Systematic Withdrawal Program For Preference Premier Variable Annuity

Transcription

1 Systematic Withdrawal Program For Preference Premier Variable Annuity

2 Systematic Withdrawal Program Page 1 Systematic Withdrawal Program Preference Premier Highlights and Rules Forms: Systematic Withdrawal Program Enrollment Direct Deposit Enrollment Form (ACH/EFT Deposits) Acknowledgement of Exception to Premature Distribution Penalty Preference Premier Change of Allocation

3 Highlights and Rules The Systematic Withdrawal Program ( the Program ) is an optional automatic withdrawal program that you elect to participate in. Under the Program you may elect to receive periodic payments (monthly, quarterly, semiannually or annually) for an amount that you choose, subject to certain limits. *The total amount paid under the Program for any contract year cannot be less than $500. Any amount that exceeds 10% of your total purchase payments will be subject to early withdrawal charges. *Each monthly payment must be at least $50. The minimum payment amount for quarterly is $125. During the first contract year, you may only select monthly or quarterly periodic payments. Your total systematic withdrawal payments may not exceed 10% of your purchase payment in the first contract year or 10% of your aggregate purchase payments each year after. Once the Program is initiated, we will continue payments until you notify us to cancel them. Cancellation may be made at any time either in writing or by telephone. Withdrawals that are processed cannot be reversed; they are irrevocable. (Adverse tax consequences may result if you change or cancel withdrawals within 5 years after beginning systematic withdrawals or before reaching 59½, whichever is later. See Taxes Exceptions to the 10% Federal Tax Penalty below, and consult your tax advisor.) You may make changes to your payment amount by notifying us in writing at least 10 days prior to your payment date. If such notice is not received in time, we will make the change effective with your next payment. As noted above, changing the amount of your payments can have adverse tax consequences, consult your tax advisor. Additional withdrawals are permitted while the Program is in effect. However any additional withdrawals may be subject to early withdrawal charges or may cause payments being made under the Program to be subject to early withdrawal charges. Whether a withdrawal charge applies will be determined at the time of each withdrawal, including withdrawals under the Program, in accordance with the contract provisions. Adverse tax consequences may result if you are under age 59½ when you begin the systematic withdrawal program and you make additional withdrawals within 5 years after beginning or before reaching age 59½, whichever is later. Consult your tax advisor. If you are electing to start the Program at contract issue and you are submitting a transfer order form(s) with your application, we will not start the Program until all transfers have been received or for 60 days, whichever is earlier. Taxes - Exceptions to the 10% Federal Tax Penalty The Internal Revenue Code ( the Code ) imposes a tax penalty in addition to ordinary income taxes equal to 10% of the taxable amount withdrawn from your contract before you reach age 59½, unless certain exceptions are met. One exception is: distributions that are part of a series of substantially equal periodic payments (paid not less frequently than annually) made for the life (or life expectancy) of the owner or the joint lives (or joint life expectancies) of such owner and his/her designated beneficiary. Under a Roth IRA, to the extent distributions would be taxable or, to the extent the withdrawal is within 5 years of conversion and would therefore be treated as subject to the 10% early distribution tax penalty, the 10% tax penalty will not apply if the withdrawals are a series of substantially equal periodic payments as described above. To the extent that the Program payments qualify for the exception to the 10% penalty tax under Code Section 72(t)(2)(A) (iv), or 72(q)(2)(D) modifying payments before you reach age 59½ or have been receiving payments for 5 years, whichever is later, results in the retroactive imposition of the 10% Federal premature distribution tax penalty for all taxable payments made before age 59½. Once retroactive imposition of the penalty tax is triggered, the Code also requires interest assessments on the deferred tax penalty. You should consult your tax advisor for the applicability to your particular situation of these exceptions or any other exception. In addition, MetLife and its representatives cannot provide any assurance regarding the tax consequences of Program payments. Page 1 of 11

4 IRS Notification If you are younger than age 59½, are receiving distributions calculated to satisfy the substantially equal periodic payment exception, and you complete the Acknowledgment of Exception to Premature Distribution Penalty Form, MetLife will report on the IRS Form 1099-R issued for your Program payments a code 2 in box 7 of the form. This code indicates the payments meet an exception to the 10% Federal premature distribution tax penalty. MetLife does not imply or give assurance that Program payments before age 59½ intended to comply with the substantially equal periodic payment exception will qualify for an exception to the premature distribution tax penalty. If you are younger than age 59½ and are: 1) not calculating your payments to satisfy the substantially equal periodic payment exception, or, 2) some modification to the payments or additional withdrawal causes you to no longer qualify for the exception to the 10% penalty tax, then MetLife will report on the IRS Forms 1099-R issued for your Program payments, a code 1 in box 7 of the form. This code indicates the payments were made before age 59½ and MetLife does not know if any exception to the 10% Federal premature distribution tax penalty applies. If you are eligible to and want to claim an exception to the premature distribution tax penalty for the Program payments, you must file IRS Form 5329 with your Federal income tax return. Generally, if you are age 59½ or older, and 1) you never received substantially equal periodic payments from your account or, 2) you have been receiving substantially equal periodic payments for at least 5 years, MetLife will report, on the IRS Form 1099-R issued for your Program payments, a code 7 in box 7. This code indicates the payments are normal distributions. If you are age 59½ or older, and: 1) you started receiving substantially equal periodic payments from your account before you were 59½ and, 2) you have been receiving these payments for less than 5 years and, 3) you no longer qualify for the exception to the 10% penalty (due to modification or additional withdrawals etc.) then MetLife will report, on the IRS Form 1099-R issued for your Program payments, a Code 1 in box 7. This code indicates MetLife does not know if an exception to the 10% Federal premature distribution penalty applies. Client Notification We will notify you when you are nearing the end of the Program payment stream and before your entire account balance has been withdrawn. Program payments will be confirmed in writing at least quarterly. Page 2 of 11

5 Systematic Withdrawal Program Enrollment Form Preference Premier Variable Annuity Use this form to... Start the Systematic Withdrawal Program Change an Existing Systematic Withdrawal program. Please complete and sign this form and return it to: MetLife Client Support Services PO Box Des Moines, IA Owner/Participant s Name: First Middle Initial Last Social Security #: Date Birth: / / Contract Number: Address: Street City State Zip Financial Services Representative Name: Producer Number: 2. Type of Withdrawal: Please check one of the following categories and provide proof of reason. (We need this information to properly code your IRS Form 1099-R.) Regular distribution - Reason Code 7 I am age 59½ or older, and: 1) I have never taken substantially equal periodic payments from this account or 2) I have taken substantially equal periodic payments beginning before age 59½ for at least 5 years. Pre - 59½ Distribution with substantially equal periodic payments - Reason Code 2. Pre - 59½ Distribution - Reason Code 1. Post - 59½ Distribution that is part of a stream of substantially equal periodic payments started before you reached 59½. - Reason Code Please complete both 3a and 3c. Please complete 3b, if applicable. 3a. I want to withdraw the following dollar amount, to be paid to me in the following frequency: Monthly $ Quarterly $ Semiannually $ Annually $ Note: During the first contract year, only monthly or quarterly payments can be selected. There is a $50 per monthly payment, $125 per quarterly payment, and a $500 per year minimum. (This is not an annuitization or an immediate annuity.) There is no guarantee that a payment amount made under the program will not incur any early withdrawal charges. Important: If you elected the GMIB Max IV, or GMIB Max IV with EDB Max IV and you take your first withdrawal prior to the 5 th contract anniversary, your dollar-for-dollar withdrawal rate will be the greater of: (a) 4.5% each year or (b) your required minimum distribution (RMD). If you take your first withdrawal on or after the 5 th contract anniversary, your dollar-for-dollar withdrawal rate will be the greater of: (a) 5% each year or (b) your RMD. For detailed information regarding early withdrawal penalties and other withdrawal provisions, please review your contract and/or prospectus. 3b. Increasing amount equal to the Annual Benefit Payment allowed under the GWB or LWG Rider. The annual Systematic Withdrawal amount will equal the Annual Benefit Payment and will be increased only on any contract anniversary on which the Annual Benefit Payment increases due to an Optional Reset or Automatic Step-Up*. (This option is only available if the GWB or LWG Rider is selected at issue.) If selecting this option at issue, the initial systematic withdrawal amount will equal the current Annual Benefit Payment annually; otherwise the initial systematic withdrawal amount will equal the Remaining Annual Benefit Payment for the current contract year.** I understand withdrawals will be deducted prorata from the active subaccounts and fixed account, if applicable. Page 3 of 11

6 Increasing amount equal to.0%*** of the beginning of the contract year Annual Increase Amount ( Compounding Income Base Component ) under the GMIB and/or EDB Riders. The Systematic Withdrawal amount will be increased only if the Annual Increase Amount increases due to, 1) additional payments made within 120 days of contract issue or 2) an Optional Reset or Optional Automatic Reset. (This option is only available if the GMIB or EDB Rider is selected at issue.)** I understand withdrawals will be deducted pro-rata from the active subaccounts, if applicable. * Optional Resets or Optional Automatic Step-ups are elected by separate election forms. ** Note: If you already have an active Systematic Withdrawal Program on you contract, both the amount and mode of your withdrawals will not be affected as described. Rather, withdrawal amount and mode will remain unchanged until the next contract anniversary on which an Optional/Automatic Reset occurs (or upon additional purchase payments made within 120 days of contract issue for GMIB.) *** Percentage must be less than or equal to the Annual Increase Accumulation Rate, as provided in the product prospectus and on your contract schedule page, in order for the withdrawal adjustment that applies to the Annual Increase Amount to be equal to the dollar amount of the withdrawals. 3c. Withdrawals may be taken from the funding options in percentages as specified by you as the contract owner. If this section is not completed, withdrawals will be made on a pro rata basis. Also, if you select a specific allocation, and there is insufficient money in a particular funding option, your withdrawals will default to a pro rata basis. To change your Systematic Withdrawal Program allocation, please fill out the Systematic Withdrawal Program Change of Allocation Form. I would like my withdrawal to be taken in the following manner: Pro rata across all funding options Using the following allocation (complete table below) In the table below, indicate from which funding options you would like your systematic withdrawal payments to be deducted. If you choose to allocate, your payments will not be processed unless this form is filled out completely and accurately. All figures must be in whole dollars. If there is insufficient money in a given funding option, your withdrawals will default to a pro rata allocation. Also, if you transfer assets among the funding options, you may need to adjust your systematic withdrawal allocation accordingly. Contracts Issued with GMIB MAX or EDB MAX, select from the funding options in the following table only. Contracts that were not issued with the GMIB Max or EDB Max please skip to the next funding option table. Funding Options Whole Dollars Only AllianceBernstein Global Dynamic Allocation Portfolio $ AQR Global Risk Balanced Portfolio $ BlackRock Global Tactical Strategies Portfolio $ Invesco Balanced-Risk Allocation Portfolio $ JPMorgan Global Active Allocation Portfolio $ MetLife Balanced Plus Portfolio $ Schroders Global Multi-Asset Portfolio $ Pyramis Government Income Portfolio $ Page 4 of 11

7 Funding Options Whole Dollars Only Funding Options Whole Dollars Only Fixed Account (N/A with C Class or in WA with any American Funds Global Small Capitalization Fund $ $ Living Benefit Rider) Dreman Small Cap Value Portfolio $ BlackRock Money Market Portfolio (Only available Invesco Small Cap Growth Portfolio $ with C Class, or in the state of WA with any living $ Benefit Rider) Loomis Sayles Small Cap Core Portfolio $ American Funds Bond Portfolio $ Met/Dimensional International Small Company Portfolio $ Barclays Capital Aggregate Bond Index Portfolio $ Neuberger Berman Genesis Portfolio $ BlackRock Bond Income Portfolio $ Russell 2000 Index Portfolio $ Met/Franklin Low Duration Total Return Portfolio $ T. Rowe Price Small Cap Growth Portfolio $ PIMCO Inflation Protected Bond Portfolio $ Clarion Global Real Estate Portfolio $ PIMCO Total Return Portfolio $ Met/Eaton Vance Floating Rate Portfolio $ Pyramis Government Income Portfolio $ Met/Templeton International Bond Portfolio $ Western Asset Management U.S. Government Portfolio $ MFS Emerging Markets Equity Portfolio $ Lord Abbett Bond Debenture Portfolio $ RCM Technology Portfolio $ American Funds Growth Portfolio $ Van Eck Global Natural Resources Portfolio $ American Funds Growth-Income Fund $ Choose Only One from this Box N/A BlackRock Large Cap Core Portfolio $ MetLife Conservative Allocation Portfolio $ BlackRock Large Cap Value Portfolio $ MetLife Conservative to Moderate Allocation BlackRock Legacy Large Cap Growth Portfolio $ Portfolio $ Davis Venture Value Portfolio $ MetLife Moderate Allocation Portfolio $ Janus Forty Portfolio $ MetLife Moderate to Aggressive Allocation Portfolio $ Jennison Growth Portfolio $ Choose Only One from this Box N/A Legg Mason ClearBridge Aggressive Growth Portfolio $ MetLife Aggressive Strategy Portfolio $ Met/Franklin Mutual Shares Portfolio $ American Funds Moderate Allocation Portfolio $ MetLife Stock Index Portfolio $ American Funds Balanced Allocation Portfolio $ Met/Franklin Mutual Shares Portfolio $ American Funds Growth Allocation Portfolio $ MetLife Stock Index Portfolio $ SSgA Growth and Income ETF Portfolio $ MFS Value Portfolio $ SSgA Growth ETF Portfolio $ MSCI EAFE Index Portfolio $ AllianceBernstein Global Dynamic Allocation Baillie Gifford International Stock Portfolio $ Portfolio $ Harris Oakmark International Portfolio $ AQR Global Risk Balanced Portfolio $ Loomis Sayles Global Markets Portfolio $ BlackRock Global Tactical Strategies Portfolio $ Met/Templeton Growth Portfolio $ Invesco Balanced-Risk Allocation Portfolio $ MFS Research International Portfolio $ JPMorgan Global Active Allocation Portfolio $ Oppenheimer Global Equity Portfolio $ MetLife Balanced Plus Portfolio $ BlackRock Aggressive Growth Portfolio $ Schroders Global Multi-Asset Portfolio $ Lazard Mid Cap Portfolio $ MIST Fund of Funds N/A Lord Abbett Mid Cap Value Portfolio $ Met/Franklin Income Portfolio $ Met/Artisan Mid Cap Value Portfolio $ Met/Franklin Templeton Founding Strategy Portfolio $ MetLife Mid Cap Stock Index Portfolio $ MFS Total Return Portfolio $ Morgan Stanley Mid Cap Growth Portfolio $ Pioneer Strategic Income Portfolio $ T. Rowe Price Mid Cap Growth Portfolio $ Page 5 of 11

8 4. Payment Processing Date: / / Check Received No Later Than / / You should allow at least 10* days for us to process your request. If the Designated Office does not receive your request at least 10 days before the payment start date, your payments will begin the following month. If no date is specified, payments will begin 30 days after we receive this form. If the payment start date is a holiday or falls on a weekend, we will process the payment on the next business day. Note that this is the date we make the payment, not the day you receive it. If you are receiving payments via the Electronic Funds Transfer, you should allow approximately two additional business days after the payment start date to receive the payment. If we mail checks to you, you should allow approximately 10 additional business days after the payment start date to receive the payment. (For example, if you want to receive a check by the first of the month, we suggest you ask us to make payment on the 20th day of the prior month.) 5. Federal Income Tax Withholding Notice and Election for Withdrawals From Your Traditional IRA/NQ/SEP/ SIMPLE/ROTH IRA: Generally, the withdrawal you take from this contract is a non-periodic payment and the taxable amount will be subject to 10% Federal income tax withholding unless you elect not to have withholding apply. You may elect not to have withholding apply to your withdrawal from this contract by checking the box below, signing and dating this form and returning it to us. If you elect not to have withholding apply to your systematic withdrawals, or if you do and you do not have enough Federal income tax withheld from your payments, you maybe responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. Even if you elect not to have Federal income tax withheld from your systematic withdrawals, you are liable for payments of Federal income tax on the taxable portion of each payment sent to you. In some states your distribution may also be subject to State income tax withholding requirements. In certain states we may be required to withhold State income tax if we withhold Federal income tax from your distribution. Your withholding election will remain in effect for future payments under this Systematic Withdrawal Program until you change or revoke it by filing a new election with us. You may change your withholding election at anytime and as often as you wish. Remember, part or all of your withdrawal(s) is subject to income tax and a 10% IRS penalty may also apply to withdrawals made before age 59½. Do not withhold Federal or State income tax. I elect to have federal and state tax withheld from this withdrawal, as indicated below: Federal % OR $ State % OR $ 6. Payee/Mailing Instructions: (check only one) Mail withdrawal check(s) to my current address of record. (If another address is intended, a change of address must be on our records.) Electronic Funds Transfer (EFT) Account Number: (Complete and sign the attached Direct Deposit Enrollment Form and attach a voided check.) 7. Signature* of Owner: IRA/Non-Qualified Owner s Signature Non-Qualified Owner s Signature Date Date *By signing this form, I hereby acknowledge that I have read and understand all the information provided in this kit, including the Rules and Highlights section. Notice: The tax law provides that deferred annuities issued after October 21, 1988 by the same insurance company or an affiliate in the same calendar year to the same owner, are combined for tax purposes. As a result, a greater portion of your withdrawals may be considered taxable income than you would otherwise expect. In addition, please note that no agent or representative of The Company is authorized to alter, change or waive any of the terms or conditions of this form or to bind The Company by any statement or representation as to the availability of a withdrawal, if any, under this contract. The Company suggests that you consult your own attorney, accountant or tax advisor for information relating to Federal and state income tax liabilities that may be incurred as a result of a withdrawal. Page 6 of 11

9 Direct Deposit Enrollment Form (ACH/EFT Deposits) Systematic Withdrawal Program: New Modify Existing Program on Contract #: Bank Account Number: ABA Bank Routing #: (Please obtain this number from your bank to ensure that payments are electronically transferred to your account.) Name of Owner s Bank: FBO: Bank Address (Where you have your account): Please tape a voided check to the following page. I (we) hereby authorize Metropolitan Life Insurance Company (MetLife) to deposit my (our) Systematic Withdrawal Program payments directly to my (our) account at the bank or depository set forth above and I (we) hereby authorize the bank or depository to accept such deposits and post them to my (our) account. This authorization is to remain in full force and effect until MetLife has received written notification from me (either of us) of its termination in such time and manner as to afford MetLife and my (our) bank or depository a reasonable opportunity to act on it. Further, MetLife has the authority to discontinue this ACH/EFT direct deposit service with a 30-day advance notification of such termination. MetLife shall be entitled to rely upon all banking/depository information on this form and the voided check (e.g. bank name, bank account, etc.) for as long as this arrangement remains in effect, and MetLife shall incur no liability or loss whatsoever as a result of relying on any such information. MetLife shall not be required to verify the accuracy of any bank/depository information (including but not limited to the name on the bank/depository account) and may rely solely on the bank/depository account number even if the number identifies a person(s) other than me (us). I (we) understand that MetLife s liability under the contract is fully satisfied as soon as the direct deposit is made to the account noted above, even if someone else (such as a joint account holder) withdraws it. I (WE) MAY REVOKE THIS AUTHORIZATION ONLY BY NOTIFYING METLIFE IN THE MANNER SPECIFIED IN THIS AUTHORIZATION. If for any reason the bank/depository information changes, it is agreed that it is the sole responsibility of the account holder(s) to give written notice to inform MetLife as soon as possible of any change [but not less than 10 business days prior to the effective date of such change]. If MetLife makes any overpayments to my (our) account, I (we) hereby authorize and direct MetLife and my (our) bank/depository to withdraw such overpayment from my (our) account and to refund the overpayment to MetLife without my (our) specific agreement upon receipt by my financial institution of MetLife s request. I (we) agree to refund any overpayments within 30 days of the receipt of appropriate documentation, including in the event of my (our) death(s). Signature of Owner(s): Date Date Address of Owner(s): Street City State Zip Street City State Zip Page 7 of 11 SWP Direct Deposit Form (08/12) ef

10 Tape your voided check below. (Please do not use staples.) John Doe Any Street Anywhere, USA PAY TO THE ORDER OF DOLLARS For: 1: : TAPE YOUR VOIDED CHECK HERE VOID Page 8 of 11

11 Substantially Equal Periodic Payments under the Systematic Withdrawal Program Acknowledgement of Exception to Premature Distribution Penalty The following is a disclosure and acknowledgement regarding substantially equal periodic payments under MetLife s Systematic Withdrawal Program. We urge you to consult with your independent tax advisor before signing up to receive substantially equal periodic payments. You acknowledge that: I am enrolling in MetLife s Systematic Withdrawal Program and intend that the resulting payments from my contract will satisfy the substantially equal periodic payment exception to the additional 10% federal tax imposed on premature distributions. I will continue the Program for at least 5 years from the date payments begin or until I reach age 59 ½, whichever is later. In accordance with IRS Revenue Ruling , my substantially equal periodic payments were determined by (check the appropriate box): Using a method acceptable for calculating required minimum distributions as provided in Section 1.401(a)(9) of the Income Tax Regulations. (The required minimum distribution method). Amortizing my account balance over a certain number of years based on the IRS tables for my life expectancy or the joint life expectancies of me and my beneficiary and a reasonable interest rate. (The fixed amortization method). Dividing my account balance by an annuity factor from the mortality table in Appendix B of Revenue Ruling for my life or the joint lives of me and my beneficiary and not exceeding a reasonable interest rate. (The fixed annuitization method). I understand that I cannot make contributions, rollovers, transfers or exchanges into the contract while I am taking substantially equal periodic payments. Important notes: If this is an IRA or a qualified plan, any distribution that is part of a series of substantially equal periodic payments qualifying for the exception to the additional 10% tax on premature distributions can not be rolled over in any transaction that would make the substantially equal periodic payments not subject to income tax. An annual distribution of a percentage of the account balance (e.g. 7% per year) does not constitute a substantially equal periodic payment and is not eligible for the exception to the additional tax on premature distributions. In accordance with the above acknowledgments, I hereby request that MetLife treat the distributions from the contract identified below as satisfying the IRS requirements for substantially equal periodic payments and code my Form 1099-R with a distribution code of 2 Early distribution, exception applies. I understand that MetLife reserves the right to code the distribution as subject to the 10% tax on premature distributions at any time, for any reason, including any modification as described in Revenue Ruling , without notice, notwithstanding this acknowledgement. I understand that by signing this acknowledgement, MetLife is not guaranteeing or implying that these substantially equal periodic payments satisfy the Internal Revenue Code and regulation requirements for the exceptions to the additional 10% tax on premature distributions. Any taxes or penalties resulting from these distributions are exclusively my responsibility and MetLife is not liable in any regard. In addition I understand this acknowledgement will apply to any substantially equal periodic payments taken from my contract during this and each subsequent tax year that payments continue. Circular 230 Disclosure: To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. Federal Tax Advice contained in this application (including any attachments) is not intended (and cannot) be used by anyone to avoid IRS penalties. It is intended to support the sale of MetLife insurance products. Our customers should seek advice based on their particular circumstances from an independent tax advisor. Owner Name: Owner Signature: Contract Number: Date: Joint Owner Name: Joint Owner Signature: Date: Page 9 of 11 SWP PremDistAck (08/12) ef

12 Preference Premier Variable Annuity Systematic Withdrawal Program Change of Allocation Form You should use this form if you are an existing Systematic Withdrawal Program participant who wishes to change your withdrawal allocation from pro rata (proportionate across all funding options in which you have an account balance) to customer-specified (withdrawals taken from those funding options in percentages specified by you as the contract owner) or to make a change to your existing customer-specified allocation percentages. If you have any questions, please contact your Representative. Complete this entire form and return it to: MetLife Client Support Services, PO Box 10342, Des Moines, IA Part I. Participant Information Participant Contract # Social Security Number Street Address City State Zip Code Part II. Systematic Withdrawal Program Information In the table below, indicate which funding options you would like your systematic withdrawal payments to be deducted. This form must be filled out completely and accurately before we can process your payments. All figures must be in whole dollars. In the event of insufficient money in a given funding option, your withdrawals will default to a pro rata allocation. Also, if you transfer assets among various funding options, you may need to adjust your systematic withdrawal allocation accordingly. Contracts Issued with GMIB MAX or EDB MAX, select from the funding options in the following table only. Contracts that were not issued with the GMIB Max or EDB Max please skip to the next funding option table. Funding Options Whole Dollars Only AllianceBernstein Global Dynamic Allocation Portfolio $ AQR Global Risk Balanced Portfolio $ BlackRock Global Tactical Strategies Portfolio $ Invesco Balanced-Risk Allocation Portfolio $ JPMorgan Global Active Allocation Portfolio $ MetLife Balanced Plus Portfolio $ Schroders Global Multi-Asset Portfolio $ Pyramis Government Income Portfolio $ Page 10 of 11

13 Funding Options Whole Dollars Only Funding Options Whole Dollars Only Fixed Account (N/A with C Class or in WA with any Living American Funds Global Small Capitalization Fund $ $ Benefit Rider) Dreman Small Cap Value Portfolio $ BlackRock Money Market Portfolio (Only available with C Class, Invesco Small Cap Growth Portfolio $ $ or in the state of WA with any living Benefit Rider) Loomis Sayles Small Cap Core Portfolio $ American Funds Bond Portfolio $ Met/Dimensional International Small Company Portfolio $ Barclays Capital Aggregate Bond Index Portfolio $ Neuberger Berman Genesis Portfolio $ BlackRock Bond Income Portfolio $ Russell 2000 Index Portfolio $ Met/Franklin Low Duration Total Return Portfolio $ T. Rowe Price Small Cap Growth Portfolio $ PIMCO Inflation Protected Bond Portfolio $ Clarion Global Real Estate Portfolio $ PIMCO Total Return Portfolio $ Met/Eaton Vance Floating Rate Portfolio $ Pyramis Government Income Portfolio $ Met/Templeton International Bond Portfolio $ Western Asset Management U.S. Government Portfolio $ MFS Emerging Markets Equity Portfolio $ Lord Abbett Bond Debenture Portfolio $ RCM Technology Portfolio $ American Funds Growth Portfolio $ Van Eck Global Natural Resources Portfolio $ American Funds Growth-Income Fund $ Choose Only One from this Box N/A BlackRock Large Cap Core Portfolio $ MetLife Conservative Allocation Portfolio $ BlackRock Large Cap Value Portfolio $ MetLife Conservative to Moderate Allocation Portfolio $ BlackRock Legacy Large Cap Growth Portfolio $ MetLife Moderate Allocation Portfolio $ Davis Venture Value Portfolio $ MetLife Moderate to Aggressive Allocation Portfolio $ Janus Forty Portfolio $ Choose Only One from this Box N/A Jennison Growth Portfolio $ MetLife Aggressive Strategy Portfolio $ Legg Mason ClearBridge Aggressive Growth Portfolio $ American Funds Moderate Allocation Portfolio $ Met/Franklin Mutual Shares Portfolio $ American Funds Balanced Allocation Portfolio $ MetLife Stock Index Portfolio $ American Funds Growth Allocation Portfolio $ MFS Value Portfolio $ SSgA Growth and Income ETF Portfolio $ MSCI EAFE Index Portfolio $ SSgA Growth ETF Portfolio $ Baillie Gifford International Stock Portfolio $ AllianceBernstein Global Dynamic Allocation Portfolio $ Harris Oakmark International Portfolio $ AQR Global Risk Balanced Portfolio $ Loomis Sayles Global Markets Portfolio $ BlackRock Global Tactical Strategies Portfolio $ Met/Templeton Growth Portfolio $ Invesco Balanced-Risk Allocation Portfolio $ MFS Research International Portfolio $ JPMorgan Global Active Allocation Portfolio $ Oppenheimer Global Equity Portfolio $ MetLife Balanced Plus Portfolio $ BlackRock Aggressive Growth Portfolio $ Schroders Global Multi-Asset Portfolio $ Lazard Mid Cap Portfolio $ MIST Fund of Funds N/A Lord Abbett Mid Cap Value Portfolio $ Met/Franklin Income Portfolio $ Met/Artisan Mid Cap Value Portfolio $ Met/Franklin Templeton Founding Strategy Portfolio $ MetLife Mid Cap Stock Index Portfolio $ MFS Total Return Portfolio $ Morgan Stanley Mid Cap Growth Portfolio $ Pioneer Strategic Income Portfolio $ T. Rowe Price Mid Cap Growth Portfolio $ Part III. Signature Signature of Owner: Signature of Joint Owner: Date Date Page 11 of 11