Required Minimum Distribution (RMD) Election

Required Minimum Distribution (RMD) Election Use this form with Qualified contracts, other than Roth and Beneficiary IRAs, to take a one-time RMD or establish an ongoing RMD. Use form FR1204 for contracts participating in the Lifetime Income Protector. For additional information, contact your personal financial representative, tax advisor or the MassMutual Customer Service Center. A Contract Information : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : 1. Contract number: 2. Owner name: 3. Taxpayer Identification Number (SSN/ITIN/EIN): 4. Phone number: ( ) - Extension: Home Work Mobile 5. Email address: B RMD Calculation : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : Calculation with Joint Life Expectancy can only be selected if the spouse is the sole beneficiary currently on record and is more than 10 years younger than the participant. The amount withdrawn will be taken on a pro rata basis. 1. Was this contract with MassMutual on December 31 of last year: Yes No (If no, complete 1a.) a. Provide the Fair Market Value of the prior year: $ 2. Calculation with Joint Life Expectancy: Yes (If yes, complete 2a - 2c.) No a. Spouse s name: b. Spouse s date of birth (mm/dd/yyyy): c. Spouse s Taxpayer Identification Number (SSN/ITIN/EIN): C Automatic RMD Election : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : For Qualified Plan-owned contracts, RMD is only available for a one-time distribution. Refer to the section I Disclosures for Automatic RMD availability. If a start date is not indicated, the RMD will begin within 5 business days. 1. Complete this section to: (Select one): Set up a new Automatic RMD Change an existing Automatic RMD 2. RMD frequency (Select one): Monthly Quarterly Semi-annually Annually 3. RMD start date (mm/dd(1-28 only)/yyyy): (Flex contracts- RMD can only run on the 7th, 12th, 17th, 22nd and 27th. If an invalid start date is chosen, your SWP will run on the next available date.) 4. Defer first year RMD Only available for the first RMD. (mm/dd(1-28 only)/yyyy): Defer first distribution until next year on or before April 1st. Cannot be the same date as the RMD start date. If selected, the first distribution must be taken before April 1st and the second distribution must be taken by December 31st of the same year. The RMD start date will initiate your second distribution. D One-Time RMD Distribution : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : A request will need to be submitted each year to fulfill the RMD requirement. Contingent Deferred Sales Charges/Surrender Charges may apply to RMD withdrawals taken from this contract that are not based on only the assets held under this contract. For Qualified Plans, RMD is only available for a one-time distribution. One-Time RMD for this contract only. This one-time distribution will be for the current year unless a previous year is indicated: Calculate my one-time RMD for all policies. If the combined value of all IRAs or TSAs is not given, MassMutual will calculate your RMD using the Fair Market Value of only the contract number listed above. Total Fair Market Value of all IRAs or TSAs: $ Include rollover amounts and recharacterized conversion contributions not included in any applicable account balance on December 31st. 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 Required Minimum Distribution F6695-AN 0818

E Distribution Instructions : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : UPS Overnight Request. Send distribution via UPS Priority. Only available for one-time RMD distribution. (The carrier charges a fee and cannot ship to a PO Box. If information below is not complete, the check will be mailed through regular U.S. Postal Service.) UPS account number: UPS account name: Associated Zip/Postal Code: Email delivery notification (If yes, Owner s email address indicated in section A will be used): Yes No 1. Pay the proceeds to (Select one and complete the corresponding section below): Owner at address of record. (Default - allow 10 business days for normal delivery) Skip to section F. Owner via Electronic Funds Transfer. (EFT) Complete question 2. Proceeds to an Allowable Alternate payee and/or alternate address. Complete question 3. Owner via Electronic Funds Transfer (EFT)/Direct Deposit (Wire transfers are not available) The name displayed on the voided check or signed specification sheet/letter of instruction from the financial institution must match the Annuitant on the contract in order to electronically transfer the payment to the account. Deposit slips and starter checks will not be accepted. Allow 3 to 5 business days for the payment to be posted in the bank account requested. If sufficient documentation to support the EFT is not provided, a check will be sent to the Owner at the address of record via mail. If the requested EFT start date is less than 10 business days from the receipt of this request, the first withdrawal will be sent via check to the address of record. Future withdrawals will be sent EFT. 2. Bank account type (Select one): Savings (Submit a signed specification (spec) sheet/letter of instruction from the financial institution.) Checking (Attach a voided check or submit a signed specification (spec) sheet/letter of instruction from the financial institution.) Allowable Alternate Payee and/or Alternate Address (Proceeds may not be sent to an agent/broker address.) If all or a portion of the distribution is to be paid to a party other than the Owner, they must meet MassMutual s definition of an allowable alternate payee. Allowable alternate payees may be: Charitable organization (Available only for IRAs where the Owner is 70½ years of age or older. Tax Identification Number of charity must be provided at time or request.) Brokerage accounts for benefit of Owner (i.e., brokerage account is in the owner s name) Participant when paid under a Qualified Plan (A distribution of proceeds from a Qualified Plan will be sent to the Plan unless otherwise requested.) If the definition of an allowable alternate payee is met, complete 3a-3c. A Notary stamp/seal is required in section K Notary Stamp/Seal. 3. Allowable alternate payee information (Complete section G Notary Stamp/Seal): a. Payee name: b. Taxpayer Identification Number (Complete if Charitable organization or Participant): c. Mailing address (PO Box or Street, Apt. or Suite #, City & State or Country, ZIP/Postal Code): page 2 of 5 Required Minimum Distribution F6695-AN 0818

F Withholding Information : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : The Owner must complete this section unless the contract is owned a Qualified Plan. The Participant must complete this section if the contract is a Qualified Plan and the RMD is being paid to the Participant. Payments you receive from Massachusetts Mutual Life Insurance Company ( MassMutual ) are subject to federal income tax withholding unless you elect not to have withholding apply. Withholding will only apply to the portion of your payment that is included in your income subject to income tax. There will be no withholding on the return of your own nondeductible contributions to the contract. If we do not know what portion of a distribution is taxable, we will withhold on the net amount after charges. If you are establishing automatic payments, any election you make will remain in effect until you revoke it y returning to us a signed and dated revocation of election. If no withholding election is affirmatively made, 10% federal income tax will be withheld, subject to certain exceptions. Once a payment has been made, the withholding election applicable to that payment cannot be changed. If you elect not to have withholding apply or if you do not have enough federal income tax withheld from these payments, you may be responsible for the payment of estimated tax and/or be subject to estimated tax penalties. State income tax withholding may also apply. State income tax withholding requirements vary by state. If required under the law of the state in which you live, state income tax withholding will also apply. For more information on the withholding requirements in your state, see State Income Tax Withholding Disclosure. You should consult with a tax advisor before you begin receiving payments. 1. Federal Tax Withholding Election Check the appropriate box below to make your withholding election. If no withholding election is affirmatively made, a 10% federal tax will be withheld, subject to certain exceptions. Do not withhold Withhold 10% (Default) Withhold more than 10% (Specify): % 2. State Tax Withholding Elections* Check the appropriate box to make a state income tax withholding election. If no election is affirmatively made, we will apply the default withholding rules in your state, if any. For residents of states other than Georgia, Minnesota & South Carolina: Do not withhold state unless mandatory Apply state default withholding Withhold the following (Specify)**: % or $ **Must comply with any state minimum For residents of Georgia, Minnesota or South Carolina: Do not withhold state unless mandatory Use the default assumption of Single with Zero Allowances Use the following filing status and allowances: a. Marital status (Select one): Single Married Head of Household b. Number of allowances: c. Withhold additional state amount (If applicable): $ * Certain states require a state specific form in order to elect other than the default state withholding. See attached State Income Tax Withholding Disclosure - FR2070. G Agreements & Signatures : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : By completing question E2 Electronic Funds Transfer (EFT)/Direct Deposit, I, the Owner, authorize MassMutual to deposit, via Electronic Funds Transfer, all payments to the bank account identified in section E. Payments made via EFT will fully satisfy MassMutual s obligation to make payments to me. Should MassMutual make an overpayment to me, I also authorize MassMutual to debit the bank account identified in section E in the amount of the overpayment in order to recoup the amount overpaid to me. To cancel this agreement, I must notify the MassMutual Service Center. I have read the Required Minimum Distribution guidelines provided and understand the options available to me. I agree to be bound by the provisions of the contract as amended and the rules and limitations stated in this election form and in the Required Minimum Distribution guidelines. I understand the income tax implications of my decision and understand that I am personally responsible for any tax implications of this election. Taxpayer Certification. By my signature, I, the Owner/Participant, certify under penalties of perjury that: (1) the number shown in section A is my correct Taxpayer Identification Number; (2) I am not subject to backup withholding; (3) I am a U.S. person (including U.S. resident alien); and (4) the FATCA code entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Strike out any of these statements if incorrect. Note: While we are required by the IRS to include item 4 above, FATCA does not apply to a U.S. account owned by a U.S. person, so we have not included the ability to enter an exemption code. If you have indicated that you are not a U.S. person, any applicable FATCA information will be captured on the Form W-8. page 3 of 5 Required Minimum Distribution F6695-AN 0818

G Agreements & Signatures continued The Internal Revenue Service (IRS) does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Marital Status. (Required for all TSA, Keogh (H.R. 10), Qualified Plan Owned contracts where the RMD is being paid to the Participant, and former Qualified Plan (individually-owned) contracts). By my signature below, I, the Owner/Participant, certify that I am (Select one): Single, divorced/legally separated, widowed or unable to locate my spouse. Married and my Plan is not subject to ERISA (Consult with your employer if you are uncertain whether your Plan is subject to ERISA). Married and my Plan is subject to ERISA (Signature of spouse and Notary stamp/seal also required). Signature of Owner/Participant: Printed name: Title (If applicable): Signature of Annuitant (If applicable): Printed name: Spousal Consent & Notary Stamp/Seal (Required for all ERISA TSA, Keogh (H.R. 10), & former Qualified Plan (individually-owned) contracts) I, the Owner/Participant s spouse, hereby consent to the Owner/Participant s election to receive a distribution from the Keogh (H.R. 10) Plan or former Qualified Plan (individually-owned ) contract. I understand and acknowledge that I am waiving any legal right to this distribution as part of any death benefit payable from this contract. Signature of Spouse: Printed name: On, (mm/dd/yyyy) (full legal name) personally appeared before me and is known to me and/or satisfactorily proved to me to be the person who signed this document of his/her own free will and accord. Signature of Notary Public: Affix Notary State/County where signed: Stamp/Seal My commission expires (mm/dd/yyyy): Plan Administrator Certification (Complete if required by your 403(b) Plan) By signing below as the Plan Administrator, you are certifying to MassMutual that you are the Plan Administrator, you are aware that the Participant is requesting a distribution, and that the employee is eligible to receive this distribution. Signature of Plan Administrator: Printed Plan Administrator name: Plan name: page 4 of 5 Required Minimum Distribution F6695-AN 0818

H Submission Instructions : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : For more information or general questions, use the resources below or for additional information regarding your contract, visit www.massmutual.com. Once you have reviewed and completed the request, return pages 1-4 for processing. We will only accept responsibility for forms that are mailed/faxed to the address/fax number indicated below. Phone: (800) 272-2216 Monday through Friday, 8 a.m. 8 p.m. Eastern Time Fax Number: (866) 329-4272 Mailing Address: MassMutual Attention: Annuity Hub PO Box 9067 Springfield, MA 01102-9067 Email Address: ANNfax@massmutual.com I Disclosures : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : Contact your tax adviser with questions regarding your particular situation. General Disclosures. If you are a participant in an Individual Retirement Arrangement (IRA), a Tax Sheltered Annuity (TSA), 457, or a pension Plan, profit-sharing or 401(k) Plan, the minimum distribution requirement applies to you. The Minimum Distribution Rule does not apply to Roth IRAs during the owner s lifetime. The year in which you must begin taking your RMD depends on the type of Plan you have and whether you are retired. Generally, if you are retired and you were a participant in any of the Plans mentioned above, the year you turn 70 ½ years of age is your first minimum distribution year. If you are working for the employer that sponsored the Plan in the year you turn 70½ years of age, the year you retire is your first minimum distribution year. This rule applies to all the Plans mentioned except IRAs and Plans with a company in which you have at least a 5% ownership interest. If you have an IRA or a Plan with a company in which you have at least a 5% ownership interest, your minimum distribution year is the year you turn 70½, even if you are still working. Deferral of First Distribution. Once you know your minimum distribution year, you have the option of deferring your first distribution until April 1st of the following year. However, before you decide to take advantage of the deferral option, keep in mind that subsequent distributions must be taken by December 31st of each year following your first minimum distribution. Taxable distributions previously taken within the current tax year will be applied toward your RMD requirement. Withdrawals in excess of the RMD amount for each individual contract will be subject to the conditions of the contract. If your requested RMD brings your contract value to zero, your contract will automatically terminate. Aggregating RMD amounts. All IRAs can be aggregated for the purpose of determining the RMD to be taken from a particular IRA contract. All TSAs can be aggregated for the purpose of determining the RMD to be taken from a particular TSA contract. However, IRAs and TSAs can not be aggregated together for the purpose of determining an RMD amount. Distribution amount. By completing this form, you choose to have MassMutual calculate your distribution and you will receive an amount based on MassMutual s interpretation of the IRS code and the information you have provided. Automatic Withdrawal Program. The Automatic Withdrawal Program for RMD is not available on the following products: Flex Extra 457 Fixed Products issued before 1992 Flex-Annuity (Flex 4 & Fund 4) RMD requests for these products must be made as a one-time distribution. Contingent Deferred Sales charges/surrender charges may apply to RMD withdrawals taken from this contract that are not based on only the assets held under this contract. Flex Extra. The withdrawal will be taken on a pro rata basis from your current investment choices unless directed otherwise. Odyssey Select and Stable Voyage. Only one calendar year s RMD withdrawal is available to be taken each contract year with no surrender charge. RMD withdrawals in excess of this limit will be assessed any applicable surrender charges. Guaranteed Minimum Withdrawal Benefit (GMWB) & MassMutual Lifetime Payment Plus. RMD withdrawals taken under our automatic distribution program will not reduce the Benefit Base, even if such RMD distributions exceed the Guaranteed Lifetime Withdrawal Amount (GLWA) for the Contract Year. RMD withdrawals taken outside of the automatic distribution program may negatively impact the rider value. Review your contract or a prospectus for full details. Guaranteed Minimum Accumulation Benefit (GMAB) & Guaranteed Minimum Income Benefit (GMIB). RMD withdrawals are treated like partial withdrawals and may negatively impact the rider value. Review your contract or a prospectus for full details. If you have elected an optional guaranteed minimum accumulation benefit, guaranteed minimum income benefit or a guaranteed minimum withdrawal benefit with your variable annuity contract and would like to understand the impact of a withdrawal on the benefit provided by those features, contact us to obtain a personalized calculation demonstrating the effect of a withdrawal. page 5 of 5 Required Minimum Distribution F6695-AN 0818

State Income Tax Withholding Disclosure State income tax withholding requirements on taxable distributions vary by state. State income tax, if required by your state of residence, will be withheld by MassMutual as detailed below. If you have questions regarding the withholding rules that we will apply in your state, or if you want to make a state income tax withholding request, contact the MassMutual Service Center at 1-800-272-2216 (Monday through Friday, 8am-8pm Eastern Time). State Withholding Requirements : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : If you are a resident of... State income tax will... Alabama, Colorado, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, New Jersey, New Mexico, New York*, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Utah, West Virginia or Wisconsin Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington or Wyoming Arizona, Illinois Arkansas, California, Maine, North Carolina, or Oregon Connecticut Delaware, Iowa, Kansas, Massachusetts, Nebraska, Oklahoma, or Vermont District of Columbia Georgia Maryland Michigan Virginia Not be withheld unless you request state income tax withholding. Not be withheld. Will be withheld from periodic payments (i.e. annuitized payments) only if you request state income tax withholding. State income tax will not be withheld from any other distribution. Be withheld if federal income tax is withheld, unless you opt out of state income tax withholding. However, even if federal in- come tax is not withheld, you may request that state income tax be withheld. In Arkansas and North Carolina, you may not opt-out of eligible rollover distributions. Be withheld, unless you claim exemption on form CT-W4P. Be withheld if federal income tax is withheld. However, even if federal income tax is not withheld, you may request that state income tax be withheld. Be withheld only on a full surrender of a qualified contract. State income taxes will not be withheld from any other distribution, unless you request state income tax withholding. Be withheld from periodic payments (i.e. annuitized payments), unless you opt-out of withholding. State income taxes will not be withheld from any other distributions, unless you request state income tax withholding. Be withheld from eligible rollover distributions, if federal income tax is withheld. You may request withholding on distributions from qualified contracts and non-qualified Annuities. Be withheld, unless you opt out of withholding by submitting form MI W-4P. Be withheld if federal income tax is withheld, unless your contract is an IRA or SEP-IRA. If your contract is held as an IRA or SEP-IRA, state income taxes will not be withheld unless you request state income tax withholding. State taxes will not be withheld on a lump sum distribution of a death benefit payable under an annuity contract, unless requested * Residents of New York may elect withholding on distributions from Annuities only. 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 2 State Income Tax Withholding Disclosure FR2070-US 0618

State Withholding Requirements continued If Withholding Applies State For non-periodic (i.e non-annuitized) payments For periodic (i.e. annuitized) payments Alabama, Colorado, Hawaii, Idaho, Kentucky, Louisiana, Mississippi, North Dakota, Ohio, Pennsylvania, Rhode Island, Utah, West Virginia Arizona N/A Will be the amount requested You may choose from the following rates: 0.8%, 1.3%, 1.8%, 2.7%, 3.6%, 4.2%, and 5.1%. You may also request additional withholding. Arkansas Must be at least 3% of the taxable amount Will be 5% on eligible rollover distributions Will be 5% on eligible rollover distributions California Must be at least 10% of the federal withholding amount Connecticut Must be at least 6.99% of the taxable amount, unless you claim exemption, unless you claim exemption Delaware, Iowa Must be at least 5% of the taxable amount District of Columbia Georgia Will be 8.95% on full surrenders of a qualified contract Will be the amount requested for all other distributions Must be at least as much as would be withheld if the payment were wages Will be the amount requested Illinois N/A Will be the amount requested Indiana, Missouri, Montana, New Jersey, New Mexico Kansas, Maine, Nebraska, Oklahoma Must be at least 5% of the taxable amount Must be at least $10. In Nebraska, except for eligible rollover distributions, must be at least 5% of the taxable amount. Maryland Massachusetts Michigan Minnesota, South Carolina Will be 7.75% of the taxable amount for eligible rollover distributions from qualified contracts. Must be at least $5 for all other payments. Must be at least 5.1% of the taxable amount Must be at least 4.25% of the taxable amount New York, Wisconsin Must be at least $5 North Carolina, Virginia Must be at least 4% of the taxable amount Will be calculated as of the payment were wages Oregon Must be at least 8% of the taxable amount Utah Will be the amount requested Vermont Must be at least 24% of the federal withholding amount page 2 of 2 State Income Tax Withholding Disclosure FR2070-US 0618