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                                                                Exhibit 4(h)
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  |   A GOLDEN OPPORTUNITY FOR SELECT CLIENTS
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  |   GoldenSelect/R/ Application
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  | [GOLDENSELECT/R/ appears down left margin]
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  |  Issued by Golden American Life Insurance Company
  |  Distributed by Directed Services, Inc., Member NASD
  |  GA-AA-1063                                         ING VARIABLE ANNUITIES
  |                                                                     107185
  |

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GOLDEN AMERICAN LIFE INSURANCE COMPANY                DEFERRED VARIABLE ANNUITY
                                                                    APPLICATION
P.O. Box 2700, West Chester, PA 19380-2700 Phone:(800) 366-0066
Express Mail: ING Variable Annuities 1475 Dunwoody Drive West Chester, PA 19380
===============================================================================
|1(A)| OWNER
------
Name:                                     SSN# or Tax ID:
-------------------------------------------------------------------------------

Permanent Address:                      City:             State:     Zip:
-------------------------------------------------------------------------------

Date of Birth:            Phone:        EMail Address:      Male / / Female / /
-------------------------------------------------------------------------------

===============================================================================
|1(B)| JOINT OWNER(S)          Relationship to Owner:
------                                               ----------------------

Name:                                     SSN# or Tax ID:
-------------------------------------------------------------------------------

Permanent Address:                      City:             State:     Zip:
-------------------------------------------------------------------------------

Date of Birth:            Phone:        EMail Address:      Male / / Female / /
-------------------------------------------------------------------------------

===============================================================================
|2(A)| ANNUITANT (If other than owner)
------

Name:                                     SSN# or Tax ID:
-------------------------------------------------------------------------------

Permanent Address:                      City:             State:     Zip:
-------------------------------------------------------------------------------

Date of Birth:            Phone:        EMail Address:      Male / / Female / /
-------------------------------------------------------------------------------

===============================================================================
|2(B)| CONTINGENT ANNUITANT (Optional)
------

Name:                                     SSN# or Tax ID:
-------------------------------------------------------------------------------

Permanent Address:                      City:             State:     Zip:
-------------------------------------------------------------------------------

Date of Birth:            Phone:        EMail Address:      Male / / Female / /
-------------------------------------------------------------------------------

===============================================================================
| 3 | BENEFICIARY(S)
-----                                                                Percentage

Primary Name:                Relationship to Owner:                  %
             ---------------                       -----------------  ---------

Primary Name:                Relationship to Owner:                  %
             ---------------                       -----------------  ---------

Primary Name:                Relationship to Owner:                  %
             ---------------                       -----------------  ---------

Contingent Name:                Relationship to Owner:               %
                ---------------                       --------------  ---------

Contingent Name:                Relationship to Owner:               %
                ---------------                       --------------  ---------

===============================================================================
| 4 |
-----
PRODUCT
-------------------------------------------------------------------------------
/ / Peak Plus:
-------------------------------------------------------------------------------
/ / Product:              / /       / /       / /       / /    / /  / /  / /
-------------------------------------------------------------------------------

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR
OTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY MATERIALLY FALSE
INFORMATION, OR CONCEALS FOR THE PUROSE OF MISLEADING INFORMATION CONCERNING
ANY FACT MATERIAL THER TO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME


GA-AA-1063                                                               107185
                                                                     04/13/2000

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===============================================================================
| 5 | INITIAL PREMIUM AND ALLOCATION INFORMATION
-----
A. INITIAL INVESTMENT
1) Initial Premium Paid: $________ (If initital premium is either an exchange
   or transfe, please indicate approximate premium.)  Please make check payable
   to Golden American Life Insurance Company
2) Fill in percentages for your initial investment allocation(s) in Column (A)
   below

B. DOLLAR COST AVERAGING (DCA) OPTIONAL
1) Amount to be transferred monthly $_________ (Max: 1/12of premium allocated
   to divisions below: 1/6 for 6 Month DCA)
2) Division or Allocation your transferred from: / /Limited Maturity Bond
   Division / /Liquid Asset Division / /1 YR Fixed / / 6 Month DCA
3) Please indicate the divisions you wish to transfer to by filling in
   percentage and dollar amounts in Column B below

INVESTMENT ADVISER         ACCOUNT DIVISION        A)INITIAL INVESTMENT  B)DCA
------------------         ----------------          ------------------    ---
A I M CAPITAL              CAPITAL APPRECIATION    $________  ________% ______%
MANAGMENT, INC.

A I M CAPITAL              STRATEGIC EQUITY        $________  ________% ______%
MANAGMENT, INC.

ALLIANCE CAPITAL           CAPITAL GROWTH          $________  ________% ______%
MANAGMENT, INC.

BARING INTERNATIONAL       GLOBAL FIXED INCOME     $________  ________% ______%
INVESTMENT LIMITED

BARING INTERNATIONAL       HARD ASSETS             $________  ________% ______%
INVESTMENT LIMITED

BARING INTERNATIONAL       DEVELOPING WORLD        $________  ________% ______%
INVESTMENT LIMITED

CAPITAL GUARDIAN           SMALL CAP               $________  ________% ______%
TRUST COMPANY

CAPITAL GUARDIAN           MANAGED GLOBAL          $________  ________% ______%
TRUST COMPANY

CAPITAL GUARDIAN           LARGE CAP               $________  ________% ______%
TRUST COMPANY

EAGLE ASSET                VALUE EQUITY            $________  ________% ______%
MANAGEMENT, LLC

EII REALTY                 REAL ESTATE             $________  ________% ______%
SECURITIES, INC.

EVERGREEN ASSET            FOUNDATION              $________  ________% ______%
MANAGEMENT, INC.

EVERGREEN ASSET            GLOBAL LEADERS          $________  ________% ______%
MANAGEMENT, INC.

EVERGREEN ASSET            SMALL CAP VALUE         $________  ________% ______%
MANAGEMENT, INC.

EVERGREEN ASSET            EQUITY INDEX            $________  ________% ______%
MANAGEMENT, INC

ING INVESTMENT             LIMITED MATURITY BOND   $________  ________% ______%
MANAGEMENT, LLC

ING INVESTMENT             LIQUID ASSET            $________  ________% ______%
MANAGEMENT, LLC

JANUS CAPITAL              GROWTH                  $________  ________% ______%
CORPORATION

KAYNE ANDERSON             RISING DIVS             $________  ________% ______%
INVESTMENT MANAGEMENT,LLC

MFS INVESTMENT             MID-CAP GROWTH          $________  ________% ______%
MANAGEMENT

MFS INVESTMENT             RESEARCH                $________  ________% ______%
MANAGEMENT

MFS INVESTMENT             TOTAL RETURN            $________  ________% ______%
MANAGEMENT

SALOMON BROTHERS           ALL-CAP                 $________  ________% ______%
ASSET MANAGEMENT, INC.

SALOMON BROTHERS           INVESTORS               $________  ________% ______%
ASSET MANAGEMENT, INC.

T. ROWE PRICE              EQUITY INCOME           $________  ________% ______%
ASSOCIATES INC.

T. ROWE PRICE              FULLY MANAGED           $________  ________% ______%
ASSOCIATES INC.

FIXED ALLOCATIONS: / /1 YR  / /3 YR  / /5 YR
                   / /10 YR (Not Available in all
                   states) / /6 Month DCA
                                          TOTAL =  $________       100%    100%
/1/ ONLY AVAILABLE WITH DVAPLUS AND ACCESS
GA-AA-1063                                                               107185
                                                                     04/13/2000

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| 6 | TELEPHONE REALLOCATION AUTHORIZATION
-----                               (Owner's initials to validate agent)_______

I authorize Golden American to act upon reallocation instructions given by
electronic means or voice command from the agen that signs below and/or the
following individuals:______________________, _______________________; upon
furnishing his/her social security number or alternative identification.
Neither Golden American nor any person authorized by Golden American will be
responsible for any claim, loss, liability or expenses in connection with
reallocation instructions received by electronic means or voice command from
such person if Golden American or other such person acted on such electronic
means or voice command in good faith in reliance upon this authorization. Golden
American will continue to act upon this authorization until such time as the
person indicated above is no longer affiliated with the broker/dealer under
which my contract was purchased or until such time that I notify Golden American
in writing of a change in instructions.
===============================================================================
| 7 | TAX-QUALIFIED PLANS  (If you are funding a qualified plan, please
-----                       specify type):

/ /IRA Indicate contribution amount and appropriate tax year ________________
/ /IRA Rollover
/ /SEP/IRA  / /SAR SEP IRA  / /401(B) TSA Transfer  / /401(a) Plan
/ /CONDUIT IRA
/ /Roth IRA  If transfer, provide original conversion date ___________
/ /Simple IRA Transfer  Provide establishment date ____________
/ / Other  ________________________

===============================================================================
| 8 | REPLACEMENT
----

Will the coverage applied for replace any existing annuity or life insurance
coverage?   / / Yes (If yes, please fill in below)   / / No

Company Name:                     Policy Number:          Cash Value:
             ---------------------              ----------           ----------

===============================================================================
| 9 | PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND SIGN BELOW:
-----

BY SIGNING BELOW, I ACKNOWLEDGE RECEIPT OF THE PROSPECTUS. I AGREE
THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL STATEMENTS AND
ANSWERS IN THIS APPLICATION ARE COMPLETE AND TRUE AND MAY BE RELIED
UPON IN DETERMINING WHETHER TO ISSUE THE CONTRACT. MY ANSWERS WILL FORM
A PART OF ANY CONTRACT TO BE ISSUED, AND ONLY THE OWNER AND GOLDEN
AMERICAN HAVE THE AUTHORITY TO MODIFY THIS APPLICATION.

CONTRACTS AND POLICIES AND UNDERLYING SERIES SHARES OR SECURITIES
WHICH FUND CONTRACTS AND POLICIES ARE NOT INSURED BY THE FDIC OR ANY
OTHER AGENCY. THEY ARE NOT DEPOSITS OR OTHER OBLIGATIONS OF ANY BANK
AND ARE NOT BANK GUARANTEED. ALSO, THEY ARE SUBJECT TO MARKET
FLUCTUATION, INVESTMENT RISK AND POSSIBLE LOSS OF PRINCIPAL INVESTED.

I UNDERSTAND THAT THE CONTRACT'S CASH SURRENDER VALUE, WHEN BASED
ON THE INVESTMENT EXPERIENCE OF A SEPARATE ACCOUNT DIVISION, MAY
INCREASE OR DECREASE ON ANY DAY AND THAT NO MINIMUM VALUE IS GUARANTEED.
THE CONTRACT'S COVERAGE IS IN ACCORD WITH MY ANTICIPATED FINANCIAL
OBJECTIVES.

MY SIGNATURE CERTIFIES, UNDER PENALTY OF PERJURY, THAT TEH TAXPAYER
IDENTIFICATION NUMBER PROVIDED IS CORRECT.  I AM NOT SUBJECT TO BACKUP
WITHHOLDING BECAUSE: I AM EXEMPT; OR I HAVE NOT BEEN NOTIFIED THAT I AM
SUBJECT TO BACKUP  WITHHOLDINGS FROM FAILURE TO REPORT ALL INTEREST
DIVIDENDS; OR I HAVE BEEN NOTIFIED THAT I AM NO LONGER SUBJECT TO BACKUP
WITHHOLDING. (STRIKE OUT THE PRECEDING SENTENCE IF SUBJECT TO BACKUP
WITHHOLDING.) THE IRS DOES NOT REQUIRE MY CONSENT TO ANY PROVISION OF THIS
DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING.

_______________________________________________________________________________
Signature of Owner                          Signed at (City, State)    Date
_______________________________________________________________________________
Signature of Joint Owner (if applicable)    Signed at (City, State)    Date
_______________________________________________________________________________
Signature of Annuitant (if other than       Signed at (City, State)    Date
                        Owner)

===============================================================================
|10| SPECIAL REMARKS
----

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|11| FOR AGENT USE ONLY
----

DO YOU HAVE REASON TO BELIEVE THAT THE CONTRACT APPLIED FOR WILL REPLACE ANY
EXISTING ANNUITY OR LIFE INSURANCE COVERAGE?

/ / YES       / / NO

Commission Alternative (select one):  / / A  / / B  / / C  / / D

Client Account No. (if applicable)_____________________


_______________________________________________________________________________
Agent Signature    Print Agent Name    Social Security #   Broker/Dealer/Branch

GA-AA-1063                                                               107185
                                                                     04/13/2000


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