EASY SYSTEMATIC PAYMENT (ESP) PROGRAM ELECTION AGREEMENT FOR REQUIRED MINIMUM DISTRIBUTIONS (RMD) (for Qualified Annuity Contracts Over Age 70½ Only)

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1 Member Companies: Great American Life Insurance Company Administrator for Loyal American Life Insurance Company Annuity Investors Life Insurance Company Administrator for United Teacher Associates Insurance Company Fixed Annuities: PO Box 5420, Cincinnati OH / / Fax Variable Annuities: PO Box 5423, Cincinnati OH / / Fax Overnight Address: 10 th Floor, 301 E Fourth St, Cincinnati OH EASY SYSTEMATIC PAYMENT (ESP) PROGRAM ELECTION AGREEMENT FOR REQUIRED MINIMUM DISTRIBUTIONS (RMD) (for Qualified Annuity Contracts Over Age 70½ Only) INSTRUCTIONS THE ESP RMD Program is not available in the contract s first calendar year because the contract must have a 12/31 balance. It is only offered on certain annuity contracts - please consult your agent or our Home Office for availability. Please fully complete all applicable sections. Incomplete or unclear requests may result in processing delays. Please be advised that after reviewing your request, additional paperwork may be required. SECTION I. OWNER Owner: Contract #: Today s Date: Address: Date of Birth: City/State/Zip: S.S. #: Daytime Phone #: ( ) SECTION II. EASY SYSTEMATIC PAYMENT PROGRAM OPTION ELECTION RMD systematic payments may be used to help meet the RMD for this Qualified annuity contract. The payments calculated under these options take into account only this single Qualified contract and will not make the minimum distribution required for any other Qualified annuity contract, account, or plan. Except as elected below, your RMD will be calculated based on the Recalculation Option using the uniform joint lifetime table, as described in Section II of the Easy Systematic Payment Program Terms and Conditions for Required Minimum Distributions. Check here to elect the 403(b) TSA Minimum Recalculation Option, if available (only available to original owner of 403(b) TSA contracts between ages 70½ - 75 where we have record of a remaining 12/31/86 balance). Check here if you meet BOTH of the following requirements and you want to have your RMD payments based on the joint life factor determined using your spouse s actual age: You have designated your spouse as the SOLE primary beneficiary under your contract AND Your spouse is more than 10 years younger than you. Name of Spouse: Date of Birth: SS#: SECTION III. PAYMENT FREQUENCY Annual mode is required unless payment is made by EFT/Direct Deposit. Annual mode is required for contracts with the Legacy Income Option. Select permitted payment frequency : Monthly Quarterly Semi-Annual Annual If a payment frequency is not elected, payments will be made on an ANNUAL basis. EFT cannot be initiated without complete financial account information see section V of this form. If you select monthly, quarterly, and semi-annual payments, but EFT financial account information is not provided or if an EFT payment is rejected at any time, future payments will be made annually to the owner at the owner s address of record.

2 SECTION IV. PAYMENT START DATE AND APPLICATION OF REQUIRED MINIMUM DISTRIBUTION RULES RMD payments will be processed in the year the request is received provided all requirements are met and the election agreement form is properly completed. Allow at least 15 days from the date submitted for processing. If you would like to begin your payments as of a particular date, please specify / /. If no date is specified, payments from variable annuity contracts will be made on the last valuation date of the selected frequency. For contracts with the Legacy Income Option, the payment must be scheduled after the contract anniversary date. For IRA qualified contracts, the IRS generally mandates that you take a RMD for the year you reach 70 ½ and each year thereafter. For 403(b) TSAs, 401 Pension/Profit Sharing plans, and 457 plans, the IRS generally mandates that you take a RMD for the year you reach 70 ½ or the year in which you retire, whichever is later, and each year thereafter. RMDs must be taken by 12/31 of each year, except for the initial RMD, which can be deferred to April 1 st of the following year. As always, please consult your tax advisor before making any decisions about your retirement. Please check one of the following options: Please start payments with the current year. Please include my last year s RMD with my first payment along with the amount for this year. You may wish to check this option if you were 70 ½ or older last year and did not take a RMD. This option is not available for contracts with the Legacy Income Option. SECTION V. PAYMENT INFORMATION Payments to the Owner at the address above. Payments are to be sent directly by Electronic Funds Transfer (EFT) to my financial institution account listed below. I also authorize the appropriate GAIG company and the financial institution indicated below to adjust any over-deposit made to my account. I understand that prior to the initial EFT of my payment, the scheduled payment may be sent via regular mail. Please fully complete the information below AND attach a voided check, account statement copy, or a letter from your financial institution providing owner(s) name(s), routing number and account number. Make payment to my: Checking Account Savings Account Financial Institution Name: List Names of ALL Owners on the Financial Institution Account: Financial Institution Address: City/State/Zip: Financial Institution Routing Number: Financial Institution Phone #: ( ) Financial Institution Account Number: IMPORTANT NOTES: EFTs may only be made to a standard bank or savings & loan account. EFTs may not be made to an IRA or other tax-qualified account or to an insurance company. An EFT transaction normally takes 2-3 business days for the funds to be credited to your financial institution account. For requests signed by a Power of Attorney, EFTs can only be made to an account where the person who gave the POA is a named owner of the account. SECTION VI. INCOME TAX WITHHOLDING If a withholding preference is not indicated, 10% will be withheld for federal income tax. State income tax withholding may also apply. Even if federal and state income taxes are not withheld, you are liable for payment of federal and/or state income tax on the taxable portion of the distribution. You may also be subject to penalties under the estimated tax payment rules if your withholding and estimated tax payments, if any, are not adequate. Do NOT withhold federal income tax. Withhold federal income tax. To have MORE than 10% federal withholding, specify TOTAL percentage: %. Any withholding election will remain in effect until revoked. You may revoke any withholding election for any payments not yet distributed by notifying the appropriate GAIG company in writing at any time. Page 2 of 4

3 SECTION VII. OWNER ACKNOWLEDGMENT AND SIGNATURE AUTHORIZATION I UNDERSTAND THE FOLLOWING CONDITIONS: 1. Effect of Other Withdrawals: Systematic payments for Required Minimum Distributions will be reduced by any withdrawals taken from the annuity contract during the same calendar year. The sum of the systematic payments should satisfy the Required Minimum Distribution for this annuity contract for the current year IF no withdrawals from the annuity contract were direct transferred or rolled over to another qualified policy. If any such direct transfers or rollovers occurred, then the systematic payments will be insufficient to satisfy the Required Minimum Distribution for this annuity contract. 2. Special Rules for Younger Spouse Beneficiary: If you have elected to base your RMD on the joint life factor using the actual age of your spouse primary beneficiary who is more than 10 years younger than you, then you are responsible for notifying the appropriate GAIG Company promptly of any divorce, death, or designation of another primary beneficiary. Failure to provide such notice may cause the systematic payments to be insufficient to satisfy the Required Minimum Distribution for this annuity contract. 3. No Rollovers or Direct Transfers: All checks for the systematic payments are payable to the annuitant and cannot be rolled over or direct transferred. 4. Tax Implications: I am personally responsible for any income tax implications of my election. 5. Annuitization Minimums: Under certain annuity contracts, the Annuity/Account Value is available upon maturity only if payments are to be made for life or for a minimum number of years. Any payments made under the ESP Program will not apply toward meeting any such minimum requirement 6. Effect on Living Benefit Rider or Death Benefit Rider: Systematic payments under this ESP Program will affect benefits under a living benefit rider or a death benefit rider. For information about your rider, please refer to the rider attached to your annuity contract or to the buyer s guide for your rider. If you have a living benefit rider, you should consider satisfying your RMD by starting rider income payments (see form #X NW for variable annuity contracts and form #X NW for fixed annuity contracts). 7. Termination of Other ESP Elections: Only enrollment in one Easy Systematic or Systematic Withdrawal Payment Program is permitted at any time. Enrollment in the ESP RMD program will automatically terminate any existing ESP or SWIP Customized Payment Option election. 8. Terms and Conditions: Payments will be subject to the Easy Systematic Payment Program Terms and Conditions for Required Minimum Distributions, which I have received and read, and which I should keep for future reference. I HAVE READ AND AGREED to the Terms and Conditions of the Easy Systematic Payment Program for Required Minimum Distributions. I AUTHORIZE the appropriate GAIG company to process this ESP Program election, and will hold the appropriate GAIG company harmless against any and all claims made by reason of its compliance with this request. Signature of Owner: Date: IMPORTANT NOTE: For requests signed by a Power of Attorney we must receive a copy of the Power of Attorney document. The Affidavit Related to Power of Attorney, Form #AAG2816, must also be completed or a valid affidavit form must be on file. Payment will be made to the Principal and not to the Attorney in Fact. SECTION VIII. PLAN ADMINISTRATOR CERTIFICATON AND AUTHORIZATION (if applicable) Name of Employer Plan: Name of Plan Administrator: Plan Administrator Phone: ( ) The Plan Administrator certifies that the distributions requested are permitted under the employer s plan and authorizes the appropriate GAIG company to process the request as indicated above. Signature of Plan Administrator: Date: Page 3 of 4

4 SECTION IX. OWNER SIGNATURE NOTARIZATION (if applicable) Your signature on this Easy System Payment (ESP) Program Election Agreement for Required Minimum Distributions must be notarized below if: 1) Requested by the home office, or 2) You purchased your contract electronically with an e-signature and you have not previously submitted a notarized or verified signature. Should we receive this form and a notarized or verified signature is not on file, we will then request your signature be notarized, which will delay processing of your request. IMPORTANT NOTE: Please be advised that after receiving and reviewing your request a signature notarization may still be needed, for example, if we do not have your signature on file or your signature doesn t match what we have on file. If needed, you will be notified. To avoid processing delays you may want to consider notarizing your signature at the time of submitting your request. STATE OF ) ) SS: COUNTY OF ) On this day of in the year before me, the undersigned, a Notary Public in and for said county and state, personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the foregoing Easy System Payment (ESP) Program Election Agreement for Required Minimum Distributions and acknowledged to me that he/she/they signed the same. My Commission expires: MM/DD/YYYY Signature of Notary Public SEAL Page 4 of 4

5 EASY SYSTEMATIC PAYMENT (ESP) PROGRAM TERMS AND CONDITIONS FOR REQUIRED MINIMUM DISTRIBUTIONS (for Qualified Annuity Contracts Over Age 70 ½ Only) DETACH AND RETAIN THIS SECTION FOR YOUR RECORDS SECTION I. INSTRUCTIONS To enroll in a Required Minimum Distribution (RMD) under the ESP Program, complete the first four pages of the Easy Systematic Payment Program Election Agreement and forward to our office. The completed form along with any other necessary paperwork should be returned to the appropriate GAIG company at least 15 days before the requested payment date. PLEASE KEEP THIS FORM FOR YOUR RECORDS. Should you have any questions, please contact your agent or our Client Relations Department. SECTION II. DESCRIPTION OF REQUIRED MINIMUM DISTRIBUTIONS Subject to age limits and restrictions set out below, and the additional terms and conditions stated in Section III, the owner of a qualified [403(b) TSA, IRA, 401 Pension/Profit Sharing/401(k) plans, 457 plans, SEP-IRA, or Simple IRA] annuity contract may elect one of the following Required Minimum Distributions: RECALCULATION OPTION Age Limits. You must be 70½ or older in the calendar year that you enroll. Amount of Payments. The amount to be paid for any given year will be determined by dividing the Annuity/Account Value as of the end of the prior year by the life expectancy factor for the distribution year, and then subtracting any distributions already made during the current calendar year. In the case of monthly, quarterly or semi-annual payments, the amount to be paid in any given period will be equal to the remaining amount for the year divided by the number of remaining modal payments in the current calendar year. MINIMUM RECALCULATION OPTION [for 403(b) TSAs only] Age Limits and Record Requirements. You must be the original 403(b) TSA owner and must be 70½ or older, but not more than 74, in the calendar year that you enroll. The appropriate GAIG company must have sufficient written information to determine the 12/31/86 balance remaining in the 403(b) TSA contract. Amount of Payments. For years ending before you reach age 75, the amount to be paid for any given year will be determined by reducing the prior year-end Annuity/Account Value by the 12/31/86 balance remaining in the annuity contract, then dividing by the life expectancy factor for the distribution year, and then subtracting any distributions already made during the current calendar year. In the case of monthly, quarterly or semi-annual payments, the amount to be paid in any given period will be equal to the remaining amount for the year divided by the number of remaining modal payments in the current calendar year. For years in which you will be age 75 or older, or for any year following the original owner s death, payment amounts will be determined as outlined under the Recalculation Option above. SECTION III. ADDITIONAL TERMS AND CONDITIONS QUALIFICATION FOR ESP PROGRAM 1. Eligibility. Available to Qualified annuity contracts only. The ESP Program is ONLY available on certain contracts. Please contact the Home Office for the approved participating contracts. For contracts with the Legacy Income Option, enrollment in the RMD program is ONLY available for RMD payments for the current calendar year forward. If a prior year s RMD is needed, the owner must take a partial withdrawal for the RMD for both the prior year and the current year. 2. Age Restriction. Qualified policyholder must be 70½ or older in the calendar year of enrollment. For the Minimum Recalculation Option, the original owner of the 403(b) TSA policy must not be over age Minimum Surrender Value. A $1,000 minimum Surrender Value is necessary to elect a RMD. For the TSA I, IRA I and GALIC 2000 (when issued as a qualified annuity), to enroll in the ESP Program, the Annuity Value must equal at least one-half of the flexible premiums paid into the annuity contract. ESP payments under a TSA I, IRA I, or GALIC 2000 will stop if at any time the sum of the current Surrender Value plus payments from your current participation in the ESP RMD program do not at least equal one-half of the flexible premiums. RESTRICTIONS ON ESP PROGRAM 4. Restrictions on Entry. You may not enter the ESP Program during the contract s first calendar year. You may not enter the ESP Program after payments are made under a settlement option. You may enroll in only one ESP or SWIP Program option (Customized or RMD), per annuity contract, at any one time. Your enrollment into the ESP RMD program will automatically terminate any existing ESP Customized Payment Option. If you discontinue payments when permitted, you may not re-enter the ESP RMD Program for 12 months. 5. Default Loan Restriction. You may not enter the ESP Program if you have a loan in a default status. You will also be automatically terminated from the ESP Program if an active loan later defaults while enrolled in the program. CHANGES AND OTHER ANNUITY CONTRACT ACTIVITY 6. Changes Limited. You may not change or revoke a RMD election in any year except to convert to a settlement option that provides for payments which are at least as rapid as the RMD. 7. Withdrawals, Loans, and Contributions. While participating in the ESP RMD program, partial withdrawals, surrenders, loans, and flexible contributions are permitted. A partial withdrawal will reduce the amount of the RMD payments to be made later in that year. Page 1 of 2

6 EASY SYSTEMATIC PAYMENT (ESP) PROGRAM TERMS AND CONDITIONS FOR REQUIRED MINIMUM DISTRIBUTIONS (for Qualified Annuity Contracts Over Age 70 ½ Only) (continued) PAYMENT AMOUNTS AND TERMS 8. Duration of Payments. Unless changed or terminated as provided in these terms and conditions, RMD payments will continue for your life. 9. Life Expectancy Calculations. RMD payments will be calculated based on life expectancies as determined in accordance with the RMD rules of federal tax law. 10. Required Minimum Distribution. RMD payments will be reduced by any withdrawals taken from the annuity contract during the same calendar year. The sum of the RMD payments should satisfy the RMD for this annuity contract for the current year IF no withdrawals from the annuity contract were direct transferred or rolled over to another qualified policy. If any such direct transfers or rollovers occurred, then RMD payments will be insufficient to satisfy the RMD for the annuity contract. Last year s RMD, if requested, will be included in the first payment. 11. Special Rules for Younger Spouse Beneficiary. If RMD payments are based on the joint life factor using the actual age of your spouse primary beneficiary who is more than 10 years younger than you, then you are responsible for notifying the appropriate GAIG Company promptly of any divorce, death, or designation of another primary beneficiary. Failure to provide such notice may cause RMD payments to be insufficient to satisfy your RMD for the annuity contract. 12. No Rollover or Direct Transfer. RMD payments under the ESP Program are not Eligible Rollover Distributions and may not be rolled over or direct transferred. 13. Payment Frequency. Payments will be made annually unless a monthly, quarterly or semi-annual payment election is in effect. Monthly, quarterly, and semi-annual payments are only available by electronic funds transfer (EFT) to the owner s checking or savings account. If EFT information is not provided or if an EFT payment is rejected at any time, future payments will be made annually by check mailed to the owner at the owner s address of record. For contracts with the Legacy Income Option, RMD payments must be made annually with payments AFTER the contract s annual anniversary date. 14. Program Changes and Termination. The company reserves the right to change or terminate the ESP Program at any time without advance notice. EFFECT ON OTHER ANNUITY CONTRACT PROVISIONS 15. Charges. Early withdrawal Charges (including surrender charges, premature use charges, contingent deferred sales charges) and Market Value Adjustments, if any, will be waived on an amount equal to the RMD payments unless the contract is surrendered within 12 months of the distribution. If surrendered within 12 months, then any applicable charges will be retroactively applied. RMD payments for a year will reduce the amount of any other penalty-free withdrawals which otherwise may be available under the annuity contract during that year. A partial withdrawal will reduce the amount of the RMD payments to be made later in that year. Proportionality adjustments, if any, may apply to amounts withdrawn for RMD payments. 16. Availability of Annuity/Account Value. Under certain annuity contracts, the Annuity/Account Value is available upon maturity only if payments are to be made for life or some minimum number of years. Payments under the ESP Program will not count toward meeting any such minimum requirement. For the TSA I, IRA I, and GALIC 2000 (when issued as a qualified annuity), the Annuity Value is only available if it at least equals one-half of the flexible premiums paid into the annuity contract. For the sole purpose of this one-half rule, payments from your current participation in the ESP Program election will be added back to the Annuity Value upon any conversion from the ESP Program to a settlement option. 17. Loans. If an outstanding loan reduces the net Surrender Value at the time of the payment to an amount less than the payment amount, the appropriate GAIG company will default the entire loan balance to satisfy the payment, which will create a taxable event for the amount of the entire loan. 18. Effect on Any Persistency Bonus. Payments under the ESP Program may reduce the values used to calculate the persistency bonus under the annuity contract, if applicable. As a result, the annuity contract may not qualify to receive any such bonus, or the amount of any such bonus may be reduced accordingly. 19. Effect on Fixed-Indexed Contracts. To the extent that the Fixed Strategies are exhausted and payments are taken from an Indexed Strategy, no Indexed Interest will be paid for the current Term on the amount withdrawn unless the withdrawal happens at the end of a Term. 20. Effect on Living Benefit or Death Benefit Riders. Systematic payments under this ESP Program will adversely affect any benefit under a living benefit rider or a death benefit rider. If you have a living benefit rider, you should consider satisfying your RMD by starting rider income payments (see form #X602008NW for variable annuity contracts and form #X NW for fixed annuity contracts). 21. Contract Minimums Waived. Any minimum Surrender Value requirement of the annuity contract will be waived. If at any time the Surrender Value is reduced to $0, the annuity contract will have no cash value and may not be surrendered. RMD payments will then cease and the contract owner must elect a Settlement Option or the contract will terminate. Great American Insurance Group Fixed Annuities: PO Box 5420, Cincinnati OH / / Fax Variable Annuities: PO Box 5423, Cincinnati OH / / Fax Page 2 of 2

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