[LOGO] John Hancock

This application for Life Insurance is to John Hancock
Life Insurance Company which will sometimes hereinafter
be referred to as "the Company."

Application No. _____________ (if applicable)

M Proprietary Products

[LOGO] John Hancock

All References to "Life 2" are applicable for Survivorship applicants only

Part A Statements to the Company's Agent

A. PROPOSED INSURED/LIFE 1

1. Name of Proposed Insured (please print): 10. Address ___________________________________________________
STREET ADDRESS
First _______________________________________ MI _______ ___________________________________________________________
CITY STATE ZIP
Last ________________________________________
11. Home Phone (_____________) _______________ - ______________
2. Sex [_] Male [_] Female
12. Work Phone (_____________) _______________ - ______________
3. Date of Birth ____/____/____
Fax Number (_____________) _______________ - ______________
4. Place of Birth __________________________________________
STATE COUNTRY, IF NOT U.S.A 13. Best time and place for Underwriting to call (in Proposed
Insured's local time zone)_________________________________
5. Soc. Sec. Number ___________ - ____________ - ___________
14. Has Proposed Insured smoked or used any other
6. Height _____ft. ______in. 7. Weight ________lbs. tobacco product, i.e., cigars, pipes, snuff, chewing tobacco,
etc., in the past 12 months? [_] Yes [_] No
8. Occupation ______________________________________________
15. Within the last 3 months, has Proposed Insured been absent
9. Driver's License State __________ Number _______________ from work for a period of 5 consecqutive business days or
more due to illness or medical treatment? [_] Yes [_] No
(If yes, please explain on additional sheet)
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B. SECOND PROPOSED INSURED/LIFE 2 (COMPLETE ONLY IF SURVIVORSHIP)

1. Name of Proposed Insured (please print): 10. What is Life 2's relationship to Life 1? __________________

First _______________________________________ MI _______ 11. Address ___________________________________________________
STREET ADDRESS
Last ________________________________________
___________________________________________________________
2. Sex [_] Male [_] Female CITY STATE ZIP

3. Date of Birth ____/____/____ 12. Home Phone (_____________) _______________ - ______________

4. Place of Birth __________________________________________ 13. Work Phone (_____________) _______________ - ______________
STATE COUNTRY, IF NOT U.S.A
Fax Number (_____________) _______________ - ______________
5. Soc. Sec. Number ___________ - ____________ - ___________
14. Best time and place for Underwriting to call (in Proposed
6. Height _____ft. ______in. 7. Weight ________lbs. Insured's local time zone)_________________________________

8. Occupation ______________________________________________ 15. Has Proposed Insured smoked or used any other
tobacco product, i.e., cigars, pipes, snuff, chewing tobacco,
9. Driver's License State __________ Number _______________ etc., in the past 12 months?

[_] Yes [_] No
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Page 1

Part A Statements to the Company's Agent

C. OWNER

1. Policy Owner Complete questions 3-5 if Owner is a Trust

[_] Trust 3. Name of Trust ____________________________________________

[_] Life 1 [_] Life 2 [_] Life 1 and Life 2, jointly ______________________________________________________________

(Choices that include Life 2 are only for ______________________________________________________________
survivorshlp applications)
4. Trustee(s) _______________________________________________
[_] Other (Complete question 6.)
5. Date of Trust __________/__________/__________
2. Tax ID or Soc. Sec. Number _________ - ________ - _________

COMPLETE VERIFICATION OF TRUST FORM ON PAGE 7 IF POLICY IS TO BE OWNED BY A TRUST
- ------------------------------------------------------------------------------------------------------------------------------------

6. Other Owners, if any

Name of Relationship Soc. Sec. Date of Birth
Owners to Life I and Life 2 Number

______________________________________________________________________________________________________________________________

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7. Name/Address/Phone for mailing of policy statements and 8. Name/Address/Phone for mailing of Premium Notices:
correspondence other than premium notices: (If same as address to left, state "same")

___________________________________________________________ __________________________________________________________
Name Name

___________________________________________________________ __________________________________________________________
Street Address Street Address

___________________________________________________________ __________________________________________________________
City State Zip City State Zip

___________________________________________________________ __________________________________________________________
Phone Fax Phone Fax

D. BENEFICIARY

Please indicate full name and relationship to Proposed Insured(s). (please print)

The right to change the beneficiary as to any proceeds is reserved to the Owner(s).
- ------------------------------------------------------------------------------------------------------------------------------------

E. SPECIAL REQUESTS

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Page 2

Part A Statements to the Company's Agent

F. UNDERWRITING INFORMATION (FOR MEDICAL APPLICATIONS ONLY)

1. In the past 7 years, has the Proposed Insured(s) done, or does the Life 1 Life 2
Proposed Insured(s) intend to do any: (if survivorship)
a. flying except as a passenger on regularly scheduled airlines?
(If yes, please complete aviation questionnaire.) [_] Yes [_] No [_] Yes [_] No
b. skin/scuba diving, parachuting, motorized racing, or other hazardous sports?
(If yes, please complete avocation questionnaire.) [_] Yes [_] No [_] Yes [_] No
2. In the past 7 years, has the Proposed Insured(s) been convicted of two or more
motor vehicle moving violations or had a driving license suspended or revoked? [_] Yes [_] No [_] Yes [_] No
3. In the past 7 years, has the Proposed Insured(s) been convicted of the
violation of any criminal law? [_] Yes [_] No [_] Yes [_] No
4. Does the Proposed Insured(s) intend to reside or travel outside the U.S. or Canada? [_] Yes [_] No [_] Yes [_] No

If any of questions 2-4 are answered "yes", please explain: _____________________________________________________________________

________________________________________________________________________________________________________________________________

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G. OTHER INSURANCE/REPLACEMENT INFORMATION (FOR MEDICAL APPLICATIONS ONLY)

1. Give information indicated for all insurance in force on the Proposed Insured(s), including term riders.

---------------------------------------------------------------------------------------------------------------------------
Life 1/2 Company Issue Year Plan Amount ADB Amount Business Insurance?
---------------------------------------------------------------------------------------------------------------------------
[_] Yes [_] No
---------------------------------------------------------------------------------------------------------------------------
[_] Yes [_] No
---------------------------------------------------------------------------------------------------------------------------
[_] Yes [_] No
---------------------------------------------------------------------------------------------------------------------------
[_] Yes [_] No
---------------------------------------------------------------------------------------------------------------------------
[_] Yes [_] No
---------------------------------------------------------------------------------------------------------------------------

2. Is any other insurance application now pending or contemplated on the life of [_] Yes [_] No
the Proposed Insured(s)? (Include any Life, Disability, or Long Term Care)

If yes, which Insured(s) __________________________________________________________________________________________________

If yes, what company(ies)/amounts? ________________________________________________________________________________________

3. The insurance applied for intended to replace or change any life insurance or annuity [_] Yes [_] No
now in force on the Proposed Insured(s)? (If yes, give writing company of insurance
being replaced, policy number, and insurance amount.)

Life 1 Life 2 (if survivorship)
------------------------------------------------------------------------------------------------------------------------------
Company Policy # Amount Company Policy # Amount

------------------------------------------------------------------------------------------------------------------------------

Is the insurance applied for a 1035 exchange? [_] Yes [_] No

4. Has any application for life, disability, or health insurance on the Proposed Insured(s) Life 1 [_] Yes [_] No
ever been modified? (If "Yes," give most recent company, including John Hancock.) Life 2 [_] Yes [_] No

______________________________________________________________________________________________________________________________
Company Approximate Date

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Page 3

Part A Statements to the Company's Agent

PLEASE COMPLETE THIS PAGE IF MAJESTIC VARIABLE COLI IS DESIRED

H. BENEFITS

1. Basic Sum Insured (BSI) $_____________________

2. Death Benefit Option (choose one)

[_] Option A - Sum Insured only
[_] Option B - Sum Insured plus Account Value

3. Life Insurance Definition (choose one)

[_] Cash Value Accumulation Test
[_] Guideline Premium Test

4. [_] Additional Sum Insured (ASI) (check if desired)

a. (Check no more than one of the following)
[_] ASI of $ ______________
[_] for life of policy.
[_] with Total Sum Insured $__________ increasing by
[_] ______ % or [_] $_____ per year for
[_] life of policy or [_] ______ policy years.

[_] Customized Level or Increasing Schedule
(List by policy year or years. ASI amount may not decrease.)

Policy Year(s) ASI Amount

_________ - _________ $_________ (1)
_________ - _________ $_________ (2)
_________ - _________ $_________ (3)
_________ - _________ $_________ (4)
_________ - _________ $_________ (5)
_________ - _________ $_________ (6)
_________ - _________ $_________ (7)
_________ - _________ $_________ (8)
_________ - _________ $_________ (9)
_________ - _________ $_________ (10)

(If more space needed, attach separate schedule.)

b. [_] Premium Cost Recovery
[_] life of policy or [_] ______ policy years

5. Additional Benefits

[_] Continuation of Guaranteed Minimum Death Benefit Option after 10th
Policy Year (not available with Option B)

[_] Enhanced Cash Value Rider

[_] Other _____________________________________

I. PREMIUM

1. Premium Billing Interval

[_] Annual [_] Semiannual

[_] Quarterly [_] Monthly-(Automatic Deduction)

2. Planned Premium (Check a or b, or Target Premium will be billed.)

a. [_] $____________ annually for ________ year(s)
Optional: Annual Increase of _______ % OR
$____________ annually for ________ year(s)

Additional first year Planned Premium $______________

b. [_] Customized Schedule (list by policy year or years):

Policy Year(s) Planned Premium Amount

(If more space needed, attach separate schedule.)

J VARIABLE PRODUCTS INFORMATION

IF ELECTING MAJESTIC VARIABLE COLI, COMPLETE SECTIONS K & L
ON PAGE 4A OF THIS APPLICATION.

Page 4 (Majestic Variable COLI)

Part A Statements to the Company's Agent

PLEASE COMPLETE THIS PAGE IF MAJESTIC VEP 98 IS DESIRED

H. BENEFITS

1. Basic Sum Insured (BSI) $ _____________

2. Death Benefit Option (choose one)

[_] Option A - Sum Insured only
[_] Option B - Sum Insured plus Account Value
[_] Option M - Sum Insured plus Optional Extra Death Benefit with
calculation beginning at policy year _____

3. Life Insurance Definition (choose one)

[_] Cash Value Accumulation Test
[_] Guideline Premium Test. (Option M not allowed)

4. [_] Additional Sum Insured (ASI) (check if desired)

a. (Check no more than one of the following)

[_] ASI of $ ______________
[_] for life of policy.
[_] with Total Sum Insured increasing by
[_] ______ % or [_] $______ per year for
[_] life of policy or for [_] ______ policy years.

[_] Customized Level or Increasing Schedule
(List by policy year or years, ASI amount may not decrease.):

Policy Year(s) ASI Amount

__________ - __________ $______________ (1)
__________ - __________ $______________ (2)
__________ - __________ $______________ (3)
__________ - __________ $______________ (4)
__________ - __________ $______________ (5)
__________ - __________ $______________ (6)
__________ - __________ $______________ (7)
__________ - __________ $______________ (8)
__________ - __________ $______________ (9)
__________ - __________ $______________ (10)

(If more space needed, attach separate schedule.)

b. [_] Premium Cost Recovery
[_] life of policy or [_] ______ policy years

5. Additional Benefits

[_] Continuation of Guaranteed Minimum Death Benefit
Option after 10th policy year
(not available with Option B)
[_] Policy Split Option
[_] Enhanced Cash Value Rider
[_] Other _______________________________________

I. PREMIUM

1. Premium Billing Interval

[_] Annual [_] Semiannual
[_] Quarterly [_] Monthly-(Automatic Deduction)

2. Planned Premium (Check a or b, or Target Premium will be billed.)

a. [_] $_____________ annually for ________ year(s)
Optional: Annual Increase of _________% OR
$_____________ annually for ________ year(s)

Additional first year Planned Premium $____________

b. [_] Customized Schedule (list by policy year or years):

Policy Year(s) Planned Premium Amount

(If more space needed, attach separate schedule.)

J. VARIABLE PRODUCTS INFORMATION

IF ELECTING MAJESTIC VEP 98,
COMPLETE SECTIONS K & L ON
PAGE 4A OF THIS APPLICATION.

Page 4 (Majestic VEP 98)

Part A Statements to the Company's Agent

PLEASE COMPLETE THIS PAGE IF MAJESTIC UL-SURVIVORSHIP 98 IS DESIRED

H. BENEFITS

1. Basic Sum Insured (BSI) $___________

2. Death Benefit Option (choose one)

[_] Option A - Sum Insured only
[_] Option B - Sum Insured plus Account Value
[_] Option M - Sum Insured plus Optional Extra Death Benefit with
calculation beginning at policy year ____________

3. Life Insurance Definition (choose one)

[_] Cash Value Accumulation Test
[_] Guideline Premium Test. (Option M not allowed)

4. [_] Additional Sum Insured (ASI) (check if desired)

a. (Check no more than one of the following)

[_] ASI of $ ______________
[_] for life of policy.
[_] with Total Sum Insured increasing by
[_] ______ % or [_] $______ per year for
[_] life of policy or [_] ______ policy years.

[_] Customized Level or Increasing Schedule
(List by policy year or years. ASI amount may not decrease.)

Policy Year(s) ASI Amount

_____ - _____ $_________ (1)
_____ - _____ $_________ (2)
_____ - _____ $_________ (3)
_____ - _____ $_________ (4)
_____ - _____ $_________ (5)
_____ - _____ $_________ (6)
_____ - _____ $_________ (7)
_____ - _____ $_________ (8)
_____ - _____ $_________ (9)
_____ - _____ $_________ (10)

(If more space needed, attach separate schedule.)

b. [_] Premium Cost Recovery
[_] life of policy or [_] _____ policy years

5. Additional Benefits

[_] Policy Split Option
[_] Enhanced Cash Value Rider
[_] Other _____________________________________

I. PREMIUM

1. Premium Billing Interval

[_] Annual [_] Semiannual

[_] Quarterly [_] Monthly-(Automatic Deduction)

2. Planned Premium (Check a or b, or Target Premium will be billed.)

a. [_] $____________ annually for_______ year(s)
Optional: Annual Increase of _______% OR
$____________ annually for_______ year(s)

Additional first year Planned Premium $____________

b. [_] Customized Schedule (list by policy year or years):

Policy Year(s) Planned Premium Amount

(If more space needed, attach separate schedule.)

3. Do you understand that you may need to pay additional premiums should the
current credited rates or charges change from those in your illustration?

[_] Yes [_] No

Page 4 (Majestic UL-Survivorship 98)

THIS PAGE MUST BE COMPLETED FOR ALL VARIABLE PRODUCTS

K. PLAN

Choose One:

[_] Majestic Variable COLI [_] Majestic VEP 98 [_] Other_________

L. SUBACCOUNT INVESTMENT OPTIONS

Percentages must be Whole and Total 100%

[Large Cap Equities Multi Cap Equities Balanced Funds

_______% Equity Index _______% VA Relative Value _______% Managed
_______% Growth & Income _______% AIM V.I. Value _______% Global Balanced
_______% Large Cap Value _______% AIM V.I. Growth
_______% Large Cap Value Core _______% Fidelity VIP Growth Bonds
_______% Large Cap Growth _______% Fidelity VIP Contrafund _______% Short-Term Bond
_______% Large Cap Aggressive Growth _______% MFS Investors _______% Bond Index
Growth Stock Series _______% Active Bond
Large/Mid Cap Equities _______% MFS Research Series _______% V.A. Strategic Income
_______% Large/Mid Cap Value _______% MFS New Discovery Series _______% High Yield Bond
_______% Fundamental Growth _______% Global Bond
International Equities
Mid Cap Equities _______% International Equity Index Cash Equivalents/Fixed Account
_______% Mid Cap Growth _______% International Opportunities _______% Money Market
_______% International Equity _______% Fixed Account
Mid/Small Cap Equities _______% Emerging Markets Equity
_______% Small/Mid Cap Core _______% Janus Aspen Worldwide Growth M Funds
_______% Small/Mid Cap Growth _______% Brandes International Equity
Sector Funds _______% Turner Core Growth
Small Cap Equities _______% Real Estate Equity _______% Frontier Capital Appreciation
_______% Small Cap Equity _______% Health Sciences _______% Clifton Enhanced U.S. Equity]
_______% Small Cap Value _______% V.A. Financial Industries
_______% Small Cap Growth _______% Janus Aspen Global Technology

Are you associated with another NASD Member Firm? [_] Yes [_] No Specify ______________________

Page 4A (Subaccount Investment Options)

Part A Statements to the Company's Agent

COMPLETE FOR NON-MEDICAL APPLICATIONS ONLY

Please give full details below for every "Yes" answer to Questions 1-4 as to
each person proposed for insurance, who is referred to below as "any person". Be
sure to include the names/addresses of any treatment providers.

1. Within the past 7 years, has any person ever been treated for or had any
known indication of disease of the heart or blood vessels, chest pain or
high blood pressure, stroke or paralysis, diabetes, tumor or cancer,
convulsions, kidney disease, gastro-intestinal disease, mental or
psychiatric disorder, lung or respiratory disease, or blood disorder? [_] Yes [_] No

2. Within the past 7 years, has any person had or been diagnosed or treated by
a physician or other medical practitioner for ARC or Acquired Immune
Deficiency Syndrome (AIDS)? [_] Yes [_] No

3. Within the past 7 years, has any person received counseling or treatment
regarding the use of alcohol, drugs, or used any illegal drug or controlled
substance? [_] Yes [_] No

4. Other than the above, within the past 7 years has any person

a) been admitted to a hospital or other medical or rehabilitation facility? [_] Yes [_] No

b) consulted or been treated by a physician, or had a physical exam or
checkup? [_] Yes [_] No

5. Is any person currently taking any prescription drug? [_] Yes [_] No

If yes, who? _________________________________________________________________________________

What drugs? How frequently? __________________________________________________________________

6. If the Proposed Insured(s) has a personal physician, please enter name,
address, and details below. Otherwise leave blank.
Life 1 Life 2

________________________________________ ___________________________________________________
FIRST NAME MI LAST NAME FIRST NAME MI LAST NAME

________________________________________ ___________________________________________________
STREET ADDRESS CITY STATE ZIP CODE STREET ADDRESS CITY STATE ZIP CODE

Date/Reason(s) last seen _______________ Date/Reason(s) last seen __________________________

- ------------------------------------------------------------------------------------------------------------------------------------
Details to "yes" answers.
Question No./Name ____________________________________________ Question No./Name ____________________________________________
Condition ____________________________________________________ Condition ____________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________
Date of onset ____________ Last occurrence ___________________ Date of onset ____________ Last occurrence ___________________
Treatment/medication, if any _________________________________ Treatment/medication, if any _________________________________
Names/addresses of physicians/hospitals providing treatment Names/addresses of physicians/hospitals providing treatment
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________

- ------------------------------------------------------------------------------------------------------------------------------------
Question No./Name ____________________________________________ Question No./Name ____________________________________________
Condition ____________________________________________________ Condition ____________________________________________________
______________________________________________________________ ______________________________________________________________
Date of onset ____________ Last occurrence ___________________ Date of onset ____________ Last occurrence ___________________
Treatment/medication, if any _________________________________ Treatment/medication, if any _________________________________
Names/addresses of physicians/hospitals providing treatment Names/addresses of physicians/hospitals providing treatment
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________

Please record any additional details on a separate piece of paper.
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Page 5

Part A Statements to the Company's Agent

AGREEMENT AND SIGNATURES

A. This Part A and any attached Part B will form the basis for and be a part
of any policy or additional benefit provision issued on this application.

B. Coverage will take effect as provided in and subject to the terms and
conditions of Conditional Temporary Insurance Agreement pages 11 and 12
bearing the same date and number of this Part A if: (1) an advance payment
of at least the Minimum Temporary Insurance Premium is made with this Part
A that satisfies the requirements of such Conditional Temporary Insurance
Agreement; and (2) the amount applied for in this and all other
applications now pending in John Hancock Life Insurance Company does not
exceed $1,000,000 life insurance if an individual policy or $3,000,000 life
insurance if a survivorship policy.

C. If the applicant has a right to have the policy issued as requested without
completing any Part B, the policy will take effect as of its Date of Issue,
provided the initial payment has been made with this application.

D. In cases other than those described in B and C above, any policy or Benefit
provision will take effect as of the Date of Issue of the policy, but: (1)
only on delivery to and receipt by the Applicant of the policy and payment
of the minimum initial premium thereon and (2) only if at the time of such
delivery and payment each person proposed for insurance in parts A and B of
this application is living and has not consulted or been examined or
treated by a physician or practitioner since the latest Part B pertaining
to such person was completed.

E. No agent or medical examiner is authorized to make or discharge contracts
or waive or change any of the conditions or provisions of any application,
policy, or receipt, or to accept risks or pass on insurability. Any such
unauthorized action is not notice to or knowledge of the Company. A medical
examiner is not an agent of the Company.

Provisions F and G apply only if a Variable Product is applied for

F. All benefits, payments, and values, including the Death Benefit and Account
or Cash, Value under any policy issued which is based upon the investment
experience of a separate investment account may increase or decrease in
accordance with the investment experience of the separate investment
account and are not guaranteed as to fixed dollar amount. The Account Value
or Cash Value may even decrease to zero. An illustration of benefits,
including death benefits, policy values and cash surrender values is
available upon request.

G. A prospectus for the policy applied for has been given to the Proposed
Insured and/or to the Applicant.
Prospectus Date: ________________

Provisions H, I,J, K, and L apply if the policy applied for is the result of a
term conversion

H. Any new policy will be a new, separate contract. If a new policy is issued
in exchange for the original insurance, all liability of the Company under
the original insurance will cease when the new policy takes effect. Until
the new policy is issued, coverage will still be in force under the
original policy. Coverage under the new policy will take effect as
indicated in Paragraph C above.

I. The application for the original insurance, unless such insurance is now
incontestable, and the application for each additional benefit provision
which is to be retained as specified on page 4 of this Application, unless
such provision is now incontestable, will also form a basis for and be a
part of any new policy.

J. If the original policy or benefit provision is being exchanged and is
subject to an assignment, the new policy will be subject to the same
assignment unless it is discharged or, in the case of a policy loan
assignment, unless the indebtedness has been repaid.

K. If the new policy is issued in exchange for the original policy, any
nonforfeiture option election applicable to the original policy will be
applicable to the new policy, if available, unless otherwise requested in
writing.

L. Ownership and control of any policy issued on the attached application will
be determined by the terms of the new policy.

Provisions M and N apply if the policy applied for is a COLI policy

M. I agree and acknowledge that my employer may be the owner and beneficiary
of the life insurance policy(ies) on my life. I further agree and
acknowledge that to the extent my employer owns or is the beneficiary under
the policy I, and my personal representative and heirs at law, have no
ownership or beneficial interest or rights in the life insurance
policy(ies) or the death proceeds thereof.

N. This consent is attached to and forms a part of any policy of insurance
issued. This consent may be used to determine eligibility for insurance.

All statements and answers in this application are, to the best of my knowledge
and belief, true and complete. They are representations and not warranties. I
assent to this application.

______________________________________________ Dated At ______________________________________________ On ____________________
Applicant's Signature City or Town State Date

______________________________________________ Dated At ______________________________________________ on ____________________
Applicant's Signature City or Town State Date

______________________________________________ _________________________________________________ _____________________________
Signature of Life I, if other than applicant Signature of Life 2, if other than applicant Witness (Agent must witness
where required by law)

Page 6

VERIFICATION OF TRUST

1. Names of Proposed Insured(s) (please print)

________________________________________________________________
First Name Mi Last Name

2. Name of Trust:

________________________________________________________________

3. Name of Trustee:

________________________________________________________________
First Name Mi Last Name

4. Address of Trustee:

________________________________________________________________
Street Address

________________________________________________________________
City State Zip

5. Names of Additional Trustees:

________________________________________________________________
First Name Mi Last Name

6. Date of Trust __________/ __________/ _____________

7. Trust established in state of

________________________________________________________________

8. Taxpayer ID# (when available)

________________________________________________________________

9. Application Date ___________/ ______________/ _____________

The undersigned Trustee(s) certify that the following statements are true:

The Trustee(s) has the authority, either by the terms of the trust or applicable
state law, to own and purchase life insurance on the life of the Insured(s). The
Trustee(s) signing this document and the application is/are sufficient in number
to act on behalf of the trust.

The trust document containing the name(s) of the Trustee(s) and the date of the
trust is in full force and effect and existed prior to the date of the
application for life insurance.

The trust empowers the Trustee(s) to exercise any and all rights associated with
owning life insurance policies and the Trustee(s) can exercise these rights
without the consent of the Insured(s). These rights include but are not limited
to: surrendering the policy, withdrawing policy values, borrowing against the
policy values, assigning the policy, transferring ownership, and changing the
beneficiary.

The undersigned Trustee(s) agree(s) that John Hancock Life Insurance Company
shall not be responsible for the application or disposition of the proceeds of
said policy purchased by the Trustee(s), and the payment to the Trustee(s) of
the proceeds of the policy shall fully discharge John Hancock Life Insurance
Company from all liability under said policy to the extent of such payment. By
signing this verification form, the Trustee(s) verifies that all information
contained herein is true and complete. We agree jointly and severally to
indemnify the Company and its agents, and hold them harmless from and against
all liability as a result of claims, demands, or judgments against them arising
from effecting any insurance transactions in reliance on this certification.

Dated At __________________________ on __________________________
City or Town State Date

___________________________________ __________________________________
Signature of Witness Signature of Trustee

__________________________________
Signature of Trustee

Page 7

NOTICE OF POTENTIAL INCOME TAX IMPLICATIONS FOR MODIFIED ENDOWMENT

The Technical and Miscellaneous Revenue Act of 1988 (TAMRA) changed the
income taxation of cash withdrawn from certain life insurance policies
called Modified Endowment Contracts, or MECs. Due to the amount of premium
you plan to pay into this policy, you will be affected by this law.

It is important for you to understand that all distributions made from your
policy as applied for, including policy loans, withdrawals, partial
surrenders and certain dividends (if applicable), will be considered to be a
distribution of any gain. This means that if your policy is in a gain
position when the withdrawal is made (i.e., the value of your policy exceeds
the amount you've paid into it), you will owe ordinary income tax on the
amount you withdraw. In addition, a 10% penalty tax is imposed by the IRS on
any taxable distribution made prior to age 59 1/2, except on disability or
if taken in the form of an annuity.

The insurance proceeds payable to your beneficiary upon the death of the
Proposed Insured(s) will continue to be income tax free under current
legislation.

This notice is designed to inform you of the income taxation of life
insurance based upon our understanding of the information currently
available. It is not intended to provide you with legal advice, which
neither John Hancock nor its Representatives can give. Therefore, if you
have questions as to the applicability of any provision of the law, you
should seek the advice of your own tax and legal counsel.

If you wish to modify your planned premium payments to avoid creating a
Modified Endowment Contract, your Marketing Representative will assist you.
Otherwise, please sign the Acknowledgment below.

Policyowner Acknowledgment and Signature

I have read the above Notice of Potential Income Tax Implications for
Modified Endowment Contracts. I understand that my premium payments will
cause the proposed policy to become a Modified Endowment Contract. I also
understand the potential income tax effects of a distribution from a
Modified Endowment Contract.

Policyowner Signature ________________________ Date _________________

TAXPAYER IDENTIFICATION NUMBER

Enter the Owner's taxpayer identification number
in the appropriate box. For most individual taxpayers,
this is the social security number.

Social Security number

-- --
OR

Employer identification number

-- --

I submit that the information provided above is true, correct, and complete.

Signature ________________________________ Date ______________

Page 8

PLEASE COMPLETE ANY SECTION BELOW THAT PERTAINS TO THIS CASE

I. COMPLETE IF THIS IS A CONVERSION OF TERM INSURANCE

1. [_] This is a [_] Full [_] Partial [_] Term Conversion from:

--------------------------------------------------------------------------------------------------------
a. Policy Number/Insured Conversion Type Amount Converted Amount Remaining In Force
--------------------------------------------------------------------------------------------------------

Name Base Policy Amount
---------------------------------------------------------------------------
__________________ __________ Rider
---------------------------------------------------------------------------
# __________ Rider
--------------------------------------------------------------------------------------------------------
b. Policy Number/Insured Conversion Type Amount Converted Amount Remaining In Force
--------------------------------------------------------------------------------------------------------
Name Base Policy Amount
---------------------------------------------------------------------------
__________________ __________ Rider
---------------------------------------------------------------------------
# __________ Rider
--------------------------------------------------------------------------------------------------------

2. Is Insured(s) now totally disabled, or is Insured(s) receiving any payments
for sickness or injury? [_] Yes [_] No

(If yes, give details on the Special Requests Box E)

II. COMPLETE FOR MODIFIED ENDOWMENTS

1. Does the sales illustration show that the policy applied for is a Modified
Endowment Contract (MEC)? [_] Yes [_] No

2. If yes, has the Policyowner signed the MEC Acknowledgment Form on Page 8?
[_] Yes [_] No

TO BE COMPLETED IN EVERY CASE

Authorization and Acknowledgment

I hereby authorize any licensed physician, medical practitioner, hospital,
clinic, or other medical or medically related facility, insurance company, the
Medical Information Bureau or other organization, institution, or person that
has any records or knowledge regarding each of the undersigned to give to the
Company or its reinsurer(s) any such information, including information
concerning every condition for which each has been under observation or
treatment, including information related to treatment for drug and/or alcohol
abuse or for psychiatric and/or mental conditions, the history obtained,
physical and laboratory findings, diagnosis and treatment.

I acknowledge receipt of the Federal Fair Credit Reporting Act notice which
contains a notice concerning the Medical Information Bureau.

A copy of this authorization is as valid as the original. This authorization is
valid for 24 months from the date of the Proposed Insured(s) signature.

____________________________________ ________________________________________
Signature of Life 1 Signature of LIfe 2 (survivorship only)

_______________________, ___________ _______________________, _______________
Date Date

Page 9

COMPLETE ONLY IF ADVANCE PAYMENT IS BEING MADE

RECEIPT AND CONDITIONAL TEMPORARY INSURANCE AGREEMENT

PLEASE READ CAREFULLY

... This Receipt and Conditional Temporary Insurance Agreement is governed by
Agreement B on page 6 of the application bearing the same number as this
receipt.

... In addition to the limitation in Agreement B on page 6, there is a total
temporary insurance coverage limit of $250,000 (individual) or $1,000,000
(survivorship) on all applications pending on each person proposed for
insurance with John Hancock Life Insurance Company, regardless of the
number of applications, and the face amounts of the policies applied for.
- --------------------------------------------------------------------------------
Life 1 ________________________________ Application Number _____________________
Life 2 (if survivorship) ______________ Total Sum Insured at Issue $ ___________
Plan __________________________________ Date ___________________________________

Received from ___________________________the Sum of $ ________________ paid with
application to the Company with the same date and number as this receipt. This
receipt is issued on the condition that any check, draft, or other order for the
payment of money is good and can be collected.

Please make all premium checks payable to the company under which your
application is being made John Hancock Life), at John Hancock Place, Boston,
MA. Do not make check payable to the agent or leave the payee blank.
- --------------------------------------------------------------------------------

Conditions of Temporary Insurance Coverage. 1) The amount received must be at
least the Minimum Temporary Insurance Premium, 2) Parts A and B of the
application and any required medical examinations and tests must be completed,
and 3) The following questions are answered "NO."

a. Within the past 7 years, has any person proposed for insurance
consulted a physician for, been diagnosed with, or had treatment for
heart disease, stroke, or cancer? _____
b. Has any person proposed for insurance been hospitalized within the
past 6 months or been advised by a physician that he or she needs
hospitalization for any reason (other than for normal pregnancy)? ____
c. Within the past 7 years, has any person received counseling or
treatment regarding the use of alcohol, drugs, illegal drugs, or used
any illegal drug or controlled substance? ____
d. Within the past 7 years, has any person had a driving license
suspended or revoked? ____

Commencement of Temporary Insurance Coverage. If the above Conditions of
Temporary Insurance Coverage are met, coverage in accordance with the terms and
conditions of the policy applied for will take effect on the latest "Completion
Date" of all persons proposed for insurance. Each person's "Completion Date"
will be the date of completion of the latest of the Parts A and B of the
application and any medical examinations and tests required by the Company's
published initial underwriting requirements, according to the age and amount
applied for.

Amount of Temporary Insurance Coverage. The amount of Coverage will be the
lesser of: 1) the amount applied for in the application; and 2) $250,000 if
individual life insurance or $1,000,000 if survivorship life insurance. However,
the amount of coverage will never exceed $250,000 (individual) or $1,000,000
(survivorship) less the total of all amounts payable under all conditional
temporary insurance agreements issued by John Hancock Life Insurance Company in
connection with any insurance application pending on the Proposed Insured(s) as
of the date of this Receipt and Conditional Temporary Insurance Agreement. No
benefit will be paid under this Agreement if the Proposed Insured(s) death(s)
results, directly or indirectly, or wholly or partially, from self-inflicted
injury.

(continued on reverse)

Page 10

Receipt and Conditional Temporary Insurance Agreement (continued)

Termination of Temporary Insurance Coverage. The Conditional Temporary Insurance
Coverage provided by this Agreement will end on the earliest of:

1) The commencement of coverage under the policy issued on the basis of the
application.
2) The date the Applicant refuses to accept the policy as offered for
delivery.
3) The date the application is declined or deemed declined. (Policy is
deemed declined if not approved within 60 days of the latest Completion Date.)
Notice of any such declination will be furnished.

If termination occurs under 2) or 3) above, the amount paid will be returned on
surrender of this Receipt. In no event will coverage be in effect under both
this Conditional Temporary Insurance Agreement and any policy issued on the
basis of the application, and any amendment thereto, with the same date and
number as this Receipt and Conditional Temporary Insurance Agreement.

Commencement of Coverage Under the Policy. Coverage under any policy issued on
the basis of the application will replace the coverage provided by this
Agreement as of the policy Date of Issue but only if:

1) The policy is delivered to and accepted by the Applicant while all
persons proposed for insurance are living and within 60 days of the latest
"Completion Date," and
2) The balance of any premium required for the policy as delivered is paid
while all persons proposed for insurance are living and within 60 days after the
latest "Completion Date."

Minimum Temporary Insurance Premium. The Minimum Temporary Insurance Premium is
one month's proportionate part of the premium according to the Company's
published rates for the policy and premium interval applied for.

______________________________________________________ -------------------------------------
Life I Date Not valid unless advance payment
has been made, the application is
complete, and the questions on the
______________________________________________________ front are all answered "No.
Life 2 (if Survivorship) Date "Confirm the coverage provided by
this Agreement with your agent.
-------------------------------------
______________________________________________________
Producer Date

(To be used in event of refund of payment)

Received from the Company, Boston, Massachusetts, the sum of $_______________

The amount mentioned in the receipt on the reverse side hereof.

Date___________________________,___________

Page 11

SUPPLEMENTARY UNDERWRITING INFORMATION REQUIRED IN ALL NON-COLI CASES

1. Please provide the addresses of the Proposed Insured(s) for the last two
years.

Time at Residence Street Address City/Town State ZIP

________yrs. ______mos. See Part A, Page 1, Section A
-----------------------------------------------------
________yrs. ______mos. _____________________________________________________

Life 2 (if survivorship)

________yrs. ______mos. See Part A, Page 1, Section B
-----------------------------------------------------
________yrs. ______mos. _____________________________________________________

2. Please provide the employment details for the Proposed Insured(s) for the
last two years.

Time Employed Employer Name Street Address City/Town State ZIP

________yrs. ______mos. ____________________________________________________

Life 2 (if survivorship)

________yrs. ______mos. ____________________________________________________

3. How long have you known the Proposed Insured(s)? Life 1?_____________________
Life 2 (if survivorship)? ______________

4. Are you related to the Proposed Insured(s)? [_] Yes (relationship)_________
[_] No.

5. Has the Proposed Insured(s) been known by any
other names within the last ten years? [_] Yes (relationship)_________
[_] No.

From my knowledge and investigation, I know of nothing affecting the AGENT
insurability of the Proposed Insured(s) not stated hereon, and I recommend Is the insurance applied for intended to replace or
his/her acceptance without qualification. change any life insurance or annuity now in force
Proposed Insured(s) interviewed by me on _____/ _____/ ____. on the Proposed Insured(s)? [_] Yes [_] No.

This application and report have been reviewed by
The Federal and New York Fair Credit Reporting Act notice has been me, and I recommend the risk.
delivered as required.

____________________________________________________
Producer

AUTHORIZATION FOR AUTOMATIC DEDUCTION BILLING

I authorize the Company to deduct the monthly premiums for the policy
applied for on this application from the bank account listed below. I
understand that the deduction will take place on or about the third Friday
of each month.

Transit Routing Number______ PC Control Number (if an existing account)______

Bank Account Number_________ EFTS Transfer Code___________________

Name(s) of Depositor(s)_____ Signature(s) of Depositor(s)____________________

SALE INFORMATION

Producer(s) Earning Credit for Case
Producer Name/Number Firm Name/Number % Credit

______________________ ________________ ________________

Page 12

THIS PAGE IS INTENTIONALLY LEFT BLANK.

REQUEST FOR AUTOMATIC DEDUCTION BILLING PLEASE SEND COPY TO M SERVICE

Please make sure that the Automatic Deduction Authorization on Page 9 is
completed and signed.

Name of Insured _________________________ Policy Number ______________________

Please attach either 1) a copy of the Payor's check for the initial premium; or
2) a copy of a cancelled check. (Note: Do not send voided check until policy is
issued.)

1. Complete if payment of initial premium accompanies this form.
Attached is a check, money order, or other (___________________) in the
amount of $__________________

2. Special Comments/Automatic Deduction Requests:

Firm _____________________________________

Producer__________________________________ Date__________________________

DETACH THIS SECTION AND GIVE TO CLIENT

JOHN HANCOCK LIFE INSURANCE COMPANY

Notice to Each Person Proposed for New or Changed Coverage

As required by the Federal and New York Fair Credit Reporting Act, we wish
to advise that in connection with the insurance (or change in coverage) applied
for, an investigative consumer report may be requested by the Company with
respect to any person proposed for insurance or change in coverage. Such a
report may contain information as to character, general reputation, personal
characteristics and mode of living of such person, and is customarily obtained
through personal interviews with neighbors, friends, or associates of the
subject of the report. You have a right to make a written request for
information as to the nature and scope of any such report under the Acts by
writing to:

John Hancock
P.O. Box 111 John Hancock Place
Underwriting and Issue - Federal Fair Credit Control C-5
Boston, Massachusetts 02117

For identification purposes, your request must include your full name,
birthdate, address, and any applicable policy number.

DETACH THIS SECTION AND GIVE TO CLIENT

Information obtained about your insurability will be treated as
confidential. The Company may, however, make a brief report thereon to the
Medical Information Bureau, a non-profit membership organization of life
insurance companies which operates an information exchange on behalf of its
members. If you apply to another Bureau member company for life or health
insurance coverage, or a claim for benefits is submitted to such a company, the
Bureau, upon request, will supply such company with the information it may have
in its file.

Upon receipt of a request from you, the Bureau will arrange disclosure of
any information it may have in your file. If you question the accuracy of
information in the Bureau's file, you may contact the Bureau and seek a
correction in accordance with procedures similar to those set forth in the
Federal Fair Credit Reporting Act.

The address of the Bureau's information office is:

Medical Information Bureau
Post Office Box 105, Essex Station
Boston, Massachusetts 02112
Telephone (617) 426-3660

The Company may also release limited information in its file to other
properly authorized life insurance companies to which you may apply for life or
health insurance, or to which a claim for benefits may be submitted.

Information may be released to proper regulatory agencies on request and to
insurance companies in connection with reinsurance.

Underwriting actions are not reported to the Bureau, nor is the Company
informed through the Bureau of the underwriting actions of other companies to
whom you may have applied for life or health insurance.

156-MAJMIB-02NY

Page 13

M Proprietary Products

John Hancock

John Hancock (R)