Systematic withdrawal program election SWP_01.14... · 2014-03-27 · Annuities Systematic...

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Annuities Systematic withdrawal program election This form is used to start or change a systematic withdrawal program for the Preference Premier variable annuity product. MPPSWP-PACK (01/14) Page 1 of 14 Fs • Distributions prior to age 59 1/2 may be subject to tax penalties. Any systematic withdrawal plan should be reviewed by your tax advisor to determine the impact, if any, of such requirements. The Company assumes no liability with regard to the tax treatment of withdrawals or compliance with minimum distribution/early withdrawal requirements imposed by the IRS. • The Owner’s signature is required in Section 7 of this form. If there is more than one Owner, all Owners must sign. Please use black ink. Things to know before you begin: SECTION 2 - Type of withdrawal SECTION 1 - Owner information (Please print) Street address City State ZIP Last name Middle name First name Social Security number Date of birth (mm/dd/yyyy) Pre - 59½ Distribution with substantially equal periodic payments - Reason Code 2. Post - 59½ Distribution that is part of a stream of substantially equal periodic payments started before you reached 59½ . - Reason Code 2. Pre - 59½ Distribution - Reason Code 1. Please check one of the following categories and provide proof of reason. (We need this information to properly code your IRS Form 1099-R.) Regular distribution - Reason Code 7 I am age 59½ or older, and: 1) I have never taken substantially equal periodic payments from this account or 2) I have taken substantially equal periodic payments beginning before age 59½ for at least 5 years. Annuity contract number

Transcript of Systematic withdrawal program election SWP_01.14... · 2014-03-27 · Annuities Systematic...

Page 1: Systematic withdrawal program election SWP_01.14... · 2014-03-27 · Annuities Systematic withdrawal program election This form is used to start or change a systematic withdrawal

Annuities

Systematic withdrawal program election This form is used to start or change a systematic withdrawal program for the Preference Premier variable annuity product.

MPPSWP-PACK (01/14)Page 1 of 14

Fs

• Distributions prior to age 59 1/2 may be subject to tax penalties. Any systematic withdrawal plan should be reviewed by your tax advisor to determine the impact, if any, of such requirements. The Company assumes no liability with regard to the tax treatment of withdrawals or compliance with minimum distribution/early withdrawal requirements imposed by the IRS.

• The Owner’s signature is required in Section 7 of this form. If there is more than one Owner, all Owners must sign. Please use black ink.

Things to know before you begin:

SECTION 2 - Type of withdrawal

SECTION 1 - Owner information (Please print)

Street address

City State ZIP

Last nameMiddle nameFirst name

Social Security number Date of birth (mm/dd/yyyy)

Pre - 59½ Distribution with substantially equal periodic payments - Reason Code 2.

Post - 59½ Distribution that is part of a stream of substantially equal periodic payments started before you reached 59½ . - Reason Code 2.

Pre - 59½ Distribution - Reason Code 1.

Please check one of the following categories and provide proof of reason.(We need this information to properly code your IRS Form 1099-R.)

Regular distribution - Reason Code 7 I am age 59½ or older, and: 1) I have never taken substantially equal periodic payments from this account or 2) I have taken substantially equal periodic payments beginning before age 59½ for at least 5 years.

Annuity contract number

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SECTION 3 - Payment amount and funding option Please complete payment option 3a or 3b. Please also select source of funds in 3c.

3a.I want to withdraw the following dollar amount, to be paid to me in the following frequency:

Note: During the first contract year, only monthly or quarterly payments can be selected. There is a $50 per monthly payment, $125 per quarterly payment, and a $500 per year minimum. (This is not an annuitization or an immediate annuity.) There is no guarantee that a payment amount made under the program will not incur any early withdrawal charges.

Please be aware that withdrawing more than your guaranteed withdrawal amount, called “excess withdrawals”, may permanently reduce your future guaranteed withdrawal amounts. If you are considering making an excess withdrawal but are uncertain as to how it will affect your future guaranteed withdrawal amounts, we encourage you to contact us prior to requesting the withdrawal to obtain a personalized, transaction-specific calculation showing the effect of the excess withdrawal. Important: If you elected the GMIB Max IV, or GMIB Max IV with EDB Max IV and you take your first withdrawal prior to the 5th contract anniversary, your dollar-for-dollar withdrawal rate will be the greater of: (a) 4.5% each year or (b) your required minimum distribution (RMD). If you take your first withdrawal on or after the 5th contract anniversary, your dollar-for-dollar withdrawal rate will be the greater of: (a) 5% each year or (b) your RMD. If you elected the GWB v1 Rider and wish to withdraw an amount that is equal to your Annual Benefit Payment and take a withdrawal prior to the 5th contract anniversary, your Annual Benefit Payment will be the greater of: (a) 5.00%of your Total Guaranteed Withdrawal Amount (TGWA) each year or (b) if applicable, your required minimum distribution (RMD). If you take a withdrawal on or after the 5th contract anniversary, but prior to your 10th contract anniversary, your Annual Benefit Payment will be the greater of: (a) 6.00% of your TGWA each year or (b) if applicable, your RMD. If you take a withdrawal on or after your 10th contract anniversary, your Annual Benefit Payment will be the greater of (a) 7.00% of your TGWA each year or (b) if applicable, your RMD. Cumulative withdrawals in a contract year that exceed your Annual Benefit Payment will reduce your TGWA and Remaining Guaranteed Withdrawal Amount (RGWA) on a proportional basis, which may significantly reduce your future benefits. If you elected the GWB v1 Rider and wish to take a withdrawal for a specific dollar amount, that withdrawal amount may not exceed the Annual Benefit Payment amount allowed under the rider.

3b.

Increasing amount equal to the Annual Benefit Payment allowed under the GWB or LWG Rider. The annual Systematic Withdrawal amount will equal the Annual Benefit Payment and will be increased only on any contract anniversary on which the Annual Benefit Payment increases due to an Optional Reset or Automatic Step-Up*. (This option is only available if the GWB or LWG Rider is selected at issue.) If selecting this option at issue, the initial systematic withdrawal amount will equal the current Annual Benefit Payment annually; otherwise the initial systematic withdrawal amount will equal the Remaining Annual Benefit Payment for the current contract year.** I understand withdrawals will be deducted prorata from the active subaccounts and fixed account, if applicable.

Monthly $

Semiannually $

Quarterly $

Annually $

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Increasing amount equal to of the beginning of the contract year Annual Increase Amount (“Compounding Income Base Component”) under the GMIB and/or EDB Riders. The Systematic Withdrawal amount will be increased only if the Annual Increase Amount increases due to, 1) additional payments made within 120 days of contract issue or 2) an Optional Reset or Optional Automatic Reset. (This option is only available if the GMIB or EDB Rider is selected at issue.)** I understand withdrawals will be deducted pro-rata from the active subaccounts, if applicable.

* Optional Resets or Optional Automatic Step-ups are elected by separate election forms. ** Note: If you already have an active Systematic Withdrawal Program on you contract, both the amount and mode

of your withdrawals will not be affected as described. Rather, withdrawal amount and mode will remain unchanged until the next contract anniversary on which an Optional/Automatic Reset occurs (or upon additional purchase payments made within 120 days of contract issue for GMIB.)

*** Percentage must be less than or equal to the Annual Increase Accumulation Rate, as provided in the product prospectus and on your contract schedule page, in order for the withdrawal adjustment that applies to the Annual Increase Amount to be equal to the dollar amount of the withdrawals.

Withdrawals may be taken from the funding options in percentages as specified by you as the contract owner. If this section is not completed, withdrawals will be made on a pro rata basis. Also, if you select a specific allocation, and there is insufficient money in a particular funding option, your withdrawals will default to a pro rata basis. To change your Systematic Withdrawal Program allocation, please fill out the Systematic Withdrawal Program Change of Allocation Form.

In the table below, indicate from which funding options you would like your systematic withdrawal payments to be deducted. If you choose to allocate, your payments will not be processed unless this form is filled out completely and accurately. All figures must be in whole dollars. If there is insufficient money in a given funding option, your withdrawals will default to a pro rata allocation. Also, if you transfer assets among the funding options, you may need to adjust your systematic withdrawal allocation accordingly.

Contracts Issued with GMIB MAX, EDB MAX or GWB (v1), select from the funding options in the following table only. Contracts that were not issued with the GMIB Max, EDB Max or GWB (v1) please skip to the next funding option table.

.0%***

3c.

I would like my withdrawal to be taken in the following manner:Pro rata across all funding options Using the following allocation (complete table below)

Funding Options Whole Dollars Only

AllianceBernstein Global Dynamic Allocation Portfolio $AQR Global Risk Balanced Portfolio $BlackRock Global Tactical Strategies Portfolio $Invesco Balanced-Risk Allocations Portfolio $JPMorgan Global Active Allocation Portfolio $MetLife Balanced Plus Portfolio $MetLife Multi-Index Targeted Risk Portfolio $Pyramis® Managed Risk Portfolio $Schroders Global Multi-Asset Portfolio $Barclays Aggregate Bond Index Portfolio $Pyramis® Government Income Portfolio $

* Portfolio only available on contracts containing GMIB Max IV, GMIB Max IV with EBD Max IV, GMIB Max V, GMIB Max V With EBD Max V, or GWB (v1)

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Page 4 of 14 Fs MPPSWP-PACK (01/14)

Funding Options Whole Dollars Only Funding Options Whole Dollars

Only

American Funds Global Small Capitalization FundAmerican Funds Growth-Income FundAmerican Funds® Growth PortfolioBaillie Gifford International Stock PortfolioBarclays Aggregate Bond Index PortfolioBlackRock Bond Income PortfolioBlackRock Capital Appreciation PortfolioBlackRock Large Cap Core PortfolioBlackRock Large Cap Value PortfolioBlackRock Money Market PortfolioClarion Global Real Estate PortfolioClearBridge Aggressive Growth PortfolioDavis Venture Value PortfolioFrontier Mid Cap Growth PortfolioHarris Oakmark International PortfolioInvesco Small Cap Growth PortfolioJanus Forty PortfolioJennison Growth PortfolioJPMorgan Core Bond PortfolioJPMorgan Small Cap Value PortfolioLoomis Sayles Global Markets PortfolioLoomis Sayles Small Cap Core PortfolioLord Abbett Bond Debenture PortfolioLord Abbett Mid Cap Value PortfolioMet/Artisan Mid Cap Value PortfolioMet/Dimensional International Small Company Portfolio

Met/Eaton Vance Floating Rate Portfolio

Met/Franklin Low Duration Total Return PortfolioMet/Templeton International Bond Portfolio

MetLife Growth Strategy Portfolio

MetLife Mid Cap Stock Index Portfolio

MetLife Multi-Index Targeted Risk Portfolio

MetLife Stock Index PortfolioMFS® Emerging Markets Equity PortfolioMFS® Research International PortfolioMFS® Total Return PortfolioMFS® Value PortfolioMorgan Stanley Mid Cap Growth Portfolio

$

$$$$$$$$$$$$$$$$$$$$$$$$

$

$

$

$

$

$$

$

$$$$$

MSCI EAFE® Index PortfolioNeuberger Berman Genesis PortfolioOppenheimer Global Equity PortfolioPIMCO Inflation Protected Bond PortfolioPIMCO Total Return PortfolioPioneer Strategic Income PortfolioPyramis® Government Income PortfolioPyramis® Managed Risk PortfolioRussell 2000® Index PortfolioSSgA Growth and Income ETF PortfolioSSgA Growth ETF PortfolioT. Rowe Price Large Cap Growth PortfolioT. Rowe Price Mid Cap Growth PortfolioT. Rowe Price Small Cap Growth PortfolioVan Eck Global Natural Resources PortfolioWestern Asset Management U.S. Government PortfolioChoose Only One from this BoxMetLIfe Conservative Allocation PortfolioMetLife Conservative to Moderate Allocation PortfolioMetLife Moderate Allocation PortfolioMetLife Moderate to Aggressive Allocation PortfolioChoose Only One from this BoxMetLife Aggressive Strategy PortfolioAmerican Funds® Moderate Allocation PortfolioAmerican Funds® Balanced Allocation PortfolioAmerican Funds® Growth Allocation PortfolioProtected Growth StrategiesAllianceBernstein Global Dynamic Allocation PortfolioAQR Global Risk Balanced PortfolioBlackRock Global Tactical Strategies PortfolioInvesco Balanced-Risk Allocation PortfolioJPMorgan Global Active Allocation PortfolioMetLife Balanced Plus PortfolioMetLife Multi-Index Targeted Risk PortfolioPyramis® Managed Risk PortfolioSchroders Global Multi-Asset Portfolio

$$$$$$$$$$$$$$$

$

$

$

$

$

$

$

$

$

$

$

$

$$$$$$

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Payment start date:

You should allow at least 10 days for us to process your request. If the Designated Office does not receive your request at least 10 days before the payment start date, your payments will begin the following month. If no date is specified, payments will begin 30 days after we receive this form. If the payment start date is a holiday or falls on a weekend, we will process the payment on the next business day. Note that this is the date we make the payment, not the day you receive it. If you are receiving payments via the Electronic Funds Transfer, you should allow approximately two additional business days after the payment start date to receive the payment. If we mail checks to you, you should allow approximately 10 additional business days after the payment start date to receive the payment. (For example, if you want to receive a check by the first of the month, we suggest you ask us to make payment on the 20th day of the prior month.)

Federal income tax withholding notice and election for withdrawals from your traditional IRA/NQ/SEP/SIMPLE/ROTH IRA:

Generally, the withdrawal you take from this contract is a non-periodic payment and the taxable amount will be subject to 10% Federal income tax withholding unless you elect not to have withholding apply. You may elect not to have withholding apply to your withdrawal from this contract by checking the box below, signing and dating this form and returning it to us. If you elect not to have withholding apply to your systematic withdrawals, or if you do and you do not have enough Federal income tax withheld from your payments, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. Even if you elect not to have Federal income tax withheld from your systematic withdrawals, you are liable for payments of Federal income tax on the taxable portion of each payment sent to you. In some states your distribution may also be subject to State income tax withholding requirements. In certain states we may be required to withhold State income tax if we withhold Federal income tax from your distribution.

Your withholding election will remain in effect for future payments under this Systematic Withdrawal Program until you change or revoke it by filing a new election with us. You may change your withholding election at anytime and as often as you wish. Remember, part or all of your withdrawal(s) is subject to income tax and a 10% IRS penalty may also apply to withdrawals made before age 59½.

Do not withhold Federal or State income tax.

I elect to have federal and state tax withheld from this withdrawal, as indicated below:

% %$ OR $Federal

Please note: A check will be sent to the address on record if Electronic Funds Transfer or Alternate Payee is not selected below. If made payable to a third party, a Medallion Signature Guarantee is required, and the original will need to be mailed in to us.

StateOR

SECTION 6 - Alternate payment instructions (optional)

SECTION 5 - Income tax withholding election

SECTION 4 - Payment start date

mm/dd/yyyy (date must be 1st through 28th of the month)

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Choose one:

1. Electronic Funds Transfer

Note: It may take up to 3 business days for the funds to appear in your bank account. It is the Contract Owner's responsibility to inform MetLife of any changes to banking information.

Savings

Checking

Type of Account:

Bank account number Bank ABA number

ZIPStateBank cityBank address

Bank name

2. Check

Alternate payee name (Bank, Brokerage Firm, etc.)

StateAlternate payee address City ZIP

Account No (if applicable)

(A photocopy of a voided check is required, unless Electronic Payments are being sent to a previously established EFT account. If the contract has joint owners, both names must appear on the voided check.)

(A letter of instruction on bank letterhead, containing EFT information and account registration, is required.)

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SECTION 8 - How to submit this form

Mail: MetLife P.O. Box 10342 Des Moines, IA 50306-0342

For Express mail only: MetLife 4700 Westown Parkway, Ste 200 West Des Moines, IA 50266

Fax: 877-547-9669

Return this form to MetLife Annuities by:

Metropolitan Life Insurance Company

Notice: The tax law provides that deferred annuities issued after October 21, 1988 by the same insurance company or an affiliate in the same calendar year to the same owner, are combined for tax purposes. As a result, a greater portion of your withdrawals may be considered taxable income than you would otherwise expect. In addition, please note that no agent or representative of The Company is authorized to alter, change or waive any of the terms or conditions of this form or to bind The Company by any statement or representation as to the availability of a withdrawal, if any, under this contract. The Company suggests that you consult your own attorney, accountant or tax advisor for information relating to Federal and state income tax liabilities that may be incurred as a result of a withdrawal.

SECTION 7 - Signature(s)* of Owner(s)

Joint account Owner’s signature

Account Owner’s signature

Medallion Signature Guarantee

*By signing this form, I hereby acknowledge that I have read and understand all the information provided in this kit, including the “Rules and Highlights” section.

Date (mm/dd/yyyy)

Date (mm/dd/yyyy)

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Annuities

Substantially equal periodic payments under the systematic withdrawal program

Acknowledgement of exception to premature distribution penalty

The following is a disclosure and acknowledgement regarding substantially equal periodic payments under MetLife’s Systematic Withdrawal Program. We urge you to consult with your independent tax advisor before signing up to receive substantially equal periodic payments.

You acknowledge that:

I am enrolling in MetLife’s Systematic Withdrawal Program and intend that the resulting payments from my contract will satisfy the substantially equal periodic payment exception to the additional 10% federal tax imposed on premature distributions. I will continue the Program for at least 5 years from the date payments begin or until I reach age 59 ½, whichever is later. In accordance with IRS Revenue Ruling 2002-62, my substantially equal periodic payments were determined by (check the appropriate box):

Amortizing my account balance over a certain number of years based on the IRS tables for my life expectancy or the joint life expectancies of me and my beneficiary and a reasonable interest rate. (The fixed amortization method).

Dividing my account balance by an annuity factor from the mortality table in Appendix B of Revenue Ruling 2002-62 for my life or the joint lives of me and my beneficiary and not exceeding a reasonable interest rate. (The fixed annuitization method).

Using a method acceptable for calculating required minimum distributions as provided in Section 1.401(a)(9) of the Income Tax Regulations. (The required minimum distribution method).

I understand that I cannot make contributions, rollovers, transfers or exchanges into the contract while I am taking substantially equal periodic payments.

In accordance with the above acknowledgments, I hereby request that MetLife treat the distributions from the contract identified below as satisfying the IRS requirements for substantially equal periodic payments and code my Form 1099-R with a distribution code of 2 – “Early distribution, exception applies”. I understand that MetLife reserves the right to code the distribution as subject to the 10% tax on premature distributions at any time, for any reason, including any modification as described in Revenue Ruling 2002-62, without notice, notwithstanding this acknowledgement.

I understand that by signing this acknowledgement, MetLife is not guaranteeing or implying that these substantially equal periodic payments satisfy the Internal Revenue Code and regulation requirements for the exceptions to the additional 10%tax on premature distributions. Any taxes or penalties resulting from these distributions are exclusively my responsibility and MetLife is not liable in any regard. In addition I understand this acknowledgement will apply to any substantially equal periodic payments taken from my contract during this and each subsequent tax year that payments continue.

Important notes:

If this is an IRA or a qualified plan, any distribution that is part of a series of substantially equal periodic payments qualifying for the exception to the additional 10% tax on premature distributions can not be rolled over in any transaction that would make the substantially equal periodic payments not subject to income tax.

An annual distribution of a percentage of the account balance (e.g. 7% per year) does not constitute a substantially equal periodic payment and is not eligible for the exception to the additional tax on premature distributions.

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Circular 230 Disclosure: To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. Federal Tax Advice contained in this application (including any attachments) is not intended (and cannot) be used by anyone to avoid IRS penalties. It is intended to support the sale of MetLife insurance products. Our customers should seek advice based on their particular circumstances from an independent tax advisor.

Signatures

Owner - First name Middle name Last name

Owner signature Date (mm/dd/yyyy)

Policy number

Joint Owner - First name Middle name Last name

Joint Owner signature

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Date (mm/dd/yyyy)

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Annuities

Preference Premier® variable annuity systematic withdrawal program – Change of allocation formYou should use this form if you are an existing Systematic Withdrawal Program participant who wishes to change your withdrawal allocation from pro rata (proportionate across all funding options in which you have an account balance) to customer-specified (withdrawals taken from those funding options in percentages specified by you as the contract owner) or to make a change to your existing customer-specified allocation percentages. If you have any questions, please contact your Representative. Complete this entire form and return it to:

In the table below, indicate which funding options you would like your systematic withdrawal payments to be deducted. This form must be filled out completely and accurately before we can process your payments. All figures must be in whole dollars. In the event of insufficient money in a given funding option, your withdrawals will default to a pro rata allocation. Also, if you transfer assets among various funding options, you may need to adjust your systematic withdrawal allocation accordingly.

Contracts Issued with GMIB MAX, EDB MAX or GWB (v1), select from the funding options in the following table only. Contracts that were not issued with the GMIB Max, EDB Max or GWB (v1) please skip to the next funding option table.

SECTION 1 - Participant information

SECTION 2 - Systematic withdrawal program information

Street address

City State ZIP

Last nameMiddle nameFirst name

Social Security numberPolicy number

Funding options Whole dollars only

AllianceBernstein Global Dynamic Allocation Portfolio $AQR Global Risk Balanced Portfolio $BlackRock Global Tactical Strategies Portfolio $Invesco Balanced-Risk Allocations Portfolio $JPMorgan Global Active Allocation Portfolio $MetLife Balanced Plus Portfolio $MetLife Multi-Index Targeted Risk Portfolio $Pyramis® Managed Risk Portfolio $Schroders Global Multi-Asset Portfolio $Barclays Aggregate Bond Index Portfolio $Pyramis® Government Income Portfolio $

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* Portfolio only available on contracts containing GMIB Max IV, GMIB Max IV with EBD Max IV, GMIB Max V, GMIB Max V with EDB Max V or GWB (v1)

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Funding options Whole dollars only Funding options Whole dollars

only

American Funds Global Small Capitalization FundAmerican Funds Growth-Income FundAmerican Funds® Growth PortfolioBaillie Gifford International Stock PortfolioBarclays Aggregate Bond Index PortfolioBlackRock Bond Income PortfolioBlackRock Capital Appreciation PortfolioBlackRock Large Cap Core PortfolioBlackRock Large Cap Value PortfolioBlackRock Money Market PortfolioClarion Global Real Estate PortfolioClearBridge Aggressive Growth PortfolioDavis Venture Value PortfolioFrontier Mid Cap Growth PortfolioHarris Oakmark International PortfolioInvesco Small Cap Growth PortfolioJanus Forty PortfolioJennison Growth PortfolioJPMorgan Core Bond PortfolioJPMorgan Small Cap Value PortfolioLoomis Sayles Global Markets PortfolioLoomis Sayles Small Cap Core PortfolioLord Abbett Bond Debenture PortfolioLord Abbett Mid Cap Value PortfolioMet/Artisan Mid Cap Value PortfolioMet/Dimensional International Small Company Portfolio

Met/Eaton Vance Floating Rate Portfolio

Met/Franklin Low Duration Total Return PortfolioMet/Templeton International Bond Portfolio

MetLife Growth Strategy Portfolio

MetLife Mid Cap Stock Index Portfolio

MetLife Multi-Index Targeted Risk Portfolio

MetLife Stock Index PortfolioMFS® Emerging Markets Equity PortfolioMFS® Research International PortfolioMFS® Total Return PortfolioMFS® Value PortfolioMorgan Stanley Mid Cap Growth Portfolio

$

$$$$$$$$$$$$$$$$$$$$$$$$

$

$

$

$

$

$$

$

$$$$$

MSCI EAFE® Index PortfolioNeuberger Berman Genesis PortfolioOppenheimer Global Equity PortfolioPIMCO Inflation Protected Bond PortfolioPIMCO Total Return PortfolioPioneer Strategic Income PortfolioPyramis® Government Income PortfolioPyramis® Managed Risk PortfolioRussell 2000® Index PortfolioSSgA Growth and Income ETF PortfolioSSgA Growth ETF PortfolioT. Rowe Price Large Cap Growth PortfolioT. Rowe Price Mid Cap Growth PortfolioT. Rowe Price Small Cap Growth PortfolioVan Eck Global Natural Resources PortfolioWestern Asset Management U.S. Government PortfolioChoose Only One from this BoxMetLIfe Conservative Allocation PortfolioMetLife Conservative to Moderate Allocation PortfolioMetLife Moderate Allocation PortfolioMetLife Moderate to Aggressive Allocation PortfolioChoose Only One from this BoxMetLife Aggressive Strategy PortfolioAmerican Funds® Moderate Allocation PortfolioAmerican Funds® Balanced Allocation PortfolioAmerican Funds® Growth Allocation PortfolioProtected Growth StrategiesAllianceBernstein Global Dynamic Allocation PortfolioAQR Global Risk Balanced PortfolioBlackRock Global Tactical Strategies PortfolioInvesco Balanced-Risk Allocation PortfolioJPMorgan Global Active Allocation PortfolioMetLife Balanced Plus PortfolioMetLife Multi-Index Targeted Risk PortfolioPyramis® Managed Risk PortfolioSchroders Global Multi-Asset Portfolio

$$$$$$$$$$$$$$$

$

$

$

$

$

$

$

$

$

$

$

$

$$$$$$

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SECTION 4 - How to submit this form

Metropolitan Life Insurance Company

Page 12 of 14 Fs MPPSWP-PACK (01/14)

SECTION 3 - Signatures

Signature of Joint Owner

Signature of Owner

Mail: MetLife P.O. Box 10342 Des Moines, IA 50306-0342

For Express mail only: MetLife 4700 Westown Parkway, Ste 200 West Des Moines, IA 50266

Fax: 877-547-9669

Return this form to MetLife Annuities by:

Date (mm/dd/yyyy)

Date (mm/dd/yyyy)

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MPPSWP-PACK (01/14)Page 13 of 14

Fs

• The Systematic Withdrawal Program (“the Program”) is an optional automatic withdrawal program that you elect to participate in.

• Under the Program you may elect to receive periodic payments (monthly, quarterly, semiannually or annually) for an amount that you choose, subject to certain limits.

*The total amount paid under the Program for any contract year cannot be less than $500. Any amount that exceeds 10% of your total purchase payments will be subject to early withdrawal charges.

*Each monthly payment must be at least $50. The minimum payment amount for quarterly is $125. During the first contract year, you may only select monthly or quarterly periodic payments. Your total systematic withdrawal payments may not exceed 10% of your purchase payment in the first contract year or 10% of your aggregate purchase payments each year after.

• Once the Program is initiated, we will continue payments until you notify us to cancel them. Cancellation may be made at any time either in writing or by telephone. Withdrawals that are processed cannot be reversed; they are irrevocable. (Adverse tax consequences may result if you change or cancel withdrawals within 5 years after beginning systematic withdrawals or before reaching 59½, whichever is later. See Taxes – Exceptions to the 10% Federal Tax Penalty below, and consult your tax advisor.)

• You may make changes to your payment amount by notifying us in writing at least 10 days prior to your payment date. If such notice is not received in time, we will make the change effective with your next payment. As noted above, changing the amount of your payments can have adverse tax consequences, consult your tax advisor.

• Additional withdrawals are permitted while the Program is in effect. However any additional withdrawals may be subject to early withdrawal charges or may cause payments being made under the Program to be subject to early withdrawal charges. Whether a withdrawal charge applies will be determined at the time of each withdrawal, including withdrawals under the Program, in accordance with the contract provisions. Adverse tax consequences may result if you are under age 59½ when you begin the systematic withdrawal program and you make additional withdrawals within 5 years after beginning or before reaching age 59½, whichever is later. Consult your tax advisor.

• If you are electing to start the Program at contract issue and you are submitting a transfer order form(s) with your application, we will not start the Program until all transfers have been received or for 60 days, whichever is earlier.

Taxes - Exceptions to the 10% federal tax penalty

• The Internal Revenue Code (“the Code”) imposes a tax penalty in addition to ordinary income taxes equal to 10% of the taxable amount withdrawn from your contract before you reach age 59½, unless certain exceptions are met. • One exception is: distributions that are part of a series of substantially equal periodic payments (paid not less frequently than annually) made for the life (or life expectancy) of the owner or the joint lives (or joint life expectancies) of such owner and his/her designated beneficiary.

• Under a Roth IRA, to the extent distributions would be taxable or, to the extent the withdrawal is within 5 years of conversion and would therefore be treated as subject to the 10% early distribution tax penalty, the 10% tax penalty will not apply if the withdrawals are a series of substantially equal periodic payments as described above. • To the extent that the Program payments qualify for the exception to the 10% penalty tax under Code Section 72(t)(2)(A) (iv), or 72(q)(2)(D) modifying payments before you reach age 59½ or have been receiving payments for 5 years, whichever is later, results in the retroactive imposition of the 10% Federal premature distribution tax penalty for all taxable payments made before age 59½.

• Once retroactive imposition of the penalty tax is triggered, the Code also requires interest assessments on the deferred tax penalty. You should consult your tax advisor for the applicability to your particular situation of these exceptions or any other exception. In addition, MetLife and its representatives cannot provide any assurance regarding the tax consequences of Program payments.

Highlights and rules

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MPPSWP-PACK (01/14)Page 14 of 14

Fs

IRS notification

• If you are younger than age 59½, are receiving distributions calculated to satisfy the substantially equal periodic payment exception, and you complete the Acknowledgment of Exception to Premature Distribution Penalty Form, MetLife will report on the IRS Form 1099-R issued for your Program payments a code 2 in box 7 of the form. This code indicates the payments meet an exception to the 10% Federal premature distribution tax penalty. MetLife does not imply or give assurance that Program payments before age 59½ intended to comply with the substantially equal periodic payment exception will qualify for an exception to the premature distribution tax penalty.

• If you are younger than age 59½ and are: 1) not calculating your payments to satisfy the substantially equal periodic payment exception, or, 2) some modification to the payments or additional withdrawal causes you to no longer qualify for the exception to the 10% penalty tax, then MetLife will report on the IRS Forms 1099-R issued for your Program payments, a code 1 in box 7 of the form. This code indicates the payments were made before age 59½ and MetLife does not know if any exception to the 10% Federal premature distribution tax penalty applies. If you are eligible to and want to claim an exception to the premature distribution tax penalty for the Program payments, you must file IRS Form 5329 with your Federal income tax return.

• Generally, if you are age 59½ or older, and 1) you never received substantially equal periodic payments from your account or, 2) you have been receiving substantially equal periodic payments for at least 5 years, MetLife will report, on the IRS Form 1099-R issued for your Program payments, a code 7 in box 7. This code indicates the payments are “normal distributions.”

• If you are age 59½ or older, and: 1) you started receiving substantially equal periodic payments from your account before you were 59½ and, 2) you have been receiving these payments for less than 5 years and, 3) you no longer qualify for the exception to the 10% penalty (due to modification or additional withdrawals etc.) then MetLife will report, on the IRS Form 1099-R issued for your Program payments, a Code 1 in box 7. This code indicates MetLife does not know if an exception to the 10% Federal premature distribution penalty applies.

Client notification

When your contract value reaches the minimum balance allowed, your Systematic Withdrawal program will automatically terminate and automatic payments will cease. Any subsequent withdrawals will require a new request. Program payments will be confirmed in writing at least quarterly.