Investment Option Change
Instructions
Use this form to make investment option transfers on a one-time basis or to change how your future premium payments will be allocated to
your variable annuity.
•
•
•
•
This form can be used for the following products: Accommodator, Independence, Declaration, Patriot and Revolution Variable annuities.
A separate form must be completed for requests on any additional contracts.
You should review your variable annuity contract for detailed information regarding trade restrictions and limitations.
If you elected to have telephone transfer authorization on your annuity, you may call us to process this transaction.
1
2
3
Information About You
Contract Number:
Owner’s Name:
Date of Birth:
Address:
Owner’s Phone Number:
Co-Owner’s Name:
Date of Birth: ___________________________________________
Address:
Co-Owner's Phone Number: _________________________________
Financial Advisor’s Name (if applicable):
Financial Advisor’s Phone Number:
Specific One-Time Transfer
Complete this section when you want to move the contract value from one investment option into another. List each investment option separately and complete
Secion 3 if you also want to change how your future purchase payments will be allocated. The available Festination Invesment Options are listed in Section 6.
Percentage OR Dollar Amount:
From (Source Investment Option):
To (Destination Investment Option):
1.
% or $
1.
1.
2.
% or $
2.
2.
3.
% or $
3.
3.
4.
% or $
4.
4.
5.
% or $
5.
5.
Reallocation of Value and Future Investment Option Change
Complete this section and Section 6 to reallocate the current contract value of your annuity among investment options and/or change where your future purchase
payments will be allocated. Check ONE of the following three options and complete Section 6 to make your investment selections
a)
b)
c)
Follow my instructions in Section 6 to reallocate all of my current contract value.*
Follow my instructions in Section 6 to reallocate all of my current contract value and future purchase payments.*
Follow my instructions in Section 6 for future purchase payments only.
*Some products do not allow fixed funds to be included in reallocations. Please see your prospectus for fixed investment option rules.
4
Authorization
I (or we) request John Hancock make the changes specified in sections 2, 3 and 6 of this form to the specified contract, and I (or we) agree to submit additional
information upon request if such information, in the discretion of John Hancock, is necessary to implement the changes on this form. By signing section 4, I (or we)
authorize John Hancock to interpret my request in order to resolve any ambiguities, inconsistencies or omissions.
SIGN
HERE
Signature of Owner:
Date:
/
/
SIGN
HERE
Signature of Co-Owner:
Date:
/
/
5
Contact Information
Mailing Address
John Hancock Annuities Service Center
PO Box 55444
Boston, MA 02205-5444
Overnight Deliveries:
John Hancock Annuities Service Center
30 Dan Road, STE. 55444
Canton, MA 02021-2809
Questions:
1-800-824-0335
To Fax This Form:
1-617-663-3160
www.jhannuities.com
Issuer: John Hancock Life Insurance Company (U.S.A.) (not licensed in New York)
ANNIO (Date 11/05/15)
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Investment Option Change (continued)
6
Investment Option Selections
Using the lists below, please choose the variable investment options and percentages for your allocation. Allocations can be made to one or any combination of
the available variable investment options. (Please see prospectus for further details.)
Declaration, Patriot, Revolution and Wealthbuilder Variable Annuities
Includes Revolution Value and Extra
_____% 500 Index B (JHAM 2)
_____% Lifestyle Balanced MVP (JHAM 1,2)
_____% Active Bond (Declaration/JHAM 1)
_____% Lifestyle Balanced PS (JHAM 1,2)
_____% Blue Chip Growth (T. Rowe Price)
_____% Mid Cap Index (JHAM 2)
_____% Capital Appreciation (Jennison)
_____% Mid Cap Stock (Wellington)
_____% Core Bond (Wells)
_____% Mid Value (T. Rowe Price)
_____% Core Strategy (JHAM 1,2)
_____% Money Market B (JHAM 2)
_____% Equity-Income (T. Rowe Price)
_____% Real Estate Securities (DIMA)
_____% Financial Industries (JHAM 1)
_____% Short Term Government Income (JHAM 1)
_____% Fundamental All Cap Core (JHAM 1)
_____% Small Cap Growth (Wellington)
_____% Global Bond (PIMCO)
_____% Small Cap Index (JHAM 2)
_____% Health Sciences (T. Rowe Price)
_____% Small Cap Value (Wellington)
_____% High Yield (Western Asset)
_____% Total Bond Market B (Declaration)
_____% International Equity Index B (SSgA)
_____% Total Stock Market Index (JHAM 2)
_____% International Value (Templeton)
_____% Ultra Short Term Bond (JHAM 1)
M Fund, Inc. (available only for Revolution
Value contracts purchased through registered
representatives affiliated with the M Financial Group)
_____% M Large Cap Value (Iridian)
_____% M Capital Appreciation (Frontier Capital)
_____% M International Equity (Brandes)
_____% M Large Cap Growth (AJO)
Market Value Adjusted Accounts
(Not available in OR or WA)
_____% 5-Year
_____% 6-Year
(Not available for contracts issued prior to
9/30/02)
Accommodator, Independence, Revolution Extra II and Revolution Value II Variable Annuities
_____% 500 Index B (JHAM 2)
_____% Active Bond (Declaration/JHAM 1)
_____% Blue Chip Growth (T. Rowe Price)
_____% Capital Appreciation (Jennison)
_____% Core Bond (Wells)
_____% Core Strategy (JHAM 1,2)
_____% Equity-Income (T. Rowe Price)
_____% Financial Industries (JHAM 1)
_____% Fundamental All Cap Core (JHAM 1)
_____% Global Bond (PIMCO)
_____% Health Sciences (T. Rowe Price)
_____% High Yield (Western Asset)
_____% International Equity Index B (SSgA)
_____% International Value (Templeton)
1 John
2 John
_____% Lifestyle Balanced MVP (JHAM 1,2)
_____% Lifestyle Balanced PS (JHAM 1,2)
_____% Mid Cap Index (JHAM 2)
_____% Mid Cap Stock (Wellington)
_____% Mid Value (T. Rowe Price)
_____% Real Estate Securities (DIMA)
_____% Short Term Government Income (JHAM 1)
_____% Small Cap Growth (Wellington)
_____% Small Cap Index (JHAM 2)
_____% Small Cap Value (Wellington)
_____% Total Bond Market B (Declaration)
_____% Total Stock Market Index (JHAM 2)
_____% Ultra Short Term Bond (JHAM 1)
_____% Fixed Investment Option
(Not available for Accommodator)
Hancock Asset Management a division of Manulife Asset Management (US) LLC
Hancock Asset Management (North America) a division of Manulife Asset Management (North America) Limited
IMPORTANT NOTE: Dollar Cost Averaging does not apply to any fixed investment option (if offered on your annuity).
Please see your variable annuity contract and/or prospectus for further details.
ANNIO (Date 11/05/15)
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