DCA Instructions

Participant Information

Instructions

A. Deposit amount: My check in the amount of $ ______________ is enclosed for deposit in the Prudential Series Fund Money Market Portfolio, to initiate Dollar Cost Averaging (minimum deposit is $1,000). Make your check payable to “AICPA Insurance Trust.”

B. Dollar amount to be transferred per month: $ ________________

C. Duration of transfers (select one): Continue DCA transfers for ______ months.

Continue DCA transfers until a total of $ __________________ is transferred from the Money Market Portfolio to the variable investment options noted on the next page of this form (this amount can include the current balance in the Money Market Portfolio, in addition to the deposit amount).

The Dollar Cost Averaging (DCA) feature allows you to systematically transfer amounts from the Prudential Series Fund Money Market Portfolio to any of your plan’s variable investment options on a monthly basis. Complete all sections, and sign and date the form. Attach your DCA check, made payable to AICPA Insurance Trust, and return to the address above.

If the DCA election form is received by the tenth day of the month in Good Order, then DCA processing will commence during the next month. If the DCA election form is received after the tenth of the month in Good Order, DCA processing will commence during the month immediately following the next succeeding month.

You may send it by fax to 1-800-242-7248. You may call toll free 1-800-223-7473 with any questions, Monday - Friday, 8:30 a.m. - 6:00 p.m., Eastern time.

1Please print using blue or black ink.

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Street Apt.

City State ZIP code

First name of participant MI Last name

Yes No Has insurance been assigned?

Group control number

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Account number

GL.98.323 Ed. 10/18 continued on next page

Group Variable Universal Life Insurance

Dollar Cost Averaging Election

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AICPA Insurance Trust I Aon Securities Inc., Member FINRA/SIPC1100 Virginia Drive, Suite 250, Fort Washington, PA 19034-3278

D. DCA Monthly Allocation: Specify the variable investment option(s) and dollar amount(s) to be transferred. The total dollar amount to be transferred (see below) must equal the dollar amount specified in section 3B on the front of this form. The DCA allocation instructions may be different from your current premium allocations.

3 DCA Instructions(continued)

Group Variable Universal Life is issued by The Prudential Insurance Company of America and distributed through Prudential Investment Management Services LLC (“PIMS”). The Prudential Insurance Company of America is located at 751 Broad St., Newark, NJ 07102, and PIMS is located at 655 Broad St., Newark, NJ 07102. Both are Prudential Financial companies. Contract series: 89759. Group Variable Universal Life is offered and administered through Aon Securities, Inc., Member FINRA/SIPC, 1100 Virginia Drive, Suite 250, Fort Washington, PA 19034-3278, 1–800–223–7473.The Plan Agent of the AICPA Insurance Trust is Aon Insurance Services. Aon Securities and Aon Insurance Services are not affiliated with either Prudential or PIMS.

Aon Insurance Services is the brand name for the brokerage and program administration operations of Affinity Insurance Services, Inc.; (TX 13695); (AR 100106022); in CA & MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.in NY, AIS Affinity Insurance Agency.

Signature I understand that the DCA transfers will continue as instructed above, unless I notify you in writing by completing a DCA cancellation form, or until there are insufficient funds to complete the next transfer. In addition, I understand that the Dollar Cost Averaging feature is subject to the rules and restrictions outlined in the product prospectus. I understand that each of the variable investment option(s) has specific investment styles and risks, and that I am the named fiduciary with full responsibility for making the investment decisions related to this product. No recommendation on investment or investment allocation has been made to me by Prudential, its affiliates, or Aon Securities, Inc. I have received a prospectus for the applicable investment option(s).

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GL.98.323 Ed. 10/18 Page 2 of 2AICPA 3764930

Total $ __________

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Investment option Dollar amount Investment option Dollar amount

month day year

month day year

X

X

Participant’s signature

Assignee’s signature (if applicable)