MEMBERS Life Insurance Co Watch

from S-1 ~1 page Risk Control Account Transfer Endorsement

from S-1 1 page Interest Adjustment Waiver Endorsement

from S-1 5 pages Data Page Continued

from S-1 8 pages Application [Trustage™ Zonechoice Annuity] Single Premium Deferred Variable Annuity With Index-Linked Interest Options [2000 Heritage Way ▪ Waverly, Ia 50677] 1 Plan Option[s] [Check One Plan Option.] [☐][trustage™ Zonechoice Annuity] 2 Owner and Annuitant Section 2a Must Be Completed. the Owner Will Be the Annuitant Unless an Annuitant Is Named in Section 2b. to Name a Joint Owner, Complete Section 2c. to Name More Parties to the Contract, Use Section 8. Minimum Age on Contract Issue Date Is [21]. Maximum Age on Contract Issue Date Is [85]. A. Owner. Complete This First Box for a Natural Person Owner. Name Gender ☐ Male ☐ Female First MI Last Date of Birth U.S. Citizen ☐ Yes ☐ No

from S-1 2 pages Nursing Home or Hospital/Terminal Illness Withdrawal Privilege Endorsement

from S-1 5 pages General Information Owner(s) Contract Issue Date [John Doe] [October 1, 2020] Annuitant(s) Annuitant(s) Issue Age(s) [John Doe] [35] Endorsements/Riders Attached: Nursing Home or Hospital/Terminal Illness Withdrawal Privilege Endorsement Individual Retirement Annuity Endorsement Roth Individual Retirement Annuity Endorsement Post Death Annuity Exchange Endorsement Purchase Payment: $[10,000.00] Surrender Charge Schedule Contract Year 1 2 3 4 5 6 7+ Surrender Charge % 9% 9% 8% 7% 6% 5% 0% Withdrawals Partial Withdrawal Information: Initial Allocation Options Initial Allocation Option Start Date: [October 10, 2020] Initial Allocation Option Maturity Date: [October 10, 2026] Allocation Option Period: [6 Years] Risk Control Accounts

from S-1 2 pages Amendment to Annuity Application Important Information Regarding Your Contract Coverage

from S-1 7 pages [Cuna Mutual Group Zonechoice™ Annuity] MEMBERS Life Insurance Company Single Premium Deferred Variable Annuity With Index-Linked Interest Options [2000 Heritage Way • Waverly, Ia 50677] 1 Plan Option[s] [Check One Plan Option.] [☐][ Cuna Mutual Group Zonechoice™ Annuity] 2 Owner and Annuitant Section 2a Must Be Completed. the Owner Will Be the Annuitant Unless an Annuitant Is Named in Section 2b. to Name a Joint Owner, Complete Section 2c. to Name More Parties to the Contract, Use Section 8. Minimum Age on Contract Issue Date Is [21]. Maximum Age on Contract Issue Date Is [85]. A. Owner. Complete This First Box for a Natural Person Owner. Name Gender ☐ Male ☐ Female First MI Last Date of Birth U.S. Citizen ☐ Yes ☐ No Complete This Box if the Owner Is a Non-Natural Person, Such as a Trust/Entity Owner. This Is Only Allowed for a Non-Qualified Annuity Type. for a Trust Owner, Submit [Form 1920(ml)] and a Copy of the Trust Document or [Form 1919(ml)]. for Entities Other Than a Trust, Complete [Form1921(ml)]. Name of Trust/Entity Date of Trust/Incorporation Person Authorized to Receive Correspondence Trustee/Authorized Person Name(s) All Owners Must Complete This Next Box. Social Security Number or Employer Id Number Daytime Phone ☐ Cell ☐ Other Residential Address Street (Cannot Be P.O. Box) City State Zip Mailing Address (If Different) Street or P.O. Box City State Zip Email Address B. Annuitant (If Other Than Owner). Complete This Box Only if the Annuitant Is Someone Other Than the Owner Named in Section 2a. Name Gender ☐ Male ☐ Female First MI Last Date of Birth Relationship to Owner(s) U.S. Citizen ☐ Yes ☐ No Social Security Number Daytime Phone ☐ Cell ☐ Other Residential Address Street (Cannot Be P.O. Box) City State Zip Mailing Address (If Different) Street or P.O. Box City State Zip C. Joint Owner. Complete This Box to Name a Joint Owner. Must Be an Individual Person. Only Allowed for a Non-Qualified Annuity Type. Name Gender ☐ Male ☐ Female First MI Last

from S-1 13 pages Contract Number: [123456789]

from S-1/A 7 pages Cuna Mutual Group Zone Income Annuity MEMBERS Life Insurance Company Individual Single Premium Deferred Modified Guaranteed Index Annuity 2000 Heritage Way • Waverly, Ia 50677 1 Plan Option. Annuity With Guaranteed Lifetime Withdrawal Benefit (Glwb) | 6-Year

from S-1 ~5 pages Guaranteed Lifetime Withdrawal Benefit

from S-1 6 pages Guaranteed Lifetime Withdrawal Benefit Rider Rider Guide and Index

from S-1 2 pages Declared Rate Account Allocation Option Endorsement

from S-1 2 pages Section 1. Data Page Continued

from S-1 7 pages Ex. 4(ii) Application [Members® Marketing Name] MEMBERS Life Insurance Company Individual Single Premium Deferred Modified Guaranteed Index Annuity [2000 Heritage Way • Waverly, Ia 50677] 1 Plan Option[s]. [Check One Plan Option. [O] [Marketing Name]

from S-1 17 pages Contract Number: [123456789]

from S-1/A 1 page Indenture or similar

from S-1/A 1 page Indenture or similar

from S-1/A ~10 pages Indenture or similar

from S-1/A ~10 pages Indenture or similar