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TPA Information MidAmerica, Administrative & Retirement Solutions, Inc. 211 East Main Street, Suite 100 Lakeland, FL 33801 800.430.7999 Investment Option Selection The AUL Fixed Interest Account(FIA) (I2) will be the only annuity investment option made available. Withdrawal Charge (presently approved in California only) A Withdrawal Charge will not be applied under this contract, with one exception. A 5% Withdrawal Charge will be applied at contract termination to any FIA monies that are paid out at the Contractholder's direction in a lump -sum rather than in 5 equal annual installments. Summary of Billable Expenses Currently, there are none. Contract Termination Provisions Upon termination of the contract, the FIA Withdrawal Value must be taken in 5 equal annual installments. A cash lump - sum payment of monies invested in the FIA is not an available option. This restriction applies to all Contribution sources. AUL Recordkeeping/Administrative Services Agreement The Proposed Contractholder hereby requests only investment recordkeeping for assets held in the applied -for Contract, and does not request any other recordkeeping or administrative services. AUL will only maintain recordkeeping of assets at a contract/plan-level. Furthermore, AUL will not be providing statements, confirmations, or any other reporting to the Contractholder. The Proposed Contractholder hereby acknowledges and agrees that, as Plan Fiduciary, it has the sole responsibility for assuring that the Plan complies with all applicable state and federal law, including ERISA, the Internal Revenue Code, and securities laws, both in form and in operation. The Proposed Contractholder hereby acknowledges and agrees that MidAmerica Administrative & Retirement Solutions, Inc. is the Third Party Administrator (TPA) and Plan Administrator, and that, other than in this Unallocated Contract Application, Acceptance, and Agreement form, AUL shall accept direction and instructions regarding both the Plan and the Contract only from MidAmerica, and shall not accept direction and instructions directly from the Contractholder. Facsimile/Electronic Media Acceptance Agreement Instructions provided to AUL and its agents to execute, cancel, or otherwise proceed with transactions including those related to, but not limited to, enrollments, loan applications, distributions, and correspondence will be accepted via facsimile, copy, or via other electronic media. This agreement does not include retirement plan adoption agreements, group annuity contracts, amendments thereto, the annual census, and Notice, Election & Release or Contract Settlement Agreement documents. This agreement includes instructions from the TPA, Plan Sponsor, Plan Administrator, and/or Contractholder. The Contractholder and TPA will indemnify and hold harmless AUL for all claims, losses, liabilities and expenses, including legal fees and expenses, resulting from any action taken or not taken by AUL in good faith in accordance with this agreement.