5(a) Retirement Cornerstone Series B	EX-99.5a
Application for an Individual Annuity (ICC20 App01 RC E-Z)

For Assistance, please call 800-338-3434 www.equitable.com

Equitable Advisors, LLC

Home Office: 3030 North Third Street, Suite 790, Phoenix, Arizona 85012

Cat. No. 161978 X04470_Compact Series E

Equitable Advisors, LLC Page 1 of 10

A. Contract Series

þ Series E ($25,000 minimum contribution)

B. Choose a Contract Type.

Non-Qualified

Traditional IRA

Roth IRA

Qualified Plan Defined Contribution (QPDC)

Qualified Plan Defined Benefit (QPDB)

C. Total Initial Contribution(s): $ ( Estimated Value Required In Case of Transfer)

Specify Method(s) of Payment:

Check or Wire (make check payable to: EQUITABLE)

1035 Exchange (NQ)

Direct Transfer (IRA, Roth IRA)

Rollover (IRA, Roth IRA)

ICC20 App01 RC E -Z

PLEASE PRINT

REQUIRED

REQUIRED

Regular Mail:

Equitable

Retirement Service Solutions

P.O. Box 1577

Secaucus, NJ 07096-1577

Express Mail:

Equitable

Retirement Service Solutions

500 Plaza Drive

7th Floor

Secaucus, NJ 07094-3619

Equitable Financial Life Insurance Company

of America

RETIREMENT CORNERSTONE® SERIES E

Application for an Individual Annuity

X04470_Compact Retirement Cornerstone® — Series E

ICC20 App01 RC E -Z Page 2 of 10

2. Account Registration (Must be legal resident of U.S. or U.S. territories)

Please check one

Individual UGMA/UTMA (Child’s SSN )

The Owner types below require additional form(s). See the New Business Form Booklet for more information.

Trust Qualified Plan Trust (DC/DB) Other Non-Natural Owner

Male Female Date of Birth (MM/DD/YYYY) Daytime Phone #

REQUIRED

A. Owner

(First) (Middle Initial) (Last)

Owner Name

(First) (Middle Initial) (Last)

Name

Owner Taxpayer Identification Number (Check one) SSN EIN ITIN

U.S. Primary Residential Address only — No P.O. Box City State Zip Code

If your Mailing Address is different from the Primary Residential Address above, please provide your Mailing Address in Section 9.

Email Address

Annuity Commencement Date: The Annuity Commencement Date will be the Contract Date Anniversary following the

Annuitant’s 95th birthday. If GMIB is elected, the Annuity Commencement Date will be the Contract Date Anniversary

following the Owner’s 95th birthday. You may commence Annuity payments earlier by submitting a written request to our

Processing Office in accordance with the Contract.

B. PATRIOT Act Information: Owner must complete this section. If the owner is not an individual, the

annuitant must complete this section.

U.S. Citizen Yes No If yes, check one: Valid Driver’s License Passport State Issued ID

If no, check either: U.S. Visa (Complete below) or Permanent Resident (Green Card) (Copy of document required)

Identification/Passport# Exp. Date U.S. Visa Type (if applicable)

Your Employer’s Name Your Occupation

C. Joint Owner (Must be legal resident of U.S. or U.S. territories) NQ only

If GMIB elected, both owners must be ages 50-80.

Male Female Date of Birth (MM/DD/YYYY) Daytime Phone #

Taxpayer Identification Number (Check one) SSN ITIN

U.S. Primary Residential Address — No P.O. Box City State Zip Code

Email Address

Joint Owner Form of Identification (Check one) Valid Driver’s License Passport State Issued ID

Identification Number Exp. Date (MM/DD/YYYY)

REQUIRED

X04470_Compact Retirement Cornerstone® — Series E

ICC20 App01 RC E -Z Page 3 of 10

D. Annuitant (Required if other than Owner) Annuitant must complete the PATRIOT Act Information section 2B

on the previous page if the owner is NOT an individual.

Male Female Date of Birth (MM/DD/YYYY) Daytime Phone #

Name

(First) (Middle Initial) (Last)

Taxpayer Identification Number (Check one.) SSN ITIN

U.S. Primary Residential Address only — No P.O. Box City State Zip Code

E. Joint Annuitant Only complete this section if this is a NQ 1035 Exchange of an existing contract with joint

annuitants who are spouses.

If GMIB elected, both annuitants must be ages 50-80.

Male Female Date of Birth (MM/DD/YYYY) Daytime Phone #

Name (First) (Middle Initial) (Last) Taxpayer Identification Number (Check one) SSN ITIN

U.S. Primary Residential Address only — No P.O. Box City State Zip Code

3. Beneficiary(ies) (Please use Special Instructions for Additional Beneficiaries)

Please enter the beneficiaries full name below. Unless otherwise indicated, proceeds will be divided equally.

A. Primary

1. %

Primary Beneficiary Name Relationship to Owner1

SSN EIN ITIN

Date of Birth (MM/DD/YYYY)

Address Phone #

2. %

Primary Beneficiary Name Relationship to Owner1

SSN EIN ITIN

Date of Birth (MM/DD/YYYY)

Address Phone #

B. Contingent

1. %

Contingent Beneficiary Name Relationship to Owner1

SSN EIN ITIN

Date of Birth (MM/DD/YYYY)

Address Phone #

2. %

Contingent Beneficiary Name Relationship to Owner1

SSN EIN ITIN

Date of Birth (MM/DD/YYYY)

Address Phone #

1 Enter the relationship to the annuitant when the Owner is not an Individua l.

REQUIRED

X04470_Compact Retirement Cornerstone® — Series E

ICC20 App01 RC E -Z Page 4 of 10

1 There is no additional charge for the Return of Principal death benefit.

2 Available for Traditional IRA and QPDC only.

3 The charge for this rider is based on the Owner’s age at the time the contract is issued, regardless of the Owner’s age

when the application is signed. The charge is higher for Owner issue ages 65-68.

4D: Annual Reset Election

• If your contract is issued with GMIB, it will automatically include the Automatic Reset program.

• The Automatic Reset program resets the GMIB and if elected the “Greater of” GMDB each year that you are eligible.

If you accept the Automatic Reset program, resets will occur automatically unless such automatic resets are or have

been terminated. The reset will result in a new waiting period to exercise the GMIB of up to the later of 10 years or the

original exercise date, but not later than age 95.

To opt out of the Automatic Reset Program, please check the box below.

I decline the Automatic Reset Program.

Or to elect a Customized Reset Program, check the box below.

Customized Reset Program Reset my GMIB and if elected “Greater of” GMDB each year up to and

including the contract anniversary date in the year only. I understand that resets will only occur

during this time period if I am eligible. (YYYY)

REQUIRED

4. Optional Guaranteed Benefit Rider Elections

These optional riders are purchased for an additional charge. You should read the disclosure on page 8, the prospectus

and applicable supplements for more complete information including the limitations, restrictions, charges and other

information that apply to these features before making a selection.

The death benefit, if any, in connection with the Investment Account Value is equal to amounts in the

Investment Account Investment Options.

• The benefit riders are optional and may only be chosen at the time of the application. There are additional charges

for these riders, unless otherwise noted.

• If you opt out of the GMIB at issue by declining it below in section 4A or 4C, you will not be able to add it later.

• Benefits under these riders apply only to amounts allocated to the Protected Benefit Account Investment Options.

• You may allocate amounts to the Protected Benefit Account Investment Options immediately or at a future date,

subject to the terms and limitations of the contract.

• If you do not allocate amounts to the Protected Benefit Account Investment Options, these rider(s) will have no value

under your Contract until you allocate amounts at a future date.

• The age requirements for all benefits are based on the Owner’s age(s) at the time the contract is issued, regardless of

the Owner’s age(s) when the application is signed.

4A: Guaranteed Minimum Income Benefit (GMIB)

• Eligible contracts will be automatically issued with the GMIB combined with the Return of Principal death

benefit1 unless you elect otherwise in section 4A, 4B or 4C.

• For single owned contracts the owner must be ages 20-80. For joint owned contracts both owners must be

ages 50-80.

• The Automatic Reset program will be automatically included with the GMIB unless you opt-out in Section 4D.

To opt out of the GMIB, please check the box below.

I decline the GMIB (Please go to section 4C to select GMDB only)

4B: Guaranteed Minimum Death Benefit (GMDB) with GMIB

To elect a GMDB other than the Return of Principal death benefit1 with GMIB, please make an election below:

Yes, I wish to elect Greater of Annual Roll up or Highest Anniversary Value death benefit (Available only for

single owner ages 20-65. For joint owners both owners must be ages 50-65.)

Yes, I wish to elect Highest Anniversary Value death benefit (Available only for single owner ages 20-75.

For joint owners both owners must be ages 50-75.)

4C: GMDB Only (without GMIB)

Yes, I wish to elect RMD Wealth Guard GMDB2 without GMIB (Available only for owners age 20 to 683)

Yes, I wish to elect Highest Anniversary Value death benefit without GMIB (Available only for owners age 0 to 75)

REQUIRED

X04470_Compact Retirement Cornerstone® Series E ICC20 App01 RC E -Z Page 5 of 10 5. Investment Selection You must allocate 100% of your initial contributions to either the Investment Options in Section 5A OR any Special DCA in Section 5B. All future allocations will be apportioned according to the percentages below unless instructed otherwise by you. Contributions received after the Special DCA program terminates will be allocated to the Investment Account Investment Options and the Protected Benefit Account Investment Options according to the instructions below. If you do not allocate amounts to the Protected Benefit Account Investment Options, the guaranteed benefits will have no value under your contract until you allocate amounts at a future date. PROTECTED BENEFIT ACCOUNT Investment Options INVESTMENT ACCOUNT Investment Options Total Allocation to Protected Benefit Account Investment Options % (percent must be a whole number) If your contract is issued with GMIB and you are younger than age 50, you may not allocate amounts to the Protected Benefit Account until you attain age 50. Please see the Protected Benefit Account Investment Options section at the bottom of page 5 to select your allocations. Total Allocation to Investment Account Investment Options % (percent must be a whole number) Please see the Investment Account Investment Option section on page 6 to select your allocations. REQUIRED REQUIRED Total Investment Account Investment Options percentage plus Protected Benefit Account Investment Options percentage must equal 100%. Choose either 5A or 5B below. 5A: Immediate Allocation Allocate 100% immediately to the Investment Account Investment Options and/or the Protected Benefit Account Investment Options. 5B: Special Dollar Cost Averaging Programs Allocate 100% immediately to the Special Dollar Cost Averaging Program selected below. Check box for one time period. 3 months 6 months 12 months You may designate either or both the Investment Account Investment Options and the Protected Benefit Account Investment Options as the destination Option for DCA. If you select the Protected Benefit Account Investment Options, your funds will be considered invested in the Protected Benefit Account from the date of contribution. The destination cannot be changed to the Investment Account Investment Options at a later date. PROTECTED BENEFIT ACCOUNT Investment Options If you allocated 100% to the Investment Account Investment Options proceed to page 6 to enter your allocation instructions. If your contract is issued with GMIB and you are younger than age 50, you may not allocate amounts to the Protected Benefit Account until you attain age 50. Percentages must be whole numbers Allocation % Growth/Aggressive Growth % EQ/AB Dynamic Aggressive Growth GB % EQ/AB Dynamic Growth GB % EQ/Aggressive Growth Strategy GB % EQ/Goldman Sachs Growth Allocation GB % EQ/Growth Strategy GB % EQ/JPMorgan Growth Allocation GB % EQ/Legg Mason Growth Allocation GB Conservative/Conservative Growth % EQ/Conservative Growth Strategy GB % EQ/Conservative Strategy GB Allocation % Moderate/Moderate Growth % 1290 VT Moderate Growth Allocation GB % EQ/AB Dynamic Moderate Growth GB % EQ/American Century Moderate Growth Allocation GB % EQ/AXA Investment Managers Moderate Allocation GB % EQ/Balanced Strategy GB % EQ/First Trust Moderate Growth Allocation GB % EQ/Goldman Sachs Moderate Growth Allocation GB % EQ/Invesco Moderate Allocation GB % EQ/Invesco Moderate Growth Allocation GB % EQ/Legg Mason Moderate Allocation GB % EQ/Moderate Growth Strategy GB 100% Protected Benefit Account Investment Options* * This amount represents 100% of the percentage shown above in the Protected Benefit Account Investment Options section.

X04470_Compact Retirement Cornerstone® — Series E ICC20 App01 RC E -Z Page 6 of 10 INVESTMENT ACCOUNT Investment Options Percentages must be whole numbers Allocation % Asset Allocation % 1290 VT DoubleLine Dynamic Allocation % 1290 VT Moderate Growth Allocation % BlackRock Global Allocation V.I. Fund % EQ/AB Dynamic Aggressive Growth % EQ/AB Dynamic Growth % EQ/AB Dynamic Moderate Growth % EQ/Aggressive Growth Strategy % EQ/All Asset Growth Allocation % EQ/American Century Moderate Growth Allocation % EQ/AXA Investment Managers Moderate Allocation % EQ/Balanced Strategy % EQ/Conservative Growth Strategy % EQ/Conservative Strategy % EQ/First Trust Moderate Growth Allocation % EQ/Goldman Sachs Growth Allocation % EQ/Goldman Sachs Moderate Growth Allocation % EQ/Growth Strategy % EQ/Invesco Moderate Allocation % EQ/Invesco Moderate Growth Allocation % EQ/JPMorgan Growth Allocation % EQ/Legg Mason Growth Allocation % EQ/Legg Mason Moderate Allocation % EQ/Moderate Allocation % EQ/Moderate Growth Strategy % First Trust/Dow Jones Dividend & Income Allocation Portfolio % First Trust Multi Income Allocation Portfolio % Franklin Allocation VIP Fund % Franklin Income VIP Fund % Invesco V.I. Equity and Income Fund % QS Legg Mason Dynamic Multi-Strategy VIT Portfolio Large Cap Blend Stocks % ClearBridge Variable Appreciation Portfolio % ClearBridge Variable Dividend Strategy Portfolio % EQ/ClearBridge Select Equity Managed Volatility % EQ/Common Stock Index % EQ/Equity 500 Index % EQ/Fidelity Institutional AM® Large Cap % EQ/Franklin Rising Dividends % MFS® Investors Trust Series Large Cap Growth Stocks % BlackRock Large Cap Focus Growth V.I. Fund % ClearBridge Variable Aggressive Growth Portfolio % EQ/ClearBridge Large Cap Growth % EQ/Large Cap Growth Index % EQ/Loomis Sayles Growth % EQ/T. Rowe Price Growth Stock % MFS® Massachusetts Investors Growth Stock Portfolio % Multimanager Aggressive Equity Large Cap Value Stocks % 1290 VT Equity Income % EQ/BlackRock Basic Value Equity % EQ/Invesco Comstock % EQ/JPMorgan Value Opportunities % EQ/Large Cap Value Index % EQ/Large Cap Value Managed Volatility % Invesco V.I. Diversified Dividend Fund Mid Cap Stocks % ClearBridge Variable Mid Cap Portfolio % EQ/American Century Mid Cap Value % EQ/Goldman Sachs Mid Cap Value % EQ/Janus Enterprise Portfolio % EQ/MFS Mid Cap Focused Growth Portfolio % EQ/Mid Cap Index % EQ/Mid Cap Value Managed Volatility % Fidelity® VIP Mid Cap Portfolio % Invesco V.I. Mid Cap Core Equity Fund Allocation % Small Cap Stocks % 1290 VT GAMCO Small Company Value % 1290 VT Microcap % 1290 VT Small Cap Value % EQ/AB Small Cap Growth % EQ/Small Company Index % Invesco V.I. Small Cap Equity Fund International/Global Stocks % 1290 VT Low Volatility Global Equity % 1290 VT SmartBeta Equity % American Funds Insurance Series® Global Small Capitalization FundSM % American Funds Insurance Series® New World Fund® % EQ/Emerging Markets Equity PLUS % EQ/International Core Managed Volatility % EQ/International Equity Index % EQ/Invesco Global Portfolio % EQ/Invesco International Growth % EQ/Lazard Emerging Markets Equity % EQ/MFS International Growth % EQ/MFS International Intrinsic Value % Neuberger Berman International Equity Portfolio % Templeton Developing Markets VIP Fund Specialty % 1290 VT GAMCO Mergers & Acquisitions % 1290 VT Natural Resources % 1290 VT Real Estate % Eaton Vance VT Floating-Rate Income Fund % EQ/Invesco Global Real Estate % EQ/MFS Technology % EQ/MFS Utilities Series % EQ/T.Rowe Price Health Sciences % EQ/Wellington Energy Portfolio % Multimanager Technology % Neuberger Berman U.S. Equity Index PutWrite Strategy Portfolio % PIMCO VIT CommodityRealReturn® Strategy Portfolio % ProFund VP Biotechnology % Templeton Global Bond VIP Fund High Yield Bonds % 1290 VT High Yield Bond % Invesco V.I. High Yield Fund % Ivy VIP High Income Bonds % 1290 VT DoubleLine Opportunistic Bond % American Funds Insurance Series® Bond FundSM % EQ/Core Bond Index % EQ/Franklin Strategic Income % EQ/Intermediate Government Bond % EQ/PIMCO Global Real Return % EQ/PIMCO Real Return % EQ/PIMCO Total Return % EQ/PIMCO Ultra Short Bond % Fidelity® VIP Strategic Income Portfolio % Lord Abbett Bond Debenture % PIMCO VIT Income Portfolio % Putnam VT Diversified Income Fund Cash/Cash Equivalents % Guaranteed Interest Option (GIO) (maximum 25%) % EQ/Money Market 100% Investment Account Investment Options* TOTAL% * This amount represents 100% of the percentage is shown above in the Investment Account Investment Option section.

X04470_Compact Retirement Cornerstone® — Series E

ICC20 App01 RC E -Z Page 7 of 10

Yes. I have granted authority to each of my Financial Professional(s), which are listed below, to act as my agent

and provide to Equitable Investment Option transfer instructions in writing, by telephone or electronically, and I hereby

authorize and direct Equitable to act on such instructions. I understand and ack nowledge that Equitable (i) may rely in

good faith on the stated identity of the person(s) placing such instructions, and (ii) will have no liability for any claim,

loss, liability, or expense that may arise in connection with such instruction s. Equitable will continue to act upon this

authorization until such time as we receive written notification in our Processing Office that broker transfer authority

has been terminated. Upon receipt of such notification, Equitable will terminate the Financial Professional’s(s’) ability

to provide transfer instructions on your behalf. Equitable may (i) change or terminate telephone or electronic or

overnight mail transfer procedures at any time without prior notice, and (ii) restrict fax, internet, telephone and other

electronic transfer services because of disruptive transfer activity.

6. Broker Transfer Authority Disclosure

7. Current Insurance

Any person who knowingly presents a false statement in an application for insurance may be guilty

of a criminal offense and subject to penalties under state law.

8. Fraud Warning

Mailing Address — P.O. Box accepted City State Zip Code

Attach a separate sheet if additional space is needed. For Owners whose Mailing Address differs from their

Primary Residential Address in Section 2A, please complete the following:

9. Special Instructions

I authorize Equitable to send all documents regarding my contract to me electronically. This means that my

contract, contract endorsements, annuity statements, confirmation notices, privacy policy, prospectuses and all

other notices regarding my contract will be sent to me electronically.

My email address is1:

This authorization will continue unless and until revoked and means that Equitable will send an email or notice to me

when documents are available on Equitable’s website. Please logon to equitable.com to update your email address,

revoke your authorization for electronic delivery or request paper copies. Certain types of correspondence may continue

to be delivered by the United States Postal Service for compliance reasons.

To receive and view such documents electronically, I understand I must register (with a user name and password) for

online account access with Equitable. Upon issuance of your contract you will receive an email providing a temporary

password and instructions to register for online account access. Through this online account you can view, download

or save statements and other documents to your home computer. If the email provided is not a valid address, you will

receive paper versions of your statements and other contract related documents. When you agree to do transactions

electronically on equitable.com, you agree to the disclosures, terms and requirements pertaining to electronic

transactions set forth on the website.

1Non-natural owners (such as trusts): please provide the email address of the authorized signatory.

10. Electronic Delivery

REQUIRED

BOTH questions in the Owner Response and the Financial Professional Response

columns must be completed and match for the contract to be issued.

Replacement Questions Owner Response Financial Professional

Response

1. Do you have any other existing life insurance or annuities?

(If yes, a State Requirements Questionnaire may be required)

Yes No Yes No

2. Will any existing life insurance or annuity be (or has it been)

surrendered, withdrawn from, loaned against, changed or otherwise

reduced in value, or replaced in connection with this transaction

assuming the Certificate/Contract applied for will be issued on the

life of the Owner?

(If yes, complete the following below and submit a State Requirements

Questionnaire, if required.)

Yes No Yes No

Please list the contract(s) below that will be used to fund this new Equitable contract

Company Type of Plan Year Issued Certificate/Contract Number

Company Type of Plan Year Issued Certificate/Contract Number

Company Type of Plan Year Issued Certificate/Contract Number

X04470_Compact Retirement Cornerstone® — Series E

ICC20 App01 RC E -Z Page 8 of 10

11. Signature and Acknowledgements

GENERAL DISCLOSURE. BY SIGNING BELOW, I/WE UNDERSTAND AND ACKNOWLEDGE THAT:

• Account value(s) attributable to allocations to the investment options, and any variable annuity benefit

payments I may elect, may increase or decrease and are not guaranteed as to dollar amount.

• In the case of IRAs and qualified plans that provide tax deferral under the Internal Revenue Code, by signing this

application I acknowledge that I am buying the Contract for its features and benefits other than tax deferral, as the

tax deferral feature of the Contract does not provide additional benefits.

• Under penalty of perjury, I certify that all the Taxpayer Identification Numbers, citizenship and owner status

information in Section 2 are correct.

• All information and statements furnished in this application are true and complete to the best of my knowledge and

belief.

• Equitable may accept amendments to this application provided by me or under my authority.

• No Financial Professional has the authority to make or modify any Contract on behalf of Equitable, or to waive

or alter any of Equitable’s rights and regulations. Equitable must agree to any change made to the Contract

and benefits applied for, or to the age at issue, in writing signed by an officer of the company.

• Charges under the Contract generally apply for the duration of the Contract.

• The prospectus and applicable supplements contain more complete information including the limitations, restrictions

and conditions that applies to the Contract and any optional benefit riders.

OPTIONAL GUARANTEED BENEFIT DISCLOSURE. I/WE UNDERSTAND AND ACKNOWLEDGE THAT:

• There are additional charges for the elected optional benefit riders, unless otherwise noted in this application.

• To receive the benefits under the rider(s), I/we must allocate amounts to the Protected Benefit Account Investment

Options either immediately or at a future date, subject to the terms and limitations of the Contract. I understand that

allocating amounts to the Protected Benefit Account either immediately or, subject to the terms and conditions of the

Contract, on a future Contract Date Anniversary maximizes the benefit of the roll up feature. If Equitable discontinues

transfers and contributions to the Protected Benefit Account Investment Options, I/we will thereafter not be able to

create or add to the benefit base.

• Contributions and transfers to the GMIB and “Greater of” GMDB (if elected) are only permitted starting at age 50. If I

am between the ages of 43 and 49 on my Contract Date, the applicable Initial Lock-in Deferral Rollup Rate and Initial

Lock-in Annual Rollup Rate will only apply after I attain age 50, and then only for the amount of time remaining of my

first seven Contract Years. If I am age 42 or younger on my Contract Date, the Initial Lock-in Deferral Rollup Rate and

Initial Lock-in Annual Rollup Rate will never apply to my Contract and my benefit(s) will rollup based on the applicable

Ten Year Treasuries Formula Rate according to the terms of the Contract.

• The rollup rate used for the rollup benefit bases under GMIB and GMDB (if elected) does not represent a guarantee of

my Account Value or Cash Value. The rollup rates that apply to my contract are specified in the Rate Sheet

Supplement to the Prospectus.

• The benefit base does not represent an Account Value or Cash Value. The benefit base cannot be split in connection

with a divorce.

• Unless otherwise declined, contracts with the GMIB will automatically issue with the Automatic Reset program. The

Automatic Reset program resets my GMIB and if elected “Greater of” GMDB Rollup Benefit Base each year that I

am eligible. Resets will occur automatically unless such automatic resets are or have been terminated. The annual

reset will result in a new wait period to exercise the GMIB, of up to the later of 10 years or the original exercise

date (but not later than age 95) which may be started beginning on each Contract Date Anniversary that the GMIB

and if elected “Greater of” GMDB Rollup Benefit Base is reset. If my Annuity Account Value does not exceed my

GMIB benefit base on any Contract Anniversary, no reset will occur. To cancel my reset I must submit a signed and

completed reset cancellation request. Any such request must be received at Equitable’s processing office at least

1 business day prior to the Contract Date Anniversary to which the cancellation applies. Requests received after

this window will apply the following year. I am not able to cancel a reset once it has occurred. For jointly owned

Contracts, eligibility to reset the benefit base is based on the age of the older owner.

• Equitable reserves the right to change the charges for the GMIB, the “Greater of” GMDB, and the RMD Wealth Guard

GMDB Riders, up to the maximum charges stated in the Contract and prospectus at any time. I will have the option

to exercise the GMIB or terminate the GMIB, “Greater of” GMDB or the “RMD Wealth Guard” GMDB Riders if a fee

increase is imposed by submitting a written request to Equitable’s Processing Office.

• Withdrawals under the Contract may reduce my optional benefit.

X04470 Compact Retirement Cornerstone® Series E

ICC20 App01 RC E -Z Page 9 of 10

11. Signature and Acknowledgements (continued)

An optional benefit, with the exception of the RMD Wealth Guard GMDB Rider after the first contract anniversary, may

be of limited use if required minimum distributions apply, now or in the future, to my Contract because withdrawals that

are made from this Contract to meet the required amount may significantly reduce the benefit. However, if I elect the

GMIB or “Greater of” GMDB and also elect the Automatic RMD Withdrawal Service, withdrawals of my required minimum

distributions made through the automatic RMD Withdrawal Service will not reduce my GMIB or for the “Greater of” GMDB

the GMDB Rollup benefit base during the GMDB Rollup Period.

Prospectus Information: I acknowledge that I have received the most current prospectus and supplements,

for Retirement Cornerstone® Series E. After reviewing my financial information and goals with my Financial

Professional, I believe that this Certificate/Contract will meet my financial goals.

Consent for Delivery of Initial Prospectus on CD-ROM:

Yes. By checking this box and signing the enrollment form/application below, I acknowledge that I received

the initial prospectus on computer readable compact disk ‘‘CD’’, and that my computer has a CD drive and I am

able to access the CD information. In order to retain the prospectus indefinitely, I understand that I must print or

download it. I also understand that I may r equest a prospectus in paper format at any time by calling Customer

Service at 800-789-7771, and that all subsequent prospectus updates and supplements will be provided to me in

paper format, unless I enroll in Equitable’s Electronic Delivery Service.

Contract State : We will issue and deliver a contract to you based upon your stat e of primary residence. If you sign the enrollment form/application in a state other than your primary residence state: I certify that either: I have a second residence where the enrollment form/application was signed (the state of sale) or I work or maintain a business in the state wher e the enrollment form/application was signed (the state of sale). (Check one) When you sign this application, you are agreeing to the elections that you have made in this application a nd acknowledge that you have read and understand the information. X Owner Signature City, State Date (MM/DD/YYYY) X Joint Owner Signature City, State Date (MM/DD/YYYY) X Annuitant Signature (if other than Owner) City, State Date (MM/DD/YYYY) X Joint Annuitant Signature (if other than Owner) City, State Date (MM/DD/YYYY) REQUIRED

12. Financial Professional Information

A. Did you (i) verify the identity by reviewing the driver’s license/passport of the Owner, or

in the case of an entity owner, obtain documentary evidence of entity’s existence

(e.g. articles of incorporation, trust agreement, etc.), and (ii) inquire about the source of the

customer’s assets and income? Yes No

B. Is the Proposed Owner/Annuitant, or is their family member or close associate, a

government, political official or foreign military official? Yes No

If “Yes”, please provide explanation of position and relationship

C. Is the Proposed Owner/Annuitant currently an Active Duty* Member of the Armed Forces? Yes No

(If Yes, you must also submit a completed and signed LIFE INSURANCE/ ANNUITY DISCLOSURE TO ACTIVE

DUTY MEMBERS OF THE ARMED FORCES).

*Active Duty means full-time duty in active military service of the United States and includes members of the reserve

component (National Guard and Reserve) while serving under published orders for active duty or full-time training.

It does not include members of the reserve component who are performing active duty or active duty for training

under military calls or orders specifying periods of less than 31 calendar days.

X ELAS

Primary Financial Professional Signature Social Security Number Agent Code

%

Print Name Phone Number

Client Account Number Email Address Agent Location

X

Financial Professional Signature Social Security Number Agent Code

%

Print Name Phone Number

Financial Professional Use Only. Contact your home office for program information.

Once selected, program cannot be changed.

þ Option I

REQUIRED

Cat No. 161978

X04470_Compact Retirement Cornerstone® — Series E

ICC20 App01 RC E -Z Page 10 of 10