EX-99.(E)(II) 4 b68365a1exv99wxeyxiiy.txt APPLICATION SUPPLEMENTS . . . Exhibit (E)(ii) (METLIFE(R) LOGO) Policy Number _____________________________ VARIABLE LIFE SUPPLEMENT METROPOLITAN LIFE INSURANCE COMPANY THIS SUPPLEMENT WILL BE ATTACHED TO AND BECOME PART OF THE APPLICATION WITH WHICH IT IS USED. SECTION I - IMPORTANT INFORMATION FOR THE OWNER ! PLEASE READ CAREFULLY. Variable Life Insurance is generally not THE CASH VALUE MAY INCREASE OR DECREASE, EVEN TO appropriate for time horizons of less than 10 THE EXTENT OF BEING REDUCED TO ZERO, IN years. These are long-term insurance products ACCORDANCE WITH SEPARATE ACCOUNT INVESTMENT that may have significant short-term EXPERIENCE. surrender charges. Variable Life Insurance is designed to provide death benefit protection THE COST OF INSURANCE RATES FOR THIS POLICY MAY while offering the potential for long-term CHANGE. THE RATES CURRENTLY BEING CHARGED ARE NOT cash accumulation, and may not be appropriate GUARANTEED, AND THE COMPANY MAY CHARGE THE FULL in situations where significant liquidation MAXIMUM GUARANTEED RATES. of assets in the near future may be expected. ILLUSTRATIONS OF BENEFITS, INCLUDING DEATH THE DEATH BENEFIT MAY BE VARIABLE OR FIXED BENEFITS AND CASH VALUES, ARE AVAILABLE UPON UNDER SPECIFIED CONDITIONS. REQUEST. SECTION II - OWNER'S INFORMATION OWNER: [ ] Proposed Insured [ ] Other Individual OTHER INDIVIDUAL INFORMATION ONLY: First Name Middle Name Last Name __________________________________ _____________________ ____________________________________ Occupation Name of Employer _______________________________________________ _______________________________________________ Employer City State Zip Position/Duties ___________________________ ____________ ____________ _____________________________________ Tax Bracket (%) ________ Is the Owner/Owners an associated person/persons of a Broker/Dealer? [ ] Yes [ ] No PRIOR INVESTMENT EXPERIENCE: (Choose ALL that apply and indicate your years of experience.) [ ] Certificate of Deposit ___ years [ ] Stocks ___ years [ ] Mutual Funds ___ years [ ] Money Markets ___ years [ ] Bonds ___ years [ ] Other ___ years If Other, specify: _____________________________________ SECTION III - COVERAGE INFORMATION ! Choose one of the following options. NOTE: Ages 85 and 121 available only by rider. Guaranteed Minimum Death Benefit Option: [ ] 5 Years [ ] 20 Years [ ] To Age 65 [ ] To Age 85 [ ] To Age 121 [ ] Other _________________ SECTION IV - INVESTMENT OBJECTIVE AND RISK TOLERANCE Have you completed the Asset Allocation Questionnaire? [ ] Yes [ ] No If YES, please submit with Application for Life Insurance. Choose one INVESTMENT OBJECTIVE below (a, b, c, d, or e). Then choose one RISK TOLERANCE for that specific Investment Objective. Be sure it supports the Investment Objective and your Risk Tolerance for this policy. A. [ ] CAPITAL PRESERVATION: Seeks income and stability with minimal risk. RISK TOLERANCE: [ ] Conservative [ ] Conservative to Moderate B. [ ] INCOME: Seeks current income over time. RISK TOLERANCE: [ ] Conservative [ ] Conservative to Moderate [ ] Moderate C. [ ] GROWTH & INCOME: Seeks capital appreciation over long term combined with current dividend income. RISK TOLERANCE: [ ] Conservative to Moderate [ ] Moderate [ ] Moderate to Aggressive D. [ ] GROWTH: Seeks capital appreciation over long term. RISK TOLERANCE: [ ] Moderate [ ] Moderate to Aggressive [ ] Aggressive E. [ ] AGGRESSIVE GROWTH: Seeks maximum capital appreciation over time by investing in speculative and/or higher risk securities. RISK TOLERANCE: [ ] Moderate to Aggressive [ ] Aggressive
(BAR CODE) SECTION V - OPTIONAL AUTOMATED INVESTMENT STRATEGIES You may select ONLY ONE of the following. IF YOU ARE NOT ELECTING ANY AUTOMATED INVESTMENT STRATEGIES, PLEASE PROCEED TO SECTION VI - INVESTMENT ALLOCATION. [ ] INDEX SELECTOR ! No other funding options can be selected when using this strategy. Check only ONE of the categories to the right. MetLife Investors USA [ ] Conservative will allocate 100% of your net premium based on the current allocation [ ] Conservative to Moderate for the Index Selector Model you choose. I understand that the Index [ ] Moderate Selector strategy will be implemented using the percentage allocations [ ] Moderate to Aggressive of the model in effect on the date of issue of my policy. I also [ ] Aggressive understand that in order to maintain this allocation, my account will be automatically rebalanced every quarter. [ ] EQUITY GENERATOR ! A percent of premium must be allocated to the Fixed Account when this option is chosen. Automatically transfers the current month's earnings from the Fixed Account into any one of the available funding options on each monthly anniversary. Please elect one funding option, except the Fixed Account, from the list in Section VI - Investment Allocation. [ ] REBALANCER Automatically rebalances the cash value among the funding options each calendar quarter to return the allocation to the allocation percentages you specify. Choose ONE of the following: [ ] Check here if you wish to rebalance to the allocation percentages chosen for your premium payments. [ ] Check here if you wish to rebalance using different allocation percentages than your premium payments and indicate the allocation percentages in the right-hand column in Section VI - Investment Allocation. [ ] ALLOCATOR ! The destination funding option(s) chosen cannot include the "source fund". Automatically transfers a set amount of money from the Fixed Account or any other funding option ("source fund") to any number of available funding options on each monthly anniversary. (The value of the "source fund" must be sufficient to ensure a minimum of three consecutive monthly transfers.) Please indicate the "source fund" from which the transfers are to be made: Please choose ONE of the following transfer options. Indicate the destination funding options and the dollar amount to be transferred to each in the right-hand column in Section VI - Investment Allocation. [ ] Transfer $__________ per month until the "source fund" is depleted. [ ] Transfer $__________ per month for ________ months. The Allocator is a form of dollar cost averaging. Dollar cost averaging does not assure a profit or protect against a loss in declining markets. It involves continuous investment in securities regardless of fluctuations in price levels. An investor should consider his/her ability to continue purchases in periods of low price levels. [ ] ENHANCED DOLLAR COST AVERAGER (EDCA) ! The destination funding option(s) chosen cannot include the Fixed Account. Automatically transfers an amount of money each month from the EDCA fixed account to any number of available funding options each monthly anniversary until the EDCA fixed account is depleted. The amount allocated to the EDCA fixed account may consist of a one-time premium payment plus 1035 Exchange monies in the first policy year. The initial monthly amount transferred is based on the initial EDCA gross amount allocated to the EDCA fixed account, divided by twelve (months). If another eligible payment is received, the EDCA transfer amount will be increased by the subsequent payment, divided by twelve. Please specify the EDCA amount ($10,000 minimum): $_____________ Premium payment $_____________ Expected 1035 Exchange amount ______________% of all 1035 Exchange amounts to be allocated to EDCA (required if an Expected 1035 Exchange amount is specified) Indicate the destination funding options and the percentage to be transferred to each in the right-hand column in Section VI - Investment Allocation. The Enhanced Dollar Cost Averager is a form of dollar cost averaging. Dollar cost averaging does not assure a profit against a loss in declining markets. It involves continuous investment in securities regardless of fluctuations in price levels. An investor should consider his/her ability to continue purchases in periods of low price levels.
(BAR CODE) SECTION VI - INVESTMENT ALLOCATION Please select funding options that are appropriate for the RISK TOLERANCE and INVESTMENT OBJECTIVE indicated in Section IV - Investment Objective and Risk Tolerance. Some funding options may be appropriate for more than one investment objective. For more complete information about a specific funding option, including charges and expenses, please read the prospectus carefully.
Use this column Indicate Initial Allocation in whole percentages; must only if you have equal 100%. chosen an option -------------------------------------------------------------- on previous page. Initial Rebalancer % Premium Allocator $ Funding Options Allocation % EDCA % --------------- ------------ ----------------- Fixed Account Western Asset Management U.S. Government Portfolio BlackRock Bond Income Portfolio American Funds Bond Fund Lehman(R) Brothers Aggregate Bond Index Portfolio PIMCO Total Return Portfolio Western Asset Management Strategic Bond Opportunities Portfolio Lord Abbett Bond Debenture Portfolio PIMCO Inflation Protected Bond Portfolio BlackRock Diversified Portfolio MFS(R) Total Return Portfolio Neuberger Berman Real Estate Portfolio Harris Oakmark Focused Value Portfolio BlackRock Large Cap Value Portfolio Davis Venture Value Portfolio FI Value Leaders Portfolio Harris Oakmark Large Cap Value Portfolio Neuberger Berman Mid Cap Value Portfolio Oppenheimer Global Equity Portfolio BlackRock Strategic Value Portfolio BlackRock Large-Cap Core Portfolio American Funds Growth-Income Fund Legg Mason Value Equity Portfolio MetLife Stock Index Portfolio American Funds Global Small Capitalization Fund
Initial Rebalancer % Premium Allocator $ Funding Options Allocation % EDCA% --------------- ------------ ---------------- FI Mid Cap Opportunities Portfolio Lazard Mid-Cap Portfolio MetLife Mid Cap Stock Index Portfolio FI International Stock Portfolio Harris Oakmark International Portfolio MFS(R) Research International Portfolio Morgan Stanley EAFE(R) Index Portfolio BlackRock Legacy Large Cap Growth Portfolio FI Large Cap Portfolio American Funds Growth Fund Legg Mason Partners Aggressive Growth Portfolio Jennison Growth Portfolio Oppenheimer Capital Appreciation Portfolio T. Rowe Price Large Cap Growth Portfolio Loomis Sayles Small Cap Portfolio Russell 2000(R) Index Portfolio BlackRock Aggressive Growth Portfolio T. Rowe Price Mid-Cap Growth Portfolio Franklin Templeton Small Cap Growth Portfolio Met/AIM Small Cap Growth Portfolio T. Rowe Price Small Cap Growth Portfolio RCM Technology Portfolio Cyclical Growth & Income ETF Portfolio Cyclical Growth ETF Portfolio MetLife Conservative Allocation Portfolio MetLife Conservative to Moderate Allocation Portfolio MetLife Moderate Allocation Portfolio MetLife Moderate to Aggressive Allocation Portfolio MetLife Aggressive Allocation Portfolio Janus Forty Portfolio
OTHER - Write in any available funds not listed above. Funding Options Initial Premium Allocation % Rebalancer %/ Allocator $/ EDCA % ----------------------------- ------------------------------ ----------------------------------
(BAR CODE) SECTION VII - OTHER IMPORTANT OWNER QUESTIONS 1. I elect to have the monthly deduction from the cash values taken as follows - choose ONE: [ ] Proportionately from the funding options based on the cash value in each at the time of the deduction. [ ] From the Fixed Account or any other specific funding option. Specify: _____________________________________________________________ If you have chosen a specific funding option, please note that if at any time that designated funding option has insufficient cash value to pay the entire amount of the monthly charges, the remaining portion of these charges will be deducted proportionately from each funding option based on the cash value in each at the time of the deduction. 2. Have you received a prospectus for the policy applied for? [ ] Yes [ ] No Date of Prospectus Date of any Prospectus Supplement Package If YES, please indicate: __________________ __________________________________________
3. Did your Producer review your financial situation, risk tolerance, and investment objectives prior to completing this application? [ ] Yes [ ] No If NO, please indicate on what basis this product was recommended. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 4. Do you understand that: A. The amount and duration of the death benefit may increase or decrease depending on the policy's investment return, subject to any guarantees provided by the policy? [ ] Yes [ ] No B. There is no guaranteed minimum cash value and the cash value may increase or decrease depending on the policy's investment return? [ ] Yes [ ] No 5. Do you believe that this policy and the funding options you have selected will meet your insurance needs and financial objectives? [ ] Yes [ ] No 6. If funding options selected do not reflect the risk tolerance in Section IV - Investment Objective and Risk Tolerance, please explain: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ (BAR CODE) (METLIFE(R) LOGO) Policy Number _______________________ VARIABLE LIFE SUPPLEMENT METROPOLITAN LIFE INSURANCE COMPANY This supplement will be attached to and become part of the application with which it is used. SECTION I - IMPORTANT INFORMATION FOR THE OWNER ! Please Read Carefully. Variable Life Insurance is generally THE CASH VALUE MAY INCREASE OR DECREASE, not appropriate for time horizons of EVEN TO THE EXTENT OF BEING REDUCED TO less than 10 years. These are ZERO, IN ACCORDANCE WITH SEPARATE long-term insurance products that may ACCOUNT INVESTMENT EXPERIENCE. have significant short-term surrender charges. Variable Life Insurance is THE COST OF INSURANCE RATES FOR THIS designed to provide death benefit POLICY MAY CHANGE. THE RATES CURRENTLY protection while offering the BEING CHARGED ARE NOT GUARANTEED, AND potential for long-term cash THE COMPANY MAY CHARGE THE FULL MAXIMUM accumulation, and may not be GUARANTEED RATES. appropriate in situations where significant liquidation of assets in ILLUSTRATIONS OF BENEFITS, INCLUDING the near future may be expected. DEATH BENEFITS AND CASH VALUES, ARE AVAILABLE UPON REQUEST. THE DEATH BENEFIT MAY BE VARIABLE OR FIXED UNDER SPECIFIED CONDITIONS. SECTION II - COVERAGE INFORMATIONO ! Choose one of the following options. NOTE: Ages 85 and 121 available only by rider. Guaranteed Minimum Death Benefit Option: [ ] 5 Years [ ] 20 Years [ ] To Age 65 [ ] To Age 85 [ ] To Age 121 [ ] Other ____________
(BAR CODE) SECTION III - OPTIONAL AUTOMATED INVESTMENT STRATEGIES You may select ONLY ONE of the following. IF YOU ARE NOT ELECTING ANY AUTOMATED INVESTMENT STRATEGIES, PLEASE PROCEED TO SECTION IV - INVESTMENT ALLOCATION. [ ] EQUITY GENERATOR ! A percent of premium must be allocated to the Fixed Account when this option is chosen. Automatically transfers the current month's earnings from the Fixed Account into any one of the available funding options on each monthly anniversary. Please elect one funding option, except the Fixed Account, from the list in Section IV - Investment Allocation. [ ] REBALANCER Automatically rebalances the cash value among the funding options each calendar quarter to return the allocation to the allocation percentages you specify. Choose ONE of the following: [ ] Check here if you wish to rebalance to the allocation percentages chosen for your premium payments. [ ] Check here if you wish to rebalance using different allocation percentages than your premium payments and indicate the allocation percentages in the right-hand column in Section IV - Investment Allocation. [ ] ALLOCATOR ! The destination funding option(s) chosen cannot include the "source fund". Automatically transfers a set amount of money from the Fixed Account or any other funding option ("source fund") to any number of available funding options on each monthly anniversary. (The value of the "source fund" must be sufficient to ensure a minimum of three consecutive monthly transfers.) Please indicate the "source fund" from which the transfers are to be made: Please choose ONE of the following transfer options. Indicate the destination funding options and the dollar amount to be transferred to each in the right-hand column in Section IV - Investment Allocation. [ ] Transfer $_________ per month until the "source fund" is depleted. [ ] Transfer $_________ per month for __________ months. The Allocator is a form of dollar cost averaging. Dollar cost averaging does not assure a profit or protect against a loss in declining markets. It involves continuous investment in securities regardless of fluctuations in price levels. An investor should consider his/her ability to continue purchases in periods of low price levels. [ ] ENHANCED DOLLAR COST AVERAGER (EDCA) ! The destination funding option(s) chosen cannot include the Fixed Account. Automatically transfers an amount of money each month from the EDCA fixed account to any number of available funding options each monthly anniversary until the EDCA fixed account is depleted. The amount allocated to the EDCA fixed account may consist of a one-time premium payment plus 1035 Exchange monies in the first policy year. The initial monthly amount transferred is based on the initial EDCA gross amount allocated to the EDCA fixed account, divided by twelve (months). If another eligible payment is received, the EDCA transfer amount will be increased by the subsequent payment, divided by twelve. Please specify the EDCA amount ($10,000 minimum): $_________ Premium payment $_________ Expected 1035 Exchange amount _________% of all 1035 Exchange amounts to be allocated to EDCA (required if an Expected 1035 Exchange amount is specified) Indicate the destination funding options and the percentage to be transferred to each in the right-hand column in Section IV - Investment Allocation. The Enhanced Dollar Cost Averager is a form of dollar cost averaging. Dollar cost averaging does not assure a profit against a loss in declining markets. It involves continuous investment in securities regardless of fluctuations in price levels. An investor should consider his/her ability to continue purchases in periods of low price levels.
(BAR CODE) SECTION IV - INVESTMENT ALLOCATION Please select funding options. For more complete information about a specific funding option, including charges and expenses, please read the prospectus carefully. Use this column only if you have Indicate Initial Allocation in whole percentages; must chosen an equal 100%. option on ------------------------------------------------------ previous page. Initial Rebalancer % Premium Allocator $ Funding Options Allocation % EDCA % --------------- ------------ -------------- MetLife Aggressive Strategy Portfolio MetLife Growth Strategy Portfolio MetLife Balanced Strategy Portfolio MetLife Moderate Strategy Portfolio MetLife Defensive Strategy Portfolio RCM Technology Portfolio MFS(R) Emerging Markets Equity Portfolio Turner Mid-Cap Growth Portfolio Met/AIM Small Cap Growth Portfolio Legg Mason Partners Aggressive Growth Portfolio Jennison Growth Portfolio Legg Mason Value Equity Portfolio Neuberger Berman Real Estate Portfolio T. Rowe Price Mid-Cap Growth Portfolio
Initial Rebalancer % Premium Allocator $ Funding Options Allocation % EDCA % --------------- ------------ ------------ Harris Oakmark International Portfolio Third Avenue Small Cap Value Portfolio Harris Oakmark Focused Value Portfolio MFS(R) Research International Portfolio Lazard Mid-Cap Portfolio Oppenheimer Capital Appreciation Portfolio Goldman Sachs Mid-Cap Value Portfolio Van Kampen Comstock Portfolio MetLife Stock Index Portfolio Lord Abbett Growth and Income Portfolio Davis Venture Value Portfolio Loomis Sayles Global Markets Portfolio Lord Abbett Bond Debenture Portfolio PIMCO Inflation Protected Bond Portfolio PIMCO Total Return Portfolio Western Asset Management U.S. Government Portfolio Fixed Account OTHER - Write in any available funds not listed above.
Funding Options Initial Premium Allocation % Rebalancer %/ Allocator $/ EDCA % _______________ ____________________________ _________________________________
(BAR CODE) SECTION V - OTHER IMPORTANT OWNER QUESTIONS 1. I elect to have the monthly deduction from the cash values taken as follows - choose ONE: [ ] Proportionately from the funding options based on the cash value in each at the time of the deduction. [ ] From the Fixed Account or any other specific funding option. Specify: ______________________________________________________________________________ If you have chosen a specific funding option, please note that if at any time that designated funding option has insufficient cash value to pay the entire amount of the monthly charges, the remaining portion of these charges will be deducted proportionately from each funding option based on the cash value in each at the time of the deduction. 2. Have you received a prospectus for the policy applied for? [ ] Yes [ ] No Date of Prospectus Date of any Prospectus Supplement Package If YES, please indicate: __________________ _________________________________________ 3. Did your Producer review your financial situation, risk tolerance, and investment objectives prior to completing this application? [ ] Yes [ ] No If NO, please indicate on what basis this product was recommended. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4. Do you understand that: A. The amount and duration of the death benefit may increase or decrease depending on the policy's investment return, subject to any guarantees provided by the policy? [ ] Yes [ ] No B. There is no guaranteed minimum cash value and the cash value may increase or decrease depending on the policy's investment return? [ ] Yes [ ] No 5. Do you believe that this policy and the funding options you have selected will meet your insurance needs and financial objectives? [ ] Yes [ ] No
(BAR CODE)