AXA Equitable Life Insurance Company
SECTION B—SURVIVORSHIP FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE
Name of Proposed Insured 1 Date of Birth
Name of Proposed Insured 2 Date of Birth
PART I
PLAN INFORMATION
1. Product Name VUL Survivorship Series 160
2. Amount of Insurance $
3. Is this a Term Conversion, Rider Conversion or Purchase Option? Yes No
(If ‘‘Yes,’’ complete Term Policy/Rider Conversion or Purchase Option Questionnaire.)
4. Death Benefit Option Option A (Level) Option B (Face Amount and Policy Account Value)
5. Backdate to save age Proposed Insured 1: Yes No Proposed Insured 2: Yes No
Max 6 months prior to application date (3 months in OH)
(Charges and Premiums for insurance coverage begin on the backdated Register Date.)
PREMIUM INFORMATION
6. a. Planned Periodic Premium Amount $ b. Initial Premium $
7. Premium Mode
a. Direct Billing (By Mail) Annually Semi-Annually Quarterly Monthly
b. Bank Draft* Quarterly Monthly Start Date (mm/dd/yyyy) Draft on day of the month
(Voided Check Required)
*If bank account holder is not the Owner or Proposed Insured, please complete Systematic Payment Enrollment Form.
In lieu of voided check, use first premium check to set up Systematic Payment Plan
c. Salary Allotment Annually Semi-Annually Quarterly Monthly
Unit name Unit number Register Date (mm/dd/yyyy)
If Allotter is not Proposed Insured, provide Name SSN/EIN/TIN
d. Single Payment Amount $ (No further premium billing will be sent.)
OPTIONAL BENEFITS/RIDERS
8.
Estate Protection Rider (EPR benefit is a maximum of 122% of the base policy face amount)
Other (as allowed or available with product)
SUITABILITY
9.
a. Have you, the Proposed Insured(s) and the Owner, if other than the Proposed Insured(s), received:
(1) the most current prospectus, and supplement(s) if applicable, for the policy(ies) applied for? Yes No
(2) the most current prospectus, and supplement(s) if applicable, for the designated investment company(ies)? Yes No
b. Do you understand that (i) policy values reflect certain deductions and charges, and may increase or decrease
depending on credited interest for the Guaranteed Interest Account and/or the investment experience of Separate
Account Funds and (ii) the cash value may be subject to a surrender charge, if any, upon policy surrender, lapse
or face amount reduction? Yes No
c. With this in mind, is (are) the policy(ies) in accord with your insurance and long-term investment objectives and
anticipated financial needs? Yes No
d. Disclosures and Consent for Delivery of Initial Prospectus on CD-Rom for AXA Equitable’s and its affiliates’ Variable Life products.
By checking the box you acknowledge that you received the initial prospectus on computer readable compact disk ‘‘CD,’’ if
available for the product chosen, and that you are able to access the CD information. In order to retain the prospectus indefinitely,
you must print it. You understand that you may request a prospectus in paper format at any time by calling Customer Service at
1-877-222-2144, and that all subsequent prospectus updates and supplements will be provided to you in paper format, unless you
enroll in our electronic delivery service.
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X04193_ICC (10/19)

SECTION B—SURVIVORSHIP FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE
10. INITIAL ALLOCATION TO THE INVESTMENT OPTIONS*
Please see the Prospectus for a description of the investment objective(s) for each Investment Option.
(Whole Percentages Only)
For Premiums For Deductions
Guaranteed Interest Account % %
1290 VT Convertible Securities % %
1290 VT DoubleLine Dynamic Allocation % %
1290 VT DoubleLine Opportunistic Bond % %
1290 VT Equity Income % %
1290 VT GAMCO Mergers & Acquisitions % %
1290 VT GAMCO Small Company Value % %
1290 VT SmartBeta Equity % %
1290 VT Socially Responsible % %
All Asset Growth-Alt 20 % %
American Funds Insurance Series® Global
Small CapitalizationSM % %
American Funds Insurance Series®
New World® % %
CharterSM Multi-Sector Bond % %
CharterSM Small Cap Growth % %
CharterSM Small Cap Value % %
EQ/400 Managed Volatility % %
EQ/500 Managed Volatility % %
EQ/2000 Managed Volatility % %
EQ/AB Small Cap Growth % %
EQ/Aggressive Allocation % %
EQ/American Century Mid Cap Value % %
EQ/BlackRock Basic Value Equity % %
EQ/Capital Guardian Research % %
EQ/ClearBridge Large Cap Growth % %
EQ/Common Stock Index % %
EQ/Conservative Allocation % %
EQ/Conservative-Plus Allocation % %
EQ/Core Bond Index % %
EQ/Equity 500 Index % %
EQ/Fidelity Institutional AM® Large Cap % %
EQ/Franklin Rising Dividends % %
EQ/Franklin Strategic Income % %
EQ/Global Bond PLUS % %
EQ/Global Equity Managed Volatility % %
EQ/Goldman Sachs Mid Cap Value % %
EQ/International Core Managed Volatility % %
EQ/International Equity Index % %
EQ/Intermediate Government Bond % %
EQ/International Managed Volatility % %
EQ/International Value Managed Volatility % %
EQ/Invesco Comstock % %
EQ/Invesco Global Real Estate % %
EQ/Invesco International Growth % %
EQ/Ivy Energy % %
EQ/Ivy Mid Cap Growth % %
EQ/Ivy Science and Technology % %
EQ/Janus Enterprise % %
(Whole Percentages Only)
For Premiums For Deductions
EQ/JPMorgan Value Opportunities % %
EQ/Large Cap Core Managed Volatility % %
EQ/Large Cap Growth Index % %
EQ/Large Cap Growth Managed Volatility % %
EQ/Large Cap Value Index % %
EQ/Large Cap Value Managed Volatility % %
EQ/Lazard Emerging Markets % %
EQ/Loomis Sayles Growth % %
EQ/MFS International Growth % %
EQ/MFS International Value % %
EQ/Mid Cap Index % %
EQ/Mid Cap Value Managed Volatility % %
EQ/Moderate Allocation % %
EQ/Moderate-Plus Allocation % %
EQ/Money Market % %
EQ/PIMCO Real Return % %
EQ/PIMCO Total Return % %
EQ/PIMCO Ultra Short Bond % %
EQ/Quality Bond PLUS % %
EQ/Small Company Index % %
EQ/T. Rowe Price Growth Stock % %
EQ/UBS Growth and Income % %
Fidelity VIP Growth & Income % %
Fidelity VIP Mid Cap % %
Franklin Mutual Shares VIP % %
Franklin Small Cap Value VIP % %
Invesco V.I. Mid Cap Core Equity % %
Invesco V.I. Small Cap Equity % %
Ivy VIP High Income % %
Ivy VIP Small Cap Growth % %
MFS Investors Trust Series % %
MFS Massachusetts Investors Growth
Stock Portfolio % %
Multimanager Aggressive Equity % %
Multimanager Core Bond % %
Multimanager Mid Cap Growth % %
Multimanager Mid Cap Value % %
Multimanager Technology % %
PIMCO VIT CommodityRealReturn Strategy % %
Target 2025 Allocation % %
Target 2035 Allocation % %
Target 2045 Allocation % %
Target 2055 Allocation % %
T. Rowe Price Equity Income II % %
Templeton Developing Markets VIP % %
Templeton Global Bond VIP % %
Templeton Growth VIP % %
VanEck VIP Global Hard Assets % %
TOTAL 100% 100%
* please see top of next page for important information
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SECTION B—SURVIVORSHIP FLEXIBLE PREMIUM VARIABLE UNIVERSAL LIFE INSURANCE
*The ‘‘Investment Start Date’’ is the business day your investment first begins to earn a return for you, as described below, and is
generally the later of: (1) the business day we receive the minimum initial premium at our Administrative Office; and (2) the Register
Date of your policy.
In AL, AK, AZ, CA, CO, FL, ID, IA, KS, NJ, OR, PA, PR, TN, USVI, and WY your Policy Account will be allocated according to these
percentages as of the Investment Start Date. In all other jurisdictions, your Policy Account (except any amounts you allocated to the
Guaranteed Interest Account) will be allocated to the EQ/Money Market Investment Option as of the later of (1) the Investment Start
Date; and (2) the Issue Date, for 20 calendar days (Money-Market Lock-in Period) and will be allocated according to the above
percentages on the 1st business day following the Money Market Lock-in Period. However, if we have not received all necessary
requirements for your policy as of the Issue Date, the Money Market Lock-in Period will begin on the date we receive, at our
Administrative Office, all necessary requirements to put the policy in force.
Any payments we receive prior to your Investment Start Date will be held in a non-interest bearing account until your Investment Start Date.
INVESTMENT OPTIONS
11. Note: Not available if you elect the Asset Rebalancing Service.
The Automatic Transfer service enables you to make automatic monthly transfers from the EQ/Money Market Investment Option to other
variable investment options that you select. A minimum of $5,000 must be allocated to the EQ/Money Market Investment Option. Up to
8 investment options can receive the monthly automatic transfer. Each transfer must be at least $50. In AL, AK, AZ, CA, CO, FL, ID, IA,
KS, NJ, OR, PA, PR, TN, USVI and WY the automatic transfer is effective on the second monthly anniversary and will continue until the
amount allocated to the EQ/MONY Market Investment Option is depleted. In all other jurisdictions the automatic transfer is effective on
the first monthly anniversary after the Money Market Lock-in Period ends and will continue until the amount allocated to the EQ Money
Market Investment Option is depleted.
AUTOMATIC TRANSFER SERVICE
Investment Options to Receive Transfer: Dollar Amount:
$ $ $ $ $ $ $ $
I (We), have read the detailed description of the Automatic Transfer Service in the prospectus. My (Our) instructions will remain in effect
until (a) insufficient funds are available to process transfers, (b) I (we) provide new written instructions or (c) the Automatic Transfer
Service otherwise terminates as described in the prospectus. I (We) understand that use of the Automatic Transfer Service does not
guarantee a profit and will not protect against loss in a declining market.
ASSET REBALANCING SERVICE
12. Note: Not available if you elect the Automatic Transfer Service.
The Guaranteed Interest Account is not available for Asset Rebalancing. Your allocation among the investment options will be
periodically re-adjusted according to the percentage you indicated in Question 10 and the frequency you choose below. Asset allocation
percentages of 2% or more (in whole percentages) may be specified for all variable investment options up to a maximum of 50 options.
Generally, Asset Rebalancing will start 12, 6 or 3 months after the register date, depending on the length of the period you choose.
Annually Semi-annually Quarterly
I (We), have read the detailed description of the Asset Rebalancing Service in the prospectus. My (Our) instructions will remain in effect until
(a) I (we) provide new written instructions or (b) Asset Rebalancing otherwise terminates as described in the prospectus. I (We) understand
that the use of the Asset Rebalancing Service does not guarantee a profit and will not protect against loss in a declining market.
THE UNDERSIGNED UNDERSTAND(S) THAT THE POLICY VALUES AND THE DEATH BENEFIT MAY INCREASE OR DECREASE IN ACCORDANCE
WITH THE INVESTMENT EXPERIENCE OF THE VARIABLE SUBACCOUNTS (SUBJECT TO ANY SPECIFIED MINIMUM GUARANTEES).
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SURVIVORSHIP PRODUCT QUESTIONNAIRE PROPOSED INSURED 2 INFORMATION
PART II
PROPOSED INSURED 2
1. Name First Middle Last
2. SSN 3. Sex Male Female
4. Is Proposed Insured 2 an Owner? Yes No
5. Are there any Owner(s) who are not Proposed Insured 1 or Proposed Insured 2? Yes No (If ‘‘Yes,’’ complete the Owner
questionnaire)
6. Primary residential address Bldg/Apt/Suite
City/Municipality County/Parish* State Zip
* County/Parish required only in AL, FL, GA, KY, LA, SC
7. Are you a U.S. citizen? Yes No (If ‘‘No,’’ complete Foreign Residence and Travel Questionnaire)
8a. Phone # Daytime Cell Evening b. Best time to call AM PM
9. Date of birth (mm/dd/yyyy) 10. Place of birth (Country/State)
11. Email address
12. Do you have a driver’s license? Yes No If ‘‘Yes,’’ provide license number, state and expiration date
Number State Expiration Date (mm/dd/yyyy)
If no driver’s license, do you have a government issued ID? Yes No
If ‘‘Yes’’ to government issued ID, type of ID Government ID #
EMPLOYMENT
13. Currently employed? Yes No Retired Other
If ‘‘Yes’’ to question 13, complete questions 14-16
14. Occupation(s) a. Title b. Years at current job**
**If less than one year at current job, give previous occupation information in remarks section
c. Duties
15. Employer name
16. Work site address
City State Zip Code
FINANCIAL DETAILS
17. Income
Gross Earned Annual Income (salary, commissions, bonuses)
Gross Unearned Annual Income (dividends, pensions, interest, real estate income, etc.)
Gross Annual Income (Household)
Total Net Worth (Household)
$ $ $ $
18. In the last 5 years, have you filed for bankruptcy? Yes No
If ‘‘Yes,’’ Chapter Date opened (mm/dd/yyyy) Date Closed (mm/dd/yyyy)
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PROPOSED INSURED 2 INFORMATION – Continued
Complete questions 19 and 20 if Proposed Insured 2 and Owner are same, unless already completed in section A. If Owner is different from Proposed Insured(s) and completing Owner’s Questionnaire, do not complete this section.
19. Complete For Personal Insurance
Income Replacement Mortgage/Debt Repayment Estate Planning Charitable/Gifting Other 20. Complete for Business Insurance Key Person Buy-Sell Deferred Comp Other (please specify) Loan indemnification (Security for Loan) Amount of loan $ Duration Interest charged on loan Collateral pledged to secure loan a. Type Sole Proprietorship Partnership Corporation Limited Liability Corp. b. Name of business Nature of business     c. How long has the business been in operation? Years d. % of business owned by Proposed Insured 2 % INSURANCE e. Fair market value of the business: $ OF    f. Are all members of the business being similarly insured? Yes No
If “Yes,” provide details of business coverage issued or applied for on other members. (Use remarks section if additional PURPOSE space is needed)
Name and Title % of Business Owned Amount In Force or Applied For
g. Has the business filed for bankruptcy and/or reorganization in the past 5 years? Yes    No If “Yes,” explain h. Business/Corporation finances: (Complete chart below for the past 2 years)
Year Assets Liabilities    Retained Earnings Gross Sales Net Profit $ $ $ $ $ $ $ $ $ $
If questions 21a, b or c are answered “Yes,” please provide details in charts below. (Use remarks section if additional space is needed)
21. Including any policies and riders with the Company checked on page 1 above section A of the Application or its affiliates and any other life insurance company: INSURANCE a. Do you have any life insurance/annuities currently in force, including any policy that has been sold, settled or     assigned to or with a settlement or viatical company or any other person or entity?    Yes No b. Will the coverage applied for replace, change, or affect any existing policy(ies) or contract(s)?    Yes No OTHER c. Do you have any other formal life insurance applications pending?    Yes No d. Including this application, what is the total amount of life insurance coverage pending (base policy face amount plus amounts attributable to additional benefits and riders) that you plan to accept on the Proposed Insured 2?
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PROPOSED INSURED 2 INFORMATION—Continued
Chart for questions 21a and b
Total Amount
Name of Company (Face Plus Riders) Year Issued Policy/ Contract # P-Personal G-Group B-Business A-Annuity To Be Replaced Changed or Affected 1035 Exchange
P B G A Yes No Yes No P B G A Yes No Yes No
OTHER INSURANCE P B
G A Yes No Yes No Chart for question 21c
Name of Company Total Amount (Face Plus Riders) Competitive or Additional $ Competitive Additional $ Competitive Additional
22. Have you ever had a driver’s license suspended, revoked or restricted? Yes No 23. Have you in the last 5 years, been convicted of, or pled guilty or no contest to reckless or negligent driving,    any moving violations or driving under the influence of alcohol or drugs? Yes No 24. Have you in the last 2 years been disabled for 2 or more weeks? Yes No
Complete if any answer to question(s) 22 through 24 is ‘‘Yes.’’ (Use remarks section if additional space is needed)
Question # Date (mm/dd/yyyy) Description of Event
25. Do you engage in regular exercise? (for example, running, walking, strength training, tennis) Yes No
HISTORY PERSONAL If ‘‘Yes,’’ give details of type, frequency and length of time
26. Have you ever had an application for life or health insurance declined, postponed, required an extra premium, offered with a reduced face amount or other modification or had a life or health policy or contract that was cancelled, recalled or denied renewal?
(If ‘‘Yes,’’ please state companies and provide full details in remarks section.) Yes No 27. Have you in the last 10 years, been convicted of, or pled guilty or no contest to a felony, or are current felony charges pending? (If ‘‘Yes,’’ state offense and penalty, date of probation, duration of probation and end date in remarks section.) Yes No 28. Do you expect to travel outside of the U.S. or Canada, or change your country of residence in the next 2 years? (If ‘‘Yes,’’ complete Foreign Residence and Travel Questionnaire) Yes No 29. In the last 2 years have you: a. Flown other than as a passenger or do you plan to do so? (If ‘‘Yes,’’ complete Aviation Questionnaire) Yes No b. Engaged or do you plan to engage in motor racing on land or water, underwater diving, skydiving, ballooning,    hang gliding, parachuting or flying ultra-light aircraft (If ‘‘Yes,’’ complete Avocation Questionnaire) Yes No 30. 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)
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PROPOSED INSURED 2 INFORMATION—Continued
31. Have you ever received medical treatment or counseling for, or been advised by a physician to reduce or discontinue, the use of alcohol or prescribed or non-prescribed drugs? (If ‘‘Yes,’’ complete Substance Usage
Questionnaire.) Yes No
USE 32. Do you currently use or have you ever used tobacco or nicotine products? Yes No
(If ‘‘Yes,’’ provide details in the chart below)
Product Type(s) Amount and Frequency Indicate date last
Indicate amount and frequency of use used (mm/yyyy) Cigarettes # per Day Month Year ALCOHOL/DRUG/TOBACCO Cigars Cigarillos # per Day Month Year Pipe Chewing Tobacco Nicotine Patch or Gum Not Applicable Other (please specify)
Section to be completed only when submitting medical examinations of another insurance company. If ‘‘Yes’’ to questions 34 or 35, complete a Medical Information Questionnaire
33. Name of Insurance Company Date of Exam (mm/dd/yyyy) MEDICAL CERTIFICATION 34. To the best of your knowledge and belief, have there been any changes to the statements in the examination? Yes No 35. Have you consulted a medical doctor or other practitioner since the examination indicated in question 33 above? Yes No
COMPLETE IF MONEY IS PAID WITH APPLICATION
Insurability Questions for Limited Temporary Insurance Agreement
36. Is Proposed Insured 2 over 70 years of age? Yes No 37. Within the past 24 months has Proposed Insured 2 been attended by a care provider or been seen at a medical facility for heart condition or disease, stroke or cancer? Yes No 38. Within the past 10 years has Proposed Insured 2 been diagnosed with or treated for Acquired Immune Deficiency APPLICATION Syndrome (AIDS) or AIDS-Related Complex (ARC) by a member of the medical profession? Yes No 39. Within the past 12 months has Proposed Insured 2: been admitted, or advised by a medical professional to be WITH admitted, to a hospital or other licensed health care facility; had surgery performed or recommended; or been advised by a medical professional to have any diagnostic test (excluding AIDS-related test) that was not PAID completed? Yes No 40. Within the past 24 months has Proposed Insured 2 been declined for a life, health or Long-Term Care policy? Yes No MONEY IF ANY OF QUESTIONS 36 TO 40 OF THIS QUESTIONNAIRE OR QUESTIONS 39-43 of SECTION A IS ANSWERED ‘‘YES’’ OR
LEFT BLANK, A PREMIUM MAY NOT BE PAID BEFORE THE POLICY IS DELIVERED AND NO TEMPORARY INSURANCE WILL BE
IN EFFECT
When REMARKS providing details to questions, please reference question number. If additional space is needed, attach additional sheet(s) of paper with your name and signature.
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