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Trading and Partial Withdrawal Authorization Form

Use this form to authorize your assigned NYLIFE Securities Registered Representative(s) and/or Registered Service Assistant(s) to submit electronic and
telephone orders on your behalf for variable products or to authorize your agent to submit partial withdrawal requests for fixed deferred annuities.
Policy Number(s)

Policy Owner Information

Policy Owner Name Daytime Email
(First, M.I., Last) Phone

Address

STREET APT. CITY STATE ZIP

If applicable: Daytime Email

Policy Owner 2 Name Phone
(First, M.I., Last)
Address

STREET APT. CITY STATE ZIP

SECTION A: Trading Authorization for Variable Products

I/We, the policyowner(s), understand and agree that:

Q With respect to the policy number(s) identified above, I/we authorize my assigned NYLIFE Securities Registered Representative(s) and/or
Registered Service Assistant(s) to submit electronic orders on my/our behalf to (i) make premium allocation changes; (ii) transfer amounts
among Investment Divisions of the Separate Account, the Index-linked Account (if applicable), and the Fixed Account; (iii) make changes to
my/our investment objective and/or risk tolerance; (iv) set-up or update Automatic Asset Reallocation (AAR), if applicable. (Any AAR change
must be consistent with any requested fund transfers or allocation changes); and (v) request one-time partial withdrawals. (Unless the with-
drawal option is elected in Section B of this form, my Registered Representative will not be granted access to request a partial withdraw-
al on my/our behalf.) I also authorize my assigned NYLIFE Securities Registered Representative(s) and/or their Registered Service Assis-
tant(s) to make transfers among Investment Divisions, the Index-linked Account (if applicable), Dollar Cost Averaging, Dollar Cost Averaging
Advantage, Dollar Cost Averaging Plus, Dollar Cost Averaging Extension, Interest Sweep and/or the Fixed Account by telephone.
Q NYLIAC will consider any allocation change, transfer order and/or withdrawal to be in good order if they are in compliance with the terms
of the product prospectus and the policies of NYLIFE Securities LLC.
Q Any allocation changes, transfers or withdrawals will be priced on the business day that NYLIAC receives the request in good order. A
business day is any day the New York Stock Exchange is open. Allocation changes, transfer orders and withdrawals received after the
close of business, generally 4:00 p.m. Eastern Time, will be priced the following business day.
Q Confirmations of executions of orders affecting my/our policy are considered conclusive if I/we do not object to them in writing within 15
days after they are provided by NYLIAC to me/us by mail or otherwise.
Q NYLIAC is not liable for any loss, cost or expense for acting on electronic orders which NYLIAC believes to be genuine, in accordance with
our procedures.
Q This authorization will remain in effect until NYLIAC receives my/our revocation. I/We may contact a NYLIAC Customer Service
Professional toll-free at 1-800-CALL-NYL to request revocation.
Q This authorization form must be complete and accurate in order for the authorization to be accepted.
Q All telephone requests will be recorded for your protection and are subject to suitability review.

SECTION B: Partial Withdrawal Authorization for Variable Annuities

Complete ONLY if you want to enable your Registered Representative(s) and /or Registered Service Assistant(s) to request
partial withdrawals on your behalf.
I/We authorize my assigned NYLIFE Securities Registered Representative(s) and/or Registered Service Assistant(s) to request
one-time partial withdrawals. This authorization will remain in effect until NYLIAC receives my/our revocation. I/We may contact a
NYLIAC Customer Service Professional toll-free at 1-800-CALL-NYL to request revocation.
Q Partial withdrawals on Variable Annuity policies are subject to our online dollar amount limits. All distributions will be made to the address of
record, and are only available under the following conditions: (i) the policy is owned by an individual or individuals. (Partial withdrawals are not
available on policies owned by an entity, such as a Trust or Corporation.); (ii) a surrender charge would not be incurred; and (iii) the policy is
either non-qualified, or is an IRA, Inherited IRA, Roth IRA, SEP IRA, or SIMPLE IRA. (This form may not be used to request a partial withdrawal
from policies held by a qualified plan.) NYLIAC reserves the right to change these conditions at any time.
Q Partial withdrawals reduce the death benefit guarantee and any living benefit guarantee elected on the policy. Please review your product
prospectus for more information.
Q A partial withdrawal may result in a taxable gain reportable to the IRS. In addition to the Federal income tax withholding requirements, some
states require withholding on policy gains. Please consult with your personal tax advisor, plan administrator, State income tax authority, or
your local IRS office if you have any questions about income tax withholding.
Q If I am under the age of 59½, I understand that partial withdrawals made from my policy may be subject to an early distribution penalty tax on
any taxable gain.

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Trading and Partial Withdrawal Authorization Form (continued)

SECTION C: Partial Withdrawal Authorization for Fixed Deferred Annuities

Complete ONLY if you want to enable your Agents and /or Service Assistants to request partial withdrawals on your behalf.
I/We authorize my assigned New York Life Agents and/or Service Assistants to request one-time partial withdrawals.
This authorization will remain in effect until NYLIAC receives my/our revocation. I/We may contact a NYLIAC Customer
Service Professional toll-free at 1-800-CALL-NYL to request revocation.
Q Partial withdrawals from Fixed Deferred Annuity policies are subject to limits. All distributions will be made to the address of record,
and are only available under the following conditions: (i) the policy is owned by an individual or individuals. (Agents or their service
assistants may not accept requests to partial withdrawals on policies owned by an entity such as a Trust or Corporation.);
(ii) a surrender charge would not be incurred; and (iii) the policy is either non-qualified, or is an IRA, Inherited IRA, Roth IRA, SEP IRA,
or SIMPLE IRA. (This form may not be used to request a partial withdrawal from policies held by a qualified plan.) NYLIAC reserves
the right to change these conditions at any time.
Q A partial withdrawal may result in a taxable gain reportable to the IRS. In addition to the Federal income tax withholding requirements, some
states require withholding on policy gains. Please consult with your personal tax advisor, plan administrator, State income tax authority, or
your local IRS office if you have any questions about income tax withholding.
Q If I am under the age of 59½, I understand that any partial withdrawals executed by me or my Agent may be subject to an early distribution
penalty tax on any taxable gain.
SECTION D: Read and Sign

By signing below you agree to accept and comply with the procedures established by NYLIAC. If there are multiple owners, all owners are
required to sign. For policies owned by Trusts or Corporations, form # 22748, Authorized Individual Request for Trusts or Corporate Owned
Policies, must be submitted with this request. Note that orders being placed by a Registered Representative(s) or Registered Service
Assistant(s) are per the client’s instructions only. Registered Representative(s) or Registered Service Assistant(s) cannot place orders without
instructions from the client.
If this policy is Corporate Owned please provide signatures and titles of two authorized corporate officers.
If one is not already on file, please provide a corporate charter to identify the below signors as authorized corporate officers.

X Title of Officer Name

Policy owner/Officer/Trustee signature (if applicable) (Print) Date

X Title of Officer Name

Policy owner (required if joint owner) Officer/Trustee signature (if applicable) (Print) Date
Done! Send us your completed form.
Mail: New York Life, Variable Products Service Center, Madison Square Station, PO Box 922, New York, NY 10159
ONLINE: Save time and postage by uploading this form at newyorklife.com/register. Log in or register to upload in minutes.

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