Systematic Withdrawal Program - John Hancock …

1 Systematic Withdrawal Program ,QWURGXFWLRQ130712 (6/18 3 DJH RI ,QVWUXFWLRQVUse this form to enroll in the Systematic Withdrawal Program for any fixed or variable product. This form should not be used for Required Minimum Distributions (form 130714), pre-59 72(t) (q) Withdrawal requests (form 130717), or if your contract has a rider and you are requesting the annual allowable amount (form 1307169). ,QIRUPDWLRQ $ERXW <RXFinancial Representative's Name (if applicable)Financial Representative's Phone NumberIssuer: John Hancock Life Insurance Company ( ), Lansing, MI (not licensed in New York) Issuer in NY: John Hancock Life Insurance Company of New York, Valhalla, NYtttTaking withdrawals from some of our products may adversely affect the underlying guarantees.)

2 Please consult your contract prospectus for additional information, D FXVWRPHU VHUYLFH UHSUHVHQWDWLYH DW RU \RXU financial representative with any in more than one special Program may conflict with the intended result. Please inform the &XVWRPHU 6 HUYLFH &HQWHU of any changes to existing Dollar Cost Averaging, Systematic Withdrawal , Rebalancing or Automated Investment programs , if applicable.$ 0 HGDOOLRQ 6 LJQDWXUH *XDUDQWHH 06* LV UHTXLUHG ZKHQ ttttt Available interest may be greater than your free Withdrawal amount and may be subject to surrender Product minimum Withdrawal amounts may apply.

3 Please consult your prospectus for review your contract and/or prospectus for further details regarding the impact of included with the Systematic Withdrawal Program form is an IRS Form W-9 Request for Taxpayer Identification Number and Certification. As part of the Systematic Withdrawal process, each 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. An owner who is not a citizen or resident alien should not complete Form W-9.

4 Instead, please complete IRS Form W-8 BEN. You are able to obtain Form W-8 from the IRS website at Please note that Systematic Withdrawal Program may be subject to adverse tax consequences unless each owner submits a completed and signed W-9 or W-8 Owner Information:Contract Number Phone Number Date of Birth (MM/DD/YYYY)Owner's Name (or Custodian's Name, if applicable) (First) (MI) (Last)City State Zip CodeAddress (Street) Co-Owner Information (if applicable):Name Phone Number Date of Birth (MM/DD/YYYY)Address (Street)City State Zip CodeMSGs are used as an added security measure for your contract and may be obtained at most banks, financial institutions or credit unions.

5 The MSG we receive must be an original; facsimiles or photocopies will not be note that if you elect the interest-only option, the Withdrawal amount could fluctuate depending on the current market value of a variable annuity contract or changes in interest rates for fixed annuity contracts. The number of days in the month or any additional withdrawals you perform on your contract can also impact your Withdrawal form cannot be used to process transfers, rollovers or exchanges from another institution, or to request a Withdrawal under a Nursing Home or Critical Illness Systematic Withdrawal Program is not available on certain qualified plans or contracts that have outstanding : Amounts withdrawn over your allotted penalty-free amount may be subject to Withdrawal charges.

6 Also, certain annuities may assess a Market Value Adjustment to your Withdrawal amount. See the end of thisdocument for returninstructionsContact us: you know you can complete this form entirely online? Questions about this form? 1-800-344-1029-Electronic fund transfer (EFT) is selected as the payment delivery method and you do not currently have an MSG for the EFT account on signed application or confirmation application is not on file. -A Withdrawal check will be mailed to an address that is not the address on file.

7 -There was a change of the address on file within the last 30 Withdrawal request is for the amount of $250,000 or Click the green "Submit Online" button4. Follow the step-by-step instructions FAX 1-617-663-3160 Click here or visit and click on the Forms Tab for an instructional video1. Visit the Forms tab on Find the Systematic Withdrawal Program FormContract Number:_____130712 (6/18)3 DJH RI )UHTXHQF\ 3 OHDVH FRPSOHWH $ DQG % A)B) D )HGHUDO ,QFRPH 7D[ :LWKKROGLQJIn accordance with IRS guidelines, the minimum amount withheld for federal tax must equal 10% (20% for TSA / 403(b) accounts if the owner is under age 70 ).]

8 State withholding is also required in certain states if federal 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. Note: John Hancock will withhold 10% from the taxable portion of your Withdrawal , unless you elect otherwise below. You must provide your residence address in order to elect no withholding. You must also provide a properly completed and signed IRS Form W-9. If you elect not to have income tax withheld from your Withdrawal , or you do not have enough income tax withheld, you may be responsible for payment of estimated tax.

9 You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. DO NOT withhold federal income tax (you MUST also submit or have an IRS Form W-9 on file with us).Note for Indirect Rollovers: Default withholding taxes will apply unless you follow the above instructions. Withhold $ or % of federal income dollar amount or percent must equal at least 10% of the taxable portion of your Withdrawal .

10 If the amountrequested is less than 10% of the taxable portion of your distribution, John Hancock will default to 10%. IMPORTANT:When an annuity is held by a trust, we will withhold taxes unless the trustee signs a Form W-9 WKDW includes the trust s * (please check one):$ 6 SHFLILF amount $Portfolio Name or Number Amount ($ or %)Amount ($ or %)Portfolio Name or Number Please note: Withdrawals may have an impact on features and optional benefits of your annuity contract. Furthermore, if you elected the Guaranteed Minimum Withdrawal Benefit rider (not available on all products), withdrawals will be in accordance with our default procedures; you may not specify the investment option from which a Withdrawal is to be made.