<PAGE>
SPECIFICATIONS
<TABLE>
<S> <C> <C> <C>
Certificate Type: Non-Qualified Certificate Number: zz00000000
Issue Date: 01/01/2000 Annuity Date: 01/01/2025
(Must be at least 1year after the
issue date)
Owner: John Doe Owner Date of Birth: 01/01/1960
Joint Owner: Jack Doe Joint Owner Date of Birth: 01/01/1960
Annuitant: Mary Doe Annuitant Date of Birth: 01/01/1950
Joint Annuitant: Michael Doe Joint Annuitant Date of Birth: 01/01/1950
Beneficiary(ies):
Primary: Surviving Joint Owner, if any
1st Contingent: Michael Doe
2nd Contingent: Mary Doe
Payment Credit Percentage: 5% of each Payment
Minimum Fixed Account Minimum Additional Payment
Guaranteed Interest Rate: 3% Amount: $50.00
Minimum Withdrawal Minimum Annuity Benefit Payment: $20.00
Amount: $100.00
</TABLE>
Surrender Charge Table:
<TABLE>
Years From Surrender Charge as a
Date of Payment Percent of the Payments
To Date of Withdrawal Withdrawn
----------------------------------------------------------
<S> <C> <C>
Less Than: 1 8 1/2%
2 8 1/2%
3 8 1/2%
4 8 1/2%
5 7 1/2%
6 6 1/2%
7 5 1/2%
8 3 1/2%
9 1 1/2%
Thereafter 0%
</TABLE>
Withdrawal Without Surrender Charge Percentage: 15%
Mortality and Expense Risk Charge: 1.25% on an annual basis of the daily
value of the Sub-Account assets.
Administrative Charge: .15% on an annual basis of the daily value of the
Sub-Account assets.
Certificate Fee: $30, if the Accumulated Value is less than $75,000.00.
Waived for 401(k)s.
Present Value Withdrawal Amount: 100% of Present Value of remaining
guaranteed annuity benefit payment if the Payments Guaranteed for a Specified
Number of Years annuity option is selected.
Principal Office: 440 Lincoln Street, Worcester, Massachusetts 01653
[1-800-782-8380]
<PAGE>
SPECIFICATIONS (CONTINUED)
<TABLE>
<S> <C> <C> <C>
Owner: John Doe Certificate Number: zz00000000
Joint Owner: Jack Doe
Initial Payment: $25,000
Payment Allocation: (The Initial Payment is allocated in the following manner:)
</TABLE>
Variable Sub-accounts:
---------------------
<TABLE>
<S> <C>
[Pioneer Emerging Markets VCT AIM VI Capital Appreciation
Pioneer Europe VCT AIM VI Aggressive Growth
Pioneer International Growth VCT
Pioneer Science & Technology VCT Alliance Premier Growth
Pioneer Mid-Cap Value VCT Alliance Technology
Pioneer Growth Shares VCT
Pioneer Real Estate Growth VCT DGPF Growth Opportunities
Pioneer Fund VCT DGPF Select Growth
Pioneer Equity-Income VCT
Pioneer Balanced VCT Franklin Small Cap
Pioneer Swiss Franc Bond VCT Templeton Asset Strategy
Pioneer High Yield VCT Templeton International Small Companies
Pioneer Strategic Income VCT
Pioneer America Income VCT Van Kampen LIT Emerging Growth]
Pioneer Small Company VCT
Fixed Account:
--------------
Initial Interest Rate (applies only to Initial Payment) [5.5%]
100% TOTAL OF ALL ACCOUNTS
</TABLE>
<PAGE>
SPECIFICATIONS (CONTINUED)
<TABLE>
<S> <C> <C> <C>
Owner: John Doe Certificate Number: zz00000000
Joint Owner: Jack Doe
RIDER(S) SELECTED:
[Enhanced Death Benefit Rider:
EDB Charge: .15% on an annual basis of the
Accumulated Value of the
Certificate deducted Pro Rata on
the last day of each month. A
prorated charge will be deducted
upon termination.]
</TABLE>
<PAGE>
SPECIFICATIONS (SUPPLEMENT)
<TABLE>
<CAPTION>
<S> <C> <C> <C>
Certificate Type: Non-qualified Certificate Number: zz00000000
Owner: John Doe Owner Date of Birth: 01/01/1960
Joint Owner: Jack Doe Joint Owner Date of Birth: 01/01/1960
Annuitant: Mary Doe Annuitant Date of Birth: 01/01/1950
Joint Annuitant: Michael Doe Joint Annuitant Date of Birth: 01/01/1950
Beneficiary(ies):
Primary: Surviving Joint Owner, if any
1st Contingent: Michael Doe
2nd Contingent: Mary Doe
Payee: John Doe and Jack Doe
Payee Address: 1 Main Street, Anywhere, USA 00000
Annuity Date: 01/01/2025
Expiration of 90-Day Period: 04/01/2025
Annuity Benefit Payment Option: Joint with 2/3 Survivor Option
Survivor Annuity Benefit Percentage: 66 2/3%
Percentage under a Fixed Annuity Option: 30%
Percentage under a Variable Annuity Option: 70%
Assumed Investment Return: [3%, 5%]
Annuity Benefit Payment Change Frequency: Annual
Annuity Benefit Payment Frequency: Monthly
Variable Allocation on Annuity Date:
</TABLE>
<TABLE>
<CAPTION>
SUB-ACCOUNTS:
------------
<S> <C>
[Pioneer Emerging Markets VCT AIM VI Capital Appreciation
Pioneer Europe VCT AIM VI Aggressive Growth
Pioneer International Growth VCT
Pioneer Science & Technology VCT Alliance Premier Growth
Pioneer Mid-Cap Value VCT Alliance Technology
Pioneer Growth Shares VCT
Pioneer Real Estate Growth VCT DGPF Growth Opportunities
Pioneer Fund VCT DGPF Select Growth
Pioneer Equity-Income VCT
Pioneer Balanced VCT Franklin Small Cap
Pioneer Swiss Franc Bond VCT Templeton Asset Strategy
Pioneer High Yield VCT Templeton International Small Companies
Pioneer Strategic Income VCT
Pioneer America Income VCT Van Kampen LIT Emerging Growth]
Pioneer Small Company VCT
</TABLE>
<PAGE>
SPECIFICATIONS (SUPPLEMENT)
<TABLE>
<S> <C>
Present Value Withdrawal Amount: 100% of Present Value of remaining guaranteed annuity benefit payments if
the Payments Guaranteed for a Specified Number of Years annuity option is selected.
Mortality and Expense Risk Charge: 1.25% on an annual basis of the daily value of the Sub-Account assets.
Administrative Charge: .15% on an annual basis of the daily value of the Sub-Account assets.
Principal Office: 440 Lincoln Street, Worcester, Massachusetts 01653 (1-800-782-8380)
</TABLE>
