1307110 GRIP Annuitization

GRIP Annuitization Form

INSTRUCTIONS

t Use this form to receive a guaranteed lifetime income stream from a Venture Series Annuity with the Guaranteed Retirement Income Program (GRIP) Rider. t For JH Legacy Annuities with the Guaranteed Retirement Income Benefit (GRIB) Rider, use the GRIB Annuitization form #1307202. t1MFBTF/PUF5IJTGPSNNVTUCFSFDFJWFEXJUIJOEBZTPGZPVS(3*1FMFDUJPOEBUF, or it will be returned to you. You may resubmit your

request the following year when your GRIP window re-opens.

t Monthly income under the GRIP Rider is determined by applying the Income Base to the Monthly Income Factors listed in the Rider. If more favorable to the Annuitant(s), monthly income will be determined by applying the Contract Value to the current fixed annuity payment rates in use by the Company on the date the Contract is annuitized.

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$0/53"$5*/'03."5*0/ Owner's Name: ____________________________________________________________________________

Contract Number: _________________________________________

Phone Number: (______) ________________________ Date of Birth: ____/____/_______

Address: _________________________________________________________________________________________________________________________________________________________________________________________

Annuitant's Name: _______________________________________________________________________________________________________________________________________________________

Phone Number: (______) ________________________ Date of Birth: ____/____/_______

Address: ___________________________________________________________________________________________________________________________________________________________________

'JOBODJBM3FQSFTFOUBUJWFhs Name (if applicable): ______________________________________@@@Financial 3FQSFTFOUBUJWF's Phone Number: (_____)@@@@@@@@@@@@

Beneficiary's ________________________________ ________/________/_______ ___________________________

NAME

DATE OF BIRTH

% OF PROCEEDS

____________________ _________________________________ __________________________

RELATIONSHIP TO OWNER

STREET ADDRESS

CITY

Beneficiary's Phone Number: ( _ff____ ) __________________________________________________________

_______________

STATE

_______________

ZIP

The beneficiaries on file will continue if no beneficiary is provided. Please include a signed letter of instruction with additional beneficiaries.

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1-&"4&/05&"//6*5*;"5*0/*4*33&70$"#-& IMPORTANT: Proof of age is required for both Life options below. Please enclose a copy of a Birth Certificate, Driver's License, or Passport. Original documents are not required. Documentation must show a legible name and date of birth.

Option 1: Life Annuity with 10-Year Period Certain * Option 2: Joint and Survivor with 20-Year Period Certain (complete information below)

Option 3: Joint and Survivor with 10-Year Period Certain ((GRIP II or III only, contracts issued after 1/27/03) complete information below). Not available to contracts issued in NY.

Name of Joint Annuitant: _f____________________________________ Spouse Non-Spouse Social Security #____________________________

Address: ______________________________________________________________________ Phone Number ____________________________

Gender (M/F): _______ Date of Birth: ______/_____/________ (Both Joint Annuitants sign in Section #6. Authorization)

*In general, Joint and Survivor Annuity with 20-Year Period Certain provides payments guaranteed for a longer period. However, the payments are at a lower level.

On qualified accounts, we may reduce the period certain if it exceeds your life expectancy based on IRS tables currently in use. Your monthly distribution will be

increased to offset the reduced guarantee period. If this applies to you, the Projected Income Amount shown on your statements already reflects this increase. 'PSOPORVBMJGJFE(3*1BOOVJUJ[BUJPOT UIF"OOVJUBOUNBZPOMZCFBEEFEPSDIBOHFEUPBOJOEJWJEVBMXIPJTZPVOHFSUIBOUIFPMEFTU DVSSFOUBOOVJUBOU

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Monthly payouts will begin the later of the earliest election date or when this form is received in good order. Payments may be received up to 7 days

after the annuitization date.

1307110 (12/18)

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GRIP Annuitization Form continued

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Electronic Fund Transfer (EFT) *.1035"/5Please attach a voided check (deposit slips and starter checks are not accepted) to this request. The voided check must be in the name

of the Annuitant(s). Payment dates falling on the weekend or a bank holiday will be credited on the next business day. Bank Name: ________________________________________________Bank Phone #: ____________________________________________

ABA Routing #: ______________________________________________Bank Account #: ___________________________________________

Bank Address: _______________________________________________ _____________________________ _________ ___________________

STREET

CITY

STATE

ZIP

Checking

Savings

#

Mail to address of record (default)

$

Mail to new permanent address. (Signature Guarantee is required in section #6. Authorization). Fax requests are not acceptable for this option.

______________________________________________________ ________________________ ________ ____________

STREET ADDRESS

CITY

STATE

ZIP

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DO NOT withhold any amount for federal taxes (Not valid for eligible rollover distributions from 403(b) contracts)

Withhold _________% or $________________ of the taxable distribution (if any)

(In accordance with IRS guidelines, the minimum amount withheld must equal at least 10% (20% for 403(b)). State withholding is also required in certain states if federal income taxes are withheld. In instances where state tax withholding is not mandatory, it may be possible to elect to have applicable state taxes withheld on a voluntary basis.)

Notice of Income Tax Withholding: The taxable portion of annuitized payments is considered ordinary income according to Internal Revenue Service guidelines. John Hancock is required to withhold federal taxes (plus state taxes where applicable) from annuitized payments, unless you elect otherwise and provide your social security number or taxpayer ID number. Withholding is a method of paying taxes that you may owe. Your tax liability is the same whether or not taxes are withheld. If you elect not to withhold taxes from your annuitized payments, or you do not have enough taxes withheld, you may be responsible for payment of estimated taxes. You may also be subject to tax penalties under the estimated tax payment rules if your payments of estimated tax and withholding, if any, do not meet IRS guidelines. 1MFBTF DPOTVMUZPVSPXOUBYQSPGFTTJPOBM if you have any questions about tax withholding.

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By checking this box I indicate my understanding that this distribution is occurring from a partial `1035 Exchange' policy within 12 months of establishment. This partial transfer of funds was originally processed as a non-taxable `1035 Exchange', which refers to section 1035 of the Internal Revenue Code. Under IRS Revenue Procedure 2008-24, this withdrawal will cause the original exchange to be re-characterized as taxable. It will then be reported to the IRS via Form 1099-R as a Gross Distribution.

I understand that on or after the Annuitization Date, the individual annuitant named on the previous page becomes the contract owner of the annuitized account and has the sole right to exercise ownership rights of that account. Therefore, I no longer retain ownership rights or responsibility for tax reporting with respect to the annuitized payments.

I understand and agree that Annuitization is irrevocable. In addition, the frequency and date of payments cannot be changed once elected. This Annuitization Form is subject to all terms and conditions of the Contract. All prior settlement options and Custodial beneficiary designations are hereby revoked through this agreement.

Signature of Owner/Annuitant: ________________________________________________________________________________________________ Date________ /________ /_______

Signature of Co-Owner/Co-Annuitant: _________________________________________________________________________________________ Date________ /________ /_______

Signature of Annuitant (if different than Owner): _____________________________________________________________________________ Date________ /________ /_______

'JOBODJBM3FQSFTFOUBUJWFhs Signature (optional): _____________________________________________________________________________Date________/________/_______

4JHOBUVSF(VBSBOUFF4UBNQ JGBQQMJDBCMF

Signature Guarantee required for address changes and in other instances 1lease call us if you have any questions.

1MFBTFreview the decision to annuitize with ZPVSGJOBODJBMSFQSFTFOUBUJWF

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