Panorama Premier Additional Payment Remittance MassMutual Overnight Address: Annuity Payment Services MassMutual PO Box 74908 Annuity Payment Services , IL 60675-4908 8th Floor-Suite 4908 Questions: (800) 272-2216 Receipt and Dispatch Use this form to submit an additional payment for Email Address: 350 North Orleans Street

IRA and Non-Qualified contracts only. [email protected] Chicago, IL 60654 I. Owner/Annuitant Information Contract/Certificate Number Annuitant Date

Owner/Participant Name (Please Print) Joint Owner Name (If Applicable)

II. Remittance Please complete and return the entire form with your payment to the To change investment allocations, use whole numbers only. address above. Make the check payable to MassMutual. If this is an IRA Allocations must add up to 100%. Signature(s) are required below contribution, please indicate the tax year. If a tax year is not specified at the for allocation changes. time of remittance, MassMutual will default to the current year. Contact  Change investment allocations for this payment only. your tax advisor regarding contribution limits.  Change investment allocations for this and all future payments. Payment $ Tax Changing allocations will not affect funds currently held in the Amount: Year: investment choices. If you wish to transfer funds among the If the contribution is a rollover, indicate date the rollover distribution was investment choices use form FR3000, call the Service Center, received by the applicant from the financial institution: or visit our Web site at www.massmutual.com/asc. ______If no allocations are selected, the payment will be invested based on existing allocations. Signature(s) are required below for allocation changes. Please use form FR3001 if you wish to allocate a payment to the DCA Fixed Account. Certain investment choices may not be available in all states. INVESTMENT CHOICE % INVESTMENT CHOICE % Fidelity® VIP Contrafund® (123/178) MML Fundamental Value (221) Invesco V.I. Capital Appreciation 1 (141) MML Global (138) Invesco V.I. Conservative Balanced 2 (147) MML Growth Allocation (196) Invesco V.I. Discovery Mid Cap Growth 3 (140) MML Growth & Income (163) Invesco V.I. Global 4 (142) MML High Yield (209) Invesco V.I. Global Strategic Income 5 (145) MML Income & Growth (124/179) Invesco V.I. U.S. Government Money Portfolio 6 (111/170) MML Inflation-Protected and Income (165) Invesco Oppenheimer V.I. International Growth (119/177) MML Large Cap Growth (135) Invesco V.I. Main Street 7 (144) MML Managed Bond (203) Invesco V.I. Diversified Dividend (153) MML Managed Volatility (152) Invesco V.I. Health Care (154) MML Mid-Cap Growth (125/180) Invesco V.I. Technology (155) MML Mid Cap Value (133) MML Aggressive Allocation (197) MML Moderate Allocation (195) MML Balanced Allocation (194) MML Short-Duration Bond (207) MML Blend (129/184) MML Small Cap Equity (126/181) MML Blue Chip Growth (167) MML Small Cap Growth Equity (132/187) MML Conservative Allocation (193) MML Small/Mid Cap Value (164) MML Equity (128/183) MML Total Return Bond (225) MML Equity Income (166) MML U.S. Government Money Market (192) MML Equity Index (130/185) PIMCO CommodityRealReturn® Strategy (189) MML Focused Equity (227) VY® Clarion Global Real Estate (188) MML Foreign (146) Fixed Account (121/190) MML Fundamental Equity (223) Total 100 % 1 Formerly known as Invesco Oppenheimer V.I. Capital Appreciation Fund. 2 Formerly known as Invesco Oppenheimer V.I. Conservative Balanced Fund. 3 Formerly known as Invesco Oppenheimer V.I. Discovery Mid Cap Growth Fund. 4 Formerly known as Invesco Oppenheimer V.I. Global Fund. 5 Formerly known as Invesco Oppenheimer V.I. Global Strategic Income Fund. 6 Formerly known as Invesco Oppenheimer V.I. Government Money Fund. 7 Formerly known as Invesco Oppenheimer V.I. Main Street Fund®.

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III. Signature(s) Signature(s) are required for allocation changes. ____________Print Owner/Participant Name Owner/Participant Signature Date ____________Print Joint Owner Name (if applicable) Joint Owner Signature (if applicable) Date

Massachusetts Mutual Company (MassMutual), 1295 State Street, Springfield, MA 01111-0001 and its subsidiaries: C.M. Life Insurance Company and MML Bay State Life Insurance Company, 100 Bright Meadow PaBoulevard, ge 2 of Enfield, 2 06082-1981 F9302 0521