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  This completed document is for restricted use only.  No part may be copied nor disclosed without prior consent of Principal®.  ICC22 AA 4950-1 Sample  Page 1 of 5  A Single Premium Deferred Individual Annuity  1.   Owner(s)   Primary owner:  Owner is a/an:     Individual     Trust     Custodian/POA     UTMA/UGMA                  Full name (first, middle, last)  Trust date (if applicable)           Street address City State Zip           Email address           M     F                 Date of birth  Gender  Social security or Tax ID #  Telephone number   Joint owner:  Not applicable for qualified contracts           Full name (first, middle, last)             M     F                 Date of birth  Gender  Social security or Tax ID #  Telephone number  2.   Annuitant(s)   Primary annuitant: Complete only if different than owner           Full name (first, middle, last)            Street address City State Zip           M     F                 Date of birth  Gender  Social security or Tax ID #  Telephone number   Joint annuitant:  Not applicable for qualified contracts      Full name (first, middle, last)            M     F                 Date of birth  Gender  Social security or Tax ID #  Telephone number  3.   Type of contract    Tax  status:  Nonqualified (NQ)  Traditional IRA  IRA transfer  IRA rollover  Roth IRA  Pension trust     SEP IRA  SIMPLE IRA   If qualified, date of the contribution year:       If Roth IRA, date of the first contribution to any Roth IRA:                           Premium details  Amount    Personal  check   NQ  transfer   Transfer from  IRA   Rollover from eligible  qualified plan     Initial premium: $                     Initial premium: $                     Initial premium: $                    Minimum premium $10,000 nonqualified or $10,000 qualified   Make checks payable to Principal Life Insurance Company  FORM ALWAYS REQUIRED    Principal Life  Insurance Company  ATTN: RIS Annuity Services   711 High Street   Des Moines, IA 50392-1770  Principal RILA Annuity  Application     





 






  This completed document is for restricted use only.  No part may be copied nor disclosed without prior consent of Principal®.  ICC22 AA 4950-1  Page 2 of 5  4.   Owner’s beneficiary   Must designate at least one primary beneficiary.     Primary  Contingent           or                                  %  Print full name  Relationship to owner  Date of birth                                   Address  City  State  Zip                               Social security number  Email address  Phone number    or                                  %  Print full name  Relationship to owner  Date of birth                                   Address  City  State  Zip                               Social security number  Email address  Phone number    or                                  %  Print full name  Relationship to owner  Date of birth                                   Address  City  State  Zip                               Social security number  Email address  Phone number    or                                  %  Print full name  Relationship to owner  Date of birth                                   Address  City  State  Zip                               Social security number  Email address  Phone number    or                                  %  Print full name  Relationship to owner  Date of birth                                   Address  City  State  Zip                               Social security number  Email address  Phone number    or                                  %  Print full name  Relationship to owner  Date of birth                                   Address  City  State  Zip                               Social security number  Email address  Phone number   Additional designations attached       A separate page is attached with additional beneficiary designations.  (Note:  The date, contract number, and  the signature of the owner must appear on all pages included as part of this request.)     





 






   This completed document is for restricted use only.  No part may be copied nor disclosed without prior consent of Principal®.  ICC22 AA 4950-1  Page 3 of 5  5.    Premium payment(s)    Check here if multiple Premium Payments will be received by Principal (as a result of a transfer, exchange or  rollover) and to authorize Principal to delay issuance of your contract until all Premium Payments are received.  We  may require a new application for Premium Payments received after [45] days.  No interest will accrue on any  Premium Payments received before the issue date of your contract.    Total expected amount $      Total number of Premium Payments expected       6.   Segment allocation     Please select the segment options you would like your purchase payment allocated to by indicating the percentage  each segment option should receive.  Allocations must be made in whole (1%) increments and total 100%.   Capped Buffer segment options   Segment term Index/Ticker Protection level Allocation   [1] – year[s] [S&P 500 (with Cap)] [10]%               %      Uncapped Buffer segment options   Segment term Index/Ticker Protection level Allocation   [1] – year[s] [S&P 500] [10]%                %   [1] – year[s] [Russel 2000] [10]%        %   [1] – year[s] [EAFE MSCI] [10]%        %   [2] – year[s] [S&P 500] [10]%                %   [6] – year[s] [S&P 500] [10]%                %   [6] – year[s] [Russel 2000] [10]%                %   [6] – year[s] [EAFE MSCI] [10]%                %      Floor segment options   Segment term Index/Ticker Protection level Allocation   [6] – year[s] [S&P 500] [0]%                %    [1] – year[s]  [S&P 500] [10]%                %   [S&P 500] [15]%        %      Fixed segment options   Segment term Index/Ticker Protection level Allocation   [1] – year[s] [N/A] N/A             %             Total       %     7.   Optional riders   Rate Enhancement Rider (only available with the Buffer segment and Floor segment option[s])   Yes   No    If neither box is marked, the Rate Enhancement Rider will NOT be added.       Step Up Death Benefit                          Yes   No    If neither box is marked, the default will be the standard death benefit under the contract.      





 






   This completed document is for restricted use only.  No part may be copied nor disclosed without prior consent of Principal®.  ICC22 AA 4950-1  Page 4 of 5  8.   Telephone and internet authorization   I (We) want telephone services as described in the prospectus. ................................................................  Yes   No   I (We) want internet transaction services for the sales representative as described in the prospectus. ................................ Yes   No   internet instructions received from the sales representative will be binding on all contract owners*  *The contract owner may elect to perform financial transactions on the internet upon establishing a Personal   Identification Number on the Principal Financial Group web site.  If these boxes are not checked telephone and internet services are not available.  Telephone or internet instructions  received from any joint contract owner will be binding on all owners.  Note:  Authorization for these services can be revoked at any time by providing us written notice.    9.   Replacement information to be completed by owner   Do you have any pending or inforce life insurance coverage or annuity contracts? ................................................................ Yes  No   If yes, will this annuity replace or change any pending or inforce life insurance or annuity contracts? ................................ Yes  No    10.   Replacement information to be completed by Financial Professional   Does the applicant have, or are you aware that the applicant has, any pending or inforce life  insurance or annuity contracts? ................................................................................................................................ Yes   No   Do you have any reason to believe this annuity will replace or change any pending or inforce life  insurance or annuity contracts? ................................................................................................................................ Yes   No    11.   Owner’s signature   The Annuity for which I am applying is not being purchased for speculation, arbitrage, viatication or any other type of  collective investment scheme now or at any time prior to its termination. The Annuity for which I am applying may not  be traded on any stock exchange or secondary market.  I have read this application and have had the opportunity to read the prospectus. I have been given the opportunity to  ask questions regarding this investment and they have been answered to my satisfaction. I understand the  following about the contract I am purchasing:   Benefits are based on the performance of the options elected and will decrease or increase with investment  experience and are not guaranteed as to dollar amount.   Optional features (“riders”) are available to me. I have reviewed my own circumstances to determine if a rider’s  benefit, cost and restrictions are appropriate for me. Refer to the Riders section of the prospectus for details.  I agree: (1) I have read this application and all statements and answers as they pertain to me are true and complete to the  best of my knowledge and belief.   (2) Such statements and answers are the basis for any contract issued, and no information about me will be considered to  have been given to Principal® unless it is stated in this application.  (3) A Financial Professional does not have authorization to accept risk, or make, void, waive or change any conditions of  this application, the contract or any premium receipt.  (4) Principal® will have no liability until a contract is issued on this application and delivered to, and accepted by the owner,  while each proposed owner and annuitant are alive.  Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense  and subject to penalties under state law.            Signed at City State  Date   Contract owner  Joint owner   X  X   Owner’s signature  Joint owner’s signature                   Print owner’s name  Print joint owner’s name  





 






   This completed document is for restricted use only.  No part may be copied nor disclosed without prior consent of Principal®.  ICC22 AA 4950-1  Page 5 of 5  12.   Financial Professional’s statement   If required, I have provided the applicant with the appropriate Compensation Disclosure form.   Financial Professional certification for replacement transaction:  By my signature, I hereby certify that I have  used only the company’s approved sales material in connection with this sale and that copies of all sales materials,  prospectus and/or illustrations used were left with the applicant.  I further certify that this replacement transaction  follows the company’s written replacement policy.   Financial Professional #1  Financial Professional #2  Financial Professional #3          Financial Professional’s signature  Financial Professional’s signature  Financial Professional’s signature                         Print Financial Professional’s name  Print Financial Professional’s name  Print Financial Professional’s name                         Principal Financial Professional ID   (or detail code)   Principal Financial Professional ID  (or detail code)   Principal Financial Professional ID   (or detail code)                         Selling entity/Bank name  Selling entity/Bank name  Selling entity/Bank name                         Phone number  Phone number  Phone number                         Email  Email  Email                         Selling split %  Selling split %  Selling split %                         Servicing split %  Servicing split %  Servicing split %       Commission Options - Refer to your commission schedule or verify with your broker/dealer to confirm that the  option you select is available.    Option A  Option B  Option C  Option D