transfer instructions permitted:       [ ] Yes    [ ] No
 The person authorized to make transfers and allocation changes by telephone on
 my behalf is:

 -----------------------------------------------------------------------------
 Name

 This limited authority applies only to the allocation of funds to the
 Sub-Accounts and the transfer of funds between Sub-Accounts within the
 Certificate and is valid until cancelled in writing by me.                    
- -------------------------------------------------------------------------------
                            9.  REPLACEMENT
- -------------------------------------------------------------------------------
 Will the annuity applied for replace any existing annuity or insurance policy?

             [ ]Yes           [ ]No

 If yes, provide insurance company name and policy number and attach transfer
 or exchange form.                                                             
- -------------------------------------------------------------------------------
                             10.  SPECIAL REQUESTS
- -------------------------------------------------------------------------------

- -------------------------------------------------------------------------------

- -------------------------------------------------------------------------------

- -------------------------------------------------------------------------------
                                11.  CORRECTIONS
- -------------------------------------------------------------------------------
 COMPANY CORRECTIONS OR ADDITIONS, IF ANY
 (Except in Kentucky and West Virginia)                                        
- -------------------------------------------------------------------------------

- -------------------------------------------------------------------------------

- -------------------------------------------------------------------------------

- -------------------------------------------------------------------------------
                                 12.  AGREEMENT                                
- -------------------------------------------------------------------------------
 I agree that, except in Kentucky and West Virginia, my acceptance of the
 annuity applied for will constitute approval  by me of any corrections or
 additions made in item #11 above.   However, I must agree in writing to any
 changes  in: amounts; ages; plan of  annuity; and benefits.  Telephone
 transfers are  subject to the conditions and procedures  in the prospectus.  I
 UNDERSTAND THAT INCOME PAYMENTS AND SURRENDER VALUES, WHEN  BASED UPON THE
 INVESTMENT EXPERIENCE OF  A VARIABLE ACCOUNT, ARE VARIABLE  AND ARE NOT
 GUARANTEED AS  TO FIXED DOLLAR AMOUNT.  I ACKNOWLEDGE RECEIVING AND READING A
 CURRENT VARIABLE ANNUITY PROSPECTUS AND I ACKNOWLEDGE READING THE DESCRIPTIONS
 RELATING TO ALLOCATION ITEMS #6 AND #7 ABOVE.                                 
- -------------------------------------------------------------------------------
 Date                     City                State (REQUIRED)

- -------------------------------------------------------------------------------
 Signature of Owner (REQUIRED)

- -------------------------------------------------------------------------------
 Signature of Joint Owner

- -------------------------------------------------------------------------------
 Signature of Annuitant

- -------------------------------------------------------------------------------
 ARIZONA Notice to Applicants: Upon written request, Sage Life Assurance of
 America, Inc. ("Sage Life") will provide within a reasonable time frame,
 reasonable factual information about the annuity's benefits and provisions. If
 for any reason the owner is not satisfied with the annuity, it may be returned
 to Sage Life within 10 days after delivery and the certificate value will be
 refunded.
 COLORADO NOTICE TO APPLICANTS: IT IS UNLAWFUL TO KNOWINGLY PROVIDE FALSE,
 INCOMPLETE, OR MISLEADING FACTS OR INFORMATION TO AN INSURANCE COMPANY FOR THE
 PURPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD THE COMPANY.  PENALTIES MAY
 INCLUDE IMPRISONMENT, FINES, DENIAL OF INSURANCE, AND CIVIL DAMAGE. ANY
 INSURANCE COMPANY OR AGENT OF AN INSURANCE COMPANY WHO KNOWINGLY PROVIDES
 FALSE, INCOMPLETE, OR MISLEADING FACTS OR INFORMATION TO A POLICYHOLDER OR
 CLAIMANT FOR THE PURPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD THE
 POLICYHOLDER OR CLAIMANT WITH REGARD TO A SETTLEMENT OR AWARD PAYABLE FROM
 INSURANCE PROCEEDS SHALL BE REPORTED TO THE COLORADO DIVISION OF INSURANCE
 WITH THE DEPARTMENT OF REGULATORY AGENCIES.
 KENTUCKY, NEW JERSEY, OHIO, PENNSYLVANIA Notice to Applicants: Any person who
 knowingly and with intent to defraud any insurance company or other person
 files an application for insurance or statement of claim containing any
 materially false information or conceals for the purpose of misleading,
 information concerning any fact material thereto commits a fraudulent
 insurance act, which is a crime and subjects such person to criminal and civil
 penalties.
 FLORIDA Notice to Applicants: Any person who knowingly, and with intent to
 injure, defraud, or deceive any insurer files a statement of claim or an
 application containing any false, incomplete, or misleading information is
 guilty of a felony of the third degree.                                       
- -------------------------------------------------------------------------------
                              13.  AGENT'S REPORT                              
- -------------------------------------------------------------------------------
 Do you have any reason to believe that the annuity applied for may replace an
 existing annuity or insurance policy?

                   [ ] Yes           [ ] No

 If yes, list carrier, policy number, whether Section 1035 exchange, and attach
 State Replacement Form if applicable.

- -------------------------------------------------------------------------------

- -------------------------------------------------------------------------------
 Agent's Legal Name (PRINTED)

- -------------------------------------------------------------------------------
 Business Address

- -------------------------------------------------------------------------------
 Agent's Business Phone                    E-Mail Address

- -------------------------------------------------------------------------------
 Agent's Social Security No.

- -------------------------------------------------------------------------------
 Agency Name                               Broker-Dealer

- -------------------------------------------------------------------------------
 Signature of Agent

- -------------------------------------------------------------------------------





- -------------------------------------------------------------------------------







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