Exhibit (27)(e)(2)

 

Equitable Financial Life Insurance Company (EFLIC),
domiciled in New York
Equitable Financial Life Insurance Company of America (EFLOA),
domiciled in Arizona
Issuing Company: The issuing Company for the contract will be Equitable Financial Life Insurance Company of America, unless the primary selling Agent is an Equitable Advisors Financial Professional whose business address is in the state of New York, in which case the issuing Company will be Equitable Financial Life Insurance Company.
STRUCTURED CAPITAL STRATEGIES® PREMIER
Application for an Individual Variable and Index-Linked Deferred Annuity
Equitable Regular Mail:
Retirement PO Box 1424 Service Solutions Charlotte, NC 28201-1424
Equitable Express Mail:
8501 Retirement IBM Dr Service Solutions Charlotte, Ste 150-IR NC 28262
please For call Assistance, (888) 517-9900 equitable.com
1. Contract Series and Type
A. Contract Series
All share Classes may not be available at all Broker Dealers
Series B Series $25,000 Select Minimum Contribution $25,000 Minimum Contribution Withdrawal 6 year: 8%,8%,7%,6%,5%,4% Charges No Withdrawal Charges
B. Choose a Contract Type.
Non-Qualified (NQ)
Traditional Individual Retirement Account (IRA) Roth IRA
SEP IRA
Qualified Plan Defined Contribution (QPDC) Qualified Plan Defined Benefit (QPDB)
Inherited IRA Beneficiary Continuation Option (BCO) (Direct Transfer of Decedent IRA) Inherited Roth IRA BCO (Direct Transfer of Decedent Roth IRA) Inherited NQ (1035 Exchange of Decedent NQ) Non-Spousal Beneficiary of Qualified Plan (QP) (Direct Rollover to an Inherited IRA BCO) IRA Non -BCO) Spousal Beneficiary of QP (Direct Rollover to an Inherited Roth
2. Total Initial Contribution(s)
Initial Contribution $ (Minimum: $25,000) Estimated Value Required In Case of Transfer
Specify Method(s) of Payment:
Check or Wire (make check payable to: Equitable) 1035 Exchange (NQ, Inherited NQ) CD or Mutual Funds Proceeds (NQ) Direct Transfer (IRA, Roth IRA or SEP IRA) Financial Professional/Client will request funds
Rollover (IRA, Roth IRA or SEP IRA)
Employer Contribution to SEP IRA (Employee contributions not permitted)
Direct Rollover (Non-Spousal Beneficiary QP to Inherited IRA BCO) Direct Rollover (Non-Spousal Beneficiary QP to Inherited Roth IRA BCO)
(Equitable’s assistance in collecting funds is not required.) (IRA or Roth IRA)
3. Account Registration (Must be a legal resident of U.S. or U.S. territories)
Individual Uniform Gift to Minors Act / Uniform Transfer to Minors Act (Child’s SSN ) The Owner types below require additional form(s). See the New Business Form Booklet for more information.
Trust Qualified Plan Trust (QPDC/QPDB) Other Non-Natural Owner Custodian (IRA/ROTH) Beneficiary of the Deceased IRA or NQ Owner Non-Spousal Beneficiary of Deceased QP Participant
A. Owner
Male Female Date of Birth (MM/DD/YYYY) Daytime Phone # Owner Name (First) (Middle Initial) (Last) Employer Name (for SEP IRA contracts only)
Owner Taxpayer Identification Number (Check one)
Social Security Number (SSN) Employer Identification Number (EIN) Individual Taxpayer Identification Number (ITIN)
Home Offices: EFLIC 1345 Avenue of the Americas, New York, NY
EFLOA 3030 North Third Street, Suite 790 Phoenix, AZ 85012
ICC26 App SCSPR
X04819_Compact
Cat. No. 900491
Structured Capital Strategies Premier
Page 1 of 11

3. Account Registration (cont’d) R
A. Owner (cont’d)
E
Q Email Address U
I I am interested in receiving all documents electronically from Equitable via e-delivery. To view and download material R electronically, you must have access to a computer with Internet access, an active email account and a software program that E allows you to view PDF documents, such as Adobe Acrobat Reader.
D
U.S. Primary Resident Address only – No P.O. Box City State Zip Code
If your Mailing Address is different from the Primary Residential Address above, please provide your Mailing Address in Section 12.
B. PATRIOT Act Information Owner must complete this section. If the Owner is not an individual, the Annuitant R must complete this section.
E Yes No
U.S. Citizen Q
U If no, check either: U.S. Visa (Complete below) or Permanent Resident (Green Card) (Copy of document required)
I
R Identification/Passport# Exp. Date U.S. Visa Type (if applicable)
E
D C. Joint Owner (Must be a legal resident of U.S. or U.S. territories) NQ Only
Male Female Date of Birth (MM/DD/YYYY) Daytime Phone #
Name
(First) (Middle Initial) (Last)
Relationship to Owner (Check one) Spouse Other
Taxpayer Identification Number (Check one) SSN ITIN
Email Address
U.S. Primary Resident Address only – No P.O. Box City State Zip Code Joint Owner Form of Identification (Check one)  Valid Driver’s License Passport State Issued ID
Identification Number     Exp. Date (MM/DD/YYYY)
D. Annuitant (Required if other than Owner.) Annuitant must complete the PATRIOT Act Information in Section 3B if the owner is NOT an individual.
Male Female Date of Birth (MM/DD/YYYY) Daytime Phone #
Name
(First) (Middle Initial) (Last)
Taxpayer Identification Number (Check one) SSN ITIN
U.S. Primary Residential Address only – No P.O. Box City State Zip Code Contract Maturity Date: The Contract Maturity Date may not be later than the Contract Date Anniversary on or following the Annuitant’s 98th birthday. You may commence annuity payments earlier by submitting a written request to our Processing Office in accordance with the Contract.
E. Joint Annuitant
Relationship to Annuitant (Check one) Spouse Other
Male Female Date of Birth (MM/DD/YYYY) Daytime Phone #
Name (First) (Middle Initial) (Last) Taxpayer Identification Number (Check one) SSN ITIN
U.S. Primary Residential Address only – No P.O. Box City State Zip Code
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 2 of 11

4. Beneficiary(ies) (Please use Special Instructions Section for Additional Beneficiaries.) Enter the beneficiaries full name below. Unless otherwise indicated, proceeds will be divided equally.
A. Primary
1. % Primary Beneficiary Name
SSN EIN ITIN
Address 2. Primary Beneficiary Name % SSN EIN ITIN
Address
B. Contingent
1. Contingent Beneficiary Name % SSN EIN ITIN
Address 2. Contingent Beneficiary Name % SSN EIN ITIN
Address 1 Enter the relationship to the Annuitant when the Owner is not an Individual.
Relationship to Owner1 Date of Birth (MM/DD/YYYY) Phone # Relationship to Owner1 Date of Birth (MM/DD/YYYY) Phone #
Relationship to Owner1 Date of Birth (MM/DD/YYYY) Phone # Relationship to Owner1 Date of Birth (MM/DD/YYYY) Phone #
5. Optional Guaranteed Minimum Death Benefit (GMDB)
For issue ages 75 or younger, your contract will be issued with a Return of Premium GMDB Rider (ROP GMDB) at no additional cost unless you select one of the optional GMDBs below. For issue age 76 or older, your Contract will be issued with the Annuity Account Value Death Benefit.
The optional Highest Anniversary Value (HAV) GMDB and Greater of Roll-Up or HAV (Greater of) GMDB Riders can be purchased for an additional charge and may only be chosen at the time of application. You should read the prospectus and applicable supplements for more complete information including the limitations, restrictions, charges and other information that apply before making a selection. Once elected, the HAV GMDB and Greater of GMDB Riders cannot be voluntarily terminated from the contract.
Yes, I wish to elect the HAV GMDB (Owner/Joint Owners issue ages 0-75 only. Allocations to iShares® Bitcoin Trust ETF is not permitted with this election. Not available for non-spousal Joint Owners or a Non-Natural Owner with non-spousal Joint Annuitants).
OR
Yes, I wish to elect the Greater of GMDB Rider (Owner/Joint Owners issue ages 0-75 only. Allocations to iShares® Bitcoin Trust ETF is not permitted with this election. Not available for non-spousal Joint Owners or a Non-Natural Owner with non-spousal Joint Annuitants).
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 3 of 11

6. Rate Hold
This Rate Hold provides you the option to invest in Segments based on the Segment Performance Cap Rate, Participation Rate and Step Rate for Dual Step Tier Segments (collectively “Rate(s)”) as of the Application Received Date*. The Rates will be applied to all Segments starting on or before the Rate Hold Expiration Date, which is the Segment Start Date on or immediately following 30 days after the Application Received Date. This option may only be elected at the time of application. You should read the prospectus, disclosure below and applicable supplements for more complete information including the limitations, restrictions and other information that apply to this option before making an election.
Yes, I wish to elect the Rate Hold and invest in Segments based on the Application Received Date, as described in this section.
OR
No, I do not wish to elect the Rate Hold and I understand that I will be invested in Segments based on current Rates as of the Segment Start Date.
• I understand that the secured Rate(s) that will be applied to any amount that is invested in a Segment on or before the Rate Hold Expiration Date may be lower than the Rate(s) otherwise in effect on any Segment Start Date during that period, and therefore electing the Rate Hold does not guarantee me higher Rate(s) than the Rate(s) that would have otherwise been applied to my investment in a Segment had I not elected the Rate Hold.
• The Rate Hold does not begin until the Application Received Date, and therefore it is possible that the secured Rate(s) applicable to investment in a Segment may be lower than the Rate(s) in effect on the date that I sign this application. • Any investment in a Segment that I make after the Rate Hold Expiration Date will not receive the secured Rate(s). If my application is incomplete when submitted, it may take additional time for my application to be finalized and for certain investment to a Segment to be received by Equitable; in such situations I understand that the Rate Hold Expiration Date is not extended and therefore it may be more likely that those investments in a Segment do not receive the Rate Hold.
• Dollar Cap Averaging in Section 7 is not available if the Rate Hold is elected.
* Your Application Received Date is either the date your application is received in our processing office for a paper application, or the date your application is submitted for an electronic application.
7. Dollar Cap Averaging (DCA) Optional Special DCA Program, which has an enhanced crediting rate, is only available for Series B. The General DCA Program is only available for Series Select.
(Not available if “Yes” is elected for Rate Hold in Section 6)
Check box for one time period. 3 months (maximum 41 Segment Types) 6 months (maximum 23 Segment Types)
By checking one of the two boxes above, I acknowledge that:
• 100% of the initial contribution will be allocated to DCA.
• Allocations to iShares® Bitcoin Trust ETF are not available under DCA programs.
• The the same initial as DCA the transfer Contract will Date, occur then on the the Segment initial transfer Start will Date occur following on the the Contract Contract Date Date, . unless the Segment Start Date is
• The subsequent initial DCA DCA transfer transfer will will be occur the Segment on the Segment Start Date Start on Date or immediately on or immediately following following establishing the monthiversary the DCA program of the . Each initial DCA transfer.
• You must complete Section 8 below.
• The funds will be systematically transferred monthly from the DCA account into Segment Type Holding Accounts and will be transferred to the Segment(s) on the Segment Start Date if all the Segment Participation Requirements are met.
• is The 167 total . This maximum means that number if you of choose Segments the 3 that month you DCA can invest program, in, and/or you can provide choose segment up to a allocation maximum instructions of 41 Segment for, at Types, any time or if you choose the 6 month DCA program, you can choose up to a maximum of 23 Segment Types.
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 4 of 11

8. Investment Selection
• You must allocate your initial contribution to the Structured Investment Option in Section 8A and/or the Guaranteed Interest Option in Section 8B.
• All future contributions will be allocated according to the percentages below unless indicated otherwise.
• iShares® Bitcoin Trust ETF Segment allocations are generally limited to 25% of any contribution. Specific additional rules apply for transfers and allocation of Segment maturity value. Please refer to your prospectus for these rules. In addition, allocations to the iShares® Bitcoin Trust ETF are not permitted if the HAV GMDB or Greater of Roll-Up or HAV GMDB is elected in Section 5. References to Index also include ETFs, where applicable.
• If you elected DCA in Section 7, your initial contribution will be allocated 100% to the DCA and the DCA transfers will be allocated according to your allocation instructions provided below. The initial DCA transfer will occur on the Segment Start Date following the Contract Date, unless the Segment Start Date is the same as the Contract Date, then the initial transfer will occur on the Contract Date.
8A. Structured Investment Option: Segment Selection (Please use whole percentages)
If Holding you elect Account any of until the your Segment Segment(s) Types listed becomes below, available once amounts on the Segment are received, Start Date they .will At that be first time, placed your in funds a Segment will be allocated Type per your selection(s) below provided that all Segment Participation Requirements specified in the Contract are met.
3-Month Segment Duration
Standard Segments
Segment Buffer Index -5% -10% -15%
S&P 500 % % % Russell 2000® % % % MSCI EAFE % % % NASDAQ 100® % % %
1-Year Segment Duration
Standard Segments
Segment Buffer
Index -10% -15% -20% -40% -100%
S&P 500 % % % % % Russell 2000® % % % % % MSCI EAFE % % % % % NASDAQ 100® % % % % % Bitcoin ETF* % % % % -
*iShares® Bitcoin Trust ETF has a maximum allocation of 25% across all Bitcoin options
Dual Direction Segments
Segment Buffer Index -10% -15% -20%
S&P 500 % % % Russell 2000® % % % MSCI EAFE % % % NASDAQ 100® % % %
Enhanced Upside 125% Segments
Segment Buffer Index -10%
S&P 500 %
Dual Direction Downside Advantage Segments
Segment Buffer Index -10% -15%
S&P 500 % % Russell 2000® % % MSCI EAFE % % NASDAQ 100® % %
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 5 of 11

8. Investment Selection (cont’d) 
8A. Structured Investment Option: Segment Selection (cont’d) (Please use whole percentages)
1-Year Segment Duration
Step Up Segments
Segment Buffer Index -10% -15% -20% -40%
S&P 500 % % % % Russell 2000® % % % % MSCI EAFE % % % % NASDAQ 100® % % % %
Optimal Mix US Segment
Segment Buffer Index -10%
S&P 500/Russell 2000®/
%
NASDAQ 100®
Optimal Mix Global Segment
Segment Buffer Index -10%
S&P 500/Russell 2000®/
% MSCI EAFE/NASDAQ 100®
Dual Step Up Segments
Segment Buffer Index -10% -15% -20% -40%
S&P 500 % % % % Russell 2000® % % % % MSCI EAFE % % % % NASDAQ 100® % % % %
Dual Step Tier Segments
Segment Buffer Index -10%
S&P 500 % Russell 2000® % MSCI EAFE % NASDAQ 100® %
6-Year Segment Duration
Standard Segments
Segment Buffer
Index -10% -15% -20% -40% -100%
S&P 500 % % % % % Russell 2000® % % % % % MSCI EAFE % % % % % NASDAQ 100® % % % % %
Step Up Segment
Segment Buffer Index -10% -20% -40%
S&P 500 % % %
Best Entry Segment
Segment Buffer Index -10%
S&P 500 %
Dual Direction Segments
Segment Buffer Index -10% -15% -20% -40%
S&P 500 % % % % Russell 2000® % % % % MSCI EAFE % % % % NASDAQ 100® % % % %
Dual Step Up Segments
Segment Buffer Index -10% -20% -40%
S&P 500 % % % Russell 2000® % % % MSCI EAFE % % % NASDAQ 100® % % %
Dual Step Tier Segments
Segment Buffer Index -10% -20%
S&P 500 % % Russell 2000® % % MSCI EAFE % % NASDAQ 100® % %
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 6 of 11

8. Investment Selection (cont’d) 
8A. Structured Investment Option: Segment Selection (cont’d) (Please use whole percentages)
6-Year Segment Duration
Optimal Mix US Segment Optimal Mix Global Segment
Segment Buffer Segment Buffer Index -10% Index -10%
S&P 500/Russell 2000®/ % S&P 500/Russell 2000®/ % NASDAQ 100® MSCI EAFE/NASDAQ 100®
8B. Guaranteed Interest Option 
Guaranteed Interest Option %
8C. Contribution Allocation Total
Structured Investment Option Total % + Guaranteed Interest Option Total % = 100%
9. Broker Transfer Authority Disclosure
Professionals Yes. I/we hereby assigned grant to authority my contract to each in the of future), my Financial to act Professional(s) as my agent and assigned provide to investment my contract option (including transfer any instructions Financial in writing, by telephone or electronically, to Equitable. By granting such authority, I direct Equitable to act on such instructions. such I understand instructions, and acknowledge and (ii) will have that no Equitable liability for (i) may any claim, rely in loss, good liability, faith on or the expense stated identity that may of arise the person(s) in connection providing with such instructions as Equitable’s . I further Processing understand Office receives and acknowledge from me written that Equitable notification will continue that broker to transfer act upon authority this authorization has been until terminated such time . I understand transfer instructions that upon on receipt my behalf of such . I further notification, understand Equitable and acknowledge will terminate that the Equitable Financial Professional’s(s’) may (i) change or ability terminate to provide telephone other or electronic electronic or overnight transfer services mail transfer because procedures of disruptive at any transfer time without activity prior . notice, and (ii) restrict fax, internet, telephone and
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 7 of 11

10. Current Insurance BOTH questions in the Owner Response and the Financial Professional Response columns must be completed and match for the contract to be issued.
Replacement Questions
1. Does the Owner have any other existing life insurance policy or annuity (If yes, submit contract(s)? a Requirements Questionnaire (which is Equitable’s    state question replacement 2) form), if required, even if you answer no for
2. Will any existing life insurance policy or annuity contract(s)be (or has it been) surrendered, withdrawn from, loaned against, changed or otherwise reduced in value, or replaced in connection with this transaction assuming the Contract applied for will be issued on the life of the Owner?
(If yes, complete the following below and submit a Requirements Questionnaire, (which is Equitable’s state replacement form), if required.)

Financial Professional Owner Response Response Yes No Yes No

Yes No Yes No
COMPANY TYPE OF PLAN YEAR ISSUED CONTRACT NO. COMPANY TYPE OF PLAN YEAR ISSUED CONTRACT NO. COMPANY TYPE OF PLAN YEAR ISSUED CONTRACT NO.
11. Fraud Warning
Any offense person and who subject knowingly to penalties presents under a false state statement law. in an application for insurance may be guilty of a criminal
12. Special Instructions
Attach a separate sheet if additional space is needed. For Owners whose Mailing Address differs from their Primary Residential Address in Section 3, please complete the following:
Mailing Address — P.O. Box accepted    City    State     Zip Code
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 8 of 11

13. Signature and Acknowledgements GENERAL DISCLOSURE. BY SIGNING BELOW, I / WE UNDERSTAND AND
ACKNOWLEDGE THAT: R
E • Annuity Account Value(s) attributable to allocations to the Structured Investment Option, I may elect, may Q increase or decrease and are not guaranteed as to dollar amount.
U • Amounts I allocate to any of the Segment Types may first be allocated to the applicable Segment Type Holding Account, I with the exception of (i) maturing Segments for which the allocation instructions on file are to allocate directly to another R Segment; or (ii) amounts that I allocate to a Segment Type on a Segment Start Date (and which are received or held by E Equitable on the Segment Start Date), which will be allocated directly to the selected Segment.
D
• in Each the Segment case of Optimal in the Structured Mix, the weighted Investment performance Option provides in the relevant a rate of indices) return tied . The to Segments the performance are not of index a specified funds and index do (or, not invest in underlying mutual funds that hold investments tracked by a specified index (or indices).
• The Enhanced Step Up, Upside Dual Segments, Direction, Dual will generally Step Tier, have Dual lower Step Performance up, Dual Direction Cap Rates Downside than Advantage, Standard Segments Optimal Mix, with and the same Index, Segment Duration, and Segment Buffer.
• Options The Segment even though Rate of the Return Segments for Segments have similar using durations one Segment and/or Option track may similar differ indices from. In Segments addition, using because different of the Segment way the Segment Dual Step Rate Tier Segments, of Return is I calculated understand for that Step in Up, certain Dual circumstances Step Up, Dual a Direction, very small Dual difference Direction in the Downside Index and Advantage, Performance and Rate can result in a much larger difference in the Segment Rate of Return for those Segments.

• Rate For Enhanced —is always Upside subject Segments, to, and thus the limited Segment by, the Rate Performance of Return— inclusive Cap Rate of . This any application means that of even the if Participation the Index Performance the Rate Performance multiplied by Cap the Rate Participation . The Participation Rate is greater Rate than for this the Segment Performance Option Cap is generally Rate, the higher Segment compared Rate of to Return other will Segment equal Types Options with offered Participation with the Rates same Index, greater Segment than 100% Duration . For such and Segment Segment Types, Buffer. Please the rules note governing there may those also Segment be other Types Segment will Performance apply, including, Cap if Rate, applicable, the Segment that even Rate if the of Index Return Performance will equal the Rate Performance multiplied Cap by the Rate Participation . Rate is greater than the • that For Best in certain Entry circumstances, Segments, a reset there of may the Best not be Entry a reset Value to is a always lower value dependent as of the on first negative four monthiversary Index performance of my . ISegment understand . • conditions The prospectus that apply and applicable to the Contract supplements . contain more complete information including the limitations, restrictions and • features In the case and of benefits IRAs and other Qualified than tax Plans, deferral by signing . IRAs and this Qualified application Plans I acknowledge derive tax deferral that I am from buying the Internal the Contract Revenue for its Code and therefore the tax deferral feature of the Contract does not provide additional benefits.

• Under penalty of perjury, I certify that all the Taxpayer Identification Numbers in Sections 3 and 4 are correct.
• All information and statements furnished in this application are true and complete to the best of my knowledge and belief.
• Equitable may accept amendments to this application provided by me or under my authority.
• of No Equitable’s Financial Professional rights and regulations has the authority . Equitable to make must or agree modify to any any change Contract made on behalf to the of Contract, Equitable, or or to the to waive age at or issue, alter any in writing signed by an officer of the company.
• Structured Capital Strategies® Premier is not sponsored, endorsed, or promoted by Morgan Stanley Capital International prospectus (MSCI), and contains MSCI bears a more no detailed liability with description respect of to the such limited product relationship or any index that on MSCI which has such with product Equitable is based and any . The related products.
• iShares®, IBIT®, and BlackRock® are trademarks of BlackRock and are used under license. Equitable products and services are not sponsored, endorsed, sold, or promoted by BlackRock; purchasers of such products do not acquire any interest in the iShares® Bitcoin Trust ETF nor enter into any relationship of any kind with BlackRock; and BlackRock makes no representations or warranties, express or implied, to the owners of any products offered by Equitable.
• The S&P 500® Price Return Index is a product of S&P Dow Jones Indices LLC (“SPDJI”), and has been licensed for use by Equitable Dow Jones, . The S&P Structured or any of Capital their respective Strategies affiliates Premier (collectively, contract is “S&P not sponsored, Dow Jones endorsed, Indices”) .sold S&P or Dow promoted Jones by Indices SPDJI, makes no representation or warranty, express or implied, to the owners of the Structured Capital Strategies Premier contract.
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 9 of 11

13. Signature and Acknowledgements (cont’d)
For purposes of this section, the references to Owner and Joint Owner below include Annuitant and Joint Annuitant, respectively, in the case of non-natural owners.
OPTIONAL BENEFIT DISCLOSURE. I/WE UNDERSTAND AND ACKNOWLEDGE THAT:
• Allocations to the iShares® Bitcoin Trust ETF are not permitted if the HAV GMDB or Greater of Roll-Up or HAV GMDB is elected in Section 5.
• There is an additional charge if the HAV GMDB or Greater of GMDB Rider is elected.
• The HAV GMDB or Greater of GMDB cannot be voluntarily terminated once it is elected.
• withdrawn The HAV GMDB . or Greater of GMDB Rider does not provide an Annuity Account Value or Cash Value and cannot be
• Withdrawals under the Contract will reduce my ROP GMDB or HAV GMDB or Greater of GMDB.
• or The in ROP the future, GMDB to or my HAV Contract GMDB because or Greater withdrawals of GMDB that may are be made of limited from use this if Contract required to minimum meet the distributions required amount apply, may now significantly reduce the benefit.

• the For death jointly of owned the first contracts Owner .with The the death ROP benefit GMDB is or only HAV payable GMDB upon or Greater the death of GMDB, of the surviving the death Joint benefit Owner is not . payable after • as For described non-spousal in Section joint owners 72(s) with of the the Internal ROP GMDB, Revenue because Code after the entire the owner’s interest death in the the annuity surviving contract owner’s must beneficiaries be distributed may not receive the benefit of the ROP GMDB.

• If of the the Joint designation Owners of divorce, the single Equitable Owner must of the be contract notified before using we a form will acceptable remove the to Joint us of Owner the change . The notice in marital must status be signed and HAV by both GMDB Joint or Owners Greater and of GMDB must be to received be payable by Equitable upon the death while both of the Joint single Owners Owner are . I/We alive understand in order for that the if ROP Equitable GMDB is not or Cash notified Value, using not a form the ROP acceptable GMDB to or us HAV before GMDB the or death Greater of either of GMDB, former will spouse be payable and signed and the by fees both for Joint the Owners, HAV GMDB then or the Greater of GMDB will not be returned.
• divorce If I/We remove cases mentioned an Owner above of the .Contract, the ROP GMDB or HAV GMDB or Greater of GMDB is terminated, except in
By signing the application below: I acknowledge that I received the initial prospectus, I understand that all subsequent prospectus updates and supplements will be provided to me in paper format, unless I enroll in Equitable’s Electronic Delivery Service. I have reviewed my financial information and goals with my Financial
Professional. I acknowledge and agree to the elections I have made and understand the terms and conditions set forth in this application.
Contract State:
We will issue and deliver a contract to you based on the state of primary residence. If you sign the application in a state other than the primary residence state: I acknowledge that either: I have a second residence where the application was signed (the state of sale); or I work or maintain a business in the state where the application was signed (the state of sale).
X
Owner’s Signature City, State Date (MM/DD/YYYY)
X
Joint Owner’s Signature City, State Date (MM/DD/YYYY)
X
Annuitant’s Signature (if other than Owner) City, State Date (MM/DD/YYYY)
X
Joint Annuitant’s Signature (if other than Owner) City, State Date (MM/DD/YYYY)
Structured Capital Strategies Premier ICC26 App SCSPR X04819_ Compact Page 10 of 11

14. Financial Professional Information

A. Did of an you entity (i) verify Owner, the obtain identity documentary by reviewing evidence the driver’s of entity’s license/passport existence (e. of g. the articles Owner, of or incorporation, in the case trust agreement, etc.), and (ii) inquire about the source of the customer’s assets and income? B. Is the Proposed Owner/Annuitant currently an Active Duty* Member of the Armed Forces?

MEMBERS OF THE ARMED FORCES).

*Active component Duty (National means full-time Guard and duty Reserve) in active while military serving service under of the published United States orders and for includes active duty members or full-time of the training. reserve It does calls not include or orders members specifying of the periods reserve of less component than 31 who calendar are performing days. active duty or active duty for training under military C. NORTH information CAROLINA provided ONLY: by the IProposed certify that Owner. I have truly and accurately recorded on the application the Yes No D. Please check this box if you are an Equitable Advisors Financial Professional and the primary selling Agent’s business address is in the state of New York, in which case the issuing company for the contract will be Equitable Financial Company of Life America. Insurance Company. In all other cases, the issuing company will be Equitable Financial Life Insurance

The applicant understands that he/she is applying for an index-based annuity, and that while the values of the policy may be affected by an external index, the policy does not directly participate in any stock or equity investments.
X
Primary Financial Professional Signature
Please provide at least one of the following numbers in full: Equitable Advisors ONLY
Social Security    Central Registration Depository National Producer Number Agent Code
% 
Print Name Phone Number
Email Address Client (BIN) Client linking Number Agent Location
X
Financial Professional Signature
Please provide at least one of the following numbers in full: Equitable Advisors ONLY
Social Security    Central Registration Depository National Producer Number Agent Code
% 
Print Name Phone Number
Financial Professional Use Only. Contact your home office for program information. Once selected, program cannot be changed.
Contract Series B:
Option I  Option II  Option III Contract Series Select: Option I
Please be sure that the commission option elected is approved by your Broker Dealer.
Cat. No. 900491
Structured Capital Strategies Premier
ICC26 App SCSPR X04819_Compact Page 11 of 11