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Pacific Life Insurance Company [schwab Retirement [P.O. Box 2378, Omaha, NE 68103-2378 Schwab Retirement ^or ^{1299Farnamstreet 6thFloor}‘^{RSD , Omaha,
NE} ⁶⁸¹⁰² ^lncome ^Variable Annuity] www.PadficLife.com Contract Owners: (800) 722-4448 Individual Deferred VariableRegistered Representatives: (800) 722-2333]Annuity Application 1.ANNUITANT(S) Must be an individual. Check product guidelines for maximum \issueage. Name (First, Middle, Last) Birth Date (mo/day/yr) SexJohn, James, Doe01/01/1950M FMailing Address City, State, ZIP SSN123 Any StreetAnytown, NE 12345123-45-6789Residential Address (if different than mailing address) City, State, ZIPSolicited at: State Complete this box for custodial-owned qualified contracts only. Will not be valid for any other contract types. Information put here will be used for contract issue state and registered representative appointment purposes.ADDITIONAL ANNUITANT Not applicable for qualified contracts or on contracts with non-natural owners. Check One: Joint Contingent Name (First, Middle, Last) Birth Date (mo/day/yr) SexM FMailing Address City, State, ZIP SSNResidential Address (if different than mailing address)City, State, ZIP2.OWN ER(S) If annuitant(s) and owner(s) are the same, do not complete this section. Check product guidelines for maximum issue age.Name (First, Middle, Last\)| Birth Date (mo/day/yr) SexM FMailing Address City, State, ZIP SSN/TINResidential Address (if different than mailing address)City, State, ZIPADDITIONAL OWNER Not applicable for qualified contracts.Name (First, Middle, Last) Birth Date (mo/day/yr) SexM FMailing Address City, State, ZIP SSNResidential Address (if different than mailing address)City, State, ZIP ICC12:25-1225

3. ELECTRONIC INFORMATION CONSENTE-Mail address: By providing the e-mail address above, I consent to receive documents and notices applicable to my contract, including but not limited to prospectuses, prospectus supplements, reports, statements, immediate confirmations, privacy notice and other notices, and documentation in electronic format when available instead of receiving paper copies of these documents by U.S. mail. I will continue to receive paper copies of annual statements if required by state or federal law. Not all contract documentation and notifications may be currently available in electronic format. I consent to receive in electronic format any documents added in the future. For jointly owned contracts, both owners are consenting to receive information electronically.I confirm that I have ready access to a computer with Internet access, an active email account to receive this information electronically, and ability to read and retain it. I understand that:There is no charge for electronic delivery, although my Internet provider may charge for Internet access. I must provide a current e-mail address and notify Pacific Life promptly when my e-mail address changes.I must update any e-mail filters that may prevent me from receiving e-mail notifications from Pacific Life.I may request a paper copy of the information at any time for no charge, even though I consented to electronic delivery, or if I decide torevoke my consent. For jointly owned contracts, both owners are consenting that the primary owner will receive information electronically. (Only the primaryowner will receive e-mail notices.)Electronic delivery will be cancelled if e-mails are returned undeliverableThis consent will remain in effect until I revoke it.Pacific Life is not required to deliver this information electronically and may discontinue electronic delivery in whole or in part at any time. Please call (800) 722-4448 if you would like to revoke your consent, wish to receive a paper copy of the information above, or need to update your e-mail address.4. TELEPHONE/ELECTRONIC AUTHORIZATIONYes TELEPHONE/ELECTRONIC TRANSACTION AUTHORIZATION As the owner, I will receive this privilege automatically.If a contract has joint owners, each owner may individually make telephone and/or electronic requests. By checking “Yes,” I am also authorizing and directing Pacific Life to act on telephone or electronic instructions from any other person(s) who can furnish proper identification. Pacific Life will use reasonable procedures to confirm that these instructions are authorized and genuine. As long as these procedures are followed, Pacific Life and its affiliates and their directors, trustees, officers, employees, representatives, and/or agents will be held harmless for any claim, liability, loss, or cost.5. HOUSEHOLDING By signing this application I consent to Pacific Life mailing one copy of contract owner documents to multiple contract ownerswho share the same household address. Such documents will include prospectuses, prospectus supplements, announcements, and reports, but willnot include contract-specific information such as transaction confirmations and statements. This service, known as “householding,” reducesexpenses, environmental waste, and the volume of mail I receive. If I do not wish to participate in this service and prefer to receive my own contractowner documents, I have checked the box below.I elect NOT to participate in householding.6. BENEFICIARIES If a beneficiary classification is not indicated, the class for that beneficiary will be primary. Each beneficiary class must equal100%. Multiple beneficiaries will share the death benefit equally, unless otherwise specified. For contracts owned by a non-individual custodian(including IRAs, 457, and qualified plans) or other non-natural owners, the beneficiary will be the owner list ed on the application and informationprovided below will not be valid. Use Section 12. Special Reauests. to provide additional beneficiary information. Name (First, Middle, Last) Birth Date (mo/day/yr) Primary Relationship SSN/TIN PercentageContingent %Name (First, Middle, Last) Birth Date (mo/day/yr) D Primary Relationship SSN/TIN PercentageContingent %Name (First, Middle, Last) Birth Date (mo/day/yr) Primary Relationship SSN/TIN PercentageContingent %Name (First, Middle, Last) Birth Date (mo/day/yr) Primary Relationship SSN/TIN PercentageContingent %

7. CONTRACT TYPE Select ONE. [ Non-Qualified¹‘² SIMPLE IRA⁴ Roth IRA³ 401 (a)\⁵ 457(b)-gov’t. entity⁵Keogh/HR-10⁵IRA³ SEP-IRA Individual 401(k)⁵ 457(b)-501(c) tax exempt⁵][¹For trust-owned contracts, complete Trustee Certification and Disclosure. ²For non-qualified contracts, if Owner is a non-natural person or corporation, complete the Non-Natural or Corporate-Owned Disclosure Statement. ³For individual-owned or trust-owned Inherited IRA contracts, complete appropriate Inherited IRA Certification. ⁴Complete SIMPLE IRA Employer Information. ⁵Complete Qualified Plan and 457(b) Plan Disclosure. 6Complete lndividual(k) Qualified Plan Disclosure. ]8. INITIAL PURCHASE PAYMENT [Mate check payable to Pacific Life Insurance Company.]8A. NON-QUALIFIED CONTRACT PAYMENT TYPE 8B. QUALIFIED CONTRACT PAYMENT TYPE Indicate type of initialIndicate type of initial payment. payment. If no year is indicated, contribution defaults to current tax year.Transfer $1035 exchange(s)/estimated transfer...!Rollover $Amount enclosed $50,000.00Contribution$ for tax year9. REPLACEMENT9A. EXISTING INSURANCEDo you have any existing life insurance or annuity contracts with this or any other company? Lives no\| _{DefgultjsTes"/fnejfherbQxjschecked)}9B. REPLACEMENTWill the purchase of this annuity result in the replacement, termination or change in value of any existing lifeYes No insurance or annuity in this or any other company? If “Yes,” provide the information below for each policy or contractbeing replaced and attach any required state replacement and/or 1035 exchange/transfer forms.Insurance Company Name Policy or Contract Number Policy or Contract Type Being ReplacedLife Insurance Fixed Annuity Variable AnnuityInsurance Company Name Policy or Contract Number Policy or Contract Type Being ReplacedLife Insurance Fixed Annuity Variable Annuity10. OPTIONAL RIDERS Subject to state availability. To qualify for rider benefits, the entire contract value must stay invested in allowable investmentoption programs Pacific Life makes available for the riders. Guaranteed Minimum Withdrawal Benefit Riders are irrevocable after election. There areinvestment and transfer restrictions associated with these riders. Optional Guaranteed Minimum Withdrawal Benefit Riders are not available withInherited IRA and Inherited Roth IRA business.[Guaranteed Minimum Withdrawal Benefit You may select only ONE.D Guaranteed Lifetime Withdrawal Benefit — Single Life Annuitant(s) must not be overage 85 at issue.D Guaranteed Lifetime Withdrawal Benefit • Joint Life Both spouses must not be over age 85 at issue. See note below. Note (applies to Joint Life selections): Available only if the Contract Type selected in Section 7 is Non-qualified (not available if the Owner is a trust or other entity), IRA (including custodial IRAs), Roth IRA, SIMPLE IRA, or SEP-IRA. Joint Owners must be spouses, if applicable. If the contract is owned by a sole Owner, the Owner’s spouse must be designated as the sole primary beneficiary. Complete the beneficiary information in Section 6. If this is a custodial-owned IRA, it is the responsibility of the custodian to verify that the beneficiary designation at the custodian is the spouse of the Annuitant]If any rider selected in this section cannot be added to the contract due to age and/or other rider restrictions or state availability, the contract will be issued without that rider. ICC12:25-1225

11. REBALANCING Optional.[ Quarterly Semiannually Annually]12. SPECIAL REQU ESTS If additional space is needed, attach a letter signed and dated by the Owner(s).13. FRAUD NOTICEAny 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.14. ALLOCATION OPTIONS Use this section to allocate 100% of your Investment. Use whole percentages only. Additional Investments will beallocated based on the options below, and where applicable If a selection was made In section 12, unless alternate Instructions are on file orprovided with the investment.[Schwab VIT Balanced Portfolio] 100 %[Investment Portfolios] _[Schwab V|T Balanced with Growth Portfolio] %[Schwab VIT Growth Portfolio] % %Total ICC12:25-1225

5. STATEMENT OF OWNER(S) I understand that federal law requires all financial Institutions to obtain the name, residential address, date of birth,Social Security or taxpayer identification number, and any other information necessary to sufficiently verify the identity of each customer. Iunderstand that failure to provide this information could result in the annuity contract not being issued, delayed or unprocessed transactions, orannuity contract termination. I, the owner(s), understand that I have applied for a variable annuity contract (“contract”) issued by Pacific Life Insurance Company (“company”). I received the variable annuity prospectus and applicable fund prospectuses for this variable annuity contract. After reviewing my financial background with my registered representative, I believe this contract, including the benefits of its insurance features, will meet my financial objectives based in part upon my age, income, net worth, and tax status, and any existing investments, annuities, or other insurance products I own. If applicable, I considered the appropriateness of full or partial replacement of any existing life insurance or annuity. I also considered my liquidity needs, risk tolerance, and investment time horizon when selecting variable investment options. I understand the terms and conditions related to any optional rider applied for and believe that the rider(s) meet(s) my insurable needs and financial objectives. I have discussed all fees and charges for this contract with my registered representative. I understand that if I cancel a contract issued as a result of this application without penalty during the Right to Cancel initial review period, depending upon the state where my contract is issued, it is possible the amount refunded may be less than the initial amount I invested due to the investment experience of my selected investment options. If I am an active duty member of the United States Armed Forces (including active duty military reserve personnel), I confirm that this application was not solicited and/or signed on a military base or installation, and I have received from the registered representative the disclosure required by Section 10 of the Military Personnel Financial Services Protection Act. I certify, under penalties of perjury, that I am a U.S. person (including a U.S. resident alien) and that the taxpayer identification number is correct. I certify that all answers to questions and statements made on this application are to the best of my knowledge and belief. I UNDERSTAND THAT BENEFITS AND VALUES PROVIDED UNDER THE CONTRACT MAY BE ON A VARIABLE BASIS. AMOUNTS DIRECTED INTO ONE OR MORE VARIABLE INVESTMENT OPTIONS WILL REFLECT THE INVESTMENT EXPERIENCE OF THOSE INVESTMENT OPTIONS. THESE AMOUNTS MAY INCREASE OR DECREASE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. Owner’s Signature | Date (mo/day/yr) | Signed at: City | State Hj^L Ji^Jiim^GKe ^ os/os/gosg ^ Anytown ^ N E JointOwner’sSignature (ifapplicable) Datefmo/cfay/yr) 16. REGISTERED REPRESENTATIVE’S STATEMENT Do you have any reason to believe that the applicant has any existing life insurance policies or annuity iom. Yes No contracts? (Default is “Yes” if neither box is checked.) Do you have reason to believe that any existing life insurance policy or annuity contract has been (or will 16B. I Yes No be) surrendered, withdrawn from, loaned against, changed or otherwise reduced in value, or replaced in connection with this transaction assuming the contract applied for will be issued? If “Yes,” I affirm that I have instructed the applicant to answer “Yes” to the replacement question in Section 9B of this application. I hereby certify that I have used only Pacific Life’s approved sales material in connection with this sale and that copies of all sales materials used were left with the applicant. Any insurer-approved electronically presented sales materials will be provided in printed form to the applicant no later than at the time of the policy or contract delivery. I certify that I have discussed the appropriateness of replacement and followed Pacific Life’s written replacement guidelines. I have explained to the owner(s) how the annuity will meet their insurable needs and financial objectives. I certify that I have reviewed this application and have determined that its proposed purchase is suitable as required under law, based in part on information provided by the owner, as applicable, including age, income, net worth, and tax status, and any existing investments and insurance program. I certify that I have provided the applicant with all product and applicable fund prospectuses for this variable annuity contract. I certify that I have also considered the owner’s liquidity needs, risk tolerance, and investment time horizon; that I followed my broker/dealer’s suitability guidelines in both the recommendation of this annuity and the choice of investment options, and that this application is subject to review for suitability by my broker/dealer. I certify that I have truly and accurately recorded on the application the information provided to me by the applicant. If the applicant is an active duty member of the United States Armed Forces (including active duty military reserve personnel), I certify that this application was not solicited and/or signed on a military base or installation, and I provided to the applicant the disclosure required by Section 10 of the Military Personnel Financial Services Protection Act. I further certify that, prior to soliciting the contract applied for, I have completed all state mandated annuity, insurance, and/or product training and agree to provide documentation of such completion upon request by Pacific Life. Soliciting Registered Representative’s Signature Print Registered Representative’s Full Name Cindy Brown Registered Representative’s Telephone Number Registered Representative’s E-Mail Address (123)456-7890 Broker/Dealer’s Name Brokerage Account Number (optional) ABC Brokerage Send completed application as follows: APPLICATION WITH PAYMENT: APPLICATION WITHOUT PAYMENT: [Regular Mail Delivery: P.O. Box 2290, Omaha, NE 68103-2290 Regular Mail Delivery: P.O. Box 2378, Omaha, NE 68103-2378 Express Mail Delivery: 1299 Famam Street, 6^th Floor, RSD, Omaha, NE 68102 Express Mail Delivery: 1299 Famam Street, 6* Floor, RSD, Omaha, NE 68102] ICC12:25-1225