- -------------------------------------------------------------------------------- This application is to: [_] John Hancock Life Insurance Company or [_] John Hancock Variable Life Insurance Company which will sometimes hereinafter be referred to as "the Company" and "John Hancock". P.O. Box 111, Boston, Massachusetts 02117 State of Issue __ __ ------------------------------------------------------------------ M Proprietary Products [LOGO] Instructions 1. Please print all answers legibly in black ink. 2. Any change or deletion must be initialed by the Proposed Insured or Applicant. 3. Required medical information must be completed on all people proposed for coverage unless they are to be medically examined. (Form 156-MAJ-01) 4. Please confirm that each proposed insured is currently working at least 30 hours per week in a normal capacity and not hospitalized or absent from work due to illness or accident. 156-MAJM-01 - -------------------------------------------------------------------------------- [LOGO] Master Application Number ______________________________________ A. CORPORATION 1. Name of Corporation 4. Address of Corporation __________________________________________________________ ________________________________________________________________ NAME STREET ADDRESS _____________________________________________________________ 2. Name and title of Company Officer ________________________________________________________________ STREET ADDRESS ________________________________________________________________ CITY STATE ZIP __________________________________________________________ ________________________________________________________________ NAME PHONE FAX ________________________________________________________________ 5. Type of Business __________________________________________________________ TITLE _____________________________________________________________ ________________________________________________________________ 3. Tax ID Number 6. Corporate Fiscal Date (Month/Day) __ __ - __ __ __ __ __ __ __ ___ / ___ - ------------------------------------------------------------------------------------------------------------------------------------ B. CORRESPONDENCE INFORMATION Name/Address/Phone for mailing of Name/Address/Phone for mailing of policy statements and correspondence Premium Notices:(If same as address to left, state "same") other than premium notices: ________________________________________________________ ______________________________________________________________ NAME NAME ________________________________________________________ ______________________________________________________________ STREET ADDRESS STREET ADDRESS ________________________________________________________ ______________________________________________________________ CITY STATE ZIP CITY STATE ZIP ________________________________________________________ ______________________________________________________________ PHONE FAX PHONE FAX Billing Frequency [_] Annual [_] Semi-Annual [_] Qtly [_] Monthly - EC Case #______________________ - ------------------------------------------------------------------------------------------------------------------------------------ C. BENEFICIARY (If beneficiary is not superseded by any individual application submitted as part of this case) - ----------------------------------------------------------------------------------------------------------------------------------- D. SPECIAL REQUESTS - ----------------------------------------------------------------------------------------------------------------------------------- E. OWNERSHIP INFORMATION (LEAVE BLANK IF INDIVIDUAL IS OWNER) 1. Owner 3. Social Security or Tax ID Number (no dashes) _______________________________________________________ _____________________________________________ NAME - ----------------------------------------------------------------------------------------------------------------------------------- 2. Name and title of Owner/Trustee (Authorized Business Official) ______________________________________________________________ NAME TITLE - ------------------------------------------------------------------------------------------------------------------------------------ Page 2 THIS PAGE MUST BE COMPLETED FOR ALL VARIABLE PRODUCTS F. PLAN Choose One: [_] Majestic Variable COLI [_] Variable MasterPlan Plus COLI [_] Majestic VUL 98 [_] Other (if applicable): ______________________ - ----------------------------------------------------------------------------------------------------------------------------------- G. VARIABLE INVESTMENT OPTIONS Percentages must be Whole and Total 100% Equities (Mid Cap) International/Global Equities Outside Trust Funds ___% Fundamental Mid Cap Growth ___% Global Balanced ___% AIM V.I. Value ___% Mid Cap Value ___% International Equity Index ___% Fidelity VIP Contrafund ___% Mid Cap Growth ___% International Opportunities ___% Fidelity VIP Growth ___% Real Estate Equity ___% Emerging Markets Equity ___% Janus Aspen Global Technology ___% Small/Mid Cap CORE Bonds ___% Janus Aspen Worldwide Growth ___% Small/Mid Cap Growth ___% Active Bond ___% MFS New Discovery Equities (Large Cap) ___% Bond Index ___% Templeton International Securities ___% American Leaders Large Cap Value ___% Core Bond Mananged/Other(s) ___% Equity Index ___% Global Bond ___% Managed ___% Growth & Income ___% High Yield Bond ___% _____________ ___% Large Cap Aggressive Growth ___% Short-Term Bond ___% _____________ ___% Large Cap Growth Cash Equivalents/Fixed Account ___% _____________ ___% Large Cap Value ___% Money Market ___% _____________ Equities (Small Cap) ___% Fixed Account* ___% _____________ ___% Small Cap Growth ___% Small Cap Growth *Liquidity restrictions apply when allocating funds to the Fixed Account 1. Have you received a prospectus for the policy applied for? (If YES, Prospectus Date: ________________ ) [_] Yes [_] No 2. Is the policy and allocation of subaccounts in accord with your insurance objectives and your anticipated financial needs? [_] Yes [_] No 3. Have you received an illustration of benefits based on your Planned Premium? [_] Yes [_] No - ----------------------------------------------------------------------------------------------------------------------------------- H. TELEPHONE TRANSFER AUTHORIZATION By checking the "yes" box below, I/We direct the Company to act upon telephone instructions from the Owner (a trustee, if the Owner is a trust, or an authorized business official, if the Owner is a business entitiy) and my/our registered representative, if applicable, to change future payment allocations and/or transfer existing funds amoung the investment options, subject to the terms of the telephone transfer provision as described in the current prospectus for the policy. [_] Yes If yes, please check one: [_] Owner(s) and Registered Representative [_] Owner(s) only [_] No - ----------------------------------------------------------------------------------------------------------------------------------- I. TELEPHONE LOAN OPTION I direct the Company to act upon telephone instructions from the owner (a trustee, if the owner is a trust, or an authorized business official, if the Owner is a business entity) to process policy loans, subject to the provisions of the policy, and any other requirements. [_] Yes [_] No - ----------------------------------------------------------------------------------------------------------------------------------- Page 3 (Variable Investment Options) [LOGO] J. AGREEMENTS All statements in this application are, to the best of my knowledge and belief, true, complete, and correctly recorded. I assent to this application and also agree that: 1. The statements and answers in this application are representations and not warranties and attachments hereto will be relied upon and form the basis of any insurance. 2. No information will be considered as having been given to John Hancock unless it is written in this application. 3. No agent or medical examiner or any other person, except an officer of John Hancock, is authorized to make or discharge contracts or waive or change any of the conditions or provisions of any application or policy, 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. In order for any of the above events to take effect they must be provided for in writing signed by an officer of the Company. 4. Any policy issued on the basis of this application will take effect as of the Date of Issue, but (i) only upon approval of the application by John Hancock and delivery to and acceptance by the Applicant of the policy and payment of the minimum initial premium (in accordance with the billing frequency chosen) and (ii) only if, at the time of such delivery and payment, the 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 was completed. 5. 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. 6. The registered representative's signature below certifies that a prospectus for the policy applied for has been given to the Proposed Insured and/or to the Applicant and that no written sales materials other than those approved by the Company have been used. Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud ______________________________________________ Dated At _________________________________________ on _________________,_________ Applicant's Signature City or Town State Date ______________________________________________ Dated At _________________________________________ on _________________,_________ Registered Representative City or Town State Date - ------------------------------------------------------------------------------------------------------------------------------------ K. SALES CREDIT FOR APPLICATION Producer(s) Earning Credit for Case Producer Name/Number Firm Name/Number % Credit ------------------- ---------------- -------- ___________________________________ _______________________ _____________ ___________________________________ _______________________ _____________ ___________________________________ _______________________ _____________ ___________________________________ _______________________ _____________ - ------------------------------------------------------------------------------------------------------------------------------------ Page 4