CONTRACT SPECIFICATIONS

Contract Number:                      [XX-0123456]

Annuitant:                            [Abraham Lincoln]

Age at Issue:                         [35]

Contract Date:                        [May 1, 2001]

Initial Gross Purchase Payment:       [$50,000]

Maturity Date:                        [May 1, 2056]

Owner(s):                             [Abraham Lincoln]
                                      [Mary Lincoln]

Beneficiary Designation:              [Refer to the Client Information Profile]

Death Benefit on Contract Date:       [Guarantee of Principal Death Benefit]


PURCHASE PAYMENT AND ALLOCATION REQUIREMENTS:

     Minimum Subsequent Gross Purchase Payment Transmitted Electronically: $25

     Minimum Subsequent Gross Purchase Payment Transmitted Other Than
     Electronically: $100

     Minimum Allocation to Any One Variable Subaccount: $20

     Minimum Allocation To The DCA Fixed Account: $1,500


ACCOUNT FEE:

     The Account Fee is $20 per Contract Year. The Account Fee will be deducted
     on the first Valuation Date following the last day of each Contract Year.
     If the Contract is surrendered prior to the last day of a Contract Year,
     the full Account Fee will be deducted upon the surrender. The Account Fee
     will be deducted from each Variable Subaccount and the DCA Fixed Account on
     a pro-rata basis. The Account Fee will be waived for any Contract Year in
     which the Contract Value equals or exceeds $50,000.00 as of the Valuation
     Date on which the Account Fee would otherwise be deducted. The Account Fee
     will be waived after 15 Contract Years. The Account Fee will also be waived
     on and after the Annuity Commencement Date.

SALES CHARGE:

     A Sales Charge will apply to all initial and subsequent Gross Purchase
     Payments paid into the Contract. This charge is taken as a percentage of
     the Gross Purchase Payment and is based on the amount of the Owner's
     Investment at the time of each Gross Purchase Payment. For purposes of
     determining the Sales Charge associated with this Contract, the following
     table will be used.

                                                    Sales Charge as a percentage
     Owner's Investment                             of Gross Purchase Payment
     ------------------                             -------------------------

     Less than $25,000                                         5.75%
     $25,000 or greater but less than $50,000                  5.00%
     $50,000 or greater but less than $100,000                 4.50%
     $100,000 or greater but less than $250,000                3.50%
     $250,000 or greater but less than $500,000                2.50%
     $500,000 or greater but less than $750,000                2.00%


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     $750,000 or greater but less than $1,000,000              1.50%
     $1,000,000 or greater                                     1.00%

     The Owner's Investment at any given time is equal to the Contract Value for
     this Contract plus the amount of the current Gross Purchase Payment made
     into this Contract.

VARIABLE ACCOUNT:

     The Variable Account for this Contract is the "Lincoln New York Separate
     Account H for Variable Annuities". There are currently [13] Variable
     Subaccounts in the Variable Account available to the Owner. The Owner may
     direct Net Purchase Payments under the Contract to any of the available
     Variable Subaccounts, subject to limitations. The amounts allocated to each
     Variable Subaccount will be invested in net asset value in the shares of
     one of the Funds. The Variable Subaccounts are:

     [Global Discovery Fund]
     [Global Growth Fund]
     [Global Small Capitalization Fund]
     [Growth Fund]
     [International Fund]
     [New World Fund]
     [Blue-Chip Income and Growth Fund]
     [Growth-Income Fund]
     [Asset Allocation Fund]
     [Bond Fund]
     [High-Income Bond Fund]
     [U.S. Govt./AAA-Rated Securities Fund]
     [Cash Management Fund]

     See Section 4.01 for provisions governing any limitations, substitution or
elimination of Funds.

DCA FIXED ACCOUNT:

         Minimum Guaranteed Interest Rate:  1.50% for all years

         [INITIAL GUARANTEED PERIOD / INTEREST RATE: [6 MONTHS] / [1.50%]]
         [INITIAL GUARANTEED PERIOD / INTEREST RATE: [12 MONTHS] / [1.50%]]
         [INITIAL GUARANTEED PERIOD / INTEREST RATE: [24 MONTHS] / [1.50%]]



VARIABLE ACCOUNT REQUIREMENTS:

     MORTALITY AND EXPENSE RISK AND ADMINISTRATIVE CHARGE PRIOR TO THE ANNUITY
     COMMENCEMENT DATE:

     We assess a daily charge equal on an annual basis to the percentages shown
     of the average daily net asset value of each Variable Subaccount. The daily
     charge will not exceed the percentages shown. If on the Contract Date, one
     of the below listed Death Benefit Option(s) has been selected, the
     Mortality and Expense Risk and Administrative Charge will be as indicated
     for the Death Benefit Option selected.

         Death Benefit Option(s):                             Charges:

         - Guarantee of Principal Death Benefit               0.60%
         - Enhanced Guaranteed Minimum Death Benefit          0.72%

     After the Contract Date, the Owner (or a spouse who continues the Contract
     as the Owner) may change at any time to a Death Benefit Option with a lower
     charge than the Death Benefit Option in effect, but may never change to a
     Death Benefit Option with a higher charge (see the Death Benefit Option
     charges above). If the Death Benefit Option is changed after the Contract
     Date, the change will be effective as of the Valuation Date the Notice to
     change the Death Benefit option is received.


                                       3.2



     MORTALITY AND EXPENSE RISK AND ADMINISTRATIVE CHARGE ON OR AFTER THE
     ANNUITY COMMENCEMENT DATE:  0.60%

     The daily charge will not exceed the percentage shown.

TRANSFER REQUIREMENTS PRIOR TO THE ANNUITY COMMENCEMENT DATE:

     Transfers cannot be made during the first 30 days.

     LNY reserves the right to require a 30 day minimum time period between each
     transfer.

     Maximum Number of Transfers: 6 per Contract Year, excluding automatic DCA
     transfers. There will be no fee imposed for these six (6) transfers.
     Transfers in excess of 6 per Contract Year must be authorized by LNY. LNY
     reserves the right to impose a fee for any transfer in excess of 6 per
     Contract Year. This fee will not exceed $25.

     Variable Account:

         Minimum Single Transfer Amount From A Variable Subaccount: The lesser
         of 1) $300; or 2) the remaining amount in the Variable Subaccount.
         Transfers to the DCA Fixed Account are not allowed.

         Minimum Transfer Amount To a Variable Subaccount: $300

     Fixed Account:

         Minimum Single Transfer Amount From The DCA Fixed Account: The lesser
         of 1) $300; or 2) the remaining amount in the DCA Fixed Account. This
         restriction does not apply to automatic DCA transfers.

WITHDRAWAL AND SURRENDER REQUIREMENTS:

     Minimum Partial Withdrawal Amount: $300

DEATH BENEFIT REQUIREMENTS PRIOR TO THE ANNUITY COMMENCEMENT DATE:

     The Owner may select a Death Benefit Option(s) to be effective as of the
     Contract Date. If no Death Benefit Option is selected, the Guarantee of
     Principal Death Benefit will be the Death Benefit effective as of the
     Contract Date.

ANNUITY PAYMENT REQUIREMENTS:

     Determination of the First Annuity Payment Date:

         For 100% Fixed Annuity Payment, the Annuity Payment Date must be at
         least 30 days after the Annuity Commencement Date. If any portion of
         the annuity payment will be on a variable basis, the Annuity Payment
         Date will be 14 days after the Annuity Commencement Date. The Annuity
         Unit value, if applicable, and Contract Value used to effect annuity
         payments will be determined as of the Annuity Commencement Date.

     Minimum Annuity Payment Amount: $50

     Minimum Guaranteed Interest Rate for the Fixed Annuity Payment: 1.50%

     Assumed Investment Rate for the Variable Annuity Payment: Between 3.0%
     - 5.0%

     WITH A MORTALITY AND EXPENSE RISK AND ADMINSTRATIVE CHARGE OF 0.60%, THE
     SMALLEST RATE OF INVESTMENT RETURN REQUIRED TO ENSURE THAT THE DOLLAR
     AMOUNT OF VARIABLE ANNUITY PAYMENTS DOES NOT DECREASE IS:


                                       3.3



     3.60% FOR VARIABLE ANNUITY OPTIONS BASED ON AN ASSUMED RATE OF RETURN OF
     3.0% PER YEAR; OR
     4.60% FOR VARABLE ANNUITY OPTIONS BASED ON AN ASSUMED RATE OF RETURN OF
     4.0% PER YEAR; OR
     5.60% FOR VARIABLE ANNUITY OPTIONS BASED ON AN ASSUMED RATE OF RETURN OF
     5.0% PER YEAR.

                                       3.4