Right to examine notice.

If the form is for use with a separate account annuity contract and contains a right to examine (‘‘free look’’) notice or provision for the contract, the notice or provision complies with the last two sentences of section 410E of The Insurance Company Law of 1921 (40 P. S. § 510d). Among other things, this means that the notice or provision provides that the amount that will be returned to the contractholder will be the sum of the following:

(1) The difference between the premiums paid and the amounts allocated to any separate accounts under the contract.

(2) The contract value on the date of surrender attributable to the amounts allocated to any separate accounts under the contract.