Change of Owner and/or Beneficiary - John …

1 Change of Owner and/or Beneficiary Introduction1307217 (11/17)Page 1 of 5 Questions about this form ? 1-800-344-1029 Contact us:FAX 1-617-663-3160 See end of documentfor return instructions7 InstructionsUse this form to make Owner and/or Beneficiary changes to a John Hancock variable or fixed annuity contract. No Change will be effective unless it is received by our Annuity Service Office and acknowledged in writing by us. If you do not receive an acknowledgment within fifteen calendar days from submission of this form , contact us at 1-800-344-1029 to ensure your request was Signature Guarantee (MSG): An MSG is required on this form for all ownership changes and can be obtained at most banks, financial institutions or credit unions. The MSG we receive must be an original; facsimiles or photocopies will not be included with the Change of ownership form is an IRS form W-9 Request for Taxpayer Identification Number and Certification.

2 As part of the Ownership Change process, each new Owner must provide us with a properly completed and signed form W-9. Please refer to the instructions on form W-9 for how to properly complete the form . If the Owner (s) is not a citizen, resident alien or other person, they should not complete the form W-9. Instead, they should complete the appropriate IRS form W-8 which is available on the IRS website at Please note that the Ownership Change request will be considered not in good order until each new Owner submits a completed and signed W-9 or W-8 Change (Absolute Assignment)An Owner Change (including addition or removal of a joint Owner ) is an absolute assignment of the contract and can cause you to owe tax on the contract gain. Consult with your own tax professional before making an Owner Change .

3 In general, John Hancock must report taxable Owner changes to the Owner Change will revoke the interest of any revocable Beneficiary . Therefore the new Owner must update the Beneficiary in section 3 of this form , otherwise the Beneficiary will be the new Owner s estate. If no Beneficiary is designated and the new Owner is a non-natural person such as a trust, the Beneficiary will be the non-natural person or Owner Change may result in the loss of guarantees and benefits under the contract and certain riders. Please carefully read the contract and prospectus to determine the impact of any Change before submitting this form . You or your financial representative may call us at 1-800-344-1029 with any related the Owner is changed to a trust or other entity, you must also complete our Certificate for Trust or Entity Ownership form (130797) and submit it with this form .

4 Both forms must be completed before an Owner Change will be acknowledged by here or and click on the Forms Tab for an instructional video)LQDQFLDO 5 HSUHVHQWDWLYH V 1 DPH LI DSSOLFDEOH )LQDQFLDO 5 HSUHVHQWDWLYH V 3 KRQH Owner Information2 ZQHU &RQWUDFW 1 XPEHU 3 KRQH 1 XPEHU 'DWH RI %LUWK 00 '' <<<< 1 DPH )LUVW 0, /DVW &LW\ 6 WDWH =LS &RGH$GGUHVV 6 WUHHW &R 2 ZQHU (if applicable) 1 DPH 3 KRQH 1 XPEHU 'DWH RI %LUWK 00 '' <<<< $GGUHVV 6 WUHHW &LW\ 6 WDWH =LS &RGHC ontract Number:_____Page 2 of 5 Change (continued)Telephone withdrawal authorization, systematic withdrawal payments, and broker trade authorization will all terminate upon an Owner Only One: Change existing Owner to another person (or to a non-natural person) Add a co-ownerRemove an existing co- Owner and provide information below for the Owner who will remain on fileAll Information is Required:New Owner (or Co- Owner ) NamePhone NumberRelationship to Current OwnerSocial Security Number (or TIN)Date of Birth (MM/DD/YYYY) Designations (Required)No Complex Beneficiaries: John Hancock cannot accept complex or conditional Beneficiary designations.

5 By signing section 4, you authorize us to interpret the Beneficiary designations on this form in order to resolve any ambiguities, inconsistencies or of Benefits and Guarantees: A Beneficiary Change may result in the loss of guarantees and benefits under certain riders. Please read the contract and prospectus to determine the impact of any Change before submitting this form . You or your financial representative may call us at 1-800-344-1029 with any related and Qualified Plans: If you designate a trust Beneficiary , the death benefit will be payable to the trust and not to individual beneficiaries named in the trust. In addition, contracts owned within certain tax qualified plans require that the plan be the Child Beneficiary : You may name an adult custodian to receive the death benefit for a minor child.

6 Your instructions must include the first and last names of the custodian and child, along with references to the Uniform Transfers to Minors Act (UTMA) and the governing state or territory. For example: John Doe, custodian for Jimmy Doe, New York or Non-Natural Persons: You may designate as a Beneficiary a non-natural person such as a trust or charitable organization. If after your death John Hancock is provided with satisfactory proof that any such Beneficiary is not then in existence, no portion of the death benefit will be allocated to it, and its share of the death benefit will be reapportioned to any surviving of Payment: A primary Beneficiary is the person entitled to the death benefit upon the death of the contract Owner (or in certain circumstances, the annuitant). A contingent Beneficiary is not entitled to the death benefit unless all primary beneficiaries die before the contract Owner .

7 If no primary or contingent Beneficiary is living upon the death of the contract Owner , then the death benefit is payable to the contract Owner 's Equal One-Hundred Percent (100%): Percentages for all beneficiaries named in each category (Primary and Contingent) must equal one-hundred percent (100%).Gender: Male FemaleProvide complete name of trust (if applicable)Issuer: John Hancock Life Insurance Company ( ), Lansing, MI (not licensed in New York) Issuer in NY: John Hancock Life Insurance Company of New York, Valhalla, NY1307217 (11/17)New Owner s (or Co- Owner 's) Address (Street)&LW\ 6 WDWH =LS &RGHC ontract Number:_____Page 3 of 5 1307217 (11/17) Designations (Required)Please note: If you need additional space to identify beneficiaries, please attach a signed and dated Beneficiary (ies).

8 Percentage of proceeds below must equal 100%. (MI) (Last)Date of Birth (MM/DD/YYYY)Primary Beneficiary Name (First)- -Social Security Number (or TIN)Relationship to PayeeAddress (Street) City State Percentage of Proceeds (must equal 100% in each Beneficiary category)Phone Number Zip(MI) (Last)Date of Birth (MM/DD/YYYY)Primary Beneficiary Name (First)- -Social Security Number (or TIN)Relationship to PayeeAddress (Street) City State Percentage of Proceeds (must equal 100% in each Beneficiary category)Phone Number (MI) (Last)Date of Birth (MM/DD/YYYY)Primary Beneficiary Name (First)- -Social Security Number (or TIN)Relationship to PayeeAddress (Street) City State Percentage of Proceeds (must equal 100% in each Beneficiary category)Phone Number (MI) (Last)Date of Birth (MM/DD/YYYY)

9 Primary Beneficiary Name (First)- -Social Security Number (or TIN)Relationship to PayeeAddress (Street) City State Percentage of Proceeds (must equal 100% in each Beneficiary category)Phone Number ZipContingent Beneficiary (ies). Percentage of Proceeds below must equal 100%. (MI) (Last)Date of BirthContingent Beneficiary Name (First)- -Social Security Number (or TIN)Relationship to PayeeAddress (Street) City State Percentage of Proceeds (Must equal 100% in each Beneficiary category)Phone Number (ies) Designations (continued)1307217 (11/17)Page 4 of 5 : John Hancock Life Insurance Company ( ), Lansing, MI (not licensed in New York) Issuer in NY: John Hancock Life Insurance Company of New York, Valhalla, NY(MI) (Last)Date of BirthContingent Beneficiary Name (First)- -Social Security Number (or TIN)Relationship to PayeeAddress (Street) City State Percentage of Proceeds (Must equal 100% in each Beneficiary category)Phone Number Zip4.

10 Signatures and AuthorizationsAll Owners Must Sign: All current and new contract owners must sign. All trustees must sign if the contract is owned by a trust. If the contract is owned by a corporation or other business entity, all authorized representatives must sign and a corporate resolution (or similar) must be attached to this : If this form is signed by an attorney-in-fact or agent appointed in a power-of-attorney, a complete copy of the power-of-attorney must be attached to this form (unless previously submitted). John Hancock reserves the right to request proof that the power-of-attorney is valid and that the principal is alive before making any contract and Conservators: If this form is signed by the guardian or conservator, a complete copy of his or her court appointment must be attached to this form .