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ARRIER / FUND COMPANY: Please Note: You must use one form per product sponsor. CLIENT NAME: ACCOUNT TITLE: PRODUCT TYPE: Mutual Fund Unregistered Group Product Variable Annuity Other: Variable Life ***Please include a copy of a recent statement. Incomplete product information will delay processing.*** RE: ACCOUNT NUMBER(S): PRODUCT/FUND NAME: SHARE CLASS: Please change the Broker/Dealer of record as follows: PRESENT BROKER/DEALER: NEW BROKER/DEALER: MML Investors Services, LLC 1295 Stat.

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