Service Office: Life New Business 30 Dan Rd, Suite 55765 Canton, MA 02021-2809 Variable Life – Fund Allocation JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (hereinafter referred to as The Company) This form is part of the Application for Individual Life Insurance. Print and use black ink. Any changes must be initialed by the Proposed Insured(s) and/or Owner(s). SECTION A: Proposed Insured(s) LIFE ONE 1. Name FIRST MIDDLE LAST LIFE TWO 2. Name FIRST MIDDLE LAST SECTION B: Owner(s) – Complete information only if Owner(s) is other than Proposed Insured. 3. Name of Owner(s) SECTION C: Investment Allocation of Net Premiums Must complete for all products. Allocation must be in whole numbers. Total must be 100%. 4. Investment Options for All Products Aggressive Growth Portfolios Growth Portfolios Growth & Income Portfolios % Emerging Markets Value % Small Company Value % Equity Income % Real Estate Securities % 500 Index % Small Cap Value % International Small Company % American Growth-Income % Mid Cap Index % American Asset Allocation % Small Cap Opportunities % American Growth % Capital Appreciation Value % International Equity Index % Mid Value % PIMCO VIT All Asset % Small Cap Index % Science & Technology % Global % Blue Chip Growth 1. % Financial Industries Indexed Accounts % Fundamental Large Cap Value % Base Capped Indexed Account % International Value % Total Stock Market Index % Base High Par Capped % American Global Growth Indexed Account % Mid Cap Stock % Capital Appreciation % American International % Small Cap Stock Income Portfolios M Funds % Fundamental All Cap Core % High Yield % M International Equity % Global Bond % Health Sciences % M Large Cap Growth % Strategic Income Opportunities % M Capital Appreciation % Active Bond Other Portfolio % M Large Cap Value % Investment Quality Bond % % Core Bond % Total Bond Market % FIXED ACCOUNT Conservative Portfolio % Select Bond % Money Market % Short Term Government Income Transfers out of the FIXED ACCOUNT % Ultra Short Term Bond may be subject to limitations. Managed Volatility Portfolios Refer to the policy prospectus for further details. % Managed Volatility Aggressive Lifestyle Portfolios 1. % Managed Volatility Growth % Lifestyle Growth Not available with Protection VUL17. To establish recurring transfers, complete % Managed Volatility Balanced % Lifestyle Balanced Request for Investment Option Changes. % Managed Volatility Moderate % Lifestyle Moderate. % Managed Volatility Conservative % Lifestyle Conservative ICC19 NB6016 (12/2019) (M) 1 of 3 (US) VERSION (01/2020)

SECTION D: Segment Proceeds Allocation (Optional) 5. Upon segment maturity, allocate Segment Proceeds to the following accounts. Select the FROM account and TO account on the chart provided. In the absence of any Segment Proceeds allocation instructions, your policy’s Segment Proceeds will automatically be reallocated 100% to new segments of the same Indexed Account. If additional space is needed for these instructions, please submit a separate page along with this form. FROM: FROM: Base Capped Indexed Base High Par Capped Account Indexed Account PERCENTAGE TO: % % Base Capped Indexed Account % % Base High Par Capped Indexed Account % % Fixed Account % % % % % % % % % % % % % % % % % % % % TOTAL (Must equal 100% for each column) SECTION E: Allocation of Monthly Charges 6 This option is not available for policies that have Policy Value in any Indexed Account. If any Policy Value is allocated to an Indexed Account, this option is discontinued and charges will be deducted pro-rata. If all Policy Value is later removed from the Indexed Accounts, you must request a new allocation of monthly charges. Investment Account Name: % Check box and attach sheet % with additional information, if necessary. SECTION F: Telephone and/or Internet Transfer/Allocation Change Authorization (Optional) 7. I understand and agree that: a) By checking one of the boxes below, I am authorizing The Company to accept telephone and Internet transfers and allocation changes. Telephone and Internet transfers and allocation changes will also be subject to the terms and conditions of the policy, and the administrative requirements of The Company. b) The Company will honor telephone and Internet instructions from anyone who provides correct identifying information. The Company, its agents or representatives of employees who act on its behalf will not be subject to any claim, liability, loss, expense or cost if acted on in good faith upon telephone or Internet instructions it reasonably believes to be genuine in reliance on this signed authorization. c) The Company, at its option alone and without prior or subsequent notice to the Owner(s), or any other person or representative of the Owner(s), may record all or part of any telephone conversation containing telephone transfer and/or allocation change instructions. d) All terms of this Authorization are binding upon the agents, heirs and assignees of the Owner(s). e) This Telephone and Internet Transfer/Allocation Change Authorization will be effective until such time as (a) written revocation is received by The Company’s Service Office, or (b) The Company discontinues this privilege, whichever occurs first. Please check (X) only one box. I authorize The Company to accept telephone and Internet instructions from me or any co-owner. I authorize The Company to accept telephone and Internet instructions from me, any co-owner or our Registered Representative.

SECTION G: Asset Account Balancer (Optional) 8. The Asset Allocation Balancer Service will only move amounts among the Investment Accounts selected; it will not move amounts to or from the Fixed Account or any Indexed Account. This service will automatically move amounts among your specified Investment Accounts as frequently as you indicate below in number 9 to maintain your chosen percentages in each account. To elect this service, check box A or B and provide details as required. We reserve the right to cease to offer this program as of 90 days after written notice is sent to you. If you have elected an Investment Allocation of Net Premiums which includes the Fixed Account or any Indexed Account, complete option B below. Indicate the Rebalancing instructions, excluding those for the Fixed Account or any Indexed Account, totaling 100%, using whole numbers. A Rebalance based on the percentages selected in the Investment Allocation of Net Premiums section of this form without regards to any amounts allocated to the Fixed Account or any Indexed Account. B Rebalance based on the listed percentages below: INVESTMENT ACCOUNT PERCENTAGE INVESTMENT ACCOUNT PERCENTAGE INVESTMENT ACCOUNT PERCENTAGE % % % % % % % % % 9. Frequency of Rebalancing Annually Semi-annually Quarterly Monthly SECTION H: Owner(s) Acknowledgement 10. I understand that under the applied for policy: a) the amount of the insurance benefits, the duration of the insurance coverage, or both, may be variable or fixed; b) the amount of the insurance benefits, the duration of the insurance coverage, and the policy/account value, may increase or decrease, even to the extent of being reduced to zero, depending on the experience of the chosen investment options and are not guaranteed as to dollar amount. Illustrations of benefits, including death benefits, policy/account and cash surrender values are available on request; and c) if the net cash surrender value is insufficient to pay the charges when due and there is not a no-lapse guarantee in effect, your policy can terminate or lapse due to insufficient premiums or poor investment option performance. SECTION I: Owner(s) Signatures SIGNED AT CITY STATE THIS DAY OF YEAR X X SIGNATURE OF OWNER PRINT NAME OF OWNER (PROVIDE TITLE OR CORPORATE SEAL, IF SIGNING OFFICER) X X SIGNATURE OF OWNER PRINT NAME OF OWNER (PROVIDE TITLE OR CORPORATE SEAL, IF SIGNING OFFICER) SECTION J: Registered Representative Signature I certify that the current prospectuses and supplements that describe the variable life insurance policy applied for and the sub-accounts of the separate account that are available under this policy have been given to the Proposed Insured(s) or the Owner if other than the Proposed Insured(s). X SIGNATURE OF REGISTERED REPRESENTATIVE SIGNED THIS DAY OF YEAR ICC19 NB6016 (12/2019) (M) 3 of 3 (US) VERSION (01/2020)