300+ Series IRA Enrollment Form To start a 300+ Series IRA for contributions, rollovers or transfers. Available through AXA Equitable Life Insurance Company TOLL-FREE VOICE # 1-800-248-2138 CORRESPONDENCE FAX # 1-816-502-0175 CONTRIBUTIONS Equitable 300+ Series FOR OVERNIGHT & CERTIFIED MAIL Equitable 300+ Series PO Box 4875 Equitable 300+ Series P.O. Box 13678 Syracuse NY 13221 100 Madison Street, Syracuse NY 13202 Newark, NJ 07188-3678 1. Information About You Mr. Mrs. Miss Ms. Other: Male Female Name: Social Security Number: Date of Birth: E-mail address: Street Address: City: State: Zip Code: This is my Home Address Business Address State of Residence: Mobile Telephone: ( ) Business Telephone: ( ) Association Affiliation: Name of Association Member Spouse of Association Member or Employee Employee of Association Affiliated Practice 2. IRA Type I am opening up a new 300+ Series IRA to make (check one) Contributory IRA (regular IRA contributions) Beneficiary Continuation Option (BCO) Rollover IRA contributions (Complete the IRA Rollover Form) Contributory ROTH IRA contributions Conversion ROTH IRA contributions If you are enrolling in a SIMPLE or SEP IRA, please attach a check made Rollover ROTH IRA contributions payable to Equitable for the one-time SEP-IRA or SIMPLE IRA contributions (Insert Employer information below) nonrefundable $25 enrollment fee. Name of Employer Employer’s TAX ID Number 3. Beneficiary Designation I hereby agree to the Beneficiary Statement below. I do not agree to the Beneficiary Statement below and have attached a designation or change of beneficiary form. If you do not agree to the Beneficiary Statement, but have not filed a designation or change of beneficiary form, or the form is not valid, the Beneficiary Statement below will apply in the event of death. BENEFICIARY STATEMENT Unless a beneficiary designation is in effect at the time an amount becomes payable, any amount which becomes payable to my beneficiary shall be payable to the first surviving class of the following: (1) widow or widower; (2) surviving children; (3) the executors or administrators of the person upon whose death the payment becomes due. IRA Enrollment 1/20

4. Investment Allocation of Future Contributions WHOLE FUND PERCENTAGE Cash Equivalents: EQ/Money Market __________% Guaranteed Interest Option __________% Bonds: Charter Multi-Sector Bond __________% EQ/Intermediate Govt. Bond __________% Asset Allocation: EQ/Moderate Allocation __________% Large Company Stocks: EQ/Equity 500 Index __________% EQ/Large Cap Value Mged. Vol. __________% EQ/Common Stock Index __________%WHOLE FUND PERCENTAGE Large Company Stocks( Continued): EQ/Capital Guardian Research __________% EQ/Large Cap Growth Mged. Vol. __________% Multimanager Aggressive Equity __________% Sector/Specialty Stocks: Multimanager Technology __________% Small/Mid Company Stocks: Charter Small Cap Value % International/GlobalStocks: EQ/International Equity Index __________% EQ/International Value Mged. Vol. __________% =100% 6. Authorization I hereby authorize AXA Equitable Life Insurance Company to issue an IRA Certificate/Contract in accordance with the instructions given above. I have been furnished with a copy of the IRA Prospectus (and any supplement to the IRA Prospectus), and I am familiar with its provisions. I understand the investment objectives of the investment options I have chosen, and have determined that the IRA is a suitable investment based upon my investment needs and financial situation. Further, I understand that any separate account investment fund unit values may increase or decrease and are not guaranteed as to dollar amount (unlike the Guaranteed Interest Option). Signature Date Instructions for 4 and 5 The percentages in PART IV determine how future contributions (including rollovers) will be invested. If you do not complete PART IV of this form and there is no election on file when a contribution is received, those amounts will be invested in the Money Market. “Future” contributions are those contributions received by us on and after the date we receive this form. You can change your allocation for future contributions by completing a change of investment allocation form, or by using the website or voice response system. If you are rolling over/transferring assets into this account, you can specify investment instructions for that contribution on the Transfer Form or Rollover Form.