Annuity Fund Transfers, Future Payment Allocation & Rebalancing Program Request

Transcription

1 Annuity Transfers, Future Payment Allocation & Rebalancing Program Request Requests available on this form may be made over the phone by contacting our Service Center at transfers and allocation changes can be processed online by visiting If you have a Evolution or contract and are currently participating in Guaranteed Minimum Accumulation Benefit (GMAB), Basic Guaranteed Minimum Income Benefit (GMIB), Guaranteed Income Plus 5 (GMIB), Guaranteed Income Plus 6 (GMIB), Lifetime Payment Plus (GMWB), Lifetime Income Protector and wish to transfer out of an Asset Allocation Program, you must first terminate your GMAB, GMIB, Lifetime Income Protector SM or Lifetime Payment Plus SM by submitting form F9708 (Mass Mutual Evolution) or F9721 ( ) to the Service Center. If you have a RetireEase SM contract with Payment Protector and wish to transfer out of an Asset Allocation Program, you must first terminate your Payment Protector SM by submitting for FR Owner Information Contract Owner Name Joint Owner Name (if applicable) Daytime Phone Disclosures Refer to your prospectus or contact the Service Center at the number above for additional information regarding transfer restrictions (including fixed account and competing account restrictions) and investment choices. For Artistry contracts: Employee and employer contributions will be allocated the same unless instructed otherwise. Refer to your prospectus or contact the Service Center at the number above for additional information regarding transfer restrictions (including fixed account and competing account restrictions) and investment choices. The entire value in an investment choice will be transferred if it is less than the value requested. If you are participating in RetireEase Budget Protector, transfers among the investment choices will not impact the amount of payments during the current payment year, but will be reflected when we calculate the payments on the next payment anniversary. Refer to your prospectus for additional information regarding transfer restrictions and investment choices. Any unscheduled transfer will terminate the Rebalancing Program. We reserve the right to restrict or reject any transfer. Massachusetts Mutual Life Insurance Company (), 1295 State Street, Springfield, MA and its subsidiaries: C.M. Life Insurance Company and MML Bay State Life Insurance Company, 100 Bright Meadow Boulevard, Enfield, Connecticut Page 1 of 5

2 2. Transfer- Current Assets Process the following request: transfer of current assets: In the lines below, indicate the investments choices you are requesting to transfer out of (Transfer FROM) and into (Transfer TO). Transfers from and to the same investment choices are not allowed. To change the allocations of future payments or to set up/update a rebalancing program, complete section 3. For Equity Edge contracts, check here if you would like to transfer your entire contract value from the MML Money Market to the 5 year Principal Protection Benefit period. For RetireEase contracts, check here if you would like this transfer to include some or all of your linked contracts. The linked contract numbers to include are:. Available investments choices are listed in section 5. Transfer FROM: Transfer TO: (required) Name $ or % (required) Name $ or % 3. Rebalancing & Future Payment Allocation Process the following request(s): Rebalancing Program (LifeTrust contracts- Asset Reallocation Program/ Flex Extra contracts- Asset Allocation Program): Use the section below to select the investment choices to be rebalanced. The Fixed Account cannot participate in the Rebalancing Program. Flex Extra contracts: If you elect to use the GPA as part of your Asset Allocation program, your transfers will automatically be processed on an annual basis. You must indicate a start date and frequency below to participant in the Rebalancing Program. If a start date is not selected, the rebalancing will start on the 1 st day of the following month. LifeTrust contracts must start on the 15 th of the month. Flex Extra contracts must start on the 10 th of the month. You may not participate in the Rebalancing Program if you are participating in the Interest Sweep or a Dollar Cost Averaging Program. Start Date: / / Month Day (1-28) Year Frequency: Monthly Quarterly (default) Semi-Annually Annually Allocation change for future payments: Use the section below to change the allocations of your future purchase payments. Not applicable for RetireEase contracts. To change the allocations of past purchase payments complete section 2. Available investments choices are listed in section 5. (required) Name % Total 100% Page 2 of 5

3 4. Signature(s) I authorize automatic rebalancing among the investment choices of my contract to maintain the allocation instructions indicated in the allocation section of this form. I further agree to be bound by the provisions of the Contract and the rules and limitations stated in this form. The requested transaction(s) will take effect on the business day this form, properly executed and completed, is received at the Service Center provided it is received prior to the close of the New York Stock Exchange. Printed Name of Owner, Employer, Trustee or Plan Administrator Signature of Owner, Employer, Trustee or Plan Administrator (Must sign in capacity if Owner is Trustee, POA, Guardian) Date Printed Name of Joint Owner (If applicable) Signature of Joint Owner (If applicable) Date Printed Name of Irrevocable Beneficiary (If applicable) Signature of Irrevocable Beneficiary (If applicable) Date Contact Information (We will only accept responsibility for forms that are submitted as indicated below) Service Center (800) Fax (toll free) (866) Mailing Address PO Box 9067 Springfield MA Address ANNfax@massmutual.com Overnight Address 1295 State Street Springfield MA Page 3 of 5

4 5. Sub-Account by Product This grid indicates the subaccounts available for each product. Use the grid to complete sections 2, 3, and 6. Artistry Evolution Flex Annuity Flex Extra LifeTrust Passage Plus Premier RetireEase Fidelity VIP Contrafund Guaranteed Principal Account 805 Invesco V.I. Diviersified Dividend Invesco V.I. Global Health Care Invesco V.I. Technology Ivy VIP Asset Strategy MML Aggressive Allocation MML American s Core Allocation MML American s Growth MML American s International MML Balanced Allocation MML Blend MML Blue Chip Growth MML Conservative Allocation MML Equity MML Equity Income MML Equity Index MML Focused Equity MML Foreign MML amental Growth MML amental Value MML Global MML Growth Allocation MML Growth & Income MML High Yield MML Income & Growth MML Inflation-Protected and Income MML International Equity MML Large Cap Growth MML Managed Bond MML Managed Volatility MML Mid Cap Growth MML Mid Cap Value MML Moderate Allocation MML Price Small Company Value MML Short-Duration Bond Page 4 of 5

5 Artistry Evolution Flex Annuity Flex Extra LifeTrust Passage Plus Premier RetireEase MML Small Cap Equity MML Small Cap Growth Equity MML Small/Mid Cap Value MML Strategic Emerging Markets MML Total Return Bond MML U.S. Government Money Market Oppenheimer Capital Appreciation Oppenheimer Conservation Balanced Oppenheimer Total Return Bond Oppenheimer Discovery Mid Cap Growth Oppenheimer Global Multi-Alternatives Oppenheimer Global Oppenheimer Global Strategic Income Oppenheimer International Growth Oppenheimer Main Street Oppenheimer Main Street Small- & Mid-Cap 023 Oppenheimer Government Money PIMCO CommodityRealReturn Strategy VY Clarion Global Real Estate Fixed Account General Account Year Fixed Account (MVA) Year Fixed Account (MVA) Year Fixed Account (MVA) Year Fixed Account (MVA) Month Fixed DCA Account Month Fixed DCA Account Month Fixed DCA Account Year Long Term Guaranteed Fixed Year Long Term Guaranteed Fixed Year Long Term Guaranteed Fixed Year Long Term Guaranteed Fixed Formerly known as Ivy Asset Strategy 2 Formerly known as Oppenheimer Core Bond 3 Effective May 1, 2009, no new purchase payments or transfers will be allowed into Oppenheimer Total Return Bond or Oppenheimer Balanced 4 Oppenheimer Balanced is unavailable in contracts issued on or after April 30, Oppenheimer Government Money is not available for contracts issued after 1/18/ Not available in WA or for contracts issued on or after 5/1/ Not available in WA or OR 8 Value cannot be transferred into the 1 Year or 3 Year Fixed Account 9 Not available in MA or WA 10 Not available in FL, NY, OR, PA and WA 11 Not available in MO as of 1/1/2009. Not available in FL, MN, NY, OR, PA and WA Page 5 of 5