EX-99.(E)(IV) 8 d53973dex99eiv.htm APPLICATION FOR INDIVIDUAL LIFE INSURANCE (ICC19-VUL-SUPP) Application for Individual Life Insurance (ICC19-VUL-Supp)

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Equitable Financial Life Insurance Company
Equitable Financial Life Insurance Company of America
Mailing address: PO Box 1047, Charlotte, NC 28201-1047
Section B – VUL Investment Options Supplement
Variable Universal Life
Proposed Insured___________________________________________________Date of Birth (mm/dd/yyyy)__________ Product Name_____________________________________________________________________________________
1. Initial Allocation of the Investment Options (1)                
Please see the Prospectus for a description of the investment objective(s) for each Investment Option. (Whole Percentages Only)
Premiums For Deductions For Market Stabilizer Option2,3 ______% ______% Guaranteed Interest Account ______% ______% 1290 VT Convertible Securities ______% ______% 1290 VT DoubleLine Dynamic Allocation ______% ______% 1290 VT DoubleLine Opportunistic Bond ______% ______% 1290 VT Energy ______% ______% 1290 VT Equity Income ______% ______% 1290 VT GAMCO Mergers & Acquisitions ______% ______% 1290 VT GAMCO Small Company Value ______% ______% 1290 VT Low Volatility Global Equity ______% ______% 1290 VT Natural Resources ______% ______% 1290 VT Small Cap Value ______% ______% 1290 VT SmartBeta Equity ______% ______% 1290 VT Socially Responsible ______% ______% American Funds Insurance Series® Global Small CapitalizationSM ______% ______% American Funds Insurance Series®                 New World® ______% ______%    EQ/AB Small Cap Growth ______% ______% EQ/Aggressive Allocation
______% ______% EQ/All Asset Growth Allocation ______% ______% EQ/American Century Mid Cap Value ______% ______% EQ/BlackRock Basic Value Equity ______% ______% EQ/ClearBridge Large Cap Growth ______% ______% EQ/Common Stock Index ______% ______% EQ/Conservative Allocation ______% ______% EQ/Conservative Plus Allocation ______% ______% EQ/Core Bond Index ______% ______% EQ/Emerging Markets Equity PLUS ______% ______% EQ/Equity 500 Index ______% ______% EQ/Franklin Rising Dividends ______% ______% EQ/Franklin Strategic Income ______% ______% EQ/Goldman Sachs Mid Cap Value ______% ______% EQ International Core Managed Volatility ______% ______% EQ/International Equity Index ______% ______% EQ International Value Managed Volatility ______% ______% EQ/Invesco Comstock ______% ______%
1,2,3 please see next page for important information
Premiums For Deductions For EQ/Invesco Global Real Estate ______% ______% EQ/MFS Mid Cap Focused Growth ______% ______% EQ/Janus Enterprise ______% ______% 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/Loomis Sayles Growth ______% ______% EQ/MFS International Growth ______% ______% EQ/MFS International Intrinsic Value ______% ______% EQ/Mid Cap Index ______%
______% EQ/Mid Cap Value Managed Volatility ______% ______% EQ/Moderate Allocation ______% ______% EQ/Moderate-Plus Allocation ______% ______% EQ/Money Market ______% ______% EQ/Morgan Stanley Small Cap Growth ______% ______% EQ/Invesco Global ______% ______% EQ/PIMCO Global Real Return ______% ______% EQ/PIMCO Real Return ______% ______% EQ/PIMCO Total Return ______% ______% EQ/PIMCO Ultra Short Bond ______% ______% EQ/Small Company Index ______% ______% EQ/T. Rowe Price Growth Stock ______% ______% EQ/T. Rowe Price Health Sciences Portfolio ______% ______% Fidelity VIP Growth & Income ______% ______% Fidelity VIP Mid Cap ______% ______% Franklin Small Cap Value VIP ______% ______% Ivy VIP High Income ______% ______% Ivy VIP Small Cap Growth ______% ______% Lord Abbett Bond Debenture ______% ______% Multimanager Aggressive Equity ______% ______% Multimanager Technology ______% ______% PIMCO VIT CommodityRealReturn Strategy ______% ______% T. Rowe Price Equity Income II ______% ______% Templeton Developing Markets VIP ______% ______% Templeton Global Bond ______% ______%
TOTAL (for VUL) 100%                
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Investment Start Date
1 The ‘‘Investment Start Date’’ is the business day your investment first begins to earn a return for you, as describedbelow,andisgenerallythelater of:(1)thebusinessdaywereceivetheminimuminitialpremiumatourAdministrativeOffice;and2)theRegisterDateofyourpolicy.YourPolicy
Account will be allocated according to the above percentages as of the Investment Start Date. Any payments we receive prior to your Investment Start Date will be held in a non-interest bearing account until your Investment Start Date.
2 If you elect the Market Stabilizer Option, the portion of your Policy Account, per the above premium percentage for such option, will be allocated as stated above. Such portion of your Policy Account will be allocated to the Market Stabilizer Option Holding Account and held for 20 calendar days. If the policy is issued as a result of a replacement, such portion of your Policy Account will be allocated to the Market Stabilizer Option Holding Account and held for 30 calendar days (45 calendar days in PA). However, if we have not received all necessary requirements for your policy as of the Issue Date, the period of time during which amounts will remain in the Market Stabilizer Option Holding Account will begin on the date we receive,atourAdministrativeOffice,allnecessaryrequirementstoputthepolicyinforce.Thereafter,suchamountwillbetransferredtotheMarket StabilizerOptionatthenextavailableSegmentStartDate,providedthattheconditionsspecifiedintheriderandtheProspectusaremet.
3 AnypercentagesspecifiedfordeductionsfortheMarketStabilizerOptionwillapplyonlytotheMarketStabilizerOptionHoldingAccountpriortoa
Segment Start Date.
2. Market Stabilizer Option
Allocations if the Market Stabilizer Option is Elected
☐ Market Stabilizer Option (Variable Indexed Option Rider)
SpecifiedGrowthCapRate._____%(indicate a Growth Cap Rate between 6% and 10% in whole percentages only)
If the Growth Cap Rate Equitable Financial Life Insurance Company sets on a given Segment Start Date is less than the rate you specify, any Policy Account Value you have in the Market Stabilizer Option Holding Account will not be transferredintothatSegment.IfyoudonotindicateaSpecifiedGrowthCapRate,theSpecifiedGrowthCapRate will be set to 6%, the guaranteed minimum Growth Cap Rate, and funds will transfer into a new Segment on all availableSegmentStartDates,providedtheconditionsspecifiedintheriderandProspectusaremet.
Transfers from the Variable Investment Options to Supplement the Unloaned Guaranteed Interest Account(GIA)
☐ If you elect the Market Stabilizer Option, monthly deductions will be allocated 100% to the unloaned GIA on a Segment
StartDate.IftheunloanedGIAisnotsufficienttocoversuchmonthlydeductionsforthelongestSegmentTerm,funds will be transferred pro-rata from amounts in the Variable Investment Options, including the Market Stabilizer Option
HoldingAccount,totheunloanedGIAtosupplementanyremainingmonthlydeductions.Youmayalsospecifydeduction percentages below for transferring amounts from the Variable Investment Options to supplement the unloaned GIA.
☐ Check here if you wish transfers to be made pro-rata from amounts in all available Variable Investment Options, including the Market Stabilizer Option Holding Account, to supplement the unloaned GIA. If this box is not checked, please specify below the Variable Investment Options from which amounts should be transferred to supplement the unloaned GIA.
Variable Investment Options to Transfer from (complete if box is not checked): Percentage (whole percentages only):
_____________________________________________________________ ____________________________% _____________________________________________________________ ____________________________% _____________________________________________________________ ____________________________% _____________________________________________________________ ____________________________% _____________________________________________________________ ____________________________% _____________________________________________________________ ____________________________%                TOTAL    100%
Segment Maturity Allocation
Each Segment of the Market Stabilizer Option has a Segment Maturity Date, which is approximately one year following a Segment
StartDate.YoumayspecifytheinvestmentoptionallocationpercentagesfortherolloveroftheSegmentMaturityValue.
☐ Check here if you wish to rollover your Market Stabilizer Option Segment Maturity Value to a new Segment. If this box is not checked, indicate allocations for rollover of the Segment Maturity Value below. Please note that by electing less than 100% rollover, the total portion of your Policy Account Value allocated to the Market Stabilizer Option will continually decrease as future rollovers occur, if no other changes were made. For example, a Segment Maturity Allocation of 50% to the Market Stabilizer Option will rollover 50% of the original Market Stabilizer Option allocation in year 2 but only 25% (50% x 50%) of the original Market Stabilizer Option allocation in year 3.


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Segment Maturity Allocation (continued)
Investment Options for Rollover (complete only if box above is not checked): Percentage (whole percentages only):
._____________________________________________________________ ____________________________% _____________________________________________________________ ____________________________% ._____________________________________________________________ ____________________________% _____________________________________________________________ ____________________________% ._____________________________________________________________ ____________________________% _____________________________________________________________ ____________________________%                TOTAL    100%
3. Automatic Transfer Service
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. The automatic transfer is effective on the second monthly anniversary and will continue Until the amount allocated to the EQ/Money Market Investment Option is depleted. The Guaranteed Interest Account is not an available investment option with the 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 remainineffectuntil(a)insufficientfundsareavailabletoprocesstransfers,(b)I(we)providenewwritteninstructionsor
(c) the Automatic Transfer Service otherwise terminates as described in the prospectus. I (We) understand that use of the
AutomaticTransferServicedoesnotguaranteeaprofitandwillnotprotectagainstlossinadecliningmarket.
4. Asset Rebalancing Service
Note: Not available if you elect the Automatic Transfer Service. Neither the Guaranteed Interest Account nor the Market Stabilizer Option are available for Asset Rebalancing.
Yourallocationamongtheinvestmentoptionswillbeperiodicallyre-adjustedaccordingtothepercentageyouindicated in the “Initial Allocation of the Investment Options” section above and the frequency you choose below. Asset allocation percentagesof2%ormore(inwholepercentages)maybespecifiedforallvariableinvestmentoptionsuptoamaximumof
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 intheprospectus.I(We)understandthattheuseoftheAssetRebalancingServicedoesnotguaranteeaprofitandwillnot protect against loss in a declining market.
5. Suitability
Have you, the Proposed Insured(s) and the Owner, if other than the Proposed Insured(s), received: a. The most current prospectus, and supplement(s) if applicable, for the policy(ies) applied for? ☐Yes☐ No b. The most current prospectus, and supplement(s) if applicable, for the designated investment company(ies)? ☐Yes☐ No
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5. Suitability (continued)
c. Doyouunderstandthat(i)policyvaluesreflectcertaindeductionsandcharges,andmayincreaseor 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    d. With this in mind, is (are) the policy(ies) in accord with your insurance and long-term investment objectivesandanticipatedfinancialneeds? ☐Yes☐ No
Disclosures and Consent for Delivery of Initial Prospectus on CD-Rom for Equitable Financial Life Insurance Company Variable Life products.
☐ By checking the box, you acknowledge that you received the initial prospectus on computer readable compact disk ‘‘CD,’’ if availablefortheproductchosen,andthatyoucanaccesstheCDinformation.Toretaintheprospectusindefinitely,you mustprintit.YouunderstandthatyoumayrequestaprospectusinpaperformatatanytimebycallingCustomerServiceat
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.
I (WE) UNDERSTAND 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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