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INDEXED UNIVERSAL LIFE - ELECTION WORKSHEET

Owner Name (if other than Insured)

Policy/File Code Number Owner Daytime Phone ( )

B. TERMS AND CONDITIONS

• The Election Date is the 28th day of each month or the next day that the New York Stock Exchange is open for trading. Instructions and payments must be received by the close of business at least three business days prior to the next Election Date in order to be processed on the next Election Date.

• The minimum Election amount is $50 or 1% of the account value of the source strategy (use whole percentages). The source strategy is defined as the strategy from which the funds are deducted when the Election occurs.

• If the balance in the source strategy is less than the requested Election amount, 100% of the available balance in the source strategy will be moved.• You must request your initial Election in writing. Subsequent requests can be submitted in writing or made by telephone by you, your agent or his/her

assistant if you have chosen telephone privileges. You may choose or revoke telephone privileges by contacting Customer Service.• Elections from the Fixed Strategy to the Indexed Strategy may be restricted if a policy loan or withdrawal results in amounts being subtracted from the

Indexed Strategy. Check your policy for details.

A. POLICY INFORMATION

Use this form to make a net premium Election, single Election, Ongoing Election or to terminate an existing Election for indexed universal life insurance policies.

ReliaStar Life Insurance Company of New York, Woodbury, NYSecurity Life of Denver Insurance CompanyMembers of the Voya® family of companies(the “Company”)Customer Service: 2000 21st Ave. NW, Minot, ND 58703Fax: 877-788-6305; Website: voya.com; Completed forms can be emailed to: liferequest@voya.com

C. DO YOU WANT TO ALLOCATE YOUR NET PREMIUM PAYMENT? (If you already have a net premium Election scheduled, we will not change it unless requested.)

Yes, allocate my net premium each time I pay a premium.

a. % Indexed Strategyb. % remain in the Fixed Strategy

The sum of a & bmust total 100%.

On the next Election Date, I want my net premium moved to the following strategies (use whole percentages):

D. DO YOU WANT TO MOVE MONEY ON A ONE-TIME BASIS?

1. Single Election to the Indexed Strategy: This one-time request will only be valid on the next eligible Election Date and must be received by the close of business 3 business days prior to the Election Date.

$ or % to the Indexed StrategyTotal must be equal to or less than

100% of the Fixed Strategy

I wish to move money from the Fixed Strategy to the Indexed Strategy one time (use whole percentages):

2. Block Maturity Single Election from the Indexed Strategy: This one-time request will only be valid for the next Block Maturity date and must be received by the close of business 3 business days prior, but no more than 30 days in advance, to the block maturity date. This Election is ONLY available after the block matures.

I wish to move money from the next matured block into the Fixed Strategy one time (use whole percentages):

TOTAL: % from the block maturing in the Indexed Strategy to the Fixed Strategy

Insured Name (First) (Middle Initial) (Last)

Only one single Election may be chosen; complete Option 1 or 2 below.

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By signing this form, you acknowledge that you have read and understand the Terms and Conditions of this form. You can cancel or change any Elections

requested by notifying Customer Service as provided above.

H. ACKNOWLEDGEMENT

Owner Signature Date

F. TERMINATE ONGOING ELECTION (Only complete this section if you no longer wish to have any Ongoing Elections for your policy. If so, select an option below and provide the necessary information.)

Terminate the Ongoing Election after my Election. (Provide the month and year.)

Terminate my Ongoing Election immediately. (initial here)

I understand that I may indicate below whether to allow telephone privileges to be provided to me and/or my agent/registered representative and his/her

assistant. Telephone privileges allow an authorized person to call the Company to make certain Elections and request certain transactions. The Company

may use procedures to ensure instructions received by telephone are genuine, such as requiring forms of personal identification and tape recording phone

calls. By accepting telephone privileges, I authorize the Company to record my telephone calls to the Company. The Company and its distributor will not be

liable for any loss, damage, costs or expenses incurred in acting on telephone instructions reasonably believed to be genuine.

I understand that if I do not want to authorize telephone privileges, I should not check either of the two boxes below. I also understand that once granted,

such privileges will only be revoked upon receipt by the Company of signed, written instructions to terminate telephone privileges.

I want telephone privileges.

I want telephone privileges granted to my agent/registered representative and his/her assistant.

G. TELEPHONE PRIVILEGES

E. DO YOU WANT TO MOVE MONEY ON AN ONGOING BASIS BETWEEN STRATEGIES?

1. Ongoing Election from Fixed Strategy to the Indexed Strategy (Note: If there is no money left in the Fixed Strategy, the Ongoing Election will NOT

process until funds are available again in the Fixed Strategy. For example, if you utilize Net Premium Elections (Section C), there may no longer be funds

in the Fixed Strategy for Ongoing Elections to occur.)

a. Election Frequency: Monthly Quarterly Semi-annually Annually

b. Total Amount from the Fixed Strategy to the Indexed Strategy $ or %

a. On each Block Maturity date, I wish to elect: % from the Indexed Strategy to the Fixed Strategy.

2. Block Maturity Ongoing Elections to the Fixed Strategy

Only one Ongoing Election may be chosen; complete Option 1 or 2 below.

INDEXED UNIVERSAL LIFE - ELECTION WORKSHEET DEFINITIONS

Net Premium - Your premium payment minus the premium expense charge. The net premium is automatically allocated to the Fixed Strategy.

Net Premium Election - When your premium is paid, you choose to elect some or all of your net premium payment to be moved from the Fixed Strategy to the Indexed Strategy on the next Election Date.

Single Election to the Indexed Strategy - A one-time request to move money from the Fixed Strategy to the Indexed Strategy. The total amount elected must be equal to or less than 100% of the Fixed Strategy.Block Maturity - Each Indexed Strategy block matures at the end of the index crediting period. By default, a new block is created in the same indexed strategy.Block Maturity Single Election from the Indexed Strategy - A one-time request for a percentage to be moved from the next matured block into the Fixed Strategy and the Indexed Strategy or a combination of both strategies.Ongoing Election - When a fixed percentage or dollar amount is automatically allocated to the Indexed Strategy or the Fixed Strategy. It can occur annually, semi-annually, quarterly or monthly based on your choice. Your Ongoing Election will continue unless you notify Customer Service that you would like to change or terminate your Ongoing Election. When an Ongoing Election is chosen, any previous Ongoing Election is terminated.Block Maturity Ongoing Election - When a percentage of the maturity block is moved to the Fixed Strategy. Only one Index Strategy can be elected at a time. Elections will occur at each Block Maturity date. No Elections will occur from any block that has not yet reached its maturity date.

INDEXED UNIVERSAL LIFE: ELECTION OPTIONS AVAILABLE

Net Premium Election – each

time you pay your premium

Money goes into the

Fixed Strategy

Money remains in Fixed Strategy or moves to

Indexed Strategy?

Fixed Strategy

Indexed Strategy

Upon payment of premium (Complete Section C on the Election Worksheet)

Ongoing Election –automatically allocate money to the Indexed

or Fixed Strategy

Money from the Fixed Strategy

Indexed Strategy

OR

Block Maturity Ongoing Election -request to move money from the matured Indexed

Strategy Block

Matured Block

(Indexed Strategy)

Yes

No

Single Election -one time request to move money from

the Fixed to the Indexed Strategy

Money from the Fixed Strategy

Indexed Strategy

OR

Block Maturity Single Election -one time request to move money from the next matured block

Matured Block (Indexed Strategy)

Fixed Strategy

One-time request (Complete Section D on the Election Worksheet)

Ongoing requests (Annually, semi-annually, quarterly or monthly)(Complete Section E on the Election Worksheet)

Fixed Strategy

A new block in the Indexed Strategy will start.

Move from Indexed Strategy?

Moves

Appendix A Order #140532 06/27/2019

Appendix B - Page 1 of 2 Order #140532 06/27/2019

INDEXED UNIVERSAL LIFE - AGENT TUTORIAL FOR ONGOING ELECTIONS (Helpful tips in how to calculate a dollar amount for Ongoing Elections.)

An illustration is a valuable tool in calculating the dollar amount for Ongoing Elections. When setting up ongoing index allocations, you have the choice of using a dollar amount or a percentage.

When a percentage is used, index blocks are uneven due to fluctuations in the fixed account value. The fixed account value changes as policy costs are deducted, interest is credited and new premium payments are submitted. Calculating a dollar amount for the Ongoing Elections will provide more uniformity between the index blocks, despite not giving perfectly even blocks.

To calculate the dollar amount effectively, follow these steps when running your illustration in the sales software: 1. Select the Cost Breakdown Pages. 2. You can select the Cost Breakdown Pages by going to Report Options and selecting it under the Illustration heading (see the red box below).

If the funds are left strictly in the fixed account, the interest amount calculated by the illustration software will be too high since the entire amount minus policy costs would get credited the fixed account interest rate for the full year.

If the funds are strictly placed in the indexed account, no interest will be calculated for the time that the premiums are sitting in the fixed account resulting in funds being left in the fixed account at the end of the year.

3. Select Redistribute between Strategies under Illustration

details (in order to get the interest to calculate as closely as

possible for the current year)

4. Fill out the Illustration Details as follows:

• Strategy Elections: 100% Fixed

• Redistribute between Strategies

• Index Strategy: Whichever option matches the strategy

you are planning on using.

• Frequency: Monthly

• Percentage: 10%

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INDEXED UNIVERSAL LIFE - AGENT TUTORIAL FOR ONGOING ELECTIONS (Continued)

5. Run the illustration and go to the Annual Breakdown Based on Current Costs pages.

6. To calculate the approximate monthly allocation use the following formula:

(Payments – Premium Expense Charge – Monthly Expense Charge – Cost of Insurance + Interest Earned) / Number of Blocks = Election Amount

During the first year, the number of blocks used is going to be dependent on whether or not the policy is backdated. If the policy is current dated, we would use 11 monthly index blocks (12 months – free look period). If the policy is backdated, we would need to reduce the number of blocks by the number of months backdated.

Note: Due to the decrease in the premium expense charge after the first year, you will probably want to recalculate the allocation amount at the beginning of year two. If the policy is backdated, you will also want to recalculate the allocation amount at the beginning of year two. If the allocation amount changes, you will need to submit a new Election Worksheet.

Example:

$12,987 (Payments) - $1,299 (Premium Expense Charge) – $7,123 (Monthly Expense Charge) - $1,071 (Cost of Insurance) + $508 (Interest Earned) / 11 (Number of Blocks)

$4,002 / 11 months = $363.81

Based on this example, you would want an Ongoing Election of approximately $364.00 a month.

These figures are the amounts you will want to indicate in the Election Worksheet, Section titled: DO YOU WANT TO MOVE MONEY ON AN ONGOING BASIS BETWEEN STRATEGIES?