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NEW YORK LIFE INSURANCE AND ANNUITY CORPORATION (NYLIAC)

(A Delaware Corporation)

Change of Allocation, Transfer, and Full Reallocation of Existing Funds Form

Date: Policy Number:

Policyowner(s): First

M.I.

Last

Instructions: 1.

To change how future payments are allocated, review and complete Section A on pages 2 and 3. If part of your future payment(s) allocation change includes any of the DCA Advantage Plan Accounts, please also complete Form 22156.

2.

To transfer funds from your Investment Division(s) and/or DCA Advantage Plan Account(s) plus the Fixed Account(s) to another Investment Division(s) and/or the Fixed Account(s), review and complete Section B on pages 3 through 5.

3.

To fully reallocate existing funds within your Investment Division(s) and the Fixed Account, review and complete Section C on pages 6 and 7. Note: If you wish to change how future payment(s) are allocated, transfer funds from your Investment Division(s) and/or DCA Advantage Plan Account(s) plus the Fixed Account(s) to another Investment Division(s) and/or Fixed Account(s), or reallocate current funds within your Investment Division(s), review and complete pages 2 through 8. If you choose a transfer on pages 3 through 5, you may not select a one-time reallocation on pages 6 and 7 and vice versa. In addition, if you choose a one-time reallocation on pages 6 and 7, you may not select a transfer on pages 3 through 5.

4.

Date and sign page 8 of this form, Section D and secure all other required signatures. If the policy is jointly owned and/or has another designee(s) who are authorized to request transactions on the policy, the signatures of all joint owners and/or designees are required.

5.

If you have any questions, please contact one of our Customer Service Representatives toll-free at 1-800-598-2019. For online policy information and service, please visit our Virtual Service Center at www.newyorklife.com/vsc.

As of February 15, 2010, in certain jurisdictions, for the New York Life Premier Variable Annuity and New York Life Premier Plus Variable Annuity, there will be fund investment/allocation restrictions for policies that have elected the IPP Rider. Please see your product prospectus for more details. Please Note: If NYLIAC receives this request and any required information is incomplete, this request will not be processed. We will notify you if your request is incomplete. If you resubmit the request, the transaction(s) will be effective as of the date on which we receive a completed resubmission. The transactions on this form will result in the cancellation of a previously established Automatic Asset Reallocation. To re-establish your Automatic Asset Reallocation, please submit form 18523 (Annuity). The transactions selected on this form do not update the following automatic options: Interest Sweep and Dollar Cost Averaging. If your policy contains one of these automatic options and you wish to change the allocation alternative(s) for that option please complete and mail service form 18523, Automatic Asset Reallocation Interest Sweep – Dollar Cost Averaging Form, to the address indicated below. A previously established Automatic Asset Reallocation will be automatically cancelled if We process a separate request to transfer funds among the Investment Divisions, Fixed Account and DCA Advantage Plan Account, or a request to change the allocation of subsequent premium payments. All policies may not be available in all jurisdictions. Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC, and offered through properly licensed registered representatives.

RETURN FORM TO: For Variable Life and Variable Annuity policies:

New York Life, Variable Products Service Center Madison Square Station, PO Box 922, New York, NY 10159

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SECTION A

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CHANGE OF ALLOCATION (Only Affects Future Payments)

Credit any future Purchase Payment(s), as permissible under my policy plan, to my policy indicated above to the Investment Division(s), Fixed Account(s) and/or DCA Advantage Plan Account(s) in the percentage(s) selected below. This designation will revoke any prior payment allocation(s) I have made. I understand and agree that payment(s) received on and after the date on which this request is received by New York Life Insurance and Annuity Corporation (NYLIAC) will be applied on the basis of the new allocation(s) indicated below. For each payment I make, the minimum amount that may be allocated to any one Investment Division or to the Fixed Account(s) is $25 (and $5,000 for each DCA Advantage Plan Account). For New York Life Access and Complete Access Variable Annuity policies, the maximum amount of any one payment that can be allocated to the Fixed Account is 25% of the total payment. Please read the product prospectus for further details. Your payment allocation(s) may not result in the Accumulation Value being allocated to more than 18 Investment Divisions and/or DCA Advantage Plan Account(s) (Please Note: DCA Advantage Plan Accounts are not available for New York Life Access and Complete Access policies) plus the Fixed Account(s). Please indicate percentages in whole numbers. The total of all choices must equal 100%. Risk classifications are provided in the parentheses after the Investment Division. Risk classifications are determined on the basis of the Lipper Category assigned to the Investment Division by Lipper Analytics as of December 31, 2009. Lipper is a widely used independent research firm, which ranks mutual funds and other investment companies by overall performance, investment objectives and assets.

NAME(1)

NUMBER

Fixed Account – 1 Year Guarantee(4) Fixed Account – 3 Year Guarantee (New York Life Essentials Variable Annuity ONLY) 6-Month DCA Advantage Plan(2) 12-Month DCA Advantage Plan(2)

NAME(1)

NUMBER

101

%

MainStay VP S&P 500 Index (High)

105

%

301 131 132

% % %

124 116 112

% % %

18-Month DCA Advantage Plan(2) MainStay VP Balanced – Service Class (Moderate) MainStay VP Bond (Moderate) MainStay VP Cash Management (Low) MainStay VP Common Stock (High) MainStay VP Conservative Allocation – Service Class (Moderate) MainStay VP Convertible (Moderate) MainStay VP Floating Rate – Service Class (Moderate) MainStay VP Government (Moderate) MainStay VP Growth Allocation – Service Class (High)

133

%

MainStay VP U.S. Small Cap (High) Alger Small Cap Growth Portfolio (Highest)(3) Calvert VP SRI Balanced Portfolio (Moderate)(5) Columbia Small Cap Value Fund, Variable Series (Class B Shares) (High)

140

%

145 107 102 108

% % % %

Dreyfus IP Technology Growth (Highest) Fidelity® VIP Contrafund® (High) Fidelity® VIP Equity-Income (High) Fidelity® VIP Mid Cap – Service Class 2 (High)

138 115 113 139

% % % %

148 119

% %

Janus Aspen Balanced Portfolio (Moderate) Janus Aspen Worldwide Portfolio (High)

114 117

% %

144 103

% %

MFS® Investors Trust Series (High) MFS® Research Series (High)

125 126

% %

151

%

143

%

MainStay VP Growth Equity (High)

104

%

MFS® Utilities Series – Service Class (Moderate) Neuberger Berman AMT Mid- Cap Growth Portfolio – Class S (High)

142

%

110

%

155

%

121

%

146

%

MainStay VP Income Builder (Moderate)

106

%

147

%

MainStay VP International Equity (High)

109

%

123

%

MainStay VP Large Cap Growth (High)

122

MainStay VP High Yield Corporate Bond (Moderate) MainStay VP ICAP Select Equity – Service Class (Moderate)

______

%

PIMCO Real Return Portfolio – Advisor Class (Moderate)( (8) Royce Micro-Cap Portfolio – Investment Class (High) Royce Small-Cap Portfolio – Investment Class (High) T. Rowe Price Equity Income Portfolio (Moderate) UIF Emerging Markets Equity Portfolio (Highest) (6)

118 ______ %

Allocation Alternative Listing for Transfers continued on next page. Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC, and offered through properly licensed registered representatives.

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NAME(1)

NUMBER

MainStay VP Mid Cap Core (High) MainStay VP Moderate Allocation – Service Class (Moderate) MainStay VP Moderate Growth Allocation – Service Class (Moderate)

NAME(1)

136

%

149

%

150

%

NUMBER

Van Eck VIP Global Hard Assets (High)(7) Victory VIF Diversified Stock (Class A Shares) (High)

127

%

141

%

TOTAL

%

(1) Investment Divisions offered in various policies differ. Please refer to your product prospectus for a list of the corresponding Investment Divisions available to you. (2) These funds apply to New York Life Variable Annuity and New York Life Essentials Variable Annuity policies. Only the 6-Month DCA Advantage Plan Account is available for New York Life Premium Plus, New York Life Elite, New York Life Premium Plus Elite, New York Life Longevity Benefit, New York Life Premier and New York Life Premier Plus Variable Annuity policies. Only the 6 and 12 month DCA Advantage Plan Accounts are available for New York Life Select Variable Annuity policies. If part of your allocation change includes any of these accounts, please also complete Form 22156. (3) Premiums or transfers will not be accepted into this Investment Division on or after 6/1/2007 if you did not have Accumulation Value in this Investment Division prior to 6/1/2007. If you remove all Accumulation Value from this Investment Division on or after 6/1/2007, you will not be allowed to reinvest in this Investment Division. (4) This Fixed Account option is not available for New York Life Premier and New York Life Premier Plus Variable Annuity Policies sold in New York. (5) Formerly CVS Calvert Social Balanced. (6) Formerly Van Kampen’s UIF Emerging Markets Equity. (7) Formerly Van Eck Worldwide Hard Assets. (8) This Investment Division is not available for New York Life Select and New York Life Longevity Benefit Variable Annuity policies.

SECTION B

TRANSFERS (Only Affects Payments Already Made)

I request that the amount(s) indicated below be transferred from and to the Investment Division(s), the Fixed Account(s) and/or the DCA Advantage Plan Account. I understand that the minimum amount that may be transferred is the lesser of $500 or the entire value of the Investment Division(s) and/or DCA Advantage Plan Account(s) plus the Fixed Account(s) from which the transfer is being made. If after a transfer, less than $500 remains in any Investment Division(s), DCA Advantage Account(s) or the Fixed Account(s), the remaining balance will be transferred in the same proportion as the original transfer amount. Depending upon the New York Life Variable Annuity purchased, there may be limits on the amount that can be transferred from the Fixed Account(s) to the Investment Divisions during a policy year. Transfers to the Fixed Account are not permitted if you transferred money from the Fixed Account during the last six months, unless the transfer was part of a Dollar Cost Averaging or Interest Sweep program. Transfers to the DCA Advantage Plan Accounts and Fixed Account - 3 Year Guarantee are not permitted. For New York Life Elite, New York Life Premium Plus Elite, New York Life Longevity Benefit and Premium based M& E charge New York Life Premier and New York Life Premier Plus Variable Annuities transfer(s) from the Investment Division(s) and the 6-Month DCA Advantage Plan Account are not permitted into the Fixed Account at any time. For New York Life Elite only interest earned in the Fixed Account is allowed to be transferred to the Investment Division(s). For New York Life Premium Plus Elite and Premium based New York Life Premier and New York Life Premier Plus Variable Annuity policies the sum of all transfers from the Fixed Account, including the Interest Sweep Option transfers, in a policy year may not be greater than 20% (New York Life Premium Plus Elite) or 25%(New York Life Premier and Premier Plus) of the Fixed Account Accumulation Value as of the beginning of each policy year and any transfer(s) into the Investment Divisions from the Fixed Account that includes more than interest earned will be subject to the Mortality and Expense Charge. For New York Life Access and Complete Access Variable Annuity policies issued on or after November 15, 2004, transfers from the Variable Investment Divisions into the Fixed Account may be limited to a maximum $5,000 during the policy year. Please read the product prospectus for further details. Any changes to your allocations may not result in the Accumulation Value being allocated to more than 18 Investment Divisions and/or DCA Advantage Plan Account(s) plus the Fixed Account(s). If you indicate percentages, please use whole numbers. The total of all funds in the “Transfers To” column must equal 100%. If you indicate specific dollar amounts, please use whole numbers. The total dollar amounts in the “Transfers From” column must equal the total dollar amounts in the “Transfers To” column. Risk classifications are provided in the parentheses after the Investment Division. Risk classifications are determined on the basis of the Lipper Category assigned to the Investment Division by Lipper Analytics as of December 31, 2009. Lipper is a widely used independent research firm, which ranks mutual funds and other investment companies by overall performance, investment objectives and assets.

TRANSFERS FROM: NAME(1)

NUMBER

Fixed Account – 1 Year Guarantee (Transfers

of interest only for New York Life Elite Variable Annuity policies)(4) Fixed Account – 3 Year Guarantee (New York Life Essentials VA- Only)

6 – Month DCA Advantage Plan(2)

TRANSFERS TO: NAME(1)

NUMBER

Fixed Account – 1 Year Guarantee 101

$_____ or _____%

301

$_____ or _____%

131

$_____ or _____%

(Transfers of interest only for New York Life Elite Variable Annuity policies) (4)

101

$ _____ or _____%

Allocation Alternative Listing for Transfers continued on next page. Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC, and offered through properly licensed registered representatives.

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TRANSFERS FROM: NAME(1)

NUMBER

12 – Month DCA Advantage Plan(2)

132

$_____ or _____%

18 – Month DCA Advantage Plan(2) MainStay VP Balanced – Service Class (Moderate)

133

$_____ or _____%

145

$_____ or _____%

MainStay VP Balanced – Service Class (Moderate)

145

$ _____ or _____%

MainStay VP Bond (Moderate) MainStay VP Cash Management (Low)

107 102

$_____ or _____% $ _____or _____%

MainStay VP Bond (Moderate) MainStay VP Cash Management (Low)

107 102

$ _____ or _____% $ _____or _____%

MainStay VP Common Stock (High) MainStay VP Conservative Allocation – Service Class (Moderate) MainStay VP Convertible (Moderate) MainStay VP Floating Rate – Service Class (Moderate) MainStay VP Government (Moderate) MainStay VP Growth Allocation – Service Class (High)

108

$_____ or _____%

108

$ _____or _____%

148 119

$ _____or _____% $ _____or _____%

148 119

$ _____or _____% $ _____or _____%

144 103

$ _____or _____% $ _____or _____%

144 103

$ _____or _____% $ _____or _____%

151

$ _____or _____%

MainStay VP Common Stock (High) MainStay VP Conservative Allocation – Service Class (Moderate) MainStay VP Convertible (Moderate) MainStay VP Floating Rate – Service Class (Moderate) MainStay VP Government (Moderate) MainStay VP Growth Allocation – Service Class (High)

151

$ _____or _____%

104

$ _____or _____%

104

$ _____or _____%

110

$ _____or _____%

110

$ _____or _____%

121 106

$ _____or _____% $ _____or _____%

MainStay VP Growth Equity (High) MainStay VP High Yield Corporate Bond (Moderate) MainStay VP ICAP Select Equity – Service Class (Moderate) MainStay VP Income Builder (Moderate)

121 106

$ _____or _____% $ _____or _____%

MainStay VP International Equity (High)

109

$ _____or _____%

MainStay VP International Equity (High)

109

$ _____or _____%

MainStay VP Large Cap Growth (High)

122

$ _____or _____%

MainStay VP Large Cap Growth (High)

122

$ _____or _____%

MainStay VP Mid Cap Core (High) MainStay VP Moderate Allocation – Service Class (Moderate) MainStay VP Moderate Growth Allocation – Service Class (Moderate)

136

$ _____or _____%

136

$ _____or _____%

149

$ _____or _____%

149

$ _____or _____%

150

$ _____or _____%

MainStay VP Mid Cap Core (High) MainStay VP Moderate Allocation – Service Class (Moderate) MainStay VP Moderate Growth Allocation – Service Class (Moderate)

150

$ _____or _____%

MainStay VP S&P 500 Index (High)

105

$ _____or _____%

MainStay VP S&P 500 Index (High)

105

$ _____or _____%

MainStay VP U.S. Small Cap (High) Alger Small Cap Growth Portfolio (Highest)(3) Calvert VP SRI Balanced Portfolio (Moderate)(5) Columbia Small Cap Value Fund,Variable Series (Class B Shares) (High) Dreyfus IP Technology Growth (Highest)

124

$ _____or _____%

124

$ _____or _____%

116

$ _____or _____%

116

$ _____or _____%

112

$ _____ or _____%

112

$ _____ or _____%

140 138

$ _____ or _____% $ _____ or _____%

MainStay VP U.S. Small Cap (High) Alger Small Cap Growth Portfolio (Highest)(3) Calvert VP SRI Balanced Portfolio (Moderate)(5) Columbia Small Cap Value Fund,Variable Series (Class B Shares) (High) Dreyfus IP Technology Growth (Highest)

140 138

$ _____ or _____% $ _____ or _____%

Fidelity® VIP Contrafund® (High)

115

$ _____ or _____%

Fidelity® VIP Contrafund® (High)

115

$ _____ or _____%

Fidelity® VIP Equity-Income (High) Fidelity® VIP Mid Cap – Service Class 2 (High)

113

$ _____ or _____%

113

$ _____ or _____%

139

$ _____ or _____%

Fidelity® VIP Equity-Income (High) Fidelity® VIP Mid Cap – Service Class 2 (High)

139

$ _____ or _____%

MainStay VP Growth Equity (High) MainStay VP High Yield Corporate Bond (Moderate) MainStay VP ICAP Select Equity – Service Class (Moderate) MainStay VP Income Builder (Moderate)

TRANSFERS TO: NAME(1)

NUMBER

Allocation Alternative Listing for Transfers continued on next page. Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC, and offered through properly licensed registered representatives.

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TRANSFERS FROM: NAME(1) Janus Aspen Balanced Portfolio (Moderate) Janus Aspen Worldwide Portfolio (High) MFS®

Investors Trust Series (High)

MFS®

Research Series (High) MFS® Utilities Series – Service Class (Moderate) Neuberger Berman AMT Mid- Cap Growth Portfolio–Class S (High) PIMCO Real Return Portfolio – Advisor Class (Moderate)(8) Royce Micro-Cap Portfolio – Investment Class (High) Royce Small-Cap Portfolio – Investment Class (High) T. Rowe Price Equity Income Portfolio (Moderate) UIF Emerging Markets Equity Portfolio (Highest)(6) Van Eck VIP Global Hard Assets (High)(7) Victory VIF Diversified Stock (Class A Shares) (High)

NUMBER

TRANSFERS TO: NAME(1)

114

$ _____ or _____%

117

$ _____ or _____%

Janus Aspen Balanced Portfolio (Moderate) Janus Aspen Worldwide Portfolio (High)

$ _____ or _____%

MFS®

126

$ _____ or _____%

MFS®

143

$ _____ or _____%

142

$ _____ or _____%

155

$ _____ or _____%

146

$ _____ or _____%

147

$ _____ or _____%

123

$ _____ or _____%

118

$ _____ or _____%

127

$ _____ or _____%

141

$ _____ or _____%

125

Investors Trust Series (High)

Research Series (High) MFS® Utilities Series – Service Class (Moderate) Neuberger Berman AMT Mid- Cap Growth Portfolio–Class S (High) PIMCO Real Return Portfolio – Advisor Class (Moderate)(8) Royce Micro-Cap Portfolio – Investment Class (High) Royce Small-Cap Portfolio - Investment Class (High) T. Rowe Price Equity Income Portfolio (Moderate) UIF Emerging Markets Equity Portfolio (Highest)(6) Van Eck VIP Global Hard Assets (High)(7) Victory VIF Diversified Stock (Class A Shares) (High)

NUMBER 114

$ _____ or _____%

117

$ _____ or _____%

125

$ _____ or _____%

126

$ _____ or _____%

143

$ _____ or _____%

142

$ _____ or _____%

155

$ _____ or _____%

146

$ _____ or _____%

147

$ _____ or _____%

123

$ _____ or _____%

118

$ _____ or _____%

127

$ _____ or _____%

141

$ _____ or _____%

TOTAL $___________ or ___________% (1) Investment Divisions offered in various policies differ. Please refer to your product prospectus for a list of the corresponding Investment Divisions available to you.

(2) These funds apply only to New York Life Variable Annuity and New York Life Essentials Variable Annuity policies. Only the 6-Month DCA Advantage plan account is available for New York Life Premium Plus, New York Life Elite, New York Life Premium Plus Elite, New York Life Longevity Benefit, New York Life Premier and New York Life Premier Plus Variable Annuity policies. Only the 6 and 12 month DCA Advantage Plan Accounts are available for New York Life Select Variable Annuity policies. (3) Premiums or transfers will not be accepted into this Investment Division on or after 6/1/2007 if you did not have Accumulation Value in this Investment Division prior to 6/1/2007. If you remove all Accumulation Value from this Investment Division on or after 6/1/2007, you will not be allowed to reinvest in this Investment Division.

(4)This Fixed Account option is not available for New York Life Premier and New York Life Premier Plus Variable Annuity Policies sold in New York. (5) Formerly CVS Calvert Social Balanced. (6) Formerly Van Kampen’s UIF Emerging Markets Equity. (7) Formerly Van Eck Worldwide Hard Assets. (8) This Investment Division is not available for New York Life Select and New York Life Longevity Benefit Variable Annuity policies. Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC, and offered through properly licensed registered representatives.

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SECTION C

FOR FULL REALLOCATION OF EXISTING FUNDS ONLY:

I request to reallocate 100% of the funds in my account and specified the allocation alternatives and percentages below. The total of all choices must equal 100%. I understand a reallocation is a redistribution of 100% of existing funds and only impacts funds currently in my policy. Anything less than 100% reallocation of the funds in my account will be considered a transfer. Future premium payments are not affected by this reallocation (Please Note: to request a change to how future payments are allocated, please complete Section A). Depending upon the New York Life Variable Annuity purchased, there may be limits on the amount that can be reallocated from the Fixed Account(s) to the Investment Divisions during a policy year. Reallocation of existing funds to the Fixed Account is not permitted if you transferred money from the Fixed Account during the last six months, unless the transfer was part of a Dollar Cost Averaging or Interest Sweep program. The 3-Year Fixed account (New York Life Essentials VA only) and the DCA Advantage Plans are not included in a reallocation of existing funds. If funds are currently invested in the 3-Year Fixed Account and/or the DCA Advantage Plans, the reallocation will be processed excluding the amounts in these options. A reallocation of funds may include the 1-Year Fixed Account, but the resulting reallocation must not violate the Fixed Account transfer rules. For New York Life Elite, New York Life Premium Plus Elite, New York Life Longevity Benefit and Premium based M&E charge New York Life Premier and New York Life Premier Plus Variable Annuities transfer(s) from the Variable Investment Division(s) are not permitted into the Fixed Account at any time. For New York Life Access and Complete Access Variable Annuity policies issued on or after November 15, 2004, transfers from the Variable Investment Divisions into the Fixed Account may be limited to a maximum of $5,000 during the policy year. Additionally, if there is an outstanding loan on my policy, the reallocation will be processed excluding money being held in collateral for that loan. Following reallocation, I would like my account to appear as indicated below:

NAME(1)

NUMBER

NAME(1)

NUMBER

Fixed Account – 1 Year Guarantee(3) MainStay VP Balanced – Service Class (Moderate)

101

%

Alger Small Cap Growth Portfolio (Highest)(2)

116

%

145

%

112

%

MainStay VP Bond (Moderate)

107

%

Calvert VP SRI Balanced Portfolio (Moderate)(4) Columbia Small Cap Value Fund, Variable Series (Class B Shares) (High)

MainStay VP Cash Management (Low)

102

%

Dreyfus IP Technology Growth (Highest)

138

%

MainStay VP Common Stock (High) MainStay VP Conservative Allocation – Service Class (Moderate)

108

%

Fidelity® VIP Contrafund® (High)

115

%

148

%

Fidelity® VIP Equity-Income (High)

113

%

119

%

Fidelity®

139

%

144

%

Janus Aspen Balanced Portfolio (Moderate)

114

%

103

%

Janus Aspen Worldwide Portfolio (High)

117

%

151

%

MFS® Investors Trust Series (High)

125

%

MainStay VP Convertible (Moderate) MainStay VP Floating Rate – Service Class (Moderate) MainStay VP Government (Moderate) MainStay VP Growth Allocation – Service Class (High)

VIP Mid Cap – Service Class 2 (High)

140

%

MainStay VP Growth Equity (High) MainStay VP High Yield Corporate Bond (Moderate) MainStay VP ICAP Select Equity – Service Class (Moderate)

104

%

MFS® Research Series (High)

126

%

110

%

143

%

121

%

142

%

MainStay VP Income Builder (Moderate) MainStay VP International Equity (High)

106 109

% %

MFS® Utilities Series – Service Class (Moderate) Neuberger Berman AMT Mid- Cap Growth Portfolio – Class S (High) PIMCO Real Return Portfolio – Advisor Class (Moderate) (7) Royce Micro-Cap Portfolio – Investment Class (High)

155 146

% %

MainStay VP Large Cap Growth (High)

122

%

Royce Small-Cap Portfolio – Investment Class (High)

147

%

MainStay VP Mid Cap Core (High) MainStay VP Moderate Allocation – Service Class (Moderate)

136

%

T. Rowe Price Equity Income Portfolio (Moderate)

123

%

149

%

UIF Emerging Markets Equity Portfolio (Highest)(5)

118

%

Allocation Alternative Listing continued on next page. Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC, and offered through properly licensed registered representatives.

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NAME(1)

NUMBER

NAME(1)

NUMBER

MainStay VP Moderate Growth Allocation – Service Class (Moderate)

150

%

Van Eck VIP Global Hard Assets (High)(6)

127

%

MainStay VP S&P 500 Index (High)

105

%

Victory VIF Diversified Stock (Class A Shares) (High)

141

%

MainStay VP U.S. Small Cap (High)

124

%

TOTAL

%

(1) Investment Divisions offered in various policies differ. Please refer to your product prospectus for a list of the corresponding Investment Divisions available to you. (2) Premiums or transfers will not be accepted into this Investment Division on or after 6/1/2007 if you did not have Accumulation Value in this Investment Division prior to 6/1/2007. If you remove all Accumulation Value from this Investment Division on or after 6/1/2007, you will not be allowed to reinvest in this Investment Division. (3) This Fixed Account option is not available for New York Life Premier and New York Life Premier Plus Variable Annuity Policies sold in New York. (4) Formerly CVS Calvert Social Balanced. (5) Formerly Van Kampen’s UIF Emerging Markets Equity. (6) Formerly Van Eck Worldwide Hard Assets. (7) This Investment Division is not available for New York Life Select and New York Life Longevity Benefit Variable Annuity policies. Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC, and offered through properly licensed registered representatives.

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SECTION D

AUTHORIZATION AND SIGNATURES

I, the policyowner, understand and agree that:

• The effective date of this request will be the date it is received in the Variable Products Service Center of New York Life Insurance and Annuity Corporation, completed with all required information for processing. See the instructions on page 1 for this address. Please confirm your current address below:

_________________________________________________ _________________________________________________ _________________________________________________

1.) Policyowner(s) Signature X _____________________________________________________ Date ___________________ 2.) Assignee or X_______________________________________________________________ Date ___________________ Other Required Signature Policyowner(s) phone number (9am - 5pm eastern time) (

)____________________________________________

If the indicated policy is corporate-owned, provide signatures and titles of two corporate officers.

3.) Signature of Officer X _________________________________________________________ Date ____________________ Print Name of Officer X ________________________________________________________ Officer’s Title ________________________________________________________________ 4.) Signature of Officer X _________________________________________________________ Date ____________________ Print Name of Officer X ________________________________________________________ Officer’s Title ________________________________________________________________ Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC, and offered through properly licensed registered representatives. NYLIFE Distributors and NYLIAC are wholly owned subsidiaries of New York Life Insurance Company.

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