0001193125-22-153626 Sample Contracts

Owner: [JOHN DOE] Annuitant: [JOHN DOE] [Joint Owner: [DORIS DOE]] [Joint Annuitant: [DORIS DOE]] Contract Number: [00000] Contract Date: [July 1, 2021]
Equitable Financial Life Insurance Co of America • May 18th, 2022 • Life insurance

This is the entire Contract. This Contract is issued in return for the Contributions made to us under this Contract. This Contract becomes effective on the Contract Date. The Annuitant and the Owner must be living on the Contract Date.

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EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA INHERITED NON-QUALIFIED PAYOUT ENDORSEMENT
Equitable Financial Life Insurance Co of America • May 18th, 2022 • Life insurance

When issued with this Endorsement, and as specified in the Data Pages, this Contract is offered to a beneficiary of a nonqualified deferred annuity contract in his/her capacity as beneficiary. It is intended to make the payments required after the death of the holder of a nonqualified deferred annuity contract under Section 72(s) of the Code.

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