FINANCIAL PROFESSIONAL/BROKER CERTIFICATION FOR VARIABLE LIFE AND INDEXED UNIVERSAL LIFE PRODUCTS

Name of Proposed Insured Date of Birth (mm/dd/yyyy) Brokerage Name/Agency Code

1. Rate Class/Tobacco Class quoted Proposed Insured 1 Proposed Insured 2

2. Are you aware of any other information that would adversely affect Proposed Insured’s eligibility, acceptability, or insurability? Proposed Insured 1 Yes No Proposed Insured 2 Yes No If ‘‘Yes,’’ please provide details

If ‘‘Yes,’’ do not accept money and/or execute a Temporary Insurance Agreement/Receipt.

3. a. Does (do) the Proposed Insured(s) speak and understand English?

Proposed Insured 1 Yes No Proposed Insured 2 Yes No b. Does the Owner speak and understand English? Yes No

INFORMATION 4. Did you: a. Verify the identity of the Proposed Insured(s) and Owner by reviewing the driver’s license, passport or other Government Issued ID?

Proposed Insured 1: Yes No Proposed Insured 2: Yes No Owner: Yes No INSURED b. Inquire about the source of the customer’s assets and income?

Proposed Insured 1: Yes No Proposed Insured 2: Yes No Owner: Yes No

(If ‘‘No,’’ to 4.a, b, money may not be taken without Company home office approval.)

PROPOSED c. Is the policy/contract for the bene?t of a Politically Exposed Person (PEP)*? Yes No If Yes, de?ne PEP position and Country:

* A Politically Exposed Person (PEP) is de?ned as: 1. A current or former senior foreign (non-U.S.) political ?gure; 2. His/her immediate family members (e.g., parents, spouse, sibling, children, in-laws); 3. Close associates - People who are widely and publicly known to maintain a close relationship with the PEP, including people who are in a position to conduct substantial ?nancial transactions on behalf of the PEP; 4. Any corporation, business or other entity that has been formed by, or for the bene?t of, the PEP.

5. How long have you known Proposed Insured 1 Proposed Insured 2

6. Your relationship, if any, to Proposed Insured 1 Proposed Insured 2

7. If Proposed Insured is a child (issue age 0–14), when did you last see child? (mm/dd/yyyy)

8.a.

Financial Professional Name(s) Financial Professional % Contact by Annualize

Number Phone E-mail Fax Commission Contact or E-mail Address Retail Only

Do not prepay (4)

PROFESSIONAL Prepay (5)

Do not prepay (4)

INFORMATION Prepay (5)

Do not prepay (4) FINANCIAL Prepay (5) 8.b. Select Commission Schedule Semi-Heaped or Heaped (Applies only to VUL OptimizerSM policies without the Cash Value Plus Rider.)

Please use the following as a guide in assessing the Owner’s Risk Tolerance, question 9e:

Conservative: investors seeking low volatility and a steady average rate of return potentially equal to or slightly exceeding the targeted rate of return on a fixed-income portfolio by investing a small portion in stocks.

Conservative-Plus: investors seeking potential returns above the average targeted return from a ?xed-income portfolio accompanied with some volatility experienced from investing a portion in stocks.

TOLERANCE Moderate: investors seeking above average returns with increased volatility experienced from investing in a balanced portfolio of both DEFINITIONS ?xed-income and stocks.

RISK Moderate-Plus: investors seeking high potential returns with the expectation of signi?cant volatility in any given year resulting from a portfolio with more stocks than ?xed income.

Aggressive: investors seeking the greatest potential return with extreme volatility in any given year from a portfolio invested mostly in stocks.

ICC11-AXA-FPCert (Var) Page FPCert 1 X03613_ICC (06/19)

THESE QUESTIONS MUST BE COMPLETED BY AXA ADVISORS FINANCIAL PROFESSIONALS FOR VARIABLE AND INDEXED PRODUCTS ONLY. QUESTION 9 m. MUST BE COMPLETED BY ALL DISTRIBUTION CHANNELS.

9. These questions MUST BE COMPLETED with respect to the OWNER a. Is the Owner affiliated with or employed by a member of FINRA? Yes No b. Has a Financial Plan been prepared by AXA Advisors, LLC for the client in the last 12 months? Yes No Plan # or Planning Tool Name: c. Investment Time Horizon: < 5 years 5–9 years 10–14 years 15–19 years 20+ years d. Investment Objective: Safety of Principal Income Income & Growth Growth Aggressive Growth (for this purchase only) e. Risk Tolerance: Conservative Conservative-Plus Moderate Moderate-Plus Aggressive (for this purchase only) f. Marital Status: Single Married Widowed Divorced Separated Domestic Partner g. # of Dependents: h. Federal Tax Bracket: % i. Liquid Net Worth $ Est. Monthly Expenses $ Est. Net Monthly Income $ j. Investments/Assets (prior to this investment): CDs $ Stocks $ Mutual Funds Bonds $ Income $ Annuities $ Growth $ Retirement Accounts $ Aggressive $ Investment Real Estate (Net Equity) $ Other Funds $

INFORMATION Other (excluding primary residence) $ k. Total Investments/Assets $ Investment Experience Chart

Cash (Checking, Savings, MMA) $ None < 1 1–4 5+

Total Investments/ CDs SUITABILITY Assets (above) and Cash $ Stocks Bonds l. Investment Experience (in years)—Complete chart at right Annuities Mutual Funds m. Source of Funds for this purchase: (Check box and circle sub-item(s)). If more than one box is checked, provide % breakdown.

(Must add up to 100%)

Cash: Death Claim, Gift, Inheritance, Checking, Savings, Money Market, Payroll Deduction, CDs: % Borrowing: Mortgage (including Reverse Mortgage), Personal Loan, Credit: % NQ Annuity or Life Insurance: (Replacement, Surrender/Exchange, Policy Loan, Dividend, Withdrawal): % Quali?ed Annuity: (Replacement, Surrender/Exchange, Policy Loan, Dividend, Withdrawal): %

401K, Pension Plans, Other Group Retirement Plans: %

NQ: Brokerage, Investment Advisory Assets, Mutual Fund Shares, UIT Shares, Stocks or Bonds: % Quali?ed: Brokerage, ERISA Plan, Investment Advisory Assets, Mutual Funds Shares, UIT Shares, Stocks or Bonds: %

Employer Contribution: %

Other: Sale of Car, Home, Business, or Other Asset (specify: ),

Legal Settlement, Lottery/Gaming Proceeds, Other: : %

ICC11-AXA-FPCert (Var) Page FPCert 2 X03613_ICC (06/19)

MUST BE COMPLETED AND SIGNED BY FINANCIAL PROFESSIONAL OR BROKER

I certify that I have successfully communicated to the Proposed Insured(s) and Owner(s) AXA Equitable’s position against stranger originated life insurance (STOLI). I have not promoted or facilitated the promotion of a planned sale or assignment of this proposed policy to a life settlement, viatical, or other secondary market provider or other investor, nor am I aware that the issuance of this proposed policy is being procured or facilitated by any such entity. I have not been involved in any sale or potential sale of a beneficial interest in this proposed policy or interest in an entity owning this proposed policy, nor am I aware of any terms in any Trust documents connected with this proposed policy providing for subsequent transfers of bene?cial interests therein. Further, I am not aware of any discussion with a third party, relative to a potential transfer of an interest in this proposed policy outside of the sales process.

I certify that I have truly and accurately recorded all information supplied by Proposed Insured(s), Owner(s) and any Applicant(s) onto this Application. I know of nothing affecting the insurability of the Proposed Insured(s) which is not fully recorded in this application. I agree to notify AXA Equitable or the Company checked on page 1 of section A of the Application if I am aware there is any material change* to any of the answers or representations made in this Application or its supplements or questionnaires before the full initial premium is paid, the proposed policy is delivered, and all other delivery requirements are completed. I further certify that all sales materials used during the sales process including buyer’s guides and disclosure notices were appropriate and in accordance with regulatory and compliance guidelines.

CERTIFICATION/AGREEMENT I, the agent, have con?rmed the account holder name provided is the actual account holder of the bank information provided.

*A change that may affect the rating or insurability of the Proposed Insured(s) or the overall approval of this Application.

Signature of Licensed Financial Professional/Insurance Broker Date Print Licensed Financial Professional/Insurance Broker’s Name License Number

ICC11-AXA-FPCert (Var) Page FPCert 3 X03613_ICC (06/19)