Instructions to Complete this Form (Important Information Below) 1. Print the (or Application number) and the Name of the Insured in the space provided at the top of the form. 2. Enter () in the FROM column for the investment option you choose. You may select only one investment option. The investment option may be a division of the Separate Account or the Guaranteed Principal Account (GPA). The Day of your Policy Date will be the Directed Monthly Deduction Program (DMDP) day. Provided there is sufficient account value in your designated investment option, the monthly charges will be deducted from your designated investment option on the appropriate Monthly Charge Date. Insufficient account value within your designated investment option will result in monthly charges being deducted pro rata from all investment options with account value. Customer Service A form is required. If you have reviewed and completed this form, please return pages 2-5 for processing. To submit your request, please mail or fax this form to: Mail this form to: Massachusetts Mutual Life Insurance Company Life Customer Service Center Hub P.O. Box 1865 Springfield, MA 01102-1865 Fax Information: 1-866-329-4527 MassMutual Customer Service Center: 1-800-272-2216 Monday through Friday, 8 a.m. 8 p.m. Eastern Time For additional information regarding your policy, please use the following resource: Internet Service Connection: www.massmutual.com We will only accept responsibility for forms that are faxed or mailed to the number or address indicated. A copy of this document transmitted by facsimile shall have the same effect as an original. Massachusetts Mutual Life Insurance Company (MassMutual), 1295 State Street, Springfield, MA 01111-0001 and its subsidiaries: C.M. Life Insurance Company and MML Bay State Life Insurance Company, 100 Bright Meadow Boulevard, Enfield, Connecticut 06082-1981. Page 1 of 5 Client Retains this Page
Please complete the entire form and print The Directed Monthly Deduction Program (DMDP) is a way to have monthly policy charges deducted from your account value in one investment option, rather than from all options on a pro rata basis. Deductions are due on policy Monthly Charge Dates, which are on the same day of the month as the Policy Date. This request may be used to elect, change or cancel DMDP. It may also be used to elect DMDP at time of policy application. The DMDP Start Month must be indicated below. Only one investment option may be elected for the Directed Monthly Deduction Program. If a DMDP End Month is not elected, DMDP will continue until you change or cancel it. DMDP Start Month / DMDP End Month / (Optional) (Month) (Year) (Month) (Year) Refer to your prospectus for additional information about the Divisions of the Separate Account and for information regarding the Directed Monthly Deduction Program. VUL VUL VUL SVUL SVUL Specialty I Invesco V.I. Global Health Care Invesco V.I. Technology MML Managed Volatility PIMCO CommodityRealReturn Strategy VY Clarion Global Real Estate International/Global Janus Henderson Global Research 1 MML Foreign MML Global Oppenheimer Global Oppenheimer International Growth Templeton Foreign VIP Small/Mid-Cap Growth MFS New Discovery MML Mid Cap Growth MML Small Cap Growth Equity Oppenheimer Discovery Mid Cap Growth T. Rowe Price Mid-Cap Growth 2 Page 2 of 5
Small/Mid-Cap Blend VUL VUL VUL I SVUL SVUL Deutsche Small Cap Index MML Small Cap Equity Small/Mid-Cap Value Franklin Small Cap Value VIP MML Mid Cap Value MML Small/Mid Cap Value Large Cap Growth Goldman Sachs Strategic Growth Janus Henderson Forty 3 MML Blue Chip Growth Oppenheimer Capital Appreciation T. Rowe Price Blue Chip Growth Large Cap Blend American Funds Growth Income Fidelity VIP Contrafund Invesco V.I. Diversified Dividend MFS Investors Trust MML Equity Index MML Growth & Income Oppenheimer Main Street Large Cap Value American Century VP Income & Growth American Century VP Value MML Equity MML Equity Income MML Income & Growth T. Rowe Price Equity Income Page 3 of 5
VUL VUL VUL SVUL SVUL Asset Allocation I MML Aggressive Allocation MML Balanced Allocation MML Conservative Allocation MML Growth Allocation MML Moderate Allocation Balanced American Funds Asset Allocation Janus Henderson Balanced 4 MML Blend Fixed Income MML Inflation-Protected and Income MML Managed Bond Oppenheimer Total Return Bond 5 Oppenheimer Global Strategic Income Money Market MML U.S. Government Money Market Guaranteed Principal Account (GPA) 1 Formerly known as Janus Aspen Global Research 2 T. Rowe Price Mid-Cap Growth division is not available as an investment option for policies issued on May 1, 2004 or later. 3 Formerly known as Janus Aspen Forty 4 Formerly known as Janus Aspen Balanced 5 Formerly known as Oppenheimer Core Bond Page 4 of 5
: Insured Name 2: (if applicable) Individual, Joint or Multiple Owners Signature Section (All owners must sign.) Printed Name of Owner (1) Signature of Owner Date Signed Printed Name of Additional Owner Signature of Additional Owner Date Signed Printed Name of Additional Owner Signature of Additional Owner Date Signed Residency Address of Owner (1) (Apt/House Number & Street Name, City State Zip) Corporate, Partnership or Trust Owned Signature Section Printed Name of Corporation, Partnership or Trust Date of Trust Date Signed Signature of Corporate Officer or Trustee Title Date Signed I am the sole officer of the corporation listed Signature of Corporate Officer or Trustee Title Date Signed Assignee Signature Section Printed Name of Assignee Signature & Title Date Signed Page 5 of 5