0001193125-21-165369 Sample Contracts

Contract
Equitable America Variable Account K • May 18th, 2021

Equitable Financial Life Insurance Company Equitable Financial Life Insurance Company of America Mailing Address: PO Box 1047, Charlotte, NC 28201-1047 Section C—Limited Temporary Insurance Agreement and Questionnaire forming a Part of the Application for Life Insurance Name of Proposed Insured Date of Birth (mm/dd/yyyy) Name of Proposed 2nd Insured Date of Birth (mm/dd/yyyy) If any of the questions below are answered “Yes” or left blank with respect to any Proposed Insured(s), no representative of the Company is authorized to accept money, and NO COVERAGE will take effect under this Agreement with respect to such Proposed Insured(s). 1. The questions below apply to all Proposed Insured(s). a) Is any Proposed Insured less than 15 days or over 70 years of age? ☐ Yes ☐ No b) Within the past 24 months has any Proposed Insured been attended by a care provider or been seen at a medical facility for heart condition or disease, stroke or cancer? ☐ Yes ☐ No c) Within the past 10 years

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SECOND AMENDMENT TO PARTICIPATION AGREEMENT
Participation Agreement • May 18th, 2021 • Equitable America Variable Account K

Second Amendment, effective October 8, 2013 to the Participation Agreement, (the “Agreement”), dated January 2, 2013, as amended, by and among AXA Equitable Life Insurance Company, MONY Life Insurance Company of America (the “Company”), American Funds Distributors, Inc., American Funds Service Company, Capital Research and Management Company, and the American Funds Insurance Series (collectively, the “Parties”).

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