AXA Equitable Life and Annuity Company …

1 AXA Equitable life Insurance Company AXA Equitable life and Annuity Company MONY life Insurance 1290 Avenue of the Americas 1675 Broadway, Suite 1700 Company of America New York, New York 10104 Denver, Colorado 80202 525 Washington Blvd. (212) 554-1234 (212) 554-1234 Jersey City, New Jersey 07310 (212) 554-1234 FLORIDA Notice to Applicant Regarding Replacement of life Insurance A decision to buy a new policy and discontinue or change an existing policy may be a wise choice or a mistake. Get all the facts. Make sure you fully understand both the proposed policy and your existing policy or policies.

2 New policies may contain clauses which limit or exclude coverage of certain events in the initial period of the contract, such as the suicide and incontestable clauses which may have already been satisfied in your existing policy or policies. Your best source for facts on the proposed policy is the proposed Company and its agent. The best source on your existing policy is the existing Company and its agent. Hear from both before you make your decision. This way you can be sure your decision is in your best interest. If you indicate that you intend to replace or change an existing policy, Florida regulations require notification of the Company that issued the policy. Florida regulations give you the right to receive a written Comparative Information Form which summarizes your policy values.

3 Indicate whether or not you wish a Comparative Information Form from the proposed Company and your existing insurer or insurers by placing your initials in the appropriate box below. Yes No DO NOT TAKE ACTION TO TERMINATE YOUR EXISTING POLICY UNTIL YOUR NEW POLICY HAS BEEN ISSUED AND YOU HAVE EXAMINED IT AND FOUND IT ACCEPTABLE. I have read this notice and received a copy of it. _____ _____ Applicant's Signature Date _____ _____ Joint Owner's Signature Date _____ _____ Agent's Signature Date _____ _____ Agent's Name (Printed or Typed) Agent's Company (Printed or Typed) _____ Agent's Address (Printed or Typed) Information on Policies which may be replaced.

4 Company Name Policy Number Name of Insured _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ B9201292--N--179 Page 1 of 1 (FL: A-1; 10-14) AXA Equitable life Insurance Company AXA Equitable life and Annuity Company MONY life Insurance 1290 Avenue of the Americas 1675 Broadway, Suite 1700 Company of America New York, New York 10104 Denver, Colorado 80202 525 Washington Blvd.

5 (212) 554-1234 (212) 554-1234 Jersey City, New Jersey 07310 (212) 554-1234 FLORIDA COMPARATIVE INFORMATION FORM FOR PROPOSED INSURANCE Replacing Agent's Name _____ APPLICANT INFORMATION POLICY INFORMATION Name _____ Policy Generic Name _____ Address Policy Number _____ Telephone ( ) Date of Issue _____ Issue Age____ Date of Birth _____ Contestable Period Expires _____ Age _____ Suicide Period Expires _____ Policy Loan Rate _____ POLICY / RIDER DESCRIPTION INITIAL / (Age) INITIAL / (Age) POLICY / RIDER CONTINUING BENEFIT RENEWAL ANNUAL PAYABLE NAME BENEFIT FROM TO PREMIUM FROM TO TOTAL INITIAL ANNUAL PREMIUM $_____ MODE OF PYMT.

6 _____ AMT. $_____ TOTAL RENEWAL ANNUAL PREMIUM $_____ AMT. $_____ Page 1 of 5 (FL: B-1; 10-14) AXA Equitable life Insurance Company AXA Equitable life and Annuity Company MONY life Insurance 1290 Avenue of the Americas 1675 Broadway, Suite 1700 Company of America New York, New York 10104 Denver, Colorado 80202 525 Washington Blvd. (212) 554-1234 (212) 554-1234 Jersey City, New Jersey 07310 (212)

7 554-1234 FLORIDA COMPOSITE DISCLOSURE OF PROPOSED INSURANCE FOR PRIMARY INSURED _____ GUARANTEES PROJECTIONS* YEAR / ANNUAL CUMLTV CASH DEATH ANNUAL CUMLTV CASH DEATH AGE PREMIUM PREMIUM VALUE BENEFIT PREMIUM PREMIUM VALUE BENEFIT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 55 60 65 75 85 95 _____ * Projections include dividends and current interest rates which are not guaranteed. IMPORTANT NOTICE: The income tax treatment of the benefits illustrated above may significantly affect their magnitude.

8 Competent tax advice should be secured to clarify income tax implications. Page 2 of 5 (FL: B-2; 10-14) AXA Equitable life Insurance Company AXA Equitable life and Annuity Company MONY life Insurance 1290 Avenue of the Americas 1675 Broadway, Suite 1700 Company of America New York, New York 10104 Denver, Colorado 80202 525 Washington Blvd. (212) 554-1234 (212) 554-1234 Jersey City, New Jersey 07310 (212) 554-1234 FLORIDA COMPARATIVE INFORMATION FORM FOR EXISTING INSURANCE Replacing Agent's Name _____ APPLICANT INFORMATION POLICY INFORMATION Name _____ Policy Generic Name _____ Address _____ Policy Number _____ Telephone ( ) Date of Issue _____ Issue Age _____ Date of Birth _____ Contestable Period Expires _____ Age _____ Suicide Period Expires _____ Policy Loan Rate _____ POLICY / RIDER DESCRIPTION POLICY / INITIAL / (Age) INITIAL / RENEWAL (Age)

9 RIDER CONTINUING BENEFIT ANNUAL PAYABLE NAME BENEFIT FROM TO PREMIUM FROM TO TOTAL INITIAL ANNUAL PREMIUM $_____ MODE OF PYMT. _____ AMT. $_____ TOTAL RENEWAL ANNUAL PREMIUM $_____ AMT. $_____ Page 3 of 5 (FL: B-3; 10-14) AXA Equitable life Insurance Company AXA Equitable life and Annuity Company MONY life Insurance 1290 Avenue of the Americas 1675 Broadway, Suite 1700 Company of America New York, New York 10104 Denver, Colorado 80202 525 Washington Blvd.

10 (212) 554-1234 (212) 554-1234 Jersey City, New Jersey 07310 (212) 554-1234 FLORIDA COMPOSITE DISCLOSURE OF EXISTING INSURANCE FOR PRIMARY INSURED _____ GUARANTEES PROJECTIONS * YEAR / ANNUAL CUMLTV CASH DEATH ANNUAL CUMLTV CASH DEATH AGE PREMIUM PREMIUM VALUE BENEFIT PREMIUM PREMIUM VALUE BENEFIT Current 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 55 60 65 75 85 95 _____ * Projections include dividends and current interest rates which are not guaranteed.