Athene Annuity & Life Co Watch

from S-1 9 pages Athene.com 4. Replacement This Section Must Be Completed 1. Yes No Do You Have an Existing Life Insurance Policy or Annuity Contract? 2. Yes No Will This Annuity Change or Replace an Existing Life Insurance Policy or Annuity Contract? 5. Annuitant (Complete if Different From Owner) First Name M.I. Last Name Suffix Social Security Number/Tax Id Date of Birth (MM/Dd/Yy) Gender M F Telephone (Required) Relationship to Proposed Owner: Spouse Other: Street Address (Required - No Po Box) City State Zip Country Mailing Address (Optional) City State Zip Country 6. Joint Annuitant Not Applicable to Non-Spouse or Qualified Contracts First Name M.I. Last Name Suffix Social Security Number/Tax Id Date of Birth (MM/Dd/Yy) Gender M F Telephone (Required, if Applicable) Relationship to Proposed Annuitant: Spouse Other: Street Address (Required - No Po Box) City State Zip Country Mailing Address (Optional) City State Zip Country Page 2 of 6icc20 21497 (07/20) *2149702* Application for Single Purchase Payment Index-Linked Deferred Annuity

from S-1 9 pages Athene.com 4. Replacement This Section Must Be Completed 1. Yes No Do You Have an Existing Life Insurance Policy or Annuity Contract? 2. Yes No Will This Annuity Change or Replace an Existing Life Insurance Policy or Annuity Contract? 5. Annuitant (Complete if Different From Owner) First Name M.I. Last Name Suffix Social Security Number/Tax Id Date of Birth (MM/Dd/Yy) Gender M F Telephone (Required) Relationship to Proposed Owner: Spouse Other: Street Address (Required - No Po Box) City State Zip Country Mailing Address (Optional) City State Zip Country 6. Joint Annuitant Not Applicable to Non-Spouse or Qualified Contracts First Name M.I. Last Name Suffix Social Security Number/Tax Id Date of Birth (MM/Dd/Yy) Gender M F Telephone (Required, if Applicable) Relationship to Proposed Annuitant: Spouse Other: Street Address (Required - No Po Box) City State Zip Country Mailing Address (Optional) City State Zip Country Page 2 of 6icc20 21497 (07/20) *2149702* Application for Single Purchase Payment Index-Linked Deferred Annuity

from S-1 54 pages Indenture or similar

from S-1 54 pages Indenture or similar

from S-1 52 pages Indenture or similar

from S-1 52 pages Indenture or similar

from S-1/A 9 pages Athene.com 4. Replacement This Section Must Be Completed 1. Yes No Do You Have an Existing Life Insurance Policy or Annuity Contract? 2. Yes No Will This Annuity Change or Replace an Existing Life Insurance Policy or Annuity Contract? 5. Annuitant (Complete if Different From Owner) First Name M.I. Last Name Suffix Social Security Number/Tax Id Date of Birth (MM/Dd/Yy) Gender M F Telephone (Required) Relationship to Proposed Owner: Spouse Other: Street Address (Required - No Po Box) City State Zip Country Mailing Address (Optional) City State Zip Country 6. Joint Annuitant Not Applicable to Non-Spouse or Qualified Contracts First Name M.I. Last Name Suffix Social Security Number/Tax Id Date of Birth (MM/Dd/Yy) Gender M F Telephone (Required, if Applicable) Relationship to Proposed Annuitant: Spouse Other: Street Address (Required - No Po Box) City State Zip Country Mailing Address (Optional) City State Zip Country Page 2 of 6icc20 21497 (07/20) *2149702* Application for Single Purchase Payment Index-Linked Deferred Annuity

from S-1/A 9 pages Athene.com 4. Replacement This Section Must Be Completed 1. Yes No Do You Have an Existing Life Insurance Policy or Annuity Contract? 2. Yes No Will This Annuity Change or Replace an Existing Life Insurance Policy or Annuity Contract? 5. Annuitant (Complete if Different From Owner) First Name M.I. Last Name Suffix Social Security Number/Tax Id Date of Birth (MM/Dd/Yy) Gender M F Telephone (Required) Relationship to Proposed Owner: Spouse Other: Street Address (Required - No Po Box) City State Zip Country Mailing Address (Optional) City State Zip Country 6. Joint Annuitant Not Applicable to Non-Spouse or Qualified Contracts First Name M.I. Last Name Suffix Social Security Number/Tax Id Date of Birth (MM/Dd/Yy) Gender M F Telephone (Required, if Applicable) Relationship to Proposed Annuitant: Spouse Other: Street Address (Required - No Po Box) City State Zip Country Mailing Address (Optional) City State Zip Country Page 2 of 6icc20 21497 (07/20) *2149702* Application for Single Purchase Payment Index-Linked Deferred Annuity

from S-1/A 50 pages Indenture or similar

from S-1/A 50 pages Indenture or similar

from S-1/A 6 pages Indenture or similar

from S-1/A 41 pages Single Purchase Payment Index-Linked Deferred Annuity Contract • Periodic Income Commencing on Annuity Date. • the Values of This Contract May Be Affected by an External Index; However, This Contract Does Not Directly Participate in Any Stock or Equity Investments. • Option to Change Annuity Date. • Non-Participating. Athene Annuity and Life Company Will Make the Payments and Provide the Benefits Described in This Contract in Consideration for the Payment by the Owner of the Purchase Payments When Due. the Company Will Pay the Death Benefit to the Beneficiary as Provided in This Contract If: (1) Any Owner Dies Prior to the Annuity Date, or (2) Any Owner Is a Non-Natural Person and Any Annuitant Dies Prior to the Annuity Date. This Is a Legal Contract Between the Owner and Athene Annuity and Life Company. the Company Holds Reserves for Guarantees Under This Contract in a Separate Account. the Assets in the Separate Account Will Not Be Chargeable With Liabilities Arising Out of Any Other Business That the Company May Conduct. Contractual Benefits and Values for Index-Linked Segment Options Are Variable, May Increase or Decrease, and Are Not Guaranteed as to a Fixed Dollar Amount

from S-1 7 pages Indenture or similar

from S-1 47 pages Single Purchase Payment Index- Linked Deferred Annuity Contract • Periodic Income Commencing on Annuity Date. • Contract Value May Increase or Decrease Depending on the Index Experience of the Segment Options Selected. • Non-Participating