Use this form to change the broker-dealer or registered representative of record on a John Hancock annuity contract. Activation of Lifetime Income Benefit Request - X4391. Additional Premium form - Perspective Advisory II Jackson Private Wealth - NV6260 [NY] Variable products are distributed by Jackson National Life Distributors LLC. May not be available in all states and state variations may apply. 1 Corporate Way ^ Guarantees are backed by the claims-paying ability of Jackson National Life Insurance Company or Jackson National Life Insurance Company of New York and do not apply to the principal amount or investment performance of a variable annuity’s separate account or its underlying investments. laserapp.sales@ipipeline.com. Jackson National Life Distributors LLC, Not FDIC/NCUA insured • Not bank/CU guaranteed • May lose value • Not a deposit • Not insured by any federal agency. By 1984, Jackson had grown to $1 billion in assets.

Jackson works with vendors and other partners to help deliver online and mobile advertisements for Jackson that we think may be of interest to you. - NV5582 [NY], Fund Transfer Request/Future Allocation Change - Fifth Third Perspective - FT4382, Fund Transfer Request/Future Allocation Change - NV4382 [NY], Fund Transfer Request/Future Allocation Change - Perspective Advisors - NV4278 [NY], Fund Transfer Request/Future Allocation Change - Perspective Advisors II - NV4482 [NY], Fund Transfer Request/Future Allocation Change - Perspective Advisory II - NV4982 [NY], Fund Transfer Request/Future Allocation Change - Retirement Latitudes - V5482, Fund Transfer Request/Future Allocation Change - Variable Life - NV3082 [NY], Fund Transfer Request/Future Allocation Change - Variable Life - V3082 [Generic], Fund Transfer Request/Future Allocations Change - Perspective Adv. May not be available in all states and state variations may apply. - V5582 [Generic], Fund Transfer Request/Future Allocation Change - Curiangard Simplified Retirement Ann. JNAM is an affiliate of Jackson National Life Distributors LLC, and Jackson National Life Insurance Company. Jackson is the marketing name for Jackson National Life Insurance Company (Home Office: Lansing, Michigan and Jackson National Life Insurance Company of New York (Home Office: Purchase, New York).

JACKSON NATIONAL Forms . Are you sure you want to leave? Jackson National Life Distributors LLC Not FDIC/NCUA insured • Not bank/CU guaranteed • May lose value • Not a deposit • Not insured by any federal agency. Jackson ® is the marketing name for Jackson National Life Insurance Company ® and Jackson National Life Insurance Company of New York ®. Jackson National Life Insurance Company

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II Jackson Private Wealth - V4982, FutureGuard 6 GMIB Election-Cancellation Form - NV6237 [NY], FutureGuard 6 GMIB Election-Cancellation Form - V6237, GMWB Optional Benefit Election - NV4390 [NY], Guaranteed Minimum Withdrawal Benefit - V6265 [AK], Immediate Annuity App - X0919A [CT-DE-DC-ND-NJ-SD], Immediate Annuity Select Good Order Checklist - X3644 [All Except NY], Important Disclosure Regarding Additional Interest Rate - N7142 [NY], Indemnification Agreement - X2909 [AO Except NY], Information Sharing Agreement and Approved Vendor Certification - N2367 [NY], Internal Exchange Request - X4170 [AO Except NY], Internal Florida Replacement Disclosure - X2614FL [FL], Jackson Advantage and Perspective Advisory II - Summary Comparison - NMV23631NY [NY], Jackson Perspective II Application - NV775 [NY], Jackson Perspective II Application - V775 [Generic], Jackson Perspective II Application - V775(MS) [MS], Jackson Perspective II Application - V775A [DE-ND-SD], Jackson Perspective II Application - V775CA [CA], Jackson Perspective II Application - V775FL [FL], Jackson Private Wealth Application - V795 [Generic], Jackson Private Wealth Application - V795 [MS], Jackson Private Wealth Application - V795A [DE-ND-SD], Jackson Private Wealth Application - V795CA [CA], Jackson Private Wealth Application - V795FL [FL], Jackson RateProtector Application - N520 [NY], Jackson RateProtector Application - X520 [Generic], Jackson RateProtector Application - X520(MS) [MS], Jackson RateProtector Application - X520A [DE-ND-SD], Jackson RateProtector Application - X520CA [CA], Jackson RateProtector Application - X520FL [FL], Juvenile Beneficiary Trustee Designation - N1335 [NY], Juvenile Beneficiary Trustee Designation - X1335, MarketProtector Advisory Application - X265 [Generic], Marketprotector Advisory Application - X265(MS) [MS], MarketProtector Advisory Application - X265A [DE-ND-SD], Marketprotector Advisory Application - X265FL [FL], MarketProtector Advisory III Application - X2685 [Generic], MarketProtector Advisory III Application - X2685(MS) [MS], MarketProtector Advisory III Application - X2685A [DE-ND-SD], MarketProtector Advisory III Application - X2685FL [FL], MarketProtector Advisory III Contract Disclosure - JMI24092 [DE-FL-ND-SD], MarketProtector Advisory III Contract Disclosure - JMI24092A [AR], MarketProtector Advisory III Contract Disclosure - JMI24092IIPRC [Generic], MarketProtector Advisory III Contract Disclosure - JMI24092NJ [NJ], MarketProtector Advisory III Contract Disclosure - JMI24092WI [WI], MarketProtector Application - X250CA [CA], MarketProtector Application - X260 [Generic], Marketprotector Application - X260(MS) [MS], Marketprotector Application - X260A [DE-ND-SD], Marketprotector Application - X260FL [FL], MarketProtector III Application - X2680 [Generic], MarketProtector III Application - X2680(MS) [MS], MarketProtector III Application - X2680A [DE-ND-SD], MarketProtector III Application - X2680FL [FL], MarketProtector III Contract Disclosure - JMI24091 [DE-FL-ND-SD], MarketProtector III Contract Disclosure - JMI24091A [AR], MarketProtector III Contract Disclosure - JMI24091IIPRC [Generic], MarketProtector III Contract Disclosure - JMI24091NJ [NJ], MarketProtector III Contract Disclosure - JMI24091WI [WI], MarketProtector/MarketProtector Advisory Crediting Method Renewal Instruction Form - X2067, Multiple Ownership Designation Supplement - N1006 [NY], Multiple Ownership Designation Supplement - X1006 [Generic], Notice Regarding Replacement - N0512A [NY], Notice Regarding Standards for Medi-Cal Eligibility - X3856CA [CA], Optional Benefit Election/Termination Lifetime Income Rider - X4390, Perspective Advisors Fund Transfer Request - V4282 [Generic], Perspective Advisors II Directed Transfer - NV4490 [NY], Perspective Advisors II Directed Transfer - V4490 [Generic], Perspective Advisors II Fund Transfer Request - V4482, Perspective Advisors II Systematic Investment - NV4475 [NY], Perspective Advisors II Systematic Investment - V4475 [Generic], Perspective Advisory II Application - NV790 [NY], Perspective Advisory II Application - V790 [Generic], Perspective Advisory II Application - V790 [MS], Perspective Advisory II Application - V790A [DE-ND-SD], Perspective Advisory II Application - V790CA [CA], Perspective Advisory II Application - V790FL [FL], Perspective Fund Transfer Request - V4382 [Generic], Perspective II and Perspective Advisory II - Summary Comparison - NMV23153NY [NY], Perspective II Systematic Investment Form - NV2375 [NY], Perspective II Systematic Investment Form - V2375 [AO Except NY], Preliminary Contract Summary - Action - JMF9536WI [WI], Preliminary Contract Summary - Action One - JMF9537WI [WI], Preliminary Contract Summary - BonusMAX - JMF9441WI [WI], Preliminary Contract Summary - BonusMAX One - JMF9541WI [WI], Preliminary Contract Summary - MAX - JMF9493WI [WI], Preliminary Contract Summary - MAX One - JMF9539WI [WI], Preliminary Contract Summary - MAX One XL - JMF9540WI [WI], Preliminary Contract Summary - MAX XL - JMF9543WI [WI], Preliminary Contract Summary - OptiMAX - JFF9522WI [WI], Preliminary Contract Summary - OptiMAX 100 - JFF9532WI [WI], Preliminary Contract Summary - OptiMAX 3 - JFF9525WI [WI], Preliminary Contract Summary - OptiMAX 5 - JFF9530WI [WI], Preliminary Contract Summary - OptiMAX One - JFF9524WI [WI], Preliminary Contract Summary - SuperMAX XL - JMF9544WI [WI], Producer as Trustee - Beneficiary Acknowledgement Form - N3859 [NY], Producer as Trustee - Beneficiary Acknowledgement Form - X3859 [All Except NY], Product Suitability Determination - X0960 [Multi-State], Product Suitability Determination Supplement- X0960-S [Multi-State], Replacement Form - External - X0512KS [KS], Replacement Form - Internal - X0512IKS [KS], Replacement Form - X0512COMBO [Multi-State], Replacement Instructions - XADV5790 [Multi-State], Request for Transfer or Exchange of Assets - IMG - N3783 [NY], Request for Transfer or Exchange of Assets - X3783 [AO Except NY], Request for Variable Annuity Outgoing Transfer or Exchange of Assets - NV3993 [NY], Request for Variable Annuity Outgoing Transfer or Exchange of Assets - V3993, Request to Change Servicing Producer/Representative - N1817 [NY], Request to Change Servicing Producer/Representative - X1817 [Generic], Retirement Latitudes Application - V776 [Generic], Retirement Latitudes Application - V776(MS) [MS], Retirement Latitudes Application - V776A [DE-ND-SD], Retirement Latitudes Application - V776CA [CA], Retirement Latitudes Application - V776FL [FL], Retirement Latitudes Directed Transfer - V5490, Roth Conversion Request Form - N4270 [NY], Roth Conversion Request Form - X4270 [Generic], Sales Material Checklist (Reg 60) - N3557 [NY], Sales Material Checklist (Reg 60) - NV3557 [NY], Sales Material Checklist - Perspective Advisory II - NV3887 [NY], Select Annual Reset Crediting Method Renewal Instruction Form - X2065, Select Annual Reset Preliminary Contract Summary - JFI4229WI [WI], Single-Premium Deferred Annuity Disclosure - X1192 [KS-OH], Systematic Investment - Curiangard Simplified Retirement Annuity - V5575 [Generic], Systematic Investment - Fifth Third Perspective - FT2375, Systematic Investment - Flexible Premium Variable Life Insurance - NV3075 [NY], Systematic Investment - Flexible Premium Variable Life Insurance - V3075 [Generic], Systematic Investment - Perspective Advisors - NV3109 [NY], Systematic Investment - Perspective Advisory II - NV5675 [NY], Systematic Investment - Perspective Advisory II Jackson Private Wealth - V5675 [Generic], Systematic Investment - Retirement Latitudes - V5385 [Generic], Systematic Withdrawal - V4370 [AO Except NY], Telephone Authorization Request - NV3982 [CA], Telephone Authorization Request - V3982 [Generic], Telephone/Electronic Authorization Request - NV3782 [NY], Telephone/Electronic Authorization Request - V3782 [Generic], Telephone/Electronic Authorization Request - X3782, Trustee Certification of Investment Powers - N5335, Trustee Certification of Investment Powers - X5335, Variable Annuities - Your Perspective Advisory II Product Summary - JMV17096NY, Variable Annuities - Your Perspective II Product Summary - JMV16685NY [NY], Variable Annuity Death Benefit Claim Form - NZ1150 [NY], Variable Annuity Death Benefit Claim Form - Z1150 [Generic], Variable Annuity Death Benefit Claim Form - Z1150A [NJ], Variable Annuity Good Order Checklist - NV3848 [NY], Variable Annuity Good Order Checklist - V3848 [Generic], Variable Annuity Systematic Withdrawal Request - NV4370 [NY], (800) 985-2174



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