(Select One) Guaranteed Issue

? AXA Equitable Life Insurance Company Application for individual ? MONY Life Insurance Company of

1290 Avenue of the Americas, New York, NY 10104 Life Insurance

America

Section A: Select the appropriate box

?Proposed Insured part of group with Multiple Proposed Insureds – Employer Owned

(If this box is checked, complete Section I only. Each Proposed Insured must complete the Consent to Insurance Application Supplement.)

?Proposed Insured - Employee owner or Single insured- Employee Owned/Individual, Trust Owned/Other Single Owner Arrangement

(If this box is checked, complete Sections I and II, date and sign the application as well.)

1.Product Name             PRODUCT Complete and attach Section B-Product Information Questionnaire for Plan.

INFORMATION Complete Owner Questionnaire if Owner is a Trust.

SECTION I Complete Owner Information

If Trust is Owner, complete Section 1 and questions 2-11 (Trust Section) of Owner Questionnaire

2. Owner’s name             

3. Relationship to Proposed Insured             

TYPES 4.?SSN ?EIN ?ITIN             

5. Address             City            State            Zip Code            

OWNER If P.O. Box, put residential address in Remarks Section

ALL 6. Person(s) authorized to act on behalf of Owner.

#             

FOR Name             Title            Phone

Email address            

Name             Title            Phone #             COMPLETE Email address            

7. If Third Party Administrator (TPA) is authorized person, include Name and Contact Information.

Name            Phone Number            Address:             Email address            

Complete question 8 if replacing policies of Owner.

8. Including any policies and riders with the Company checked above, its affiliates, and any other life insurance company, will the coverage applied for replace, change, or affect any existing policy(ies) or contract(s)? ?Yes ?No INSURANCE If “Yes,” please complete chart.

P-Personal OTHER Total Amount G-Group

(Face Plus Year Policy/ B-Business 1035 Name of Company Riders) Issued Contract # A-Annuity Exchange

OWNER ? P ? B

? G ? A?Yes ? No ? P ? B

? G ? A ?Yes ? No ICC12-AXA-GI (06/19) Page 1

9. Is the beneficiary the same as the Owner? ?Yes ?No 10. If “No,” complete as appropriate.

Full Name            Relationship to Insured            % BENEFICARY Full Name            Relationship to Insured            % Full Name            Relationship to Insured            %

OF 11. Employer assets/funds (including policies on List/Salary Allotment billing where premiums are to be paid by employer)

SOURCE FUNDS? Company Assets ? Other (please specify)             

Complete questions 12 to 17 only if Individual owners.

12. Is the Proposed Insured the Owner? ?Yes ?No If “No,” relationship to Proposed Insured             13. Do you have a driver’s license? ?Yes ?No If “Yes,” provide license #, state and expiration date Number            State             Expiration Date             (mm/dd/yyyy) If “No” to driver’s license, do you have a government issued ID? ?Yes ?No If “Yes,” to government issued ID, type of ID             Government ID #            OWNER 14. Date of birth            (mm/dd/yyyy) 15. Are you a member of the armed forces, including the reserves? ?Yes ?No (reserves includes active duty or full time training of 31 days or more per year) (If “Yes,” you must also submit a completed and signed Life Insurance/Annuity Disclosure to Active Duty Members of the Armed Forces) INDIVIDUAL 16. Are you a U.S. citizen? ? Yes ? No (If ‘‘No,’’ please complete ‘‘a’’ and ‘‘b’’ or ‘‘c,’’ where applicable) a. Country of Citizenship             Date of Entry into the U.S.             (mm/dd/yyyy) FOR b. Residents with legal permanent status (Resident) in U.S. only Green Card/Visa Type             Expiration Date             (mm/dd/yyyy) COMPLETE c. Residents residing in the U.S. temporarily (Non-Resident) with valid Visa only Visa #            Visa Type            Expiration Date            (mm/dd/yyyy) Form I-94 Expiration Date            (mm/dd/yyyy) Passport #             Complete Question 17 for all non-resident (foreign) Owners. If the Owner is not a U.S. Person (U.S. Citizen or U.S. Corporation, Partnership or Trust established or organized under the laws of a state of the United States), then he, she or it may have to provide additional documentation, including IRS form W-8 BEN. Any foreign Owner (Individual, Trust, Corporation, Partnership, Other Entity) must have a US bank account).

17. U.S. bank name             Account #            

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SECTION II Proposed Insured to Complete

Face Amount            

18. Name First             Middle             Last             19. Date of birth            (mm/dd/yyyy) 20. SSN            21. Sex ? Male ? Female 22. Job Title            

23. Work site address             

City            State             Zip Code            

INSURED Complete only if Proposed Insured and Owner are different.

24. Do you have a driver’s license? ?Yes ?No If “Yes,” provide license #, state and expiration date

Number            State             Expiration Date             (mm/dd/yyyy) PROPOSED 25. Are you a member of the armed forces, including the reserves??Yes ?No

(If “Yes,” you must also submit a completed and signed Life Insurance/Annuity Disclosure to Active Duty Members of the Armed Forces)

26. Are you a U.S. citizen? ? Yes ? No (If ‘‘No,’’ please complete ‘‘a’’ and ‘‘b’’ or ‘‘c,’’ where applicable) a. Country of Citizenship             Date of Entry into the U.S.             (mm/dd/yyyy) b. Residents with legal permanent status (Resident) in U.S. only Green Card/Visa Type             Expiration Date             (mm/dd/yyyy) c. Residents residing in the U.S. temporarily (Non-Resident) with valid Visa only Visa #            Visa Type            Expiration Date            (mm/dd/yyyy) Form I-94 Expiration Date            (mm/dd/yyyy) Passport #             

27. During the previous three (3) months have you, the Proposed Insured, engaged in active full-time employment (at least 30 hours per week in a normal capacity and, in particular, not been hospitalized or absent from work due to illness or accident for more than five (5) consecutive working days)? ?Yes ?No (If “No,” give details below.)             QUESTIONS             UNDERWRITING             28. Are you, the Proposed Insured, actively at work on the date this application form was signed? ?Yes ?No

29. Do you currently use or have you ever used tobacco or nicotine products? ?Yes ?No

(If “Yes,” provide details in chart below)

Product Type(s) Amount and Frequency Indicate date last USE Indicate amount and frequency of use used (mm/yyyy)

?Cigarettes #            ?Pk(s) ?Single per

Year

?Day ?Month ? ?Cigars ?Cigarillos #            ?Pk(s) ?Single per

TOBACCO ?Day ?Month ? Year ?Pipe ?Chewing Tobacco ?Nicotine Patch or Gum

?Other (please specify)             

REMARKS

When providing details to questions, please reference question number. If additional space is needed, attach additional sheet(s) of paper with your name and signature.

ICC12-AXA-GI Page 3

AGREEMENT. Each signer of this application agrees that:

(1). The statements and answers in all parts of this application are true and complete to the best of my (our) knowledge and belief. AXA Equitable/MLOA may rely on them in acting on this application.

(2). No insurance shall take effect on this application: (a) until a policy is delivered and the full initial premium for it is paid, or an approved payment authorization is signed, while the person(s) proposed for insurance is (are) living; (b) before any Register Date specified in this AGREEMENT application; and (c) unless to the best of my (our) knowledge and belief the statements and answers in all parts of this application continue to be true and complete, without material change, as of the time such premium is paid or an approved payment authorization is signed.

(3). No financial professional has authority to modify this Agreement, nor to waive any of the Company checked on page 1 rights or requirements. The Company checked on page 1 shall not be bound by any information unless it is stated in this Application.

Under the penalties of perjury, I (we) certify that (i) the number showing on this form is my (our) correct Taxpayer Identification Number (Social Security Number, Employer Identification Number or other Taxpayer Identification Number), and (ii) I (we) am (are) not subject to backup withholding because (A) I (we) am (are) exempt from backup withholding or (B) I (we) have not been notified

NUMBER by the Internal Revenue Service (IRS) that I (we) am (are) subject to backup withholding as a result of a failure to report all interest or dividends or (C) the IRS has notified me (us) that I (we) am (are) no longer subject to backup withholding and (iii) I (we) am (are) TAXPAYER a U.S. person (including a U.S. resident alien). Certification Instructions: You must cross out item (ii) above if you have been CERTIFICATION notified by the Internal Revenue Service that you are currently subject to backup withholding because you have failed to report all IDENTIFICATION interest or dividends on your tax return. The Internal Revenue Service does not require your consent to any provisions of this document other than the certification required to avoid backup withholding.

ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE/SHE IS FACILITATING A FRAUD AGAINST AN INSURER, FRAUD SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING AN INTENTIONALLY FALSE OR DECEPTIVE STATEMENT MAY BE STATE DISCLOSURES GUILTY OF INSURANCE FRAUD.

PLEASE INDICATE YOU HAVE REVIEWED THE APPLICATION AND QUESTIONNAIRES AS THEY HAVE BEEN COMPLETED BY CHECKING THE APPROPRIATE BOX(ES) BELOW. FAILURE TO CHECK THE APPROPRIATE BOX(ES) WILL REQUIRE YOU TO SIGN AN APPLICATION AMENDMENT.

Section B?Product Information (Must select at least 1 product) Section C?Additional Underwriting Requirements

?Term Life ?Owner Questionnaire (if Trust Owned)

?Indexed Universal Life (IUL Protect) ? Long Term Care Services Rider Questionnaire* ?Indexed Universal Life (BrightLife® Grow) (I have received the Outline of Coverage and, ?Variable Universal Life (Optimizer) if required, the Personal Worksheet)

?Variable Universal Life (Legacy) ?Interest Sensitive Whole Life (ISWL) ACKNOWLEDGMENTS?Corporate Owned Incentive Life (COIL)

* The optional Long?Term Care Services Rider is not guaranteed issue. That means, if you, the Owner, elect to apply for the Long?Term Care Services Rider, you will be responsible for accurately completing a separate questionnaire and will be subject to underwriting.

I (We), the undersigned agree that the statements and answers in all parts of the Application and any application questionnaires checked above are true and complete to the best of my (our) knowledge and belief. Further, I (we) understand that I am (we are) agreeing to all the terms and conditions of this application, including, but not limited to, the Acknowledgment and Authorization.

X Signature of Proposed Insured            

X            SIGNATURES Signature of Owner or Applicant if not Proposed Insured(s) Signed by Owner at City, State Dated on (mm/dd/yyyy) If trust is Owner, trustee must sign on behalf of the trust. If corporation is Owner, an authorized officer of corporation must sign.

If Corporation: Name of Firm (print)             Name of authorized officer who signed application (print):             

ICC12-AXA-GI Page 4

Will any existing insurance be replaced, changed or affected (or has it been) assuming the insurance applied for will be issued? ?Yes ?No

TO

If ‘‘Yes,’’ is the information provided in question 8 on Section 1 of the Application. ?Yes ?No

If ‘‘No,’’ provide details            

SECTION Certification for VUL Policies Only, signature required FOR ALL POLICIES

THIS Based on the information furnished by the Proposed Insured(s) and Owner, if other than the Proposed Insured(s), in this and any other part PROFESSIONAL of the application(s), I certify that I have reasonable grounds for believing the purchase of the policy applied for is suitable for the Applicant or the Owner. I further certify the current prospectuses were delivered and that no written sales materials other than those furnished by the Company were used.

COMPLETE X Signature of Licensed Financial Professional/Insurance Broker             

FINANCIAL Dated on (mm/dd/yyyy)

Print Licensed Financial Professional’s Name            License Number            

ICC12-AXA-GI Page 5

FINANCIAL PROFESSIONAL/BROKER CERTIFICATION

SIONAL/AGENT/BROKER CERTIFICATION

Brokerage Name/Agency Code             

Financial Financial Contact by:

Professional(s) Professional ?Phone ?E-mail ?Fax INFORMATION Name(s) Number % Contact or E-mail Address INSURED/FINANCIAL

PROFESSIONAL

Select Commission Schedule? ? Semi-Heaped or ? Heaped (Applies only to VUL Optimizer policies without the Cash Value Plus Rider.)

THESE QUESTIONS MUST BE COMPLETED BY AXA ADVISORS FINANCIAL PROFESSIONAL FOR VARIABLE AND INDEXED PRODUCTS ONLY. DO NOT COMPLETE FOR OTHER PRODUCT TYPES.

BUSINESS INSURANCE

(1) Is the owner a member or an affiliate of a member of FINRA? ? Yes ? No (2) Persons authorized to transact business on behalf of Owner:

Name:             Title:            Name:             Title:            (3) Total Assets (as of last fiscal quarter): $            If the answer to Question 3 above is less than $50 million, please answer (a) and (b) below.

(a) Net Income (last fiscal quarter): ? less than $500,000 ?$501,000-2 million ? $2 million-5 million ? $5 million-10 million ?$10 million +

(b) Net Worth (last fiscal quarter): ?less than 0 ? $0-500,000 ?$501,000-2 million ? $2 million-5 million ? $5 million-10 million ?10 million + (4) Purpose ? Key Person ? Buy-Out Funding ? Deferred Comp. ? Salary Continuation ? Executive Bonus

?Overhead Expense ?Qualified Retirement Plan ?Investment/Savings ? 401(k) Plan ? 125 Cafeteria Plan ? (Other) (5) Type of Business ?Manufacturing ? Wholesale ?Transportation ? Agriculture ? Construction ? Service ? Professional Service ? Mining ?Retail ? Financial, Real Estate ?Insurance ? (Other) (6) No. of Employees ? 10-24 ? 25-49 ? 50-99 ? 100-499 ? 500+

INDIVIDUAL OWNERS

1. a. Is the Owner affiliated with or employed by a member of FINRA? ?Yes ?No

INFORMATION 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

SUITABLITY d. Investment Objective (for this purchase only): ?Safety of Principal ? Income ?Income & Growth ?Growth ?Aggressive Growth e. Risk Tolerance (for this purchase only): ?Conservative ?Conservative-Plus ?Moderate ?Moderate-Plus ?Aggressive f. Marital Status: ?Single ?Married ?Widowed ? Divorced ? Separated ?Domestic Partner OWNER g. # of Dependents:            h. Federal Tax Bracket:             % i. Currently employed? ?Yes ?No ?Retired j. Liquid Net Worth $            k. Estimated Gross Annual Household Income $            l. Total Net Worth $            m. Investments/Assets (prior to this investment): ?CDs $             ?Mutual Funds $            ?Stocks $             ?Income $            ?Bonds $             ?Growth $            ?Annuities $             ?Aggressive $            ?Retirement Accounts $             ?Other Funds $            ?Real Estate (Mortgage/Equity) $            ?Other (excluding primary residence $             

n. Total Investments/Assets $             o. Investment Experience (in years) Cash (Checking, Savings, MMA) $             None < 1 1-4 5+

Total Investments/ CDs ? ? ? ? Assets (above) and Cash $             Stocks ? ? ? ?

Bonds ? ? ? ? Annuities ? ? ? ? Mutual Funds ? ? ? ?

ICC12-AXA-GI-FPCert Page 1 (06/19)

Did you :

(i) verify the identity of the Policyowner by reviewing certified articles of incorporation, a business license, a partnership agreement or a trust instrument? ?Yes ?No (ii) inquire about the source of the customer’s assets and income? ?Yes ?No

If “No”, sales associate must contact Branch Controls Person

This question MUST BE COMPLETED with respect to the OWNER (S)

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):             % ? Qualified 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:             % IDENTIFICATION ? Qualified: Brokerage, ERISA Plan, Investment Advisory Assets, Mutual Funds Shares, UIT Shares, Stocks or Bonds:             %

? Employer Contribution:             %

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

Legal Settlement, Lottery/Gaming Proceeds, Other:             :             % Total: 100%

(iii) Is the policy/contract for the benefit of a Politically Exposed Person (PEP)*? ? Yes ? No

If “Yes”, define PEP position and country:             * A Politically Exposed Person (PEP) is defined as: 1. A current or former senior foreign (non-U.S.) political figure; 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 financial transactions on behalf of the PEP; 4. Any corporation, business or other entity that has been formed by, or for the benefit of, the PEP.

I certify that I have truly and accurately recorded all information supplied by Owner(s) onto this Application.

Signature of Licensed Financial Professional/Insurance Broker            Date            (mm/dd/yyyy) AGREEMENT Print Licensed Financial Professional/Insurance Broker’s Name            CERTIFICATION/ License Number            

ICC12-AXA-GI-FPCert Page 2 (06/19)