ARI Venture.indd - John Hancock Annuities

Asset Rebalancing
Venture®Product Series
Instructions
Use this form to enroll in the Asset Rebalancing Program for your variable annuity contract. Asset Rebalancing reallocates the value
in your annuity on an established schedule so you maintain a predetermined investment mix among the variable investment options held in
your annuity. Therefore, this program is designed for contracts invested in more than one investment option. If you frequently change your
variable investment options, the Asset Rebalancing Program may not be appropriate for you.
This form can be used for the following products: Venture, Venture III, Venture 4, Venture 4 Series, Venture 7 Series, Venture Vantage, and Venture Vision.
A separate form must be completed for requests on any additional contracts.
You may not rebalance to the Guaranteed Interest Account or to the Market Value Adjusted Accounts, if available on your annuity.
This program only rebalances your current portfolio. If you have phone authorization and you would like to change your future allocations, please contact us at the number
listed below. If you don’t have phone authorization, please submit an Investment Option Change form with this request.
• Asset Rebalancing will occur on the 25th day of the month. If the 25th is a non-business day, then it will be rescheduled to the next business day.
• Participation in multiple investment programs may conﬂict with the intended result.
• Please refer to your variable annuity contract and/or prospectus for trade restrictions and limitations.
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1
Information About You
Contract Number:
Owner’s Name:
Date of Birth:
Address:
Owner’s Phone Number:
Co-Owner’s Name:
Date of Birth: ____________________________________________
Address:
Co-Owner's Phone Number: ________________________________
Financial Advisor’s Name:
Financial Advisor’s Phone Number:
2
Program Details (please complete A and B)
A. ACTIONS
B. FREQUENCY
Initiate Program
Change Program
Terminate Program
Quarterly (March, June, September, December) – Circle the month that you would like this program to begin
Semi-annually (June, December) – Circle the month that you would like this program to begin
Annually (December only)
If a frequency is not selected, the default will be quarterly.
When your contract is rebalanced, any ﬁxed investment options in your portfolio are excluded and only your variable portfolio is taken into account. Using the
total value of your variable portfolio as of the rebalancing date, we will automatically rebalance the investments under your contract so that the percentage levels
for the investment options you select below will be maintained. You may change the rebalancing percentages or terminate your participation in the program
by providing John Hancock with a completed Asset Rebalancing Program form or by providing instructions via telephone to an authorized John Hancock
representative prior to the day the rebalancing will occur.
3
Authorization
I (or we) request John Hancock make the changes speciﬁed in sections 2 and 5 of this form to the speciﬁed contract, and I (or we) agree to submit additional
information upon request if such information, in the discretion of John Hancock, is necessary to implement the changes on this form. By signing section 3, I (or we)
authorize John Hancock to interpret my request in order to resolve any ambiguities, inconsistencies or omissions.
SIGN
HERE
Signature of Owner:
Date:
/
/
SIGN
HERE
Signature of Co-Owner:
Date:
/
/
4
Contact Information
National Contracts
John Hancock Annuities Service Center
PO Box 55444
Boston, MA 02205-5444
New York Contracts
John Hancock Annuities Service Center
PO Box 55445
Boston, MA 02205-5445
1-800-824-0335
1-800-551-2078
www.jhannuities.com
www.jhannuitiesny.com
All Contracts
Overnight Deliveries
John Hancock Annuities Service Center
30 Dan Road, STE. 55444
Canton, MA 02021-2809
To Fax This Form:
1-617-663-3160
Issuer: John Hancock Life Insurance Company (U.S.A.) (not licensed in New York)
John Hancock Life Insurance Company of New York, Valhalla, NY
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Asset Rebalancing (continued)
5
Investment Option Selections for All Venture Variable Annuity
Using the lists below, please choose the variable investment options and percentages for your allocation. Allocations can be made to one or any combination of
the available variable investment options. (Please see prospectus for further details.)
SECTION A
Variable investment options available to contracts purchased after June 26, 2011
Investment Options if Guaranteed Minimum
Withdrawal Benefit is elected
_____% Lifestyle Balanced PS (JHAM 1,2)
_____% Lifestyle Conservative PS (JHAM 1,2)
_____% Lifestyle Growth PS (JHAM 1,2)
_____% Lifestyle Moderate PS (JHAM 1,2)
_____% Ultra Short Term Bond (JHAM 1)
Investment Options if NO Guaranteed Minimum Withdrawal Benefit is elected
_____% Lifestyle Growth MVP (JHAM 1,2)
_____% Lifestyle Growth PS (JHAM 1,2)
1,2
)
_____% Lifestyle Moderate MVP (JHAM
_____% Lifestyle Moderate PS (JHAM 1,2)
_____% Ultra Short Term Bond (JHAM 1)
_____% Core Strategy (JHAM 1,2)
_____% Lifestyle Balanced MVP (JHAM 1,2)
_____% Lifestyle Balanced PS (JHAM 1,2)
_____% Lifestyle Conservative MVP (JHAM 1,2)
_____% Lifestyle Conservative PS (JHAM 1,2)
SECTION B
Variable investment options available to contracts purchased without a Guaranteed Minimum Withdrawal Benefit between November 24, 2009
and June 26, 2011, and to contracts purchased with a Guaranteed Minimum Withdrawal Benefit prior to June 26, 2011.
_____% Core Strategy (JHAM 1,2)
_____% Lifestyle Balanced MVP (JHAM 1,2)
_____% Lifestyle Balanced PS (JHAM 1,2)
_____% Lifestyle Conservative MVP (JHAM 1,2)
_____% Lifestyle Conservative PS (JHAM 1,2)
_____% Lifestyle Growth MVP (JHAM 1,2)
_____% Lifestyle Growth PS (JHAM 1,2)
_____% Lifestyle Moderate MVP (JHAM 1,2)
_____% Lifestyle Moderate PS (JHAM 1,2)
_____% Money Market3 (JHAM 2)
_____% Total Bond Market B (Declaration)
_____% Ultra Short Term Bond (JHAM 1)
SECTION C
In addition to Section B, variable investment options also available to contracts purchased without a Guaranteed Minimum Withdrawal Benefit
between May 1, 2006 and November 23, 2009 (between February 12, 2007 and November 23, 2009 for Venture Vision contracts)
_____% American Asset Allocation(Capital Research)
_____% American Global Growth(Capital Research)
_____% American Growth(Capital Research)
_____% American Growth-Income(Capital Research)
_____% American International(Capital Research)
_____% American New World(Capital Research)
_____% Blue Chip Growth (T. Rowe Price)
_____% Bond (JHAM 1)
_____% Capital Appreciation(Jennison)
_____% Capital Appreciation Value (T. Rowe Price)
_____% Equity-Income(T. Rowe Price)
_____% Financial Industries(JHAM 1)
_____% Franklin Templeton Founding Allocation
(JHAM 1)
_____% Global Bond (PIMCO)
_____% Health Sciences (T.Rowe Price)
_____% High Yield (Western Asset)
_____% International Core (GMO)
_____% International Growth Stock (Invesco)
_____% International Small Company (Dimensional)
_____% International Value (Templeton Investment)
_____% Investment Quality Bond (Wellington)
_____% Lifestyle Aggressive MVP (JHAM 1,2)
_____% Lifestyle Aggressive PS (JHAM 1,2)
_____% Mid Cap Index (JHAM 1,2)
_____% Mid Cap Stock (Wellington)
_____% Real Estate Securities (DIMA)
_____% Science & Technology (T. Rowe Price/RCM)
_____% Short Term Government Income (JHAM 1)
_____% Small Cap Growth (Wellington)
_____% Small Cap Opportunities (DFA/Invesco)
_____% Small Cap Value (Wellington)
_____% Small Company Value (T. Rowe Price)
_____% Total Return (PIMCO)
_____% Value (Invesco)
SECTION D
In addition to Section B and Section C, variable investment options also available to contracts purchased without a Guaranteed Minimum
Withdrawal Benefit prior to May 1, 2006 (prior to February 12, 2007 for Venture Vision contracts)
_____% 500 Index B (JHAM 2)
_____% Core Bond (Wells Capital)
_____% Active Bond (Declaration/JHAM 1)
_____% Fundamental All Cap Core (JHAM 1)
_____% All Cap Core (QS Investors)
_____% Fundamental Large Cap Value (JHAM 1)
_____% BlackRock Basic Value V.I.4 (BlackRock Investment) _____% Global (Templeton)
_____% BlackRock Global Allocation V.I.4
_____% International Equity Index B (SsgA)
(BlackRock International)
_____% Mid Value (T. Rowe Price)
_____% BlackRock Value Opportunities V.I.4
(BlackRock Investment)
_____% PIMCO VIT All Asset Portfolio (PIMCO)
_____% Real Return Bond (PIMCO)
_____% Small Cap Index (JHAM 2)
_____% Strategic Income Opportunities (JHAM 1)
_____% Total Stock Market Index (JHAM 2)
_____% US Equity (GMVO)
_____% Utilities ( MFS1)
1
John Hancock Asset Management a division of Manulife Asset Management (US) LLC
John Hancock Asset Management (North America) a division of Manulife Asset Management (North America) Limited
3
You must currently have an Asset Rebalancing program with the Money Market investment option in effect in order to elect this investment option.
4
Available only to John Hancock USA contracts distributed through Merrill Lynch prior to January 28, 2002. Not available with any John Hancock New York contract.
2
IMPORTANT NOTE: Asset Rebalancing does not apply to any fixed investment option (if offered on your annuity).
Please see your variable annuity contract and/or prospectus for further details.
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