EQUI-VEST Series 202 - Equitable America Opt-Out

For 403(b) and 457(b) Plan Administrators

As communicated to you in May 2024, Equitable will begin issuing contracts from Equitable Financial Life Insurance Company of America ("Equitable America") to new participants under your plan effective June 24, 2024 (subject to state approvals). Please complete this form if you do not want your organization to offer EQUI-VEST® series 202 from Equitable America in your plan.

A variable deferred annuity, such as EQUI-VEST®, is a long-term financial product that is designed for retirement purposes. In essence, it is a contractual agreement in which payments are made to an insurance company, which agrees to pay an income stream or lump-sum amount at a later date. There are contract limitations, fees, and charges associated with variable deferred annuities, which include, but are not limited to, mortality and expense risk charges, withdrawal charges and administrative fees. The variable investment options offered in this contract will fluctuate and are subject to market risk, including loss of principal.

Annuities contain restrictions and limitations. For costs and complete details, contact a financial professional. Certain types of contracts and features may not be available in all jurisdictions.

Guarantees described are subject to the claims-paying ability of Equitable Financial Life Insurance Company and Equitable Financial Life Insurance Company of America.

EQUI-VEST® is a registered service mark of Equitable Holdings, Inc.

EQUI-VEST® variable annuities are issued by Equitable Financial Life Insurance Company (NY, NY) and Equitable Financial Life Insurance Company of America (Equitable America). Co-distributed by Equitable Advisors, LLC (member FINRA, SIPC) (Equitable Financial Advisors in MI & TN) and Equitable Distributors, LLC.
Equitable Financial, Equitable Advisors and Equitable Distributors are affiliated companies and do not provide legal or tax advice.

Contract form #s: 2006BASE-I-A/B, 2006BASE-A/B, 2008EQVTSA201, 2008EQV201, 2008EQVEDC201, 2008EQVBASE201-A, 2023EVBASE-A-Z and any state variations.

Contract endorsement form #s: 2010SIO201-I/G, 2023EVSIO202-Z and any state variations.

Equitable is the brand name of the retirement and protection subsidiaries of Equitable Holdings, Inc., including Equitable Financial Life Insurance Company (Equitable Financial) (NY, NY), Equitable Financial Life Insurance Company of America (Equitable America), an AZ stock company with an administrative office located in Charlotte, NC, and Equitable Distributors, LLC.

GE-6417191.1 (02/2024) (Exp. 02/2026)