Page 5 of 5
Print name of individual signing -
First name Middle name Last name
Signed at city State
Title (If you are acting in a representative capacity)
Signature of Co-Owner
For sales office use only
Sales office/Agency number - Representative ID Date (mm/dd/yyyy)
Sales representative - First name Middle name Last name
SECTION 8: How to submit this form
Return pages 1 through 5 of the completed form to the address or fax number listed below for the company that
issued the policy. If policies are issued by more than one company, return the completed form to any company
that issued at least one of the policies.
P.O. Box 336
Warwick, RI 02887-0336
SECTION 9: Additional information and instructions (About the Total Control Account)
Total Control Account (TCA) - Please keep this page for your records. If payment is made by
establishing a new TCA, the signature you provide will be placed on file with that account.
Availability: A TCA may be elected when the amount payable to you is at least $10,000, or you have an
existing TCA Account issued by the same MetLife affiliated insurance company that issued the policy (you must
provide the TCA Account number). The TCA generally is not available to corporate entities, or to residents of
foreign countries. For more information, call our Customer Service Center at 1-800-638-7283.
• Interest compounded daily. Rates are set weekly and are equal to or higher than one of two nationally
recognized money market rate indexes. Interest is credited monthly and is currently taxable.
• Detailed, easy-to-read statements.
• Free unlimited check writing privileges - Minimum check amount $250.
• No penalties for withdrawing all or part of your money.
• No charge for processing or printing checks. Free check reorders.
• No transaction or monthly fees, although there may be charges for stop orders and special services.
• Additional amounts from other sources may not be added to the TCA, nor can amounts withdrawn be
redeposited. However, proceeds from other life insurance policies and annuity contracts issued by the same
insurer may be added to an existing TCA in some circumstances.
• Information available electronically
through MetLife's eSERVICE web site.
• Principal and interest are guaranteed by the financial strength and claims paying ability of the affiliated
MetLife insurance company which issued the policy/policies above.