MassMutual Transitions SelectSM Additional Payment Remittance MassMutual Overnight Address: Annuity Payment Services MassMutual PO Box 74908 8th Floor-Suite 4908 , IL 60675-4908 Receipt and Dispatch Questions: (800) 272-2216 350 North Orleans Street Use this form to submit an additional payment for Email Address: Chicago, IL 60654 IRA and Non-Qualified contracts only. [email protected]

Complete Form FR3002 for Transitions Select to change your participation in the Asset Allocation Program, which will affect funds currently held in investment options in addition to future contributions.

I. Owner/Annuitant Information Contract Number Annuitant Date

Owner Name (Please Print) Joint Owner Name (if applicable)

II. Remittance Please complete and return the entire form with your payment to To change investment allocations, use whole numbers only. the address above. Make the check payable to MassMutual. If Allocations must add up to 100%. Signature(s) are required this is an IRA contribution, please indicate the tax year. If a tax below for allocation changes. yea r is not specified a t the time of remittance, MassMutual will default to the current year. Contact your tax advisor regarding  Cha nge investment a llocations for this payment only. (Not contribution limits. a pplicable for Custom Alloca tion Choice) Pa yment Tax Amount: $ Year:  Cha nge investment allocations for this a nd a ll future pa yments. If the contribution is a rollover, indicate date the rollover distribution was received by the applicant from the financial institution:

III. Signature(s) Signature(s) are required for allocation changes. ______Owner/Assignee Signature Date

______Joint Owner Signature (if applicable) Date

IV. Allocation Changes for Enclosed or Future Payments Unless you are invested in the Custom Allocation Choice, changing allocations will not a ffect funds currently held in the investment options. If no a llocations are selected, the payment will be invested based on existing allocations. Some investment options may not be a vailable in a ll states. Signature(s) a re required for allocation changes. If participating in a n Asset Allocation Model, a ny payments ma de outside of the model, excluding payments made to the fixed account, will be a utomatically rebalanced the next calendar quarter, or your chosen frequency if you are invested in the Custom Allocation Choice, in a ccordance with the Asset Allocation Model chosen. If you wish to transfer funds among the investment choices use form FR3000, call the Service Center, or visit our Web site a t www.ma ssmutual.com/asc. Please use form FR3001 if you wish to a llocate a payment to the DCA Fixed Account.

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 Boulevard, Enfield, 06082-1981. Pa ge 1 of 2 F9303 0821 Custom Allocation Guidelines  If you a re allocating funds a ccording to the Custom Allocation Choice, please select funds a ccording to the following a sset class minimums and maximums:  No more than 25% may be allocated to any one fund.  If no a llocations a re selected, the payment will be invested based on existing allocations.  Custom Allocation Choice may not be a vaila ble in a ll sta tes.

Asset Small/ Small/ Class Balanced & Large Large Cap Blend & Mid Cap Value Mid Cap Blend International/ Specialty A Specialty B Cap Value Funds Growth Funds Funds & Growth Funds Global Funds Funds Funds Range 15% to 25% 15% to 25% 0% to 10% 0% to 10% 5% to 20% 0% to 5% 0% to 5%

Fixed Income Funds Fixed Income Funds Asset Contracts Issued ON or BEFORE March 31, 2009 Contracts Issued ON or AFTER April 1, 2009 Class If 6% GMIB or GMWB is If 6% GMIB or GMWB If GMAB, GMIB, or GMWB is If GMAB, GMIB, or GMWB elected. is NOT elected. elected. is NOT elected. Range 20% to 65% 0% to 65% 35% to 65% 0% to 65%

New Investment Options: Asset Allocation Balanced & Large Cap Value International/Global _____% 585 MML Aggressive Allocation _____% 536 MML Blend Allocation _____% 588 MML American Funds® _____% 587 MML American Funds® Core _____% 539 MML Equity International Allocation Fund _____% 557 MML Equity Income _____% 559 MML Foreign _____% 582 MML Balanced Allocation _____% 520 MML Fundamental Value _____% 533 MML Global _____% 581 MML Conservative Allocation _____% 521 MML Income & Growth _____% 596 MML International Equity

_____% 584 MML Growth Allocation _____% 549 Invesco V.I. Global 7

_____% 583 MML Moderate Allocation Large Cap Blend & Growth _____% 551 Invesco Oppenheimer V.I. _____% 527 Fidelity® VIP Contrafund® International Growth Stable Value _____% 586 MML American Funds® Growth _____% 580 MML U.S. Government _____% 556 MML Blue Chip Growth Specialty A Money Market _____% 540 MML Equity Index _____% 529 Invesco V.I. Health Care _____% 553 Invesco V.I. U.S. _____% 593 MML Focused Equity _____% 530 Invesco V.I. Technology Government Money Portfolio 1, 2 _____% 591 MML Fundamental Equity _____% 519 Delaware Ivy VIP Asset Strategy 8 _____% 513 3 Yr Long Term Guarantee _____% 561 MML Growth & Income _____% 542 MML Managed Volatility _____% 514 5 Yr Long Term Guarantee _____% 526 MML Large Cap Growth _____% 590 MML Strategic Emerging Markets _____% 515 7 Yr Long Term Guarantee _____% 548 Invesco V.I. _____% 579 PIMCO CommodityRealReturn® _____% 516 10 Yr Long Term Guarantee Capital Appreciation 4 Strategy _____% 552 Invesco V.I. Fixed Income Main Street 5 Specialty B _____% 509 Fixed Account Small/Mid Cap Value _____% 528 Invesco V.I. Diversified _____% 599 MML High Yield _____% 522 MML Mid Cap Value Dividend _____% 563 MML Inflation-Protected _____% 595 MML Small Company Value _____% 578 VY® Clarion Global Real Estate and Income _____% 562 MML Small/Mid Cap Value _____% 543 MML Managed Bond Total of all columns must equal 100% _____% 598 MML Short-Duration Bond Small/Mid Cap Blend & Growth _____% 592 MML Total Return Bond _____% 558 MML Mid Cap Growth _____% 555 Invesco V.I. _____% 545 MML Small Cap Equity Global Strategic Income 3 _____% 544 MML Small Cap Growth Equity _____% 547 Invesco V.I Discovery Mid Cap Growth 6 Certain investment choices may not be available in all states. 1 Invesco V.I. U.S. Government Money Portfolio is not available for contracts issued after 1/18/2008 2 Formerly known as Invesco Oppenheimer V.I. Government Money Fund 3 Formerly known as Invesco Oppenheimer V.I. Global Strategic Income Fund 4 Formerly known as Invesco Oppenheimer V.I. Capital Appreciation Fund 5 Formerly known as Invesco Oppenheimer V.I. Main Street Fund® 6 Formerly known as Invesco Oppenheimer V.I. Discovery Mid Cap Growth Fund 7 Formerly known as Invesco Oppenheimer V.I. Global Fund 8 Formerly known as Ivy VIP Asset Strategy

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